Why is it so difficult to write about such a nice book––a book that offers an elegant and important argument about industrial capitalism and growth that is devouring the world in which we live? The originality of how this story is recounted through a succession of tales that come to be imbricated into each other, skillfully looped together in the end, should ease the writing of a review. The fact that these stories coalesce in a tiny southern African country that I know well, where I did ethnographic research for my PhD, does not give me immediate access to the depth and profoundness of the connections drawn here. Botswana is where I met Julie Livingston just before starting my own work at a hospital where she was also conducting research. I had the luxury to interact with her, to get advice, and above all, to laugh together about so many tricky and funny situations we both encountered despite the harshness and suffering that surrounded the hospital. Now after several months of COVID-19, having to discuss the book feels very timely and very tricky: the pandemic has so many self-devouring growth tales to be written!
Tales from a country in the world
Let me start with a few subjective, affective comments about the book and its parable. It is a story about rain and cows, about cars and how they made Botswana the country it is now. A story about rain becoming privatized and rationalized, about cows becoming beef to be exported in neighboring countries and Europe, about trucks, cars, and roads, about sand, and water returning to water again. What transforms these everyday things, these materials and elements that make us human and social, is our voracious appetite for growth, a self-devouring growth. This one parable is made up of three, all told from a place in the world, Botswana, a country that was touted as the success story of development in Africa––Africa’s exception. In truth it is not an exception but an exemplar of “self-devouring growth” that is ravaging our collective existence on earth.
The parable starts with rain. Rainmaking was once political and social; it was the condition of living, of growing crops and herds of cows. Rain became water, which was technicized and rationalized to serve the development of the country through its diamond mining industry and the creation of beef export market. What has transformed a cow, a subject of poetry, “an object of desire,” “an object of ecstasy,” into a thing that can be mass-produced and slaughtered? Abandoning the fact that cows bring sociality, relatedness, otherness and wealth, cows became beef, a product that has helped develop Botswana’s national economy. This was possible through the rapid deployment of road networks allowing for trade, the mobilization of workers, and the rapid deployment of ambulances for public health and trauma care. But these same roads produce ravaging road accidents and pollution. Self-devouring growth is voracious, ambiguous and paradoxical––growth is imagined for the good of the country, the public health system, and the people, but it is slowly ravaging bodies, sociality, and the planet. Several times throughout the book, we are reminded that this is about us, our own responsibility or agency. Taken from the essentialness of “water, food, movement – all vital human needs. Or put in another way rain, cattle – all distribution systems that are good to think with” (10), we are reminded that this surrounds us intimately and we actively take part. This invitation to reflexivity gets very crude––it deals with our bodies, how our bodies are fed, cleaned and over cleaned, how we like to swim in pools and fly to distant places. The carnal aspects of self-devouring growth are a brilliant wire in future narratives, as a way to continue wondering about our bodies in relation to food and toxins, as well as what comes out of our human bodies and those of animals. Not only are cows as beef slaughtered (see the beautiful and destabilizing photo essay in the middle of the book) but beforehand they are fed, grow large, and fart, producing methane emissions that contribute to the heating of the atmosphere (see “the Fartopocene,” 58-59).
Devouring, suffocating and smiling
Self-devouring Growth adds to and complicates global health studies. It is a book firmly grounded in critical medical anthropology, which has for a long time dug into the political economy of health and the structural violence of capitalism in order to uncover the many nefast effects of extraction, accumulation, dispossession all over the world. Think of how the title of the 1979 study by June Nash, We Eat the Mines and the Mines Eat Us: Dependency and Exploitation in Bolivian Tin Mines, resonates with Botswana’s self-devouring growth. There is nothing actually new in the tales Livingston’s is knitting together in the book, but she presents a challenge to how we might continue to tell stories about global health. She has collected the parable through patient and beautiful encounters during years of research. In every tale, we understand the paradoxical character of SDG (Self-Devouring Growth not Sustainable Development Goals!)––a story as much about the basics of primary health care (access to water, hygiene, food security against hunger and malnutrition) as it is about epidemics of obesity, hypertension and non-communicable diseases.
After Improvising Medicine, Livingston’s beautiful ethnography of the cancer ward in Princess Marina Hospital in Gaborone, where we discover the intense suffering caused by advanced forms of cancer, I would like to ask what more can we do with the cancer metaphor, beyond the study of cancer itself? “We live in a carcinogenic world,” Julie Livingston writes. Cancer indeed condenses all the exposures to industrial capitalism. What else might the cancer metaphor open as an ethnographic or epistemological tool for studying health and other issues around the globe?
Lastly, in a time of COVID-19, can self-devouring growth studies help surpass the intensity and astonishment we are all––really all of us––observing? Here, too, we can use these methodological and conceptual tools to dismantle the voraciousness around us all. The self-devouring character of the planetary COVID-19 crisis is overwhelming. Our mode of consumption is again responsible––the destruction of ecosystems, international trade, and eating habits are at the heart of how this crisis started, as it was the case of other emerging diseases. Disaster Capitalism responds to the virus with the empire of the disposable. As in previous “crises” like Hurricane Katrina, when recovery becomes its own industry, today the automobile and aeronautic industries are the first to receive government subsidies while the need of health care workers still awaits recognition (such is the case in France). Everywhere in the world, COVID-19 responses are a mix of incredible solidarity and care which are met with schemes that are disempowering, depoliticizing, and infantilizing.
What can we expect from the new cycle of growth that is starting in front of our eyes? Read Anna Tsing (2017) and we can see whether and how it is possible to continue to live with our auto-devouring attitudes. As Divine Fuh (2020) recalls in “Smiling behind the Mask”:
Smiling and laughing had not only been deployed to survive the pandemic. In fact, after COVID-19, smiling and laughing had themselves become a resilient pandemic requiring a different kind of sanitizing, social distancing, and masking, especially given the manner in which masks made it difficult to decode and distinguish smiling, laughing, and grimacing.
This beautiful book reminds us of the possibility to laugh and smile at the edge of our own finitude, smiling at our own crazy dreams of accumulation, our desire for more and better, for speed and mobility. We can smile and laugh, as always, to convey the worst of the situation (I recall several similar moments in Improvising Medicine), to smile at our own suffering and to work at re-establishing social bonds with each other.
Fanny Chabrol is a research fellow at Institut de Recherches pour le Développement (IRD), currently attached to the Centre Population & Development (CEPED). After conducting research related to global health, HIV/AIDS, co-infections and co-morbidities (HIV, hepatitis, TB), she is currently developing research on health systems reforms (universal health coverage), renovation of health infrastructures and building of new hospitals, particularly in Niger and Mali.
Fuh, Divine. « Smiling Behind the Mask ». American Ethnological Society (blog), 27 July 2020. https://americanethnologist.org/features/pandemic-diaries/post-covid-fantasies/smiling-behind-the-mask.
Livingston, Julie. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham: Duke University Press, 2012.
Nash, June C. We Eat the Mines and the Mines Eat Us: Dependency and Exploitation in Bolivian Tin Mines. Columbia University Press, 1993.
Tsing, Anna Lowenhaupt. The Mushroom at the End of the World: On the Possibility of Life in Capitalist Ruins. Princeton: Princeton University Press, 2015.