Zika, tropical medicine, and infant monsters of the third world

What’s struck me most about U.S. coverage of the Zika virus are the images: black and brown children, inevitably from Brazil, with smaller-than-expected heads. Zika is thought to cause microcephaly, and although there’s still no solid proof of the link, it’s almost impossible to find a recent article about the virus that doesn’t take the connection for granted — and then adopt dehumanizing language to describe the condition.

Sunday’s New York Times featured an in-depth look at the Zika outbreak in Brazil; the accompanying video featured some of the faces of those black and brown children who are born with microcephaly, described in the video as having “abnormally small heads and often deformed brains.” Vox even created its own phrenology-like illustration, in case you’ve somehow missed the hundreds of photographs attached to your news reading.

Nearly every news story about Zika includes images of infants with the condition; perhaps most recognizable among them is Jose Wesley, the so-called bucket baby. As a term, “bucket baby” is hardly the worst I’ve read — but it does suggest disposability. When it comes to babies born with microcephaly in the tropical regions of the Americas, we’re not always placing their humanity first (as we should be). Instead of describing microcephaly as a condition with attending disabilities, the words that English language media use to describe the way infants look include “strange,” “deformed,” “terrible,” and “shrunken heads.” As literary scholar Sarah Schuetze points out, “seeing these babies is the real threat of Zika.” Forget accommodating the challenges these children will face with additional first-world resources; our first concern is being exposed to the horror of images of them.

The media coverage doesn’t say it outright (and I doubt most journalists consciously intend it) but black and brown babies, because of their race and geographic location, are being represented as infant monsters — monsters that, just like Zika itself, we profoundly fear.

And yet: We still can’t confirm whether — or to what degree — Zika causes microcephaly. Sure, Brazil’s health ministry has registered 4,783 microcephaly cases between the middle of 2015 and Jan. 30; 1,113 of those have been closely examined. As of February, 2,709 cases have already been dismissed; 404 have been confirmed as actual cases of microcephaly or similar central nervous system conditions (the remaining cases are still under investigation). Most importantly: Only 17 of those are linked to Zika. Equally surprising: Of the 76 recent miscarriages or stillbirths thought to microcephaly-related, only 15 were confirmed as such — and only five of those have been linked to Zika. It’s been found in brain tissue of a fetus diagnosed with microcephaly, but that still doesn’t prove the connection researchers want to establish.

Countries like El Salvador and Colombia, meanwhile, have not linked one case of microcephaly to Zika. (More common there is Guillain-Barré Syndrome, which is sometimes a precursor to microcephaly — but the images of people with GBS bound to wheelchairs or beds don’t animate the fear that dark-skinned babies with small heads do.) These numbers will likely rise in the coming weeks and months, and it’s also likely that researchers will soon link Zika to microcephaly (or not). In the meantime, the CDC has already issued travel warnings, one Olympian is boycotting the games (in Brazil this summer), and some presidential candidates are calling for quarantines. All while our imagination has been directed to fear a virus that, on its own, is hardly serious and rarely life-threatening.

Zika was first documented in 1947 and first appears in medical literature in 1952. Poor people, especially those without running water (who are more likely to have stagnant water that attracts the mosquitos that spread Zika), are the ones who are largely at risk. So why has it taken 68 years to capture first-world fear and imagination? Because now there’s a chance that we may also be at risk for what’s common in other parts of the world. More to the point, there’s a chance that white people in the United States may be affected. (The rest of us, and Latinos especially, are hardly the audience for the way English language media has been writing about Zika — notice the way that Puerto Rico, which is U.S. territory and has declared a Zika state of emergency, has been largely invisible in English language coverage.)

There’s precedent for this: In fact, the entire discipline known as tropical medicine was founded to protect the health of white settlers in the invented region we call the tropics. That label may have begun as the simple definition of the geographic region between the Tropic of Capricorn and the Tropic of Cancer — a gigantic area containing a vast range of climates, peoples, and cultures.  But it long ago became shorthand for an imaginary, exotic, hot region where palm trees sway and poor, dark-skinned people huddle.

Don’t just take my word for it. When Frank Snowden, a professor of history and medicine at Yale, lectures about tropical medicine, he explains the implications of the tropics within a white worldview:

One is that Africa, Asia, and Latin America had something in common. This was an artificial construction of European imagination. They were seen as reservoirs of diseases that threatened Europe; Europe was protected by the ramparts of civilization and medical science. So, tropical medicine embodied, down to a later period — certainly in this period down to the First World War — a Eurocentric worldview. It was initially not responsive to specific locations, as the tropics were artificially constructed as some single homogeneous place. The natives of the tropics were also conceptualized as somehow dangerous, harboring a vast array of lethal and highly contagious diseases.

Although Snowden is specifically referring to tropical medicine, that paragraph alone illustrates a lot of what we’ve seen when it comes to Zika. For instance, coverage of Zika in El Salvador, which has no cases of microcephaly, still features photographs from Brazil (some 4,000 miles away), which does.

Snowden is clear to distinguish the first iteration of tropical medicine, which lasted from the late 1890s up until World War I, from two later versions — but that doesn’t mean the legacies of the origins of tropical medicine have completely disappeared. As Snowden explains, the early form of the discipline was blatantly racist, and sought to defend the health of white settlers while “largely ignor[ing] the general health of indigenous societies.” He also describes the difference between horizontal and vertical approaches to public health programs: the former “dealt with living conditions across a broad spectrum of diseases,” while the latter “targeted instead single diseases, and they were designed to protect, above all, Europeans against the most menacing epidemics.”

The parallels between the early days of tropical medicine and the way Zika is currently being framed are strong. Instead of a preoccupation with a range of diseases in under-resourced regions, we’re most worried about how the epidemic might one day affect people in the U.S. (and their healthy, perfect babies). Rather than creating narratives around combating the kind of dire poverty that feeds Zika, we’re clicking on image after image of black and brown babies that are deemed inferior and worthy of being aborted. In place of acknowledging the Zika state of emergency in Puerto Rico, we pretend Zika hasn’t already entered the United States. We reserve science fiction-themed chronicles about savage climate dystopias to a flawed understanding of the region known as Latin America, while Zika is already part of real life for some human beings. We’re trapped in the fears of a first-world imagination.

Those fears will only make it more difficult to approach even obvious solutions. The images, language, and assumptions — that is, the very framing of Zika — are in dire need of interruption, especially for those of us who think about climate change. Creating an environmentally just planet is about establishing equity for those people who are already most affected by the way our world is changing. We won’t achieve that kind of equity by dehumanizing black and brown infants in a made-up nether region.