Solving the global health crisis with an English professor

On Thursday, Duke Professor of English Priscilla Wald gave a truly interdisciplinary talk on “Imagined Immunities: Narratives of Emerging Infections and the Epidemiology of Belonging.” Wald’s talk centered on the narratives we tell about emerging infections, newly surfacing diseases such as Ebola, SARS, and most recently the Avian Flu. Wald argued that the language we use to talk about these diseases changes the way in which doctors see them, or that “being careful about the stories we tell will affect health outcomes.”

As an example, she offered Gay-Related Immune Deficiency, the original name for HIV/AIDS. The disease was originally discovered because a doctor in Los Angeles noticed that many gay men were coming in with problems in their immune system. While it did important work for the doctors, “it also foreclosed some of the things they might have seen,” such as women and children with the same symptoms.

Wald provided personal anecdotes such as that of Paul Farmer, a doctor who founded a state-of-the-art clinic in the poorest part of Haiti. When three men who should have been curable all died of tuberculosis in the same week, the American doctors blamed the deaths on the men being “superstitious and not taking their drugs,” but the local doctors believed that “they died of poverty,” that because they were malnourished and poorly sheltered, they died of secondary infections while their body was fighting the tuberculosis. Once the clinic decided “to define disease as not just the microbes, but also as the living conditions contributing to the illness,” the clinic had much better success.

With these case studies in mind, Wald turned to the problem of emerging infections. At a 1989 conference on the problem of such infections, “conventions of the outbreak narrative” were introduced, stock images that circulated through both scientific literature and the popular media. Using examples from such popular texts as Richard Preston’s “The Hot Zone,” Laurie Garrett’s “The Coming Plague,” and of course the Dustin Hoffman film “Outbreak,” she argued that we see the infectious viruses as “primordial earth spirits emerging to battle western science.” Because we don’t want to face the possibility of our own extinction through the simple indifference of nature, we add human agency to the infection narratives. In Wald’s words, “we make it our fault, we make it something we can do something about.” The viruses are coming after us because they see the development of the Third World and patterns of globalization as a nuisance. The underlying subtext is that through getting rid of humans, the viruses will renew and reclaim the world. Wald called this narrative “cartoonish,” and asserted that it appears both explicitly in popular media and implicitly in the scientific literature. “What are the consequences?” she went on to ask. “What is the story we’re not telling?”

She described the revolutionary health care narrative that came from the 1978 Alma-Ata conference on primary health care, where 153 nations signed a declaration of health and human rights. The primary health care movement made “the dramatic claim that every human being was entitled to health care,” and defined health care as not merely the absence of disease, but as a certain minimum standard of living. According to the declaration, this was supposed to happen by 2000. Where did we go wrong? According to Wald, part of the answer can be found in the outbreak narrative. The conventional narrative sees disease as a problem that begins in the jungle, when it should see it as a problem that “begins in the West, where we have not taken social responsibility and we have not attended to questions of distributive justice.” The outbreak narrative could be a critique of irresponsible development, but instead it is “a mythic depiction of a heroic struggle.”

Wald claimed that when we worry about diseases such as Ebola and avian flu, we are only worrying about ourselves. “We should not worry because their diseases might affect us, but because those people are entitled to the same standard of care that we areÉ it is the difference between focusing on our common susceptibility and our common humanity.” Wald apologized for her idealism, an odd touch at a campus like Swarthmore, but ultimately asserted her belief that if we can change our narratives of disease, we can also change global health for the better.


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