Between 2007 and 2008, 32 children and six young adults were killed by rabid vampire bats in the Orinoco River delta of Venezuela. In Tell Me Why My Children Died, Charles L. Briggs and Clara Mantini-Briggs offer a gripping and harrowing account of the epidemic. The book is at once a deftly crafted “epidemiological thriller,” a tribute to indigenous health activism, and a tool for global health advocacy. The ethnographic data were collected during the panic of the outbreak and afterward, when the cause of the outbreak was initially a mystery. Local leaders’ frustration with health experts, who were unable to cure patients or provide any useful information to parents, spurred the leaders into action. They decided to form their own investigatory team of six, including Briggs and Mantini-Briggs (who is also a physician), in search of answers that medical authorities could not or would not supply.
The team undertook this ethnographic and epidemiological project to compile a report to show health officials and journalists in Caracas. And while this book offers practical recommendations for improving the experience of illness for the rural poor, it is no manual. The authors weave Warao people’s illness narratives and lamentations together with interviews with health officials and journalists, and astute excursions into semiotics and perspectivism. In addition, the book answers Warao parents’ need to communicate their tragedy to a global public. It was intolerable for them to imagine that the biological deaths of their children would also signify their social deaths.
The book is organized in two parts, the first describing participants’ perceptions of and responses to the rabies outbreak and the second drawing on an eclectic mix of social theory to explore multiple aspects of communication. The argument centers on the health iniquities that arise from poor communication between medical experts and laypeople and from the mediatization of health-related news. The book contributes a new approach to medical anthropology by bridging the perspectives of science and technology studies on the one hand and media and communication studies on the other. The authors name their object “health/communicative iniquities,” stressing that mistranslations and misunderstandings not only perpetuate health disparities but also deepen the pain and suffering of survivors, as people of Delta Amacuro can attest.
The rabies epidemic exposed a failure in healthcare delivery (vaccinations could have prevented many deaths), which hinged on communication problems at different geographical scales: in the local clinic, at the regional health center, and in nation’s capital, Caracas. The authors use the term “biomediatization” to denote the “coproduction of medical objects and subjects” through collaborations among medical professionals, journalists, laypersons, and others. Unequal relations of power rooted in ideologies of race, gender, class, and rural–urban subjectivities shape how medical professionals interact with laypeople, and how journalists report on health news. Whose medical knowledge and experience matters, whose etiologies are credible, and which stories circulate? While it is evident that the devaluation of indigenous people’s experiences and insights ramifies through medical and media networks, we also see how tenacious activism and sympathetic journalism construct a counter-narrative about indigenous caretaking practices and medical knowledge.
In Part I, we follow parents desperately carrying their sick children to various healers, clinics, and intensive care units, all to no avail. The children and young adults died excruciating deaths without ever receiving diagnoses. Local clinicians were truly stumped by the unfamiliar symptoms and the lack of patients’ response to pharmaceuticals. To compound the tragedy, however, health care experts showed little interest in talking with family members about their insights into their children’s condition. Medical authorities often seemed more interested in shielding their own reputations and that of then-president Hugo Chavez’s populist program of “health care for all” than in giving solace to family survivors. Regional and national authorities often deflected blame onto the Warao for illness-related deaths, denigrating their hygiene and reliance on local healers.
In Part II, the authors draw on linguistic and perspectival frameworks to illuminate Warao cosmologies and myriad forms of communication. Throughout the book, however, the authors are careful to avoid creating false dichotomies, such as Warao versus biomedical perspectives, or journalists versus the people. No one group has a homogeneous outlook on or reaction to what transpired. As they point out, Warao individuals did not reject biomedical treatments for their relatives; rather, they tapped into all available systems.
An intriguing thesis in the book addresses why so many bats bit humans in 2007, and why the viral load was so heavy at that time. The authors tackle this through an exploration of Warao people’s beliefs about human–nonhuman mingling, which we can take to be a form of interspecies communication. The Warao’s “Myth of Bat,” about a vampire who feeds on women’s blood at night and transforms upon death into a flock of bats, evokes a set of questions for the authors about how a changing terrain of species interactions, marked by the introduction of cats and chickens into human settlements, may have lured more bats, increasing humans’ risk of nocturnal bites over time. A multispecies perspective draws attention to how an altered “ecology of blood, flesh, and knowledge” may have triggered the outbreak (p. 195).
The team that set out to investigate why Warao children died discovered the answer early on. While they solved the etiological mystery, a demographic mystery emerged that may be linked to the altered ecology. Why did (mostly) children die, and not older adults? The authors appear to dance around this question, not skirting it and not explicitly asking it. It may not yet be answerable. They cite a rabies study carried out in Peru that suggests certain individuals may develop immunity to bat rabies over time after successive bites. Is this what happened in Delta Amacuro?
Although the thrust of the book analyzes health/communicative iniquities, the authors demonstrate how expanding the boundaries of communication to include interspecies encounters can yield important epidemiological clues. These, in turn, compel one to reinterpret local “myths” about transforming biologies.