Medicine and Health “in the Least Civilized Regions”

Abstract

Abstract In nations with large Indigenous populations like Guatemala and Ecuador, overlapping narratives of nationalism, public health, and race signal the complexity of modernizing health care. Various variables—race, gender, class, geography, the role of the state, divisions within the ruling class—impinged on people’s health care decisions. To analyze how racial thought and public health influenced each other during Guatemala’s predominantly dictatorial rule and Ecuador’s authoritarian but more participatory government at a time when the most significant international public health organization—the Rockefeller Foundation (RF)—sought to improve public health in both countries, I combine transnational and comparative historical analyses of the first half of the twentieth century. Triangulating Guatemalan, Ecuadorian, and RF archives and focusing on the primacy of Indigenous voices reveals an interactive matrix of different types of racism in Guatemala, Ecuador, and RF that shaped indígenas’ (Indigenous people’s) engagement with, exclusion from, or rejection of public health initiatives and scientific medicine. The politics of indigeneity was as consequential for public health as scientific developments. Many state agents and RF representatives used public health contexts to mobilize social constructions of race and ethnicity that advanced their agendas and marginalized indígenas. In turn, indígenas often determined the extent to which authorities’ aspirations matched their accomplishments.