Steven Palmer, Lauching Global Health: The Caribbean Odyssey of the Rockefeller Foundation Conversations in Medicine and Society (Ann Arbor: University of Michigan Press, 2010) pp. xi 301, $70.00, hardback, ISBN: 978 0 472 07089 3.
Steven Palmer's Launching Global Health: The Caribbean Odyssey of the Rockefeller Foundation is a very welcome addition to the fascinating body of literature on the international health work of the Rockefeller Foundation (RF) This is not only because of the new insights it offers on the significance of RF philanthropy in the early twentieth century, but also, as Palmer points out, for the lessons it offers for the new generation of non governmental operators in public health in this century, such as the Gates Foundation. The principal subject of this study is the hookworm campaigns of the RF health division in the two Central American states of Costa Rica and Guatemala, and the two British Caribbean colonies of British Guiana and Trinidad. Palmer's stated objective is to explore these 'campaigns in depth and to treat them as an ensemble as a laboratory for discovering and testing the elements of a global health system for the twentieth century' (p. 1) The main source for this account is the archive of the Rockefeller Foundation. As Palmer himself emphasises much of the literature on RF health initiatives is driven by these sources, which has the tendency to produce an inevitable homogeneity in accounts. One counterweight to this, arguably, certainly in any exploration of the British colonies and Rockefeller initiatives, is the similarly voluminous archives of the British imperial government. For practical reasons perhaps, these are unfortunately but scantily consulted in this volume. However, Palmer's aim, to present a 'worm's eye' view which is grounded in the specific political, social and cultural contexts of his chosen areas, in itself presents an effective challenge to the temptations of the Rockefeller archive and enables this fruitful critique. It is impossible to do justice in this short review to the wealth of evidence presented. The central chapters of the book examine such aspects as: the local politics; the composition of the hookworm teams; the role of local staff; and existing perceptions of hookworm disease. All these factors tested RF objectives, imposing a need to adapt, accommodate and modify. To take just one of these aspects as an illustration: in Guatemala, the teams were composed of elite white male physicians, despite the fact that their subjects were indigenous estate labourers; in Costa Rica they were middle class men of mixed racial origin, if not doctors, then with degrees in pharmacy; in British Guiana, they had backgrounds as estate dispensers or sanitary technicians; whilst in Trinidad, they were mainly teachers. The local staff both reflected the different political, social and cultural contexts and, in turn, were instrumental in the production of 'multiple and hybrid medical modernities' (p. 8) Additionally, in the British Caribbean, the American directors 'made self conscious efforts to creolise the biomedical narrative of hookworm disease and its treatment' (p. 141) A revealing example of which was the pamphlet produced by British Guiana's director, 'The Demon That Turned Into Worms' which was based on a Hindi popular story collection, Baital Pachisi; an attempt to co opt a traditional form to convey the RF message. Furthermore, in Trinidad, a well known Brahmin was even put on the RF payroll for a while to do home demonstrations using characteristic methods of Hindu education (pp. 172 5) Was this a throwing out of the biomedical baby along with the bathwater, Palmer muses? The enforced accommodations made the 'intensive method' as Palmer argues 'highly porous' (p. 137) Thus, it is important to see the resulting syncretism as coming from above as well as below. Medical pluralism was not simply a 'failure of biomedicine to achieve domination' but was the 'form of biomedical hegemony' which had emerged from these encounters (p. 218) It is the richness of the comparative detail that lends authority to Palmer's questioning of the scholarly consensus on the hookworm campaigns. He sees no disparity between the aims of eradication and the demonstration effect, but rather argues that the two objectives created a 'complementary duality' (p. 15) Similarly, the field laboratories were scenes of 'demystification and popularization' not creators of difference and hierarchy (p. 161) Palmer accepts the legacy of these RF programmes on subsequent RF initiatives and global health actors, but claims that rather than being authoritarian, the American method was 'egalitarian and inclusionary' (p. 215) In terms of lessons to be learned from this Caribbean odyssey, his most compelling conclusion is that it is 'free, literate, and politically engaged populations who respond well to, participate in, and benefit from international health programmes' (p. 214) In the quest to improve the health chances of peoples today, it is essential that histories of global health, as this one does, address not just other historians, but also today's policy makers.
Medical History