June 10, 2020
by Irène Favier, lecturer in extra-European contemporary history at the University of Grenoble and at the LARHRA.
The "return of epidemics", in the words of historian Marcos Cueto, is a recurring feature of contemporary Peruvian history.
The bubonic plague, yellow fever and malaria are all disruptive phenomena that have come to punctuate social life. They also call into question any linear narrative of a triumphant, and unclear for that matter, modernity. Covid-19 makes no exception to this series of diseases, and suggests the relevance of articulating natural and social sciences in order to grasp viruses’ impact on societies. Not only a hazardous calamity, the virus brings into play human and institutional actors, first and foremost a State whose construction has been quite sinuous since the Independence. That is what also suggests the reading of Daniel Rojas’ diary as a medical student, notably when he recounts his time in the surgical department of a hospital in Lima, this time using the tools of anthropology:
"There was a shift during which none of the interns set foot in the operating room. The reason? There were no beds available in the entire hospital. (...) For hours the doctors had been trying in vain to transfer the patients to other hospitals in Lima. (...) The day went on; so did the appendicitis. A hospital accepted a transfer. While we were running to prepare for the patient's departure, a stretcher arrived.
"— Here is a transfer. We called a few hours ago. It's peritonitis, the nurse explained who brought the patient in.
— I'm sorry, but that won’t happen. We’ve already informed your hospital that we don't have any beds left. Someone please have the department head come in." (...)
What was certain is that it was a ticking time bomb - several appendixes and no beds. There were three operating rooms for a population of over a million. And what would happen when disaster stuck? Could the hospital cope? I'm so afraid to live in Peru. »
Written in 2018, Diary of a Medical Intern tells the story of a physician in training within the Peruvian public health system . Its words aim to describe daily, banal events, and as such they shed a preoccupying light on the current situation in Peru. If the capital was already struggling to meet the urgent needs of the population, how can the country today cope with the eruption of an unknown epidemic?
A PERUVIAN PUZZLE
If the hope was at first to contain the spread of the virus by adopting early measures, combining border closures, social isolation and curfews, the time for prevention has passed. In the region, Peru now ranks third in terms of the number of deaths behind Brazil and Mexico  – a bitter record, all the more so because the crisis was managed in sharp contrast to the light-handedness displayed by the authorities of these two other countries. Having been a "good pupil", Peru seemed at first to be able to contain the pandemic, aware as it was of the limits of its health system: how can we therefore explain the current dramatic situation?
FROM THE CENTER AND THE BORDERS, A FEW ELEMENTS OF EXPLANATION
Two cases located in the city of Lima and in the Amazon, both areas heavily affected by the pandemic, provide elements of explanation for this sad Peruvian enigma which, paradoxically enough, combines early preventive measures and pandemic explosion:
In the Amazonian department of Loreto, several cases of contamination have been recorded in indigenous Ticuna communities of Santa Rosa. This island is located in the so-called "Amazonian trapezoid", which borders Peru, Colombia and Brazil. It therefore challenges the nationalized management of a pandemic that knows no borders, despite the differences and acute nationalisms. Smuggling and narco-trafficking adds to a history of institutional abandonment. These borders are porous, especially given that the Ticuna ethnic group includes representatives in other countries. Hence the call for an alternative, i.e. regional strategy for the management of these territories, as the Defensoría del pueblo recently urged.
Back to the capital, the underprivileged district of La Victoria offers another aspect of the challenges currently facing the Peruvian State. Informality, which rules there as well as in 70% of the active population, thwarts the measures of containment, which are regularly braved by people who are forced to sell their goods one day in order to ensure tomorrow. The media stigmatization of these economically fragile populations has had little impact on behaviors, given the very unequal distribution of income and health coverage in the country.
This confirms Marcos Cueto’s thesis, who emphasizes the major role of health infrastructures and living conditions in order to account for the global health of populations, ahead of the neoliberal stance which sees health as an individual asset, to be "managed" on an individual scale. The elitist "trivializing (of) preventable deaths and diseases"  and heroicizing of health care workers seems to have reached a limit.
FROM ONE HISTORICAL SEQUENCE TO ANOTHER?
The current pandemic is therefore confronting the Peruvian State with historically constructed loopholes: while the process of regional integration is not in full swing, as illustrated by the case of Santa Rosa, the extreme precariousness of urban populations appears to be the result of a process of State dismembering going on since the 1990s. The challenge of finally managing the epidemic collectively calls into question the validity of Thatcherian slogans that have been in the spotlight since the Fujimori presidency.
Will the crisis trigger a shift towards intervention? Only time will tell, but it will in any case be a political process , not a natural one, since the extent of the current crisis seem to be at least as much linked to the lack of infrastructures and profoundness of poverty as to the mortality of the virus. The 1991 cholera outbreak in Peru, which did not lead to any change in the already weak health infrastructures, had already made clear that crises lack any intrinsic virtue. Current events may only provide an opportunity for a sequence that could put the common(s) back into the public debate. Coming from the airports and from "connected" lives, Covid-19 will at least have reminded Peruvians that they are a society – if not to their delight, at their own risk.
 Rojas Daniel, Diario de un interno de medicina. Aproximaciones a la educación médica y al sistema de salud en Lima, Perú, Lima, IEP, 2018, 169 p. The author is currently working on gathering accounts from medical personnel who were doing an internship during the health crisis.
 Peru: 4767 deaths (MINSA numbers on June 3rd); Mexico: 10167, Brazil: 29937 (OPS/OMS numbers on June 2nd).
Irène Favier is a lecturer in extra-European contemporary history at the University of Grenoble and at the LARHRA (UMR 5190). She has written a thesis on the Peruvian Amazon, to be published by PUR under the title Le Pérou et ses confins. Le cas du Haut Marañón (1946-2009), and is now interested in the history of mental health in Peru. This month she is organizing a virtual round table with the French Institute of Andean Studies (IFEA) entitled "El rastro de la salud en el Perú: perspectivas de ayer y de hoy", in which Daniel Rojas, Jorge Lossio, Gabriela Ramos, Santiago Stucchi will take part. It will soon be possible to register via the IFEA facebook page.