By Pamela J. Downe, University of Saskatchewan
COVID-19 is sweeping headlines. Incidence rates, death counts, risk factors, and public health responses are updated with unprecedented frequency. Most anthropologists in Canada are experiencing the rapidly changing pandemic from multiple locations, including our workplaces, homes, and research communities. We are reorienting to social distancing rules, virtual interactions, and increasing anxieties. As anthropologists, we are already well aware of the complexities of COVID-19. Infectious diseases are not, nor have they ever been, purely biological phenomena (though that certainly is an important aspect to the reality of any disease). The burdens of illness and infection are carried and managed by families and communities, and those burdens are not evenly distributed. Communities rendered vulnerable by poverty, unrelenting colonialism and displacement, homelessness, incarceration, war, and political abjection will experience, and are currently experiencing the worst of COVID-19’s effects. Families that are already coping with chronic hunger, social ostracism, racism, violence and abuse, will face greater hardship as daily networks shrink, expenses increase, and economies flounder. COVID-19 is, in other words, a syndemic. In each community, the novel coronavirus interacts with other illnesses and health-related conditions to exacerbate their combined risks and effects.
Over the past 14 years, I have partnered with AIDS Saskatoon on several major projects. The people who access their services (PWAS) commonly live with addiction, Hepatitis-C (HCV), HIV, and Type-2 Diabetes. Homelessness, stigma, and food insecurity are realities that PWAS face every day. Because the majority of PWAS at AIDS Saskatoon are Indigenous, they also live with the aftermath of Canada’s residential school system and the ongoing realities of child apprehension, as well as discrimination when seeking housing-, health- and social-services. COVID-19 does not exist apart from these other conditions. The virus is ensnared by them, making their cumulative effects more deadly.
The syndemic not only affects individuals. It creates a burden of cumulative ill-health and risk that is carried by extended families. Parents, grandparents, and other caregiving kin work together to meet children’s needs. They do so while helping each other undergo methadone treatment for addiction, adhere to anti-retroviral therapies for HIV and HCV, and access ever-depleted stocks at foodbanks. The social distancing protocols called for in response to rising COVID-19 rates simply cannot be followed by those who live amidst this kind of syndemic. Collective care is the ethos of survival among AIDS Saskatoon’s PWAS. They look after each other. The calls for social distancing are therefore incomprehensible to those mired in Saskatchewan’s HIV epidemic.
It is, however, the very social networks and daily interactions on which PWAS have relied to survive that are now putting them at greater risk for COVID-19. This is a wicked problem that has no easy solution. It is a problem, though, that can be chronicled and communicated. Because of our long-standing and trusting relationships with our interlocutors, anthropologists are in a better position than most public health or emergency workers to identify how syndemics manifest themselves daily, and how individual burdens amass into community afflictions. More than that, we have a vocabulary that allows us to contribute to public discourses and debates in ways that others often cannot. We can speak and write about political pluralea, the multiple hazards that neoliberal governments have unleashed through privatization, deregulation, and an erosion of publicly funded health services. Just as our analyses of syndemics highlight the synergistic connections among health-related conditions, anthropological models of pluralea allow us to see how individual political decisions, priorities, actions and inactions are interconnected to worsen social inequities and entrench community vulnerability.
Medical anthropologists are particularly adept at outbreak ethnography. If done well – as Rob Lorway, Janice Graham, Sylvia Abonyi, Vinay Kamat, Mark Nichter, and Charles Briggs (among many others) exemplify – the syndemic dynamics and political pluralea are not secondary to epidemiological curves, flatten the curve movements, or calculations of the infection’s basic reproductive number (R0s). Outbreak ethnography inserts a community-grounded understanding of the COVID-19 entanglements and hazards into the centre of public health responses and interventions. In doing so, we contribute directly to the municipal and regional efforts to address the vulnerable gaps that are too glibly and superficially referenced in journalistic accounts. There is a place for us here. Let’s claim it.
Great article, Pam – and thank you for teaching me two new words!