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© Frank

interviews

We Can't Help You

by Adia Benton
April 10, 2020

This interview with Adia Benton, an associate professor of anthropology and African studies, was conducted and condensed by frank news.

Her work focuses on epidemics and government responses to them. Specifically how social inequalities that exist play out in institutional responses to health, health interventions, and humanitarian aid. 

frank | Most of your work focuses on West Africa - did you anticipate your work being this central to a conversation in the United States?

Adia Benton | Yes and no, because, even if my research is based in Sierra Leone, a lot of what I study is about how foreign governments like the U.S. and British deliver aid. I happen to know things about the national stockpile or pandemic preparedness, because I would have to also understand the U.S. policy. The U.S. policy dictates the Sierra Leonean one. All humans are actually intimately connected through these kinds of policies, but we often don't see that until we're faced with a similar crisis that these policies are supposed to address.

We function in an advisory role in poor countries, but absolutely have no capacity to handle the problem we're advising people on.

There’s this assumption this sort of horrible thing could never happen here.

Or that it's going to come from somewhere else and that we’re just going to stop an outbreak by stopping it at the border, you know? That's like the movie version. We're envisioning the movie version of our pandemic where we have a special force that can defeat the virus through sheer force and will once it has entered. 

When you talk about response, I hear it in two ways. Part of it is mechanics and logistics, and part of it is narrative – the outloud response from the government. 

Right. There's a process, or roadmap, and a practice – what we actually do. They inform each other. 

When it comes to the roadmap, one of the things I've been thinking about a lot is the war and military metaphor, which I speak out against all the time. This metaphor was particularly acute during the West African Ebola outbreak. Obama said, we're going to stop Ebola at its source: fight the virus over there to keep it from affecting us over here. His actual words and talking points to high-level officials at the time.  His proposal was to send three thousand troops to Liberia – which turned out to be a more literal use of war and military than I would've expected. Usually we phrase disease as we are fighting a war against this virus, but the mechanics of the response – diagnosis, contact tracing, hygiene, protective barriers – remain the same. But to actually send troops is another level. It's like what are we going to do? Kill the virus? 

Shoot the virus?

Viruses live in bodies. 

We are also seeing that in response to this crisis. Governor Cuomo, during a press conference, announced they were going to “kick the virus’ ass”. There was a piece in the New York Times today, where people were outraged about that Navy ship in the New York City harbor. Everyone's freaking out because there are no patients in there. Those on the other side of the debate argue that it was never intended for COVID patients, it was always intended for overflow.

That debate to me is a moot debate, because the problem starts with the military intervention itself.

The issue is that we are using military medicine and military logistics to address what's essentially a public health problem. This is partially because of the disproportionate allocation of funding to the military versus public health. It becomes the ‘natural’ solution to any logistical problem during a crisis. And when we use the military to solve certain kinds of problems, we have to accept all of the things that come with that. Which is this – if this is a war, the military objective is to keep the enemy at bay, while also protecting military assets. Military assets are not simply ships and hospital beds and weapons, but also the people who are deployed. Which in this case, means that for all of the training that military physicians might have received in areas of biohazards and infectious diseases, they cannot be sacrificed. They are never going to be seeing COVID patients, because the U.S. government is too afraid to put their assets at risk. Which says something about who they are willing to put at risk. 

[Side note: someone recently reminded me that soldiers were forced to purchase their own shields and armor for their deployments to Iraq in the early 00s, so one has to wonder about the relationship between risk and value within the military itself – even when it is strong and well-financed.]

This month was originally supposed to focus on the intersection of humanitarian aid and military. But we didn’t frame it domestically, so I hadn’t thought through the scenario you just described. 

It's sort of a funny thing, military institutions are absolutely equipped to set up infrastructure because that is how empires are built.

When I was studying the role of the national and foreign militaries during the Ebola outbreak in West Africa, I read a brilliant essay by political scientist, Laleh Khalili, who writes about infrastructure and capitalism. She shows how militaries pave the way for colonial governance and capitalist extraction. If they build roads, bring water, put up hospitals, if they make it possible for a place to be habitable by outsiders, it also becomes easier to move and circulate goods, natural resources, or whatever they're extracting, in and out. Where I work, Sierra Leone, extractive industries are a major source of the country’s revenue, so it’s interesting to think about how.

Preserving capitalism at all costs is important for the Trump administration, though this administration is not unique. He marketed himself first and foremost as a businessman, and I think that connection is really salient and important to think about. Do we want our country to be run like a business? That’s how we get derailed into a false decision about when we can “open up America for business”. What's also very fascinating about the way the military works, and particularly how it works under our current regime, since 9/11, is that we also contract a lot of our military labor out to private companies.

We're also going to see the challenge and problems of that gutting of in-house expertise, in-house capacity, to do a lot of things that would fundamentally need to be done under the circumstances. Not only in the military, but also how that impacts how our public health system functions. It is one of the reasons we cannot mobilize a massive health campaign rapidly.

When Trump stands up there during his daily press briefers and says, I have the guy from Honeywell, I have the MyPillow guy...

It's insane.

Right? He's essentially talking about outsourcing or subcontracting what could be in-house expertise and capacity. Do we really need a call center that basically handles pillow orders? Probably not.  

Back to the question of language – what language would you like to hear when we discuss public health?

I feel like the Sontag exercise where she was like, I hate when people talk about the fight against cancer or whatever.

Let’s just dispense with metaphors altogether.

The problem is that we, as humans, seem to need metaphors. That’s what George Lakoff and Mark Johnson wrote about, what, 40 years ago?

But I've been trying to think about care, because it feels the farthest from the military metaphor. I do wonder if we thought about care and safety and protection outside of war and combat, would that allow for community forms of care? Would we have had the opportunity to ramp up testing in affected communities early on, or build up sufficient solidarity around social service provisions?

I was reading this piece about the Italian physicians and they were talking about how we have been too patient centered in care, and we should think about community modes of caring. I had some problems with it because I think the issue is that the starting point was that clinical work and public health necessarily sit on opposite ends of the spectrum. That’s a privileged position. I think it's because the imagination is that public health is about populations and clinical care is always about the individual. But I liked the idea of thinking communally.

I definitely have heard about communities that set up a spreadsheet and started to note which of the  neighbors and community members were not capable of going out and getting their own stuff and people who might be struggling financially. That support system seems quite important here when the intervention is physical distancing. 

While this community thing is I think necessary and possible, we've also been privatizing our quarantines, domesticating them, as a way of making up for the shortcomings of national pandemic preparedness. We've been told, you absolutely have to stay home indefinitely because we messed up.

We can’t test you unless you meet a certain threshold, we can’t care for you unless you’re on the brink of death, we can’t support you when you can’t pay the bills as a result of this home detention.

We are learning what constitutes ‘essential work.’ And it’s often the people who are poorly compensated for their labor; it is service and caring labor. We have received some guidance from the agencies responsible for public health. But they are not always adequate. The CDC has some guidelines, and if you have the space to section off everything, great, but if you don't have that space, which is the case for many people, you're basically ensuring you will have clusters of infections that are localized to households. Someone asked me very early on what happens if someone in my house gets sick, what should I do?

Part of the issue that government leadership – particularly those who are given the task for developing a massive response to this outbreak – is understanding how people live in the day to day. This means calibrating guidelines that reflect people's lived realities and experiences, but also understanding the way that expertise gets constructed and communicated in this particular moment.

Right. And there are a lot of different realities to consider. 

I was thinking about China. One of the questions I originally asked, and this was months ago, was how would household structure shape these transmission dynamics? When they started talking about age related mortality, that kids weren’t substantially driving transmission, one of the things that troubled me was, is anyone thinking about the fact that China has a particular, and significant, childbirth policy? Is anyone talking about the fact that for a long time you could only have one kid? Let's think about what that might've looked like with respect to community transmission dynamics. Let's talk about the fact that there's migrant labor housing. There are people who live in work housing who may be sleeping with 10 bunk beds in a room, who are perhaps cleaning up for the jet-set types who were the first to get sick. 

It's about the density of social networks, and about compositions of households and how that would aid transmission.

What does your household look like? What does your work look like? Is it ‘essential’?

A lot of my friends have three or four year olds. They work, their partner works, and then they have the parents living in the house to help take care of the three year old and the baby. Those kinds of households are actually going to be the households we see all kinds of issues in. 

Americans on the whole have a lot more health problems than any of those other places. We might not smoke as much as the Italians or Chinese, but we're much more hypertensive. A lot of us have other comorbidities. Diabetes, cardiovascular disease and asthma. And these conditions vary by region, which is why we're going to see huge spikes at different times in the South and midwest. In terms of deaths we have rural populations who are actually at heightened risk because they don't have ready access to healthcare, rural hospitals have closed, local health departments have minimal resources.

A lot of people have been screaming about this for decades now with respect to community health centers, rural health centers, and their relationship to deindustrialization and depopulation. These are really old questions and they've been exacerbated by different administrations in different ways.

We can look at Reagan, but we can also look at Clinton. We can look at Obama. Trump is just another variety of bad for poor and vulnerable people, and poor and vulnerable regions. 

You wrote about sports in relation to Corona. I feel athletes occupy this god-like stature in the U.S., so, of course we test them first. Are athletes less precious commodities in other countries? What does it say about our culture?

It's interesting that you say that because I feel like for a second, people were actually quite willing to sacrifice these folks because they're young and healthy. I think we questioned their privilege when it came to being tested. 

It also depends on the sport. For example, tennis. We all know tennis is mostly people who have tons of money. Occasionally you get the person who has been able to recruit the “poor kid” who shows unusual talent at a young age. That is probably why we saw reluctance at first from tennis to shut down their major events, but then really quick, they agreed that things needed to be shut down. Nobody's going to really suffer if we shut down these tournaments for a year. I mean, except for the sponsors probably.

Even the sponsorship is like, Rolex.

Right? But then we look at places like the NFL, NBA those are different. They’re team sports; they have “ownership” – actually the NFL are the only ones who talk about ownership.

It's so weird.

Yes, it's slavery. Okay. It's like can you be a $2 million slave? Yes. I think you can.

It's a bunch of 60, 70, 80 year old white men who call themselves owners. Young guys sacrifice their bodies and their lives all the time for our entertainment. The idea is that if they're compensated well enough, it shouldn't actually matter. 

When we see the NFL taking a stand about this disease, it's because they are worried about the health of the players as the commodities in which they have invested and also about the health of their paying customers. As opposed to tennis, the NFL’s original response was, we'll just have them play, but then we'll just have everybody else watch from home. 

But here's the thing. NFL league owners couldn't meet when they were supposed to because of flight restrictions. Scouts weren't able to travel because of flight restrictions. It ultimately shaped their ability to actually staff a team, to actually fill their roster. This is how all of that trickles down. They couldn't do the business of football. They couldn't do the back end of football to give us the pleasure of entertainment. 

Then take the NBA. The players association is better at arguing for their safety. In fact, one of the things that this episode revealed was that the NBA takes health so seriously that they make all kinds of extra allowances and pull out all the stops to ensure the health of players, which is why they were able to get state tests in Oklahoma when Gobert tested positive. That set off a cascading of 58 other people being tested that day, that day. The NBA, I think, was the first league to just shut down, postpone the season.

So, yes, it reveals hero stuff, but also there's value placed on life, and particularly on young black men that wouldn't otherwise have been placed there because they are entertainers, because they are athletes, because they occupy a particular space or place, not necessarily in our eyes, but value in the eyes of people who run a very big business.

My mistake in phrasing that question was in interpreting NFL response as care for players rather than as protecting a commodity. Why the discrepancy between NFL and NBA?

Basketball teams are smaller. They tend to play longer. Most NFL players only have a few years in them.

They're more disposable.

They're absolutely disposable and interchangeable. They go through a different kind of pipeline. Even though you still kind of need to go to college for basketball to move up, there is still the avenue to be able to bypass or at least accelerate through that pipeline. Harm to the body is slightly different. I don't know if it's that they're not commodified in the same way, but that the value is rooted in different kinds of temporalities.You're investing in someone for a much longer period of time. You're investing in fewer people over time. 

As an anthropologist, what are the indicators of lasting change? Socially or politically.

This is fundamentally going to show us new things about work and care. I'm wondering the extent to which some forms of labor will be valued better and differently. Are we going to rethink child care, nursing, home health aids and all of those things – not as casualized and low paid work, but as necessary work for our society. Those would be my structural questions.

My other question would be about the extent to which we will be advocating for those things. Are we going to be more open to the political possibility of fairly compensating people, of reconfiguring debt relations? Are we going to be more grateful when we encounter people who perform this labor? I'm used to interacting with and engaging with people digitally, but I don't use that as a replacement for other forms of social engagement. I’m not sure I could get used to it in the long term.

But there are other things that we didn’t think we would accommodate but end up doing it anyway. One of the examples I use is TSA in the airport. If you watch a movie from the 90s, you'll always see some dude, usually a dude, buying a ticket and running right to meet her at the gate or to stop her plane or whatever. 

To ruin her life!

You watch it now you go, Oh my God, that could never happen or it looks strange, and you realize that you've been completely acculturated or socialized to think that it is perfectly okay to take your shoes off or put your laptop in an X Ray machine. There are all these little things that we look back on and go, huh, when did this become normal? 

I'm actually really worried that we'll be okay with more surveillance.

I was talking to a sports journalist and he asked something like, will we feel okay to even go back into a stadium and watch a game? I don't know what that looks like, but I'm thinking about the fact that the last game I went to was a White Sox game and I had to put my purse through a machine and I was like, this is what constitutes “community safety” at the ballpark. I mean, I don't think that's going to be the thing that stops something like a shooting from happening. What would that look like for a disease? 

I mean we are already acclimating by standing six feet apart in the grocery store with masks and gloves on like it’s normal.

Right, like are they going to have temperature checks at the stadium gate? I could totally see that becoming a new normal or at least something that can be reverted to. So they may not necessarily always have temperature checks, but if there's an outbreak or an epidemic or the potential for one, they may have temperature sensitive cameras that will allow them to better assess your risk to others. These are the kinds of things I worry about too, the extent to which we come to accept certain invasions, certain forms of violence, that otherwise might not have been acceptable or normal.

How do you balance public safety, community, and personal privacy?

I think that's what epidemics challenge us to do. At some point we're forced to think about the things we could do without. It's possible we may see absolute change in what it is that we do. That actually also scares me. What if we never get to go back to see the White Sox or The Bulls or Rage Against The Machine? It sounds selfish but these are things that bring so many of us pleasure. I think that was one of the points of Station Eleven, what forms of sociality, artistic production, entertainment, will become obsolete as a result of our efforts to survive an epidemic, as a result of our dying off in huge numbers?

I don't know about indicators, but I think, more broadly, it's about the things that we thought we never imagined or we thought impossible or we thought were temporary. There are a lot of things that I think we feel like we do them just as a way to deal with the problem at hand, but then we ultimately adopt them as practice. We didn't have a TSA or Homeland Security 20 years ago. 

But I also wonder if this is an opportunity to move to new ways of thinking, new ways of being in the world with each other. I want to believe that maybe a Bernie candidacy felt less threatening to a democratic base as a result of his actually saying, look, now you see what I'm talking about when I talk about Medicare for all. Now you see what I'm talking about when we talk about the militarization of everyday life.

Yeah. Now you see where the money is. 

Right. You see that it's not helping us, they're not saving us. 

I have also been thinking about how we are displacing all of this sort of heroism to the frontline responders and experts right? Like, suddenly Fauci is a saint, I mean, I've literally seen him on votives and on candles. 

Clearly it means we're starved for something because we are in a vacuum of expertise, a vacuum of good management. We are also socialized to believe that there is some magic bullet there. There's a singular solution, there's a singular hero, when in fact, we are who we are waiting for. We are the ones that have to work our way through this.

This is indeed the grand illusion of a hero or of a savior in these positions, but I think it's being revealed to be an illusion.