Portal de Periódicos da CAPES

Marriage of Convenience: Rockefeller International Health and Revolutionary Mexico

2009; Duke University Press; Volume: 89; Issue: 1 Linguagem: Inglês

10.1215/00182168-2008-080

1527-1900

T.F. O'Brien,

History of Medicine and Tropical Health

Anne-Emanuelle Birn’s Marriage of Convenience is the latest in a series of studies drawing on the Rockefeller Foundation’s rich archival material to analyze its Latin American reform programs, which ranged from disease control to agricultural productivity and educational reform. This work is a deeply researched examination of the evolution of modern medical care in Mexico as well as the roots of global health services in the contemporary era. Birn’s study offers insights into the goals and strategies of the foundation as well as its complex relationship with the Mexican state and public health professionals. Interactions between the foundation’s International Health Division (IHD) and its Mexican partners were shaped by two often contrasting strategies. The foundation’s professionals sought to eradicate specific contagions in campaigns that would be conducted by trained doctors, nurses, and engineers. Mexican professionals, while they did not reject a disease-oriented approach, were also concerned with the social origins of disease such as poverty and malnutrition. They were willing to employ a varied array of nonmedical professionals such as school teachers to try and disseminate the principles of public health. Ultimately the Mexican public health system reflected elements of both approaches.One of the more interesting aspects of Birn’s study is her analysis of the politics of the foundation’s public health initiatives. The foundation chose demonstration projects that would quickly impress political leaders and the public, encouraging increased expenditures of national resources in the cause of public health. The joint hookworm campaign provided a striking example of this strategy. Hookworm was by no means the most serious or widespread disease threatening the Mexican population, but it had particular appeal for the foundation, which had already enjoyed considerable success with its hookworm campaign in the American South. The disease was easy to diagnose and readily treatable with medication and preventive measures, and response to treatment was rapid and visible. The Mexican government had its own reasons for embracing the initiative. The project provided a quick and visible benefit to the public as compared with more controversial policies such as land reform and labor laws. Furthermore, the campaign’s organizers centered their initial efforts in Veracruz, a volatile area, where the hookworm initiative could win support for a still fragile revolutionary regime. Despite the convergence of interests in the hookworm campaign, points of contention repeatedly challenged the relationship between the U.S. foundation and the Mexican public health system.American doctors often took a dim view of their Mexican counterparts and Mexi-can society in general. Mexican doctors and political leaders remained suspicious of the foundation as an extension of American capitalism and U.S. power. Yet despite periodic conflicts, the relationship endured and evolved over the decades from disease-specific campaigns and training fellowships for Mexican doctors to the creation of cooperative health clinics and advanced training for medical professionals. Birn also demonstrates that while the IHD contributed to the development of the Mexican public health system, it was never a dominant influence. The Mexican state and medical professionals drew on a variety of inspirations, from European medical science to traditional healers, to create their system. Indeed the foundation’s influence was rapidly waning by the end of the 1930s and the IHD withdrew from Mexico in 1951. Yet the foundation’s strategy of focusing on disease and selecting campaigns for quick results and high visibility influenced not only Mexican public health but global health organizations, most notably the World Health Organization.As excellent as this study is, it leaves a historian asking for more. While there is passing mention of the link between the foundation’s programs and progressivism, the book would have benefited from some discussion of Americans’ self-conceived mission to transform Latin America. Not only foundation and medical professionals, but Washington policy makers, corporate executives, Protestant missionaries, and military officers envisioned themselves as reshaping Latin America into free market, individualistic societies much like their own. These reformers, like the foundation’s professionals, were certain that American technology could uplift Latin Americans without having to address the social, political, and economic causes of poverty. Placing the Mexican public health project in this larger context would have further enhanced the study’s impact. And while the book offers considerable detail about the interactions of Mexican and U.S. professionals, it would have been further enriched by some insight on the dreams, aspirations, and values that inspired doctors on both sides of the border to join in a project that relieved the medical maladies of so many. Yet these are demands on an impressive piece of scholarship that can be read profitably by scholars interested in a range of fields including the American mission in Latin America, Latin American public health, and the origins of multilateral health organizations.