Book Review: Country of poxes: three germs and the taking of territory

By guest contributor Prativa Baral

As the COVID-19 pandemic continues to unfold around us, it can be easy for some to think that this has been but our first battle with an infectious disease. Dr. Baijayanta Mukhopadhyay’s Country of Poxes corrects that illusion of separation between illness and us by demonstrating that our relationship with infectious diseases has preceded the current times many times, with our defences failing not just biologically, but socially and politically as well on the backdrop of varying power dynamics. Highlighting the trajectory of three different ailments – syphilis, smallpox and tuberculosis, Country of Poxes is a reckoning on the psyche of the lands we now call Canada, showcasing the intricate association between colonialism, land theft, and infectious diseases in the Americas – and the devastating consequences that are still felt by Indigenous communities today.   

This book is a queasy gut-twisting but necessary read, revealing the inaccuracies of mainstream assumptions: that technical medicine is absolved of politics, that our health systems were initially designed to help the sick, that the Euro-American science – foundational of modern medicine – is most advanced because of technical superiority. Country of Poxes challenges this thinking and demonstrates that modern medicine is where it is because colonialism enabled it to be so. “It is not because Euro-American medicine is effective that it is powerful – rather, the inverse is true: because it has been powerful, it is effective.”  This power was intentionally crafted, displacing communities, disrupting their livelihoods and making them dependent of settler economy, and extracting resources from their land that allowed for the accumulation and concentration of knowledge as well as the space and time to enhance scientific findings.

The book makes it clear that tropical medicine – and subsequent versions of medicine – emerged not with a healing mindset, but because those in power wanted to know how disease would impact their colonizing plans – and later, economic plans.

The book makes it clear that tropical medicine – and subsequent versions of medicine – emerged not with a healing mindset, but because those in power wanted to know how disease would impact their colonizing plans – and later, economic plans. Historically, strategies were as deliberate as using the raging infectious disease at the time for gain, victorious at all costs (e.g., smallpox blankets sent to “hostile” Indigenous communities, affected households burned and obliterated to “free” up the land and swoop in). Is it really surprising then that due to the close ties between authority and public health and medicine, certain communities – those that have lost the most, that have not been protected, and instead been intentionally harmed by said-authority – lack trust in today’s health systems? Even when healthcare was finally offered to these communities, it never was with the right intentions – using coercion and pressure, residential schools and sanitoriums, with a tunnel vision to provide care, only and only if that care would limit damage to the settler communities or to demonstrate the glories of British rule.

We often think of science as the process of uncovering truth – but this book makes it abundantly clear that science and research agendas are not just about seeking to understand processes in the name of truth, but rather to use said processes for control. The question of knowledge: who creates it, what form of knowledge is accepted (e.g., colonial documents filtering what aspired vs. the oral passing of lived experiences across generations), which “truth” do we choose to investigate, the superiority of certain types of scientific knowledge over more traditional forms of healing – all of this forces us to think about the counterfactual and the missed opportunities. What would have happened to medicine and health outcomes if traditional forms of knowledge systems had not been decimated and dismissed by imperialism? What would we have learned about healing, what connections between health and our environment would we have seen, how would our approach and understanding of medicine been different? In the absence of this counterfactual, we see the consequences of the deliberate choice of forsaking non-European knowledge in how medicine is practiced today and the vast health inequities in health outcomes among immigrant and Indigenous communities.

Country of Poxes also illustrates that a disease is more than just a physical ailment – throughout history, it has been used as a convenient way to distract and blame communities from the forced transformations brought in by imperial economies and thinking. Dr. Baijayanta shows us that “othering” on the basis of race, class, “morals”, and eugenics was rampant, with these three diseases used as scapegoats. It was easy – and politically useful – to associate any forms of disease as a flaw, and to “other” communities on the basis of this so-called flaw. Politically useful because racial hybridity was seen as a threat to the settlement projects and so-called imperial prestige. As such, infectious diseases were used as tools to repeatedly spread moral arguments of individual failings of Indigenous communities as being sinful, uneducated, dirty, sexual, weak and on the flip side, to bolster the image of colonies as being more civilized, with the power to mold “model” citizens. By blaming Indigenous communities for their choices and lifestyle, saviourism could swoop in and commit crime on Indigenous bodies – sterilizing Indigenous women to “weed out feeble-mindedness”, separating families using residential “schools” on the backdrop of tuberculosis, forced quarantine, using prisoners to test smallpox vaccines, conducting rapid deathbed baptism, citing divine providence for the loss.

As a healthcare worker and a Bengali settler, Dr. Mukhopadhyay’s personal anecdotes peppered throughout the book add an additional global layer to our understanding and patterns of migration. And perhaps because of this –  the loss of his great grandfather to smallpox against the backdrop of British-controlled India, self-reflections on his personal trajectory of practicing medicine in northern communities, his sensitivities associated with the othering of “outsiders” as bearing disease – he is brutally honest about the medical and public health institutions needing a reckoning. And with good reason –  after all, these institutions were a coercive extension of the expanding state, using medical interventions to exploit and police poorer bodies, and public health authority to institutionalize racial segregation. Together, missionaries and militaries pushed for the colonialism of healthcare, dangling medical resources as a “benevolent” gesture in exchange for compliance or strategic interest, and destroying communities by forcibly removing the sick or institutionalizing children in residential “schools” (which incidentally became superspreaders for tuberculosis, in addition to causing irreparable damage with its eugenic aims). The book makes it clear that the historical attributes of these institutions have ensured that diseases will never be just a physiological manifestation of illness but a disease of poverty and marginalization, a battle between coercion and consent.

Ultimately, Country of Poxes is less about the particularities of three infectious diseases, and more about understanding the exploitative power dynamics that shaped this land and its systems, including our coveted national healthcare, through the discussions surrounding the origins and expansion of these pathogens and institutions.

Ultimately, Country of Poxes is less about the particularities of three infectious diseases, and more about understanding the exploitative power dynamics that shaped this land and its systems, including our coveted national healthcare, through the discussions surrounding the origins and expansion of these pathogens and institutions. It’s about unpacking the assumptions, stories, and platitudes we have told ourselves, assuaging post-colonial guilt, about the supposed sanctity of our medical and public health system, and recognizing its complicity with an authority that completely disregarded, exploited, and destroyed communities of this land. It’s about recognizing that politics, social factors, and in some cases, religion, cannot be separated from medicine – diagnosis and treatment are social processes affected by all of these larger determinants.

In many ways, much of this has not changed. Modern exploitation still points to the extraction of material for power and wealth, and the reliance of undervalued labour for our society to function – as demonstrated keenly during the acute phase of the pandemic. Racial bodies have been used one too many times in the name of science. Indigenous communities are still disproportionally affected by syphilis and tuberculosis, with limited access to care and lower social determinants of health. We still blame poor health to lifestyles, when choices can only be made from the options available. A continued 19^th century tradition of visiting physicians instead of creating permanent postings still exists, as does the displacement of Indigenous communities to receive care. Saviourism is still rampant in global health practices. And the political power and social structures – including a community’s relationship to authority, and by extension, health institutions – still alter health outcomes and epidemics, with the poorest quarters and communities disproportionately affected. Though viruses shaped the colonization of Americas, thriving in close contact, urbanization, and trading, the agendas of the powerful determined the course of the outbreaks, the relationships and the power imbalances between medicine and society. All of this remains heartbreakingly true today.

Country of Poxes illustrates that health cannot be discussed without discussing people’s relationship with land in parallel. This book is a painful but necessary read for every settler, and in particular, those who are from the medical and public health professions. Our health system is what it is today because of expansionist colonialism. Perhaps it is high time for us to acknowledge this backbone, and reimagine health, centering Indigenous communities for once.

Country of Poxes can be accessed here or at your local library.

About the author:

Prativa Baral is a Nepalese settler who grew up in the Tiohtia:ke region. She is an epidemiologist and a PhD candidate at Johns Hopkins School of Public Health, focusing on health equity, health systems resilience, and global preparedness against health emergencies. She also runs Let Science Connect, an initiative aimed to bridge the scientific world to the public through effective science communications.