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Hirschfeld on Mas, 'Culture in the Clinic: Miami and the Making of Modern Medicine' [Review]
Mas, Catherine. Culture in the Clinic: Miami and the Making of Modern Medicine. Studies in Social Medicine. Chapel Hill: University of North Carolina Press, 2022. 305 pp. $99.00 (cloth), ISBN 9781469670973.$29.95 (paper), ISBN 9781469670980. 
Reviewed by
Katherine Hirschfeld (University of Oklahoma)
Published on
H-Sci-Med-Tech (August, 2023)
Commissioned by
Penelope K. Hardy (University of Wisconsin-La Crosse)
Printable Version: https://www.h-net.org/reviews/showpdf.php?id=58861
For many North American scholars who work in Latin America, Miami manifests as a liminal space—a zone of transition—between university life and fieldwork rather than a research destination in its own right. The city is too culturally Latin for most historians of the continental United States to research, and too geographically North American for most Latin Americanists. This oversight is unfortunate because, as Catherine Mas’s book reveals, Miami deserves much more attention from all of us. The city was especially interesting during the second half of the twentieth century due to its location as a center of Cold War intrigue and a site of dynamic multicultural innovation in art, music, architecture, literature, dance, and cuisine.
So my first response upon reading Culture in the Clinic: Miami and the Making of Modern Medicine was to applaud the author for having the foresight to recognize the unique appeal of twentieth-century Miami as a site of scholarly inquiry. My second round of applause comes from her decision to explore the city’s history through the lens of health and medicine. As a card-carrying medical anthropologist I believe this creates the best vantage point for observing social and cultural change. On the whole, I believe the book is a great success, though there are several minor areas of weakness that may leave some readers feeling unfulfilled.
The book begins with an introductory homage to Cuban anthropologist Lydia Cabrera, including an overview of her ethnographic work on Afro-Cuban religious practices in the 1940s. This section is followed by a vignette detailing Cabrera’s unhappy exile in Miami—a city she described as a “desert of cement” (p. 1).[1] This spatial and temporal transition from traditional magic and religious healing in prerevolutionary Cuba to the secular, concrete (and comparatively dull) urban landscape of Miami captures a good deal of the book’s intellectual journey. At its heart, Culture in the Clinic is about the importance of biomedicine in the larger twentieth-century project of modernity in the United States and Latin America, as well as the parallel cultural loss created by rapid secularization of health and healing. The field of medical anthropology emerges in the background of this transition as a noble but ultimately flawed effort to document and validate the health beliefs of Miami’s diverse immigrant and minority populations.
The book is divided into five chapters. Chapter 1 explores the history of Miami’s international outreach and training center for foreign health professionals. Originally developed to help exiled Cuban physicians gain US credentials, the program soon expanded into “a crucial site of hemispheric collaboration at the nexus of research, education and health” (p. 27).
Chapters 2 and 3 explore the expansion of applied medical anthropology in Miami in the 1970s. This was done under the direction of Dr. Hazel Weidman, an anthropologist affiliated with the University of Miami medical school. Weidman then became director of the school’s social medicine program, known as the Health Ecology Project. Once established, this research center began creating maps of Miami’s ethnic neighborhoods with the goal of training anthropologists and community outreach workers to document health beliefs and behaviors. The group also researched the geography of alternative clinical spaces including informal clinics, botánicas (stores for religious goods including herbs), and religious healing centers. The goal was to collect cultural information that could be shared with clinicians to improve health outcomes.
Chapters 4 and 5 explore the limitations of the Health Ecology Project including the cultural backlash against Cuban American religious healing practices of Santería, which often involve animal sacrifice. This time period coincided with the rise of HMOs (health maintenance organizations), which were developed to contain health costs at a time of rapid inflation. Within this context, the incorporation of medical anthropology into clinical practice was viewed as an extravagance, and the Health Ecology Project soon faced funding cuts.
Professional organizations like the American Medical Association were also opposed to the informal clinics that dotted Miami’s ethnic neighborhoods despite the “culturally appropriate” care offered by many of these unlicensed practitioners. Orthodox Marxist “critical” medical anthropologists fought against the expansion of Hazel Weidman’s applied clinical research, arguing that revolutionary change was the only real solution to health crises created by poverty and oppression. The book concludes with an homage to Dr. Paul Farmer, a medical anthropologist and physician who founded a clinic in Haiti in the 1980s. Farmer’s clinic soon expanded into an international nongovernmental organization named Partners in Health. By the late 1990s, Partners in Health had developed an outstanding global reputation for providing culturally informed clinical care at no cost to some of the world’s most impoverished and vulnerable communities. Paul Farmer was a close associate of Dr. Weidman and in some ways Partners in Health represents a continuation of her work.
The greatest strength of this book is its thorough documentation of Miami’s formal and informal healing systems in the 1960s and 1970s. The parallel exploration of the brief, troubled convergence of medicine and medical anthropology in clinical space is also a welcome addition to scholarly literature. The book does have some limitations. Its scope is terrifically broad, and this breadth creates thin spots in the research. The discussion of Miami’s diverse immigrant groups, for instance, does not differentiate between voluntary versus forced migration, or address the violent internal conflicts and traumas unique to the Miami Cuban community at this time. The author also seems unaware of the earlier history of mutual assistance associations (including health clinics) established in the ethnic enclave of Ybor City, Florida, in the 1920s. Swedish and Norwegian immigrants brought similar traditions to Minnesota in the 1930s. The Cold War itself is curiously minimized in the book, and the existence of parallel Soviet medical modernization projects in satellite regions of the Soviet Union is not discussed. And finally, the importance of Cuba itself in shaping debates between medical anthropology’s critical Marxist and applied clinical branches in the 1980s is not fully addressed. This last omission is especially unfortunate because contemporary iterations of these debates still echo in the field, and these discussions would benefit from more scholarly engagement with the Cuban diaspora in Miami.
Overall, however, the book is an extremely engaging read and should appeal to scholars in medical humanities, history of medicine, medical anthropology, medical geography, and ethnic studies. It is a welcome contribution and will hopefully inspire other researchers to explore the rich cultural history and healing traditions of Miami and other diasporic enclaves in the United States.
Note
[1]. Lydia Cabrera to Isabell Castellanos, date unknown (translated from Spanish by Catherine Mas), Lydia Cabrera Papers, box 1, folder 6, Cuban Heritage Collection, University of Miami Libraries, Coral Gables, FL (CHC-UML).
Citation:
Katherine Hirschfeld.
Review of
Mas, Catherine.
Culture in the Clinic: Miami and the Making of Modern Medicine.
H-Sci-Med-Tech, H-Net Reviews.
August, 2023.
URL:
https://www.h-net.org/reviews/showrev.php?id=58861
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
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