Becoming Gods: Medical Training in Mexican Hospitals. Vania Smith‐Oka, New Brunswick, NJ: Rutgers University Press, 2021, 228 pp.
Becoming Gods: Medical Training in Mexican Hospitals. Vania Smith-Oka, New Brunswick, NJ: Rutgers University Press, 2021, 228 pp.
University of Liverpool
The rarefied world of biomedicine is a long-standing concern for anthropology, where principles of scientific detachment, knowledge transferability, scalable interventions, binarized thinking, and privilege have been shown time and again to be context saturated phenomena, intimately bound to culture, politics, and place. This is the starting point for Smith-Oka’s ethnography, where she explicates the acquisition of a professional vision from the “lowest rung on the medical ladder”: the intern. The intern is positioned to offer a unique perspective on Mexico and the structural inequalities that pervade both health care and the medical profession. Becoming Gods: Medical Training in Mexican Hospitals is an exercise in studying up, though one charged from below. It deftly demonstrates how history, political economy, gender, class, race, and labor relations are constitutive of the medical self.
Training, the intense pursuit of becoming a physician, is Smith-Oka’s central concern. Learning how to take notes, build case histories, produce paperwork, perform lab work, think etiologically, handle bodies, mimic professional others, tinker, as well as navigate bureaucratic regimes mediate both the routine, mundane work of the trainee doctor as well as the disruptive, unusual, and unanticipated aspects of the job. These features of medical work are filtered through the tropes of “ordinary” and “extraordinary” medicine. Obstetrics, her primary focus, is an exemplar speciality where ordinary and extraordinary happenings perpetually interweave the social relations of gender, race, and class. Situated at the boundaries of life and death and steeped in Catholicism, obstetrics is infused with religious fervor. Giving birth, as one physician tells his young students, is “daily bread,” symbolic of God’s love with the doctor as divine caregiver. In obstetrics, medical self-making is, as a consequence, one of becoming Gods.
Thirty-six interns participate in Smith-Oka’s ethnography. We follow their embodied labors through two hospitals: one public, the other private, both based in Puebla, Mexico’s fourth-largest city, situated southeast of the country’s capital. The comparison between hospital regimes affords the reader insight into Mexico’s profoundly fragmented health care system. Through it, we are shown how an uneven and unequal political economy of health engenders the sacrificial labor of the medical intern. This has, over the years, politicized huge numbers of Mexican doctors to seek social justice for health inequalities, as well as redress for impoverished working conditions and limited opportunity for those working in the public health system. Such concerns are most keenly felt by women, both as patients and physicians. Everyday acts of misogyny, discrimination, and sexism intertwine with the critical consequences of femicide, gender-based violence, and the extraordinarily high rates of obstetric violence. Taken together, they reproduce the kinds of gender norms that determine how one gives birth in Mexico, as well as the kind of medicine women can and cannot practice.
Perhaps most interesting in Becoming Gods is Smith Oka’s capacity to show how doctorly behavior and practice cannot be taken for granted as a function of hierarchy and privilege. They are, instead, are highly circumscribed and modulated by politics and culture. Despite their capacities to navigate and control the interfaces between “life” and “death,” Mexican doctors are probably best seen as ambivalent actors: neither fully agents of the state, nor fully part of the public body. They embody dual identities—simultaneously culpable and vulnerable, powerful and impotent. Their ambivalent position reflects the contradictory demands placed on them by both ordinary and extraordinary events and signifies the critical importance of attending to paradox as a central element of becoming doctors. The dualities at play, as Smith Oka explains, creates friction that continues to define and give shape to the trainees’ medical selves. In the process, they learn how to balance competing narratives and forces, and in turn, acquire an expertise.
While I applaud the play of ambivalences and contradictions in Becoming Gods, I felt the use of the ordinary–extraordinary framing could have been pushed further analytically and released from its own binary rendering. Gupta (1995), for instance, in his analysis of corruption in India suggests that exceptional, extraordinary, or illicit activities, such as abuses of power, require an institutional (ordinary) ground of social hierarchy and collective expectation against which they can be interpreted. Extraordinary practices can, then, render some institutionally organized practices as ordinary, even when approached from other standpoints, they can appear as anything but. Extraordinary activities function to make ordinary activities ordinary by removing or casting extraordinary activities outside of normal routine functions.
The extraordinary and ordinary are more closely aligned than we might think precisely because the systemic and routine operations of the clinic produce opportunities for misconduct, harm, or the abuse of power (Kierans 2019). As such, some of the routine institutionalised harms that Becoming Gods attends to might, as Veena Das (2006:1) suggests, be approached as instances of “everyday violence”—the kinds of violence that enters “the recesses of the ordinary” and are, therefore, no longer remarkable. These harms no longer interrupt life but are intimately bound to it, not as exceptions but as the rule. While I would have liked to seeSmith-Oka further reflect on the dyad, her rich ethnographic descriptions offer a nuanced, well-crafted study of the intern at the intersections of political, social, and market relations. Becoming Gods is an important and critical read for medical anthropologists.
Das, V. 2006. Life and Worlds: Violence and the Descent into the Ordinary. Berkeley: University of California Press.
Gupta, A. 1995. Blurred Boundaries: The Discourse of Corruption, the Culture of Politics and the Imagined State. American Ethnologist 22: 375–402.
Kierans, C. 2019. Chronic Failures: Kidneys, Regimes of Care and the Mexican State. New Bruswick, NJ: RutgersUniversity Press.