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Department of Foreign Languages
College of Liberal Arts & Social Sciences [CLASS]
Georgia Southern University
Statesboro, GA, USA
Global Health and Politics: Julia Alvarez’ Saving the World
University of North Carolina Wilmington
Wilmington, North Carolina, USA
Abstract
Julia Alvarez’ novel Saving the World (2006) is a comment on the politics of Global Health. Alvarez reconstructs the tale of Isabel Sendales y Gomez, the lone female participant in the early 19th century’s Spanish Royal Expedition to eradicate smallpox around the world, mainly in the Spanish colonies. The historical narrative is paralleled by the tale of Alma Rodríguez, a 21st Century Dominican American author who is faced with a similar situation, aiding in an idealistic project to eradicate AIDS in the Dominican Republic. Alvarez’ work throws into sharp relief what happens when the philanthropic ideals of healing the world clashes with local politics and foreign policies. It also questions the ethical issues behind the use of third world volunteers in the testing of medicines manufactured by the first world pharmaceutical companies.
In the recent years, Dominican American author Julia Alvarez has shifted the focus of her narrative, from the Latinos of the United States, as seen in her novel How the Garcia Girls Lost Their Accents (1992), to her country of origin: The Dominican Republic. Alvarez’ use of history to deconstruct ideas of national identity and the role of women in public life are represented in her novels In the Time of the Butterflies (1995) and In the Name of Salomé (2000). Her novel Saving the World (2006) continues the motif of the two earlier novels in its use of history and multiple narrators, but also moves into a discussion crucial not only to the Dominican Republic, but also to the whole world. The novel is a comment on the politics of global health. The novel’s protagonist, Alma Rodríguez, is a Dominican American author, who finds herself unwittingly enmeshed in a conflict between the local politics of a rural Dominican village, and the exploits of a North American pharmaceutical corporation. Alma is pulled into this clash when her North American husband Richard, is captured and later killed while leading a philanthropical mission for an American NGO there. Following the shock of this brutal loss, Alma takes it upon herself to confront the problems at the root of this conflict. She uncovers hard truths about the abuses of the corporate-style globalization of the third world. Through this work of fiction Alvarez highlights the very real need to re-examine the growing apathy towards third world crisis like the AIDS epidemic and the growing capitalistic attitude towards health care.
In the novel, Alma’s tale is paralleled by the story of the historical Galician woman Isabel Sendales y Gomez, the lone female participant in the early 19th century Spanish Royal Expedition to eradicate smallpox around the world, mainly in the Spanish colonies. This expedition was headed by the doctor Francisco Xavier Balmis, an honorary member of the Spanish Royal Chambers. Isabel was the rectoress of the orphanage, Casa de expósitos in Santiago de Compostela in the northwestern Spanish province of Galicia. Orphan boys from the orphanage were to be the carriers of the smallpox vaccine. Small amounts of live smallpox virus would be introduced in the blood-stream of the boys, who would then be transported to the Spanish colonies and their blood would be used as vaccines. In the absence of refrigeration this was the only way known to the medical profession to keep the smallpox virus alive. A person with the virus develops skin lesions in a couple of weeks after the introduction of the virus in their blood-stream. It was believed that the person affected with controlled amounts of the virus would develop an immunity against the disease and be saved from an epidemic which was killing in large numbers. The boys were thus used sequentially to keep the virus alive. The risk was that the virus could also kill somebody if the carriers’ body was unable to produce an immunity. Isabel insisted on being part of this voyage to the New World to accompany and in order to take care of the orphan boys. Very little is documented about her in history books, however in this work of historical fiction, Alvarez gives Sendales y Gomez’ voice fresh life as the caretaker of this group of orphans on an arduous journey. Isabel speaks for both the orphans and of their role in the eradication of the fearful disease. The carriers were chosen based on their history of not having ever being either vaccinated or suffered from the disease. But the choice of orphans, and not any boy is clearly based on the fact that they belonged to that part of society which could be easily wooed or exploited to take on such a project. Isabel’s orphanage homed sixty two boys under the care of only two women, in an orphanage where there was room for fewer than fifty. They ate only once a day at the orphanage, but those chosen for the expedition were promised proper full meals while on the journey. The chosen boys were to become royal charges who would be fed, clothed and educated (38). Eight of the boys were only three years old. Once they reached the colonies and there blood was used to vaccinate others, they would be relieved of their duties as carriers, as they could no longer serve as carriers after having procured immunity against the disease. The boys were also promised proper care and shelter for the services rendered. But colonial politics did not make it that simple a proposition. Isabel had to fight for the rights of the children, over a number of years after the journey to obtain what had been promised by the King of Spain. In a striking parallel, Alma becomes the voice of the Dominicans who are being exploited for present-day clinical trials of HIV vaccines by North American pharmaceutical companies.
The method of using human beings as test subjects is always open to questions of human rights. Yet it is a method that at some point becomes necessary. After all, human diseases need to be treated with medicines that work on humans. History has recorded multiple instances of less-powerful humans becoming test subjects for many diseases. In the case of smallpox, the Princess of Wales was convinced of the effectiveness of inoculation by the wife of the English ambassador to Constantinople. Lady Mary Wortley Montague had her son inoculated against smallpox with success. The Princess in 1721 then ordered the inoculation of five prisoners condemned to death (Smith 10). King George I offered to grant them pardon if they survived (Bollet 82). For the Galician boys the choice was between being poor and orphaned and the lifelong title of royal charge if they survived. This fact of having little to lose has a long history of being the condemning factor of the third world nations and the people living in third world conditions.
The novel Saving the World looks at this very situation, this time involving HIV-positive people in a small village in the Dominican Republic. The people have been enticed into a possible cure by being a human test subject for a HIV/AIDS vaccine being created by a US pharmaceutical company called Swan. Like the Galician orphans, the HIV-positive Dominicans have little to lose. In the absence of cure and power to buy antiretroviral drugs they are condemned to die, and therefore they do not see the harm in being test subjects in the hope that they might be saved if the test is successful. But the harm is in this attitude. There is greater harm being done by people who are administrating the test, the pharmaceutical company which seeks the tests and the governments who approve these testing. Why does the testing not take place in the United States itself, where there are sufficient number of HIV/AIDS patients? Why does the company chose instead to go to a small nation like the Dominican Republic? Why does the non-governmental organization agree to be the go-between in the whole process? These are some questions brought to light on by this novel, with some disturbing answers.
In Alvarez’ novel, Help International, the non-governmental organization, serves as the liaison between the Dominican patients and the North American pharmaceutical company. Richard, Alma’s husband, heads this project. His NGO provides resources for development projects in nations in need. Richard is charged with his dream job, spearheading an “eco-agri-social-justice-sustainable green project” of reforestation in the central mountains of the Dominican Republic (51). He offers Alma the chance to travel with him, but she cannot, due to a pending deadline to her publisher. Richard’s NGO receives funding for the project from the pharmaceutical company called Swan. The pharmaceutical company provides the funds in return for the establishment of a clinic which will test HIV-positive Dominicans with an experimental vaccine.
In Inside Development in Latin America: A Report from the Dominican Republic, Colombia, and Brazil James Lang reports of a real-life project similar to the one mentioned in Alvarez’ novel. Lang writes about Plan Sierra, a grass-root program started in 1979 by Dominican agro-economists working with Dominican health workers, community groups and the government. Plan Sierra targeted rural populations of the Dominican Republic’s mountainous interior. As in many developing nations, development in the Dominican Republic has taken place largely in urban centers despite its being a largely agriculture-based nation. Rural families have to fend for themselves with whatever they can get. Deforestation of the mountains has been an immediate result, with trees being used for fire wood and timber. Today, Dominican forests are protected by the law and timber is imported. Plan Sierra’s grassroots project is to help farmers. It provides farmer with a credit to buy seeds, crops and other resources and also provides training and resources to create eco-friendly farming. Its personnel help with reforestation of the hills with timber, fruit and coffee plants. They also provide health education with hygiene facilities and safe water supplies. Plan Sierra also has health clinics, but that is not the focus of their project. A project evaluation done by Emily Yerkes has shown that Plan Sierra has faced funding problems. The project was initially funded by the government, but were unable to carry on and now other international organizations have to help and provide loans. NGOs are known to survive on charitable contributions. Alvarez’ novel looks at a similar fictionalized project in which the funding is provided by private corporations through NGOs like Help International. (Help International is actually a real NGO with projects in Central America and Africa.)
Health care in any nation is only as effective as its accessibility. In nations with economic inequality, poorer sectors of the population suffer more health problems because of the lack of access, and in most cases lack of economic means, to procure health care. According to Amnesty International, 25 percent of the Dominican Republic’s eight million inhabitants live below the national poverty line. There are also eighty-eight thousand officially reported cases of HIV, and ten to fifteen thousand people in need of antiretroviral treatment. The main mode of HIV transmission is heterosexual sex.
Julia Alvarez’ novel is a fictionalization of a very real issue. In his article, “We are the World,” Cullen T. Vogelson explains the reasons for North American and European pharmaceutical companies’ testing of possible cures like HIV vaccines on human test subjects in other countries, other than their own. Drug research and its introduction to the market is a long and expensive process. Within the United States, there are extremely strict regulations. One of the fastest growing practices is to conduct clinical trials in nations without such prohibitions. This is a quicker and less expensive method. Results are then turned in for approval by the US Food and Drug Administration. Research conducted in poor and developing areas like Africa, the Middle East, central and eastern Europe, and Central America are attractive because of “high patient availability, abundance of diseased populations, lax regulations and low investigation fees” (par. 5). However, clinical trials conducted on human subjects in other countries call to mind three key issues: ethics, fraud and data quality.
In the novel, Alma is unable to speak with her husband once he leaves for the Dominican Republic. Worried she decides to meet with his boss, Emerson, to learn more about the project. She soon learns of the real nature of the funding. She is unable to understand how Emerson and Richard were both convinced to take the pharmaceutical’s money to create the green center in return of human test subjects. Emerson is an idealist, but knows the reality when it comes to funding. He has accepted their organization’s strange bedfellows because he sees what can be achieved for the Dominicans: in this case a sustainable green farming system. He says,
That’s why these models are important. You have to create sustainability, not just health. These countries have to get organized. Connect to global markets with green products that can bring them top dollar. Then they’re players. They don’t have to prostitute themselves; they don’t have to be pleasure palaces for the rich of the world. (175)
In spite of Emerson’s idealistic goals to create equal global players, Alma is not sure if the Dominican test subjects will receive a fair deal once the pharmaceutical company has achieved its goal of obtaining results. She fears that the HIV-infected Dominicans will not continue to get the vaccine once it is approved, and if it were to be made available, that they would have to buy the prohibitively expensive drug. Emerson believes people like him and Alma have to safeguard the human rights of the Dominicans and guarantee a fair deal despite of the capitalist goals of companies like Swan. Alma remains skeptical. Emerson says, NGOs must keep a watchful eye, and they are responsible for educating the locals and getting their consent. There are regulations which every company has to follow. In her article “Globalizing Clinical Research,” Sonia Shah describes the case of the pharmaceutical company Pfizer, whose 1996 study of meningitis in Nigeria has been accused of violating this code by performing an unapproved risky experiment on subjects who, as a result, suffered from brain damage, paralysis and death. This cautionary tale demonstrates the dangers of overseas clinical trials. Like Alma, the locals in Dominican Republic also start to question the motives of the Green Center/Clinic, and take Richard hostage, demanding that the trials to stop. The locals mistake the clinic for a health center, and become confused and angry when they are refused treatment for regular ailments. The discovery of the center’s real motive only sparks more hostility, moving a group of local youths to take hostages at the center, including Richard.
At this point, Alma arrives in Dominican Republic with Emerson and officials from the pharmaceutical company. With the escalating situation and the military involvement, the kidnappers seek amnesty and demand political refuge in the United States. They also demand to speak with the press. Unable to wait for official negotiations between the military and the boys who have been termed as “local terrorists,” Alma takes the matters into her hands. She enters the hostage area without authorization, claiming to be a journalist named Isabel, like the Galician surrogate mother to the orphan vaccine carriers. She claims to have come to hear the kidnappers’ tell their side of the situation, and if possible, to help them. The leader of the three kidnappers says,
The first thing to tell them is that we are sick of being utilized. They come with their empty promises and build this fucking jodida clinic and bring in all the pájaros and putas so we all get sick, millones de dólares, to test their drugs and our children die because they cannot get medicina for a little fever that would cost us una fortuna to buy! (275)
The young man’s anger and skepticism about the American intentions are quite clear, but he also echoes the local community’s ignorance about AIDS. They see it as a disease of homosexuals and prostitutes, and fear they too would be infected with HIV by the presence of the disease. The project has not been able to establish the very basic and essential trust of the locals whom they wish to involve. This lack of trust arises from the NGO and the pharmaceutical’s negligence and ignorance of the local attitudes and world view. Instead of having worked through community groups to educate, the clinic is an imposition. John Kreniske, in “AIDS in the Dominican Republic: Reflections on the Social Nature of Disease,” studies the local cultures of HIV/AIDS patients in the Dominican Republic, and offers methods of intervention. Kreniske’s methods differ in one key aspect: they are based upon the principle of Global organizations like the WHO and UN, working together with central governments, local medical organizations, local leaders and community groups.
Alma realizes that the kidnappers have no real plan. While they have adopted extremist methods, at the root of everything they are only reacting to poverty, hunger, and the basic need of survival. One of the boys, in whom Alma sees the soul of a poet, says he wants to “infect” people with his questions. “The questions are simple,” he says. “Why do we go hungry? Why do our people die of curable diseases? What is it that has excluded us? What is it that has isolated us?” (278). The military takes the hostage center by surprise while everybody sleeps. They kill the kidnappers, but in the darkness of the night, Richard too is shot and dies.
In spite of having lost her husband, Alma becomes a voice of the local Dominicans who might be discarded once the clinical tests are over. It is ironic that the people who die as a result of the kidnapping are the idealistic NGO leader Richard with philanthropic ends for the Dominican people, and the youth with a soul of a poet who really believes in bringing change to his society through questioning through his writings. Both are manipulated by profiteers: Richard by the corporate world which funds the project with the condition of testing the AIDS vaccine on the Dominicans and the boy, by the local ruffian who sees kidnapping an American as a way to attract attention to himself instead of to the exploitation of the locals.
Alma returns back to the United States but promises to come back to the Dominican Republic and be part of Emerson’s project. What keeps her from joining the forces with him is her determination to turn her curiosity into reality. Her interest in the history of Isabel and the orphan vaccine carriers is no longer a dabbling in abstract history, but rather a new project to be written, in order for the world to know who Isabel was and what she did for the orphans. Alma strongly feels that it is the socially-responsible thing to do instead of focusing her energy to write a Multigenerational Latino Saga, projected to sell well in the market.
The characterization of Alma as an involved Dominican American in the affairs of the Dominican Republic is a very different approach from the one Alvarez took in her novel In the Time of the Butterflies. Ruth Behar criticizes Alvarez’ characterization of the Dominican American interviewer in her earlier novel, about the role of the Mirabal sisters in the fight against the dictator Rafael Trujillo. According to Behar, the voice of the author veiled as the inquisitive interviewer, the gringa dominicana, could have created a further complexity and nuance, had Alvarez written the text from the perspective of migrated Dominicans who are forgetting, while forgiving, the times of Trujillo (7). Saving the World’s Alma, conversely, acts as voice of the author, and is not simply a minor character. Alma as a voice of the under-represented emerges as the main character. This novel is yet another successful effort at calling the American reader’s attention to the politics and culture of the Dominican Republic. Through Alma, Alvarez brings to light the disastrous personal and political results when philanthropic ideals clash with local politics and foreign policies. It further questions the ethical issues of the involvement of third world volunteers in medical testing of first world medicines, an ongoing practice and concern of the ever growing corporate-style globalization. It is also a call to us all, to be aware of our social responsibility as global citizens in this ever-growing world of Globalization.
Bibliography
Alvarez, Julia. How the García Girls Lost Their Accents. New York: Plume, 1992.
---. In the Name of Salomé. Chapel Hill: Algonquin Books, 2000.
---. In the Time of the Butterflies. New York: Plume, 1995.
---. Saving the World. Chapel Hill: Algonquin Books, 2006.
Amnesty International. "I am Not Ashamed!": HIV/AIDS and Human Rights in the Dominican Republic and Guyana. London: Amnesty International, International Secretariat, 2006.
Behar, Ruth. “Revolutions of the Heart.” The Women’s Review of Books. 12.8 (1995): 6-7.
Bollet, Alfred Jay. Plagues and Poxes: The Impact of Human History on Epidemic Disease. NY: Demos, 2004.
De Janvry, Alain, Sadoulet Elisabeth, and Santos Blas. “Project Evaluation for Sustainable Rural Development: Plan Sierra in the Dominican Republic.” Journal of Environmental Economics and Management. 28: 2, 1995 (135-54).
Fort, Meredith, Mary Anne Mercer, and Oscar Gish, eds. Sickness and Wealth: The Corporate Assault on Global Health. Cambridge, Massachusetts: South End P., 2004.
Koop, C. Everett, Clarence E. Pearson, and M. Roy Schwarz, eds. Critical Issues in Global Health. San Francisco: Jossey-Bass, 2001.
Kreniske, John. “AIDS in the Dominican Republic: Anthropological reflections on the Social Nature of Disease.” AIDS in Africa and the Caribbean. Eds. George C. Bond, et. al. Oxford, England: Westview Press. 1997. 33-50.
Lang, James. Inside Development in Latin America: A Report from the Dominican Republic, Colombia, and Brazil. Chapel Hill, NC: University of North Carolina UP, 1988.
Shah, Sonia. “Globalizing Clinical Research.” The Nation. July 1, 2002. <http://www.thenation.com/doc/20020701/shah>
Smith, Michael. “The ‘Real Expedición Marítima de la Vacuna’ in New Spain and Guatemala.” Transactions of the American Philosophical Society. 64.1, 1974.
Yerks, Emily. “Fifteen Years On: An Assessment of the Sustainability of a Sustainable Agricultural Project in the Dominican Republic.” Diss. Ohio State U, 2004.
Vogelson, Cullen T. “We are the World.” Modern Day Drug. 4:6, 2001 (36-38, 40, 42) <http://pubs.acs.org/subscribe/journals/mdd/v04/i06/html/06vogelson.html>
Amrita Das is an Assistant Professor of Spanish at the Department of Foreign Languages and Literatures at the University of North Carolina Wilmington. She specializes in US Latino literature and culture. She focuses on writings of Latina authors of the Caribbean origin. Her other research and teaching interests are Contemporary Latin American literature.
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