Nancy Scheper-Hughes

Parts unknown Undercover ethnography of the organs-trafficking underworld

This article addresses some of the ethical, ethnographic and political dilemmas of an idiosyncratic multi-sited research project exploring the illegal and covert activities surrounding the traffic in humans and their body parts by outlaw surgeons, kidney hunters and transplant tourists engaged in ‘back-door’ transplants in the global economy. In its odd juxtapositions of ethnography, documentation, surveillance and human rights work, the project blends genres and transgresses longstanding distinctions between anthropology, political journalism, scientific reporting, political engagement, public interest anthropology and human rights work. How does one investigate covert and criminal behavior anthropologically? When, if ever (and on what grounds), is it permissible to conduct research ‘under cover’? When crimes are being committed, to whom does one owe one’s divided loyalties? Following a discussion of politically engaged research I pluck a few ‘backstage’ scenes from this Goffmanesque study of the organs trade to illustrate the very different forms, practices and emotions it encompasses. I want to recapture the ‘basic strangeness’ of a routine medical procedure – kidney transplant – that has become increasingly dependent on medically supported claims and rights to the healthy bodies of marginalized ‘others’. I close with an argument against bioethics and its capitulations to medical markets in bodies.

Bodies for Sale – Whole or in Parts

This article introduces the topic of body and commerce commodification as an effort to return sociological and anthropological thinking to a consideration of bodies as tangible, palpable and real material objects as well as semi-magical and symbolic representations. It argues for an enlarged conception of commodification as encompassing all monetized relations in which human bodies (whole or in divisible parts) are the token of economic exchanges that are often masked as something else love, pleasure, altruism, kindness.

The Ends of the Body--Commodity Fetishism and the Global Traffic in Organs

A the neoliberal readjustments of the new global economy, there has been a rapid growth of “medical tourism” for transplant surgery and other advanced biomedical and surgical procedures. A grotesque niche market for sold organs, tissues, and other body parts has exacerbated older divisions between North and South, haves and have-nots, organ donors and organ recipients. Indeed, a kind of medical apartheid has also emerged that has separated the world into two populations—organ givers and organ receivers. Over the past 30 years, organ transplantation—especially kidney transplantation—has become a common procedure in hospitals and clinics throughout the world. The spread of transplant technologies has created a global scarcity of viable organs. At the same time the spirit of a triumphant global and “democratic” capitalism has released a voracious appetite for “fresh” bodies from which organs can be procured. The confluence in the flows of immigrant workers and itinerant kidney sellers who fall prey to sophisticated but unscrupulous transnational organ brokers is a subtext in the recent history of globalization. Today’s organ pro-

Dangerous and endangered youth: social structures and determinants of violence

Abstract: Structural violence is violence that is permissible, even encouraged. It refers to the invisible social machinery of inequality that reproduces social relations of exclusion and marginalization via ideologies, stigmas, and dangerous discourses (such as “youth violence” itself) attendant to race, class, sex, and other invidious distinctions. Structural violence “naturalizes” poverty, sickness, hunger, and premature death, erasing their social and political origins so that they are taken for granted and no one is held accountable except the poor themselves. Structural violence also refers to the ease with which humans are capable of reducing the socially vulnerable (even those from their own class and community) into expendable non‐persons, thus allowing the licence—even the duty—to kill them. I exemplify this through two ethnographic critical case studies: the operation of a virulent death squad in Northeast Brazil that mobilized the support of ordinary people in an almost genocidal attack against Afro‐Brazilian street kids and young “marginals”; and the uneasy truce with, and incomplete integration of “dangerous and endangered” youth still living in squatter camps and shack communities of urban South Africa.

Rotten trade: Millennial capitalism, human values and global justice in organs trafficking

This article documents the growth of “transplant tourism” and the global traffic in human bodies, desires, and needs. Organ transplantation today takes place in a transnational space with surgeons, patients, donors, sellers and brokers following new paths of capital and technology. In general, organs flow from South to North, from third to first world, and from poorer to richer bodies, and from black and brown to whites and from females to males. The “scarcity” of organs and tissues combined with the scarcity of patients of sufficient means to pay for these expensive operations, has spawned a lucrative business driven by the market calculus of supply and demand. The spread of new medical technologies and the new needs, scarcities, and commodities –for instance, fresh organs and tissues– that they inspire raises urgent public issues concerning: the reordering of relations between bodies and the state in late modernity; the appearance of “fluid” and divisible bodies that disrupt early modern notions of the indivisible and autonomous body-self; the emergence of new forms of barter and social exchange that breach the conventional dichotomy between gifts and commodities and between kin and strangers; the interplay of magic and science; and the power of rumours and urban legends to challenge the official medical and transplant “narratives” on the meanings of life, death, and sacrifice.

Introduction: Medical Migrations

This special issue of Body & Society brings together articles that describe contemporary forms of bio-medical travel. The conjuncture of mobility and bodily states occurs at a particular epistemic moment: the first decades of the 21st century, when medical travels and travelers are participating in border crossings as self-consciously biological beings, and when biological life, health and sickness, survival and death, are central to subject formation, ethical practice, political struggle, regulation and governance. In the last several decades, increasing numbers of people have crossed national borders and traversed great distances for bio-medical, experimental or alternative (complementary) medical, surgical or cosmetic interventions and/or bodily transformations. Some of these travelers – often described by the mass media as ‘medical tourists’ (a term we subject to a pointed critique) – journey to foreign lands in search of cures and therapies for a variety of conditions. The elderly and well-insured are searching for cures to the maladies that commonly accompany aging: chronic, noncontagious illnesses and afflictions, from heart disease to end-stage kidney failure, from obesity to diabetes to congestive heart disease to dental care and depression. Women and their partners travel in search of solutions to infertility; men in search of cures for sexual dysfunction. Both men and women, young and old, search for cures to addictions and psychiatric illnesses. And many people travel across borders to purchase much sought-after and expensive

Mr Tati’s Holiday and João’s Safari - Seeing the World through Transplant Tourism:

Moshe Tati, a sanitation worker in Jerusalem, was among the first of more than a thousand mortally sick Israelis who signed up for illicit and clandestine ‘transplant tour’ packages that included: travel to an undisclosed foreign and exotic setting; five-star hotel accommodation; surgery in a private hospital unit; a ‘fresh’ kidney purchased from a perfect stranger trafficked from a third country. Although Tati’s holiday turned into a nightmare and he had to be emergency air-lifted from a rented transplant unit in a private hospital in Adana, Turkey back to Israel, Moshe (now deceased) became a poster-boy of transplant tourism for the next decade. João Cavalcanti was among the first of 38 residents of the slums of Recife recruited by retired military Captain Ivan da Silva and his sidekick Captain Gadddy Tauber (of Israel) to travel to Durban, South Africa to provide a spare kidney to an Israeli transplant tourist in Durban. This article examines the logics and practices through which kidney buyers and kidney sellers, organs brokers, surgeons and their accessories convince themselves that they are engaged in an illegal but still mutually beneficial ‘medical-recreational’ adventure, an ‘extreme medical sport’ of sorts. While life, health and survival motivate ‘transplant tourism’, a euphemism for human trafficking in spare body parts, the freedom to roam, mobility, is an essential feature of transplant tours for kidney buyers and kidney sellers.

'Mental' in 'Southie': individual, family, and community responses to psychosis in South Boston.

The deinstitutionalization of psychiatric patients is a deeply cultural as well as political task. It entails the sharing of responsibility for human distress with family and community. Consequently, the locus of social control has also shifted from psychiatric and medical expertise to community and legal institutions. Diagnosis and treatment models must be more compatible with lay explanatory models. This paper explores the various meanings of “going ‘mental’” and “being ‘mental’” in the white, working class, ethnic neighborhood of South Boston. The data are extracted from a study of the impact of deinstitutionalization on a cohort of middle-aged, psychiatric patients discharged from Boston State Hospital in the attempt to return them to community living. Individual, family, and community responses to, and interpretations of, the symptoms of mental distress are discussed. The study indicates that even seriously disturbed individuals are sensitive to cultural meanings and social cues regarding the perception, expression, and content of psychiatric episodes. While madness invariably disenfranchises, it does not necessarily deculturate the individual.

Child Abuse and the Unconscious in American Popular Culture

During the 1960s child abuse and neglect, long grappled with as a vexing and chronic social problem by generations of child welfare and social workers, was suddenly “discovered” and expropriated by a more powerful profession: medicine. When C. Henry Kempe and his associates (1962) at Colorado General Hospital created a new diagnostic entity — the “Battered Child Syndrome” — the American public finally sat up and took notice.1

Why We Should Not Pay for Human Organs

The right to buy and sell human organs is challenged by the authors within the framework of a broad Christian perspective. Opposition to organ sales is argued in the light of the developing underclass of poor organ donors throughout the world who sell their organs to the rich. Very often neither the donors nor the recipients are fully informed about the medical risks involved in the procedure of organ transplantation.