November 6, 2009 Matt Sparke

1. The Aid Enclave:
Mapping an Emerging Geography of Global Health
Matthew Sparke, sparke@u.washington.edu
From the enclave as an
unfinished utopia …
http://act.pih.org/page/invite/thisIbelieve
Partners in Health clinics
as practical utopias in a
“distopian world”
…to the enclave as parasite
“Today, someone who walks from the northwest toward the
Malawi hospital ward where I watched a young woman die long ago
may still pass the herbalists selling their medicines. Those approaching
from the east or south must make their way between the gleaming
buildings of the transnational research projects. Gates, Wellcome, the
CDC, Johns Hopkins are all represented: all the big guns in
international research, plus many smaller guns. The studies conducted
within have been carefully vetted, stamped, and approved as ethical;
there will be no more research on second-best therapies, though this
restriction sometimes means the projects are not very relevant to the
local clinical world. Climate controlled, well equipped, stuffed with staff
and microscopes and laboratory reagents and automated specimen
processors, the research buildings make for a striking contrast with the
hospital they surround. It is sometimes hard not to see them as
parasites feeding on an emaciated host.”
Claire Wendland, 2008
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2. So how does the enclave emerge
and spread as a parasite?
Economic Enclaving
Political Enclaving
Ethical Enclaving
Economic Enclaving
The creation of the “emaciated host”
SAPs & ongoing aid conditionalities in PRSPs
Accumulation by dispossession
Disease
The economics of the “parasite”
Enclave pay versus local pay
Enclave as tax free haven
Enclave of entrepreneurial intermediation (macro & micro)
Enclave as targeted investment opportunity
Enclave as expatriate compound of privilege
Economic enclaving: Investment Ops
} Triangulate on
- targeting areas for ‘product’ development
- verticalization as alternative to state corruption
- biomedical investment in ideas about an ‘IV’ injection the enclave
http://www.gatesfoundation.org/regions/Pages/default.aspx#/?action=region&id=0
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3. Economic enclaving: compound privilege
- the place of privilege
“I was paid a salary of $23K…the Nigerian project manager … was
paid less than $400 a month…the watchmen as little as $50 a month.
Further I was provided free housing…, and because my project provided
house was inside the NGO compound, the office generator supplied my
fully furnished house with electricity…and the project’s compound
supervisor doubled as my steward helping me with shopping, cooking,
cleaning my house and washing my laundry. Compared with the palatial
quarters of expatriates working for bigger agencies like USAID or
UNICEF, my house was relatively humble. Many expatriates’ houses are
far more luxurious than anything they could afford in their own
countries….I remember feeling particularly empowered controlling a fleet
of vehicles, … and I was especially fond of our white Toyota Land
Cruiser.”
Daniel Jordan Smith, 2009
Economic enclaving: compound privilege
- the place and pace of privilege
“The NGOs bore the brunt of the anger at reconstruction because they were
intensely visible, slapping their logos on every available surface along the coast,
while the World Bank, USAID and government officials dreaming up Bali plans
rarely left their urban offices. It was ironic, since the aid organizations were the
only ones offering any kind of help at all – but also inevitable, because what they
offered was so inadequate. Part of the was that the aid complex had become so
large and so cut off from the people it was serving that the lifestyles of the
staffers became … a national obsession. Almost everyone I met commented on
what priest called the “NGO wild life”: high-end hotels, beachfront villas and the
ultimate lightening rod for popular rage, the brand new white sport utility
vehicles. All the aid organizations had them, monstrous things that were far too
wide and powerful for the country’s narrow dirt roads. All day long they went
roaring past the camps, forcing everyone to eat their dust, their logos billowing on
flags in the breeze – Oxfam, World Vision, Save the Children – as if they were
visitors from a far-off NGO World. In a country this hot, these cars with their
tinted windows and blasting air conditioners were more than modes of
transportation; they were rolling microclimates.” Naomi Klein, 2008
Economic enclaving: compound privilege
- the place and pace of privilege
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4. Economic enclaving: compound privilege
- the time-space of privilege
Prominent features of the research practices were intrusion and control. We interrupted school
activities, enlisted and numbered the children and turned them into 'study subjects'. The research
hierarchy expanded the close association between bodily discipline and knowledge, already present in the
rural schools, beyond the limits of the locality: the emissaries of the government and the university in the
capital city arrive in a government car and, rescinding the existing regime of bodily discipline and inducing
even teachers to break their routines, access the children's bodies, inflict pain and extract blood. When the
collection of medical specimens was extended to the village, this hierarchical order of research expanded
further, intruded into domestic life and incorporated the children's families: from the distant city and from
overseas, researchers travel in big cars to the end of the tarmac road, follow dirt roads, branch into
footpaths, and plough through the bush as far as they can drive; further on they move on foot, into a
family's homestead, where they enter hastily and noticeably without social purpose; they enter the house
of a mother, examine her child and take some of its bodily fluid with them. Research confronts the people
in the village with a hierarchy of power, wealth, education and mobility, which embraces global spaces
spanning from Africa to Europe, village to capital city, wealthy to poor, powerful to marginalized, in which
they themselves are at the periphery and at the bottom.
Wenzel Geissler, 2005
Political enclaving:
Macro: a return to imperial projects
A new scramble for Africa?
• Flags & logos
• Body-counts
The enabling public-private global governance ‘ecosystem’ of WHO,
UN, WB, WTO, G8, Gates, NGOs and IHRs/TRIPS
Micro: a return to pastoral power
“Several funding mechanisms of PEPFAR, such as the “New Partners Initiative”, are specifically designed
to facilitate US FBOs to set up treatment and prevention programs in Africa. Indeed, in some countries,
evangelical congregations are dispensing treatment. Even without the explicitly religious dimension that is so
particular to PEPFAR, other HIV programs also target reproduction, body and soul. Pregnancy is an important
“entry point” for reaching HIV positive women who can be given preventive drugs to stop transmission to
their child and enrolled in treatment programs, and those who are on treatment are exhorted to adhere
properly to their drug regimens through counselling, self-help groups and therapy “clubs”. For those who are
not HIV positive, “life skills and HIV prevention programs teach youth to respect themselves, to respect
others, including the opposite sex, and to practice personal responsibility” Vinh-Kim Nguyen, 2009
Ethical enclaving:
Spaces of ethical compensation
VK Nguyen: PEFAR as an indulgence for GITMO
Spaces of biomedical correctness
Adrianna Petryna: treating the ‘treatment naïve’ body right
Spaces of moralization
The problem with Saint Paul
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5. Ethical enclaving: the marginalization of miraculation
“Paul Farmer is a
sort of saint… I have
the highest respect for
him. He is a great man
who has done more
good in the world than
I will do in a hundred
lifetimes…. He has
saved so many lives….
But, we cannot
replicate what he has
done personally
globally….”
Daniel Wikler, 2009
Ethical enclaving:
Farmer: Reframing morals as ethics as
ideals for collective global struggle
against dispossession
“I know it's not enough to attend only to the immediate needs of the
patient in front of me. We must also call attention to the failures and
inadequacy of our own best efforts. The goal of preventing human
suffering must be linked to the task of bringing others, many others, into
a movement for basic rights.” Paul Farmer, 2008
Breaking out of the enclave
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