Abstract

In January 1958 the Council of Ministers of the Romanian People's Republic launched a worldwide effort to showcase Romania's progress in health care. The decision reflected the Communist regime's medical Cold War diplomacy and was also a result of growing interest in what outside Eastern Europe was called “socialized medicine,” that is, a state-funded and organized health care system with equal and universal access for all citizens. Among the governments that wished to learn from Romania's experience were those of Bolivia and Argentina. Their representatives were invited to Bucharest for official visits or specialization courses. In the case of Argentina, the collaboration also stemmed from interwar encounters at international medical congresses between physicians of the two countries.This example of early exchanges between Romania and Latin American countries signals a broader research field that has recently emerged in Cold War studies: the multiple geographies of medical exchanges, mobilities, and conceptualizations in the 1945–1989 period. The volume edited by Anne-Emanuelle Birn and Raúl Necochea López is an essential addition to the growing literature about the relationship between health care, the bipolarity of the Cold War, and decolonization. Along with other pioneering studies, such as those by Marcos Cueto (Cold War, Deadly Fevers: Malaria Eradication in Mexico, 2007), Young-Sun Hong (Cold War Germany, the Third World, and the Global Humanitarian Regime, 2015), and Dora Vargha (Polio across the Iron Curtain: Hungary's Cold War with an Epidemic, 2018), the collection explores the fascinating terrain determined by the relationship between Cold War politics and rhetoric, on one hand, and notions of health, disease, and welfare, on the other.Peripheral Nerve brings two new dimensions to this scholarship. First, it offers a comprehensive panorama of Latin American cases of local, regional, and transregional alignments engineered by medical experts. It goes beyond the usual focus on U.S. interventions in and hegemony over this part of the world. The contributors convincingly emphasize the agency of Latin American actors, their ability to engage with multiple partners, and their savviness in taking advantage of the ideological competition between the two camps of the Cold War.Second, Peripheral Nerve brings a new chronological perspective for discussing health care entanglements, circulations, and partisanships: ideas, choices, and affinities during the Cold War were rooted in the interwar period. They are linked to the institutional and intellectual history of medical reforms in Latin America before 1945, to international experiences such as cooperation within the League of Nations Health Organization, or to the fascination with the Soviet Union's radical experiment in state-managed health care. Moreover, many of the contributors provide suggestive connections between pre-1989 policies and phenomena that unfolded after the end of the Cold War.The overarching theme of Peripheral Nerve is that of local agency and, consequently, of revising the history of the Cold War from its margins. Such an approach brings Latin America back into the global history of the period, a task flagged by other recent publications as well. For instance, in the introduction to the impressive volume Latin America and the Global Cold War, Thomas Field Jr., Stella Krepp, and Vanni Pettinà affirm that they compiled the book to revive “the history of what were once powerful interactions between Latin America and the rest of the Global South” (p. 2).Peripheral Nerve opens with a foreword by Gilbert Joseph, who places the volume in the general trend of “remaking . . . Latin American Cold War history” (p. ix). Three sections follow, each with its own distinct vantage point. The first deals with the interplay between leftwing internationalism and U.S. pressure on Latin America during the early Cold War. Katherine Bliss examines the biography of Lini de Vries, a former U.S. antifascist volunteer in the Spanish Civil War who sought to elude the U.S. Federal Bureau of Investigation by going into exile to Mexico in the 1940s. The Mexican government welcomed her contribution to rural health care reform, despite encountering criticism from U.S. officials. Nicole Pacino shows how the shrill anti-Communism of the 1950s in Washington led to the politicization of the Rockefeller Foundation's grants to medical schools in Bolivia, a departure from the institution's more ecumenical approach before 1945. Gabriel Soto Laveaga offers a fascinating study of how U.S. pharmaceutical companies skillfully employed Cold War rhetoric to control international prices and exert pressure on the Mexican government to open up its steroid hormone industry. If in the early 1950s a Mexico City company, Syntex Laboratories, controlled much of the world's steroid trade, by the end of the decade U.S. investors had purchased Syntex and relocated its headquarters to Palo Alto, significantly diminishing Mexico's domestic pharmaceutical capacities. In these three cases one can observe the degrees to which Latin American governments were able to maneuver in the increasingly troubled waters of U.S.-Soviet competition.The second section of the volume deals with the circulation of ideas and experts within the ideological camps of the Cold War. Each contribution underlines levels of ideological adaptation and transfer in various Latin American countries. Raúl Necochea López analyses how fertility surveys in Puerto Rico were the basis for U.S. advocacy of family planning policies throughout Latin America. He insists that this process antagonized Puerto Rican nationalists who used the Cold War to consolidate their position on the island. Gilberto Hochman and Carlos Herinque Paiva present the intellectual and ideological itinerary of parasitologist Samuel Pessoa. They link his fascination with Communist states’ health care systems (from the Soviet Union or China) and his membership in the Brazilian Communist Party to his interwar advocacy for medical, social, and economic reforms in the Brazilian countryside. The chapter provides glimpses into the multifaceted Latin American engagements with “socialized medicine.” From 1956 to 1961, Brazilian President Juscelino Kubitschek emphasized state centralization and planning of programs for the control and eradication of rural endemic diseases (p. 151). Jennifer Lambe examines the evolution of psychiatry in Cuba from the perspective of debates pitting Sigmund Freud against Nikolai Pavlov as central paradigms of the profession. She stresses the prerevolutionary roots of these discussions. She insists on the eclecticism, particularly in the 1960s, of Cuban responses to official attempts to emulate the Soviet focus on the Pavlovian tradition. She also shows how the two Soviet psychiatrists sent to Havana to advise on the revolutionary reform of the discipline had to acknowledge the diversity of local approaches (pp. 172–173).The third section is centered on the multidirectionality of Latin American medical experiences throughout the Cold War. Jadwiga Mooney focuses on two biographies—those of Salvador Allende and Benjamin Viel—when recounting Chilean attempts to create a national health service. For both men, Mooney emphasizes the pre-1945 origins of their reformist projects as well as the role of other health care models, such as the British or the Soviet, in shaping their visions of the Chilean medical system. Marco Ramos's chapter explores Argentinian psychoanalysts’ syncretic interactions and cross-fertilizations with Soviet, Western, and Third Worldist approaches in the field. These exchanges pushed some professionals to call in the 1970s for the “nationalization” of psychiatry so that it would better reflect Argentine realities. Ramos shows the shifting meaning of anti-imperialism and its embeddedness in the local context. This sometimes caused “failed encounters” (desencuentros) between strands of anticolonial medicine (p. 212). Cheasty Anderson contributes a study of Cuban medical teams’ activity in Nicaragua during the Sandinista regime. The Cuban government sought to insulate its medical workers from Nicaraguan society, beyond their medical provision tasks. Nicaraguan officials likewise safeguarded their policymaking autonomy. Anderson offers an engrossing analysis of daily contacts between Cuban personnel and the Nicaraguan population, but she does not fully explore the potential hierarchies of this interaction, particularly the Cuban superiority complex that sometimes appears between the lines of her interviewees’ accounts. Anderson could have also pursued a comparison between Cuban activities and East German doctors’ experience at the Carlos Marx hospital, created and operated by the German Democratic Republic in the 1980s. Iris Borowy has written a captivating account of this medical institution in the journal História, ciências, saúde—Manguinhos (2017). Peripheral Nerve would have benefited from a more comparative exploration connecting Latin American experiences with other instances of medical entanglement and circulation in different regions during the Cold War.Peripheral Nerve ends with a conclusion by the two editors that discusses the new vistas for research on health, medicine, and the Cold War in Latin America. The linchpin for the issues they raise is the central role played by international institutions (e.g., the World Health Organization or United Nations International Children's Emergency Fund) in global health care dynamics. These bodies offered world forums for various governments and their experts to pursue their interests, engage in dialogue, and imagine their positions in international political and medical hierarchies. Birn and López also explore the continuities across the 1989 threshold, underlining that the end of the Cold War did not bring “a wholesale rebooting of health philosophies and proposals in Latin America, instead hosting a mingling of the old and the new” (p. 272). They connect medical solidarities across the region during the post-2000 Pink Tide of elected left-leaning governments with programs first established during the Cold War. For instance, they show how the 2005 PAHO Declaration of Montevideo revived the primary health care principles of the Alma-Ata Declaration (1978), and they point out that the Cuban-Venezuelan Misión Barrio Adentro (Inside the Neighborhood) was an offspring of Havana's pre-1989 medical diplomacy. In this last case, they should have stressed the blatant manipulation of the program by Venezuelan president Nicolás Maduro to ensure his and his party's reelection, as detailed for instance in extensive reporting by Nicholas Casey in The New York Times in March 2019.The volume edited by Birn and López is a trailblazing contribution to the global history of medicine during the Cold War. It presents geographies and expertise that recapture the complex connections pursued from Latin America, which equally echoed and defied ideological divides during the second half of the 20th century. Such versatile reading of international health care politics is highly topical for the present: the COVID pandemic has reopened debates about medical diplomacy, competition among health care models, and vaccine nationalism.

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