Fighting Poverty with Passion
On a recent Monday afternoon, I follow a community health worker through the swampy southern Louisiana air, as she points to rusty dilapidations, pausing to reminisce her memories as a child in what used to be thriving community buildings before the storm. The landscape is green, blue, and black, as we look out over the water at the silent sky-high cranes that residents love and deplore. I can faintly smell petrol, collecting in the soil and in the water. In the distance, fishermen thrash about on deck, preparing for the day’s catch, hopeful they find more than they did yesterday, hopeful they find as much as they did more than eleven summers ago. Besides the gentle hum of the marshland, the air is quiet. We are not in New Orleans anymore.
Among the various places where the Louisiana Public Health Institute conducts data collection for their various projects – the most frequent our air-conditioned, double-computer-monitored office spaces on Poydras Street overlooking the Superdome – neighborhoods provide the richest ethnographic insight into health disparities and concerns. In southwestern Louisiana, a corridor characterized by poor outcomes for education, health, and poverty, residents are happy to share their disappointment with the American health system, and with some probing, their fear of falling ill in a place where the only hospital they trust is 45 miles north. When I interrupted the 40 or so individuals to ask what they prioritized as health concerns in their community, they took only a few seconds to voice what seemed to be the mantra for the day: “diabetes, obesity, heart disease.” Many relied on Medicaid for primary care, and many lamented the unavailability of green spaces for physical activity. Some decried their bronchial infections as a result of airborne particulate matter, some decried the large substance-abusing population in their community for their poor choices. All were proud of their communities, and all had recommendations for improving the well-being of the poorest and sickest of their neighborhoods.
Learning about these attitudes that individuals harbor toward the healthcare (or sickcare) system is an essential component to what Braithwaite details as the “importance of citizen participation in the planning, assessment, and implementation of community-based health initiatives” for “effective health promotion and disease prevention programs” (1994). This practice is especially important for a place like southwestern Louisiana, a place sociologist Arlie Hothschild describes as distinctly contradictory, where residents have both built and lost entire livelihoods from large industry, where they continue to feel marginalized and ridiculed as “ignorant, backward rednecks,” and where they are tired of feeling like “stranger[s] in [their] own land” (2016). In her fieldwork, where she intercepted members of communities that struggled with Hurricane Katrina, and struggled with the Bayou Corne, and struggled with Deepwater Horizon, and are struggling with restoring honor to their people, Hothschild offers the paradoxes that arise out of trauma at the intersection of the most powerful lobbies in the country. Would she have learned this without ethnography?
Before Monday, I had never been this far south, and I had not given much thought to manifestations of marginalization outside the realms of race and ethnicity, class, or gender – but this manifestation of marginalization, based on geography and on stereotype of the American right, is arguably just as devastating and traumatic. When I started my position at the Louisiana Public Health Institute, I had not yet understood the significance of these health needs assessments and why we need to keep our eyes and ears open to ideas that are different from those we’re accustomed to. Only then can we begin to dismantle structures that inhibit our neighborhoods from being well.