BLOG: History in the Hospital (Part II): Disciplinary and Ethical Considerations by Cari Maes

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Today we complete a two-part series on maternal and infant health in Brazil. If you missed the first installment, please click here. And if you’d like to contribute to a discussion of physical or digital resources for Latin Americanists or to muse on the how-to’s of research, especially in a pandemic, Research Corner wants you! We accept posts year-round, but are particularly looking for pieces to be run in the winter and spring semester. To express your interest, fill out this Google Form or email Gretchen Pierce at gkpierce@ship.edu.

Cari Maes is an assistant professor of History at Oregon State University. She earned her Ph.D. in modern Latin American history at Emory University. Her research focuses on the rollout of Brazil’s first national maternal and infant health system during the era of Getúlio Vargas. She has recently written about the connections between infant mortality discourses in this period and rhetoric surrounding COVID-19 mortality. Her current book project took her to the IFF/BibSMC where she investigated the history of the institute and its role in Vargas-era maternal and infant health programming.

History in the Hospital (Part II): Exploring Brazil’s BibSMC Archive

Historians who venture to the BibSMC’s (Biblioteca de Saúde da Mulher e da Criança, Library of Women’s and Children’s Health) reading room, which is located inside the Instituto Fernandes Figueira (IFF)  in Rio de Janeiro, will find themselves in a space unlike other more conventional archives (see Figure 1). Research here requires visitors to traverse two distinct institutional environments: the hospital and the archive. What, then, does it mean to practice the historian’s craft in a medicalized space surrounded by patients and practitioners? And, what are the ethical and political considerations researchers must confront when “doing history” in a hospital setting? To briefly explore these questions, I draw on my own experiences during a short summer research trip to the BibSMC in 2018.

Figure 1: Instituto Fernandes Figuera, active hospital and home of BibSMC.

(https://portal.fiocruz.br/noticia/instituto-fernandes-figueira-comemora-90-anos-com-atividades-culturais-no-dia-284)

I first grappled with these questions as I waded through the IFF’s crowded lobby in search of the staircase that leads to the BibSMC. As I passed through, I heard babies fussing. Boisterous children ambled around the few scattered chairs in the waiting area. Pregnant patients chatted on cell phones to pass the time. Doctors and nurses scurried through the hallways. A loudspeaker barked announcements. I questioned how an archive could even exist in such a chaotic space and wondered how my research process would unfold there.

Many of us, after all, are accustomed to quiet, solitary work in well-ordered environment.1 Archives usually feel austere, even desolate. We often construct the archive as a passive “deposit of the past” where materials, as an effect of being stored there, become “dead matter.” While the protagonists and stories we find in archival documentation breathe some life into the space, we often find ourselves working alone in quietude. This archive and its surroundings, on the contrary, teemed with life, movement, and noise. Even though the BibSMC felt somewhat cloistered from the sights and sounds of the 131-bed hospital surrounding it, it generated an energy distinct from other archival spaces. For the first time in my career, I had to reconceptualize my idea of an archive and reorient my approach to archival research. Specifically, the present-day environment of the hospital provided valuable insights for my research into what Brazil’s “healthscape” looked like in the past. The experience allowed me to think more holistically and intersectionally about the power dynamics between patients and practitioners and about the role of institutions like hospitals play in shaping public health. In the process of undertaking research in the BibSMC, a few observations emerged that help answer the questions I posed at the outset of this post. 

First, “doing history” in the hospital required me to think about the archive in a material, rather than abstract sense. As Peter Lester argues, historians tend to overlook the physical and material properties of the archive and its contents. We think less about the built environment of the archive itself and more about the information it contains. Yet, as Lester urges, it is critical to consider our archival experience as an emotional and multi-sensorial one, and not simply as an intellectual exercise.3 For the case of the BibSMC, I was confronted with the reality that working in the archive meant being in the hospital. Past experiences have conditioned most of us to feel a certain way in a hospital or medical setting. These emotional and somatic responses are quite different from those we may feel in an archive. And, hospitals — like archives — are not neutral institutions. The modern hospital, as Foucault describes, is “therapeutic instrument,” a place where a host of biopolitical relationships materialize.4 Like an archive, deeply embedded hierarchies of power order the space of a hospital. However, hospitals are also complex ecosystems where different classes and cultures mix and where humans undergo dramatic transformations from sick to healthy, from living to dead, and, in this particular hospital, from pregnant to parent.5 Some of the patients and health practitioners I passed on my way to the BibSMC were experiencing these transformations in real time: some of them filled with hope for a successful therapeutic intervention and others faced with the agony of unexpected diagnoses and losses.

The weight of these collective human experiences unfolding around me indeed influenced the research I was doing on site. I couldn’t help but draw connections between what I witnessed in the present-day hospital and the realities facing doctors, public health officials, mothers, and children in the mid-20th-century period — a period of high infant mortality and intense public health intervention — I was researching. For example, the knowledge doctors and scientists produced back then not only accrued on the shelves of the BibSMC, but within the traditions of care and practice reproduced within the hospital walls through the years. What’s more, many of the same political and social determinants of health I was tracing in the archives continued to influence the health and well-being of the mothers and children downstairs. Finally, seeing multiple generations of women gathered in the lobby also reminded me of the historically-fraught co-existence of “lay” maternal knowledge and medical science. Here, I reflected on the fact that the BibSMC, like many archives, privileged the ideas and voices of elite, male doctors and scientists in its collections. Being inside a working hospital renewed my desire to practice more feminist archival methods and modes of source analysis to draw out subjects like midwives, mothers, and children. As a result, I sought out alternative sources, such as a contemporary grassroots feminist magazine and a local newspaper’s child health advice column, to find perspectives and voices left out of medical and scientific source material.

What I realized was that archival research in a hospital setting required the historian in me to think more like an ethnographer at a “field site.” Historians tend to focus on our one-on-one relationships to the archival documentation and the subject matter in question. Lest we be accused of being “presentist,” we immerse ourselves in questions of historical context and subjectivity. Though we consider how our positionality and perspectives shape our engagement and interpretation of historical sources, we often think less about who and what we encounter in the physical space of the archive. But, as Nina Littel contends, it is critical to consider how an archive’s physical and social environments shape how the researcher accesses, experiences, and analyses its collections.6 I found that BibSMC forced this consideration of environment. It required a different level of situational awareness than other archives. I also had to approach this research endeavor with a different kind of humility. In this space, I was less concerned with institutional protocols about the use of gloves, rules about cell phones, and other archival norms. Instead, I had to consider what my presence and purpose meant in the larger context of the hospital. I was not only a cultural outsider, but a disciplinary one. And, the nature of my intellectual work in the library could not be compared to the others kinds of medical and therapeutic practice happening elsewhere in the building. As David S. Jones argues, historians need to tap into humility more often, particularly in their uses of history as an explanatory tool for health crises in the present.7 At BibSMC, practicing humility meant recognizing that I am not a medical doctor and that I held considerably more social privilege than the patients I encountered.

Historians and other scholars should be encouraged to use the BibSMC and other similar repositories situated in medicalized spaces. However, we have to reorient our often baked-in disciplinary dispositions. Historical research needs to extend beyond the insular relationship we have with our archival sources. It means deeply considering the contexts of our research, down to the very spaces of our archival work. In addition to practicing humility in these spaces and in our work, we should seek to produce analyses that, as much as possible, attend to current social justice issues. In my own work, I have tried to bring historical perspectives to bear on present-day health crises that disproportionately affect historically-marginalized groups, such as poor mothers and children of color impacted by the Zika Virus epidemic. Ultimately, “doing history in the hospital” entails bearing witness to current health disparities in the present and, hopefully, leveraging history towards more structural solutions in the future.

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1 I would argue that even archives that lack an organized built environment or formal classification system, still transmit a sense of “order” and historians most often approach such spaces with the conventional disciplinary disposition.

2 Ariella Azoulay, “Archive” in Political Concepts: A Critical Lexicon (2017). See her analysis of Patrick Tourneboeuf’s photographs and the social construction of “lifeless” archives.

3 Peter Lester, “Of mind and matter: the archive as object,” Archives and Records 39: 1 (2018), 10.

4 Michel Foucault, “The Incorporation of the Hospital into Modern Technology,” in Elden and Crampton, eds., Space, Knowledge, and Power: Foucault and Geography (New York: Routledge 2007), 141. It is interesting to note that Foucault was a frequent visitor to Rio de Janeiro in the sixties and seventies. His visits included some lectures at local hospitals and universities. See Heliana de Barros Conde Rodrigues, Ensaios sobre Michel Foucault no Brasil: presença, efeitos, ressonâncias (Rio de Janeiro: Lamparina, 2016).

5 Debbi Long, Cynthia L. Hunter, and Sjaak van der Geest, “When the field is a ward or a clinic: hospital ethnography,” Anthropology & Medicine, 15, no. 2 (August 2008), 73.

6 Nina Littel, “Visibility and Vulnerability in the Physical Space of the LGBTI+ Archive,” Leiden Art Society Blog (June 11, 2020).

7 David S. Jones, “COVID-19, history, and humility,” Centaurus 62 (2020), 370-80.

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