Steven Palmer

Demanding democracy : reform and reaction in Costa Rica and Guatemala, 1870s-1950s

1. Introduction Part I. The Liberal Authoritarian Period, 1870s-1940s: 2. Between building states and agricultural export markets Part II. The Democratic and Social Reform Period, 1940s-1950s: 3. Demanding democracy 4. Addressing the social question 5. Organizing labor Part III. From Reform to Reaction: Democracy Versus Authoritarianism: 6. From opposition to regime-founding coalitions 7. Enduring regimes Notes Bibliography Index.

Smallpox eradication, laboratory visits, and a touch of tourism: travel notes of a Canadian scientist in Brazil

The paper presents and discusses the travel notes diary of Canadian scientist Robert J. Wilson when he visited Brazil in April 1967 during the Smallpox Eradication Programme run by the World Health Organisation. Wilsons report makes it possible to reflect on the smallpox eradication campaign in Brazil; on the Canada-Brazil cooperation to improve the quality of the smallpox vaccine; on his assessment by of scientists and Brazilian laboratories; on the effects of intersections between scientific activity and social and cultural activities; on the role played by specialist communities of experts role in international scientific cooperation projects; and on a Canadian travellers concepts and prejudices about Brazil at the end of the 1960s.

Toward responsibility in international health: death following treatment in Rockefeller hookworm campaigns, 1914-1934.

Late in October 1926, a poor man from Bucamaranga, Colombia, wrote a letter to the richest man in the world. Juan de la Rosa Quintero Parra informed John D Rockefeller that his ten-year-old son, Jose Vicente, had “died suddenly as a result of a purge administered by the Bureau of Uncinariasis”, the local incarnation of the Rockefeller Foundation’s global project to eradicate hookworm disease. The death of the boy, who worked full-time as a streetsweeper for the municipality, had been “a serious blow since he was the only one who contributed to the support of the family consisting of seven young children”. Having heard of Mr Rockefeller’s generosity, Quintero appealed to him for assistance, thanked him in advance for the attention he would give to the matter, and hoped that Divine Providence would spare the great philanthropist’s life for many years to come. He mailed the letter to Rockefeller Foundation headquarters at 61 Broadway in New York City, the same address where, probably unbeknownst to him, bits of his son’s organs had been sent following a post-mortem. Quintero Parra’s letter came to the attention of either the 84-year-old patriarch or his son, John D Rockefeller, Jr, the Foundation’s president. Their executive secretary, F M Read was instructed to make inquiries into the death of the child, Jose Vicente Quintero.1

Smallpox eradication and Brazil: an interview with Donald A. Henderson

Interview with Donald A. Henderson, the U.S. physician and epidemiologist who headed the World Health Organizations Smallpox Eradication Program from 1966 to 1977. The interviewer talks about the endemic nature of smallpox in Brazil; relations between WHO, the Pan American Health Organization, and the Brazilian government; the role of Connaught Laboratories in the quality of the Brazilian smallpox vaccine; the process that brought certification of smallpox eradication in Brazil; international cooperation in eradicating smallpox and the various strategies applied; the role played by Brazilians in eradicating smallpox in India, Bangladesh, and Africa; and the future of the notion of disease eradication

Esbozo histórico de la medicina estatal en América Central

Este trabajo esboza los rasgos basicos de la medicina estatal y de la salud publica en America Central, con enfasis en el siglo XX. El panorama es variado, dadas las distintas configuraciones de los regimenes politicos, divisiones etnicas y conflictos sociales; algunos de los cuales fueron sumamente extremos. A partir de este analisis se nota un alto grado de continuidad historica en la manera en que estos factores han influenciado la formacion y deformacion de sistemas de salud publica y medicina estatal. A pesar de la fuerte presencia de agentes externos en el sector salud de los paises centroamericanos, el trabajo sostiene que las fuerzas historicas determinan la naturaleza de los sistemas de medicina estatal en el istmo, y que las mayores influencias son de caracter interno y no externo. Aun cuando el desarrollo de la medicina estatal en la mayoria de los paises de la region ha sido debil, la cuestion del acceso publico a los servicios medicos ha jugado un papel importante, y a veces explosivo, en sus desarrollos politicos.

A Cuban Scientist Between Empires: Peripheral Vision on Race and Tropical Medicine

Abstract The article explores explores a conjuncture in the emergence of tropical medicine at the end of the 19th century, as it was transformed from a heterogeneous ensemble of multi-sited research endeavours into a unified discourse reproduced within an institutional network of US and British imperial medicine. The effect this had on Latin American-based research into tropical medicine is traced through the case of the Cuban ophthalmologist and medical research entrepreneur, Juan Santos Fernández. Between 1898 and 1900, as the Spanish empire gave way in Cuba to the United States occupation and a neo-colonial future under US tutelage, Santos Fernández abruptly changed his position on a number of key questions in tropical medicine, backing the priority and originality of Carlos Finlays work on yellow fever and rejecting both the proposition that diseases differed according to race and the idea that there were pathologies specific to the tropics. The article suggests possible connections between this scientific shift and Santos Fernándezs political inclinations as a former Autonomist and a Hispanophile.

Medicine and Public Health in Latin America: Primary Health Care, Neoliberal Response, and Global Health in Latin America

Two processes above all others have inflected health and medicine in Latin American over the last forty years. One was the proposal of primary health care (PHC) as a comprehensive approach to reorient and emphasize preventive health services for the entire population of the region, especially those on the urban and rural margins, and to involve them in the promotion of their own health. Several cases of health in adversity in the late twentieth and early twenty-first century can be understood in terms of efforts to embrace PHC. Similar to experiences going on around the developing world, the approach was eventually codified at a crucial 1978 meeting of international health delegates in Alma-Ata (a city in Kazakhstan now known as Almaty), whose final declaration famously called for the implementation of PHC in order to achieve “health for all by the year 2000.” While PHC did not emerge from Latin America, and many experts consider that it has yet to be fully implemented there, many partial and national programs in the region anticipated the global consensus reached at Alma-Ata. The continent’s most ambitious primary health care–based systems offer the promise of health services to all members of society and the integration of popular medicine, biomedicine, rehabilitation programs, and preventive medicine into a dynamic health system. Though the degree to which Cuba actually achieved this is hotly debated, its embrace of such integral medicine was able to elevate the tiny island nation into something of a world medical power, achieving developed-world health indicators for its population while exporting tens of thousands of trained health professionals to areas of the world in need of expanded primary care. The radical, populist tinge of the comprehensive approach to PHC signed off on at Alma-Ata was quickly challenged by advocates of measurable, cost-effective, selective primary care interventions. These more conservative proposals were promoted and adopted by major bilateral and multilateral players in the context of the end of the Cold War and the rise of a neoliberal consensus that states should remove themselves as much as possible from providing or expanding social services. The ultimate logic of this consensus was that the state should cease to operate many programs and manage the health arena in a way that would give space to private providers. The assumption was that competition would make services more efficient and provide the public of public health, now reconceived as a group of individual patients, more choice. The more extreme versions of neoliberal health policies conceive state medicine and public health as part of a culture of survival of the poor.

Medicine and Public Health in Latin America: Medical Innovation in the Twentieth Century

There was a tendency for public health and medical research to overlap in Latin America over the first half of the twentieth century. There was also a gradual movement of medical education toward the emerging hegemony of the U.S. model of the teaching hospital conjoined with the laboratory, led by full-time clinicians and medical and life scientists. Even so, the leading medical figures of the continent were notable in their ability to maintain relative autonomy from U.S. and local state sponsors and carve a niche for themselves and their disciples under adverse conditions. They were also successful in making their mark in areas outside of tropical medicine and public health, with pioneering forays into tuberculosis, physiology, cardiology, oncology, psychiatry, and nutrition. Latin American physicians were also at the forefront of a eugenics movement that distinguished itself from dominant trends elsewhere by embracing the idea that, while race mattered (and widespread elite racism reigned), acquired characteristics could be inherited. This dovetailed with growing acceptance that the mixed-race masses could become citizens of modern nations given the extension of certain state policies in education, health, and welfare. After World War II, as Latin American countries began to show notable increases in population growth rates, the region became a focus for national and international population control efforts. Paradoxically, the partial success of public health programs (the control of malaria, for example) was now criticized by population growth alarmists for exacerbating the boom. The region’s health actors, often outside the loop of the more dynamic efforts to introduce birth control and family planning, were slow to respond. Nevertheless, a number of Latin American physicians achieved prominence as political leaders in the postwar period, playing crucial roles a number of regimes advocating dramatic social transformation.

Medicine and Public Health in Latin America: Indigenous Medicine, Official Health, Medical Pluralism

The foundations of Latin American and Caribbean medicine and health were laid over three-and-a-half centuries of complex interplay among what were initially three broadly distinct civilizations. One was the grand variety of indigenous American healing systems, many of which were dismembered by contact and conquest. A second was made up of elements brought from Africa by slaves, some of them specialized healers, and reinvented by a variety of Afro-descended practitioners in contact with both indigenous and European medicine. The third was medicine from the countries of the colonizers, both popular and official, transferred to the Americas and in its official guise refashioned as an important pillar of colonial rule and legitimation. The history of this interplay provides cues and clues to understanding the way that medical pluralism exists and interacts with official health and healing in contemporary Latin America and the Caribbean. The new history of medicine, covering the period from just before indigenous contact with the Spanish and Portuguese at the end of the fifteenth century until most of Latin America’s revolutionary republics and Brazil’s autonomous empire had established a tenuous independence in the mid-nineteenth century, has also expanded our knowledge of local social history. Perhaps most surprisingly, it has increased our knowledge of political history in which official and popular healers often played transformative parts. The new history of medicine and health during these three-and-a-half centuries also provides a much better sense of the agency of local actors, including indigenous and Afro-descended ones, in the global circulation of medical materials, ideas, and practices. This is parallel to a new history of science that finds insufficient the unidirectionality and dichotomy implied in previous models that emphasized the notions of cultural diffusion, center-periphery, or scientific imperialism as frameworks of analysis. This novel history conceives the circulation of plants, people, and ideas as an asymmetric creative process, one where nations and savants from different nations negotiated power, interacted, and reconfigured knowledge.

Medicine and Public Health in Latin America: Making National and International Health

Over the course of the twentieth century, Latin America acquired a justifiable reputation as a place where the poor – and especially the rural poor – lacked adequate health services. At the same time, recent research into the history of national state health agencies and international health organizations in the region underlines how important Latin America was in staging the world’s first international health system. These two stories were intertwined. The link took place under the auspices of a large U.S. philanthropy, the Rockefeller Foundation (RF), and as part of an informal sanitary wing of U.S. foreign policy, which chose as an entry point into the sanitary concerns of many nations the fight against a widely dispersed rural affliction, ancylostomiasis (hookworm disease). Attempts to address specific issues of rural health and sanitation were core to this system, as was state modernization in the interests of hemispheric prosperity. To varying degrees, these health systems sought to incorporate new sectors into political life as well as to establish international contacts. While most of the non-Western world at this time was under the colonial rule of the United States, Japan, and the European powers, each with a distinct health apparatus governed by the logic of colonialism and formally subordinate to the metropole, the national states of Latin America generated something quite different. Their interactions with other Western states, and especially the United States, would provide the principal blueprint for the fully “international” health apparatus that emerged in the post–World War II era, when the nation-state became the global norm. Despite the growing influence of the United States in the region, university-trained professionals, working-class leaders, politicians, and middle-class elites struggled to find their own niche in postcolonial Latin America society by exploiting the possibilities of formal state sovereignty.