Laura Frances Goffman, Disorder and Diagnosis: Health and the Politics of Everyday Life in Modern Arabia (Stanford University Press, 2024).
Jadaliyya (J): What made you write this book?
Laura Frances Goffman (LFG): In graduate school, as I was preparing to head to the archives, I felt like histories of Arabia and the Gulf were missing stories of everyday life, as well as the voices of people who could slip between official frameworks. Amid discussions of merchant capital and imperial policy, what did it feel like to be an ordinary person navigating the transformations brought by European empire, global integration, and state modernization in the nineteenth and twentieth centuries? I also wanted to write against the conventional, elite-centered ways of talking about the Gulf that elide the diversity, creativity, and historical dynamism of the region’s residents.
Once I began my research in the Gulf, the United Kingdom, the United States, and India, I found that disease, health, and medicine offered exciting avenues for approaching these concerns. As my book describes, the escalation of the British imperial presence and American missionary projects in the nineteenth-century Gulf corresponded with a growing microbiological understanding of contagion among the global scientific community. As non-elite people assumed new roles, from quarantined travelers to itinerant hospital patients, they became not only a target of governance but also a threat to more valued white, wealthy bodies. In other words, the diseases that they had the potential to carry led to their greater visibility in the historical record. Thanks to this confluence of biological, social, and political factors, I found that astonishingly resilient and resourceful historical protagonists emerge out of the crevices of accounts of disease and medicine.
I approach childbirth as a rich social process and a thick site of power struggle during periods of political and economic transformation...
J: What particular topics, issues, and literatures does the book address?
LFG: Disorder and Diagnosis is a social and political history of how medicine, disease, and public health transformed life in the Arabian Peninsula and Persian Gulf from the late nineteenth century until the 1970s oil boom. My goal was to center and contextualize surprising and striking archival fragments in ways that integrate the Gulf and Arabian Peninsula into global circulations of commodities and movements of people. I also sought to make women’s worlds more visible in the face of a historiography that has overwhelmingly characterized the rhythms of oceanic mobility and national development as masculine experiences.
Across the book’s six chapters, I focus on an array of health projects—quarantines, hospitals, childbirth, vaccinations, nursing, and folk medicine—to illustrate how the Gulf and its Arabian hinterland served as a buffer zone between “diseased” Asia, the Ottoman Empire, and white Europe; as an object of economic development; and as a space of scientific translation. My book is not just a top-down story: the chapters emphasize how mobile and multi-ethnic residents of regions that would become Kuwait, Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, and Oman accepted, modified, or rebelled against medical projects.
For example, in chapter 3, “Childbirth,” I read American missionary accounts, scientific publications, and Arabic-language ethnographies of local folk medicine alongside each other to tell the story of how local women creatively pursued an assortment of health-seeking strategies even as various medical professionals clamored for control over childbirth. I approach childbirth as a rich social process and a thick site of power struggle during periods of political and economic transformation, which allowed me to center women as makers of their own history, even (or especially) when their menfolk were absent.
J: Who do you hope will read this book, and what sort of impact would you like it to have?
LFG: I write out of a political conviction that ordinary, non-elite people matter, and that their actions have far-reaching consequences. So, ideally, my work will challenge predominant expectations that some people are temporary or less important in the Gulf, and that their histories are not “of” this region. I hope that people who might fall into these categories will recognize their histories in this book, and I hope that readers coming from other areas of interest—science, medicine, women’s history—will use my book as an entry into understanding more about this part of the world.
In terms of academic audiences, this book will be of interest to scholars of health, medicine, sexuality, the body, state building, and everyday life. My book as a whole presents a coherent trajectory of health interventions over time, but it is also possible to pull out particular sections for special interests: each chapter tells a separate story of how a range of protagonists such as travelers, doctors, patients, mothers, nurses, oil workers, and scientists shaped the modern Gulf through their understandings of disease and their quests for health.
J: What other projects are you working on now?
LFG: In the late twentieth century, concerns of a shrinking proportion of citizens in the Gulf flooded local discourse. I am currently thinking about how such demographic anxieties intersected with discussions of sexuality and reproductive health. My 2021 article in Radical History Review, “Waiting for AIDS in Kuwait,” represents my initial foray into these issues. Through a close reading of Kuwaiti media, the article traced how, in the late 1980s and early 1990s, anxiety surrounding Kuwait’s integration into transnational networks of travel and tourism brought tensions over gender roles, citizenship, sexuality, and marital infidelity to the forefront of public health. My new research will further explore such assemblages of health and political economy by examining the convergence of politicized demographics, gendered citizenship and migration, and biological reproduction.
Excerpt from the book (from Chapter 5, “Nurses,” pages 131 to 134)
In 1965, the menace of cholera gave Kuwait an opportunity to deploy its expanding medical infrastructure. Cholera had appeared on Iran’s Afghan frontier in July, and Iran responded by shutting down communications with its eastern regions, dispatching 1,428 medical workers, closing schools, banning public gatherings, and imposing quarantines on its borders. In stark contrast to the Sultan of Oman’s lackluster response in 1899 to warnings that cholera would likely make landfall in Muscat if he did not take precautionary measures, by 1965, the Kuwaiti reaction to news of cholera in Iran exemplified how drastically government attitudes toward preventing disease had transformed. When Kuwaiti authorities learned of the outbreak, they halted travel between Kuwait and Iran and prohibited the import of food. The government requested additional vaccine from abroad and ordered vaccination for “the entire population of Kuwait.” Moreover, Kuwait’s residents were willing participants in these public health measures, perhaps thanks in part to the long history of vaccinations in Kuwait. According to the director of the Ministry of Health’s preventive services, “Vaccination is currently being done without resorting to force and compulsion because health awareness in Kuwait has reached an impressive level . . . the people are coming for vaccination in a manner that is reassuring.”
Nurses, the largest population of medical professionals, were on the front lines of these sweeping vaccination efforts. Jamila Fadil Khoury, the Syrian woman who directed Kuwait’s nurses throughout the 1960s, seized on the cholera epidemic to argue forcefully that Arab women nurses were state builders, comparable to—and in no way less than—skilled male professionals and even patriotic soldiers. Using military metaphors to explain disease, Khoury declared, “In my opinion, as far as Kuwait feels the need to build a strong modern army to protect its borders and defend them from the enemy, there is also a need for another army of Kuwaiti Angels of Mercy to keep the country safe from the invisible enemy of disease.” Emphasizing the central role of the nurses in Kuwait’s response to cholera, she continued, “This [need] became clear in recent days when this army— I mean the female nurses and the male first aid responders—played their honorable role in immunizing citizens to stave off the danger of cholera.” The role of the nursing staff, she elaborated, “was exactly as the role of the army in a state of antagonism and war . . . side by side, day and night, with full attention and desire to vaccinate the citizens.”
Khoury’s comparison of nurses and soldiers suggests that she understood how a sizable population of working women, many of whom were unmarried, sat uneasily with patriarchal norms and anxieties surrounding citizenship, family, and sexuality in Kuwait’s rapidly changing social world. Throughout her interviews in Kuwait’s vibrant press, Khoury combated such tensions over the professional status of women nurses by presenting her own migration to Kuwait—and the migration of other women Arab nurses—as a political act. Nurses, in her view, helped to stitch the newly minted sovereign state (Kuwait gained independence in 1961) into the Arab world and to integrate it into a particular transregional vision of decolonizing modernity. More than a medical administrator, in her interviews she used her personal narrative to advocate for the professional virtue of women workers. Khoury was born and completed primary school in the town of Mashta Al Hilu in northwestern Syria. She moved with her family to Tripoli, where she finished secondary school, and then enrolled in the nursing program at the American University of Beirut. After graduating at age nineteen with a nursing certificate, she worked in Tripoli and Homs. With the outbreak of the 1948 war, Khoury rushed to Lebanon’s border with Palestine so that she could “provide first aid to the mujāhidīn and fighters.” The war proved a formative experience, solidifying her sense that nursing was a patriotic duty. The fact that Khoury had worked as a nurse in the 1948 Palestine war also would have endeared her to Kuwait’s expanding professional class who were deeply involved in Pan-Arabism and the Palestinian issue. In a 1963 interview, she explicitly linked her work as a nurse to her political awakening in 1948, stating, “In this war, painful calamities occurred that affected my soul and pushed me to devote myself more and more to the profession.”
After the war, Khoury was head nurse at a hospital in Jeddah. Her next stop was Syria, where she also taught nursing. Khoury then traveled on a Rockefeller Foundation fellowship to the United States, where she earned a bachelor of science in educational and administrative nursing before returning to Syria. Kuwait’s Department of Public Health, at that time headed by Shaykh Fahad al-Salem Al-Sabah, offered her a position in 1959. She worked as the director of nurses in Al-Amiri and Al-Sabah hospitals before being promoted to lead the country’s nursing staff, a position she held until the 1970s. Although in her public narrative she emphasized her credentials as an Arab woman dedicated to serving the pan-Arab community, her American education—both at the American University of Beirut and in the United States—facilitated Khoury’s professional mobility in the Arab world and authorized her to promote an Arab version of this universally feminized profession.
Gulf migration is regularly presented as an explanatory mechanism for twentieth-century transformations in the Arab world. But histories of state building and multidirectional migration within, to, and from the Gulf have yet to fully explore the ground-level interactions that populated large-scale economic, social, and political changes, let alone how people understood the meaning of their own migrations. Largely because of the focus on the oil industry, there also has been scant attention to how Arab women’s labor shaped these demographic and social processes or to the gendered experiences of Arab women migrants. As state agents, nurses were tasked with translating, standardizing, and implementing biomedicine into local health practices. As migrant and professional women whose jobs entailed intimate interactions of physical touch and personal care with Kuwaiti residents from all walks of life, nurses also contributed to shifting dynamics between women and men. Their specialized training made them essential to the state’s modernizing project, but their status as women resulted in systemic economic devaluation of their labor, frequent workplace harassment, and paternalist laws that regulated their movements and leisure.
The focus on elite and male foreign experts and on economic causality rather than social processes has elided an important reality: migrant women mediated the majority of residents’ interactions with the state’s medical infrastructure. These women’s labor was crucial to building the modern welfare state. Moreover, Khoury’s argument for the moral and professional role of Arab women reminds us that, as Andrea Wright states, “migration is not a simple economic calculus,” and “much is lost in using supply and demand, surplus and scarcity” to explain the migration of workers to the Gulf. Khoury did not conceptualize the presence of noncitizen Arab women nurses as the result of a surplus of people in Egypt, Lebanon, and Syria and a shortage of medical workers in Kuwait. In 1963, when a reporter asked Khoury, “What is your view of the Arab girl and what is your advice to her?” Khoury replied: “The Arab girl is distinguished by her strong morals and her ambitions. She is now working in all fields. She has proven her great merit and her ability to master every job that is entrusted to her. My advice is to avoid vanity and to learn a lot from science.” Khoury adeptly used her position of medical leadership to promote the idea that women had a duty to participate in the Arab national project as nurses, that their efforts demanded specialized training and expertise, and that they deserved society’s respect. She offered up Arab nurses as agents of social change in a newly independent Kuwait.
