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New Technologies of Hope: Cancer, Social Inequality and Biological Citizenship in Post-Socialist Albania

Introduction

As post-socialist countries of Eastern Europe grapple to come to terms with shifting grounds of daily lives 20 years after the fall of the Iron Curtain, assessments in cancer mortality rates point at a deep divide- yet another (imaginary) Iron Curtain- between Western and Eastern Europe. While cancer death rates have been steadily decreasing in Western Europe, the countries of Eastern Europe show a high increase in mortality rates since the early 90ies.  In this article I focus on Post-Socialist Albania. A country once in the margins of the Soviet enterprise and now in the periphery of the European Union, Albania has experienced a surge in cancer rates with about 6000 new cases each year, second to cardiovascular disease as a cause of death.

If we follow Katherine Verdery (1996: 19ff), in her argument that the health care systems of the former Socialist block were the epitome of the institutional apparatus of state power, then, how may we understand what impact the withdrawal of the state in healthcare provisioning has had on maladies such as cancer? If the greatest achievement of the Socialist health system was to deliver power to the state, how has this power broken down after the fall of the system? How does the privatization of a formerly state held health care system affect the way new regimes of beings are molded? Of particular interest to me is how are social inequalities produced and articulated through terminal diseases such as cancer? Put differently, what may looking at cancer tell us about the resurging social inequalities in Eastern Europe? Furthermore, if healthcare and medical authority continues to be a central issue to post-socialist politics as an arena for conceptualizing and implementing the “new” social order as Michelle Rivkin-Fish tells us[2], what actors are involved in shaping this “new” order and what stories may be told about it by approaching it through cancer?

I will attempt to address these question through via two cases: The first case, “Mammography as the Promised Good” attempts a close reading of an event that took place in Albania’s capital Tirana during the Cancer Awareness Month in October 2011.   Besides narrating important milestones that give rise to the situation, I elaborate upon what I see forming a new style of activism around issues of health and medicine. In case two, “Standardization and Speculation in the Margins of the European Union”, I will trace the footsteps of the Albanian pharmaceutical company Pharma-Matrix as it tries to establish a market for the cancer treatment medicine Vidatox, which to date may be legally sold and purchased only in Cuba and Albania[3].

More than attempting to provide any answers, this work in progress aims at generating the vignettes of an under-researched site to date. While poverty and unequal access to healthcare have attracted the interest of Medical Anthropologists for decades, limited effort has been put to date in trying to understand how some of the fundamental questions of the discipline play out in the former Socialist block. It is not an easy task to write about issues that are unfolding right before one’s eyes and where publications on the issue at hand are scarce or non-existent. Hence, through elaborating upon these two cases, and by using the theoretical framework of biological citizenship, which I borrow from Nikolas Rose and Adriana Petryna, I hope to explore these new spaces of “public dispute”, the transformation of the citizen-consumer, as well as to understand how new technologies of hope shape this “new” citizen.

Biological Citizenship and Cancer- Some Notes on the Theoretical Framework

 In “The Politics of Life Itself” Rose argues that the language in which citizens are coming to understand and describe themselves is increasingly biological” (Rose 2005: 141). Even though citizenship almost always had a biological dimension, he argues, new kinds of biological citizens-with new subjectivities, new politics and new ethics are forming around contemporary developments in biomedicine. Even though Rose’s framework deals with so-called  “liberal democracies” and he only touches upon Eastern Europe through the work of Adriana Petryna, I’m particularly interested in exploring avenues in which these ideas about biological citizenship make their way to post-socialist countries such as Albania through “foreign intervention”: Be it through international organizations such as the IAEA (International Atomic Energy Agency) or be it through programs of standardization of healthcare programs as promoted by the European Union within its Eastern Enlargement project. Furthermore, what kinds of active biological citizens are being shaped and this to what end? Here, I’m particularly interested first, to parse out and understand visions about particular biological citizenship that are incorporated through “global experts” in such new technologies of hope.  Further, what kind of activism and what kind of biosocial communities are taken for granted? How does such a “biological citizen” that belongs to this community is supposed to look like? Third, if we stay with Rose who locates citizenship within the political history of citizenship projects that, as he argues, have taken several shifts, from the political, to the social, to the bio, how does bio- citizenship compliment, goes hand in hand with other forms of belonging in the nation-state?

Biological citizenship is all about being active in relation to one’s biomedical condition (Rose 2005: 27). Jane Comaroff has made a similar argument that resembles that of Nikolas Rose about the increasing centrality of bio-politics in our time.  In her article Beyond Bare Life: AIDS, (Bio) Politics, and the Neoliberal Order, Comaroff asks, “why has the biomedical definition of life become so central a site of contestation where other kinds of populist politics-the politics of labor movement for instance-seem to be eroding? Why is it that, in many places, access to medicine-rather than say jobs, clean air, freedom of war- has come to epitomize citizenship, equity and justice? (Comaroff 2007: 206). The argument that biological citizenship has displaced other forms of social inequalities is questionable in my opinion, but it is not something that I necessarily want to pursue within the framework of this article.

 CASE 1 – Mammography as the Promised Good

Some days short of October 30th, 2011, the end of the worldwide Breast-Cancer Awareness Month, a private oncology clinic in Tirana, Albania, aired an advertisement in a local TV station in which women were invited to join the first annual “Together Against Breast Cancer” rally and receive a free mammogram during the festivities. Several hundreds of women followed the call, overwhelming the organizing parties and coagulating into what seemed to take the shape of a fair: Women wearing pink caps, pink balloons placed all over Tirana’s most central public space, the front of the public university, and volunteers distributing flyers on breast cancer 101 and self-check ups. On a tribune, Albania’s first lady, the head of the parliament, several public health officials and the envoyee of the US-embassy—all women, are delivering their speeches on the extremely high mortality rates caused by breast cancer among Albanian women and the importance of early detection of breast cancer for survival. At one point, the peaceful enterprise that I’m watching on Web-TV turns violent. The camera slides along long lines of women, a considerable number of which has traveled from afar, waives their pink coupons in the air that are supposedly distributed to grant them free mammograms. Angry crowds have to be patrolled by police and kept in check in order for violence not to spill out.

To somebody that has spent a considerable time in Albania or to scholars acquainted with life behind the Iron Curtain in Socialist Eastern Europe, these scenes are all too familiar:  They recall the shortage economy of the Socialist period, the coupons for the rationed food such as meat, oil, chocolate or luxury goods, such as hairdryers. The long lines that we see during the breast cancer rally recall decades of long lines of people forming up in the wee hours of the morning in the hope of obtaining the promised good. If they resonate 20 years after the fall of Socialism, these pictures do so, because I believe they carry a similar message, only that the hopes and expectations about the promised good in this case may be slightly different: In the rally, women patiently waiting in long lines articulate their deeply emotional expectations that new medical technologies will help contain the disease- breast cancer that is before it’s too late or that they will deliver them from the suffering. Thus, in this case it is new technologies that are rationed and women try to access it by the use of coupons.

Albania is a Model Demonstration Site for the IAEA’s  (International Atomic Energy Agency) Program of Action for Cancer Therapy (PACT), for which it collaborates with the WHO; its national cancer control strategy, elaborated with Agency’s assistance, envisions the country’s oncology centre to soon achieve the level of “centre of competence” in radiotherapy. Albania is also implementing a project on breast cancer awareness funded by a grant allocated by the OPEC (Organization of Petroleum Exporting Countries) ExpoFund for International Development through PACT. From 2005-2009, a total of €2.5 million was spent on equipment and training for the country’s Oncology Department through the IAEA’s technical cooperation program[4].

(….)

CASE 2

“Can’t travel to Cuba? The solution is right next to Italy”- Standardization and Speculation in the Margins of the European Union

If you’d like to continue to read this paper, please drop me a line at ahoppe (at) gc.cuny.edu

[2] Rivkin-Fish 2005: 5.

[3] India may be the next country in line: http://www.thesundayindian.com/en/story/cuban-drug-for-cancer-to-enter-india/14748/

 

 

 

Welche Vergangenheit? Welche Geschichte? Ein Kommentar zu Daniel Ursprung’s “Albanien’s blockierte Aufarbeitung der Geschichte” (Neue Zuercher Zeitung vom 05/01/2011)

Endlich mal ein Artikel  in der deutschsprachigen Presse, der sich nicht auf Exotika wie Blutfehde (kanun) oder die eingeschworenen Jungfrauen fokussiert, um den post-sozialistischen albanischen Alltag zu beschreiben und analysieren. Davon gibt es leider immer noch zu Hauf. Daniel Ursprung sollte man hierzu herzlich gratulieren.

Dennoch, Ursprung’s Argument basiert auf eine sehr eingefahrene “westliche” Art und Weise, die Geschichtsverarbeitung zu konzipieren. Die geht so, um es kurz zu machen: Man stelle sich ein Papa-Freud-Psychoanalytiker- Szenario vor. Dort geht man hin, um seine Kindheit (Vergangenheit), die man lange in den hintersten Gehirnritzen sitzen lassen hat,  auszukotzen (aufzuarbeiten). Je nach Dauer und Laenge der Sitzung verspricht man sich einen kathartischen Effekt, der foerderlich fuer das gesunde Weiterleben sein soll. Was ich hier im individuellen Fall beschreibe, laesst sich auch auf kollektiver, sprich nationaler Ebene uebertragen: Oeffentliche Brechorgien (oder um es schmackhafter zu machen, Ausgrabungen??) sollen dazu dienen, die Vergangenheit zu verstehen; ein Gespuer dafuer entwickeln, warum sich Ereignisse in einer bestimmten Art und Weise entwickelt haben und nicht anders. Durch dieser Archaeologie der Ausgrabung (um einen Foucaudschen Term zu benutzen) ist zumindestens der erste Schritt getan, um die Zukunft anders (sprich: besser) zu gestalten. Im spezifisch albanischen Fall heisst dies, man verspricht sich dadurch, die langanhaltenden “Transitionsperiode” zu beschleunigen und als Nation/Staat mit der Vergangenheit abzuschliessen (“to come to terms with smth, sagt man dazu im englischsprachigen Raum). Was ich mit dieser geborgten psychoanalytischen Analogie bezwecken will,  ist dass Daniel Ursprung einen ganz bestimmten Diskurstypus praesupposiert: Einen, der oeffentlich-offiziell ausgetragen wird und einer der seiner Meinung nach Aufgabe der Eliten ist. Und hier hat er, immer der Logik seiner Argumentation folgend, zumindestens Recht: Die scheinen nicht im geringsten Fall interessiert zu sein, die Vergangenheit “aufzuarbeiten” und sich in einem Dialog zu verwickeln. Aber hier scheint die Lupe eines Historikers mal nicht gerade foerderlich, um solche Prozesse zu verstehen, denn “Aufarbeitung” kann man ganz anders auffassen.

Wenn man die elitenhafte, nationale Ebene kurz verlaesst und sich die vielfaeltigen Unternehmungen (Dialogismen) anschaut, die sich in der Kunst oder Literatur in den letzten Jahren ereignet haben, dann stellt man fest, dass dort sehr wohl, in der einen oder anderen Weise mit der “Vergangenheit” (was sie immer heissen soll) beschaeftigt ist.  Man nehme z.B. Ardian Klosi’s kuerzlich veroeffentlichte Anthologie : http://xhaxhai.wordpress.com/2010/11/12/shpresa-te-tendosura/  oder Max Gjerazi’s Erzaehlungen, um nur einige zu nennen. Diese Unternehmungen nimmt man leider nicht als “Vergangenheitsaufarbeitung” wahr, wohl weil sie nicht gerade als “Politik” gelten. Dennoch, es laesst sich nur noch abwarten, bis sie sich von den kleinen-bits-and-pieces zu einem Diskurs zusammenfuegen, der von den “Eliten” nicht mehr uebersehen werden kann.

Dann werden wir die Kotze wohl nur noch aufsammeln muessen und nicht so erstaunt tun, wenn sie uns ueberstroemt.

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