Book Review: Malaria, Poems

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Irène Mathieu
Irène Mathieu is a pediatrician and writer based in Philadelphia. She holds a BA in International Relations and was a Fulbright scholar in the Dominican Republic. She has also completed global health projects in Peru, Guatemala, and with immigrant populations in Virginia and Tennessee. Her interests include child and family health, public policy, migration/urbanization, mental health, and chronic disease prevention. Irène’s poetry, prose, and photography have been published extensively. She is author of two poetry collections, the galaxy of origins (dancing girl press, 2014) and orogeny (Trembling Pillow Press, forthcoming).

“Malaria pivots / on the silver / point of poverty” Cameron Conaway writes in his new poetry collection Malaria, Poems. Rarely do the worlds of poetry and global health collide, but Conaway’s work begs the question of why not.

Poems rich in imagery, written in a variety of forms, take place in rural developing countries and sterile OECD laboratories. Interspersed with data and quotations from diverse sources, the poems tackle cerebral malaria, stillbirths resulting from malaria in pregnancy, the problem of counterfeit drugs (“to profit with pills on people / is as natural as moon song”), and the overarching structural causes of malaria’s global persistence.

From substandard housing to prohibitively expensive bed nets – which are housed in a store that “has never sold any / because each net costs as much as two years of work” – to lack of access to appropriate health care, global inequity plays many roles in the endurance of malaria as a public health crisis. When Conaway writes “something about how violence / seals itself silently within us / and we sometimes carry on” one cannot help but think of structural violence, the term first coined by Johan Galtung in his sentinel paper “Violence, Peace, and Peace Research.” The global setting of Conaway’s poems reminds us that structural violence is usually produced and reproduced in places far from where its victims reside. Standing behind a window in a malaria vaccine laboratory he writes, “although solutions may be on the other side of the blur, I am far closer to the problems.” As (high-income country) readers, we are forced to consider how our daily choices reinforce global inequities.

Malaria remains the sixth leading cause of death in low-income countries. Although it was eradicated from the U.S. American South in 1951, malaria persists in less economically developed parts of the world despite decades of vaccine research and countless local mosquito control efforts. Towards the end of the book, Conaway asks, “Has death become an excuse / for art? […] Has death become an excuse / for business?” and finally concludes, “Death has become an excuse / for life.”

Malaria death rate per 100,000 population

 Source: Roll Back Malaria Annual Report (2013). http://www.rollbackmalaria.org/microsites/annualreport2013/

Even as he writes with empathy about the scourge responsible for millions of deaths around the world each year, Conaway indicts himself, an artist, as a voyeuristic part of the problem. We know that malaria is eradicable; it has been done before. When he invokes business, he asks us to consider who profits from health disparities. Whose livelihoods are predicated on the existence of disease? Furthermore, if all people (except those with genetic variations such as sickle cell trait) in warm climes are equally physiologically susceptible to malaria, then why does the disease disproportionately impact the poorest inhabitants of low-income nations, the children, the pregnant, and people of color? In this way, malaria is emblematic of many health disparities.

Poetry – and art in general – gets at something beyond epidemiological data. When art occupies itself with human suffering, it offers a window into the fundamental humanity that binds us all. Suddenly there are faces, and not simply graphs, in our minds. Statistics are augmented by stories. Art offers a moral checkpoint for us. When we are faced with the heartbreaking scene of a mother and her stillborn child – “At cock’s crow she presses the pink / of his unformed lips to her breast. / Soon the dead will have another / Birthday, and she will tell him stories” – we cannot help but ask ourselves if we are doing enough. Those who suffer are perhaps the most important artists we must hear; their realities should inform our work. And art can be an important vehicle for public health messages; I am reminded of Haitian musician Bélo’s song “Pap Negosye,” which promotes condom use for HIV prevention. Finally, art is well known to be a healing tool for populations dealing with significant trauma, from war refugees to those displaced by natural disasters. A public health crisis such as malaria necessitates public conversation across many sectors of society, and art is a common language that offers the possibility of such conversation.

While we dedicate ourselves to the eradication of global health disparities, we must be proactive in our avoidance of global health neo-colonialism. Towards the end of the book, Conaway inserts this quotation from John Farley in Bilharzia: A History of Imperial Tropical Medicine: “Tropical medicine from 1898 to the 1970s was fundamentally imperialistic in its basic assumptions, its methods, its goals, and its priorities.” The quote is a reminder that ignorance of political context can be just as dehumanizing as is reducing people to diagnoses and numbers. Poet and pediatrician William Carlos Williams once wrote, “It is difficult / to get the news from poems / yet men die miserably every day / for lack / of what is found there.”

The richness of this collection begs another question – perhaps the most pressing: where are the voices of those affected by what Conaway describes? Where is the poetry of African, Asian, and Latin American women, men, and children who bury their stillborn babies, their cousins, and spouses? Where are the words of the people who spend their lives caring for survivors in the aftermath of cerebral malaria? Where will their poems be published? For all of Conaway’s poetic deftness, I suspect that the people about which he writes could convey their own suffering and survival in still richer terms. For a book like Malaria, Poems is limited by its Western gaze, as Conaway acknowledges when he writes, “I am here, but I am not really here as the locals are, and as much as I try I never will be.” It’s a crucially important limitation.

For those of us who work in public health and medicine, often we develop coping mechanisms that allow us to do our work with a certain amount of emotional distance. We cannot fully take on the entirety of the suffering we face on a daily basis. But sometimes we need to be reminded – particularly when those who are affected live in countries or neighborhoods far from our own. While epidemiology helps us to quantify the “what” of a problem, art asks, existentially, “why?” Art helps us remember that “[e]ach other is ourselves.” Regardless of the empathy that might have drawn us initially to these careers, a book like Malaria, Poems can be the perfect prophylaxis for burnout and apathy – and it’s a reminder of how much potential there is in the alliance of global health and art if we include voices from all around the globe.

 

 

Note: All opinions are my own and do not necessarily reflect those of my employer.

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