Episode 7: Adia Benton on Military Power and Public Health

In this episode of the Global Health Politics Podcast, Joseph Harris sits down with Northwestern University anthropologist Adia Benton. They talk about her book, HIV Exceptionalism, her recent work on the Ebola outbreak in West Africa, the militarization of public health, and efforts to decolonize global health.

Transcript

Global Health Politics Podcast: 

Episode 7 with Adia Benton

Joseph Harris  00:00

Welcome to the Global Health politics podcast, where we go beyond the articles and books and have real intimate conversations with people working in the field of global health today, I'm your host. JOSEPH HARRIS. 

Today, I'm really pleased to be here with Dr ADIA Benton, associate professor of anthropology at Northwestern University. Dr Benton is one of the leading anthropologists in the field of global health today and has conducted research on a wide range of topics, including HIV/AIDS, Ebola, COVID-19 and global surgery. In addition, she's been involved in a large number of private and public conversations that have informed policy decisions related to global health and pandemic preparedness. Thanks for coming to speak at the Global Health politics workshop and for joining the Global Health politics podcast.

Adia Benton  01:02

Thank you for hosting me.

Joseph Harris  01:06

You've made some really important contributions to the field of global health. How did you first become interested in global health issues, and why did you choose to become an anthropologist?

Adia Benton  01:16

So I think I first became interested in global health related issues when I was an undergraduate. I started out kind of exploring things like Engineering and Biological Sciences and moved into some social sciences, so sort of the social studies of health and well-being, and took a couple of courses that focused on AIDS and focused on the burden of disease in developing countries, and kind of decided that that was something that I'd like to pursue. Now. Why I became an anthropologist? That's probably a more roundabout story. So after I went to public health school, I worked with NGOs in a variety of capacities, some way, in some ways, I was sometimes I was doing research, sometimes I was doing monitoring and evaluation. And then one of my bosses was an anthropologist. And I said, you know, the window of time in which I could use my GRE score was running out, so I'm thinking, I don't want to take the test again. I should probably try to get a PhD in something. And she said, “Oh, maybe anthropology would be good for you. You have a sort of ethnographic sensibility.” And I said, “Okay!” But I didn't know what that meant because I'd only taken one anthropology course. Well, no, I took two anthropology courses, courses taught by anthropologists, but only one of those courses was with a cultural anthropologist. I also talked to a couple of other people who said, “Ah, you know, if you're interested in this health stuff, you might consider medical anthropology.” And so I said, “Okay, you know, knowing nothing, I think this was even pre-Google, I just found a few papers and put in an application or three and sort of moved in that way.” 

Joseph Harris  03:13

That's fascinating. Medical Anthropology has a long history in the discipline of anthropology, how would you say that interest and issues associated with global health, like infectious disease, has changed since you became an anthropologist? 

Adia Benton  03:31

Wow. So it's so interesting that you say that. I don't think about it often, but there are definitely camps. And I think when I sort of look at the what I would say the earliest literature about medical anthropology, or anthropology and infectious diseases, for example, or any kinds of sort of health conditions, or the focus was on things like idioms of distress or idioms of wellness and/or poor health that were used cross-culturally. And what I found a little bit lacking in those, I guess, ways of thinking about health was they, they were very often, I guess, sort of separate from the politics, separate from some of these questions of power and so the and I'd say that wasn't always those, I guess that bifurcation didn't always exist, or that limitation didn't always exist, but there was a point at which we moved from simple idioms, or thinking about like different sort of cross-cultural notions of the body, to understanding the body as something that is in a in a place, situated in in politics, situated in community, in ways that that required thinking more broadly about the body, or what it means to be healthy, or what it means to be well, and just how how people seek care under those circumstances, how people deliver it, how people theorize about the kind of movement between health and well-being and illness. So I'd say over time it's less common to see this sort of grappling with political economy, particularly as it relates to health, understanding the institutions involved in all of that.

Joseph Harris  05:42

And I know that in the broader field of global health, there's been growing interest in issues that go beyond infectious disease, things like universal health coverage, recently non-communicable disease reparations. Do you feel like the issues that medical anthropologists are working on track that or disconnected? How does the field of anthropology connect to broader global health?

Adia Benton  06:08

I mean, I think in some ways, we probably pioneered part of that, that thinking more broadly, thinking about systems. I think particularly the people who were sort of clinician/practitioner anthropologists who understood their work as sort of operating within a broader framework of broader institutional framework, so understanding that you can't really talk about, especially in the US, you can't talk about health care with or health people's experiences of wellness or illness outside of understanding the kinds of institutions in which that care is delivered, so the financing structures. I'd say that that a lot of anthropologists and historians and sociologists were involved in this shift in thinking. I think one of the things that also happened was a sort of reclaiming of saying medical anthropology within sort of the cultural and political realm. I think there was a sense at some point that it sat outside of or was ancillary to or was very much rooted in the biological. But it's so beyond infectious diseases. Like the people that I worked with as a graduate student were, one was a psychiatrist, Arthur Kleinman, and Byron Good, who's not a psychiatrist, but was a psychologist, is a psychological anthropologist, and his wife, Mary Jo is a medical sociologist but claims anthropology as her home. So I kind of see health beyond infectious diseases because that's where I was also situated. It's weird actually to think about. I was sitting with these sort of people who are interested in psychoanalysis and psychiatry, but doing this other stuff related to infectious diseases.

Joseph Harris  08:22

That's fascinating. So thinking more broadly about these issues than just narrowly about infectious disease? That's great. You publish with researchers outside the field of anthropology. I think of people like Kim Yi Dionne who’s a political scientist at the University of California-Riverside. How does work outside the discipline of anthropology inform your approach to research?

Adia Benton  08:48

Well, I was just talking about this the other day, and one thing that I can say about anthropology more so than other disciplines, I think, we're kind of forced to read outside of our discipline. I'd say it's where you'll see a slightly more undisciplined kind of scholarship. So when I had to write about health I was because I was talking about international organizations, because I was talking about health financing, because I was talking about NGOs, non-governmental organizations, I couldn't do that without also engaging in and with political science. I couldn't do that without engaging with for political theory, without thinking about the sociologists who are interested in institutions and complex organizations. So there's no way to do that work without engaging with those outside things. I think the deepest engagement with my book at first – actually having forums – was political scientists, international relations scholars, who said, “Oh, I found this super interesting.” The first person that I heard about who read it from cover to cover was a political scientist. He blurbs for like Foreign Affairs or Foreign Policy, whichever one the war criminals publish in [laughter]. I think part of that comes out of being an anthropologist, but also part of it because of what I'm studying. I can't just sort of stay within the cloister. Otherwise, I won't be able to have any kind of insight, or my insight will be limited.

Joseph Harris  10:45

That's great. I mean, it sounds like you found your work to connect to people and other disciplines. And I know that sometimes it's frustrating as academics that we don't feel like our research connects to the outside world, much less outside of our discipline. 

Adia Benton  11:00

For sure. I mean, the funny thing, though, is that political science, I make fun of political scientists, economists too. When they read the book, they would say things like, “I don't understand how this is your method. You know, what do you mean? You just sort of hung out and talk to people for that long?” Even though they're obviously political scientists who conduct field work and are interested in learning languages and cultural stuff. It’s still that kind of like you're doing this diagnosis of a system, but you're doing it from a space that isn't quantifying it, quantifying it in this legible way. And so it's about, like, well, explaining how that method allows me or leads me to certain insights. I won't be able to quantify certain things. You know, that's true, but that's not my that's not my method. That's not my concern. Others can do that sure, but I can certainly talk about experiences and practices of navigating various kinds of systems. I can, you know, I can interpret organizations documents and make a case about how they choose to think about their work, or how they choose to think about their work or how they think about their work. So, yeah.

Joseph Harris  12:22

Your book, HIV Exceptionalism, made a major impact, not just in anthropology, but in related fields. Can you share a bit more about the impact that it made about you know, conversations that were prompted by its publication, that were gratifying to you or that you didn't expect?

Adia Benton  12:48

Yeah, I'm still trying to grapple with: does it really have an impact? You can never tell with these things, I mean.

Joseph Harris  12:58

I mean, I remember I always worried [after I wrote my first book]. I was very careful in writing my book. I was worried about how it would be received. And, of course, for so many of us academics, the problem is the opposite. Is anyone listening? 

Adia Benton  13:12

I mean, so there are a couple of moments where I felt like that I was sort of surprised, actually a couple of times. One a friend of mine, he was working doing sort of mental health work in Sierra Leone, and he sent me a text, “Hey, my boss is handing your book out to people who are going into the field.” And I was like, I have no idea what that looks like. I'm sorry, but you know, he was just like, “Here’s just a little nudge, just to let you know.”

Joseph Harris  13:52

And this was an NGO?

Adia Benton  13:56

it was like a mental health NGO that works, that was working in fairly remote areas to deliver some mental health care stuff. Yeah, so a lot of mental health counseling stuff. And another, Paul Farmer. One of the reasons I think my book actually did well compared to what I would have expected, is at some point Paul Farmer got his hands on it and started buying people copies. And he reviewed it in the London Review of Books, which was funny. And he said it was because he had been told he'd been asked to blurb it, but he hadn't. He didn't know that he was asked to blurb it. He found out that his assistant had misplaced the email, and so he said, Oh, can I make it up? This is how I'm making it up to you. It's in the London Review. And but he bought the book, and he said, “Oh, I'm handing it out to all these like people in Sierra Leone, because I think it's really interesting.” And so he said, “During one of these Ebola meetings that he was in, I think it was in Freetown, he said there was grumbling at the table that they didn't want “Ebola Exceptionalism.” And he's like, “That's because of you! They are really thinking about how not to kind of verticalize this, how to really think about improving health systems and their claim or their aim for universal health care. So, I mean, those are a couple that were kind of interesting. But, you know, it's sort of like having a proud uncle handing out your book. 

Joseph Harris  15:30

That's not a bad proud uncle to have! One of the things I really love about those two vignettes you share is that there are impacts beyond the field of HIV/AIDS. I mean mental health, Ebola. Those are very different situations. That's amazing! 

Adia Benton  15:47

I was pretty impressed that people found it accessible enough to use it that way, use it those ways. 

Joseph Harris  15:58

Were there any engagements that resulted based on the findings related to HIV AIDS?

Adia Benton  16:10

Actually, I don't think so. That's the funny thing. I don't think anybody cared about AIDS at the end. Well, no, it's interesting that you say that. I saw one of the people who's actually in the book, maybe three or four years ago, and she, she's so funny. She, you know, she's a nurse, and she, she's like, we're having beers, drinks, and food or whatever. She says, “Hey, whatever happened to that thing you were, like, researching when you were staying with us?” And I was like, “I wrote a book. Didn't you remember?” She's like, “Oh, that's nice.” And she's an HIV nurse. I think she had moved on since that book. But, you know, I would say I was that was also very funny to me because that was what I expected for the entire thing. Like I actually kind of expected that that would be the response, which is also why I felt like less concerned about what would people think. Yeah, I really did, just like you were saying, I thought that no one was going to read it, and in fact, she was one of them.

Joseph Harris  17:25

But it's had a major impact in so many ways.

Adia Benton  17:27

I suspect it's possible that a few of the ministry people who were working in AIDS at the time read it and had some thoughts. I mean, I think in some ways, they were also pushing against an exceptionalism, even though it was offering all kinds of incentives and stuff. I think they were also kind of like, it would be more interesting for me professionally, technically, to be doing something else, and to be engaged in a lot of other issues. Because I do remember hearing from some of the people that I talked to and I wrote a little bit about it, and they would say, “Yeah, like, it's sort of rewarding, but it's boring at this point because I don't have that many patients, and these are not complex cases. None of these are complex cases. I would like to be doing something a little bit more challenging, something that allows me to use my skills and kind of expand my horizons.” And so that for at least for the technical folks, I think to some extent for the people who are actually HIV positive as well, like they kind of wanted to do other things, which is weird to say. It's like, because HIV sort of became the profession for the people who were positive, right, and who didn't have other means. So I think they were kind of like, “Yeah, I'd like to kind of get back into some of my political life and interest. to find other ways to engage in communities and not really be sort of fixed to this HIV thing.”

Joseph Harris  19:04

So that's fascinating. Well, I know you published a number of public-facing pieces as well, like the one on the role of the IMF in West Africa in Ebola crisis in the Washington Post’s Monkey Cage. That one was with political scientist Kim Yi Dionne. And you're also very active in the Twitter space. Can you say a bit about the importance of public engagement to you? Why is it important?

Adia Benton  19:31

You know, for me, well, at first, when I started doing a lot of that stuff, it was because I wanted to see what other people were saying, right? Like, I wasn't really that invested in speaking out anywhere. I think this was a little bit before the West African Ebola pandemic. I was calling it that then, but there were some objections, and so I was just curious about what's going on on the ground, what's the sort of unofficial readings or interpretations of what's going on? And then I started to see things that didn't make sense, like I was just like, “Who are these people? Who are these experts and pundits speaking about something about which they absolutely know nothing? And so I started kind of chiming in and, you know, and that was the case with writing with Kim. I think we found, met each other on Twitter. I had used her work in my book. I was writing, I think my dissertation, or maybe book, and I came across that paper and was like, “Yes, this is what I'm seeing in Sierra Leone.” That AIDS exceptionalism paper that she had written, I think with Ann Swidler. I can't remember who the other author. I could be wrong. But there was this point at which we were both like, “What in the world are these, like, weird economist types saying about the IMF, like they have a conversation with somebody from the ministry, and they think they understand everything and then, you know, it's very easy to do some research and discover that these were the actual policies that were implemented in the early 1980s in this country that can really show you precisely what happened with healthcare resources, like human resources for health, all of that, is very, very obvious. There were even anthropologists writing about how do you provide child care? Child health related services when you have tried to reduce salaries of health workers, when you cut all of these the civil service? That's why the war in Sierra Leone actually happened, and so I was like, “Not under what circumstances?” That was actually an interesting little piece that we wrote. We were just angry. I think we had a lot of fights. It must have been Chris Blackman, I have a feeling that's what it was at the time. But we also ended up meeting some more like demographers and economists as a result of that, more progressive economists who said, “Oh, this is how the World Bank and the IMF respond to these kinds of challenges.” They have a sort of, you know, they have their own little sort of crib that they that they used to respond to this.” And that's when we sort of learned, “Oh, they're watching us.” But I think it's important when I say that it was never my intention to be public. It's something that having a platform has made it easier to share ideas, to learn about others, and learn about others’ ideas, and to be able to kind of engage in a richer dialogue, richer conversations about a range of policies and a range of, I guess, practices by organizations or governments or whatever.

Joseph Harris  23:39

And it sounds like, you know, practitioners and beyond Anthropology right?

Adia Benton  23:43

Yes, absolutely. So, yeah. I think that's the thing. It's just because it's just a way for me to learn more and to share more. I have learned so much just from those kinds of engagements and those conversations. 

Joseph Harris  24:07

Yeah. I mean, that's fascinating. So it sounds like for you, it's a lot more about sharing and having a conversation rather than necessarily deliberately trying to push an outcome. 

Adia Benton  24:20

No branding. Like, I know a lot of people are kind of concerned about their brand and how they build following stuff, but I was never, I feel like when you are deliberate about it, t's fine, I guess, but it's it's not to me, it's not the purpose, it's not the aim. And so if that happens, cool. But it's, it's actually been really rewarding to have, like I said, really enriching conversations, learning more stuff and having people kind of go building ideas there, to do it for the experience. I should say that in social media, you also have to learn a lot of different cultural norms about socializing. Promotion is part of the thing. It's part of the sort of world of social media. But it's also that you have to understand like there are all of these sort of layers of how you communicate with people, the tweet, the sub tweet, the quote tweet, the reply, how those metrics kind of play into other your experience. And so to some extent, t's another kind of cultural space whose practices, I think, shape what kind of information, what kinds of conversations can be had. And I think there are a lot of folks who are so concerned with their branding, who don't understand that, you're officially in a community, you kind of have to behave a certain way.

Joseph Harris  26:01

That's fascinating. I'd love to read your book on that!

Adia Benton  26:06

On the etiquette of social media! 

Joseph Harris  26:10

I know that there are other scholars now who have also taken the IMF to task for its mishandling of the Ebola crisis, but also other things. I think, of people like Alexander Kentikelenis and some of his colleagues. Have you been following that or engaging with that, or had conversations with folks who continue to talk in that space?

Adia Benton  26:37

It's been a while, I haven't really. I think the last time I did so I was actually supposed to be on an IMF panel a couple of years ago at APHA, yeah, the Public Health Association, with a bunch of ministers from, I'd say, progressive countries, so like Mozambique, which had a socialist Minister of Health, a bunch of those types to talk about the impacts on their spending. But something happened, I can't remember. I'm pretty sure it was family stuff, so I guess I'm still sort of in a side conversation about it, but it's not as central to my work. But it's certainly a conversation that I continue to have with people. 

Joseph Harris  27:35

Maybe you could share a bit more about your current project on the militarization of public health.

Adia Benton  27:47

Oh, yeah, that book's about everything. That's one of the problems. That's why I'm having trouble finishing it. The contract that I had, I think I was supposed to have finished it like 2020, 2021, something like that. But it was originally supposed to be a series of essays drawing on a lot of the public scholarship that I did about Ebola, so I was trying to kind of edit those things into a coherent piece. And I realized that that wasn't going to work because I had a lot more to say about kind of global health, global health cultures, I guess is one way to think about it, but I had lots of other concerns that exceeded the content of those essays. So some of it is about militarization and the use of the military and the police to address this outbreak stuff. Some of it's about what I call the racial immunologics of pandemic response, which I had a realization about. I'm trying to remember what it was!...

What I realized is, actually speaking of sociological theories, Victor Ray's work on racialized organizations and racialized burdens had me thinking, “Oh, that's interesting!” It kind of maps onto an argument I made in an article a few years before that was published. I said, “This is very US-centric piece, but I do think there are some bits that can be retained, particularly around some of the ways that race and racialization, global racial hierarchies, map onto where one sits within organizations, but also the rules guiding a series of policies.” So some of the policies that I talk about in the racial immunologic stuff is about who gets evacuated for care especially in a place that has very few health care workers, and they're all getting sick and dying? Who is seen at the triage hospital in that's been designated for international workers? Or how is labor divided? What are the labor divisions in the work of care, the work of burial, the work of all these other things within epidemic surveillance intelligence, which also maps onto the policing hierarchies, the patrolmen versus the detective? And those kind of play out in a bunch of different ways, how organizations like the CDC train people internationally? What kinds of responsibilities people from different countries have in within those in those organizations and their roles? I used to tell people who read the AIDS book, I would say it's actually not about AIDS, and it's actually not about all of these other things. It's about organizations. It's an ethnographic study of organizations, and they're usually kind of boring because you have to go to a lot of meetings and read a lot of books, read a lot of bad reports. But I think this may be the same kind of thing. And I think it's something that can be done when you're not like in the field in this sort of the way that anthropology demands in the midst of a crisis. 

It occurred to me, I was giving a talk in Freetown, and it was to a bunch of people who are interested in biosecurity and pandemics. It was weird. It was like it was a fully African conference. So people from all over Africa were there, and I gave this talk about Ebola as keywords, and I started describing events that I knew had happened, but I had not witnessed, and a guy who'd been in in Sierra Leone during the pandemic, because he was a part of the response says to me, “How did you know about that thing that happened in whatever province?” I said, “Oh, I read a bunch of stuff. I also talked to people, but yeah, I wasn't there.” He was just like, “When were you there? Because of how I talked about it and the fact that I could say something convincing that I did not directly experience says something about a lot of things, and not always good. But it made me feel like there were ways to think about certain kinds of experiences, certain kinds of practices, without direct observation, and that those are perfectly valid and useful. 

Joseph Harris  33:13

What would you say drew your interest to these particular issues? And can you say a bit more too about how, or if they connect to similar issues in the US?

Adia Benton  33:25

Which ones, the ones about policing, the military? Oh, yeah. I don't even know where all of that stuff came from. I think it was, maybe it was, oh, I know what it was. Well, no, I can't say for sure, but I can say the one thing that contributed was when they fired the Minister of Health in Sierra Leone, or no, when they hired another, and then they moved the responsibility for the outbreak response to the Ministry of Defense. A lot of folks were puzzled by this, but the other piece was the Obama administration pledging money and troops to Liberia to address the pandemic response. And I, you know, I teach every year, I teach almost every year, not every year, with [the film] Outbreak, the 1995 Wolfgang Peterson film starring Dustin Hoffman and Renee Russo, Morgan Freeman and Donald Sutherland. I mean, even Cuba Gooding Junior is in that. I mean, this is a fabulous film, and it's so much better than films like Contagion, which are slick and very accurate or whatever. But what I found really interesting about Outbreak was the fact that the movie starts with the US Army in a mercenary camp in the Democratic Republic of Congo, or what was then called Zaire in 1967. And I'm just like, “What are they doing? That is amazing!” They're trying to do anti-colonialism or decolonization. They're trying to do, you know, Central African Civil War. They're trying to tell us that military is essentially the sort of first line, the front line for an infectious disease outbreak. It has everything. They even like bomb, plan to bomb a town in California because those people have the disease and, and I was like, “This is so fascinating because ultimately, in that movie, you know, Dustin Hoffman's like the good military guy, Morgan Freeman and Donald Sutherland are the bad military guys. But there's always going to be military “They're just saying, “Do you want the good ones in charge, or do you want the bad ones in charge?” And to me, that sort of choice was illuminating. It had me. I was already working on the surgery project and had to drop that. But I was looking at all of the ways that all of the many of the innovations of surgery are battlefield related. And, and so I was trying to think why all many trauma surgeons were in the military or whatever. And so just thinking about those connections, thinking about the emergence of certain kinds of technologies and strategies and ways of thinking about the world in terms of policing and military, military strategy. So that's kind of how I got there, in a probably roundabout way, which is I watched some movies, but I also saw, like in real life, the election, all of that stuff playing out. It also happened in the US as well with COVID.

Joseph Harris  37:21

Would you say unfolding in similar ways or different ways [in the U.S.]? How would you characterize that? 

Adia Benton  37:35

I mean, there was certainly violence that took place, right? I think framing the ways that we talk about what the enemy is and who poses the threat, which body is under attack, I think in terms of representation, it looks very different for Africa, and it looks very different in Africa in terms of the spectacle of political violence and the spectacle of sovereignty. This is probably fairly crude to say, but I remember reading a book, actually fairly recently, about by a young anthropologist, Jonah Lipton, and he was living in Freetown when the outbreak happened, and that was not his project. His project was about young men riding motorcycles. There's this moment where he's talking about how the police are always harassing the motorcycle taxi guys, and how they threaten them, they try to take their money and stuff, and but they also carry guns, and there are no bullets. One thing that we do know about the military in Sierra Leone is they're the only ones who are always paid, which is another story. It used to be a kind of funny joke that we would talk about, like, “Well, why would you have military doing this? Why would they be in charge?” And I think it was a Sierra Leonean doctor who said, “Well, they're the only ones who get paid for sure. They're always going to get a check.” And that's been the case since 1995 because the coup was started by military guys who did not get paid. So your first line is for them.

Joseph Harris  

Talk about legacies! 

Adia Benton  39:40

So that's like the first paycheck that you make sure has some funding behind it. You have sufficient funds to pay the military, and that means that they're the only ones who are also expected to take on certain kinds of risks, tests, responsibilities. They started with the whole ships off the coast minimizing risk to themselves, so the same logics of, sort of, no casualties, zero risk, that applied to international military forces in West Africa also applied to the forces here if they were involved in setting up testing sites or whatever, patrolling the perimeter, making sure that there was order, using their logistical skills or prowess, in ways that don't necessarily help with delivering care, and don't put the put their these assets at risk, which is interesting, because they're also often sacrificed, right? So you kind of it's like, under what circumstances are military actors sacrificed? And it's certainly not under these sort of pandemic conditions. So I think there were some instructive moments there, like, how does that work? How does that play out? I was just saying the movie Contagion doesn't do this, but they do. They actually have military in very strategic places, right? They have it in the delivery of food. They have them at the borders. Interestingly, and this is a subplot. Thank goodness I read the script and watched the movie with my students this quarter. But the police are slowly quitting. They are quiet quitting. They're resigning. And then there's like unrest and people breaking into homes, and so they're trying to make this very liberal kind of reform ideology there, but they're also like, “Oh, but we need police!” But they're not not feeling appreciated, so they're just like slowly not doing their job, and they look disorderly. It's subtle, but not so subtle in some ways, like it's on the news and Matt Damon's character is watching the news, and then you see someone breaking into the house next door. And so there's this sort of vague hinting at the necessity that the police as a necessary institution enforcing social order, fabricating and maintaining social order. So it's just something that's intrigued me. It's something that I'm hopefully going to talk about in this thing, but that's how I think that sort of plays out in this way. It’s sort of interesting.

Joseph Harris  43:09

One of the things that that came up in the comments that you just made, you brought up decolonization, and we're at this moment where the decolonize global health movement has made an impact, and you see it very visibly within the field of global health. Can you say a bit about that and its meaning at this moment, both for the fields of anthropology and allied disciplines, but also for the broader world?

Adia Benton  43:44

I'm wondering if I've made this clear. I actually don't know if it's possible to decolonize global health. I think I have said this because it's like, one of those kind of snarky things I would say, like, “If you decolonize global health, what will be left?” You know, it emerged out of…I don't know if it emerged from colonialism or if it's like a rearrangement of a certain kind of assemblage. It's hard for me to not to see it as even possible outside of the colonial framework because it it's a direct descendant of tropical medicine, hygiene, 

Joseph Harris  

Imperialism 

Adia Benton

Yeah, imperlalism essentially. And so if it were to decolonize itself, it wouldn't exist. I think a lot of people are saying, “Well, what if we take things from the ground up and do it like this?” And I was like, “Well, that's just public health.” I remember very distinctly, because I got a degree in international health before they switched it over to global health, and I remember the debates at the time, which is it takes the nation state as the sort of primary container, and it's between different nations. But we want to think globally because disease doesn't know borders and no borders exist. Like they may not be physical things, but something productive is happening at the places demarcated as or named as borders. They are defended. They are patrolled. They are guarded. They're not just containers. They are channels. So you know the globe that is imagined in the global health discourse, especially once it changed, was one in which there are poor countries and there are rich ones, and the knowledge resources flow from one to the other, and in the service of managing health at a sort of population level, there are a network of organizations that engage in this work, that shape people's movements. In and out of them, various technologies emerge…but I think one of the challenges is, is we have a sort of world system. This is dating me. This is making me feel like an old, old Marxist. But we have a world system. We'll call it a historically informed dinosaur. I might as well be Noam Chomsky, right. But that's where we're operating. And so if you're talking about what it means to decolonize, it's like you are situating the locus of power, situating the forms of knowledge and the kinds of technologies that are assembled to produce something that might be imagined as a global intervention in the issues of health, I think you'd have to dismantle a lot that actually helps to constitute the thing that you're trying to change. Yeah? So I think what's why I kind of like Jarima Bonilla's discussion, and she's not the only one, but she's one of the more sort of clear eyed writer about this. She's Puerto Rican. 

Joseph Harris  

Could you say the name again for our listeners? 

Adia Benton

Jarimar Bonilla, okay, Puerto Rican anthropologist. Her work in Guadalupe. She also works on Puerto Rico's sovereignty movement, and she talks about unsettling rather than decolonizing, because it sort of takes away the colony as the sort of central, the sort of root of the problem. What happens if you unsettle? What if happens if you right? So in some ways it works, because then I guess you decenter the colony, decenter the relations embedded in that node. Yeah, I think she makes a very good case. Full disclosure, we were co-editors of Public Anthropologies together back in the day. But a lot of our conversations, particularly around Puerto Rico, after the earth earthquake and hurricanes, really like a lot of that. A lot of my thinking came out of conversations in those moments, particularly around how disaster response was organized for Puerto Rico, how it's operationalized and how it's happening within the context of neoliberal governance: the privatization of a lot of public goods, charter schools, private water, and all these other things that are part of the sort of aftershocks of the earthquake and of the transformation of the economic system of the island.

Joseph Harris  49:43

So I love this point, especially what you brought up in the beginning of your answer to that question: what's left in global health once we decolonize? And I think that that's something I've been grappling with. I was involved in a conversation recently leading up to a conference about decolonization and raised the issues of white supremacy and white saviorism and just how central those seem to be if we're going to really grapple with those issues. 

Adia Benton  50:20

Yeah. I just don't see how you can learn it, because there is also this affective economy as well brewing up around this, and it's been that way for two centuries, and I was just thinking, what's his name? Arjun Shanka, I think is his name. He's an anthropologist, a really junior anthropologist who just finished a book which I'm supposed to blurb, like last week, about brown saviorism and about, you know, these sort of upper caste folks in India who are all tech folks who are living in the US trying to help, but it still deals with these questions of sort of white supremacy, brahminism, caste ideologies, and what it looks like. It’s a super fascinating book, but I had to write a commentary for an article he had published in Current Anthropology, where I also said something like, what are we decolonizing here, particularly in a place like India, with its very rich dynamics within the more recent British colonial presence but then this other stuff was going on in terms of South Asia partition, so yeah. I actually wanted to say one more thing I was thinking about: the white savior industrial complex. People often cite it by Teju Cole. And I remember there was a moment when I had to write about it, and I said, I think it's really interesting that people focus on the white savior part but not the industrial complex part, which I don't think he does that much either like it's all the affective economy, the benefits derived from being in the position of savior. But also the kind of industry built up around that. So it's not enough to just have the figure and the figures’ feelings, but it’s also the sort of political economic infrastructure to kind of drive it, to scale it up and to make it profitable for some people. 

Joseph Harris  52:59

And useful to those who are receiving.

Adia Benton  53:02

There's a part in my book where I talk about the CDC Museum’s Ebola exhibit, and it's a funny stack of boxes, UNICEF USAID, a vest that says from the American people, or the safari vest with the World Health Organization. And things have come a long way, since I was in the field working for an organization. It used to be that a t-shirt used to be enough. But now you want a vest. You want a safari vest with pockets, a fleece vest, whatever it is, as part of that branding. And there's those boxes, those branded things, all the negotiation about who gets to put their sticker or magnet on whatever good that's circulating in the sort of “helped” place. And then they have something like 80 oral histories collected for this museum exhibit as well. And so I listened to a bunch of them. I have all the transcripts coded, I think all of them. And there's this really interesting exchange between two pretty senior CDC staff going into Freetown and Magazine Wharf, one of the last clusters of Ebola infection. And they're talking about their daily work, and they're kind of giggling with each other. And there's this moment where they talk about this one, I'm assuming white, but certainly American member of their staff who was had food poisoning. She smelled the area Magazine Wharf, a low-lying slum area, and she immediately starts vomiting. She pulls over and is vomiting. And they're like, it was very precarious for us because we're going around neighborhoods saying, “Do you have anyone who's vomiting with diarrhea, fever?” And we're so worried that they're gonna think she has it. And you know that everyone talks. There's so many rumors circulating around, so there's this moment where you don't want to seem like hypocrites, right? She's not in the holding center, she's not being taken away. But also they start talking about how it was that people know that these people don't belong. And so there's a moment where they say something like, “Well, you could tell people who are part of the response, and there's a pause, it’s not because they're white, it's because they're wearing T-shirts that completely mark them that way.” And I was like, what is going on? I mean, there are a lot of moments in interviews like that where they're sort of stumbling over their own whiteness or even defining themselves in relation to and opposition to whatever institutional power, and there are a few uncomfortable moments like that. Of course, there were black Americans who were doing this. There were Sierra Leonean British who were also involved in these things, people from other parts of Africa who were expats doing this work. But there was something about this sort of marking that they were conscious of, but also wanted to kind of brush away, and they wanted to be able to say that they had a certain kind of relationship recognition. But it was sort of interesting because it also revealed, to some extent, how they talk a lot about community trust, how the communities engage with them and how they have to build it. But there's also this sense that a lot of the work that they're doing sort of presumes that they don't trust those people that they're coming out to see. They don't trust them to not hide. They don't trust them to not go, “We saw that sick white lady, so we don't have to listen to you.” There’s this subtext in all of this. It's hard to think about global health and practice without also invoking or thinking about white supremacy or whiteness in general and how it shapes so many encounters. How are you going to divest or disinvest in whiteness, in white supremacy when whiteness is a credential? Yeah, I don't know.

Joseph Harris  58:35

This conversation bears so much relationship to trust, empathy. You know, in my Sociology of Health and Healthcare class this week, the students have been reading A Spirit Catches You and You Fall Down, and we're talking a lot about just how fraught the idea of compliance is and what it means to negotiate these things cross culturally. And obviously that book brings up different issues, but certainly it has everything to do with conflict and trust. But yeah, I appreciate everything that you share.

Adia Benton  59:17

I forgot about the compliance part. I think that Arthur Kleinman’s in that one, right? I'm sure you know there are a lot of critiques of that book. I know you know them, but I I thought Janelle Taylor's piece about that book is really interesting because she talks about how doctors interpret things and how it gets used. She sort of inverts it and says, “Let's talk about some of the rituals of the doctor.” But she uses the book to kind of do that as a launching off point. It's a really interesting piece. And I have actually have taught with that book and always found it really interesting to teach it among Hmong people. I actually had a Hmong student during one of those classes, but also in places that have a lot of Hmong people, maybe not in Boston, but certainly probably other places.

Joseph Harris  1:00:20

Madison where I did my PhD.

Adia Benton  1:00:22

And also Madison, St, Paul, Providence. They had the SOS people, the SOS boat people. It's a really interesting conversation to have when you actually have Hmong people in the conversation.

Joseph Harris  1:00:46

Yeah. It transforms the conversation, right? Yeah, absolutely.

Adia Benton  1:00:50

Like guess what? They're actually Hmong people here, so what do you think about that?

Joseph Harris  1:00:56

I think that that's obviously inverting that conversation which is how we get somewhere new, right? So we only have a few moments left, but let me ask you two last questions. So one is, what would you say are the most meaningful parts of the research process to you? Do you feel like there's any parts of it that don't get enough attention?

Adia Benton  1:01:24

I would say so for this book that I'm currently writing I feel like the research process has been collaborative and dialogic and built off of conversations that I have sharing very germinal, very rudimentary readings of the things that I've came across. You spoke about Kim Yi Dionne a few times. One of the first talks that I gave about Ebola was with her. And I remember distinctly there was a woman in the audience, who worked for the Ministry of Health in Liberia and said let me give you some insight into the thing you just said. And it was really funny, because the thing she said was not at all different from what we said, but she needed to say her piece. And you know, after we left, we were going to lunch, and we invited her to lunch to actually have another conversation. And so there was a Nigerian political scientist at the meal, a political scientist, an art critic who had worked in Cote d’Ivore and we just had this really fabulous conversation about, “How do you interpret the thing that happened in your city?” And we sort of came down on the side of, “Well, we're just politically different. We interpret this differently because we don't have the same sort of political views. She's like, “Those people were a bunch of ruffians who did this.” We were like, “Well, no.” We're just not in the same place on this. So, it was a conversation that informed the next thing that I wrote, and then I would go to something else, and someone would say, “Well, that's interesting. I will take what you say into account.” Or I would say I disagree with you for the following reasons. And it sort of it spins out. I have these conversations with people like the CDC Museum thing I told you about. I talked to people who donated things from their field experiences. And then I talked to the curator, and I felt bad for saying snarky things. But I felt completely justified in others. And so it continues to be a dialogue with a bunch of people who just happened to come to talks, or who happened to reach out and say that they heard something that I said, or they read something that I wrote and want to sort of talk through some things that I've talked about. So I'd say this time, the research is sort of generative and iterative, and it's like  having those conversations about those like little threads that I'm pulling on. 

Joseph Harris  1:05:01

One of the things I love most about the thoughts you shared is the way in which we come to these places of understanding, where we feel we've learned all we can, and they're solid, and then we realize we don't know, and we sort of somehow come to give way and find ourselves suddenly in this whole new place of understanding and then continue to seek to, as much you said earlier, invert our way of thinking.

Adia Benton  1:05:34

Absolutely.

Joseph Harris  1:05:38

if you could give first year PhD students doing work on global health one piece of advice, what would it be?

Adia Benton  1:05:50

Develop your workflow system.

Joseph Harris  1:05:54

[Laugher] I didn't expect to hear that. Tell me more about that.

Adia Benton  1:06:00

So I'm speaking totally from an ethnographer's perspective because I draw on so many data sources. It's not just notes, note taking. Some people are like, “Oh, you take field notes.” But I also read a lot. So actually deciding how you're going to manage all of the stuff that you read, all that stuff in classes, set up your Zotero or whatever, catalog those PDFs, make notes and make it searchable. And you know immediately when you start doing field work. Not all global health people are going to be doing field work, but I'm assuming that there's a substantial part who are, you need to come up with a system, not just the stuff you say you're going to do for the IRB or whatever, but really come up with a system that works for you, which is, you know, for Me. I think what worked for me, I'm a list maker. I'm a habitual list maker. So I had a daily list, you know, and I just, I would say, this is the stuff I did. And I would write the date on top, and then I could cross check that with any of my notes. Like, if I found out that I had notes from this, I would say, “Oh, well, I also went and had lunch at whatever place. So this is the route I must have taken, you know, something like that. So I would have this way of constantly, sort of checking, what I'm doing and how I'm doing it. So I had the notebook. I had the book that I took actual physical field notes. And I drew a lot of pictures. I now tell people take pictures of settings that you think are mundane and that you think you know because you will forget. Tag them. Geotag them and put them in, categorize them by date and place and all that stuff, so that when you get back to it, you can start to reconstruct it. Some of those pictures are going to feel completely meaningless to you, but there's some things that you should catalog because some years down the road, if you're going to have to deal with it again, it's nice to have those records. I mean, so much better! You have so many more options now, so why not use them? But definitely find a workflow so that you can just sort of fall into it when you don't have the same time to be able to come up with it.

Joseph Harris  1:08:40

Some of those pictures may be evocative down the road. And one of the other things that I love that you relate is I have so many students who come to me and they have the same feeling a lot of faculty have: that there's never enough time, and they feel overwhelmed, and there's so much. And I find that those kind of lists help remind me of all I have done and can be really valuable for the soul as well as for the mind.

Adia Benton  1:09:10

You did a lot of stuff!

Joseph Harris  1:09:16

Yeah, pat yourself on the back. Well, this has been a truly delightful conversation. I want to thank you for your time, for your insight and for your wisdom. 

Adia Benton  1:09:23

Thank you. It was great. It was a lot of fun.

Joseph Harris  1:09:32

This episode of the Global Health Politics Podcast was produced with the assistance of Bethany Hartman and Jane Pryma. Thanks for listening.