“Hygiene” is the Future: Lessons from “Post”-Cholera Haiti

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This essay is about paying respect. In 2018, after my first summer of preliminary fieldwork in the Artibonite region of Haiti, I returned disappointed and disillusioned. With the intention of studying local health related issues in the port city of Saint-Marc, the projects that were seemingly possible for me were ones I wanted to avoid. As a typical graduate student, I was searching for nuance in a world that was so oversaturated yet obscure. I mean, everyone knows about Haiti, right? It’s an underdeveloped and disaster-prone nation defined by its high mortality rate: one of the “shite-holes” of the international community. A small Island nation enmeshed in white savior narratives. Yet despite being a symbol of a backward past, “Haiti is the Future.” I heard these words from my advisor—Damien Sojoyner—who’d heard them from his mentor— Clyde Woods. For Clyde Woods to say “Haiti is the Future” was to allude to how racial capitalism has utilized the developing world as laboratories—testing grounds and models for governing disasters. Clyde Woods, who dedicated his career to studying the plantation economies of New Orleans and the larger Cancer Alley, was in tune with black residents’ vulnerability to health and “natural” disasters perpetuated by the making of capital. He believed the future of the state is decentralized and in the hands of neoliberal forces, just as it has always been in post-plantation societies: a trajectory theorized by some of the most brilliant minds of neoliberal thought as the ideal governing structure of capitalism. Since the beginning of my scholarly journey as a Caribbeanist, Clyde Woods’ words have functioned as method. In the words of Damien Sojoyner, it calls us to “follow the capital”: where money is being spent, on what, by whom, and the larger implications for governance. During this time of crisis, I am aware of the true power of Clyde Woods’ words, and in this light, I use them to read and examine not the responses to COVID-19, but instead the possible aftermath of those responses.

The international community did not need the COVID-19 outbreak to comprehend the importance of hygiene. In January 2010, following a 7.0 magnitude earthquake, Haitians were hit by a cholera epidemic that killed thousands in the Artibonite region. In response to the earthquake, the United Nations had sent international workers to assist in Haiti’s recovery, including soldiers from Nepal—where cholera is endemic. These peacekeepers, who may have disposed of their feces in the river, were allegedly the source of the epidemic in Haiti. For this generation of Haitians, cholera was a novel entity, an infectious disease that had not been seen on the Island since the 1800s. This microbial menace reemerged and produced mass panic amongst poor rural Haitians, even sparking violence against those helping to manage the outbreak, revealed during the “lynching” of about 45 spiritual healers in Southwestern and Northern provinces. By November 2013, more than 8,000 people had died from cholera in Haiti alone. For many, the cholera epidemic called into question the structural and imperial undertones that paved the way for such a disastrous outcome. The cholera outbreak exposed the biopolitical use of hygiene as a means of reifying borders. Fueled by anti-black racism and xenophobia, the Dominican Republic closed itself off to Haiti to protect its citizens from the disease. Similar undertones have developed in the wake of the coronavirus pandemic, as we have seen the U.S. close its borders, as well as a rise in hate crimes against Asian Americans. These parallels are more than striking; they are indicative of a cycle that become apparent during plagues where  social contagions and the microbial contagion becomes the same threat.

Based on my research at the University of California, Irvine, with a focus on how biomedicine and Vodou have approached hygiene post-cholera, I am unafraid to claim that hygiene is something of a universal practice that goes by many names and forms. Hygiene is also tied to cultural logics and epistemologies. The global responses to COVID-19 speak to different techniques of monitoring bodies by states around the world. But the haunting of the COVID-19 epidemic will remain, not just in the memories of the things and ones that have been lost, but also in a haunted public. Governments will be consumed by the constant effort to manage our new enemy by implementing rigid, authoritarian policies, in which hygiene predominates and the invisible world becomes a target. 

Though personal, hygiene also carries collective implications. Through hygiene, the state can assert its full power for the sake of the public. Epidemics test the sovereignty of nations as well as expose some of the contradictions in our global governance system. In 2018, the CDC reported on helping the Haitian Ministry of Health strengthen disease surveillance in post-disaster cholera sites in Haiti. In 2017, the World Bank identified about 18 countries that would need to spend $150 billion dollars a year on sanitation. A 10 year time frame has been given to fight cholera, based on the models of fighting cholera in Peru in 1990s. As COVID-19 is being understood as a crisis in sanitation, investments in hygiene practices are only a fragment of how marginal spaces have served as models for development. 

“Hygiene” is older than “culture.” By hygiene, I mean acts one must take and rules one must follow in order to prevent disease. Humans’ ability to tell the difference between what is dirty and clean has been instrumental in disease prevention. What started as an essential adaptation critical to human survival became tied to cultural and social context as society evolved. Human mastery over the sanitation crisis was critical to the making of modernity, especially in the Western world. Yet epidemiological disasters such as cholera, Ebola, and now COVID-19 illustrate that not only have humans not fully mastered hygiene, but also that our current capitalist mode of functioning might be to blame for the devastation of these diseases. But as observed in many outbreaks, a public health terminology/technology such as hygiene has powerful social implications that can and have become genocidal. Since a fundamental dimension of hygiene is the elimination of a contagion, this can easily be used to justify the elimination of a perceived human contagion. Haiti, part of what was once called the “torrid zone”, has always been entangled in a narrative of sanitization—whether it is a racial or viral threat that must be contained.

As many speculate what the outcome of the pandemic will be in places like in the Global North, I say look to the developing world, or more specifically, Haiti. Within our North American landscape, there is no telling exactly how COVID-19 will impact Americans post-disaster. Although this isn’t the first time that microbial life has brought the public to its knees, many nations have reacted differently. The Global South have developed responses to COVID-19 based on past experiences of dealing with outbreaks. From working in post-disaster spaces, I have learned that there are patterns that teach us lessons that we can employ in the future. Hygiene is the future not because of COVID-19, but because time and time again our immunity, institutions, and social bonds will be tested by pandemics, some we will see coming and others we won’t. Yet the true novelty of this virus lies in its formidable effect on impeding on fundamental parts of humanity: spending quality time and physical interacting with other people.

When cholera first hit Haiti, city residents were among the first people to be saved from its devastation, after the disease had ravaged the country. Some have compellingly argued that the U.S. death toll from COVID-19 is a quasi-racial genocide: a state sanctioned purged that makes the demand for state accountability fall on deaf ears. As Foucault himself hinted, a “plague” is the perfect time for governing apparatuses to act in exceptional ways. Although some have used this to critique the West, with good reason, we should not be naive to think that the future of sanitization won’t indeed intensify existing processes of othering. As states take steps to limit the spread of the virus, the argument has been made that some of these practices limit personal freedom. But what these hygiene crises have shown us is the very irony of freedom under neoliberal capitalism. When we call for the government’s protection against this virus, we must be willing to surrender to the rules of the state, especially for the sake of the collective.

The fear of cholera still looms during hurricane season in Haiti, especially in the southern parts of the Island. But COVID-19 is another test of Haiti’s already weak healthcare system, a bigger challenge due to the highly contagious nature of the virus, as well as the lack of centralized sanitation systems in most of Haiti’s major cities. Medical workers in Haiti’s top facilities fear that they won’t have enough equipment, such as ventilators, to handle a major COVID-19 outbreak. This, of course, led Haiti’s health institutions to plea to the U.S. for supplies they, too, are lacking. In fact, under Trump’s “Defense Production Act”, essential materials such as masks and ventilators are restricted from being shipped, leaving Caribbean nations to fend for themselves as the coronavirus begins to take hold.

So, I depart with the wisdom of Clyde Woods’ “Haiti is the Future.” It is poetic to think that worlds that were seen with no future, but ruins have lived the current reality of COVID-19 time and time again. In following the capital and working in a country still haunted by Vibrio cholerae, I have found the urgency in sanitation. If “man” wants to enjoy the current “utopias” that come with modernity, they must master, and reconsider, the old but still relevant doctrines of hygiene.

My lessons from post-cholera and what to expect after COVID-19; 

1) There will be an increase in state and sanitation infrastructure post COVID-19. Get ready for hygiene to be your life.

2) The capacity of the state will be questioned, and power will be ceded to the philanthropic and corporate entities in handling social and economic needs.

3) The political and social scapegoating will continue to occur, and the most marginalized will continue to be targeted.

4) There will be an uptick in the reliance on alternative health practices and ideas when handling crises due to an increased public distrust of the state.

5) COVID-19 will continue to haunt the public imagination. 

6) Capitalism will continue to make way for more lethal epidemics.

Guilberly Louissaint is a third year Ph.D. student in Cultural Anthropology at the University of California, Irvine. His current focus is on Biomedical and spiritual epistemologies around hygiene and health governance in Haiti. His work has appeared in The Conversation, The National Interest, and the Houston Chronicles.