Offline: Flies of our remorse

that of Eugene Richardson Epidemic illusions (2020) is subtitled On the coloniality of global public health. Although listed as the author of the book, he prefers to describe himself as “a single node in a vast, interconnected network of support, mentorship, tolerance, encouragement, inspiration and generosity”. It lists more than 140 “other nodes” – individuals, organizations and groups – to which it owes, with “the double objective of epistemic reconstruction and improvement of human well-being”. While not a textbook on how to decolonize medicine and global health, Richardson delivered what may be the first attempt to explore what decolonization could achieve. His criticism of the business we call public health is striking. As a group of professionals (a word that itself deserves consideration), we tacitly tolerate and continue to deal with inequalities in global health. As an academic discipline, we gladly maintain them. Coloniality is about power – who has it, how it is exercised, and for what purposes. Decolonization must consist in questioning and destabilizing these power relations, and “imagining alternatives”. A first objective of this project of unraveling the links around sanctioned truths is, he argues, to confront the privileged influence of global health data – “an ideological apparatus of protected wealth disguised as an objective investigation”. Instead, we should recognize the political nature of health and its determinants and “begin to parameterize historical and structural forces to shape people’s dispositions towards medicine and health care”. “Global social injustice is,” he writes, “roughly an epistemological injustice”. Enter scientific journals, such as The Lancet, which validate “the types of discourse that society accepts and makes work as true”. Richardson quotes Arundhati Roy: “There really is no ‘voiceless’. There are only the deliberately silenced, or preferably inaudible.

There are signs that other voices are being heard. Frantz Fanon is an example. But there are others that deserve attention, those who have proposed alternative imaginaries that would allow us to better understand health (an outcome), healthcare (a process) and global health (a field of development). ‘investigation). One writer who captured a fateful entanglement was Albert Memmi in The colonizer and the colonized (1957). Memmi was born in Tunisia in 1920 under French colonial rule. He supported Tunisian independence but, feeling increasingly marginalized, he moved to France, where he wrote extensively on the colonial experience. Memmi invites us to see the “colonial relationship” as one where the colonizer is chained to the colonized in “an implacable dependence”. He maintains that the colonizer leads a life of “humanitarian romanticism”. But the more the colonist breathes freely, “the more the colonized is suffocated”. Indeed, it is an unrecognized racism which “sums up and symbolizes the fundamental relationship which unites colonialists and colonized”. And this racism is based on continued political and economic exploitation. Over 60 years later, these addictions, along with their cruelties and abuses, still define the boundaries of global health.

The answer? New health stories, of course, like Megan Vaughan’s Healing their ills: colonial power and African disease (1991) or that of John Farley Bilharzia: A History of Imperial Tropical Medicine (1991). But these are rare examples. A broader shift in perspective is needed. Viet Thanh Nguyen writes on “the problem of representation”. The problem for the colonized is that they are rarely able to represent themselves. They must always be represented by others: the colonizers “own the means of production, and therefore the means of representation”. And “not having the means of representation is also a kind of death”. Let me conclude with Memmi who describes her experience of coming face to face with the consequences of the omnipresent “colonial drama”: the mouths were smiling, but whose eyes, almost all eyes, were teary; I worriedly searched for a non-sick gaze on which to rest mine. Tuberculosis and syphilis, and those skeletal and naked bodies which pass between the chairs of cafes like living dead, sticky like flies, the flies of our remorse ”. So what should be the main objective of decolonization? I am thinking of dismantling a new nascent empire. Not an empire ruled by one person, one government or one country. But an empire that defends a threatening idea: anti-globalization.

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