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.

Professor, English and Women’s Studies
Duke University
pwald@duke.eduThis email address is being protected from spam bots, you need Javascript enabled to view it
“The Outbreak Narrative: Disease Emergence and the Obscured
Geography of Poverty”

Abstract: Accounts of newly surfacing diseases appeared in scientific publications
and the mainstream media in the West with increasing frequency following the
introduction of the human immunodeficiency virus (HIV) in the mid-1980s.  They
put the vocabulary of disease outbreaks into circulation, and they introduced the
concept of “emerging infections.”  While these accounts were neither monolithic,
nor static, their repetition of particular phrases, images and story lines produced a
formula that was amplified by the extended treatment of these themes in the
popular novels and films that proliferated in the mid-1990s. Collectively, they
drew out what was implicit in all of the accounts: a fascination not just with the
novelty and danger of the microbes, but also with the changing social formations
of a shrinking world.

The outbreak narrative--in its scientific, journalistic, and fictional incarnations--
follows a formulaic plot that begins with the identification of an emerging infection,
includes discussion of the global networks throughout which it travels, and
chronicles the epidemiological work that ends with its containment.  As the
epidemiologists trace the routes of the microbes, they catalogue the figures and
spaces of global modernity. Microbes, figures, and spaces blend together as they
animate the landscape and motivate the plot of the outbreak narrative: a
contradictory but compelling story of the perils of human interdependence and
the triumph of human connection and cooperation, scientific authority and the
evolutionary advantages of the microbe, ecological balance and impending
disaster.  These stories have consequences.  As they disseminate information,
they affect survival rates and contagion routes. They promote or mitigate the
stigmatizing of individuals, groups, populations, locales (regional and global),
behaviors and lifestyles, and they change economies.

They also influence how both scientists and the lay public understand the nature
and consequences of infection, how we imagine the threat and why we react so
fearfully to some disease outbreaks and not others at least as dangerous and
pressing, as well as which problems merit our attention and resources.