Book Reviews of Books by Bentivegna and Farmer
Reviewed by Robert Lawless

The following was published in 1995 in Journal of Third World Studies 12(1):391-393.

Bentivegna, Joseph F. The Neglected and Abused: A Physician's Year in Haiti. Rocky Hill, Connecticut: Michelle Publishing Company, 1991. 176 pp. Paper $12.95.

Farmer, Paul. AIDS and Accusation: Haiti and the Geography of Blame. Berkeley: University of California Press, 1991. xiv + 338 pp.

By Robert Lawless

Both of these books were published in 1991, and both were written by physicians working in Haiti. Except for these characteristics and the fact that both authors sympathize with the plight of Haitians, the two books are of quite different types. Farmer's work is a revision of his Ph.D. dissertation and

"is an attempt to constitute an interpretive anthropology of affliction based on complementary ethnographic, historical, epidemiologic, and political-economic analyses" (p. 13).

Bentivegna's book is a personal account of the day-to-day activities of a physician practicing in Haiti.

Although Farmer's characterization of his goals may sound a bit forbidding, his book is actually highly readable. Based on the complaint that "although HIV is a very cosmopolitan microbe, AIDS discourse . . . has always been provincial" (p. 16), Farmer's book expands our minds as it informs us of the interconnections between development and disease, the past and the present, the poor and the prosperous, the humble and the haughty. Farmer concludes that AIDS in Haiti can be best understood as a pandemic of the West Atlantic System, a politicoeconomic order centered in North America (superbly described in a few paragraphs in Farmer's article in the 1988 Dialectical Anthropology titled "Blood, Sweat, and Baseballs").

The Caribbean countries most dependent on the United States are those countries with the highest incidence of AIDS.

The cliche that the book has to be read to be appreciated applies in force here. A book of such magnitude and ambition is not easily summarized. I urge everyone to read this sensitive, personal, and scholarly account of one of the most important medical and social events of our time.

Bentivegna's work, in contrast, is not at all scholarly and, in fact, repeats a number of misconceptions, such as the notion that Creole "combined African tongues with Norman French" and the denigrating comments that "one can express most of the nuances of English with it" (emphasis mine, p. 6) or that one can "learn Creole in a matter of weeks" (p. 36). The book also contains some of the overworked cliches of travelogues such as the "taxi story" about "just escaping death at the hands of the Tap-Tap drivers" (p. 36).

The book is, nevertheless, well worth the reading, if only for its sympathetic description of the diseases of the Third World. There is, for example, a fine description of tuberculosis (pp. 72-80). Bentivegna also describes malaria, typhoid, hepatitis, diarrhea in the way that only a physician intimately involved with treating these diseases can. The descriptions include technical terms but are quite vivid and can only produce empathy from even the most detached reader.

Bentivegna concludes, "I could cure tuberculosis, malaria and dysentery but I could not cure the disease of living in Haiti" (p. 4). And he recognizes, "The number of faucets in a country is a more accurate health indicator than the number of doctors. Medicine can not solve social problems" (p. 72).

In fact, it is not modern medicine that has improved the health of people in the First World significantly in the past few generations but rather improvements in hygiene. The invention of such things as screens, food processing techniques, pesticides, and flush toilets did more for health than all of medical science. In almost every case--particularly scarlet fever, tuberculosis, typhoid, measles, streptococcus, bronchitis, pneumonia, and the three most common diseases, diphtheria, tetanus, and pertussis--the mortality rates from these diseases had shown their major sharp declines well before any medical therapies or drugs came along. The mortality rate from measles, for example, declined from 13.3 per 100,000 population in 1900 to 0.3 in 1955, prior to the licensing of a measles immunization vaccine. Health is rather more a personal, sociopolitical, and ecological matter than a medical one.

Bentivegna eventually recognizes that most of the diseases he treated issued from malnutrition. Haiti clearly needs to develop the ecological and economic infrastructure so that it can concentrate on feeding its people properly.

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