The Amazonian Tropical Bites Research Initiative, a hope for resolving zoonotic neglected tropical diseases in the One Health era.

BACKGROUND: Neglected tropical diseases (NTDs) disproportionately affect populations living in resource-limited settings. In the Amazon basin, substantial numbers of NTDs are zoonotic, transmitted by vertebrate (dogs, bats, snakes) and invertebrate species (sand flies and triatomine insects). However, no dedicated consortia exist to find commonalities in the risk factors for or mitigations against bite-associated NTDs such as rabies, snake envenoming, Chagas disease and leishmaniasis in the region. The rapid expansion of COVID-19 has further reduced resources for NTDs, exacerbated health inequality and reiterated the need to raise awareness of NTDs related to bites. METHODS: The nine countries that make up the Amazon basin have been considered (Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Peru, Surinam and Venezuela) in the formation of a new network. RESULTS: The Amazonian Tropical Bites Research Initiative (ATBRI) has been created, with the aim of creating transdisciplinary solutions to the problem of animal bites leading to disease in Amazonian communities. The ATBRI seeks to unify the currently disjointed approach to the control of bite-related neglected zoonoses across Latin America. CONCLUSIONS: The coordination of different sectors and inclusion of all stakeholders will advance this field and generate evidence for policy-making, promoting governance and linkage across a One Health arena.

Beyond the Linguistic/Medical Anthropology Divide: Retooling Anthropology to Face COVID-19.

Differing analytics and ethnographic practices impede conversations between linguistic and medical anthropologists. Here I juxtapose articles in this special issue that use diverse ethnographic sites to rethink anthropological concepts of health, disease, care, the body, language, and communication in the light of the 2020 COVID-19 pandemic. I track how anthropologists and their interlocutors envision relations between ideologies, embedded modeling (or metacommunication), and ordinary pragmatics, particularly by projecting their actual or ideal consonance versus exploring how sounds, bodies, technologies, and practices emerge from disjunctures. Comparing H1N1 in 2009 and COVID-19 prompts reflection on why anthropologists must transcend this foundational divide to tackle pandemic complexities.

Descubriendo una falla trágica en las políticas revolucionarias de salud: Desde las inequidades en salud y comunicación a la justicia comunicativa en salud / Uncovering a tragic flaw in revolutionary health policies: From health and communicative inequities to communicative justice in health

RESUMEN Este artículo analiza una contradicción enfrentada por los gobiernos de izquierda de América Latina en sus esfuerzos por transformar la salud en un derecho social fundamental. Las políticas y prácticas que confrontan las desigualdades en salud, en general, no llegan a dirigirse a las inequidades en salud y comunicación; las distribuciones jerárquicas de los derechos dan forma al conocimiento legítimo en salud. El artículo presenta un análisis etnográfico sobre la epidemia de una enfermedad misteriosa -identificada clínicamente como rabia trasmitida por murciélagos- en la selva del Delta Amacuro en Venezuela, en 2007-2008, centrado en cómo los padres y las madres que perdieron entre 1 y 3 hijos e hijas lidian con inequidades agudas en salud y comunicación en entornos clínicos, investigaciones epidemiológicas, trabajo con sanadores/as, la cobertura de las noticias, las políticas de salud y la comunicación en salud. A partir de demandas por parte de los y las residentes de la selva por una justicia comunicativa en salud, el análisis utiliza la noción de autoatención propuesta por Menéndez para explorar cómo la labor en salud y comunicación se coproduce con la labor de cuidado.

ABSTRACT This article analyzes a contradiction facing efforts by left-leaning governments in Latin America to transform health into a fundamental social right. Policies and practices that confront health inequities generally fail to address health/communicative inequities, hierarchical distributions of rights to shape what counts as legitimate knowledge of health. This ethnographic analysis focuses on an epidemic of a mysterious disease - identified clinically as bat-transmitted rabies - in the Delta Amacuro rainforest of Venezuela in 2007-2008, tracing how parents who lost 1-3 children faced acute health/communicative inequities in clinical settings, epidemiological investigations, work with healers, news coverage, health policy, and health communication. Taking as a point of departure rainforest residents' demands for communicative justice in health, the analysis draws on Menéndez's notion of autoatención in exploring how health/communicative labor is co-produced with the labor of care.

Towards Communicative Justice in Health.

This article approaches care from a different angle by looking ethnographically at how it is shaped by structural differences in the power to control the circulation of knowledge. I focus on an investigation conducted by people classified as "indigenous", of an epidemic that killed 38 children and young adults in a Venezuelan rainforest. I trace how health/communicative inequities structured clinical interactions, documents, epidemiological investigations, news stories, and dialogues with healers, thwarting the identification of the epidemic, clinically identified as rabies. Although the Bolivarian socialist government provided access to care, professionals denigrated parents' contributions to care and communication and reduced complex, unequal relations between languages to practical problems of translation. Pointing to parallels with US social movements, I suggest that responding to demands for communicative justice in health requires seeing how health inequities are entangled with health/communicative inequities. The typographical slash points to importance of challenging the subdisciplinary boundary-work that relegates their study to non-overlapping conversations in medical and linguistic anthropology.

Uncovering a tragic flaw in revolutionary health policies: From health and communicative inequities to communicative justice in health. / Descubriendo una falla trágica en las políticas revolucionarias de salud: Desde las inequidades en salud y comunicación a la justicia comunicativa en salud.

This article analyzes a contradiction facing efforts by left-leaning governments in Latin America to transform health into a fundamental social right. Policies and practices that confront health inequities generally fail to address health/communicative inequities, hierarchical distributions of rights to shape what counts as legitimate knowledge of health. This ethnographic analysis focuses on an epidemic of a mysterious disease - identified clinically as bat-transmitted rabies - in the Delta Amacuro rainforest of Venezuela in 2007-2008, tracing how parents who lost 1-3 children faced acute health/communicative inequities in clinical settings, epidemiological investigations, work with healers, news coverage, health policy, and health communication. Taking as a point of departure rainforest residents' demands for communicative justice in health, the analysis draws on Menéndez's notion of autoatención in exploring how health/communicative labor is co-produced with the labor of care.

Este artículo analiza una contradicción enfrentada por los gobiernos de izquierda de América Latina en sus esfuerzos por transformar la salud en un derecho social fundamental. Las políticas y prácticas que confrontan las desigualdades en salud, en general, no llegan a dirigirse a las inequidades en salud y comunicación; las distribuciones jerárquicas de los derechos dan forma al conocimiento legítimo en salud. El artículo presenta un análisis etnográfico sobre la epidemia de una enfermedad misteriosa -identificada clínicamente como rabia trasmitida por murciélagos- en la selva del Delta Amacuro en Venezuela, en 2007-2008, centrado en cómo los padres y las madres que perdieron entre 1 y 3 hijos e hijas lidian con inequidades agudas en salud y comunicación en entornos clínicos, investigaciones epidemiológicas, trabajo con sanadores/as, la cobertura de las noticias, las políticas de salud y la comunicación en salud. A partir de demandas por parte de los y las residentes de la selva por una justicia comunicativa en salud, el análisis utiliza la noción de autoatención propuesta por Menéndez para explorar cómo la labor en salud y comunicación se coproduce con la labor de cuidado.

Biomedicalization and the public sphere: newspaper coverage of health and medicine, 1960s-2000s.

This article examines historical trends in the reporting of health and medicine in The New York Times and Chicago Tribune from the 1960s to the 2000s. It focuses on the extent to which health reporting can be said to have become increasingly politicized, or to have shifted from treating the production of medical knowledge as something belonging to a restricted, specialized sphere, to treating it as a part of the general arena of public debate. We coded a sample of 400 stories from the two newspapers for four different Implied Audiences which health stories can address: Scientific/Professional, Patient/Consumer, Investor and Citizen/Policymaker. Stories were also coded for the origin of the story, the sources cited, the presence of controversy, and the positive or negative representation of biomedical institutions and actors. The data show that through all five decades, news reporting on health and medicine addressed readers as Citizen/Policymakers most often, though Patient/Consumer and Investor-oriented stories increased over time. Biomedical researchers eclipsed individual physicians and public health officials as sources of news, and the sources diversified to include more business sources, civil society organizations and patients and other lay people. The reporting of controversy increased, and portrayals of biomedicine shifted from lopsidedly positive to more mixed. We use these data in pinpointing how media play a constitutive role in the process of "biomedicalization," through which biomedicine has both extended its reach into and become entangled with other spheres of society and of knowledge production.

"All Cubans are doctors!" news coverage of health and bioexceptionalism in Cuba.

In a multi-country study of media coverage of health, professionals often deem reporters as only interested in selling newspapers and criticizing physicians. Since the health system and the media are controlled by the socialist state, Cuba provides an interesting test case. Health, the key symbol of the Cuban revolution, is constantly characterized as unique. In this study I asked: will health media also exhibit bioexceptionalism-will coverage differ dramatically from that in capitalist countries? I compiled all health stories published in 2002 in three national newspapers, others appearing 2003-2011, plus television and radio coverage (totaling 961). I recorded interviews during fieldwork periods in 2005, 2006, and 2008 with health and media professionals and laypersons; ethnography focused on media and health institutions and lay reception. Cuban health news stories generally project knowledge as produced in biomedical institutions, circulated by media and health professionals, and received by laypersons, a model common in capitalist countries. A second type lauds "achievements of the revolution" but similarly subordinates lay participation. Nevertheless, avid reception of biomedical knowledge leads many Cubans to describe themselves as "frustrated doctors" who know as much as their physicians. Inviting charges of self-medication, lay reception most closely embodied bioexceptionalism. Stories projecting the quality, accessibility, and humanism of Cuban medicine gained importance as the post-Soviet "Special Period" catalyzed shortages of medications and services and greater inequality; nevertheless, the frustrated citizen-consumers described by researchers do not figure in health coverage or lay reception. Media constructions of laypersons as passive recipients of professional knowledge contradict appeals for popular participation and reveal how political ideologies and health policies often fail to match the way that media coverage differentially projects contributions by professionals and laypersons.

Communicating biosecurity.

Shifting from risk-calculation orientations focusing on populations to preparedness perspectives that model uncertainty through scenario-based projections, biosecurity debates redefined notions of "health" and "security." Nevertheless, a key focus of biosecurity discussions--the domain labeled "communication"--has not been fundamentally rethought, even as it has expanded and professionalized. Bracketing preconceived ideas about the term's content, the article traces debates about biosecurity "communication" from the 1990s to the present, drawing on ethnography and textual analysis. Using a notion of biocommunicability, the cultural modeling of how discourse is produced, circulates, and is received, the article analyzes assumptions regarding subjects, subject-positions, objects, spatializing and temporalizing practices, scales, economies of affect, and regimes of ethics that are built into discourse about "communication." Ironically, the conviction that "communication" is of marginal importance as a focus of critical inquiry, seemingly shared by most medical anthropologists, enables these assumptions to fundamentally shape discussions of biosecurity and emergency management.

Confronting health disparities: Latin American social medicine in Venezuela.

OBJECTIVES: We explored the emergence and effectiveness of Venezuela's Misión Barrio Adentro, "Inside the Neighborhood Mission," a program designed to improve access to health care among underserved residents of the country, hoping to draw lessons to apply to future attempts to address acute health disparities. METHODS: We conducted our study in 3 capital-region neighborhoods, 2 small cities, and 2 rural areas, combining systematic observations with interviews of 221 residents, 41 health professionals, and 28 government officials. We surveyed 177 female and 91 male heads of household. RESULTS: Interviews suggested that Misión Barrio Adentro emerged from creative interactions between policymakers, clinicians, community workers, and residents, adopting flexible, problem-solving strategies. In addition, data indicated that egalitarian physician-patient relationships and the direct involvement of local health committees overcame distrust and generated popular support for the program. Media and opposition antagonism complicated physicians' lives and clinical practices but heightened the program's visibility. CONCLUSIONS: Top-down and bottom-up efforts are less effective than "horizontal" collaborations between professionals and residents in underserved communities. Direct, local involvement can generate creative and dynamic efforts to address acute health disparities in these areas.

Biocommunicability and the biopolitics of pandemic threats.

In this article we assess accounts of the H1N1 virus or "swine flu" to draw attention to the ways in which discourse about biosecurity and global health citizenship during times of pandemic alarms supports calls for the creation of global surveillance systems and naturalizes forms of governance. We propose a medical anthropology of epidemics to complement an engaged anthropology aimed at better and more critical forms of epidemic surveillance. A medical anthropology of epidemics provides insights into factors and actors that shape the ongoing production of knowledge about epidemics, how dominant and competing accounts circulate and interact, how different stakeholders (citizens, politicians, journalists, and policymakers) access and interpret information available from different sources-including through a variety of new digital venues-and what they do with it. These insights together provide a compelling agenda for medical anthropology and anyone working in health-related fields.

Misión Barrio Adentro: medicina social, movimientos sociales de los pobres y nuevas coaliciones en Venezuela / Mission Barrio Adentro: social medicine, social movements of the poor and new coalitions in Venezuela

En Venezuela, los gobiernos locales junto con el gobierno nacional, crearon un sistema nacional de salud paralelo, Misión Barrio Adentro (MBA), ubicando a unos 33.000 profesionales de la salud, inicialmente cubanos, en vecindarios de bajos ingresos. A través de la etnografía y entrevistas, se concluye que MBA proporcionó acceso a la atención médica y logró obtener apoyo popular a consecuencia de: movimientos sociales de los pobres; cooperación entre trabajadores comunitarios, residentes, profesionales de salud y funcionarios públicos; la integración de la atención médica con programas sociales y económicos; la ubicación de médicos como residentes en barrios pobres; interacciones positivas y equitativas médico-paciente; el papel clave de los Comités de Salud; y el impacto de la hostilidad de la prensa, un segmento grande de los médicos venezolanos y la oposición en transformar a la salud en un tema político esencial. Todo esto nos sugiere que el Estado puede confrontar las inequidades de salud cuando se unen perspectivas teóricas de la medicina social y la epidemiología crítica con los saberes populares dentro de las comunidades afectadas. Estructuras institucionales flexibles, no burocráticas y creativas aumentan la efectividad de las intervenciones...(AU)

Misión Barrio Adentro: medicina social, movimientos sociales de los pobres y nuevas coaliciones en Venezuela / Mission Barrio Adentro: social medicine, social movements of the poor and new coalitions in Venezuela

En Venezuela, los gobiernos locales junto con el gobierno nacional, crearon un sistema nacional de salud paralelo, Misión Barrio Adentro (MBA), ubicando a unos 33.000 profesionales de la salud, inicialmente cubanos, en vecindarios de bajos ingresos. A través de la etnografía y entrevistas, se concluye que MBA proporcionó acceso a la atención médica y logró obtener apoyo popular a consecuencia de: movimientos sociales de los pobres; cooperación entre trabajadores comunitarios, residentes, profesionales de salud y funcionarios públicos; la integración de la atención médica con programas sociales y económicos; la ubicación de médicos como residentes en barrios pobres; interacciones positivas y equitativas médico-paciente; el papel clave de los Comités de Salud; y el impacto de la hostilidad de la prensa, un segmento grande de los médicos venezolanos y la oposición en transformar a la salud en un tema político esencial. Todo esto nos sugiere que el Estado puede confrontar las inequidades de salud cuando se unen perspectivas teóricas de la medicina social y la epidemiología crítica con los saberes populares dentro de las comunidades afectadas. Estructuras institucionales flexibles, no burocráticas y creativas aumentan la efectividad de las intervenciones...

Why nation-states and journalists can't teach people to be healthy: power and pragmatic miscalculation in public discourses on health.

This article analyzes how Venezuelan public health officials collaborated with journalists in producing information about cholera in January-December 1991. It uses Michael Warner's (2002) observation that such public discourse involves a contradiction: it must project the image of reaching an actually existing public at the same time that it creates multiple publics as it circulates. The analysis explores the language ideologies that hide complex sets of practices, networks, and material conditions that shape how public discourses circulate. At the same time that epidemiologists targeted poor barrio residents, street vendors of food and drink, and indigenous people as being "at high risk," health education messages pictured women in well-equipped kitchens demonstrating cholera prevention measures. The gap between these ideal audiences and the discrepant publics created by their circulation limited the effectiveness of prevention efforts and created a substantial chasm between public health institutions and the publics they sought to reach.

The indians accept death as a normal, natural event: institutional authority, cultural reasoning and discourses of genocide in a Venezuelan cholera epidemic

A cholera epidemic killed some 500 people in a fluvial region in eastern Venezuela. Most of the 'victims' were classified as 'Warao', that is, members of an 'indigenous ethnic group'. In combatting the threat to the legitimacy of public health institutions posed by alarmingly high rates of mortality, officials racialised the disease: 'Warao cultural practices' were depicted as the cause of the cholera outbreak. Genocide rhetoric provided members of the affected population with a means of countering stigmatising images, regaining a sense of agency, and calling attention to the conditions in which they were living. By virtue of its monopoly over official (especially statistical) representations of the cholera outbreak, the state was largely successful in suppressing narratives that charged it with genocide. Implications of withholding access to genocide discourse in such settings are explored.(AU)