Book reviews
Brotherton, P. Sean. 2012. Revolutionary Medicine: Health and the Body in PostSoviet Cuba. Durham and London: Duke University Press. xxvii + 256 pp. Pb.: $24.95. ISBN: 9780822352051.
P. Sean Brotherton's monograph chronicles the transformation of the Cuban medical system and succeeds in bringing forth the nuances and contradictions of contemporary (post-1991) Cuban life while focusing on the health care system. For those like me, who have lived and worked in the post-Soviet context, the book has a certain sense of familiarity about it, from the dual economy that extends into health care to the subtleties of using strategic connections and bribes in order to obtain access to medical services. Brotherton shows that revolutionary medicine is a product many years in making, touted as 'free for all' but, in the end, a great example of the Cuba's complicated reality. The book is based on more than 10 years of intermittent fieldwork and hundreds of interviews with medical professionals and patients. This wealth of ethnographic material is channeled into a fluent analysis that makes it an exceptional read.
One need not be a Cuba expert to find this ethnography of value, as it provides a rich account of a medical system undergoing a post-Soviet transition. However, it is the specifically Cuban twists that help contextualise Cuba as one of the few nations with developing world economic indicators but first world medical statistics. Cuban citizens consider medical care to be one of their fundamental human rights. The previous ease of access to medical services has prepared Cubans to be highly adept in the Westernised biomedical realm, as they are familiar with its core beliefs and jargon, which enables them to possess what the author terms 'highly medicalised' bodies. It is exactly these bodies that Brotherton is interested in, and he puts the individual into the picture through what he describes as the genealogy of individual bodily practices.
Part I of the book addresses biopolitics in the periodo especial or the special period when, in the early 1990s due to the global geopolitical changes, Cuba was forced to form new political alliances and entered a severe period of hardship that extended into the medical sphere. Brotherton argues that it is specifically the realm of health care that will bear the lasting marks of the special period, as it is upon the bodies of Cuban citizens that these marks have been imprinted deepest. Brotherton illustrates the daily experiences of Cubans during this period with a wealth of ethnographic examples and effectively paints a picture of the distorted dual economy and, more subtly, of the social and political realms.
Brotherton is particularly successful in highlighting the changes to the Family Physicians Program, the institution of family physicians that was originally established in all neighborhoods to ensure public access to medical care, but which has since been diminished to offering advice on usage of prescription drugs that patients have obtained via other channels or have been shipped off to Venezuela in exchange for oil contracts. Cubans, therefore, view family physicians more and more as superfluous, and it is understandable why there is a shift towards self-medicalisation and an increased interest in alternative (non bio-medical) healing, both Cuban (such as Creyente, a spiritual practice that has historically been practiced in Cuba as well as herb gardens that even Cuban
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physicians now sometimes cultivate in order to provide their patients with medicine) and foreign (such as acupuncture).
Part II of the monograph focuses on the social governmentality, public health and risk. It provides a historic overview of body-related public policies from 1902 until 1958, when the revolution took place. The period after the revolution is of particular interest to Brotherton, and he argues that the body was turned into a revolutionary battleground during this time by utilising a heavy artillery of ideology linking body health to the health of the revolution. Notably, Brotherton reveals how the state's actions turned into medicalised subjectivities on the individual level. The author provides a multi-faceted analysis of the above-mentioned Family Physician Program that was institutionalised in the 1980s and is widely credited with the success of the Cuban health care system, as reflected by improved health statistics in the areas of infant mortality and life expectancy, for example, despite the extremely harsh social and economic conditions of the early 1990s. Part II of the book also examines the public campaigns (preventative strategies), such as the campaign to fumigate all apartments against mosquitoes carrying dengue fever, which are still carried out in Cuba. This section also offers a glimpse into the controversial HIV education and prevention programs that have been described, alternatively, as prisons or spa vacations.
The well-known maxim We have to think like capitalists, but continue to be socialists is the title for Part III of the book, in which Brotherton poses the profound question of how many capitalist strategies can Cuba embrace while still remaining socialist. Here, Brotherton provides an account of two developments: the so-called New Health tourism in Cuba (which is consistent with the dual economy model in which those with access to convertible currency receive preferential health treatment) and the export of doctors abroad (most notably to Venezuela) in exchange for a preferential trade relationship. The author argues that the former has 'challenged the moral legitimacy of the socialist project, yet is necessary, on the ground, for the maintenance of the country's crumbling health and welfare system' (p. 165). I would argue that the latter has the same effect.
Botherton succeeds in showing that 'Cuba's health care system is an apt example through which to interrogate the broader social, political, and economic changes that characterise contemporary Cuban life' (p. 156). The monograph possesses a literary quality (i.e. it is highly descriptive and showcases wonderfully compelling stories), provides plenty of complementary visual material, and it reads well despite the theoretical depth. Overall, I would recommend Revolutionary Medicine: Health and the Body in Post-Soviet Cuba to anybody interested in the cultural aspects of the health care field and, in particular, the evolution of a health care system from one which is a state-managed to whatever would be the next stage, referred to in the book as post-Soviet in the case of Cuba. The book allows the reader a powerful glimpse into post-Soviet Cuban life through the medical lens as, after all, health care lies at the core of the human struggles.
KARINA VASILEVSKA
Riga Stradins University (Latvia)
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