Comrades in Health

Anne-Emanuelle Birn, Theodore M. Brown

• Publisher: Rutgers University Press
• Year: 2013
• Print ISBN: 9780813561219
• eBook ISBN: 9780813569642
• Topic: Medicine
• Subtopic: Health Care Delivery

Since the early twentieth century, politically engaged and socially committed U.S. health professionals have worked in solidarity with progressive movements around the world. Often with roots in social medicine, political activism, and international socialism, these doctors, nurses, and other health workers became comrades who joined forces with people struggling for social justice, equity, and the right to health.Anne-Emanuelle Birn and Theodore M. Brown bring together a group of professionals and activists whose lives have been dedicated to health internationalism. By presenting a combination of historical accounts and first-hand reflections, this collection of essays aims to draw attention to the longstanding international activities of the American health left and the lessons they brought home. The involvement of these progressive U.S. health professionals is presented against the background of foreign and domestic policy, social movements, and global politics.

Part I

Health Comrades in Context

Chapter 1

Introduction

Health Comrades, Abroad and at Home

Anne-Emanuelle Birn and Theodore M. Brown

In January 1937 Lini De Vries, a widowed nurse and former factory worker from New Jersey, volunteered to be part of the American Medical Bureau’s (AMB) mission to Spain. For months she struggled to save the lives of brave young men who had been mortally wounded while fighting the enemies of Spanish democracy: General Francisco Franco’s army and his fascist allies. As she later recalled:

Men coming out of anesthesia cowered . . . [o]thers shuddered when they heard planes overhead. Spain, a recognized, legally elected government with representation in the League of Nations, was being brutally attacked . . . I hated what I saw and the forces responsible for this suffering, anguish and death. . . . Perhaps never again in my life will I be with such idealistic, gentle people from so many lands. This was a crusade for the freedom of man. . . . I had played a small part in the uneven struggle of the Spanish people defending themselves against Hitler’s forces, Mussolini’s Black Shirts . . . I had received far more than I had given to Spain. I had received daily experience in valor, courage, bravery. I saw idealism expressed by men from many lands. I saw democracy in the making. Spain had given me the chance to work, think and act at the highest level of humanity that I was able to attain. In this action I had a chance to grow.1

When people think of those dedicated to international or global health2 nowadays, the image that comes to mind is a person—at least on the surface—much like Lini De Vries. She or he may be pictured as a young, idealistic health professional who travels to a war-torn or impoverished setting where patients are destitute or displaced, medical supplies are limited, and standards of sanitation and safety are inadequate. In such settings, brave souls put careers on hold and sometimes risk their lives in order to offer compassion and clinical skills to suffering people. For a few months or perhaps many years, these nurses, doctors, and other health workers devote themselves to providing the best possible care they can with minimal resources amid daily frustrations and often threatening political instability.

But De Vries was different from today’s more typical global health volunteer or professional: she was a health leftist. By leftist we mean someone who adheres to some version of anticapitalist (including socialist, Communist, or possibly anarchist) belief, and who subscribes to the view that “people come before profits.” Leftists hold that it is possible for societies to build economic and political democracy premised on respect for human rights. Hence, by definition, leftists oppose economic exploitation, oppression, and discrimination at home and abroad, the latter particularly in relation to colonization, imperialism, and usurpation of indigenous sovereignty and territory. It is also important to note that leftists are willing to expose publicly those who engage in, tolerate, or benefit from exploitation and oppression; leftists correspondingly work collectively to challenge the privileges and priorities of those seeking to maintain and increase private wealth and power at the expense of others, thus denying needed economic resources and rights to large swaths of the population. Although most leftists are linked by their political economy analysis,3 they have been more variable, past and present, in their grasp of politics pertaining to racism, gender, sexuality, and religion.

It was as a health leftist that De Vries went to Spain, possessing a well-developed political sensibility. This sensibility derived from her teenage years, when she labored in silk, ribbon, and cotton mills, from her years of experience as a social worker and public health nurse in New York, and from her membership in the Communist Party. With strong views about the injustice of the fascist-supported assault on a democratically elected government that was deeply committed to improving the lives of long-oppressed and largely illiterate rural and urban populations, De Vries wanted to offer medical assistance not only for its own sake, but to support a political cause. Experiencing the enormous brutality of Franco’s fascist forces firsthand,4 she developed a clear sense of how health, politics, and struggles for social justice were closely connected.

Thus, there was more than narrowly defined medical aid in what De Vries contributed in international health. Like various of her comrades (a term, borrowed from French, popularized by German socialists in the nineteenth century as a more egalitarian form of address), she returned to North America on a speaking tour to raise awareness and money for the voluntary medical efforts that supported the Republican (antifascist) side in Spain’s civil war. She subsequently worked in New Mexico, Puerto Rico, and Los Angeles, providing public health services and training for low-income, working-class communities and serving under the federal Works Progress Administration.5 Until her death in 1982, DeVries continued to translate the lessons she learned in Spain into a lifetime of community health work, writing, and political engagement, first in the United States and then for two decades in Mexico, where she was exiled during the red-baiting witch hunts of the early Cold War.

This book traces the international involvement of U.S. health professionals of Lini De Vries’s genre—here we refer to them as both “health leftists” and “health internationalists”—and the impact of these experiences on their subsequent work and activism. Those covered in this book represent a range of fields—medicine, nursing, social work, law, policy, advocacy, and public health—and have witnessed and worked in a variety of international settings from the 1930s to the present: these settings have all demanded a mix of urgent medical need and political struggle for equity and justice, with relevance in situ and back home alike. Indeed, a hallmark of the health internationalists included in this volume is that they have transposed their overseas engagement and learning to the U.S. context, where it has shaped and informed their health work and political activities.

The health internationalists who are the authors and subjects of this volume have taken part in endeavors abroad that were and are, at one and the same time, practical, political, and educational—to the health professional herself or himself and to alternatively admiring, critical, or menacing domestic audiences. Some were longtime activists whose international commitments were consistent with decades of militancy. Others experienced a political awakening while working overseas, returning to the United States with new sensibilities and novel approaches to fighting for health and social justice. Like De Vries, our protagonists can be characterized by their high ideals, strong convictions, and self-reflectiveness, as well as their dedication to continuing political engagement and struggle.

An American Internationalist Focus

This book focuses on the activities of American health internationalists, although health leftists from other countries who influenced or worked with U.S. activists abroad will also be discussed. Our attention to the American angle of health internationalism derives from the particular political part played by U.S. health leftists both abroad—where, since the 1920s they have worked to counteract their country’s role in military, political, and economic domains—and at home, where left-wing politics, including the forging of a working-class (labor) party and the universal, public provision of health care services remain an elusive goal, exceptionally so for industrialized countries.6

U.S. health internationalists have thus served as a small but crucial left-wing counterpart to official foreign policy before, during, and after the Cold War, as well as playing an internationally informed oppositional role on the domestic political front. As such, U.S. health activist efforts may be understood as a form of resistance. Perhaps because biomedicine’s professional and scientific ascendancy unfolded simultaneously to the rise of American political power and capitalist ideology, progressive health workers, particularly doctors, have had greater reach and resonance than many other leftists.

Yet the story of American health internationalists remains little known. Little known is, of course, a relative term. American health workers have been inspired by, and subsequently inspired, fellow activists in domestic movements and in international circles. Paradoxically in an immigrant society like the United States, transnational and overseas learning came naturally7 yet was increasingly rejected as the country became a world power. The pushing aside of internationalists and their ideas, past and present, compounded by repeated Red Scares and prolonged periods of repression before, during, and subsequent to the McCarthy era, means that American health internationalists are not as renowned as they should be.

Our emphasis on Americans, while it helps map the contours of this book, is not a matter of chauvinism (noting that both coeditors are U.S. citizens). To the contrary: we believe that the part played by U.S. health internationalists—almost inevitably countering their own government’s foreign policy—has historically marginalized their work, even as it has magnified its importance. Moreover, we depict the often-humbling learning experiences of health leftists who have seen what collective activism in other countries has achieved under often extremely challenging circumstances. As we shall see, at times health leftist groups—and leftists generally—engaged in destructive infighting that weakened their cause; at other moments, political alliances that seemed to offer hopeful prospects for progressive social transformation at one juncture proved catastrophic or repressive at another. We also explore the sacrifices made by countless activists, as well as the difficulties of transnational “knowledge transfer,” as these experiences were directed back to the United States in an often-Sisyphean attempt to influence domestic political, social, and health movements.

Our focus on health leftists from the United States means that we will not discuss in detail the lives of two of the most famed health internationalists of the twentieth century, both of whom died fighting for their political beliefs: Canadian Norman Bethune,8 a surgeon and Communist who campaigned for a system of state-run medical care in Canada, innovated mobile blood transfusions in the Spanish Civil War, then participated (and perished from septicemia in 1939) in the Chinese revolutionary struggle; and the iconic Ernesto “Che” Guevara,9 the asthmatic Argentine physician turned revolutionary, Cuban diplomat, and minister of industry, who later left Cuba to support guerrilla efforts in Congo and then Bolivia, where he was captured and executed in 1967. Yet Bethune and Guevara are nonetheless present in this book. Virtually all of the contributors to this book are familiar with and inspired by one or both of these figures, and they serve as stirring symbols of health internationalists to wide audiences.

To date the medico-political trajectories of U.S. health internationalists have been covered in a handful of mostly individual autobiographical accounts or as parts of larger stories of international political activism that generally overlook the health and medical aspects of this involvement.10 This book aims to draw systematic attention to the international activities of U.S. health leftists by presenting a combination of historical analysis and firsthand reflections by several generations of health activists whose work spanned the twentieth century and continues into the twenty-first. We seek to lift these narratives from obscurity and to understand the motivations, experiential learning, contextual influences, courage, commitment “against the grain,” and sometimes complex contradictions of a heretofore little known kind of activist. While this recognition of health leftists includes various accounts of bona fide heroism, our aim is not to celebrate these lives uncritically, but rather to subject them to scrutiny, analyzing the often searingly difficult decisions related to, and consequences of, their efforts.

It is important from the outset to distinguish the health internationalists who are the focus of this book from those individuals who serve and have served under the auspices of major international health organizations as advocates, bureaucrats, or field operatives. To be sure, many idealistic and “liberal” (in the North American sense of “left-leaning”) individuals, including some of the subjects and contributors to this book, have been involved at all levels of these institutions and have sought to push them—from within and from without—to take more progressive stances and pursue policies and activities based on social justice principles. Yet leading international health agencies, most notably the World Health Organization (WHO) and other UN agencies; international financial and development institutions like the World Bank; philanthropies, particularly the Rockefeller and Bill and Melinda Gates Foundations; public-private partnerships; religious missions; bilateral aid agencies such as the United States Agency for International Development (USAID); large and small nongovernmental organizations (NGOs) from CARE to Unite for Sight; and the many other organizations that now make up the international/global health “establishment” did not and do not challenge the tenets of capitalist political economy (even as they may try to meliorate its excesses). These organizations have generally relegated politically progressive efforts to the margins, ignored them, or even consciously worked against them. We will mention earlier varietie...

Table of contents

• Series Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Figures
• Foreword
• Acknowledgments
• Part I. Health Comrades in Context
• Part II. Generation Born in the 1870s–1910s
• Part III. Generation Born in the 1920s–1930s
• Part IV. Generation Born in the 1940s–1960s
• Part V. Generation Born in the 1960s–1970s
• Part VI. Conclusion
• Notes on Contributors
• Read More In This Series