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"Geography should never be why a child dies:" spatial narratives and the Pediatric Medical Clinic of the Americas

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"Geography should never be why a child dies:" spatial narratives and the Pediatric Medical Clinic of the Americas

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Content “GEOGRAPHY SHOULD NEVER BE WHY A CHILD DIES:” SPATIAL NARRATIVES AND THE PEDIATRIC MEDICAL CLINIC OF THE AMERICAS by April Ruth Hoffmann A DISSERTATION Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY Department of Geography December 2013 Copyright 2013 April Ruth Hoffmann i Dedication For my teachers: My parents and elders, you have taught me about integrity, love, and courage. I am honored by your sincere wishes for my life to be compassionate and meaningful. My college professors, especially Paul Steed, Rosa-Linda Fregoso, and Ruthie Gilmore, you have taught me how to think rather than know, how to discuss instead of argue, and that there is no substitute for plain hard work. My daughter Iris, and little ones everywhere, you are forever my favorite teachers. ii Acknowledgements The trust, generosity, and honesty of the staff and volunteers of the Pediatric Medical Clinic of the Americas made this dissertation possible. I will never forget the ethics of care and impassioned determination that is practiced every day at PMCA, nor the extraordinary kindness of those who shared their professional and personal lives with me during my time in Southville. Thank you. Dr. Ruth Wilson Gilmore was the Principal Investigator of this study. Her guidance in the lifecycle of this project was invaluable, as was her mentorship throughout the dissertation process. This required disproportionate amounts of patience, advice, support, and criticism, all for which I am grateful. Dr. Macarena Gomez-Barris and Dr. Manuel Pastor both served on my dissertation committee and provided feedback that improved my insights considerably. This dissertation received funding from the Wallis Annenberg Endowed Fellowship from the University of Southern California, and an Advanced Year Merit Award Fellowship from the University of Southern California. Dr. Ruth Wilson Gilmore provided the major editorial support for this dissertation. Thank you to Joseph Lukesh for your fact checking and copy editing skills. Finally, I would not have completed this dissertation without the editorial, technical, and emotional support of Dr. Jacob Peters. Jake, your friendship is one of life’s great gifts. iii Table of Contents Dedication i Acknowledgements ii Abbreviations v Abstract vi Chapter One: Introduction and Literature Review 1 Geography 5 Medical Anthropology 11 Human Rights 14 Methodology: Framework, Fieldsite and Data 21 Chapter Two: The PMCA Archive and the Scale of the Body 26 The Children of PMCA 33 Creating the PMCA Subject 38 The Ideal Donor: Doctors- and Mothers-by-Proxy 47 Conclusion 50 Chapter Three: PMCA, Southville, and the Community Scale 52 Weekly PMCA Staff Meeting, September Monday Morning, PMCA conference Room 52 Introduction 55 The Community Scale 57 PMCA Office Environment 58 PMCA's Antecedent Organization: Southville Rotary Club 62 Identifiable Spatial Narrative of Everyday PMCA 67 “Miracle Stories” 68 Mothering-By-Proxy 73 iv Conclusion 81 Chapter Four: Making the Globe: PMCA's Tropic Gems Gala 83 1pm, TGA event site, 5 hours until 9th Annual Tropical Gems Auction and Gala 83 Introduction 85 Life Cycle of The Tropical Gems Auction and Gala 89 Phase One: Choosing the Team and Theme 90 Phase Two: Creating the Event Aesthetic 93 Phase Three: Orchestrating the Event 96 Spatial Narratives of the Global: Event Aesthetic as a Place-Making Process 101 Performance of the Global Scale: PMCA Narratives about the World 108 Conclusion 124 Chapter Five: Conclusion 126 Bibliography 137 Appendix A: Interview List and Research Time Line 149 Appendix B: Data and Methods 153 v Abbreviations PMCA Pediatric Medical Clinic of America TGA Tropical Gems Auction MCA Membership Categorization Analysis vi Abstract My dissertation is an ethnography of the Pediatric Medical Clinic of the Americas (PMCA), a humanitarian organization in the Upper South USA with an economically elite donor base that focuses on critically ill children in the developing world. Using Geography, Medical Anthropology, and Human Rights discourse, I ask and answer the following question: How do the archives, everyday office, and fundraising processes of PMCA interact to create powerful stories that are both about and produce PMCA as well as the wide range of places affected by the charity's cultural politics? My data and analysis emphasizes the importance of spatial narratives--event-driven stories about the real or imagined places where people's activities intersect—as an empirical context for understanding how geographic scales are produced, experienced, and differentiated, and the project’s focus on a humanitarian organization provides the capacity to more fully understand precisely how the spatiality of human connection underlies the concept of both “humanity” and “human rights.” This dissertation shows how geographical scales and differences may be produced through the very processes that seek to bridge them, as the contradictory nature of elite philanthropy lies in this evidence, that organized activities to address inequality are required to simultaneously reinforce these inequalities. 1 Chapter One: Introduction and Literature Review How do people in one place come together to respond to human suffering elsewhere? This dissertation is an ethnographic examination of the Pediatric Medical Clinic of the Americas (PMCA) 1 , described in a 2006 newspaper article as a “matchmaker,” charity “that connect[s] sick children in developing countries with hospitals in the U.S.” (Winslow and Fong 2006, A10). It asks and answers how the place-making activities of PMCA operate through powerful stories – spatial narratives that reconstitute inequalities even as the charity works to eradicate inequalities. “Matchmaker” charities have emerged over the last decade as a response to “Hospitals [sic] and charity organizations [that] are besieged by pleas for help, the most poignant involving children with life threatening diseases” (Winslow and Fong 2006, A10). These charities fit into a much larger, and expanding, web of international humanitarian organizations. PMCA is of further interest because its programs rely on a small donor base of local “ultra elites,” those who are not only elite compared to the general population but also among their peers (Stephens, 2007). PMCA place-making activities work to transform the health resource conditions of the Caribbean and Central American locations where their efforts are aimed, while at the same time are effective as part of the social reproduction of the elite donor community in Southville, the pseudonymous mid- sized city in the USA Upper South where the charity is located. 1 The name & exact location of the charity have been changed for IRB protocols. All names in this dissertation are pseudonyms. The exact dates, phrasing of charity slogans, and other information that has the potential to expose the charity’s identity has been altered, appropriately adhering to human subjects ethical guidelines. Neither the data presented nor the people who participated in the dissertation are compromised. 2 PMCA is an excellent organization, recognized as a leader in its field, and this dissertation looks closely at how they do what they do to understand why it is that such excellence doesn’t change the structural conditions underlying the health inequalities their work addresses. The various geographies involved in outreach and fundraising efforts make PMCA an ideal “thick” case study about how people use organizations to think about and make sense of themselves and a variety of imagined and real geographies (Geertz, 1973). The fundraising efforts of PMCA center on an annual gala, aimed at the economic elite of Southville, that includes a high-end-designer fashion show and a vacation auction to elite resorts in the same countries that the patients involved in the charity’s efforts come from, called the “Tropical Gems Auction” (TGA) gala. Perhaps most intriguing about this field site is that although there are offices in Southville where the PMCA staff works to coordinate outreach projects and fundraising efforts there is no actual clinic that is the Pediatric Medical Clinic of the Americas. These “matchmakers” do just that, engaging in a process to select individual patients, programs, and places where their fundraising dollars will be distributed. “Matching” goes in the other direction too in the form of carefully selecting target donors. What is the role of stories in the work of PMCA and what kinds of places are affected by these narratives? While narratives about place in PMCA use themes and tropes that transcend Southville, the global imaginary that is reinforced at PMCA also works to reinforce the social hierarchy of Southville. My work looks to fulfill the recommendations of the scholars whose work guides this analysis, who insist that more empirical work is required to more fully understand the processes by which the coupling 3 of power and difference can result in the production and maintenance of places that exhibit consistent premature death for particular kinds of people, persistent global health inequality, and other human rights violations, even as antiracist and utopian discourses of humanity and human rights have more prominent circulation worldwide. My dissertation uses these insights to better understand spatial narratives as vernacular theory that works to construct, disrupt, and maintain a range of geographies. In other words, places are made in part by narratives that people tell about real and imagined places. What kind of narratives circulate at PMCA and what range of geographies are affected by these narratives? PMCA is an award-winning charity that consistently produces measurable outcomes in terms of the children that they serve. PMCA’s ethical standards include industry-leading protocols for their long-term programming strategies, interaction with patient families, and partnership with indigenous healthcare providers. However, these stories are not the most effective for PMCA fundraising. Instead PMCA’s most prominent stories focus on individual children, many centered on narratives of difference. How do those who run PMCA manage these paradoxes and contradictions? They are uniquely qualified to do just that, as they are each experts in the social geography of Southville, a racially divided city wherein gender roles are clearly defined and generational divisions are seamlessly enacted. Following a discussion of the three literatures that are foundational to this dissertation and presenting details about my fieldsite and methods, three chapters of data provide over a dozen examples of identifiable spatial narratives of PMCA. Each of the three data chapters that follow hones in on one scale and one aspect of the PMCA social 4 world. Using the public archive of PMCA promotional materials, observations from the office culture of PMCA, and examples from three years of attendance at the charity’s annual gala, I will describe how narratives used in these areas contribute to place-making processes. Narratives that circulate through these three areas of PMCA have specific but complementary approaches to facilitate a response to the needs of the families of the critically ill children that they focus on. Chapter two looks at the PMCA public archive and how narratives of the scale of the body are created at PMCA. Chapter three focuses on the everyday office culture of PMCA wherein narratives about Southville are analyzed. In chapter four the lifecycle of PMCA’s annual Tropical Gems Auction gala, where the global imaginary that is made through PMCA’s narratives, is analyzed. One final word: Although the chapters are divided into three different ways that spatial narratives circulate at PMCA, through the archive, the everyday office activities, and the annual gala, the entire social world was studied as a whole and my activities were rarely restricted to only one of the three areas on any given day. Just as during the fieldwork these three areas were at play simultaneously, in the chapters that follow as we shall see, it was impossible to “hold the field steady” as Brackette Williams cautions, for very long (1991). So, while there is specific attention paid to the scale of the body in chapter two, that of the community in chapter three, and the global scale in chapter four, in the end, no area of consideration was treated as mutually exclusive to any other area of the PMCA social world. That’s what made this an exciting and challenging project for me. 5 Geography Three areas of spatial theory shape this dissertation. First is Neil Smith’s theory of the production of scale, characterized by the use of spatial metaphors that create, maintain, and transform complex boundaries of differentiation, showing the “politics of human life as inherently spatial” (1992a, 58). Those who participate in PMCA use spatial metaphors implicitly and explicitly to both produce and contest space and Smith’s typology provides a vocabulary for showing how this is done. A second area of geographic scholarship is work on geographies of difference, needed for analyzing the range of consequences that result from PMCA’s narratives about racialized, gendered, and aged individuals and groups of people. Finally, James Blaut’s insights on Western diffusionism are useful for thinking about the world as both the context and the product of PMCA activities. Geographers ask why spatial variation is significant. The concept of geographic scale is a way to answer this question. Geographers’ writings in the 1980s and 1990s advanced the perspective of thinking about spatiality as the intersection of social relations (c.f. Smith 1992a; Smith 1992b; Massey 1994). This position offered a corrective to thinking about space as a container, instead noting material and discursive spatial processes as co-constitutive, rather than as mutually exclusive. A turn towards the social construction of place, emphasizing experience and multiple subjectivities, was part of a broader shift in social analysis. Spatial metaphors seemed to permeate much critical thinking in the humanities and social theory from the late 1970s forward, but the underlying logic of the metaphors 6 was not part of the conceptual toolkit – or, as Smith put it: there was no “articulated language of spatial difference and differentiation” (Smith 1992a, 61). To correct this, Smith presented a framework of dialectically related types of places, his typology of geographic scales (1992a). Smith’s approach to scale as the organization of capitalist space is a theory of how the world works and an analytic tool for understanding the relationships created, maintained, disrupted, and restored within and between kinds of places. A hierarchical ordering is what appears at first glance of Neil Smith’s categorization of scales as a nesting framework: body, home, community, urban space, region, nation, and global (1992a). However, Smith does not present his typology to argue for a static ordering of types of places, explaining that “the hierarchical character of this typology is deliberate, and reflects a practical rather than philosophical judgment” (1992a, 66). In other words Smith’s typology identifies the types of places that are created as a result of the logics of capitalism and patriarchy, which Smith explains requires constructing various boundaries of identity marked by difference (1992a, 64). How do people use PMCA to make the scale of the body, community, and global? The analysis of spatial difference, rather than the identification of spatial hierarchy, shows how boundaries of difference are made and unmade. Smith’s typology provides a way to understand how those at PMCA “conceive of scale as the geographical resolution of contradictory social processes of competition and cooperation,” wherein scale both “defines the boundaries and bounds the identities around which control is exerted and contested” (1992a, 64; 1992a, 66). This dissertation looks at how people use PMCA to 7 make sense of themselves and to construct, maintain, and disrupt geographies. The charity itself is also a scaled place, “the embodiment of social relations of empowerment and disempowerment and the arena through and in which they operate” (Swynegedouw 1997a, 169). PMCA’s role as “matchmaker” makes this organization particularly useful for documenting the making, maintaining, and transformation of geographies at various scales, as the charity operates within the context of “multiscalar power geometries” spanning the body to the globe (Marston, 2000). Social constructionist approaches to place illuminate the material realities and spatial practices that mark contemporary political, economic, and cultural processes. To emphasize that place is socially constructed is to emphasize that under different conditions places would be different than they are. So spatial realities- like uneven development- can be thought of as the consequence of material and discursive processes, the genealogies of which can and have been traced by various scholars (c.f Hise 2004, Wilson 2000, Gilmore 2002b, Pulido 2006, Nagar 2006, Woods 1998). The scale of the body is the most explicit kind of place through which the charity’s efforts are aimed as well as the place through which human rights narratives are most distinctly articulated. Smith emphasizes that the body marks the boundary between self and other and is the site at which geographies of social difference are most explicitly constructed, most notably gender, race, age, and ability (Smith 1992a, 67). This dissertation looks at narratives of difference and place. The study of race, gender, and age in the discipline of geography have all been neglected in relation to their importance, the consequence of which has been the marginalization within geography of these topics and 8 the scholars who study them (Dias and Blecha 2007; Katz 2002; Knopp 2007; Kobayashi 1994; Pulido 2002; Raju 2002; Gilmore 2002a; Woods 2002; Loyd 2005). Nonetheless, these scholars’ focus on the body as a scale where spatial inequality takes on the form of illness, wellness, death, and life drives my research to focus keenly on how social difference both informs and is produced by the narratives of PMCA. In particular, Nagar and The Sangtin Writers’ findings about inherent contradictions of empowerment and disempowerment in the context of gender and NGOs shows the ways in which “elitism and hierarchies within the NGO structures parallel and reproduce the very hierarchies that they are ostensibly interested in dismantling” (2006, 144). PMCA is also run by women who engage in these negotiations and confrontations albeit from their own set of communal norms and regulations. Nagar’s insights about the relationship between the work of NGOs and the underlying social conditions that inform that work apply to PMCA, especially because unlike other organizations that are community formed and small in size PMCA’s work has never included an explicit critique of the global political economy that produces the gross health inequality that their work responds to. Gilmore explains that race is shaped simultaneously by gender, class, and scale, functioning both “as a condition of existence and as a category of analysis” (2002a, 22). Place is one consequence of these “overdeterminations of race, gender, and power” (2002a, 15). Recognition of effects of racism, numerous in origin, is substantially experienced at the scale of the body, resulting in the “fatal coupling of power and difference” (Hall 1992, 17, in Gilmore 2002a, 15). These couplings are the product of “a 9 practice of abstraction, a death-dealing displacement of difference into hierarchies that organize relations” (Gilmore 2002a, 16). Sans this “violence of abstraction” there are examples of and possibilities for nonfatal couplings of power and difference (2002a, 16). Gilmore’s work shows how differentiated power organizes hierarchy, a critique of approaches that propose hierarchies as an inevitable, and therefore naturalized, effect of difference. This insight enables analysis of the concomitant fatal and nonfatal couplings of power and difference in PMCA’s work to alleviate global health inequality. How then do spatial narratives contribute to the contradictory processes that are the consequences for the people and places that PMCA affects? Analysis of the underlying socio-spatial backdrop of PMCA is required to answer this question. I use James Blaut’s “colonizer’s model of the world” to understand the global imaginary of PMCA, described in its promotional materials as a “hospital without walls” whose aims include “giving hope to critically ill children from developing nations” and “making a healthier and more peaceful world” (PMCA promotional documents; Blaut 1993). Blaut’s critique of modern diffusionism as a belief system wherein European global hegemony is taken for granted and seen as the sole source of innovation and intellectual expertise is useful for studying an organization that aims to provide resources that are plentiful in their place of origination, Southville, to places without those resources, countries in the Caribbean and Central America (1993). The hallmark of diffusionism as a belief system is seeing the world as Inside or Outside, a metric marked by inclusion in or exclusion from Eurocentric religious, biological, technological, and intellectual superiority (1993). Here the non-Eurocentric Outside naturally progresses through 10 contact with European Inside ideas and in turn provides compensation for those “gifts” in the forms of material and human resources (1993, 957). Blaut looks at the durability of western diffusionism even as ideas about colonialism and biological superiority have been rejected (1993; see also Blaut 1992). PMCA’s narratives about making the world “healthier and more peaceful” are more often than not compatible with the teleological explanation of European global hegemony, reflexively linked with the logic of colonialism (PMCA 2007 Annual Report; Blaut 1993; Stea 2005). Quijano adds that today this model persists along racial axes that have proven “more durable than the colonialism in whose matrix it was established” (Blaut 1993; Quijano, 2000: 572). The consequences of western diffusionism as a belief system proliferate in development discourses where efforts largely reflect this teleological path wherein all places are “condemned to follow the same, European-inspired, path to development” (Sheppard, 2005: 960). This is the case despite the intentions of those working to address inequality who Sheppard notes are oftentimes “well meaning people” with “genuine desire” to change the world for the better (2005, 960). As Sheppard explains, Blaut’s model can be seen today as a reinvented version of the “spectre of the white man’s burden, albeit now shouldered by a progressively diverse global elite” (2005, 961). Sheppard echoes Quijano’s insight that “United States elites are at the center of this ideological hegemony” wherein the “impulse to civilize, common to colonialism, flies in the face of increased inequality of wealth and opportunity, at multiple scales” (2005, 560; see also Sheppard and Nagar 2004). How does western diffusionism as a belief system circulate through narratives at PMCA? Chapter four addresses this question in detail, the 11 data revealing how narrative is useful to more fully understand the global narratives that dominate the PMCA annual gala. Medical Anthropology Medical anthropologists Cheryl Mattingly and Paul Farmer, both ethnographers who deal with narrative and discourse, each provide crucial perspectives for my work. Following Mattingly’s idea that narratives function as theoretical interventions, my data analysis chapters focus on how storytelling practices are spoken, lived, and enacted. Mattingly’s work centers on narratives used by the “network of actors” […] “who try to make practical sense of [serious illness] and decide what can be done about it,” (1998, 267). Mattingly explains that the concept of “moral willing” is most dominant in healing narratives, not the practical reasoning that she expected to find at the onset of her work (2006). These everyday stories center on explaining how “the self that is narratively constructed is not an individual achievement but a self constructed in a community” (2006, 33). Narratives that dominate the medical worlds Mattingly examines are reflexively spatial, “always constructed by reference to some defining communities” (Mattingly 2006, 33). Dialogical self depends upon what Taylor calls “webs of interlocution’” a concept that emphasizes how identity is not formed in a vacuum but only through interactions through a variety of social worlds (Taylor 1989, 22, in Mattingly 2006, 33). The webs of interlocution that Mattingly notes as a component of narrative construction are potentially distilled by combining spatial theory with narrative 12 theory to show how people use narratives to make sense of what is going on in their various social worlds. Mattingly analyzes both told and lived stories in medical social worlds. Mattingly defines stories as “someone trying to do something, and what happens to her and to others as a result” (Mattingly 1998, 7) 2 . This is a corrective to earlier work in narrative theory that divorced lived and told experiences (Mattingly 1998, 37). Separating narrative from experience, Mattingly explains, ignores the co-emergence and engagement between the two (Mattingly, 1998, 45). The relationship underscores the role of stories as the “rendering and ordering of a succession of events into parts which belong to a narrative form” (Mattingly 1998, 46). How then, are stories lived and told by those at PMCA? Mattingly looks at how stories take two distinct forms in vernacular settings, those told in “dramatic time” where the plots reflect familiar genres like a doctor heroically saving a patient, and those in “ordinary time” where stories are told in bits and pieces, the parts often repeated over days or weeks, using vocabulary that is often unique to the social group (1998; 2006). My work analyzes narrative forms from PMCA’s printed materials as well as in the context of lived actions and experiences, as “the issue is not what a story is, as some kind of text, but what a storytelling episode is- and does- as some kind of social act” (Mattingly 1998, 7). What discourses intersect at PMCA and what is their role in the spatial narratives used by PMCA? For instance, when PMCA publications say “Geography [sic] shouldn’t be the reason a child lives or dies” what discourses are being referred to? Paul Farmer’s 2 Emphasis in original. 13 scholarship on the growing outcome gap in terms of global health distribution and disparity provides a context by which we can better understand and evaluate PMCA’s work. His perspective as a doctor, an activist, and an ethnographer inform his tripartide critique of anthropology, human rights, and medical discourses in case study work that centers on the “creation and maintenance of [infect ions disease] disparities, which are biological in their expression but are largely socially determined” (1999, 4). Here, Farmer calls for “biosocial analysis” that connects clinical medicine, social theory, ethnography, and political economy, using case studies as the best lens to conduct a “critical reassessment of conventional views on human rights” (1999, 4; 2005, 19). How is Farmer’s critique of human rights discourse useful in understanding organizations like PMCA? He explains that while health and human rights advocates argue for the “equitable distribution of the fruits of scientific achievement” in practice public health ideologies favor “efficiency over equity” (2005, 18). Farmer thinks that only looking at the medical world will never solve the problem of sick people—you have to look at the total social picture. Or, as Farmer frankly states: “only if unnecessary sickness and premature death don’t matter can inegalitarian systems ever be considered efficious” (2005, 19). Here, Farmer sets up the context by which we can better evaluate and understand PMCA’s work. Farmer and Campos charge that this failure to acknowledge the “millions [that] are still denied the chance to become patients” contributes to an ongoing “slick ruse to distract us from the fundamental ethical problem of our era: the persistence of readily treatable maladies and the growth of both science and economic inequality” (2004, 250). What Farmer and Campos present as a 14 connection between health, social, and economic rights that is avoided in bioethics discourses, insisting that researchers must “resocialize the way we see ethical dilemmas in medicine. Restoring such problems to their full social complexity is our best vaccine against ignoring large segments of the human race” (2004, 250). How is “full social complexity” of global health inequality exploited by PMCA in various storytelling practices? Farmer and Campos’s recommend more research that focuses on how the most affluent people on the planet are part of this “full social complexity” (2004). My focus on elites has potential to illuminate “the social machinery of oppression” and “the impact of extreme poverty and social marginalization” that are pervasive in both symbolic and material forms including narratives about place (Farmer and Campos 2004, 307). As Farmer and Gilmore both remind us, when this complexity is experienced via premature death and epidemic disease, both pragmatically and conceivably preventable, well documented, and persistent, the “final common pathway” of these discourses is in the material (2004, 308). Human Rights How are narratives of human rights incorporated into conversations and also evident throughout PMCA publications? Extensions of Giorgio Agamben’s work on spaces of exception informs a critique of the cultural political context from which PMCA emerges. A discussion of the assertion that modern human rights have a “Western” origin, a complement to Blaut’s model of the world and also as a contest for 15 understanding more fully the highly contested nature of “universal” human rights, is necessary in my work to analyze how narratives of human rights are used by PMCA. An extension of Giorgio Agamben’s writings on states of exception, spaces of exception are those where political and civil rights are disallowed, like war camps, functioning as a legitimating complement to state sovereignty (Agamben 2005, 1). Current scholarship on spaces of exception examines spaces wherein humans are excluded from civil, human, or other types of rights (Sparke 2006; Gregory, 2006). My work looks at narratives of exception rather than literal spaces of exception. In human rights discourse when Article 25 of the UDHR is cited this is one such narrative. The Universal Declaration of Human Rights was ratified on December 10, 1948 by the member states of the United Nations. Its thirty articles outline “the rights which belong equally to every person” (UNDP, 2). Article 25 (1) begins “Everyone has the right to a standard living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care” (UNDP, 11). Article 25 is used by politicians, scholars, and activists to affirm health as a human right. Here, all people are entitled to health care and those that lack health care are outside of human rights laws that should include all humans. Therefore a narrative of exception is used when those who work for access to “standard living adequate for the health and well- being of himself and his family, including food, clothing, housing and medical care” (UNDP, 11). These juxtaposing worlds of outside-human-rights and inside-human-rights complement Blaut’s writings on Western Diffusionism discussed in the geography section earlier in this chapter. 16 How are narratives of exception used by those at PMCA to do their work? My evidence and analysis looks at how PMCA narratives create and reinforce their ideal patient. Through incorporating narratives of human rights into their work PMCA casts those they help as outside of human rights, and it is the acts of PMCA that seek to bring the subject into human rights. Without some subjects being “outside” of human rights law PMCA’s goal of bringing human rights could not exist. This narrative of exception create the conditions for PMCA to exist. This is seen most directly in the narratives of the ideal subject of PMCA, the story of the child that can be saved from eminent death. Narratives about PMCA patients are an example of a narratives of exception at the scale of the body. Here, narratives of exception work as legitimating discourses of the very systems that created the conditions that produced the conditions from which the exception was originally drawn. For example, the places where PMCA does its outreach are outside of human rights law, and therefore the bodies are outside of the human rights law, and therefore abject. Contradiction lies at the heart of PMCA, a charity whose efforts center on the process of selecting patients for surgeries that are not available where those patients live. The diseases that are readily treated in the US are not treated in the countries the sick- and-dying children come from. Following Fregoso, my work aims to account for the contradiction between the visibility and invisibility of the transnational-subject-patient, aka exceptional body space, by juxtaposing the public discourse of the charity with the broader context of health outcome inequalities that this discourse is embedded within (2003, xiii). At PMCA the subject is drawn from an abject subjectivity, the scale of the 17 body taken outside of the community wherein premature death is the foregone conclusion of illness, the community being outside of the laws of universal human rights. Taken with the apolitical culture of PMCA, a situation exists where transformation becomes possible at one scale without the interruption or interrogation of other related scales. Analysis of the data in chapter two illuminates how narratives of exception are produced and maintained across myriad scales, ranging from the body to the global. In other words I will analyze how social categories represent abject subjects (implicitly) via the inclusion of particular subjects (explicitly), drawing connections between these contradictory processes, explaining how they are mutually reinforcing. Complementary to Blaut’s writings on Western diffusionism, another contribution from critical human rights scholars is the assertion that modern human rights have a “Western” origin. When human rights scholars say this there are two things going on. First, there is a critique that modern human rights discourse is reflexively linked with Western diffusionism, and therefore colonialism. At the same time there is the uncritical normative take wherein the modern human rights movement as “Western” is reflexively unique, ideologically superior, and innovative. The “Western” origin of human rights both in terms of theories of diffusionism stemming from the Enlightenment aka the colonial encounter, and also in terms of the 20 th century post World War II establishment of the United Nations, both show how these moments have in common the a-historicizing of viewpoints that do not emerge from Western cultural roots. Rather, their legacy is widespread and a contemporary world order organized in terms of structural violence has been responded to by various movements in terms of what Nancy Scheper-Hughes 18 describes as a “new kind of theodicy, a cultural inquiry into the ways that people attempt to explain the presence of pain, affliction, and evil in the world” (2000, xii). How are modern human rights are an extension and legacy of Western Enlightenment? How is this useful in understanding a self-described “humanitarian health care organization” (PMCA mission statement)? Rights are stories that are vibrantly lived, longed-for, abused, or ignored through the production and circulation of powerful narratives that shape both the formal and everyday stories that people tell about real and imagined places. While important and powerful human rights also can be used materially to reify inequality even though the discourse claims to establish radical “equality.” Following Gilmore, in my work I show the limitation of “human rights practice” on the one hand while highlighting, through absence, what “practical human rights” might consist of (Gilmore, forthcoming). These contradictions can be traced to the hierarchies embedded in the “universals” of European Enlightenment, but the concept of radical equality is neither the invention nor the wholly controlled property of the Enlightenment and its reform-minded epigones. Most important, framing rights as Western disavows legacies of patriarchy, imperial racism, and the fact that human rights violations are the products of western imperialism. When the position is put forward that modern human rights have a “western” origin, this refers to enlightenment discourse wherein the rights of man became a foundation for understanding humanity. The “rights of man” explains Walter Mignolo, were the discursive and material effects of political and legal conditions that complemented the colonial encounter and the emergence of the market economy in 18 th 19 century Europe (2005). In this context of capitalist imperialism, the co-emergence of a market economy in Europe and the relentless invasion of the Americas, white (this too a relatively new concept of the time) social elites began to legitimate the very process of legitimacy when it came to determining who emancipation (aka the rights of man) would apply to, an antecedent of contemporary human rights discourse (Mignolo 2005, 51-56). Mignolo’s explanation of the processes that emerged in the context of conquest via which humans were ideologically transformed into non humans is useful in understanding the range of consequences that emerge from the diffusion of Enlightenment concepts (2005, 51-56). Anibal Quijano adds to Mignolo’s insights with analysis of this geneology of in the context of Latin America (2000). Quijano explains coloniality of power as the Eurocentric social geography of capitalism. Quijano shows how what is ‘known’ is distorted by what may be ‘reasoned’ and how models of power like the rights of man are designed to legitimize old ideas, for example globalization as the latest iteration of a “civilizing trajectory from a state of nature” (2000, 542) supported by a “theory of history as a linear sequence of universally valid ideas” (2000, 550). His explanation moves beyond identifying factors included in the “civilizing trajectory” of Eurocentered modernity to “spread with virus-like cunning and totality” in Latin America (2000, 542). Quijano shows how these ideological trajectories shape how theory and knowledge come to take form, for example how theorizing race became possible as a consequence of the radical separation of the body and the non-body in Christian theology (2000, 554). Here one can think of the colonial encounter as both the birth of the modern notion of human 20 rights (universalism) as well as a relational concept that was only possible vis-à-vis the native Other encountered through the expansion of technologies of colonialism (Quijano 2000; Quijano 2007; Fregoso 2007). Coupling universalism and human rights implies a logic of progress as the concept of coloniality, a framework that extends the logic of patriarchal domination (in order to achieve progress aka modernization) even after the colonial encounter ends (Mignolo 2005 6-7). In other words, 18 th century notions of autonomy and emancipation within a global colonial system of racial regimes buttressed by gender regimes were developed as the rights of man which in turn function as the origin of the modern human rights system (Fregoso 2007). In this way human rights also functions as an idiom of Western hegemony. To say that human rights have a western origin is to recognize the legacies discussed above as well as problematize the “universal” framing of modern human rights which many scholars argue is better understood as “particularistic Western values masquerading as universal concepts,” namely individualism, patriarchy, and cultural imperialism (Bell, Nathan, and Peleg 2001, 5). The framing of human rights as “western” also ignores non-European oriented contributions to human rights discourse (Carozza 2003; see also Glendon 2003). A number of non-Western philosophical traditions, both written and oral, have complex ideologies of justice, obligation, and reciprocity that are not reducible to, but do not altogether ignore, the “rights-bearing subject” (Gilmore, forthcoming). How are these “practical human rights” incorporated into the narratives of PMCA? My analysis in the data chapters looks both at narratives of “human rights practice” and of “practical human 21 rights,” noting that the second group of narratives are often best understood through absences in the prevalent stories of PMCA (Gilmore, forthcoming). Using the work of the scholars discussed in this and the two previous sections, my analysis looks beyond the “western” origins of modern human rights that are most dominant in the narratives of PMCA. Using the challenges of these scholars as a guide I look at how PMCA narratives of global health inequality reinforce the very processes that PMCA programs are aimed at eradicating. These challenges function to reverse the processes of elision, ignorance, and disavowal that the assertions of modern human rights advance, opening the capacity for, as Rosa-Linda Fregoso explains, “shaping new understandings of human rights and re-imagining new democratic possibilities and subjectivities” (2006, 2). Next I will discuss the data for this project and the methods for analyzing the data. Methodology: Framework, Fieldsite and Data I employ Sally Engle Merry’s deterritorialized ethnographic approach (2006). Three of Merry’s guiding principles complement this dissertation. First PMCA is a site through which we can understand how meanings generated in global discourses are remade in the vernacular because it is “specific places where transnational flows are happening” (Merry 2006, 1). Second PMCA enables thorough documentation and analysis of the fieldsite’s cultural norms and assumptions-- what Merry calls the “rules people carry in their heads,” -- along with the consequence(s) of those rules, the juxtaposition of these rules when contradictory rules are encountered, and the resulting negotiations and transformations (Merry 2006, 3). Here the spoken, visual, and 22 performed texts of PMCA illuminate these rules as theoretical vernacular interventions 3 . The third of Merry’s principles critiques the compatibilities and incompatibilities of “universal principles” across differentiated scales, even when both have similar aims (Merry 2006, ch. 4). PMCA is a site through which to illustrate and analyze how people’s interactions with a medical matchmaking charity extend far beyond the immediacy of the sick-and-dying child, while at the same time this capacity also enables that immediacy to be taken seriously as an intervention in response to global health inequality. A self described humanitarian health care organization, PMCA features quotations from international human rights groups like UNICEF, and its most commonly used slogan is “Geography should never be why a child dies,” -- evoking a utopian global imaginary wherein health inequality is eradicated. Merry’s approach pays attention to how global ideologies inform communities and how these in turn affect global human rights. Merry’s guiding principles informed my ethnographic method. For this ethnography I immersed myself in the social world of Southville and of PMCA in order to become fluent in the vernacular of the spatial narratives that were observed, documented, and experienced. I incorporated as many ways as I could to see and experience PMCA both in ways both formal (such as attending staff meetings) and informal (such as overhearing people at the local farmer’s market have a discussion about 3 I am aware of a rich tradition of “vernacular theory” in African American literary criticism, and recognize Merry’s formulation employs similar terms but on different grounds. Merry’s work on global human rights regimes looks at the “cultural flow” between the United Nations and local activist groups all over the world. Merry analyzes how local groups explain and understand what is going on in terms of violence and inequality and uses “vernacular” to categorize the “rules people carry n their heads” in order to understand and respond to human rights abuses. 23 PMCA). Guided by research experts Denzin and Lincoln who note the “multiple approaches to narrative, storytelling as lived experience, narrative practices and narrative environments, the researcher and the story, auto-ethnography, performance narratives, methodological and ethical issues, big and small stories, content analysis, going beyond written and oral texts, narrative and social change, collective stories, [and] public dialogue” (Denzin and Lincoln 2010, 415). I chose PMCA for this project after a six month case selection process based on the following criteria: granting me access; located in a familiar cultural environment; has a small staff; provides outreach that is significant in the regions where they work; has a good reputation in their field; regularly produces printed solicitation and promotional materials; has high donor participation; has a small group of donors; and has an economically elite group of donors 4 . Three stages were involved in this representative case study: indirect data collection, direct data collection, and data analysis. First, indirect data collection consisted of assembling a public archive of PMCA. The data set consists of the body of printed and web based materials, including but not limited to the charity’s web site, newspaper articles about the charity, invitations and other mailed materials sent to potential donors, materials from fundraising events, and any useful secondary sources, for example lifestyle magazines published locally in Southville that inform the cultural norms of the charity’s donor class. Concomitant was the second stage of this research, direct data collection, in the form of nonparticipant and participant observation in various charity settings with the 4 See Appendix B: Data and Methods 24 purpose of documenting spatial practices and cultural norms within the social world of PMCA. This stage consisted of more than a year of cumulative residency in Southville. I was granted access to PMCA’s offices, I was permitted to attend PMCA meetings, and I was granted access to PMCA’s annual charity gala. I observed daily office interactions, attended staff meetings, attended board meetings, and spent my year of cumulative fieldwork living in Southville during which I attended community and cultural events 5 . I conducted interviews with people who participate in PMCA, and I conducted in-depth interviews with over twenty people including employees of PMCA from the past ten years. The third stage, data analysis, involved collation and synthesis of both data sets. I identified recurrent visual, spoken, and enacted spatial narratives used by the charity. PMCA is like all complex social worlds in that it is only usefully understood in terms of its complexity. For this reason the data were analyzed using complementary qualitative methodologies, including narrative analysis, visual analysis, discourse analysis, place frame analysis, and membership categorization analysis in concert (Dittmer 2010; Mattingly 1998; Martin 2003; Housley and Fitzgerald 2002; Crang and Cook, 2007; Watson and Till 2010) 6 . This approach is a geographic one and therefore focuses on how places are produced, in this case through the use of storytelling practices. As people participate in place making, building the capacity to do something, decisions must be made along the way and these decisions are animated through lived, written, and spoken 5 See Appendix A: Interview List and Research Time Line line. 6 See Appendix B: Data and Methods. 25 narratives. Place making is done within the cultural constraints of already existing places that are constantly in flux as transformation is a constant process in all social worlds. This dissertation provides insight about potential sites for global justice interventions within the context of everyday cultural politics. Understanding the relationships between the spatial narratives and spatial practices that intersect at PMCA contributes to critical scholarship that seeks to understand the world in order to change it. The evidence, while firmly rooted in material interactions- public relations, NGO office culture, and fundraising- is embedded in a narrative or story arc which itself partially constitutes the ways in which places are made, experienced, understood, and differentiated. These everyday cultural practices are situated at PMCA, chosen for the contradictory nature of the many places and people who intersect there. In short, I seek to achieve anthropologist Jane K. Cowan’s insistent call for “empirically grounded studies of rights and culture” [that] “confront us with- and force us to grapple with- the messiness, contradiction, ambiguity, impasses, and the unintended consequences that neither neat and tidy theory nor the best-laid plans for political reform can ever fully anticipate” (2006, 21). What are the everyday cultural practices of PMCA, what spatial narratives are identifiable within then, and what are the range of consequences of these narratives? These questions will be asked and answered in the following three data chapters beginning with an analysis of the public printed materials archive in chapter two. After this I analyze the everyday office culture of PMCA, and then the life cycle of the TGA gala. 26 Chapter Two: The PMCA Archive and the Scale of the Body “It’s that Carribbean smile. Those kids. They just can’t help but make you love em. I just wanna eat em up. It’s like they don’t even know where they come from. Oh that smile.” –Heather Cardin, PMCA public relations staff Healing children. Restoring families. Empowering communities. –PMCA 2002 Annual Report Cover Headline. To heal a child is to heal the world. –PMCA promotional slogan used in printed materials. “Some healing hands pick up a scalpel, others pick up a pen.” –Dr. Warren James, PMCA Medical Director. Quote used in PMCA promotional materials. What’s routine for us is a miracle for them. –PMCA promotional slogan used in printed materials “Our story is so visual.” –Victoria Conway, PMCA President 7 . This chapter looks at how scale and narrative are used by those who participate in PMCA to produce and differentiate the body that gives from the body that receives, through the normalization of narratives of place-based differentiation. The data analyzed are the public printed materials that are used to explain the mission, programs, and merit 7 I noted Conway’s use of this sentence over 100 times during my fieldwork at PMCA. This statement is almost always incorporated into the beginning of formal PMCA presentations, face-to-face potential new donor solicitations, and press interactions. 27 of PMCA. Using ten years of published materials produced by PMCA -- including annual reports, advertisements, informational materials for potential financial and in-kind donors, and website content -- I show how those who manage PMCA use visual images as narratives that evoke place in a variety of ways to explain both the condition of children and their families who are threatened by critical illnesses and the capacity to respond to those threats. The role of the visual in these materials is paramount as these images are chosen for their capacity to evoke a response by the donor base that secures the financial viability of PMCA. The visual narrative of PMCA is key to its success and that success relies upon a particular construction of the body. Creating and maintaining the network of financial donors and medical volunteers requires those at PMCA to be fluent in recognizable visual cultural texts. The body is not the only scale that is created, reiterated, and differentiated in the visual imagery of PMCA. On the contrary, the body as a distinct and recognizable place relies on the maintenance of cultural, racial, gender, and economic differentiations that are strategically addressed through narratives in the PMCA archive where bodies of the patients, doctors, donors, and staff must be calibrated appropriately both through explicit decision making and also indirectly, using what Merry refers to as the “rules people carry in their heads” (2006, 2). More than ninety percent of PMCA donations come from people who know PMCA board members, volunteers, and/or staff personally, and none of those groups are mutually exclusive. PMCA is a small organization with a high dependency on donor remittance. It is not enough that they portray themselves as professional but must also win a social popularity contest in Southville. The staff must 28 create visuals that sustain interest and do not offend the base. This is no small task; rather it requires painstaking attention to detail and a coherent aesthetic. It is often said at PMCA that “it’s all about the kids,” therefore any serious consideration about the body must begin with how the children that PMCA helps are understood both through the protocols of PMCA programs and also in the PMCA public archive. PMCA is considered an innovator in the field of humanitarian outreach in part due in part to their ability to connect with children and their families on a personal level 8 . Tens of thousands of children’s health outcomes are improved each year as a result of large scale prevention programs and health initiatives that are created by PMCA, for example through the creation and implementation of a folic acid distribution program via midwives in one Central American country resulting in an unprecedented ninety percent drop in the rate of hydroencephaly, the birth defect that folic acid prevents (PMCA annual 2005 report). However this program, and other PMCA programs that look at underlying problems of health inequalities, are underrepresented in the PMCA promotional materials. Instead the press archive is mostly focused on the less than one hundred individual patients who receive lifesaving surgical care annually as a result of PMCA’s efforts. From these only a handful are chosen to be featured in the promotional materials. This subset of images comprises the narrative of the PMCA subject as represented through the visual in the public archive. 8 These connections that PMCA is known for are truly unique in their field. The PMCA volunteer physicians almost always make multiple year commitments, returning to the same locations each year and more often than not these doctors train medical staff in the countries where PMCA programs exist and reconnect with former patients year after year. 29 The entire range of geographies that are brought together by PMCA are illustrated and literally personified by these visual narratives of children. The visual data in the PMCA is analyzed for how the narrative of the scale of the body is constructed as the body is the scale where spatial inequality takes the form of illness, wellness, death, and life (Nagar et.Al. 2006; Gilmore 2002a; Swynegedouw 1997a). The ways in which the patient criteria are reflected in the images used in publications, especially the selection of which patients to “feature” in these publications, further reveals how the images of children both do and do not represent the broader context of the charity’s efforts. The selected images must appeal to the local elite donor base and it is their norms that the press materials are calibrated to, and PMCA’s mastery of the social codes of this donor base is foundational to its fundraising successes and the resultant financial viability. Scale, Smith reminds us, “defines the boundaries and bounds the identities around with control is exerted,” in the PMCA archive the control of the narrative of the scale of the body via the strategic inclusion and exclusion of visual materials that are strategically aligned along axis of embodied differentiation (1992a, 66). The Upper South USA, where PMCA is located and its elite donor class has been entrenched for generations, has a well documented past where racial hierarchy is central to the social order. The data examples in the next section show how this racial hierarchy is reflexively incorporated into the narratives of the PMCA public archive. The history and continuing effects of racism in the US South is well documented. Despite an imagined geography of Southville that has transcended its legacy of racial discrimination, inequality persists in every category of Southville economic, educational, and health statistics, and countless referential statements and actions to embodied differentiation are ubiquitous in Southville 30 (Hodder 2002; Butler, 2006). The word “invisible” is misleading to refer to this set of understood racial cues because even the nonverbal communication, understood by natives of the region, contributes to the reproduction of social power the legacy of which extends back over hundreds of years, and as Clyde Woods reminds us is not merely a geographical backdrop but persists as “a whipsaw of social, cultural, and physical destruction [that] seems invisible to all but its amputees” (2002, 62). My project aims to look at examples of how the spatiality of race works in the context of PMCA, following Laura Pulido’s recommendation to conduct research that adequately addresses persistent processes of social reproduction involved in the creation of spaces of white privilege in particular (Pulido 2000; Pulido 1996). The visual images that work as spatial narratives in PMCA’s public archive reflect an oversimplification of racial differentiation, as the data will show. Interviews and non-participant observation show a pattern of referring to groups of people as White, Black, and Latino/Hispanic/Brown, and the choices made for images to use in publications further reiterate this oversimplification. Here I follow Smith looking at how the scale of the body is the site at which geographies of social differentiation are most explicitly constructed (Smith 1992a, 67). Southville is unique in the region especially in the case of perceived racial homogeneity. In the 2000 US Census ninety-eight percent of Southville’s population reported as identifying with one race, in a state where one in six people identify with two or more races. This suggests that either there are less bi-racial people in Southville than elsewhere in the region or that people answering the census questions consider themselves affiliated with only one racial group despite family composition. Of that ninety-eight percent, Southville is fifty-seven percent Black, thirty-eight percent White, 31 and three percent Latino/a, the last number markedly lower than the US South overall where Latino/a immigration has accelerated in the past several decades (2000 US Census). Southville is also segregated, experts noting “two Southvilles: one Black, one White,” 9 in neighborhoods, schools, churches, recreational sports leagues, restaurants, and theaters (Austin 2012, 1; Steins 2005, 2). Describing Southville as two cities, one White and one Black, was shared by many interview subjects and also was readily observed everyday that I spent in Southville during my fieldwork. If there are two Southvilles which one is PMCA a part of? The PMCA donor class is mostly, but not exclusively, White, some of whose families have lived in Southville for generations. Communicating effectively with this group of donors is what makes PMCA’s work possible. My work’s analysis of the narratives of PMCA is an analysis of Southville as understood by White Southville’s philanthropic elite. In the data that comprises the rest of this chapter I follow Austin using the “terms ‘Black and White’ [to] take the place of ‘African-American and European American’ to show’s Southville’s shallow prejudice as honestly as possible” (Austin 2012, 1). Black Southville and White Southville are both economically, politically, and socially diverse; Nevertheless socio- cultural interactions, including those of philanthropic participation, are marked by the differentiation that Ausitn notes (2012). PMCA is a charity whose donor base is almost exclusively from elite White Southville. The next section will explore five examples that work together to show how the visual narratives of PMCA’s archival materials construct the body as a place where the cultural politics of PMCA are produced, negotiated, and reinforced. This is especially, 9 The name of the actual city has been changed to its pseudonym Southville. 32 but not exclusively, seen in the case of the children chosen to represent those who receive PMCA’s medical services. The stability of PMCA is dependent on these images that are vital to the integrity of the organization and the capacity to meet its goals. Integrity depends upon a strategic use of the racialized and gendered context that the organization operates within. Those who participate in PMCA are not only involved in the production of distinct spatial narratives but are also participating in existing spatial narratives. These metanarratives can provide clues to the reproduction of structural inequalities vis-à-vis stories of human differentiation that are normatively left unchecked. While the archives of the PMCA published materials are the primary data source for these examples other complementary data are used when needed, especially the more than twenty hours of interviews that I conducted with the PMCA development staff that were specifically devoted to why certain photos and children’s stories were chosen in PMCA publications. The examples of PMCA narratives in this chapter are divided two groups. The first group are narratives of the PMCA subject patient, a strategic and specific narrative of an idealized patient that is compatible with the normative socio- spatial discourses of the elite philanthropic donor class. This narrative is represented by images of children in the PMCA publications. The second group of examples are narratives of Southville participants in PMCA as presented in the archive, and how these images produce and maintain the integrity of differentiated hierarchies that elite philanthropy simultaneously seeks to alleviate while at the same time reinforces. 33 The Children of PMCA When PMCA president Victoria Conway says “our story is so visual” she is primarily referring to the images of the children toward whom the PMCA’s outreach is aimed. The archive reflects what PMCA President of Development Gail Doyle explains is the most important factor in creating a successful PMCA publication, that it is instantly appreciated by the target donor class due to its stylistic resemblance to media that the elite donors of Southville are accustomed to. PMCA decision-makers intentionally developed a particular quality of photographic documentation, images that work to produce an aesthetic of high-end philanthropy, in order to connect with the target donors. Three years after PMCA’s founders began their outreach programs in Central America and the Caribbean Victoria Conway was recruited to become the charity’s President. One asset that won her the job was her ideas about the type of photography that she insisted should be used by PMCA. Conway’s first career was as a high fashion runway model in Southville, New York City, Paris, and Tokyo. During that time she formed a close relationship with noted fashion photographer Posy Rudy who decades later would become the sole photographer whose work is featured in PMCA publications. The impact of the decision to hire a fashion photographer whose work prioritizes creative composition over journalistic documentation was noted in several interviews as a key to PMCA’s reputation as a status symbol in Southville. Rudy is considered an expert on not only fashion trends but also “cultural and social trends ahead of the curve” as put by one PMCA board member. PMCA has paid for Rudy to go on several surgical mission trips and she also photographs activities in Southville and the annual gala. In several PMCA publications there are tributes to Rudy’s contribution to the organization, one 34 example being the 2005 Annual Report where the inside of the back cover has a photograph of Rudy on the bottom third of the page. The top two-thirds of the page, a two sentence paragraph written in very large font, explains PMCA’s enthusiasm for visual storytelling, stating: … It is impossible to put into words the miracles our volunteers and donors work, but with [Rudy’s] help, you are holding these young lives and their stories in your hands.” –PMCA 2005 Annual Report Just as Rudy garnered success for her ability to capture the normative conception of beauty ideals, for PMCA she captures images of their ideal subjects. Many in PMCA cite the organization’s success in becoming the “it” charity in the elite community of its donors to their focus on positive outcomes, rather than honing in on the negative aspects of the global health inequalities that the organization works to alleviate. One high level staff member explained to me that for PMCA’s donor class “sob stories” don’t work because they cause too much discomfort to most of those who have lived a life of exceptional privilege. Some board members and staff contend that the choice to use a fashion photographer as the documentaritan is “the secret to PMCA’s success” as her images are automatically identifiable by prospective donors who “are more likely to read Vogue than National Geographic.” Over the course of my fieldwork I attended meetings where PMCA PR materials were created, and I decision-makers, discussing the motivations and choices behind over 100 published PMCA materials. The use of Rudy’s photographs in PMCA publications has expanded over time, as visual images have gained prominence over written text. The PMCA public archives are not void of written text but words are 35 intentionally kept to a minimum, especially in the last three years as a result of donor feedback that publications had too much to read in them. The result of these collective PMCA decisions are visual narratives of an idealized patient, one that potential donors will hopefully identify with immediately and effortlessly incorporate into a cultural script that prompts them to donate money and/or resources to PMCA. These visual stories are spatial narratives, working to produce and reiterate both a real and imagined place where PMCA intersects with donors and patients, via the scale of the body. Following Smith I look at how the construction and reinforcement of these narratives requires the incorporation of various boundaries of identity marked by difference (1992a, 64). PMCA President of Development Gail Doyle is the final authority, along with Conway, for press documents. According to Doyle, although only forty percent of images in the photographic database are of patients, more than seventy percent of images used in publications are of patients. Doyle encourages this practice as images of patients are the most effective in terms of resulting donations. The centrality of the individual patient- only one part of PMCA’s work- is evident throughout the publications of the charity. The visual narratives of these bodies are reflexively spatial “always constructed by reference to some defining communities” (Mattingly 2006, 33). The PMCA offices are decorated almost exclusively with large canvases upon which Rudy’s photographs of PMCA’s patients are featured, as are the publications. Some within the programming staff would prefer less focus on these images as they feel that this limits the capacity of PMCA to expand its donor base beyond the core of the Southville elite. However, Doyle insists that it is the perception of an intimate connection between donor and patient that is foundational in PMCA’s fund-raising 36 success. She contrasts this approach to that of large scale NGOs where she worked for decades before being recruited to join PMCA. In those organizations the messaging had to be generalized in order for strangers to make enough of a connection to solicit small donations in large numbers, and also to connect with multinational companies that could perceive that their significant financial involvement would be, in Doyle’s words, “good for the world and also good for their public image.” Corporate personhood critiques aside, this strategy for donor solicitation contrasts with that of an organization as intimate with its donor base as PMCA. At PMCA Doyle knows every donor who contributes $1000 or more each year by name, many of whom provide unsolicited input into the messaging of the organization. Reiterated in interviews and at PMCA meetings, this donor feedback is one of the reasons for the centrality of the strategic use of images of patients at PMCA. Thus, the public materials of PMCA are an ideal source to identify the cultural expectations of the mostly white, mostly heteronormative married family-based, and mostly regionally native, elite donor class. Doyle considers part of her role as the development director of PMCA to include input from the top donors whenever possible. This sometimes contributes to agitation between the development staff and the program staff who in many instances expressed that their programs could be better represented in the PMCA-generated-press. Doyle explains that potential donors need to be “presented with the most simple story possible that they can imagine themselves in, and if we get too deep into the programs we lose them. They see these beautiful children and they want them to have a better life. Once they get more involved they can learn about how that works but if they don’t get the hook right away we never get that chance.” 37 Still, there are contradictions that sometimes exist between the narratives that the images represent and the actual PMCA programs, and these contradictions only further underscore how the press materials use a subset of actual images to present an ideal subject for donors to identify with. This contradiction also reiterates the analysis of human rights expert Upendra Baxi who traces how market forces are of increasing importance to humanitarian NGOs and oftentimes occlude the original intentions of charitable organizations (2005, 2006). The difference between the full scope of PMCA programs, many of which are focused on prevention and training programs, and those presented in the press materials which disproportionately present individual patient stories, is a source of disappointment for some in PMCA. In particular the programs staff regularly express frustration about the publications not including more information on the programs that do the best job at addressing global health inequality, the prevention and capacity building programs. During these amicable discussions programs staff members suggest that not including the full scope of PMCA programs may be “misleading,” “unethical,” and “unprofessional.” The development staff makes all final decisions for PMCA published materials however and their fundraising experts insist that the charity’s donor base expects and responds most favorably to the stories about the children. Images of the bodies of the idealized patients enable a particular process of identification to serve PMCA’s fundraising needs, and in doing so also create a subject that receives aid. A potential donor must then not only identify the image as representing a narrative of legitimate and urgent need, but be led through the process of identification in a manner that prompts a specific reaction. It is not enough that the Southville donor base identify the children of PMCA as in need, they must also identify themselves as the 38 appropriate avenue for alleviation of the perceived suffering. This identification process is a narrative of the body and scale, wherein the donor response centers on identifying a subject as removed from available resources that are taken for granted by the donor. Here donors must identify the subjects of PMCA publications as abject, and also must identify themselves as valuable in contrast. This is achieved via the visual cues that the narratives of the bodies in the publications provide, casting donor and patient into a narrative arc that prompts the response of the donor making a financial contribution and thus reinforcing the narrative and the places created within. The spectrum of humanity that is suggested by this process of abjection wherein resource allocation is central in how life is valued already exists as a cultural backdrop to the more particular narratives that the children’s images evoke. So who then is the PMCA subject that can be saved by proxy through the contributions of donors? Creating the PMCA Subject In this first example of PMCA's spatial narratives, the scale of the body is a narrative about youth, potential, happiness, and innocence. Visual narratives create a kind of place, the body, with particular qualities. Four qualities mark the place that is the body of the ideal PMCA subject: a specific age range, affect, race, and gender. While there is a range of representation in all four of these categories, analysis of the PMCA archive, augmented by interview and observational data, reveal patterns that coalesce into a visual narrative of the body produced by PMCA. This narrative is created to be recognizable and palatable to the PMCA donor class. The most successful visuals of the scale of the body are those that are reflexively understood by the donor base immediately and capable 39 of eliciting a financially favorable outcome for PMCA. The first identifiable public spatial narrative that is part of the process of creating narrative of the body of the PMCA patient, is a specific calibration to what counts as a child. The age range of those who benefit from PMCA’s programs range from birth to young adulthood, but the narrative of the patient as is told via the images in PMCA publications is a much smaller age range. According to the visual narratives in the PMCA publications the children that PMCA helps are young, with a majority of featured child images ranging from ages two to ten. According to staff members images of infants result in responses that are “too emotional,” “too intense which makes people just turn the page. 10 ” Slightly older children allow donors to imagine that child’s life and how it would be changed by a donor’s action. By the time they are teenagers the imaginative capacity of saving their lives is diminished. A twenty year old is too old to save and an infant is too delicate to identify with. There are examples of patients outside of this model patient that are featured in the PMCA publications, but the majority of patients shown are young, smiling, reflexively perceived as full of potential and not yet contaminated by longer- term effects of illness. Happy child images are the foremost image in PMCA publications. When asked about why this is, interview subjects consistently spoke of the positive attitude of the very poor people who PMCA programs serve, the two most common descriptions being “precious” and “full of spirit.” This concept of preciousness speaks directly to the cultural script of Southville where this is the highest compliment that can be given about a child. 10 Any interview quotations reflect responses that occur at least five times by various interview subjects. 40 The second component of the narrative of the scale of the body is that the PMCA subject is Brown. As explained earlier in this chapter the understanding of racial categories in Southville is oversimplified, with two Southvilles, one White, from where the donor class is largely concentrated, and one Black, this Southville most identifiable in the PMCA archive via its omission. PMCA development staff members, who are in charge of deciding what images to use in publications, contend that images of children that are neither Black or White are instantly recognized by the donor class as being non- Southville. The use of images of Brown skinned children has increased in the PMCA archive over their ten years. Staff members explain that this change was needed as the donor base grew so that people knew automatically that PMCA was an “international” organization. In interviews, subjects said that the shift was due to complaints from the donor base that the kids were not “exotic,” “foreign,” “interesting,” or “beautiful” enough. 11 In the database of PMCA photos the skin color of the patients photographed ranges from very pale skin to very dark skin. But those chosen for publication are almost always within a particular range of skin color, as the narrative of Brown skin of a certain color signifies an exotic or foreign body, and one that is recognizable at PMCA. Here Brown is equated with both otherness and with preciousness, the Southville vernacular for innocence and worthiness of outreach. Particular, regional, racialized understanding of skin color, although sometimes discussed explicitly, is more often expressed implicitly via the endorsement of the chosen images. For example, I asked open-ended questions about why portraits were chosen for use in press publications. I did not ask why one skin color was chosen over another. An 11 In over twenty interviews that discussed the public archive each of the quoted words was used at least five times. 41 exception to this was when the responder explicitly noted skin color as the reason why an image was chosen, examples of which are, “he’s too dark,” “she is the perfect brown just look at her,” and “we would have loved to have used this one, but she’s way too white there, so we chose this one instead.” These direct responses were less common than responses that alluded to, rather than directly implicated, skin color. Here I used membership categorization analysis (MCA) which is guided by the notion of incumbency “by which members [of a social group] present themselves in terms of a particular category or identity” within the context of the interaction, referring to individual or sets of attributes by terms known by the social group (Housley and Fitzgerald 2002, 62-3) 12 . In other words, texts and actors deploy categories and everyday terms to refer implicitly to themselves or others, as well as to social groups to which they either do or do not belong. Housley and Fitzgerald emphasize that categories and terms are not fixed but rather “identities and roles [that] can be understood to be situated” within the specific context of the fieldsite (2002, 63). The narrative of the PMCA patient body is part of a story arc where a deserving subject receives lifesaving care by a benevolent donor. While this narrative is told explicitly through the visuals in the publications there is a deeper narrative also being reinforced in the archive. Analysis of both inclusion and exclusion of particular images reinforces cultural norms of Southville including Black children being understood as Other but in comparison to Brown children these kids are seen as less precious, less deserving of care. The PMCA development staff explains this as an appeal to the donor base that wants to give to a charity with an international focus, “more hip 12 For a full explanation of the methods used in this dissertation see Appendix B: Data and Methods. 42 and interesting than charities working in this region” (Gayle Doyle, PMCA president of development). Many of the racial references in the data were subtle and nonverbal, understood as the result of ethnographic immersion at PMCA and in Southville. For example, by tracing recurrent references over time I was able to identify when PMCA consciously seeks to make certain that Black bodies are marked as non-Southville Black children. Here narratives of bodies are more than referential indicators of place but scaled places in their own right, Smith reminding us that spatial metaphors create and maintain complex boundaries of differentiation, showing the “politics of life as inherently spatial” (1992a, 58). The motivations for image inclusion and exclusion were revealed over time by references made to particular images of Black bodies in the publications, such as “we could use this one because she is in her school uniform,” “these kids all playing on the beach are so happy, how could we not include it,” and “look at that face and smile, you only see that Caribbean smile on these kids, not anywhere else, they’re just so happy no matter what.” These comments reveal a pattern wherein explanation to justify the choice of a Black girl was required, while Brown bodies chosen for use in the archive was left unexplained. This further reinforces the understanding by those in PMCA that unless there are additional variables present, narratives of Brown children are the default PMCA patient body. For example, the 2007 Annual Report features a very dark skinned girl on the cover page. In one interview this choice was explained as follows: We just couldn’t resist using this picture because, well, look at that smile and those bright eyes. She just glows. She has the uniform on so people won’t think she’s local. Plus it’s our AR [annual report], which mostly goes out to donors anyway. Her uniform matches the logo too, which is just perfect. We just couldn’t resist her. –Dianne Doppel, PMCA Development Staff 43 Here the color of the girl’s skin is not discussed explicitly but this response is no less an explanation of the decision to use an image of someone with dark skin and the ways that local donors would be able to differentiate this girl from a Southville girl. The complexity of the narrative of the PMCA patient body is further seen through interview data. In fourteen out of twenty eight interviews that addressed the topic of the archive I asked subjects to choose between five PMCA publications and tell me which one best represented PMCA and why, and then which was their favorite and why, followed by which represented PMCA least and which was their least favorite and why. These five publications are almost identical, with the name of the charity at the top and either a small banner along the bottom with a slogan or quote, or the title of an “article” contained within the document in a borderless left hand column. Three of the images were portraits of faces: a ten year old Black girl, a five year old Brown girl, and a Brown boy between their ages. The other two images were a portrait from the waist up of a Brown Maya mother in contemporary dress and her five year old daughter, and a hospital room blurred in the background and in the foreground a White doctor with a young Brown Maya mother holding her infant who is wearing a hospital gown and cap. Every respondent to this set of questions answered using racial categories, rather than gender, age, or country of origin for example, to partially or wholly justify their responses. So, this common set of interview questions became useful for looking at how race is discussed at PMCA. In response to the first two questions the young Brown girl was chosen thirteen out of twenty-four responses, by far the favorite, with ten responses making direct reference to her skin color including noting her: “pretty skin,” “perfect Hispanic look,” “she looks so Maya and cute,” “I want to eat her up with that mocha 44 skin,” “let’s face it, brown kids are cute,” “her skin is the perfect color. Not too light and not too dark,” “looks less happy than the other girl but the lighter skin makes her cuter.” The next closest choice of the image that best represented PMCA was the hospital photo, which only one person chose as their favorite but four chose as best representing the organization, with one of these respondents remarking “It shows that white people want to help Latin people and how caring we really are,” and another stating “it shows what we do and works because the mom is there because the baby is still so young it almost looks White.” The mother and child were chosen as the favorite in four answers, with people noting “you can tell they’re Latin even though they are wearing regular clothes because of the look in her eye,” and “her love for her [daughter] is there and those sad Hispanic eyes just break your heart.” The photo of the young Black girl was chosen twice, by the same person for their choice as the favorite of the bunch and the best representation of PMCA. The respondent explained, “I like her because she is a beautiful Black girl full of confidence and sass and that picture just says it all.” These images construct a particular spatial narrative also by who is and is not preferred. In response to the second set of questions, four people declined answering and an additional four people declined to answer the second part of the question, indicating which least represented PMCA. Notably, the young Brown girl was not chosen by any respondents as being the least favorite or the least representational of PMCA. The hospital photo was chosen in three responses, one respondent saying that the use of a White doctor was “misleading because so much of what we do is not bringing kids here [to Southville] for surgeries but is helping them at home, and people think we are just one of those groups who flies White people around saving people and we’re not that.” The 45 photo of the mother and child were chosen in four responses as the least representative; all noted that neither are smiling in the photo. The least popular was the older Black child, chosen as least favorable in five instances, with respondents noting that “she looks too perfect, like a model and not a real person, and she doesn’t look sick,” “she is just missing a special magic that the other kids have. Don’t get me wrong, she’s a pretty girl, but there that something special missing,” “she is the least precious of the lot. Cute but not as precious as the others.” The choices to exclude these images further reiterate that the scale of the PMCA patient body is that of a Brown child. The third identifiable characteristic of the PMCA subject is that this subject is a she. That the common responses from the previous interview example all referred to race is interesting, especially when crosscut by the collective response to the young boy’s image, chosen by none of the respondents for any of the categories. Simply put, more than seventy percent of press images used by PMCA have at least one little girl in them, and when the subset of portraits is examined this number exceeds eighty percent. Young girls are most consistently featured in the publications, represented twice as often as other types of images, for example hospital photos taken during surgeries, family photos of patients with their parents, and images of large groups of children taken in their home villages. These images are disproportionate to the PMCA patient cases. The diagnostic medical teams do not have predetermined quotas based on gender or race, and the age limit for patients is twenty years of age which is older than some donors think is appropriate for a child-directed charity 13 . 13 The age limit is one of the specific protocols of PMCA but there were patients older than this who received care from PMCA during my fieldwork, mostly as a result of follow-up care related to earlier surgical outreach assistance. 46 When considering narratives of the PMCA subject analysis cannot be limited to young Brown skinned girls. Instead, these characteristics should be thought about in relation to the spectrums upon which they exist, providing useful information not only about the particularities of PMCA’s place-making processes but also the scales that extend beyond and within the charity. Why are babies and teenagers less appealing as subjects worth saving? Why is it thought of as less appealing to save little boys than little girls? Why are darker skinned or lighter skinned children unable to prompt the same imagined response that brown skinned children are able to prompt? What do these choices say about PMCA and the community of elite Southville donors? How do these choices reflect the values, assumptions, and hyperracialized context that Southville is embedded within? This data shows how place, here the scale of the body, is one consequence of “overdeterminations of race, gender, and power” that Gilmore reminds us are complicated, contradictory, and vital to addressing conditions of persistent inequalities such as those that PMCA’s programs are aimed at (2002a, 15). Still, if one were to look solely at the visual narratives of PMCA press documents the impression given would be that young Brown girls’ lives are saved by PMCA efforts. It would be inaccurate to conclude that since the press documents feature a disproportionate representation of young Brown girls the people who come together to form PMCA are unwilling to respond to the needs of non-Brown, non-female, babies and teens. These three examples are indicators of trends that reflect the ideal narrative that PMCA is choosing to provide potential donors. The creation and maintenance of these PMCA ideal bodies are created within the social constraints of the racialized and gendered partitioning that differentiates kinds of 47 places while simultaneously affirming their similarity. These social constraints are not just a backdrop from which these bodies emerge, but rather are reproduced by these images that contribute to the reproduction of social power and deeply entrenched knowledge systems of gender, race, and age that circulate in Southville. But of course, in order for there to be an ideal subject, its contradiction must also exist – and it does: actively participating in the production of the narrative of an abject subject is the valuable by-proxy emancipator who makes the transformation of the children’s bodies possible while at the same time reinforcing the systems of inequality that the charity’s efforts are aimed at eradicating. We shall now turn to the emancipator. The Ideal Donor: Doctors- and Mothers-by-Proxy The interplay of subjects and the proxy narratives that they evoke are required to make PMCA’s work possible. The narratives of adults do not dominate press materials but are strategic in that it is adults who must identify with PMCA as a compatible charity within which to participate as a financial donor, volunteer, or member of the public. The adult narratives in the PMCA public archive are divided into three general types: PMCA medical volunteers, donors, and staff members; adult patient-family members; and people in advertisements that appear in some of the PMCA media materials (for example, the promotional magazine insert that is published in Southville Magazine each year). Family photos, where a child is pictured with an adult, usually their mother, often accompany written stories detailing the experience of individual patients. Here, the visual narrative is often accompanied by a short written account that praises the love for and participation of the patient’s family. These “wonderful parent” stories are a consistent 48 narrative at PMCA and the use of these types of narratives has increased over their ten- year history 14 . Many within the PMCA staff feel that this is a direct appeal to the wives of prominent Southville donor families–some of whom are deeply involved in both their children’s lives and with PMCA and identify strongly with the role of being a mother. Mothering-by-proxy is a spatial narrative wherein the place of the mother next to her child defines and legitimates both the body and household scales. Here the scales of body and household via narratives of the ideal mother and child, and the related capacity to reinforce these roles by the community of elite Southville as a place of heteronormative parenting, is an example of how spatial narratives extend through multiple scales at the same time. The largest group of adult images is of doctors, PMCA staff members, and occasionally PMCA donors; the narrative arc of these images is most strongly expressed in what I call “doctor stories”. 15 With few exceptions these white doctors are wearing medical scrubs or lab coats and the photos used are of doctors with their patients, either in surgery or posing with patients at the hospitals. Most photos of staff members are like 14 These stories reflect the business practices of PMCA, the only organization of its kind that requires family participation when a child is brought to Southville from another country. Other organizations have less strict guidelines when children travel or more commonly they prohibit family members from traveling with their children for medical care, usually citing immigration difficulties and financial costs associated with having family members travel with children. PMCA is a staunch opponent of these policies, insisting that family members are crucial to the emotional well being of patients as well as being a vital component of rehabilitative care once the patient returns home. PMCA staff have gone on record with international agencies in their contention that children traveling alone for surgical care is an unethical practice. 15 There is considerable overlap, especially in the last five years, of financial donors and volunteer physicians. When I refer to images of donors I mean people whose only role is of a financial donor. There is a high visibility and strategic use of the images of doctors who donate larger sums of money however, especially in the case of those doctors who are also board members. These photographs always feature these donors in their role as physician. 49 these, with PMCA program staff members in medical attire with patients in photos taken at clinics. Infrequently there are portraits of a staff member or donor posing with a child, such as in President Conway’s annual letter to donors, as these non-candid style photographs are an exception to the dominant photos of “doctor stories.” One other notable exception is a very heavily used photograph of Dr. Warren James, PMCA Medical Director and founding board member, in a suit holding a young child on his lap, accompanied by the quote “Some healing hands pick up a scalpel, others pick up a pen.” Acting as doctor-by-proxy is central to the “doctor stories” that show the role that doctors have in transforming the bodies of PMCA’s patients, and at the same time show the role that donors can have in that same transformation. Here the donor is able to cast him or herself into the role of doctor-by-proxy. That the doctor-patient relationship of a white doctor and a Black patient or brown patient reinforces longstanding racial norms of Southville and the narrative of a global north of privilege participating in the paternalism of an underdeveloped global south. The even cruder version of this narrative, that of the white man’s burden to care for the non-white people’s of the world, is strategically calibrated within this archive. Following Mattingly I note that complexity of the consequences of reiteration of these stories into PMCA’s social world as “the issue is not what a story is, as some kind of text, but what a storytelling episode is- and does- as some kind of social act” (1998, 7). PMCA decision-makers must strategically associate themselves with what Austin explains are two Southvilles, one White and one Black, reflected in the spatiality of the city, the media, and the associations of people with one another in Southville (2012). Social geography that centers on “shallow prejudice” is reiterated in the spatial narratives presented in this chapter (Austin 2012, 1). While 50 Southville is a city with a sixty African American population, the Southville represented in the images of the PMCA archive is ninety-five percent White people. A disproportionate representation of White people in non-patient images in the PMCA archive is also seen in analysis of the advertisements of sponsors in PMCA documents. The advertisers who sponsor PMCA publications are mostly from hospitals and medical specialist facilities, investment and financial service providers, and lawyers, but this data set also includes advertisements for luxury automobiles, expensive jewelry, and air charter services. The advertisers serve as part of the visual work in PMCA publications that deliver the narrative of a particular Southville, a particular place from which giving and charity is not only possible but expected. Conclusion The identifiable public spatial narratives- that of the PMCA subject who is: between the ages of two to ten, smiling, female, and has Brown skin, that of the by-proxy emancipator who is White, affluent, and nurturing, contribute to the production of PMCA as a scaled place where “the embodiment of social relations of empowerment and disempowerment and the arena through and in which they operate” are illuminated (Swynegedouw 1997a, 169). Here the narrative of the body is enacted as young Brown girls are saved by the proxy mothers and doctors of. The undoing of the inequality that created the need for PMCA in the first place is only imagined as possible via the capacity of Southville’s economic elite. This is a paradoxical narrative wherein the undoing of inequality is dependent on the stability of the foundation of the economic social hierarchy, not to mention the racial, gendered, and generational hierarchy that is highly 51 stable in Southville.. PMCA being fundamentally contradictory is an indication of the depth and power of narratives about place, here as represented by the scaled bodies of the abject patient and by-proxy emancipator, to remain durable over time, and evidence that contradiction itself is a component of this durability. PMCA is not extraneous to the community of donors that fund its work but is a component of the social fabric of the Southville elite. This push/pull contradiction seen in the visual stories of the PMCA archive is a straightjacketed narrative wherein a person can easily insert themselves into the role of mother or doctor-by-proxy. This narrative triggers what human rights expert Kelly Oliver calls “response-ability,” that which prompts not only a connection with imagined or real human suffering but also a course of action to address it. These narratives work together to provide the capacity to respond to crisis without disrupting the socioeconomic way of life that makes the response possible (2004, 80). The examples enumerated here provide an empirical context for how the body is the scale where spatial inequality takes the form of illness, wellness, death, and life (Smith 1992a, Gilmore 2002a). The next chapter looks at how the office culture of PMCA produces the community scale via the reinforcement of everyday lived narratives. 52 Chapter Three: PMCA, Southville, and the Community Scale “Good morning, y’all. All right. Let’s start with the kids. As always, it’s all about the kids.” –Victoria Conway, PMCA President “Dear Lord, thank you for our beautiful hospital. May the Lord bless our staff and the doctors as they help precious little Nicolas over at Good Sam and bless his mother and their family. Please Lord help us to fulfill our mission and help these people who need our guidance, Lord. Let’s have a moment of silence please for my friend Jack who is in for his third round of chemotherapy… … God bless our hospital, Amen. I hope you girls have a great week and I’ll talk to you next week.” –Samuel Patterson, PMCA founder Weekly PMCA Staff Meeting September Monday morning, PMCA Conference Room Mandatory staff meetings, held on Monday mornings at PMCA, begin almost identically each week. The first to arrive in the PMCA conference room are members of the Programs staff, mostly unmarried women in their twenties, who enter the room with notepads and pens, smiling faces, and greetings for one another. Conversations are typically about what people did over the weekend, the current status of surgical missions in the Caribbean or Central America if any are going on that week, and updates on any children that have been flown to Southville for medical care. Some staff members bring in mugs and make specialty coffee with a ‘pod’ brewing system that is on one of the tables along the wall. Sometimes a staff member will bring in a tray of breakfast pastries but unless they are considered to be very nutritious they are not readily devoured, as the 53 PMCA staff is overall a very health conscious group. Staffers choose a seat, usually not the same seat every week and usually not sitting next to the same people each week, although PMCA president Victoria Conway always sits at the head of the table closest to the door. The conference room is barely big enough for a large table with ten chairs around it, small cabinets against two of the walls that house PMCA documents and coffee making supplies, and two extra chairs tucked into two of the room’s corners. There is a large television screen in the corner of the room. The walls of the room, like the rest of the PMCA offices, feature photographs of PMCA patients and their families. In the center of the table is a telephone. Every weekly meeting starts with a phone call from PMCA founder Samuel Patterson. Patterson, a retired Southville dentist, has not been involved with PMCA operations for years but his status is prominent to the organization. It is Patterson’s preference for every staff member to be in attendance for his phone call so it is rare for anyone to be late for the meeting that begins at 9am. However it is not uncommon for members of the development staff to arrive just one or two minutes before Patterson’s call, usually as a group, usually discussing their daily agenda. Gail Doyle, PMCA Vice President of Development, carries a stack of binders, notebooks, and folders that is sometimes a foot high, especially if she has another meeting immediately following. All but two staff members are women, the men being CFO Justin Harland and part-time office assistant Robert Frederic, a retired PMCA donor and close friend of Patterson. When the entire staff of fifteen is in attendance additional chairs must be rolled into the room with whoever arrives last required to sit in the doorway. 54 The group engages in congenial small talk until the phone rings at which point the room silences instantly and PMCA administrative assistant Michelle Austin answers the phone. If it is a call for one of the staff members the caller is directed to the voice mail system but when it is Patterson, Austin greets him and puts him on speaker-phone. Patterson typically asks who is at the meeting that week and people take turns exchanging hellos. After this Patterson leads the group in a prayer. This is sometimes brief but can be as long as five minutes, the longer prayers typically incorporating a long list of personal friends of Patterson’s who are being treated for various maladies. In Patterson’s prayer he always refers to PMCA as a hospital, which is also the case with Patterson face-to-face. During the prayer the room, filled with people whom Patterson cannot see, remains silent, some people bowing their heads and closing their eyes, some sitting still with eyes remaining open, some praying along and some not. During longer prayers staff members often make eye contact and widen eyes at each other, raise eyebrows, smile, or shake their heads, and occasionally staff members must stifle laughter when Patterson is unable to stop rambling. When the prayer is done the group says “Amen” in muffled unison, Conway and Patterson say goodbye to one another, and a button is pushed on the phone to end the call. Conway always asks Austin if Patterson is “gone,” and when this is confirmed a collective sigh is visible and audible at the table. Conway quickly transitions to the meeting-proper, which begins with a report of the status of children who are currently in Southville receiving treatment. 16 Conway’s introduction includes a sentence that is 16 There is one exception to this. The Monday following the annual TGA gala the official tally of money earned is always the first thing reported at the staff meeting. Even then Conway includes her phrase as a disclaimer, saying “This is the one meeting of the 55 ubiquitous in the PMCA offices, “It’s all about the kids.” The report is given by program staff member Beth Carter who is in charge of all patient relations for families in Southville. Papers with each child’s picture, country of origin, and surgical information are passed around the room as Carter gives a child-by-child update. Even when staff members do not read the words on the page nobody immediately passes the paper to the next person. Along with the medical update for each child Carter includes anecdotes about the children or their families from that week. After the patient updates Conway reviews what is going on with PMCA programs since the last meeting and what will be going on that week, after which she hands over the floor to Gail Doyle who gives the same updates for the development staff goings-on. Before the meeting ends staff members usually give very brief reports, some less than one minute in length, on what they are up to that week. After this Conway ends the meeting. Each meeting is usually between thirty and forty minutes in length. After the meeting people exit the conference room. The programs staff walks out of the door and down a long hallway to their offices. The development staff offices are across the hallway, adjacent to but disconnected from the rest of the PMCA offices. This is how every week at PMCA begins. Introduction This chapter is about the everyday office culture of PMCA, the narratives that circulate there, and their role as a producer of the wider Southville community. Within the weekly workplace ritual just reiterated are cultural scripts that contribute to narratives year that we don’t start with the kids. We’ll hear from Gail about the auction numbers and then talk about the kids.” 56 that produce and reproduce the community scale. This chapter analyzes how this everyday vocabulary, for example recurrent references to religion, miracles, mothering, and medical resource capacity, culminate to create the capacity for the sustainability of both PMCA and Southville. The seemingly mundane activities of the PMCA office environment are in fact integral components of narratives that produce PMCA and the places the charity affects. The previous chapter looked at how PMCA images work as spatial narratives of the scale of the body. This chapter looks at how the community scale is produced through narratives of PMCA. These narratives that conflate PMCA, Southville, and the donor class, are traced through the cumulative observations, interactions, and interviews that were conducted during my fieldwork at PMCA and in Southville. As Gulbrium and Holstein remind us, narrative is not observed solely via “linguistic criteria, but as any communication- even a word or a nod-that people treat as ‘narratively adequate in the circumstances, functioning to smoothly facilitate casual yet consequential interaction” (2009, 43). The community scale produced by these narratives provides a foundation for the hyperbolized narratives that are enacted at the PMCA gala, the subject of chapter four. After a brief discussion on how community is understood for this project, I provide examples of characteristics of this PMCA community as identified in the everyday activities of the charity’s office environment. Next, the relationship between the donor base and PMCA is reiterated through a discussion of the Rotary Club, as PMCA originated as a project of the Southville Rotary Club and the core of PMCA’s elite donor base are to this day active in both organizations. The chapter ends with examples of 57 identifiable spatial narratives that circulate in the PMCA office environment wherein the community scale especially is produced. The Community Scale How do narratives observed at the PMCA offices make a particular Southville that is recognized by donors as being emblematic of their community? They do so as part of the process of social reproduction that is required for any place to remain durable within the constraints, opportunities, and existing conditions of a place. Using data gathered during ethnographic fieldwork at the workplace I show how these everyday spatial narratives produce a community scale that incorporates the donor base, PMCA, and Southville as interchangeable components. The workplace is an example of what Gulbrium and Holstein call a narrative environment, wherein there is a reflexive interplay between environment and narrative practices (2009). As they explain, this is a place where “stories are produced and received in society” [and thus] requires that we step outside of narrative texts’ to ask ‘who produces particular kinds of stories, where are they likely to be encountered, what are their purposes and consequences, [and] who are the listeners” (Gubrium and Holstein 2009, 23). At PMCA the production and reception of spatial narratives must be understood in the context of their elite donor class to whom the charity’s efforts are calibrated towards. How is “community” understood and identified for the purposes of this dissertation? Neil Smith, who provides the scale typology that guides this dissertation, explains that the community scale is the “least specifically defined of spatial scales, and the consequent vagueness yet generally affirmative, nurturing meaning attached to ‘community’ makes it one of the most ideologically appropriated metaphors in 58 contemporary public discourse” (Smith 1992a, 70). The data presented in this chapter, especially in the examples of mothering-by-proxy narratives, illuminate this insight. Smith also explains the fluidity of the community scale, nothing that while “properly conceived as the site of social reproduction, [but] the activities involved in social reproduction are so pervasive that the identity and spatial boundaries of community are often indistinct” (Smith 1992a, 70). This fluidity is exacerbated in the case of the cultural elite, like that of PMCA’s donor class. Smith explains that for elites, community has a “far wider spatial reach, rarely coterminous with any spatially contiguous neighborhood” and may include a “whole orbit of noncontiguous but habitually visited places” (Smith 1992a 70; 71). These places include “myriad intertwined social and cultural institutions” as well as “places of work” (Smith 1992a, 70). PMCA is one such place that is incorporated into the community of Southville elites for whom PMCA is their charity of choice. PMCA Office Environment Before discussing the underlying socio-cultural context of PMCA I will next describe some of the basic elements of the narrative environment of the PMCA offices. Although PMCA is described in publications as a “hospital without walls” plenty is done inside the walls of their offices, located on the third floor of a small brick office building in a mostly residential neighborhood near a major commercial thoroughfare. The donors who fund PMCA may be from the ultra-elite class but its offices are located in a working class neighborhood. A member of the development staff explains that this deters a small percentage of the elite donors from wanting to visit the offices. However, this staff 59 member explains, for most of the donors this location is interpreted as a cost-effective and therefore good location. Lastly, much of the visible work done by PMCA programs in Southville occur at the city’s hospitals, and staff members explain that this makes the location of the offices of secondary importance to the reputation of PMCA. If one were to map the community of PMCA this would include: the PMCA offices, the hospitals where PMCA volunteer doctors see PMCA patients, the site of the annual charity gala, the country club where board meetings are held, and the neighborhoods where the donors reside, which are concentrated in the historical district near downtown Southville and in gated communities that cater to the elite that are located just outside of the borders of the city. This reflects the discontinuity that Smith notes is emblematic of the community scale for elites. While my research incorporated all of the places listed above the PMCA offices were most prominent in my fieldwork as this is the site where the PMCA staff reports for work each day. The entire third floor of the five-story building where the offices are located houses PMCA. When visitors walk up the stairs to the offices (there is no elevator, which sometimes presents problems when patients or older donors visit) they exit the staircase and walk down a hallway lined with three foot by five foot framed photographs of PMCA patients and their families. Visitors enter the reception area, through a door on their right, where administrative assistant Michelle Lawson greets them. There are additional PMCA offices on the left side of the hallway but there is no signage to indicate this. These unmarked offices are where the development staff does its work. Like their roles at PMCA, the two groups of staffers, development and programs, are divided by a hallway disabling their ability to interact during their work week, an 60 irony is not lost on the staffers whose desire for increased interaction was noted in interviews and informally. Although welcome, visitors without appointments are rare, people usually coming to the office because of a scheduled meeting. The most common visitors are board members and doctors who work with the PMCA programs staff. It is not uncommon to meet donors who have never been to the PMCA offices but instead interface with PMCA only at the charity gala and other fundraising events. Many staff members noted in interviews that the perception of frugality that donors have upon visiting the PMCA offices has been to the advantage of fundraising efforts. For this reason sometimes small groups of potential donors are invited to PMCA for lunch to learn more about the organization; these lunches are strategically modest, usually consisting of a sandwich, potato salad, cookie, and deviled egg, the combination being a typical lunch in Southville. During these lunches a PMCA development staff member gives a brief presentation about PMCA. Occasionally very big money donors visit the offices, almost always to meet with Conway and be directly solicited for donations. On days when there is a presentation the entire staff is aware and everyone is prepared to greet and speak with anyone who is visiting if they take a tour of the offices while at PMCA. Some meetings and presentations occur outside of the office setting. Development staff members have a variety of presentations that they give to small groups such as Rotary Club chapters. Another part of the everyday office environment are meetings between staff members. These meetings are held in the conference room or in staff member offices, most commonly with two or three people from either the development staff or the programs staff. Interaction between the two groups is rare. An exception to this is when a 61 new staff member is hired at PMCA and is required to have one-on-one meetings with every PMCA staffer so everyone knows each other. Another way that people at PMCA get to know each other is by regularly attending lunch together. At least once monthly part or all of the staff is invited to lunch at a nearby restaurant that the charity sometimes pays for. Birthdays are a common reason for these lunches. Establishing and maintaining the social ties between staff members is a priority for Conway, who explains that this contributes to a “gossip-free and efficient work environment where people are happy to work.” An intentionally amicable, humble work environment is important in the PMCA social world. What can the expectations of staff members of PMCA reveal about the community scale produced by the charity? Conway explains that staff members are expected to be friendly and sociable. She notes “manners and respectability” as two characteristics that she looks for in an ideal employee. Conway prefers to hire staff members who have been interns at PMCA as this is the best way to identify the appropriate personality for an ideal employee. It is also important to Conway that employees have particular standards of clothing and sociability. Several donors and staff members refer to the PMCA staff as “the sorority” because of the high proportion of young women who are hired upon college graduation to work in the PMCA programs staff. Those who use this term describe the staff as “beautiful,” “young,” “sweet,” “stylish,” “friendly,” and “bubbly.” 17 The social expectations of Conway are reflected in narratives of domesticity that are discussed later in this chapter. 17 Each of these responses was provided a minimum of five times by various interview subjects and/or during observations. See Appendix A: Interview List and Research Timeline. 62 These daily worksite expectations contribute to what Georgakopoulou calls “small stories” from everyday interactions that “comprise habitual associations” with places (2007). Georgakopoulou explains that narratives have a life cycle which are constantly being recycled and reinforced, especially in the case of familiar environments with social expectations like that of the workplace (2007, 6). This insight helps us recognize how seemingly mundane workplace interactions, like the purposeful creation of an amicable environment wherein manners and attractiveness are seen as important to the legitimacy and durability of PMCA, are in fact part of a more complex socio-cultural backdrop that extends far beyond the office walls. To more fully understand this backdrop and the PMCA community that is its product we now look at the origins of PMCA. PMCA’s Antecedent Organization: Southville Rotary Club “President Bush’s ideal citizen is a Rotarian, moved by a sense of neighborliness, Christian charity, and social responsibility, but untouched by having any sense of a personal stake in public justice.” (Schudson 2003, 271) The Pediatric Medical Clinic of the Americas is traced back to 1990 when the Southville Rotary club began an effort called the Caribbean Initiative to provide “medical and dental services” to children who, according to PMCA’s website, “otherwise would have known only disease and despair” (“Rotary’s Project”). These efforts are credited to PMCA founder Dr.Samuel Patterson who explains that the original outreach project was inspired by Rotary International’s global effort to eradicate polio. The majority of the 63 original donors for PMCA met through their affiliations with Rotary and the organization partners with PMCA to this day. Rotary is a civic service organization structured through belonging to various local chapters. Rotary has greatly expanded its membership in the last thirty years to be more inclusive, however this expansion has occurred mostly though the creation of new chapters. For example the Rotary chapter that key PMCA donors belong to is mostly comprised of doctors, is entirely comprised of white men over the age of forty, and their meetings have been held at the same country club for over twenty years. This contrasts with a newer chapter I observed, under five years old, made up of mostly female small business owners, and whose meetings are held in the dining area adjacent to the service deli of a grocery store. So, while the diversity of the organization is expanding both economically and demographically the long-existing affiliations of the older chapters remain in tact. Participation in Rotary has a financial component, a participation component, and also the expectation that members will identify and select ideal new members to be recruited into Rotary. Members of the Southville Rotary are expected to spend at least two thousand dollars a year on luncheons and fundraisers as well as attend weekly meetings (“A candidate’s” 2004). This commitment becomes possible only after membership is granted. This involves being recommended by three members and being “in upper levels of management in business or are leaders [sic] in their profession” (“A candidate’s” 2004). This process is an interesting antecedent to the matchmaking processes that PMCA is involved in where targeting and carefully selecting ideal subjects is thought to be a key to the organization’s success. 64 The Rotary Club has a long history as a civic service organization in the US and around the world. Rotary International describes itself as “the world’s first service organization” composed of “a global network of [1.2 million] business and professional leaders who volunteer their time and talents to serve their communities and the world” (Rotary Basics 2007, 1). The motto of the organization is “service above self” and is prominently featured on the organization’s literature. Rotary was founded in 1905 in Chicago, expanded outside of the US in 1911, and in 1915 Cuba became “the first non- English speaking Rotary country” (Rotary Basics 2007, 2). Along with service, Rotary and their Rotarian members also have guiding principles directed at “high ethical standards” in business and the community (Rotary Basics 2007, 4). There are a wide range of service programs that various Rotary groups are involved in but the most widespread in this history of the organization is the PolioPlus program, started in the early 1980s through which Rotary International is credited with being the primary driving organization that contributed to the eradication of Polio worldwide (Rotary Basics 2007; Seytre 2005). This effort was explained by the chairman of this effort in a book about Polio eradication: “Until 1978, Rotary clubs acted individually in their communities. Then we decided to do something that would involve all members worldwide, something important that clubs couldn’t do alone. The eradication of a disease corresponded to our will to do something together, and gradually we reached the conclusion that the disease should be polio. Our choice had a great deal to do with the fact that polio affects little people, the most innocent members of society.” –William Sergeant, chairman of Rotary International’s PolioPlus Committee, in Seytre 2005, 104. That the best philanthropic efforts are considered equivalent with assisting those in society who are perceived as the most “innocent” is particularly interesting for the 65 antecedent organization of PMCA which consistently frames the children who they help in this way, that they are the most in need of help because they are the most innocent. The service contributions from Rotarians are coupled with its legacy as an organization that equates membership with social status. Membership in the Rotary club has been a factor in US political success (Feeno 2000; Anderson 2000). Feeno, an expert on how politicians present and represent themselves to constituents, explains that membership in the Rotary Club is still key for politicians who use Rotary to garner support from elites “through personal, not policy, connections” (2000, 67). The key to political success Feeno explains, depends not on being motivated by the question “How should I vote?” but instead “How should I connect?” (2000, 4). One politician who Feeno profiles credits the Rotary club as the best place to locate “the quality people” (2000, 67). In the case of the Southville Rotary chapter where PMCA began the composition of the membership is solely drawn from what locals commonly refer to as “White Southville” (Austin 2012). Membership in Rotary is still key for elites today, Anderson notes, as it is an indicator of whether someone is “one of them” or “one of us” (Anderson 2000, 6). Armony describes the relationship between Rotary Clubs and white elites examining the relationship between civic associations and segregationist groups that proliferated in the South in the twentieth century (2004). Armony explains the “close connection between these segregationist groups [Citizens’ Councils] and associations that have been seen as the backbone of the ‘golden age’ of U.S. civic activism in the 1950s and early 1960s” citing the Rotary Club as the most effective of these associations (2004, 80). Armony’s analysis links the development of segregationist groups with the establishment of 66 philanthropic efforts during this same era (2004, 80). Critical human rights literature complements these insights in that scholars explore the many ways that extensions of colonialism and hegemony operate within the discourses of humanitarianism, normative human rights discourse, and popularized global justice movements (cf. Mignolo 2005; Baxi 2007; Merry 2006; Aziz 1998). The relationship between Rotary and American society was explored almost a century ago by Antonio Gramsci who was interested in “the principle, adopted in 1928, that the Rotarian philosophy of life attempts to reconcile the eternal conflict between the wish to earn money and the duty to serve one’s neighbor: ‘who serves best earns most’” (1995, 709). Gramsci sees Rotarian philosophy as “an interesting expression of Americanism” marked by the secularization of Calvinism, one in which the haves and have-nots are predetermined by God (1995, 709; 1995, 121). Gramsci explains that “the difference that the Rotarian religion cannot become universal- it is typical of an aristocracy of the elect (the chosen people, the chosen class)” [that] “functions by a principle of selection” (1995, 121; 709). This insight on the impossibility of universal subjecthood is an interesting precursor to contemporary human rights discourse that permeates PMCA’s publications presenting a global imaginary where health inequalities are eradicated. The impossibility of this spatial narrative of the philanthropic elite, that outcomes can achieve equilibrium in a global political economy the foundation of which is hierarchies of difference, is a focus of critical human rights scholars and geographers alike (Mignolo 2005; Baxi 2007; Merry 2006; Aziz 1998; Fregoso 2010; Loyd 2005; Pulido 2002). In terms of global health outcomes Gramsci’s observation is especially 67 interesting when considered with Loyd’s insights on healthcare geographies where she notes the tendency to “paper over difference while declaring universality” (2005, 202). One way that difference is papered over, to borrow Loyd’s phrasing, is through the narratives that are told explaining the relationship between the haves and the have nots. At PMCA the haves are those of White Southville and the have nots are not those of Black Southville, which is rendered invisible by its exclusion from the recurrent spatial narratives of PMCA, but instead are from the Eastern Caribbean and Central America. The narratives presented in the next sections show how PMCA is able to affectively communicate its identity and secure its legitimacy in part through the lack of recognition of any Southville but that of the donor class, an extension of the legacy of US health geographies that fail to adequately address persistent health disparities at a range of scales (Loyd 2005; Austin 2012; VDH 2002; Pestronk and Franks 2003). Identifiable Spatial Narratives of Everyday PMCA In the PMCA office environment there are two recurrent spatial narratives that are observable almost daily. Each of these is discussed in the rest of this chapter. Since the community scale is so pliable the underlying socio-cultural geographies that inform these narratives are included as needed. The first example is narratives about the healing miracles that are key to PMCA’s donor appeal. The health geographies of so-called White Southville and Black Southville provide an important backdrop to understanding how these narratives reiterate a particular Southville that reflects the donor class of PMCA. Last are mothering-by-proxy narratives, the analysis of which includes insights 68 about how motherhood is understood by those that produce the community scale through participation in PMCA. “Miracle Stories” “What’s routine for us is an absolute miracle for them.” –Victoria Conway, PMCA promotional video The promotional video quoted above exemplifies one of the most reiterated narratives of PMCA, that the need for life-saving healthcare interventions is obsolete in Southville and void in the places where PMCA programs are focused. Whether simply put as above or reiterated as the experience of specific patients, this narrative is ubiquitous at PMCA. Using religious-infused language potential donors are told how the surgical outreach that is done by PMCA programs provides medical resources that are obsolescent in the US due to the ubiquity of these resources. This vocabulary is part of the everyday talk at PMCA and in Southville, a city in the US Bible Belt. In Southville and at PMCA telling stories using religious terms is not solely an expression of belief in the divine. More to the point, the terms are used as everyday expressions to connote importance. For example instead of saying “wow,” someone might say “praise the Lord.” “Luck” becomes “blessed”. Another common word that you hear many times a day is amen, used to express agreement for the most casual of topics. For example you could tell someone that the sandwich you had for lunch is delicious and they could respond in affirmation, “Amen.” In the presentations given to potential donors 69 these narratives are more pronounced. One example is that of a child, “Lily” who stayed for weeks in Southville receiving several surgeries and called “our miracle baby” by most of the people at PMCA, this phrase used in mailings, conversations, and presentations wherin the life-saving efforts of the doctors were detailed for potential donors. The high frequency of the use of the word “prayer” when reiterating stories about the patient experience is another example of this vocabulary. This suggestion that divine intervention is one of the components of PMCA success echoes the insights of Gramsci who links philanthropic participation though civic organizations like Rotary (and I add by extension PMCA) with supernatural pre-destination. One of the questions that potential donors ask is why should they contribute to an international organization rather than one whose efforts are based locally. This question is so common that both staff members and board members are provided guidance in how to answer this inquiry. This narrative is used as an answer. These narratives are about the generosity, superiority and expertise of not just the medical professionals but of Southville, and are a requirement for inclusion in presentations to potential donors. An example of what this sounds like is the typical beginning of an explanation of what PMCA does: “Our vision at PMCA is that regardless of geography all children should have the chance to live long productive lives. Our organization connects our talented and gifted doctors from Southville with children who need life-saving care in the Caribbean and Central America. If children here are born with these diseases they would be treated right at the hospital. But in the places where we send our teams that care is simply not available. We provide expert surgical care to children that they would otherwise never have access to. When children need care that is too complex for our teams to do while on mission those children are brought here to Southville where they can get the help that they desperately need. What is routine to us is nothing short of a miracle to them” –Susie Fonda, PMCA development staff 70 The “here” in this narrative is the Southville community that is understood and experienced by the target elite donors of PMCA, where it is undoubtedly true that medical resources are adequately provided for. This narrative is effective through both the conflation of Southville with the work of PMCA doctors and with its reflection against the places that are void of those qualities. This Southville is a community characterized by expertise, innovation, generosity, and possessing divine qualities. However examination of the health geographies of the city show that this narrative elides Black Southville, which has one of the highest instances of infant mortality rate (IMR) in the US, over twice the national average and triple that of White Southville (VDH 2002; VDH 2012; Williams 2011). 18 The disparities between these two groups are recognized by health care experts and scholars who note that IMR is the most useful statistic in understanding the quality of care available to infants, children, and their mothers (Williams 2011, Masho 2011, VDH 2002). Despite a well documented legacy of systematic racism in the US healthcare system that one scholar aptly describes as a “discourse of pathology” that ignores the unequal access to resources, this gap in IMR was recently characterized by a New York Times article as “a mystery that has eluded researchers even as the racial disparity continues to grow” revealing that the insights of health inequality social science research is still underappreciated if not overlooked (Loyd 2005, 180; Williams 2011, A10). What makes this story about two places, one with an abundance of healthcare resources, and one without, a spatial narrative of the community scale? Why isn’t it, for 18 To further underscore the use of the terms White Southville and Black Southville, health statistics data provided by local government officials used these terms in their official presentations, charts and graphs as recently as 2011 (Masho 2011). 71 example, about the scale of the body? While PMCA’s “miracle stories” are indeed those about the outcomes as expressed at the scale of the body Neil Smith reminds us that “If [sic] the body is the immediate source of corporeal difference appropriated in the construction of racism, it is at the scale of the community that racism and indeed every form of localism is most firmly rooted” (Smith 1992a, 71). Here we see that the scale of the body and that of the community, and indeed the global that is evoked through the juxtaposition of “us” and “them,” are all incorporated, as one level of abstraction isn’t produced in a vacuum but in relation to and in connection with a scale typology that requires consistent reinforcement and reproduction, here through the use of narrative. In these “miracle stories” the community of PMCA does not recognize Black Southville, and when this socio-cultural context is considered the narrative’s durability remains in tact. I am not arguing that PMCA should aim its efforts at the local polity but rather showing how this spatial narratives reinforces a spatial blindspot that has a traceable legacy in Southville extending back to the 1870s, providing empirical evidence of how “the idea of community is appropriated to rescript less salubrious realities” (Smith 1992a, 70). This co-existence of two Southvilles was explained in a 1934 article “Black Southville” in the social issues magazine Survey Graphic, wherein Southville is described as “contradictory and full of contrasts; gorgeous in its gardens in the spring, hideous and unsanitary in its Negro quarters; delightful in sporadic hospitality; disturbing in self- content and indifference to reality” (Guild, 276)5. This “shallow prejudice” is still observed in Southville where residential, cultural, educational, political and economic geographies are largely concentrated into de facto segregated albeit spatially incongruous geographies (Austin 2012). Smith notes that spatial metaphors address “questions of 72 social power,” producing scale through “societal activity,” the examples here a reiteration of the legacy of what Glenda Gilmore describes as a “caste system” in the turn of the 20th century era South wherein “skin color, class, and gender dictated the pattern of every daily interaction,” a legacy that still has resonance in Southville (Smith 1992a, 62; Gilmore 1996, 25). This is not to say that people at PMCA are unaware of the racialized landscape of the local geography but rather that these long standing relationships inform on narratives about place that contribute to the possibilities imagined about what community is and what community is capable of. Gilmore’s analysis of how possibility and place interacted in the Jim Crow era characterized by the ideology of white supremacy offers insights into why two de facto Southvilles continue to coexist. In the examples here of the community scale wherein the world of the donors, one of excess and privilege, can through participation in PMCA redistribute excess resources to those deemed most worthy, the children spatially far and distant from their community, this action reinforces and reproduces White Southville, noted for its co-existence with but lack of interaction with Black Southville. Here we see a twist on Smith’s notion of “jumping scales” where the leap is taken both horizontally and vertically as connections are forged between the community of PMCA and that of the “international” locations where their outreach is aimed (Smith 1992a; PMCA public archive). The miracle story narratives that produce the community scale of PMCA require an elision of one Southville affectively reproducing Jim Crow era social norms. Gilmore’s insights on this era note another social norm that persists in PMCA’s Southville, a particular set of values that are associated with nostalgia for the past or as Gilmore puts it “change as [sic] anathema to the southern way of life” (1996, 60). One of the components of this way of 73 life is seen in Conway’s emphasis on manners and gendered expectations of dress and personal appearance. Another are particular conceptions of motherhood which inform on the second example of everyday spatial narratives of PMCA, discussed next. Mothering-By-Proxy “90% of the world has access to only 10% of the world’s healthcare resources.” 19 “PMCA exports everything that is good about America.” –Eileen Goldenblaut, PMCA donor “These parents are 110% committed to their families, so my service is a gift I am happy to give.” –Dr. Susan Jamsur, PMCA volunteer surgeon “You have opened doors for my whole family. I am so thankful the Lord put you in my path.” –parent of PMCA patient “We not only send people to help those who have no where else to turn, out of love for children, but we go back and continue our relationships. That’s what I love about PMCA. We never really leave.” –Dr. Susan Jamsur, PMCA volunteer surgeon “Sending hope, help, and healing where there is little or none.” –PMCA publication The last example of an identifiable spatial narrative in the everyday office culture of PMCA is further iteration of mothering-by-proxy. There are many ways that 19 PMCA materials feature this fact prominently. 74 mothering as interchangeable with Southville is reinforced in the PMCA social world. One example already provided in the relationship that Victoria Conway has with her staff. Second is ubiquitous talk at PMCA about “our kids,” “the kids” and “our miracle child” that all allow the narrator to be a by-proxy mother. While these by-proxy narratives are almost absent from the PMCA publications the way that the work of PMCA is explained through the daily interactions of staff, volunteers, and potential donors is full of examples of mothering being central to the work of PMCA and a cornerstone of the community scale produced by these people’s efforts. The community that is produced by these narratives is one that expresses motherhood in particular ways that resonate with the donor class. As a female-run organization in a region that still observes a considerable amount of unmasked gender hierarchy and explicitly patriarchal social norms, the circulation of this narrative is used to produce a valorized community where children are spoken about more as offspring than as patients. This narrative is an empirical example of Smith’s suggestion that women oftentimes produce the scale of “community as a virtually borderless extension of the home” (1992a, 70). Insights on motherhood and the discourse of domesticity that is foundational to contemporary gendered social norms are useful in understanding the socio-cultural context of how these narratives circulate at PMCA. Traced back to the mid nineteenth century, the Victorian Era (and I add Civil War era) was marked by the growth of industrial capitalism and the ideologies of imperial expansion, racialized differentiation masked as scientific fact, and the establishment of new roles for women as a by-product of the proliferation of new industries. During this era changing roles for women dominated popular culture, a discourse of idealized gendered norms deemed a “cult of 75 domesticity” that centered on conceptions of “true womanhood” (Lavender, 2013). The key characteristics of “true womanhood” are piety, purity, domesticity, and submissiveness, and each of these elements can be seen in the narratives of community produced by those who participate in PMCA both in terms of their approach to the problems they address and also in their projected explanations of the mothers whose children their outreach is aimed at (Welter 1966). However, domesticity is more complicated than a set of identifiable characteristics, as Kaplan explains, linking this Victorian-era legacy with the “imperial project of civilizing” that was in full force during the time that the discourse of domesticity had prominent circulation (1998, 582). Kaplan notes that it is more accurate to situate “domestic in intimate opposition with the foreign” rather than interpretations that center on the separate social spheres of men and women (1998, 581). The circulation of the discourse of domesticity reveals how “spatial and gendered configurations” were “dependent on racialized notions of the foreign” wherein the imperial project of mid nineteenth century expansion was one of domesticating the otherness vis-à-vis the scale of the nation state while at the same time reiterating the gendered and racialized social norms of the household scale (Kaplan 1998, 582; 591). During this era the “sentimental ethos” that proliferated in the form of domesticity discourse wherein women were valorized for their pure intentions, divine motivations, and willingness to accept hierarchies of subordination and domination with grace, no less contributed to the capacity for “imperial expansion of the nation” (Kaplan 1998, 599). This discourse, that the world can be tamed by the superior civilized “cult of domesticity” resonates in the narratives of PMCA whose resource provision narratives circulate aspects of nurturing and the alleviation of suffering that is seen as the incidental 76 byproduct of taken-for-granted geographies of difference. The circulation of stories that center on individualized patients cast into the role of child to the PMCA parent, along with narratives that cast PMCA into the role of nurturing and well-intentioned mother responding accordingly to the problem of global health inequality, create and reproduce a community characterized by “sentimental values” that Kaplan explains are foundational to the discourse of “manifest domesticity” (1998). The contradiction of sentimentality, that a discourse that seeks to dissolve difference also works to reinforce” [these same] “racial and class hierarchies” is noted by Kaplan and seen in PMCA where the community scale is characterized by both exclusivity (in the social capital that comes with belonging to the donor class) and inclusivity (via the programs that seek to remedy global health inequality). These insights are complemented by Smith’s assertion that more than other scale community is ideologically constructed and that considering home and community together is vital in “understanding relationships between social production and reproduction” of scale iteration (1992a, 65). Via the juxtaposition of the domestic to the foreign the domestication of the foreign becomes a way to “tame” what is considered a “savage” place into a “civilized” place, which aptly if crudely lays out the spatial project of international philanthropic efforts like those at PMCA (Kaplan 1998, 582). This idea of “taming space” is echoed by Massey who contends that it is though narrative that people attempt to tame that which is “open, multiple and relational, unfinished and always becoming” (2005, 140; 58). The mothering-by-proxy narratives that are presented in what remains of this chapter show how these attempts at taming space are animated by PMCA. 77 The mothering-by-proxy narratives are one of the most ubiquitous at PMCA and also one of the most subtle, conveyed though words and even more so through non-verbal communication as well physical contact between those at PMCA and those who PMCA helps. The most identifiable are heard every day at the PMCA offices. Talk about children is ubiquitous at PMCA. This is almost always presented in the possessive form which PMCA staff, volunteers, and donors discussing “our kids,” “our miracle baby,” and “my precious girl” for example. The prominence of these explicit mothering-by- proxy narratives, informally through conversations at PMCA and also in PMCA meetings and presentations, does not come without resistance although its prominence is recognized by everyone at PMCA regardless of their insights in terms of the consequences of these narratives. For example some of the members of the programs staff critique the development staff’s “constant talk about the kids the kids the kids. We are trying to be bigger than Southville here. We do more than just bring kids here” (PMCA Programs staff member). This critique was echoed in several interviews despite the fact that every person who disclosed this criticism deploys this spatial practice of speaking possessively of the children that PMCA helps as this is understood as being vital to the legitimacy of the organization, that PMCA is worth giving time and money to because they truly care about the kids they help. In the everyday workings of PMCA the circulation of mothering-by-proxy narratives take many forms, sometimes causing conflict as this next example traces. The desire to care directly for patients on part of the donors is a source of recurrent conflict at PMCA. Gail Doyle, PMCA vice-President of Development, explains how some prominent donors consistently request interaction with the children who are in Southville 78 to receive treatment. According to Doyle these donors see this as their right because of the financial contributions that these donors link directly with these children. Therefore Doyle must strategically dissuade these donors from their insistence on being directly involved with patients. The donors who make these requests want more than just to meet the patients, which is allowed, but want to bring the patients to their homes, establish relationships with the patients and their families, and be photographed caring for the children, to provide just a few examples of the types of requests Doyle and her staff receives. Doyle explains that despite this being common practice for similar organizations as it is highly effective for fundraising, PMCA protocols limit these kinds of interactions. This is no small matter and is a source of pride for many at PMCA. When this topic was discussed in interviews PMCA staffers often had intense responses, sometimes crying when expressing opposition to using “host families,” where financial donors literally become the surrogate families to the children served by other matchmaker charities. Here too is a mothering-by-proxy narrative wherein protecting children from what is seen as an unethical business practice is vehemently defended, staff members describing such policies as “wrong,” “gross,” “exploitative,” “unethical,” and “insulting.” According to PMCA vice president of Programs Jessica Hafner, who is in charge of travel arrangements for PMCA patients, these policies are justified by other medical matchmaker charities as enabling them to save in travel resources and accelerate the approval processes that are required though the Department of Homeland Security. Hafner explains, the DHS does not consider the patient as much of a flight risk as when children travel with a family member. However, she continues, for PMCA this is non- 79 negotiable as it is believed that mothers (or another close family member although it is almost always the patient’s mother), have an integral and irreplaceable role in the healing of the patient. This is not important solely for the rehabilitative work that often continues once the child is sent home, which volunteer surgeon Susan Jamsur explains is often done by the family members who live with the child, but also for emotional support. This topic was the subject of the most intense moment of interviews with PMCA President Victoria Conway who raised the volume of her voice as she responded to my asking about this policy, answering: “what would you do if Iris (my daughter) was dying of some awful condition, and people showed up and the only way you could help her was to give her to those people. That would be the worst moment of your life, but of course you would do it, to save her life. Can you imagine that? We would never do that, take a little one from her mother. Sometimes we have to delay treatment until a family member can be found who can come, because some of these moms are the only ones to care for all of their other children, but we have to have a family member here. These moms are no different from you or me. They love their precious children and would do anything, anything, to get the help that they need for their babies. We don’t just save kids we save whole communities. These folks love these little ones. And so do we. It’s all about the kids. And kids need their moms.” Conway’s valorization of the patient’s mother and role as co-advocate shows in sharp relief the importance of mothering-by-proxy as a narrative that produces a coherent PMCA community. Here the “we” that she refers to produces Southville and PMCA concomitantly. Simply put this style of talking about the kids in a mothering way is something that those who contribute to PMCA are proud of, interchangeable with the Southville values that the charity was founded upon. This viewpoint, that Southville “values” are the foundation of PMCA’s respected reputation, was reiterated time and again in interviews, fieldnotes, observations, and informal conversations. When considering this perspective and re-examining the PMCA archive as well as the images 80 that hang on the PMCA office walls, the characteristic of nurturing at PMCA is easily identified. There are images of doctors cradling patients in their arms, staff members embracing patients and their families, PMCA volunteers reading to and playing with patients, PMCA patients and their parents kissing or moms staring at their children in hospital beds, to give but a few examples. 20 This direct use of nurturing imagery reinforces the community scale of PMCA where a mother’s love is understood as a key to their motivation and success. Mothering-by-proxy also describes the metanarrative of PMCA’s role in solving the problem of global health inequality. In Conway’s speeches in particular and in the PMCA publications in general the problem of health inequality is oftentimes presented through the lens of motherhood, with PMCA resources vital in identifying and responding like a mom would to the problem of sick and dying children in the world. In this example of mothering-by-proxy PMCA is the mom and here the mothering-by-proxy is PMCA’s programs. In this narrative that has been increasing in use as a result of Conway’s effective use of it, PMCA staff members, medical volunteers, donors, and especially the mothers of PMCA patients, are valorized as nurturing, resilient, and uncompromising in terms of acceptable standard of care and scope of programs. Here is an example from Conway’s regular speech repertoire: At PMCA it is all about the kids. These children come from loving homes with parents who would do anything for them, just like we would do for our kids. When I first learned of these innocent fragile children who just happen to be born in a country without availability of critical care resources the instinct to help was immediate. When good people come together to do the right thing, miracles do happen. They happen for children and families who once worried they have 20 Each of these descriptions have a minimum of five recurrent examples in a combination of the press materials and the images that are featured on the office walls of PMCA. 81 nowhere to turn for help. On your behalf it is our privilege to carry forward our shared belief that every child, regardless of geography, deserves the chance to live a healthy life. Here the familiar echo of “its all about the kids” is framed in terms of sacrifices that the mothering Conway, Southville, and PMCA make in order to solve the happenstance problem of geography. In this narrative global health inequality circulates via the material spatiality of children. That this circulation is explained as happenstance illustrates one iteration of the ways in which hegemony is naturalized in this current epochal moment by an institution run and funded by the ruling class. Following this logic, in this global imaginary the diffusion of resources from Southville to non-Southville will eradicate the problem of global health inequality, the places of PMCA outreach to ultimately have identical resources to Southville, affectively becoming Southville. Here we see the narrative of “manifest domesticity” in action, wherein the “imperial project of civilizing” the underdeveloped world is realized via the cultural script of spatiality (Kaplan 1998, 582). Conclusion This chapter provided examples of the way that what the people do in the offices connects with and shapes, and is shaped by, the elites of Southville and how the projects and programs of PMCA reiterate “community” in globalizing ways. The community scale narratives of PMCA link the scale of the body as “the site for moral action” with the global scale, as through this community both are being simultaneously fixed, tamed, and domesticated (Loyd 2005, 342). That many of these narratives are contradictory, simultaneously expanding possibilities in terms of health care provisions for the patients of PMCA and no less the incorporation of diversity into the social identities of those that 82 are members of this community, while also reinforcing the socio-cultural norms and exclusivity of elite White Southville, only reinforces their utility as markers of geographic scale. Smith reminds us that scale is not an expression of social totality but rather is the “geographical resolution of contradictory social processes” within and between scales, emphasizing the “active social connectedness of scales” (1992a 64; 66). These narratives reveal the “double-edged nature of scale” … “a means of constraint and exclusion, a means of imposing identity” and also “a means of enlarging identities” (Smith 1992a, 72). This simultaneous expansion and contraction of scale is looked at in depth in the next chapter that analyses the spatial narratives of PMCA’s global imaginary at their TGA gala. Here we will see hyperbolized versions of the narratives this dissertation has already presented, where the saving of the world from global health inequality is only possible via participation in the exclusive world of elite philanthropy. 83 Chapter Four: Making the Globe: PMCA’s Tropical Gems Gala 1pm, TGA event site, 5 hours until 9 th Annual Tropical Gems Auction and Gala The National Weather Service issues flash flood warnings as record setting rain, worse than in two decades, turns major thoroughfares of Southville into rushing streams. With gusts of wind strong enough to bring down tree limbs, accompanied by booming thunder and dramatic flashes of lightning, the organizers of PMCA’s largest fundraising event of the year gather at the event location to speculate on how the storm will affect that night’s gala. The 2,000 square foot all-white-circus-style tent, which covers the parking lot of the most exclusive shopping center in Southville, must be secured and the wind keeps blowing the canvas and vinyl walls in. The white carpet and the fashion runway are yet to be installed over the temporary plywood flooring that covers the painted asphalt stripes of the parking lot underneath. The audio-visual team requires that the floor be in place in order to install the sound system so that the fashion models, who have been flown in from New York City, can rehearse. The catering company, operated by one of the most exclusive fine dining restaurants in Southville, is waiting to build elaborate food serving stations. The PMCA volunteer committee, comprised of some of Southville’s wealthiest wives, have little time to figure out how adjustments due to the weather must be made, as it is five hours until the most exclusive social event of the year and they all have appointments at the city’s most expensive salons. After quickly dismissing the option of canceling the gala, the women disperse throughout the tent. While event co-hosts Maggie Peeler and Nell Labrie discuss logistics 84 with hired event coordinators whose tasks are hours if not days behind, the other committee members hang signs, arrange flowers, and socialize. All activities come to a halt when a ten-foot tall tropical flower arrangement crashes to the floor as a gust of wind blows one of the fabric entryways over. The tent should have been completely set up twenty-four hours prior, and a sense of urgency drives everyone working in the tent. In less than five hours this chaotic scene, an almost empty tent with caving in walls, will be transformed into the epitome of luxury. The women who work rapidly to complete last minute pre-event tasks in jeans and sweatshirts, as there is no heat in the tent and the outside temperatures are an unseasonably cold fifty degrees for mid- November in Southville, will return in high heel shoes and tropical themed formal attire, entering a tent that will be eighty degrees. Upon arrival at the yet-to-be-set-up valet parking area outside of the tent, they will walk with their husbands down a red carpet into the welcome reception area where coats will be taken and hung at the makeshift coat- check, and they will enter the event tent proper, the reaction to which will include dropped jaws, audible gasps, and broad smiles. The transformation of the space from parking lot to tropical paradise is dramatic. PMCA’s Ninth Annual Tropical Gems Auction and Gala (TGA), which will not be cancelled due to weather, will cost over $100,000, and will by the end of the night raise over one million dollars for PMCA, making it one of the country’s most successful annual charity events. The imaginative place that the gala evokes is in fact transcendent even of Southville, as organizers pride themselves in creating a space that, as event co- host Maggie Peeler put it, “is so much more than [Southville], no one here could even dream this up.” The aesthetic of the event-space is evocative of the tropics; from the 85 flowers to the food and cocktails served, from the designer selected for the evening's high-fashion runway show to the attire of the event hosts and PMCA staff, the atmosphere of the annual gala is tropical, formal, exclusive, excessive, and fantastical. Introduction You won’t find anything like it anywhere near here. It’s like New York City. For the night we’re New York City. –Ruby Browning, PMCA Development Staff The tent has to be another world. We want it to take their breath away. When they walk in they aren’t in Southville anymore; they’re in the Caribbean. The food, the flowers, the music, the fashion, they all have to feel that way. This is a party. We have to give them a party. That’s why we do the live [auction] when we do- so that they can let loose afterward. And we do it after the fashion show. That puts people in the mood. –PMCA event co-host Maggie Peeler Did you see his face when he walked into the tent? Pow. He was impressed. He was like ‘that’s something special.’ –Victoria Conway, PMCA President It all starts with the theme. We really like to let the co-hosts do as much of the work as they can, to really take ownership of the gala. The theme is key. We take a backseat but arrange for the [menu] tastings, tent specifics, the [fashion show] designer, and the like. But it’s really their event, for their friends. You won’t find anything like it anywhere near here. It’s like New York City. For the night we’re New York City. –Ruby Browning, PMCA Development Staff 86 In the previous chapter I analyzed how everyday life in the PMCA offices uses narratives to reinforce and contribute to the production of the local geographic scale. In this chapter I answer the following question: How does PMCA's biggest annual charity event, the Tropical Gems Auction (TGA) gala, function as a place-making process, and what does this process reveal about how the global geographic scale is imagined, enacted, and produced? Most notably, as you will read in the pages that follow, this event dramatizes the idealized places that PMCA uses as a backdrop to do their work. The TGA gala aims to create an environment of luxury and exclusivity, wealth and status. Creating an elite space is seen by those in PMCA as crucial to the event’s capacity to result in large donations. While the charity’s work serves as a backdrop at the event, this is not a humble or somber affair. Here, the Caribbean and Central American worlds where IHC does its outreach are recast from their role as sites of inexcusable inequality, into premier luxury vacation destinations. Analysis will focus on the global geographic scale and how the annual TGA gala reinforces normative sociospatial hierarchies of the global even while responding to the inequalities inherent in these hierarchies. This chapter will trace how the annual gala and auction works as the most important nexus of social relationships wherein the social actors of PMCA intersect, and the explicit and implicit global narratives of PMCA are consolidated. Simply put, narratives about the global geographic scale are ubiquitous at the TGA gala. The TGA gala is an example of what ethnographer Cheryl Mattingly calls “dramatic time,” wherein cultural scripts are sensationalized in narrative acts that “have great cultural resonance” (1998, 182). These narratives are marked by “evanescence” wherein the ephemerality of the moment makes it possible for cultural scripts to be dramatized, and are characterized 87 by a sense of urgency accompanied by “an elusive gaze into possible futures” (Mattingly 1998, 199; 206). The TGA gala is an exceptional space wherein the social world of PMCA is amplified. Through creating and participating in the TGA gala a normative global scale is produced by spatial narratives wherein narratives about the range of places that are incorporated into the operations and outreach at PMCA are told explicitly as well as enacted implicitly. The evidence that follows looks at examples of place-making processes from the life cycle and implementation of the TGA gala and discusses the consequences of these processes. As the second chapter focused on narratives from the PMCA archive about the body, and the third chapter looked at how the local geographic scale is created in the everyday office culture of PMCA, this chapter looks at how the global scale is affectively produced in the annual TGA gala. Namely these examples work together to show how the global imaginary of PMCA is dependent upon ongoing philanthropic processes that simultaneously work to challenge and reinforce tropes of difference. Contradictory push and pull against inequality, here at the global scale, is a key component of the social world of PMCA. When considering only the printed archives and the everyday goings-on of this charity a blind spot is created that masks the elite donor base. It is at the annual Tropical Gems Auction that the global geographic scale in which PMCA sees itself embedded is revealed. This is the world of status and taste. Participating in the gala, and doing so in a particular way, is how you become a part of that world, or reiterate and consolidate your status and role in that world. The motivation for participating in the annual auction is most obvious in the form of raising money for resources to be sent to the countries where 88 PMCA does its work, transforming the health outcomes for the individual children, the families that they belong to, the communities where the families live, the regions within which these communities are located, all made possible as a result of contributions that directly transform the inequalities that PMCA's efforts address. However just as important as this explicit purpose for participating in the TGA gala is the participation in an exclusive elite society within which cultural norms and long standing relationships are key for PMCA to emulate in order for the association between their organization and the targeted donor class to be solidified and reinforced. Elite White Southville is reflected in the physical appearance of those involved in the gala, the formal and informal conversations that go on at the gala, the aesthetic environment created by the event coordinators, and the culmination of the environment into a total sensory experience wherein one is immersed in an exclusive, luxury-laden space. After first outlining the major characteristics of the annual event I will then discuss how this event functions as a place-making process, working as an exceptional space wherein the social world of IHC is amplified. PMCA’s global imaginary is not outlined explicitly but rather is created as an artificial party environment. The narrative examples presented in this chapter are divided into two groups, the event aesthetic and the performance of PMCA. The event aesthetic refers to the created environment of the Tropical Gems Auction gala, from the décor to the decorated bodies of those in attendance. The second group of examples is drawn from the auction and entertainment of the gala as well as the social interactions of attendees of the event. The global geographic scale that is exemplified at the TGA gala fits into the teleological arc of Blaut’s modern diffusionism, here standing in for the next iteration of the world that can 89 be imagined as the foregone conclsion of what Blaut describes as a belief system of modernization via diffusionism that results in (imagined) eventual equilibrium (Blaut, 1993). An empirical complement to Blaut’s formulation of the colonizer’s model of the world is provided by this evidence, where the sequence of changes that result from ongoing processes of European global hegemony are extended into the future, which I will show is a key component of elite philanthropic place-making processes. Life Cycle of The Tropical Gems Auction and Gala While PMCA’s core group of donors are obviously compelled to participate in PMCA to save dying children, the participation of this small group of local economic elites is part of a set of cultural practices that calibrate into the accepted norms of the elite philanthropic society from which the majority of donors originate. These norms are what Merry refers to as the “rules people carry in their heads” (2006, 2) and are key to understanding how place-making narratives are enacted at the TGA gala. The major annual charity event thrown by PMCA is a must in the social circles of Southville’s social and economic elite. Held each fall, strategically after the warmth of the summer months has subsided and the holiday spending budget is yet to be solidified, the “Tropical Gems Auction” (TGA) includes a runway fashion show and a live auction wherein exclusive vacation packages in the same countries that the patients involved in the charity’s efforts come from. This auction is the primary source of PMCA fundraising dollars raised annually, where between $650,000 and $800,000 is raised each year. 21 The 21 All together over a million dollars are raised as a result of the auction’s efforts. There is also a silent auction and direct contributions that are made the night of the event 90 TGA event has a life cycle that eclipses that of the night of the fundraiser. Planning the details for each year’s gala begins several months in advance when the co-hosts are selected. The process depends on a solid foundation of donor support that is years in the making. After the initial planning stages comes creating the event space environment that succeeds in becoming a particular type of place that makes this level of elite fundraising possible. Lastly is the successful orchestration of the evening so that the place can be experienced by attendees in such a way that provides them with a fulfilling experience in terms of philanthropy and elite status. Phase One: Choosing the Team and Theme The planning of the annual gala begins the previous summer when two couples from the donor base are courted to be the hosts of the event. The goal of the development staff is to garner participation from the most influential donors, in terms of local social status, as the reputation of the event hosts is key to the event’s success. These co-hosts, usually two husband-and-wife teams, are not necessarily from the pinnacle of the hierarchy of the social strata, as their active participation and social standing are both key. My fieldwork extended over three years of the gala, but the examples in this chapter are from the 2009 gala. The two co-host couples of the 2009 TGA gala were Maggie Peeler, close friend of PMCA president Victoria Conway, and long-time board member Nell Labrie. Peeler, a middle-aged woman (age is not discussed in Southville) who closely resembles celebrity and as a result of the invitation and follow up processes. The cost of the event is also a significant financial factor and can cost PMCA over $100,000 annually. 91 Nicole Kidman, lives in the heart of the historic district of Southville among the city’s political and social elite, amidst museums and colonial era churches. Her home, a Greek revival with columns framing the moulding laden front porch, is decorated with colorful tapestries adorning an extensive antique furniture collection. She is a featured singer in her church, a mother of grown children, former fashion model, and aspiring actress. Tall and blonde, Peeler is the epitome of classic Southern style, always wearing elaborate make-up, dressed in the latest fashions, a descendent of a well known local family, and never without her charismatic charm. Peeler and her close friends, including PMCA president Victoria Conway, spend considerable time and money at local salons and on local doctors who specialize in deemphasizing the signs of aging. It would not be an understatement to say that Maggie Peeler is the life of any party. She recently won the first ever “Southville Dancing with the Stars” and those who are around her are often laughing and affectionate. Nell Labrie is the mother of four school-aged children, and resembles actress Meg Ryan in appearance and personality. A friend to the local intellectual elite of world traveling journalists and artists featured in local and national museums, Labrie lives with her family in a plantation-style estate in the close-in suburbs just east of Southville, in a county with one of the highest concentrations of wealth in the entire country. Her home is designed in a classical modern style that has been featured in local and regional decorating and architectural magazines, and her social calendar is filled with philanthropic duties for PMCA and activities for the private preparatory schools that her children attend. Often dressed in jeans and an expensive top, Labrie dresses more casually than most of the other women of the donor base. Her main topics of 92 conversation are her young children, the local art scene of which she has a prominent role, and her desires to help the children of PMCA. Labrie’s family is not from Southville and she has used her social contacts in a neighboring state to extend the reach of PMCA’s fundraising and programs. Together, Peeler and Labrie represent old world and new world Southville, as well as the positive happy yet refined personality type that is required for social adeptness in Southville. Once the main co-hosts have been chosen these two couples then recruit other co- hosts from their circle of friends to participate in the planning of the event. The core co- hosts have always been married couples. It is almost totally the efforts of the wives of each couple that do the actual work of meeting, working with PMCA staff, making choices for the event, and volunteering to set up the event space. The team of co-hosts are in charge of the aesthetic decision making for the gala, including but not limited to choosing the food that will be served, the floral design, room layout, and choosing that year’s specialty cocktail. The PMCA development staff does the actual legwork in terms of making arrangements. The gala has approximately 400 ticketed guests, with tickets starting at $400 and going up to $2000 per couple. The entire PMCA staff attends the gala along with their significant others, dressed in formal attire but there as hybrid volunteer/guests. There are also PMCA volunteers who attend each year to sell raffle tickets wherein one of the resort vacations from the live auction is raffled off as a prize. Altogether other than service staff there are approximately 450 attendees at each year’s TGA gala. The annual headcount is dictated by the local fire codes. The importance of a sold out gala cannot be understated. While the event is advertised as a public event as this is needed to peak the 93 interest of the local and regional media, the development staff attempts to limit public participation by assuring that the pre-chosen guest list can account for all of the available tickets. Each year the auction committee attempts to be included in the Society section of Vanity Fair magazine, although this has not yet happened. Phase Two: Creating the Event Aesthetic The appropriate aesthetic is key in all aspects of the TGA gala. From the linen paper used in the auction booklet that each attendee receives, to the music played in the background as guests arrive, every choice must reflect what Thrift describes as corporate storytelling, the “use of artistic genres that both communicate and create corporate values and strategy” (2000, 682). The aesthetic of the Tropical Gems Auction is one of an exclusive tropical paradise. Each of these elements is key to creating a world inside of the event space that is at the same time a Caribbean luxury microcosm and a platform to reinforce a particular expression of philanthropic community. These two components, popularity-based-elitism and exclusive philanthropy, are key to the success of the event and indeed the social fabric of PMCA. Creating this image begins with the design of the event invitation. For the first major decision of the event planning committee several factors are considered, the first of which is the color scheme of the invitation which will align with the décor of the event. Debates over which colors are the “hottest” that season are intense. The best-case- scenario is that the colors chosen in early summer for that autumn's auction are those featured in the style sections of high fashion magazines that fall, reflecting the fashion 94 line up of the following spring 22 . The layout of the invitation is key, as is the quality of paper used. While linen paper represents the pinnacle of quality, some organizers feel strongly that linen invitations are too costly and that this reflects poorly on the efficiency of PMCA (the 400 invitations that are mailed cost upwards of $1000 to mail, even with donated printing services). The appropriate balance of responsible spending for a non- profit organization without compromising the exclusivity and luxury status of the TGA gala is a recurring topic especially during the initial planning stages as this is when major budget decisions are made. The organizers must be careful not to look wasteful with the charity's resources without compromising their capacity to raise very large donations that are made possible by the luxury aesthetic of the event. Every aspect of the TGA Gala involves the decision-making process with the event committee. One element is the menu style and selections. Each year food trends are incorporated, as are decisions about what kind of food is best to elicit larger donations. It is debated, for example, whether one-bite portions or two-bite portions are more conducive to generosity 23 . The balance between restraint and being on-trend is key here as well. The site layout is also key to the initial event planning. First, the location of the fashion runway and the length of the runway must be decided, followed by how many tables and what type of tables will be used in the tent and where they will be located. The 22 Fashion Week in New York occurs twice each year. In the Summer the fashions for the following spring and summer are revealed. In the winter the fashions for the following fall and winter are revealed. The invitation color schemes for the auction are chosen in June and they aim to match the latest hot summer colors, which are not known until later in the summer. Although the auction occurs in the fall it is the spring and summer colors that are key as the tropical theme features an atmosphere that looks to escape the cooling weather trend of late fall in Southville. 23 In one of the more lively after-auction meetings I attended most people agreed with Labrie who cited cheese portions that were deemed as far too large as “costing us who knows how much” in potential donations in the auction. 95 aim is to provide enough seating for corporate sponsors and for some people to sit during the fashion show, but that only a percentage of people can be seated, as standing and moving are thought to create a better atmosphere, and the atmosphere is key to the success of the live auction. 24 How beverages and food will be served is also strategic. People must be able to have as much alcohol as they wish to and have access to beautiful trendy food. However this must be tempered with the assumption of event organizers that hungry and thirsty people are louder and loud is good at an event. Of course people's needs must be met or this would prove disastrous. Likewise, overfed guests become lethargic which is very bad for the auction, where over half of the event's money is raised in under an hour, and if there is an appropriate time for intoxication it is not at the event proper but for the even more exclusive after party, attended by only the most popular ten percent of the event's guest list. All of these factors culminate in the master timeline of the event, as the lengths of time that are designated for mingling are as important as those for the fashion show and other entertainment. Incorporated into the timeline are various announcements and entertainments, the transitions between which must be as efficient as possible. It is the resounding opinion of the event organizers that less is more in terms of time spent talking. The reception portion of the evening and runway fashion show create the ideal environment for the one hour of the year where PMCA will bring in up to half of their annual operating expenses during the auction of resort properties. There are approximately thirty vacations in a silent auction, and twenty that are chosen for the live 24 Corporate sponsorship is another topic of considerable debate in the TGA planning stages. While the event has grown in popularity in Southville close attention must be made to keep the feel of exclusivity, so corporate participation is limited. 96 auction each year. A professional auctioneer orchestrates the live auction, the status of whom is known by the wealthiest of the event guests, and with whom a relationship must be cultivated by the development staff for months in advance as one cannot simply hire the best known auctioneers. Phase Three: Orchestrating the Event These elements all come together the week of the event. The de facto start of the orchestration of the event comes when the tent goes up and the decorating can begin. The location of the TGA gala is unique; years ago event organizers decided that renting a typical event space would be too boring, opting instead to construct a temporary location, in the form of a large circus-like tent, within which they are able to create an environment of their own design. Using a tent resulted in a spike of the all-important pre-event buzz, and the “unveiling” of the tent each year as a key draw to those in attendance. The technical name for the type of tent used for the TGA gala is a tension tent, with swooping peaks along high ridge lines, made of PVC fabric built to withstand inclimate weather and winds. These tents are temporary buildings, requiring a permit and professional set up, constructed with interior fabric walls as well as a variety of flooring. For the TGA gala a 4000 square foot tent is built each year. While the main body of the tent is a large open room there is also a stage, a runway, a backstage area, an adjacent bathroom area, and an entry room, all of these areas under one roof partitioned by PVA walls. The floors are covered in the main area with a temporary hardwood floor and in the adjacent rooms and entryway with temporary carpeting. The flooring material is attached to plywood 97 underlayment. Underneath this plywood temporary sub-flooring is a parking lot. The popularity of the TGA gala is in part credited due to this dramatic spatial transformation of a parking lot of an upscale strip mall ten miles from downtown Southville into an ephemeral place that is the epitome of tropical paradise. The strip mall features the most expensive high fashion boutique in the city, Chaucer. Stu Fisher is the owner of Chaucer, a supporter of PMCA, and his contacts are essential to the successful execution of the runway show. The annual TGA gala is a passion of Stu Fisher, owner of Chaucer, a petite balding man often seen dwarfed by tall models, and considered to be the penultimate expert on designer fashion in Southville. Fisher is in charge of the fashion show element of each year's gala and can be found in the backstage area behind the stage and runway during the event, tending to the models and designer, until the end of the fashion show when he escorts that year's designer down the runway and a standing ovation is standard audience procedure. Fisher shared in an interview that he does not consider himself the owner of a retail clothing establishment but instead is “the curator of a gallery of beautiful clothes.” Also in the same strip mall is a fine dining restaurant, Collage, that has catered the TGA event each year since the event has been held in its parking lot. Collage has won dozens of awards in the greater Southville region for, as their head chef described to me, their “trendy global cuisine.” Each year the Collage culinary team designs an array of unique menu options exclusively for the TGA gala, the chosen items remaining confidential until the event and never appearing on the Collage restaurant menu until after the gala. The orchestration of the food service is complex and requires expert timing and a professional service staff. Some food must be hand-passed, served to guests on trays that wait staff 98 carry throughout the room. Other food is artfully displayed on platters in various strategic areas of the tent. The Collage staff is also in charge of the creation of the annual cocktail, which is served in specialty glassware and adorned with intricate garnishes, for example one year there were fresh orchids in each specialty beverage glass. There are two bars flanking the sides of the room, assuring that guest never have to wait in a long line to retrieve and refill beverages. All food and beverages are complimentary for everyone who attends the TGA gala. There are logistical considerations that must be handled with the event taking place in a tent. First and foremost is parking, as the tent covers the parking lot. The valet parking team uses the lot of a large medical facility that works with PMCA to meet this need. The facility is across the street from the event site, and the valet parking team must sprint across a four lane road dozens of times over the course of the evening to assure that people do not incur an inappropriate wait to drop off their car or have their car retrieved when needed. The arrival area, a small room in the tent where guests arrive, has a coat check and long tables where people check in, verify payment information for potential auction sales, and receive a paddle to be used in the live auction and a fully detailed auction book that lists all of the items available. The auction book is as strategically crafted as the invitation, and is sent to all of those who have RSVPed to the event three weeks before the auction, to give people enough time to preview the resort properties without having the information for long enough to become bored of the catalog. The book is the size of a small phone book, approximately 50 pages in length, and features pictures of the featured resort locations, advertisements from event sponsors, information 99 about current PMCA programs, and listings of corporate and individual supporters of the charity. Upon entering the main tent area the lighting and sound elements must be in place and all potential technical difficulties must be taken care of in advance of the event. The lighting and sound team arrives the morning of the event to install lights and speakers throughout the tent. The lights range from a spotlight system installed in the tent ceiling that is used for the runway show and auction to dimmer lighting around areas for conversation. The lighting must be bright enough in the silent auction area for people to read signage and participate in the bidding process, and must, organizers insist, be soft enough in the tables area that women feel that they have reached maximum capacity of their attractiveness. The bathroom area is perhaps most heavily scrutinized, as the majority of guests in attendance are not accustomed to using portable toilets. Using the facilities requires attendees to exit the main tent through a side door constructed from the PVC tenting material and use one of three tractor-trailer-portable-bathrooms 25 . The tent enfolds the doorway areas of the tractor trailers that house the bathroom units so that all guests experience is a transition of flooring from the hardwoods in the tent proper to the carpeting on the other side of the doorway, and slightly brighter lighting to illuminate the stairways that lead to three bathroom solid hardwood doors with brass doorknobs. These bathrooms are top-of-the-line for portable bathrooms, with porcelain flushing toilets located behind additional doors inside of each two-room bathroom suite, each featuring a 25 Tractor-trailer-portable toilets, as opposed to free standing portable toilet units, are custom fit into standard cargo container units that are delivered by eighteen-wheelers and uncoupled onsite prior to the event. 100 sink area with a countertop adorned with flower arrangements and a variety of complimentary toiletries. Inside of the main tent area is the silent auction area, a focal point for event attendees flanking the main doorway into the tent proper. Large posters of the non-live-auction sites are hung from the tent walls, no easy feat and requiring double and triple checking to assure that none will fall during the event. In front of the signs are long tables draped with white linen tablecloths and clipboards upon which guests can bid on each item. The setup and organization of this area must be accessible to guests while not detracting from the luxurious atmosphere. For this reason the silent auction area is just inside of the entry doors. Guests would have to turn around to see the silent auction items as they walk in. Instead the space is designed to draw guests into towards the food and beverage areas, and to admire the flowers and decor upon initial arrival. The display of the silent auction items is prominent enough that guests eventually notice it, but the placement of this area is strategically effective as to not distract people upon their initial entry into the tent. Each of the elements culminate in an environment that organizers aim to “be otherworldly,” “take their breath away,” “transport them when they enter the tent,” wherein guests are able to “leave Southville” and experience the “beyond beyond 26 .” From the hair dos to the lighting, from the volume and selection of music inside the tent to the feel of the paper on the invitation and auction book, from the impressive array of never-before seen food choices to an efficient and professional valet staff, each item is not unlike a well played instrument the night of an orchestral premier. Like an orchestra, 26 As in previous chapters, each example provided has been expressed a minimum of five times. The sources of this commentary are from direct questions asked in interviews, discussions observed in meetings, formal, informal, and overheard conversations. 101 the TGA gala is live and ephemeral, and the organizers and PMCA staff only have one chance to get all of the elements into alignment to take advantage of what Mattingly calls “evanescence,” getting caught up in an ephemeral moment during which “dramatic time” becomes a key factor in hyperbolizing the environment (Mattingly 2000, 199). These elements are all parts of the narrative of PMCA, a story that is dramatically told each year on the night of the TGA gala. It is here, in the ephemeral space of the annual gala that the narrative of PMCA is most firmly consolidated, and the global scale is foundational to this consolidation. Simply put, PMCA narratives about the global scale legitimate the social practices of the donors, staff, and public, extending beyond the scope of the charity. The following examples will effectively re-visit the “show” of the TGA auction that was just outlined in depth as a recurring geopolitical incident in the making of the global. Spatial Narratives of the Global: Event Aesthetic as a Place-Making Process The following section looks at examples from the TGA gala wherein the global scale is made through the creation of the event aesthetic. When thinking about an event as a place-making process the ephemeral aspect of the experience cannot be understated. The appeal of an event is that it must be attended in person to share the experience with others who are there, that an atmosphere must be created to entice people to both enjoy themselves and to donate generously, and that there is one chance on this one night to get every detail right in order to succeed in the twin goals of entertainment and raising funds. The organizers of the Tropical Gems Auction are experts at this, the result of which is a one night gala that raises over half of PMCA’s annual operating expenses, an outcome 102 that cannot be divorced from the event’s reputation as a premier social event of the Southville elite. The examples that follow are based on the senses that must culminate to create the ideal experience and with it the ideal world in which joining PMCA’s efforts is the result. The materials that are used to build the event space work together as a narrative of tropical luxury. The décor of the tent is designed to create a tropical environment. From the palm fronds and birds of paradise in the large-scale flower arrangements to the grass mats that line the walls of the auction a global trope of tropical paradise and exotic otherness is enacted. Three foot by four foot full color posters of the exclusive resort properties hang from the ceilings lining one wall show the lap of luxury. Posters include destinations of expensive tourist oriented resorts but those most prominently featured are the properties that will be featured in the live auction. These are rarely locations where just anyone can pay to go. At the 2009 gala less than half of the sixteen properties featured in the live auction were places available to public clients, one of which being a hilltop on a private island in Mexico with a mansion, maid, butler, and chauffer where two well known celebrities, a Grammy-winner and a supermodel, were married the previous year. The people attending the auction are very wealthy. According to internal PMCA development documents over eighty percent are in the top one percent of wealth by US standards, yet these vacation destinations are described by auction attendees as “once in a lifetime,” “a dream come true,” and “beyond beyond.” The majority of the auction locations are private homes mostly on very small islands in the Caribbean but 103 also in the countries where PMCA does its work 27 . These homes, which are offered at auction for week-long stays, are giant mansions, the renting of which often includes a staff of servants. Although the identity of the homeowners is officially a secret, gala insiders spread information that they know about the homeowners at the gala via word- of-mouth. Most of the information spread in this way the night of the event is facilitated by those who have won particular auctions in earlier years and seen pictures of the celebrity owners while in their homes. A tropical paradise aesthetic illustrates the idealized global imaginary of PMCA. From the colors chosen for the event invitation, like the aqua blue and bright magenta that were featured in 2009, to the design of the elaborate food platters, the tropical theme is strictly adhered to. Blaut’s observations about Western diffusionism are most useful in understanding the global imaginary that is seen in the aesthetics of the TGA gala (1993). Blaut presents diffusionism as a belief system within which Europeans are the source of human innovation, progress, and cultural superiority, using the term Inside to refer to those that benefit from this division and Outside for the people and places that are in the non-European world (1993) 28 . This superiority is subsequent to outdated theories of religious and biological superiority, which Blaut explains is inextricably linked with 27 PMCA’s reputation for being a lifeline to critically ill children on these islands is the primary reason that celebrity and extremely rich homeowners on these islands donate their properties. According to those at PMCA in charge of maintaining the relationships with these property donors, their participation is motivated by their personal affection for the native residents of their island homes, especially those employed as domestic laborers who many rich homeowners describe as “family.” 28 This theory of diffusionism, according to Blaut, is automatically practiced by Eurocentric cultures, which includes Americans (1993). Blaut also provides guidance on how people are active producers of space in continual mediation of spatiality vis-à-vis mapping abilities that are human universals, constantly in process as part of every human experience (Blaut et. Al. 2003). 104 colonialism and its legacy (1993). Blaut’s observation that in this theory the material riches, which include the human resources, of non-European places serve as compensation for the benevolent sharing of superior innovations and modern technologies can be seen firsthand at the TGA gala. Western diffusionism is epitomized by two worlds, the superior people, places, and technologies of the Inside, and the inferior counterparts of a non-Eurocentric Outside. A crude interpretation of the event focused on here is that at PMCA’s TGA gala those from Inside are enjoying the beautiful resources of Outside. Here, the “Tropical Gems” are on display, in the form of the beautiful coastal landscapes shown in the oversized posters that adorn the walls, in the flowers, food, and colors that are chosen to decorate the tent, and on the bodies of those who attend the gala. The impact of the decorations at the gala to create the scene of what organizers describe as an “exotic paradise” is augmented only by the attire and personal adornment of the women who attend the exclusive event. Everywhere one looks at the TGA gala they are reminded of the tropical paradise that is symbolic of PMCA. Complementary to the sights of the TGA gala are the smells and tastes. The entire tent smells like the food that is served, with guest commenting on the “fragrances of coconut” and “Caribbean spices” that permeate the environment. The menu is designed each year to reflect contemporary food trends in Southville but always must incorporate food that is associated with Central America and the Caribbean. Event organizers view this as essential to putting people in the appropriate mood to spend money. The menu items are chosen to impress the guests and also to remind those who have been on the auctioned trips in years past of the flavors of the food that they have enjoyed while on their luxury vacations. Each menu choice is debated by the co-hosts who attend the menu 105 tastings where final selections are made. The official event hosts and not the PMCA staff receive credit for the menu. The same is true for the signature cocktail that is served, a unique beverage each year that almost always includes an ornate garnish. In 2009 each pink rum and fresh juice concoction was garnished with its own orchid. Along with the sights, smells, and tastes of tropical paradise is the unmistakable attention paid to another of the five senses, as the room feels, in a word, hot. An essential element of the TGA gala is that the tent feels like stepping into the tropics. While there is plenty of chatter at the gala about the décor and the food, perhaps the most commented on and important element of at the TGA gala is the personal embodiment of the tropics found on the guest attendees. Each of the event hosts and many of those in attendance spend hours in local salons having their hair and makeup professionally done before the event in order to look their very best. Although the event is held in the late fall each year, the clothing selections evoke summertime, with bright colors well represented, especially by the event hosts. Many men wear suits or tuxedos, and some of the women wear more somber, classic, or conservative apparel, but those on the organizing committee don never-before-worn gowns and lateral coiffures that turn many heads throughout the evening. In Southville it is not only important to be in vogue with the very latest in designer clothing and accessories but to also be unique. The women are overwhelmingly dressed in bright colors. Their ornate jewelry is often adorned with large medal and rhinestone flowers that complement the arrangements seen in the décor. The fashion norms of Southville are not drab and each woman is expected to display a style that is both unique and compatible with contemporary fashion trends, with the only thing rivaling the ornate jewelry being shoes that cost in the hundreds of dollars. 106 The designers chosen for the fashion show are also selected in part according to the tropical aesthetic. In 2009 organizers insisted that the appropriate designer evoke “the islands,” “paradise,” “fantasy,” and “pure escape.” For those who cannot afford new expensive outfits and salon treatments fitting in with the crowd is of utmost importance. Staff members, who are known to many of the donors personally, go to great lengths to blend into the high fashion atmosphere. The female staff members wear borrowed gowns, outfits found in consignment stores, on sale, worn previously in weddings, or in the case of some staff members who are drawn from the economic elite social circles of the donor class, outfits that rival the most expensive in the room. The clothing, jewelry, and shoes worn by the women in attendance of the TGA gala is a topic of conversation throughout the night of this event. The crowd is photographed and those best dressed appear in local and regional newspapers. The media members allowed to attend are carefully scrutinized by the event coordinators, a mixture of veterans of the local and regional media along with younger journalists that are often intimidated by those in attendance. Event organizers purposefully invite carefully selected younger people to the event as this is thought to legitimate the night's gala as one that is not only exclusive, but popular. One such local reporter whom I interviewed said that covering the PMCA gala was the scariest assignment of her then three-years-long career, describing the crowd as “all the who-you-should knows and who-you-don't-know-but-want-to-knows.” What is about the aesthetic of an “exotic” “tropical” imaginary that results in such effective fundraising? Perhaps the environment is simply beautiful and provocative of fun, as some attendees insist, claiming that the uniqueness of the setting in Southville is so different from the “ballgown and champagne scene,” as one board member put it. 107 While this may be true, there is more than aesthetic exceptionalism at work. Human rights scholars that study the link between imagined utopias and humanitarian ideologies are in sync with geographic scholars who study the legacy of colonial philanthropy and its reliance on using utopian tropes to advance projects of globalization (Baxi 2005; Farmer 2004; Grear, 2006; Grear 2007; Lambert and Lester 2004). Consideration of the TGA aesthetic as the utopian ideal world in which participating in PMCA can one day result in fixing the gap between the haves and have-nots in terms of global health inequality, and therefore inequality writ large, is in sync with scholars that study the wide range of consequences of the colonial encounter, as well as critical human rights scholars who note the use of humanitarian and utopian tropes as essential marketing tools of transnational philanthropic schemes (Quijano 1993; Baxi 2005). At the TGA gala people who attend are absorbed into an environment wherein they are, for the night, part of an imagined future that has been transformed into a utopian paradise. Here we see the enactment of what Mattingly calls “moral willing,” wherein people who are experiencing events in dramatic time are able to participate in projects of self transformation, what Goldberg refers to as the enactment of response-ability (2006; 2007). Putting these critical human rights scholars in conversation with Blaut’s Western diffusionism we see that in the case of the elite philanthropic endeavor, the Inside requires the embodiment and enactment of the Outside to gain its legitimacy. This observation is in alignment with Blaut’s ideas, as he emphasizes that the global imaginary of diffusionism relies on a teleological arc upon which all paths lead to the eventual acquiring of the conditions of Eurocentric culture, which Blaut reminds us is flawed in a number of ways, namely that the assumptions of Western superiority are 108 unfounded, inaccurate, and racist (Blaut, 1992, 1993). The aporia in analysis of the TGA gala is that the place of Outside has at the gala become the pinnacle of inclusion into the Inside, borrowing Blaut’s terms, demonstrating the complexity of the contradiction that Blaut observes in the dialectic that underpins the belief system of diffusionism. The same places where PMCA does its work, explained in their literature as locations marked by inequality, a lack of resources, and a place of poverty and need, are at the TGA gala presented as the ideal places in the world to be for leisure, or as it is said in the Southville vernacular, places that are “beyond beyond.” Performance of the Global Scale: PMCA Narratives about the World Alright folks, now you don’t want to miss out on this next one. A one week stay in your own private villa with an infinity pool, sleeps up to eight. This comes with your own butler, maid, and cook for the week- it doesn’t get any closer to paradise than this. Come on yall- let’s start the bidding at sixteen thousand dollars. Great! Do I hear seventeen? […]… –Peter Goodwin, professional auctioneer, Live auction at annual IHC Treasures in Paradise gala We thought the fashion show would be just for the girls but it’s really a hit with the men. It’s what makes us different- this is a New York fashion show. There’s nothing like this in this town. The men really loosen up after the show. That’s why we do it right before the live [auction]- the bids go up that way. It’s just so much fun. –Victoria Conway, PMCA President 109 Complementing the aesthetic wherein the elite become the anthropomorphized cultural cannibals of those they aim to help, narratives of PMCA’s imagined global scale are told through the material objects, written and spoken discourses, and performative interactions at the TGA gala. In the fashion show, the auction, and the dance party that ends the evening, the scripted and unscripted performances at the PMCA gala epitomize the global imaginary that makes PMCA’s work possible. Here performance also applies to the vernacular discourse that is understood by those in attendance at the gala. The event, while it aims to be transcendent of Southville is dependent on the cultural norms of the PMCA donor class. After explaining the fashion show as an example of place-making by PMCA the last two examples of this chapter, the Tropical Gems Live Auction, and the dance party that follows, will further show how a global imaginary is enacted at the event and discuss how this contributes to making PMCA’s work possible. A transcendent global imaginary is uniquely Southville even as those involved in PMCA repeatedly evoke New York City, a place that is neither Southville or in the Caribbean or Central American regions where PMCA does its work. In dozens of instances among the crowds at the gala and during the event planning process, comparing the inside of the tent to New York is a reoccurring comment, as is referring to the night itself as simply “New York,” as in Conway’s comments to staff the morning of the 2009 gala when she explained that “tonight we’re New York, so let’s act like it and look the part.” Whether those in PMCA are in fact experts on what this means is irrelevant. What is important is the elite status that New York City represents to them in terms of legitimacy. In order to achieve their goal to not only raise money but to be the most coveted social event to attend each year, the aim of organizers is to ascend one rung 110 higher on the hierarchical social ladder of style and status. Although the event as a whole serves this purpose the fashion show is the foundation of the legitimacy of equivalence with New York City. The designer whose work is featured in the fashion show is chosen in part by their reputation in high fashion circles. Each year the designer is flown to Southville from New York City at the expense of the charity, along with the fashion models 29 . Immediately preceding the fashion show Conway and the event co-hosts each give brief speeches. These are very brief and require pre-approval by Conway. In fact the logistics of the fashion show, auction, and the transition to the post-auction portion of the evening that always includes a “spontaneous” dance party, are all orchestrated by Conway based on her years of experience first as a high fashion model, and later as the wife of an elite businessman in Southville. Conway’s explicit guidelines for the speeches are that they each must be positive, be very brief, and to result in crowd excitement. The speeches must be, to quote Conway, “100% positive.” For example, in 2009 one of the co-hosts wanted to mention all the work done for “sick” children. This was edited at Conway’s insistence to instead say that PMCA works to “heal” children. Topics vetoed at meetings I attended included mentioning global health inequality, statistics about access 29 There is a notable exception to using New York fashion models in the TGA runway show. One year there was a last-minute need for an additional model and one of the PMCA staff members, receptionist Michelle Austin, participated at the last minute. The crowd response was notable, with considerable cheering for the recognizable Austin, who greets visitors when they come to the PMCA offices. From that year forward PMCA president Victoria Conway makes considerable effort to persuade those staff members who wear clothing size zero to size four, almost the entire staff, to participate in the runway show. While no staff member has ever agreed to do this, and many on the programming staff in particular have expressed discomfort in the repeated requests, Conway’s daughter, in her late twenties and with some experience as a model in her childhood, has been in the fashion show three times, a tradition that has become a crowd favorite. 111 to health care resources, and using medical jargon. This part of the evening is the most strategic in Conway’s opinion. The speeches set the tone for the fashion show and auction, remind people why they are at the event and that their money is needed to continue to do PMCA’s work, establish an intangible yet vital momentum for the evening’s program, and remind people in attendance of the high profile donors and organizations of Southville that are affiliated with PMCA and the TGA gala. They can also be a liability because the transition from reception to fashion show must be, Conway insists, as close to ten minutes as possible. Those participating in this portion of the evening rarely if ever complain about Conway’s control over the pace and content, instead praising her effectiveness in achieving the desired effect of inducing crowd excitement, recognizing sponsors and co-hosts, delivering a positive image of PMCA and the work that it does, and doing so with plenty of ovations within the ten minute time- frame. Once speeches are delivered the lights in the room are lowered, a spotlight shines on the curtain that drapes the far back of the stage and the fashion show begins. The light show starts on the runway and the entire room turns their attention to the spectacle of tropics inspired clothing draped on tall thin models who march up and down the runway to pulsating music that is in sync with the lighting scheme that includes spotlights, lasers and other specialty effects wherin lights, with names like “Fresnels” and “Par 56’s,” appear to “dance” along with the music. This work is done by a team of professional lighting and music designers that are hired in some years by the tent rental company and some years by the fashion design team that is flown in from New York. This presentation style, couture catwalk lighting, is crucial to the legitimacy of the TGA gala. Although 112 couture fashion is literally the presentation of outfits that cannot be replicated, the cultural scene of the fashion elite, including its elite consumers, is also referred to as “couture” (Troy, 2003). The couture runway show is marked by its noticeable aesthetic, with serious-faced quickly-marching very tall and very thin models who pose and spin at the end of a runway, lighting and music that accompanies this pace, and a rapid procession of models who must change clothes with the help of a team of attendants in order for the pace of the show to be possible. The models walk so rapidly down the runway that their clothes, in the 2009 show mostly full length dresses made of silk, fly in the breeze created by the speed of their wearers’ marching. The fast-paced style wherin lights and music follow the models up and down the runway is evocative of runway shows in New York, Paris, or Milan. There is no announcer during the show, just a parade of models emerging from the curtain at the back of the stage at a pace of one person per twenty to thirty seconds. Behind stage professional dressers help the models change clothes rapidly. Indeed, a couture-style runway show depends on stylists, make- up artists, dressing attendants, the designer who chooses the order of presentation, and the choreographer who sets the pace and tone of the show. Fashion “parades,” as they were called, originated in Paris almost 150 years ago (Currid, 2007). New York City’s fashion week is less than one hundred years old, taking place for the first time in 1933, but it was not until the 1990s that intimate exclusive smaller scale shows with celebrities became the penultimate social events that they are seen as today (Schweitzer , 2009). The fashion show’s total time in 2009 was just under eleven minutes; Couture fashion shows typically run between nine and twenty minutes in length, the longer shows 113 reserved for the very top designers while most shows are at the shorter end of the spectrum (Troy, 2003). During the fashion show the audience, who sit in two rows of chairs that line each side of the runway, stand in a crown at the front of the runway, and sit in round tables that are on platforms behind the two rows of seats, pays close attention to each minute of the show. Some viewers comment on clothing, and there is occasional applause. Many of the men stare at the women and a few people ignore the fashion show, moving to the far corners of the room to converse, but most of the audience watches the show with close attention. People nod, tap feet, or sway to the syncopated rhythms of the music. People’s expressions range from very serious, as if they are paying attention to an important lecture, to broad smiles. Interviews that I conducted revealed what is obvious to anyone in attendance at the gala. The audience is ”impressed,” drawn in,” “in awe,” “swept away,” and “overwhelmed” by the spectacle 30 . The end of the fashion show is signaled by the designer’s entrance onto the runway, hand in hand with local boutique owner and event co-sponser Stu Fisher, who announces the designer by name as they wave to the crowd who gives a standing ovation. Here is the loudest moment of the TGA gala, the pinnacle of audience excitement, as loud clapping and cheering continues until Fisher hands the microphone to another couple as they walk through the curtain and onto the stage, PMCA president Victoria Conway and auctioneer Peter Goodwin, whose reputation as the best auctioneer in the region is credited with bringing in 15%-20% higher auction totals, which at the Tropical Gems auction means up to $100,000 in additional funds for the charity. The abrupt transition from fashion show to auction is 30 Each of these phrases occurred in interviews and/or overheard at the event a minimum of five times each. 114 deliberate with the largest donation solicitation being done exactly at the moment of highest audience excitement. Sustaining the momentum of the fashion show is crucial during the auction, the orchestration of which is handled by Conway herself, with every detail of what will be said, how it will be said, and to whom, is rehearsed and executed with precision each year. It is in this moment, with Southville recast and elevated to the status of New York City that the elevated status of the utopian global imaginary of PMCA is reflexively evoked. The house lights are turned back on at the end of the fashion show, but the lighting is less bright than before the fashion show. The auction proceeds at rapid speed, with each property being introduced by Goodwin and Conway in a strategic sixty to ninety second speech, followed by audience bidding with Goodwin at the helm and Conway providing encouragement. Holding audience attention is key to getting huge donations, and this can be a challenge because only a handful of the room’s four hundred guests are wealthy enough to bid during the live auction. As the TGA gala has grown in popularity in Southville as a social event, this challenge has become more prominent, as Conway explains that crowd noise eclipsing the auction is disastrous and must be minimized at all costs. To combat this, staff members and event volunteers spread throughout the room and informally “shush” people who begin to converse too loudly during the auction. The people who do this task do so in somewhat of a clandestine nature, often attempting to blend into the very groups that they are shushing, a strategy explained to me as more effective than a less subtle quieting of the crowd, giving the impression that people in the building want to pay attention to the auction even if they are not bidding on auction items. Overall people do pay attention to the auction proceedings 115 even if they are not potential bidders. Conway provides entertaining commentary and the auctioneer speaks in stereotypical fast auction talk that is entertaining to watch. Southville has a legacy of auctions as entertainment that over my years of time at PMCA I never heard people discuss or acknowledge. Southville has a historical legacy as a site of live auctions for humans during the centuries of chattel slavery that provided a foundation for the political economy of the region. The legacy of auctions in Southville in the antebellum period is part of the existing landscape there with thousands of tourists visiting historical auction sites each year. There is a museum for the history of slavery currently being built at one of these sites in Southville. During a handful of interviews I conducted I noted the complete absence of recognition of this link. In one of these interviews the subject evoked a trope used by many in Southville that is ubiquitous in the local vernacular, “Heritage not Hate,” 31 suggesting that the legacy of auctioneering is one of pride in Southville that although it cannot be divorced from the legacy of slavery in the region should not be automatically affiliated with any legacy of discriminatory practices. Most interesting is the overall non-acknowledgement of this link, indicating a pervasiveness of auction as entertainment that makes the link entirely unnoticed. In order to keep the audience captivated and keep potential bidders focused Goodwin and Conway deliver initial property speeches loudly and rapidly, after which 31 The topic of “heritage not hate” came up in several interviews that I conducted, and in countless everyday interactions that I had with people within and without PMCA during my time in Southville. Those who broached the controversial, albeit commonly discussed, trope almost always refused in one way or another, usually indirectly, to share their opinion on the concept, instead directing the relevancy of the “argument” as it is commonly referred to, back at me. People in Southville asked me dozens of times what my thoughts were on this controversial “argument.” This phrase is so common in the Southville region and the state where it is located that it is featured on advertisements, overheard in everyday conversations, and even featured on state-issued vanity license plates that feature the confederate flag. 116 Goodwin orchestrates the bidding while Conway stands behind him repeating keywords about the properties and locations and also responding to the ongoing bidding process. Conway’s amplified responses include shrieks and applause that effectively recapture the audience’s attention and serve the dual purpose of bringing attention to the winning bidders, albeit only for a moment because once one property’s is done the next one begins with barely a pause between. Although the auctioneer’s participation is seen as non-negotiable in terms of key elements to a successful event, for all intents and purposes this is Conway’s show. Her performance during the auction sets the tone for the spontaneous outbreak of dancing that occurs less than an hour after the auction’s conclusion, and her charisma and wit are the main topic of conversation in the crowd during and after the auction. The commentary on Conway’s behavior during the auction is almost entirely praiseworthy, with people complementing her “energy,” “enthusiasm,” “passion,” “charisma,” saying she is the “life of the party,” the “spark of PMCA,” the “heart of PMCA,” and the “reason for this event.” Although at the event there is the impression that Conway is creating material completely spontaneously she in fact adheres to very specific guidelines to earn maximum donations. First, Conway’s goal is to keep the entire live auction under thirty minutes in length which leaves under two minutes per property to deliver a descriptive speech, conduct bidding, and transition to the next property. Conway does not hesitate to speak directly to potential bidders, using their first names if she knows them well enough, and she will flirt, joke, prod, or anything else that might work to raise bids. Goodwin talks very fast while Conway strives to keep the crowd energy heightened and focused, providing ongoing commentary and directing volunteers to gather needed information 117 from winning donors. The volunteers who help with the auction are preferably men wearing suits who are physically fit. They must rush from the stage area to the entry tent where payment arrangements are processed as fast as possible so that any needed signatures can be collected when guests leave, which for some of those who participate in the live auction is immediately at the end of the auction. The logistics of payment processing must be seamless and largely invisible, the only thing seen by the crown being the contact between the auction runners and the winning bidder. The niche volunteers who fit this role have been for the past several years the husbands of the staff members. This is in fact a rite of passage for suitors of the “sorority” members who are expected to serve in this key role during the gala. The global narratives of PMCA are enacted during the live auction. There is a consistent and strategic use of keywords and key phrases by Conway and Goodwin. Goodwin’s most repeated phrases are hierarchical in nature, saying at least a dozen times each “best of the best,” “top,” “pinnacle,” “most exclusive,” “absolute best,” “most elite,” “priceless,” and “richest of the rich” to describe those who live on one island in particular. This very small private island, less than ten square miles in size, Exclusivo, is the location of six of the auction’s sixteen featured properties. Exclusivo is owned by the Exclusivo Corporation, which is owned by the part-time-resident billionaires who reside there. These billionaires include members of the British royal family and celebrities in the upper echelon of worldwide recognizeability. Exclusivo, like many of the islands in that part of the Caribbean, was a sugar plantation until the nineteenth century, and is now only accessible by private plane or boat. Access to these properties is a result of the personal relationship building that Conway has done in the region over the past decade. 118 Most of the homes that are offered for auction cannot be otherwise rented. In fact if anyone who Conway does not personally know were to win some of the auction items PMCA would have to vet the winners before awarding them their items, as Conway’s reputation is unspoken collateral for many of the properties. The island has recently expanded its development and has a fledgling tourism industry for those who want the private island experience but the island is still largely a playground for the handful of families who own properties there. Goodwin’s use of hierarchical terminology is consistent throughout the entire auction, offering those bidding the ideal opportunity to ascend in their vacations as they ascend the social hierarchy that evening, as their idealized globe is similarly ascendant. In the world that PMCA is creating the sick children are healed while their benefactors concomitantly ascend in their leisure pursuits. As Goodwin highlights that no matter how much money is directly spent the value is incalculable because these auction items are priceless, Conway’s ongoing commentary both echoes the hierarchical theme while also showing two additional patterns. She sometimes uses sentences but mostly speaks in fragments and often in single words, with her voice shouting a cheer in the background of Goodwin’s bidding process or inserting phrases as asides like “wow that is so enchanting,” or simply “beyond beyond.” Conway repeats words that highlight the beauty of the locations of the auction properties, and also calculates on the fly the potential impact of the donation amounts for PMCA. The first group of keywords are delivered by Conway in a style that people in the crowd describe as “sexy,” “sultry,” “passionate,” and “over the top.” The highest frequency words for Conway during the auction in 2009 were “tropical,” “paradise,” “enchanting,” “lush,” and “stunning.” Used less frequently, but still said at 119 least five times each, were the hierarchical words “exclusive,” “best,” and “beyond beyond.” Conway’s ability to encourage people based on the equivalent resources illuminates the global scale of PMCA. In the middle of the first item’s auction, which is in fact always strategically a property where the winning bid is approximately known in advance and is very large, Conway switches mid-sentence, saying “this house is just stunning, so lush and tropical, come on yall let’s get another five here and we will have enough for a team” meaning that if the winning bid can go up by an additional $5,000 the money for that auction will sponsor an entire week long surgical mission to the Caribbean. In this example one week of vacation that can elevate the vacation experience of those who win the auction is explained as interchangeable with one week of building the capacity of the medical care in the same region. This illustrates what Blaut explains in his theory of diffusionism wherein the sharing of technological and intellectual innovation is exchanged for the material wealth of the ecosystems of the recipient region, here in the form of a vacation experience that consists of one week on a private island with a staff of servants to cook, clean, and drive for you. The notions of equilibrium that are evoked with these narratives is no less Blautesque, to borrow the term from Mathewson and Stea, as the trickle-down diffusion of leisure resources is possible through the benevolence of the extreme elite who own property on Exclusivo which makes possible the lessening of global health inequality for the children of the Caribbean region (2003). Although there is considerable chatter about how “fun,” “amazing,” and “beyond beyond” she is, the highest frequency word that people use to describe Conway at the gala is “contagious,” as guest attribute the lively atmosphere largely if not exclusively 120 due directly to Conway. It is noticeable that near the conclusion of the live auction the crowd swells around the silent auction area as Conway’s encouragement for the crowd to bid on the additional thirty available items is woven into her talking points. During the last four property auctions in 2009 the crowd noise got considerably louder, and these last auctions are as a result even more rapidly processed through, with the auctioneer speaking so rapidly at times it is difficult to understand him, which is partially deliberate as it reinterests the crowd, and during these final four auctions Conway directs the crowd three times to “hang in there” and be quiet until the auction is finished. She explains in later interviews that she withholds any form of audience instruction of this type for as long as she possibly can although she must inevitably directly reengage the audience each year. In 2009 the live auction lasts almost forty minutes. Conway’s observation that after thirty minutes the crowd starts to dissipate is true almost to the minute, as the numbers of the crowd surrounding the stage is reduced by half right around the thirty minute mark, with people dispersing to the food and bar areas, to the silent auction display, to bathrooms, to socialize and mingle, and some guests begin to head for the exits. It is in this transition time after the live auction and before the end of the evening that the status of PMCA as a hip and trendy charity is solidified as an orchestrated “spontaneous” dance party emerges. The TGA auction is not only a night where lots of money is raised but also has the reputation as being one of the most fun parties of the annual Southville calendar. This transition to “ultra party mode” as one staff member put it, happens strategically after the oldest of PMCA”s donors leave, which is almost immediately after the live auction ends. Once PMCA founder Samuel Patterson and his family are gone the music is turned up and the intricate lighting set up is used to create a 121 nightclub atmosphere on the runway. When PMCA staff and donors emphasize that for the night of the gala inside of the tent it is not Southville but is instead New York City they are referring not just to the fashion show but the entire event and very importantly the casting off of the formality of the beginning stages of the event with a transition that is later described as “wild,” “letting go,” and a time to “celebrate.” Staff members are expected to contribute to the atmosphere of fun at the end of the event as the deejay who choreographed the couture lighting show during the fashion portion of the evening puts on a light show, plays music that shifts from the current top forty hits to dance party classics mixed with a considerable amount of tropics inspired rhythms, and the runway becomes a dance floor with those in attendance climbing the stairs to the runway turned dance floor. The TGA gala would not be what it is without its tradition of ending the evening this way. The New York models join in with PMCA doctors, staff, and board members, some of whom are intoxicated, in a scene that is equal parts heartwarming and bizarre. High fashion models, working class staff members, wealthy board members, and volunteer doctors dance together on the runway. Very intimate dancing is common, especially among husbands and wives, and public displays of affection are plentiful. The dance floor becomes a further expression of the global imaginary where notions of equilibrium are realized, the divisions between those at the gala forgotten for the moment. Conway is a ringleader of the raucous bunch, encouraging anyone remaining at the event to join in on the runway, sometimes personally escorting them to the stage. On the following Monday the professionalism of the PMCA staff will remain intact but for this brief moment the staff and everyone else still at the gala, about half of those who attended, dance with abandon. This portion of the evening is most commonly described 122 as “wild” by those who participate. The runway dance floor action lasts for almost an hour, after which the event ends with the transition from formal party to the exclusive after party wherein those personally invited by Conway are treated to more drinks and abundant food at an expensive local restaurant or night club. Much like the scene on the dance floor, at the after party the hierarchies that are firmly in tact within the social world of PMCA are momentarily erased. This too could be interpreted as “New York City” known for the cultural merging of so-called high culture and low culture in the name of style and artistic superiority. How is it that even as PMCA does its show to recast the places where they do their outreach as the epitome of luxury they also, with no less hierarchical imagination, present themselves as New York City? Here we look again to Blaut’s insights about how mapping as a human universal works in the colonizers model of the world (1993; see also Blaut Et. al 2003). As Blaut reminds us in his explanation of modern diffusionism, as each culture ascends along the path of “development” it does so along a teleological arc. Culturally speaking New York City is above Southville on the cultural hierarchy. This presumption is expressed by many at PMCA in their pride that “for the night, we are New York City.” The elevated status of Southville at the event of place that is the TGA gala is compatible with the elevation of the global imaginary that is evoked by the event as a whole, showcasing an idealized future wherein the promises of diffusionism are realized. This is possible as a consequence of the successful contact and interaction between what Blaut calls the Inside and Outside, wherein the intellectual and technical innovations of the first group come to benefit the second, in exchange for the compensation of material and human resources of the latter that are taken by the former (Blaut 1993). Just as the 123 participants in PMCA can ascend to become New York City for the night, this night also holds the promise that the world can ascend to one transformed for the better by their philanthropic participation. Here Blaut’s model of the world is in conversation with Mattingly’s insights on moral willing as a project of self transformation where people experiencing dramatic time are prompted to do and say things that are more in sync with their idealized versions of themselves than exist in ordinary time, what Goldberg calls “response-abilty” (Blaut 1993; Mattingly 2006; Goldberg 2007). Here we see an important extension of Blaut’s ideas wherein the utopian endgame of global hegemony is a key component of elite philanthropy. In the TGA gala the people of PMCA enact what Sheppard and Nagar call the ideological hegemony of the United States, an example of what Sheppard calls the “spectre of the white man’s burden, albeit now shouldered by a progressively diverse global elite” (2004, 560; 2005, 961). The global place that is created and performed at PMCA’s annual TGA gala is compatible with the type of world that is most compatible with the households and community of peers that form the primary PMCA donor base, most importantly seen through the articulation of their version of the world we “all” want, a world with no sick children, and their explanation, in spatial and aspatial terms, of what that looks like and how to create that world. This global imaginary of PMCA is marked by the relationship between potential donors and the suffering children that they aim to help, and how those who have “so much” determine how to help those “without.” Here, the imagined globe of the teleological future where the world of material resources that is disproportionately enjoyed by the donor elite class is left undisturbed, and indeed even augmented through the philanthropic endeavors that are participated in along the way. 124 Conclusion Chapter four outlined and discussed how the PMCA annual gala epitomizes performance as a key place-making process, especially in terms of the global imaginary of the PMCA social world. Enactment of the ways that those who have “so much” determine and operationalize the helping of those “without” illuminates the contemporary norms of a historically deep relationship between the elite and the poor, reinforcing concepts of inequality and suffering that contribute to the maintenance and reinforcement of normative race, gender, and economic discourses. The examples discussed in this chapter when taken as a whole function as reinforcement of normative everyday idioms, the consequences of which expand the capacity of the idioms to enter into the realm of taken-for-granted everydayness that [counts as] common sense. The process of common-sense-making is varied and complex, but these examples provide a glimpse into the ways that people participate in the construction, reproduction, and disruption of normative notions of key social concepts. Here the global scale is reinforced largely through various interactions with Western imperial cultural diffusionism, including the unquestioned treatment of development as a global modernization project. The global imaginary that is reinforced and reproduced through participation in PMCA’s annual TGA gala is informative and indeed critical to the interrelated scale typology within which the global is situated. The examples discussed in this and the last two chapters are produced under the constraints of a social context that extends beyond the social world of PMCA, and the spatial narratives that are seen at the gala reinforce the metanarratives of this broader social context. Any meaningful analysis must both acknowledge the common sense, or 125 everyday-ness, of these processes and practices. Nevertheless, regardless of how aware social actors are in their participation in deeply rooted racial, gender, and economic hierarchies, this participation has material consequences. The final chapter of this dissertation will next highlight the complexity that emerges when considering the breadth of the different types of place-making processes discussed in the last three chapters. 126 Chapter Five: Conclusion “Geography Should Never Be Why a Child Dies:” Spatial Narratives and the Pediatric Medical Clinic of the Americas critically analyzed place-making processes of the Pediatric Medical Clinic of the Americas (PMCA), a medical matchmaker charity with an economically elite donor base that focuses on critically ill children in the developing world. Using cultural geography, anthropology, and critical human rights discourse as foundations, I considered how narratives -- storytelling practices -- are used at PMCA. Evidence presented in this shows how space is not simply a container for human action but the product of intersecting social relations. That is, the production of space is comprised of discursive-material interactions embedded in a context of distinct hierarchies that are in part consolidated through narratives. These identifiable spatial narratives--event-driven stories about the real or imagined places where people's activities intersect- provide an empirical context for understanding how geographic scales are produced, experienced, and differentiated. In particular, this project shows how geographical scales and differences may be produced through the very processes that seek to bridge them: the contradictory nature of elite philanthropy demonstrates how organized activities to address inequalities also require practices that simultaneously reinforce inequalities. The project’s focus on a humanitarian organization lets us more fully understand precisely how the spatiality of human connection underlies the concept of both “humanity” and “human rights.” The concepts of human rights and humanity that circulate through these narratives offer a promise that is paradoxically impossible. If the 127 underlying structures that produce inequalities are left unexamined these ideas automatically get caught up in the service of maintaining a system the foundation of which is the colonial encounter, itself a philosophy centered on the absence of “human- ness” by those who were not the colonizers. In the case of global health equity this paradox is illuminated by attempts like those made by PMCA to amend the material spatiality that is expressed in the form of premature death of the kinds of children it serves without disturbing the hierarchical structures that create the conditions they are responding to in the first place. In all this dissertation looked at six distinct spatial narratives of PMCA and when considered together the total social picture of PMCA and the worlds it produces, reinforces, and disrupts, are brought into relief. These narratives provide an empirical template for Neil Smith’s scale typology that guides the geographical approach of this dissertation, and each of his four propositions for scale is seen at PMCA: “scale is a primary means through which spatial differentiation ‘takes place;’” scale works as a “language of spatial differentiation;” “the construction of scale is a social process;” and scale production has potential for “intense political struggle” (1992a, 62). As we review each of these narratives with Smith’s propositions we see how spatial narratives produce scale and are, like the scales they make, “far from” [merely] “providing an innocent if evocative imagery,” [but] “actually taps [sic] directly into questions of social power” (1992a, 62). Chapter Two discussed the scale of the body as evident in the visual narratives of the PMCA published archive. The bodies of the ideal patient and ideal donor are differentiated by race, age, gender, and ability. The public archive reinforces the narrative 128 of a young, Brown skinned, happy, girl who is emancipated from inevitable suffering by a White, affluent Southvillian who possesses invaluable resources for the child in the form of exemplary medical care or of nurturing affection. In this narrative, differentiation is both the product and process of this socio-culturally informed narrative of the intense political struggle for global health inequality, all four of Smith’s propositions easily identifiable. High relief of gender, race, age, and ability seen in the PMCA archive is reflected by Young’s observation that the “scaling of bodies” by gender, race, age, and ability creates a template for subjugation by “cultural imperialism” (1990, 136; in Smith 1992a, 67). In Chapter Three the community scale is analyzed. In PMCA’s “Miracle Stories” members of the elite While Southville community, one of abundant health resources, are altruistic motivated to redistribute these resources to communities in need, communities very far from Southville. These benevolent donors of medical and financial resources are guided by divine motivation and through surgical outreach or mothering they are able to fix, heal, and domesticate those they help. These communities are differentiated by supernatural favoritism in the form of geography as happenstance. The political economies are elided in the narratives and the focus is on an extension of values that PMCA affiliates with their households and by extension their community, nurture, generosity, expertise, and altruism. The hyperbolized global imaginary of Western cultural diffusionism as shown in chapter four requires a socio-cultural fluency in these aforementioned narratives by those at PMCA. Through the celebration of the luxury tropical landscapes of the places PMCA does its outreach, the benevolent nurturing affection that the community of elite White Southville and PMCA represents is commemorated with an auction and gala that shows how elite philanthropy relies on an 129 intimate relationship between the elite and the poor. Health care resource differentiation is presented in this narrative of PMCA’s utopian global scale as a problem that can be overcome through embracing development as a global modernization project. The narrative of PMCA’s global imaginary of elite philanthropy reinforces the divinely inspired community of PMCA’s motivations to remedy the problems of those PMCA helps, achieved through the transformative emancipatory process of healing individual bodies. PMCA’s success is owed in part to their ability to exploit these narratives to guarantee their own production and reproduction, as the PMCA community is a scale too. Spatial narratives, like the ones discussed in this project, are part of a visual and lived economy of modernity that maps the normative conditions of privilege and disadvantage while simultaneously projecting a mirage of the promise of diffusionism, these narratives working as model examples of what Paul Farmer calls the “symbolic props” of structural violence (2004, 218). Spatial narratives can work in service of these props or function as the props themselves as they implicitly reinforce a hierarchy based on difference as they simultaneously explicitly challenge the merits of these logics. The people of PMCA perceive a global imaginary, as shown in chapter four, where far-and- distant places are synonymous with suffering children. Southville is cast on a teleological arc as superior to these places as it has technologically solved the problem that so plagues the places where the charity’s outreach is directed. Their solution to this inequity of resources is possible though the diffusion of technological medical innovation after which the global imaginary of paradise for all will be achieved. This elides anyone who might be suffering in Southville as this is a place, as explained in chapter three, that is characterized by healthiness, prosperity, generosity and the happenstance of geographical 130 superiority in terms of resource access. The underlying economic system that creates the wealth of these conditions goes unsurprisingly unchecked, casting the unlucky children of non-Southville as suffering merely from the unintended consequence of an otherwise unproblematic political economy. PMCA affectively casts these children into the role of exceptional abject subject wherein the redemption of the most innocent and therefore more savable children becomes metaphoric for the possibilities of fulfilling the promises of humanitarian discourses that promise an end to all forms of human suffering. Or as it is said at PMCA, “To heal a child is to heal the world.” The examples provided in this dissertation are some of the most prominent spatial narratives used by PMCA and largely center on the direct relationship with and understanding of the children that are served by the charity’s efforts. These narratives about by-proxy healing and mothering, a utopian future with access to resources for all, and unimpeachable young brown skinned girls, are together a range of geographies that the charity affects and produces. But this is all predicated on the requirements of elite philanthropy, the legacy of which is central to the validation of the legitimacy of inequalities, as the rich donors are at the other end of that spectrum of global health inequality. Through PMCA they use philanthropy as a way to justify their disproportionate wealth. So, elite philanthropy is not about giving only as an extension of generosity but also as legitimation of the right to overaccumulate resources. You cannot divorce philanthropy from elitism or treat it as an externality as philanthropy and elitism are fused into the same logics of a social order wherein the path of resource diffusion is best determined by those who have been innovative and superior enough to accumulate those resources. 131 How can an underlying system that is based on a logic of domination ever possibly result in anything that resembles the eradication of inequality that the concept of a particular form of universalism implies? If human rights are to be universal, then, it is inappropriate to ignore the structures of violence that produce the conduits for the circulation and perpetual renewal of geographies of abstraction that result in persistent inequalities. This research provides empirical evidence to support that observation that a global-in-scope geography of violence is not about the direct perpetration of violence, and therefore remediable by the identification of these perpetrators, but is in fact a more deeply complicated structure. This model locates violence inside of social realities, not individual people, as “violence exerted systematically- that is, indirectly- by everyone who belongs to a certain social order” (Farmer 2004, 215). The people who use PMCA to think about, understand, and produce places exemplify this social order. Despite the prominent spatial narratives presented in this dissertation, further contradictions abound as I was not only documenting the storytelling practices of PMCA but I was deeply immersed in the goings-on of this very sincere group of people whose wish for a world with no sick children is worked toward daily. There were countless instances in this fieldwork where the ontological totality discussed above was tempting to ignore, as PMCA is a place where people come together and produce measurable outcomes in terms of the children that they serve. Their doctors are vehemently opposed to so called “helicopter medicine” and “vacation philanthropy” where doctors are dispatched all over the world for a few days to provide medical resources and then leave. Instead, every doctor that works with PMCA develops a comprehensive long-term program, commits to multiple return trips to the same places, and partners with and trains 132 medical personnel where they do their outreach. There is no other organization of PMCA’s size anywhere in the world that has programs that have been so altering in the countries they serve: PMCA’s programs have dropped birth defects in one country by over 90%, and have eliminated a crippling condition in another country. In a third country PMCA is no longer needed as, because of the resources given to and training provided by PMCA, there is now heart surgery available and what was once an almost guaranteed death sentence is now treatable there. PMCA’s ethical standards include industry-leading protocols for their interaction with patient families where a concerted effort is made to recognize the dignity of everyone they work with. However, these stories rarely reach their donor audience, as the resilience and necessity of stories that focus on individual children, like many of the examples in this dissertation, are the most effective for the fundraising efforts of PMCA. The narratives that those at PMCA have decided are required to do their work are paradoxically co-constitutive of the conditions that underlie the inequalities that their programs address. So, even with the undoing of some of the embodied outcomes of the persistent health inequalities that PMCA focuses, on the spatial narratives illuminated in this project ultimately work to reproduce the very thing that people are aiming to end. These spatial narratives reflect Western diffusionism, which Blaut describes as the “system of belief” for those in power. This dissertation has clearly shown how these epistemies of derivation are experienced through an ongoing legacy that changes the story but not the plot. So, what is to be done? How are we to appropriately elicit what Goldberg calls “response-ability” in terms of addressing both the proximate and underlying conditions of existence that result in so much death? How are we to confront the presence of the 133 “symbolic props” of violence through which the spatial narratives discussed in this dissertation circulate? I do not suggest that we throw out the baby of life-saving medical technologies with the bathwater of modernity. But it is interesting how a politics of recognition in the form of philanthropic endeavor works in the service of a logic that runs counter to its aims. As heartfelt, and deeply sincere, as these efforts are for those who use PMCA to respond to human suffering, there simply has got to be a better way. The focus of this research was not to prescribe a remedy for these vexing problems but instead to be indicative in the ways that these problems are affected through place-making processes driven in part by storytelling. Nevertheless I would hope that those at PMCA who look at the underlying causes of the inequalities that they address, as indeed many of them do, continue doing so, even as insights gained from this analysis must be tempered with the constraints of the geographies as they are. As someone who has critically researched human rights for over a decade I agree with Farmer and Campos in the potential for addressing these issues within the discourse of global medical ethics, the current direction of which is misdirected at best and at worst egregiously unethical in its reluctance, and some say refusal, to make the center of their collective intellectual agenda the billions of individuals on the planet who lack the opportunity to even become patients (2004). Alas, I digress. As I said this research aimed to be indicative rather than conclusive and those indications have been explained throughout the data chapters and extended here. In this contemporary moment global hegemony continues to work its improvisational magic, re-explaining the world in ways in which the underlying system of spatialized violence becomes ever more challenging to discuss. It has been twenty years since James Blaut observed the persistence of racism in a society where being 134 called a racist is “deeply offensive” (1992, 289). The same insight applies here to humanitarianism and human rights, the violations of which are increasingly thought of in terms of the violation of the individual. Here too are spatial narratives to be deeply considered if we are to contribute to emancipatory geographies. Rights are stories that are vibrantly lived, longed-for, abused, or ignored through the production and circulation of powerful narratives that shape both the formal and everyday stories that people tell about real and imagined places. These “stories” are not just identifiable in storytelling practices but also in the cultural texts of daily life. This dissertation shows how these narratives of humanity are used not by those who are directly longing for change but by those who are in positions of power to distribute the resources for transformation and who control not only these resources but the narratives that explain how and why inequality looks as it does. The discussion of underlying systems of inequality and the persistent ways that these systems morph over time is dismissed through its increased recognition. Paul Farmer warns that the symbolic props of today’s economic elite are “far more powerful- indeed, far more convincing- than anything we might serve up to counter them”- Farmer, 2004, 317). The spatial narratives analyzed in this dissertation are ideal examples of how this works in an empirical context. Herein lies the potential of understanding how spatial narratives work in place-making. They are one way to see the traps in Clyde Woods’ trap economics as they are being set (2005). They offer potential to see the latest iterations of the enduring legacy of Western diffusionism which explained one part the world at first scientifically and then serendipitously superior to the rest. Taking seriously the material spatiality of storytelling has the potential to identify, illuminate, and indeed undo and remake the geographies of abstraction that continue to persist and produce wide ranging 135 inequalities. But this task can never be taken lightly, as Gilmore reminds is that the overdeterminations of abstractions in the mediated nature of spatial engagements result in fatal couplings of power and difference (2002a). Important, Gilmore also notes that this fatality is not predetermined. Indeed, if narratives have the power to contribute to maintaining the symbolic props of global hegemony than they also have the power to create places of emancipation and freedom. It is here that the work of this research offers the potential to the ongoing efforts of critical scholars to imagine and operationalize emancipatory geographies. As Ruthie Gilmore once put it, scholars can recast politics of subordination into politics of liberation, and refocus efforts from getting stuck in a template to getting out of it, or more simply to use the very power that scholars understand so complexly to “make it, keep it, and use it for ourselves. 32 ” Spatial narratives are one way to achieve this recasting and imagine material spatialities of emancipation. This dissertation shows conclusively how powerful narratives are in making places as intimate as the body and as vast as the globe. It also shows how narrative is essential in the circulation and constant reimagination of structures of power. Places are always in flux and the ways in which they are materially and discursively reproduced are in a process of constant transformation. As my time at PMCA was drawing to a close the next phase of reimagining the narratives of the organization was underway. “Branding” consultants were beginning to work with the development and programs staff to adjust their image and narratives to appeal to a wider audience. Not only does this provide additional confirmation that PMCA reinforces Southville in its narratives, but more 32 March 11, 2011. Critical Ethnic Studies and the Future of Genocide Conference. Riverside, CA. Plenary Two: Settler Colonialism and White Supremacy. 136 importantly it shows the malleable nature of narratives as part of what Woods so aptly lines out in his formulation of planter hegemony. Woods teaches us what is echoed here, that hegemonic discourse has an extemporaneous quality that works to reproduce disparate hierarchies, oftentimes just as these hierarchies seem to be on the edge of dismantling, as Glenda Gilmore puts it, “the moment of possibility before disfranchisement” (Woods 1998; Gilmore 1996, 25). This is no less the case with the discourses of humanity that circulate at PMCA. Narratives once dominated by “your hands can touch a child in need” and later became “what is routine to us is a miracle to them” is now becoming “every dollar brings us one step closer.” I suggest that this new storytelling form is the latest in the improvisational cunning of the narrative of Western diffusionism, that of incremental change. The taken-for-granted assumption of the validity of the concept of incremental change is quickly becoming incorporated into the “rules that people carry in their heads” in regards to elite philanthropy. Although its expression is new, the idea is as old as the logics from which it is extended, that something is better than nothing, because change and progress is inevitable if the world’s poor can just be patient enough. This narrative offers emancipatory potential as long as those in need are in no rush. I conclude with this observation as a reminder that geographic scales are fluid as are the narratives that co-constitute them. Understanding the circuits of narrative circulation, as contradictory and paradoxical as they may be, as PMCA’s narratives certainly are, are as important as being capable of identifying and categorizing the scales themselves. Indeed, narratives have the power to transport us out of where we are and to create redemptive worlds where the possibilities of liberation become the new circuitous channels of transformation. 137 Bibliography Agamben, Giorgio. 2005. State of exception. Chicago: University of Chicago Press. Andersen, Elmer L. 2000. A Man’s Reach. 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See Appendix C for details. • *March 2008-April 2008: Southville, Site Survey o In-person site survey in Southville, including regional cultural observation, indirect data collection, and logistics research. • May 2008-October 2008: Los Angeles, Site Selection Preparation o I wrote my formal dissertation proposal and prepared appropriate site clearance and access paperwork, and conducted background research about PMCA for the site approval process. • *November 2008-December 2008: Southville, Site Clearance o I presented my research proposal to and gained site access from PMCA President Victoria Conway and the PMCA Board of Directors. I attended the 2008 Gala as a guest and observer and conducted indirect data collection. • January 2009-March 2009: Los Angeles, Pre-Fieldwork Preparation o I conducted further research about PMCA and about living in Southville. • *April 2009-May 2009: Southville, Fieldwork Phase One of Four o I lived in Southville and studied local culture, conducted direct and indirect data collection, and observed PMCA meetings. • June 2009-July 2009: Los Angeles, Fieldwork Preparation • *August 2009-December 2009: Southville, Fieldwork Phase Two of Four 150 o I lived in Southville, attended Gala, observed PMCA meetings and daily office culture, conducted interviews, atttended Southville cultural events, conducted direct and indirect data collection. • January 2010-April 2010: Los Angeles, Data Analysis • *May-June 2010: Southville, Fieldwork Phase Three of Four o I conducted follow-up interviews, observed PMCA meetings and office environment, lived in Southville, and attended local cultural events. • July 2010-October 2010: Los Angeles, Data Analysis • November-December 2010: Southville, Fieldwork, Phase Four of Four o I attended the Gala as an observer, and conducted indirect data collection. No interviews were conducted during this fieldwork phase. • January 2001-December 2011: Los Angeles, Data Analysis • January 2012-May 2013: Los Angeles, Dissertation Writing and Editing • June 2013: Los Angeles, Dissertation Defense • July 2013-August 2013: Final Dissertation Editing and Filing 151 Interview Subjects List 33 1. Michelle Austin PMCA receptionist 2. Ruby Browning PMCA Development Staff 3. Heather Cardin PMCA Development Staff 4. Beth Carter PMCA Programs Staff 5. Aurelia Carthy Southville Local Newspaper Journalist 6. Daniel Cashus Southville Event Producer 7. Rachael Conway Daughter of PMCA President 8. Victoria Conway PMCA President 9. Jaime Cordle PMCA Volunteer Coordinator 10. Lenny Dear University Researcher Studying PMCA 11. Dianne Doppel PMCA Development Staff 12. Gayle Doyle PMCA Vice President of Development 13. Stu Fisher PMCA Volunteer & Donor 14. Susie Fonda PMCA Development Staff 15. Delta Franklin Southville Resident 16. Dexter Franklin Southville Resident 17. Robert Frederic PMCA Staff Member 18. Eileen Goldenblaut PMCA Donor 19. Jessica Hafner PMCA Vice President of Programs 20. Tammi Jo Hance PMCA Programs Staff 21. Dr. Warren James PMCA Medical Director 22. Dr. Susan Jamsur PMCA Volunteer Surgeon 23. Paul Jones PMCA Board Member 24. Nancy Kemp PMCA Volunteer Coordinator 25. Nell Labrie PMCA Board Member 33 Interview Subjects listed in alphabetical order by pseudonym. Subjects who participated in shorter interviews, group interviews, and subjects observed in public PMCA events were provided Information Sheets per IRB protocols. Those who participated in one-on-one interviews are listed here. 152 26. Nick Lukesh Southville Politician 27. Marta Maddox PMCA Progams Staff 28. Samuel Patterson PMCA Founder 29. Maggie Peeler PMCA Donor 30. Maya Rango PMCA Development Staff 31. Posy Rudy PMCA Photographer 32. Steven Schaller PMCA Vice President of Finance and Operations 33. Dr. Laura Starling PMCA Board President 153 Appendix B: Data and Methods 1) Data Set. A) Archival. While there are academic debates and discussions on expanding what counts as an archive the use of archive here is straightforward. In this dissertation I refer to the PMCA archive and the PMCA public archive. The public archive consists of the publicly available printed materials made by and written about PMCA. In addition to this I collected cultural data about Southville, for example local magazines and newspapers, and these were used to understand the culture of Southville. I was also granted access to PMCA’s database server and the information contained within was useful in understanding the office culture of PMCA and donor relations especially. The database contains a variety of materials that includes: donor correspondence, hundreds of photographs taken during surgical missions, and patient information. No private records are used in this dissertation. When I refer to the PMCA archive I mean all of the material cultural artifacts gathered during my fieldwork including electronic materials (like PMCA web site content), printed materials (like solicitation publications that are used by PMCA), and artifacts (like the invitations, napkins, and décor items from the annual gala). This archive contains written and visual texts. All together this collection of over four thousand individual items together with my experience in the field contributes to the total social picture of PMCA. Within these materials recurrent spatial narratives are identifiable, explicitly in visual and written forms as well as implicitly in the conversations and actions of those at PMCA. All of these storytelling practices were considered in my analysis. My ethnographic approach, especially long-term participation 154 and immersion in the social world of PMCA results in understanding “how people narrate their experiences,” and “how narrators make sense of personal experience in relation to cultural discourses,” as this study looks deeply at how “narration is the practice of constructing meaningful selves, identities, and realities” (Denzin and Lincoln 2010, 422). Denzin and Lincoln, qualitative researchers whose insights guided my analytic approach, explain that “these texts are social facts; they are produced, shared, and used in socially organized ways” (2010, 418). My approach to analyzing these texts follows Silverman and assumes that “construction and deconstruction of texts as artifacts with meanings beyond their explicit aim of communication” can be identified and examined in reference to theoretical frameworks (2001: 8). In reporting my findings in this dissertation anonymization protocols have been followed, the names and identifiable details have been altered without altering the content. B) Interviews and field observation. I observed hundreds of hours of PMCA meetings and conducted dozens of interviews during my cumulative year studying PMCA. During the semi-structured interviews I took extensive notes. During meetings, which are part of the non-participant observation of my study, I also took notes. I used the over twenty field notebooks that were filled with interview and observational data during my fieldwork in the analysis that is presented in the next three data chapters. The data gathered was more than, for example, a survey could have produced, an example borrowed from Clifford and Geertz (1973). Herbert explains that: “the constitutive role of place cannot be read from the results of a broad survey. It must, instead, be examined through direct experience with the group in question, through close contact and ongoing interaction. One must, in the words of Clifford Geertz (1973: 21) acquire ‘exceedingly extended acquaintances with 155 extremely small matters.’ This occurs over long stretches of time in repeated engagements, through extended interviews or observations, or some combination of the two” (Herbert, 71). I did not record interviews although I did write down exact quotes from people in many instances. In qualitative analysis oftentimes the most useful data cannot be identified on a transcript, as many other factors matter in these exchanges, for example body language, clothing, and the relationship between the researcher and the subject. Indeed as Watson and Till explain, “observing and writing fieldnotes about everyday geographies, emotions, fluid social spaces, and material encounters is more a practice of discovery than an ‘objective’ form of reporting. Language is never a transparent signifier of witnessed events; furthermore, recording practices (through notes, video, audio, maps) always involve ethical choices” (Watson and Till, 2010, 126). I engaged in participant observation during my fieldwork, as “Only [sic] by participating with others can ethnographers better understand lived, sensed, experienced, and emotional worlds” (Crang and Cook, 2007; Herbert, 2000, in Watson and Till, 2010, 129). To interpret the interview, ethnographic, and archival data I gathered during my cumulative year in Southville, I used complimentary qualitative methodologies. Here I used my experience as a field researcher with these methodologies, noting that: “Ethnographic sensibilities are needed for understanding narrative environments, but they are also needed for understanding narrative practices: the mechanics of how stories are activated, how storytellers create and develop meaning through interaction with each other, how speakers collaborate with each other or struggle over narrative meanings, and how narrators perform their identities for specific audiences and with specific (but not always intended) consequences” (Denzin and Lincoln, 423). During four separate fieldwork stints I was granted access to PMCA’s offices and 156 database, I was permitted to attend meetings held at PMCA, and I was granted access to PMCA’s annual charity gala. I observed over 500 hours of daily office interactions, attended over 100 staff meetings, attended 5 board meetings, observed over 100 additional hours of PMCA activities outside of the offices, and spent my year of cumulative fieldwork living in Southville during which I attended over fifty community and cultural events. I conducted interviews with over fifty people who participate in PMCA, and I conducted in-depth interviews with over twenty people. Those who were interviewed signed consent forms and those who were present during meetings received printed information about this dissertation. Those who participated knew that the data I was gathering could be used for this critical analysis of the place-making processes of PMCA. Anonymization protocols were followed in this dissertation. Names, places, and minor facts have been altered as needed, as dictated by IRB protocols. 2) Site Selection. The site selection process took six months and started with dozens of organizations. Ultimately PMCA was chosen by meeting the following criteria: granting me access; located in a familiar cultural environment; has a small staff; provides outreach that is significant in the regions where they work; has a good reputation in their field; regularly produces printed solicitation and promotional materials; has high donor participation; has a small group of donors; has an economically elite group of donors. Of the original dozen I narrowed down the site candidate list to five. I conducted further research into the programs, reputation, and professional standards of each potential site. My findings for PMCA were that PMCA’s programs are considered 157 exemplary in their field, and that their patient relations protocols exceed all recommendations in terms of established human health care rights. In addition to this PMCA is located in the Upper South USA, a region I have a high familiarity with as I resided there for twenty years. I visited PMCA and presented my dissertation proposal to the President of the organization, Victoria Conway, and two board members. They granted me access to the organization and I returned several months later once consent forms and appropriate ethics documentation were prepared, distributed, and signed by the people who would be subjects of this dissertation. 3) Narrative Analysis. My approach to narrative analysis follows the work of anthropologist Cheryl Mattingly, who looks at socially constructed forms of experience in the form of stories. Mattingly defines stories as “someone trying to do something, and what happens to her and to others as a result” or “the sequence of events that narrative is ‘about’” (Mattingly 1998, 7; 44) i . Narrative “refers to the actual discourse that recounts the events” (Mattingly 1998, 34). In this dissertation narrative forms will be looked at in the context of structuring texts from printed materials as well as in the context of lived actions and experiences. This dissertation used narrative analysis in the context of public documents and documented public discourse and then analyzing these forms and features in the context of PMCA. In this dissertation “storytelling episodes” are often public narratives presented in promotional materials, prompting potential donors to insert themselves into constructed plots within healing narratives (Mattingly 1998, 7). Direct storytelling is only one type of narrative and this study looks at the entire 158 narrative context, considering “what does and doesn’t get said, about what, why, how and to whom” (Denzin and Lincoln 2010, 422). Denzin and Lincoln explain that in a qualitative approach to narrative analysis “researchers treat narratives as a window to the contradictory and shifting nature of hegemonic discourses, which we tend to take for granted as stable monolithic forces” (2010, 419). Place-making is never void of context, as “people create a range of narrative strategies in relation to cultural discourses, and that individuals’ stories are constrained but not determined by those discourses” (2010, 419). Sometimes these subtleties are used to identify stories about place that are not easily seen by someone not immersed in the social world. In other cases that place is being evoked in a story is blatantly obvious, but a full and appropriate interpretation requires knowing the context within which the narrative is produced. 4) Cultural/ Visual Analysis. This dissertation uses published photographs in the PMCA archive as part of the data set. I analyze this archive using qualitative visual methodologies that look for recurrent themes, here in the images themselves as well as in the descriptions of images and conversations about images by those at PMCA. I look at the visual images in the charity’s publications in the context of their use in fundraising. This analysis follows work in geography that looks at how visual imagery used in tourism publications and how they have a “vital role in disciplining and controlling both the subjects of knowledge but also the modes of knowing” (Crang 2010, 211). I follow the methods of those who have studied tourism and advertising because of PMCA’s choice to partner with a high fashion photographer with a background in print media advertising and journalism. PMCA 159 decision-makers also regularly reiterate that their “story is so visual” and that the “pictures tell the whole story of what we do,” therefore in addition to looking at the images alone I also include the context of interviews about image selection in my analysis. The categories of images are based on the information gathered from interviews and observations, treating the visual data “not as detaching and enframing but as connective and performative,” Crang 2010, 223). The visual archive is considered as part of the total social picture of PMCA, or as Dittmer puts it, the visual data is a “negotiated relationship” that is affected by many factors and cannot be considered separately from these factors (2010). At PMCA the images chosen for publication are part of a professional strategy to present PMCA in particular ways to the donor base, therefore I pay close attention to how the subjects of PMCA are represented as well as how Southville is represented as the publications are mostly distributed in the Southville region. This approach allows me to see how PMCA’s visual archive in the context of a local charity doing international outreach, in order to analyze how PMCA’s images do or do not “help to unpack fantasies of stable places and pure cultures in a world of global flows” (Crang 2010, 223). 5) Discourse Analysis. A) Qualitative Human Geography. I recognize discourse as “processes through which ‘truths’ become embodied and enacted” via a variety of “culturally-specific mode[s] of existence” (Dittmer, 2010, 275). I follow over twenty years of work in qualitative human geography research that studies “the recognition and interaction of the various discourses in which we are embedded that meaning is created, power is conveyed, and the world is 160 rendered recognizable” (Dittmer, 2010, 276). Although I recognize poststructuralist perspectives on discourse that follow Foucault’s decades of work on analysis of “the phenomena of power,” the objective of which is to “create a history of the different modes by which, in our culture, human beings are made subjects” my analysis is more grounded in a structuralist perspective (1982, 777). While insights from the post- structuralist approach are helpful, especially within contemporary critical human rights projects that consider the durability and circulation of various forms of global subjectivities, this dissertation is more closely in alignment with a structuralist approach that “views discourse as a mechanism for inculcating ideology among populations, and it ithe importance of ideology that gives discourse its political relevance” (Dittmer, 2010, 276). This perspective follows the tradition of geographers that address what Peet calls globally hegemonic discourse which aligns with the process that Blaut refers to as Western diffusionism (see Peet 2002 and Blaut 1993). So when I engage in discourse analysis as a methodological tool, I am paying attention to ways in which the social world of PMCA uses what Peet calls cultural economy, “economic rationalities, including the motives, methods, experiences, through the media of social imaginaries, formed within relations of power” (Peet, 2002, 55). These “Collectively [sic] randomized actions create the developmental logics of economic systems. In return, these confirm as true the original interpretive schemas” (Peet, 2002, 55). Peet also notes the complimentary, rather than contradictory, relationship between Gramsci and Foucault, especially in the case of social actors “constituting a complex of convictions and beliefs from which concrete social goals are proposed to collective consciousness”(Peet, 2002, 56). The hegemonic consciousness of economic elites that is characterized by processes that work in 161 “harmonizing the interests of the leading and subordinate classes into an ideology expressed universalistacly” is also considered in this analysis (Peet, 2002: 56, following Gramsci 1971: 180-195). Geography scholars have used discourse analysis to identify hegemonic normativity in various international development organizations both governmental and non-governmental, while this study looks in depth at an ethnographic case study of a privately run self-described humanitarian health care organization that while its work is global in scope and uses global hegemonic discourse to meet its aims, does so in a local context that constricts this discourse in particular ways. Social activity is embedded in discourse therefore there is no identifiable complete static set of characteristics that can encapsulate any discourse because “practice is not the product of rules internalized by actors; rather it is fundamentally improvisatory, inventive, and creative” (Mehta and Bondi, 1999: 69). B) Place Frame Analysis. Place frame analysis is a type of discourse analysis used to study how social movements characterize social issues in terms of place to gain appeal (Martin, 2003). Place framing is a method developed by geographer Deborah G. Martin, who examined how activist organizations describe goals and agendas “as grounded in a particular place and scale” (730). Her study shows how place-frames “constitute a motivating discourse for organizations seeking to unite residents for a neighborhood- oriented agenda” (730). Frames are used to “articulate issues, values, and concerns in ways that foster collective identity” (733) and are also discourses that “embrace particular combinations of narratives, concepts, ideologies, and signifying graces” (Barnes and 162 Duncan 1992, 8; in Martin 2003, 733). Martin shows how the relationship between place and activism contributes to understanding social movements, showing how the community is actually made through the framing discourse (747). Place framing also provides a “conceptual tool for imagining and understanding alternative scales and forms of place-based organizing” (747). Martin’s work looks at the material and discursive formation of a local polity while my dissertation looks at a global polity, animated through local discourses. Using place frame analysis this dissertation identifies norms, values, and cultural practices that are present in the data set. I use this method to identify and analyze “concrete references to place, people, and events in organizational discourses and the ways that they are linked to recommended actions” (Martin 2003, 747). I also apply Martin’s conceptual tool to the spatial practices that I document, looking for explicit and implicit references to the same set of variables. Lastly, I combine my findings from place-frame analysis with narrative analysis to identify spatial narratives, looking for examples from the findings where “concrete references to people, places, and events in organizational discourses” take the form of stories with identifiable genres and tropes that reveal an even more complex rendering of the relationship between social movements and place making (Martin 2003, 747). 6) Membership Categorization Analysis (MCA). Membership categorization analysis (MCA) is a method for analyzing the use of everyday terms and categories in interactions with others and was developed originally by sociologist Harvey Sack. Housley and Fitzgerald emphasize that categories and terms 163 are not fixed but rather “identities and roles [that] can be understood to be situated” within the specific context of the fieldsite (2002, 63). These categories are not imposed but achieved, produced in the form of talk, interaction, or through texts. The coding and analysis of categories must include “illustrating the local production of interaction as an endogenous reflexive accomplishment” (Housley and Fitzgerald 2002, 69). My analysis incoportes the notion of incumbency “by which members [of a social group] present themselves in terms of a particular category or identity” within the context of the interaction, referring to individual or sets of attributes by terms known by the social group (Housley and Fitzgerald 2002, 62-3). In other words, texts and actors deploy categories and everyday terms to refer implicitly to themselves or others, as well as to social groups to which they either do or do not belong. These references can be place based as well, as research that investigates the relationship between people and places has also used MCA. Two examples described by Housley and Fitzgerald are Drew’s work (1978) using geographic place names to categorize the religious affiliations of social groups, and research conducted by McHoul and Watson (1984) that interrogates the formal geographical knowledge of children based on “common-sense knowledge of the children’s own locality” (Housley and Fitzgerald 2002, 63). MCA is a method for interpreting how people communicate using categories and everyday terms, and how they make sense of the texts they encounter, as well as how these texts are constructed, maintained, and reproduced, using these same categories and terms. I identify these categories and terms and coded my data by references to human attributes and place attributes within the various collected data sets, noting how attributes are not only deployed but also how they are created in the context of the three areas of the 164 charity investigated. I examine ways in which the production and appropriation of broader frameworks are deployed in the consensus building process (Merry 2006a; 29- 41). My examination of these negotiations focuses on the construction of difference, and how various attributes that serve as markers of difference are discussed, how these attributes are constructed in these institutional settings, and how they change over time. These constructions of difference are identified in terms different membership categorizations used by people at PMCA. This analysis addresses related levels of abstraction in terms of the relationship between attributes and multiscalar geographies. Here I am guided by Gilmore, who notes that analysis at one level of abstraction, for example an analysis centered on race, “cannot be complete at any level of abstraction without attending to gender, class, and culture in the simultaneous processes of abstracting and reconstructing geographies of liberation,” as these attributes function as both “conditions of existence and categories of analysis” (2002: 17, 22).

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Creator Hoffmann, April Ruth (author)

Core Title "Geography should never be why a child dies:" spatial narratives and the Pediatric Medical Clinic of the Americas

School College of Letters, Arts and Sciences

Degree Doctor of Philosophy

Degree Program Geography

Publication Date 12/16/2013

Defense Date 06/12/2013

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag elite philanthropy,ethnography,geographic scale,global health inequality,human geography,human rights,narrative,OAI-PMH Harvest

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Language English

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Advisor Gilmore, Ruth Wilson (committee chair), Gómez-Barris, Macarena (committee member), Pastor, Manuel, Jr. (committee member)

Creator Email aprilruthie@gmail.com,arhoffma@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c3-359201

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Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA