Su-ming Khoo and Mayara Floss
A shadow hangs over the struggle to understand the COVID-19 pandemic’s different problems – a shadow of necropolitics that puts some people and risks in the obscure background, while others are highlighted, in the foreground. Social activists and primary care professionals are working hard to help people stay safe and providing basic necessities like food, water or soap.
Meanwhile, far-right protesters, some from the better-off classes who protest from the safety of their cars, but also daily workers, Uber drivers and street traders are out against the lockdown, in protests described as nearing a military coup. They want workers to get back to work, contrary to public health recommendations. The elites want the economy to be re-opened, so they can go back to profiting, while the precariously-employed are torn between the need to stay safe and the need to return to work in the absence of alternative means of survival.
The question of survival marks the ‘edges’ of the pandemic. ‘Edges’ or borders (Bhattarcharya 2018) are where rights and freedoms are differentiated for different groups of people. Bordering is not only about the control of migration, or about the differences between the ‘global north’ and the ‘global south’. Bordering takes place within states, within public institutions and even within the public sphere.
Brazil is rapidly becoming a front-runner in the horrible reversal of the ideal of justice playing out across the world – the last are coming first in experiencing the brunt of mass ill-being, fear, insecurity, and death. Necropolitical assumptions run through current ‘scientific’ models and conceptions of society, especially those that model society as synonymous with ‘economy’. The aggregated statistics of pandemic monitoring offer an impersonal universalizing language of a single ‘population’ or ‘economy’. Science, law and ethics are complicit when they universalize in ways that disguise troubling questions about who or what is being kept alive, while others are let die.
Quarantine and ‘lockdown’ are especially contradictory for the many who live on the ‘edges’ of rural and remote areas. These many depend on precarious and arduous transport routes to get supplies and medication, and sell the products of their labour. Bolsonaro’s necropolitics refuses to see these realities, having long ago rejected evidence-based policies for policy-based evidence. Denialism has been his government’s modus operandi, as it pushes for ‘re-opening’ the economy. A sense of uncertainty, even chaos has pervaded the country as two Health Ministers have come and gone in the space of less than a month.
The edges are not a metaphor – care and geographical gradients
On the frontline, the ‘edges’ are where workers have to deal with the realities of exposure, illness and survival. On the health services frontline, we can only describe what workers are doing as survival activism. Society cannot survive without services. Activism is required to maintain existing health services, but health personnel cannot engage in activism to preserve their health system, already under huge strain before the pandemic, without the survival of their own selves and communities. Survival requires health workers to keep challenging the government’s denialist and lockdown policies, while working extra hard. Survival activism requires daily effort to construct a micropolitics that resists and counters government narratives and policies. Survival, by definition, is the act and fact of surviving under these adverse and terrifying circumstances.
The pandemic has brought to the fore multifaceted strains of cleaning and care. Brazil’s first documented coronavirus victim was a cleaner from a favela. Her employer returned from a trip in Europe, having been quarantined for suspected infection. She neglected to inform or protect her cleaner, a 63 year old woman, who subsequently contracted COVID-19 and died. In the Brazilian North, the Mayor of Pará has exempted ‘essential’ domestic cleaners from travel restrictions. The cleaners face a contradiction. Their richer employers feel that it is essential to have cleaners (usually black women), come to clean their houses. But to travel to an employer’s house means exposure to risks of bringing the virus home, and having children in quarantine at home requires someone to be there to care for them.
The ‘edge’ that marks carelessness from care is significant in the care sector, where many COVID-19 deaths have remained uncounted because of lack of testing. It has become widely known that care settings are a hugely risky potential source of uncounted fatalities. The lack of PPE for health professionals has been denounced throughout the world, but less has been said about the protection of receptionists, cleaners, security guards and others, who are in no less need of protective equipment. Care work tends to be badly paid, precarious, and done by people who have to travel distances to reach their work. Patients are salient in everyone’s consciousness as ‘precious’, vulnerable and needing protection, but many workers caring for them are somehow at the edge, in the peripheral vision of the debates about safety.
Many people involved in caring work lack the protection that comes with being noticed, respected and not-poor. Respect, not just personal protective equipment, is in short supply. Too many workers are at the edges of the health system, being barely noticed, even when they are right there. Last week, Mayara saw a patient with flu-like symptoms, whose job is to deliver food to hospital patients. The employer only provided PPE at the beginning of May, when the pandemic was already nearing a peak. The patient was fearful, wondering whether the patients she had delivered food to while unprotected had the coronavirus.
Workers who do the jobs of feeding, touching and cleaning are very much at risk because work associated with these tasks is both necessary for survival and low-status, thus poorly paid and stigmatized. Such work is usually done by women, especially black women. Early on, epidemiologists stated that food is not a vector of the virus, but hands are and many hands were neglected in that analysis, especially those performing less visible and low status work. Making and delivering food and cleaning up before and after people eat food and cleaning people after food has been digested – all that is someone’s work, and it is work that is essential for survival. The virus reminds us that humans cannot survive alone, and cleaning matters far more than many would like to admit, from the domestic cleaners cleaning the houses of the rich to the cleaners remaining invisible in the stories of medical and nursing heroism, but who are just as essential for battling COVID-19.
Better-off metropolitan Brazilians benefit from effective physical distancing regardless of government measures and advice because privilege is social distancing, something unavailable to poorer people living in favelas and in rural and remote locations. It seems absurd to have to point out that Brazil is a very large country, but in the Northern Amazonas region, the distance between the state capital Manaus and its farthest city, São Gabriel da Cachoeira is 853km.
90% of São Gabriel da Cachoeira’s inhabitants are indigenous, representing 23 different ethnic groups and it opens onto the Yanomami Indigenous Territory, an area of about 10 million hectares sharing borders with Venezuela and Colombia. This means that the region had been receiving many immigrants before the border was closed due to COVID-19. São Gabriel da Cachoeira’s 45,000 inhabitants’ nearest ICU bed is in Manaus. Air and river passenger transport has been suspended, but this lockdown measure is pushing already remote populations deeper into dangerous, rather than safe isolation. The closure of riverine and air transport is also preventing the movement of health staff, medicines and PPE.
Very little information is getting out regarding how people are being affected and who can reach Manaus for ICU treatment and Manaus’ facility is reported to have collapsed. The state capital, São Gabriel da Cachoeira is hardly better and also facing systemic health collapse. Oxygen stocks are running low for the seven ventilators there. No field hospital has been built. The entire region has been suffering from longer-term environmental health impacts of biomass and forest burning that was going on in the Amazon long before the pandemic started. This has worsened the environmental determinants of respiratory health, making people more susceptible to contracting illness.
The deforestation and burning have not lessened just because the COVID-19 pandemic started. Deforestation is reaching higher peaks as the Environment Minister, Ricardo Salles announced that that COVID-19 pandemic offers an ideal time to slash legal protection for the rainforest and promote cattle ranching. The violently misogynistic language that Bolsonaro uses to describe the Amazon is appalling, declaring that Brazil is ‘…a virgin that every pervert wants’.
Meanwhile, reporters in Manaus have not been permitted to film public burials, but reports have been circulating that gravediggers were working without PPE while being drenched by heavy rain. In nearby Tabatinga, Milena Kokama, Director of the Kokama People’s Federation described long delays in transferring patients because there is no aerial ICU in the municipality. By May 12th were 77 registered deaths and people from 34 indigenous ethnic groups have been exposed to the coronavirus in Brazil.
Survival beyond the edges
The shortage of aerial health support units brings up the difficult and sensitive question of what to do about the ‘uncontacted’ peoples beyond the edges of the health system. For the uncontacted living beyond the edges, it is their ‘emergence’ from uncontactedness that could be the real emergency, making the present emergency one that they are unlikely to survive. FUNAI, Brazil’s indigenous affairs agency, has a longstanding policy against contact with isolated groups as a basic measure to ensure their survival.
The pandemic may be opening the way for a ‘missionary aviation’ contact plan by evangelical Christian agencies in contravention of the ‘no contact’ policy. Transmission of new diseases to isolated peoples in the remote Western Amazon risks entirely wiping them out under the guise of ‘helping’ them. Under the cover of COVID-19, the government is relaxing the no-contact restrictions while having little consideration for the consequences.
The edges of the pandemic are a complicated place where healthcare professionals, care workers, local government and communities are trying to pursue various forms of survival activism. The spaces for choices and action are tense and limited, and the immediate aim is just to keep going, as a matter of survival for individual persons and whole communities. People are faced with their own bodily limits – of getting sick, being hungry, experiencing terror and burnout. At the edges of the pandemic, in the shaded lower reaches of the care and geographical gradient, where incomes are low and vulnerability is salient, nobody is safe and there is somehow the feeling that love, important though it is, cannot save you.
Mayara Floss is a Family Medicine Resident in a Primary Health Care Unit of SUS in Brazil, she is also involved in the access and care of rural people and Planetary Health. Su-ming Khoo is a lecturer in the School of Political Science and Sociology at the National University of Ireland, Galway. Mayara and Su-ming are working together on a project on ‘survival activism’.
Image from www.geospatialworld.net