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efficient and comprehensive healthcare, guided by the
inspiring models of social and preventive medicine of
the time, was not a priority.
However, the regime did not object to international
support for developing rural health in Portugal, as
long as it did not interfere with landowners’ inter-
ests. Thus, in 1934, a station for the study of malaria
financed and directed by the International Health Di-
vision of the Rockefeller Foundation was created in
Águas de Moura, a very small village surrounded by
great extents of rice fields, 65 kilometres south of Lis-
bon. It was renamed Institute of Malariology in 1939
(Saavedra 2014; Câmara Municipal de Palmela 2001).
This institute was mainly a research centre although
a dispensary had eventually been provided to help the
many people who went there looking for assistance.
The institute’s purpose was to develop epidemiological
research and experiment with larvae and mosquitoes’
control techniques, as well as with malaria treatment.
Before that, in 1931, the Portuguese government and
other institutional donors had created a malaria station
in Benavente, a small village also surrounded by rice
fields about 60 kilometres north-east of Lisbon. During
the 1930s and 1940s other malaria stations, posts and
dispensaries were installed in rural areas to treat the
population and develop sanitary interventions to con-
trol malaria infections.
The most striking feature of former rural workers’
speech about malaria was their deprecation of the dis-
ease in face of the retrospectively perceived everyday
deprivation, hard work and hunger threat. Therefore,
without directly blaming malaria on their everyday life
circumstances these people’s memories show that it
must be considered as the result of a compound causa-
tion model; as part of a complex set of local conditions
and personal experiences that dictated the order of
priorities in the face of multiple vulnerabilities that af-
fected them.
2
Although it has a specific agent (
Plasmodi-
um
parasites), malaria is deeply inscribed in ecological,
historical, political and social circumstances that dictate
its distribution, determine who is more vulnerable and
why, and how it is handled.
Most of the memories collected refer to the period be-
tween 1940 and 1970 marked by dictatorship, its resist-
ance to changes and its repression of any form of dis-
sent and opposition. Until the 1960s the economy was
dominated by agriculture. On the valleys of the rivers
Tagus and Sado, where wide expanses of rice fields were
located, the differentiation of social groups and social in-
teractions were strongly marked by people’s relation to
the land.The two extreme groups in a gradient of modes
of access to land were “landowners” and “day-labourers”.
The agricultural landscape was dominated by large prop-
erties (in some districts they could be over 250 acres)
and social relations were highly hierarchical and unequal.
Life could be hard for day-labourers, subject to un-
certain work and meagre wages, sometimes having to
move from place to place in search of work:
Here, the rice thing was over and there was no more
work; and so what did I do? My wife stayed at home
with my two grown up daughters, and I did not know
what to do with my life. In those days we had poultry;
my wife fried a couple of eggs with a little shredded cod
and a little bred, put everything inside a basket and I
went down there to catch a train, there atVale de Guizo
station […] I went to Algeruz to ask for work at the
vineyards. (Antonio, 2006)
3
Therefore, in their narratives about “having malaria”,
former rural workers would always downplay the dis-
ease while giving emphatic, detailed and emotional de-
scriptions of their labour; of its harshness; of their des-
titution or scantiness of comfort; of the hunger threat.
Malaria came as one among the many struggles of eve-
ryday life being not much thought of except when it
prevented them from working, compromising their day
wage, or caused them extreme physical discomfort.
The interviewees’ discourse was often punctuated with
the expression “we suffered a lot”. Suffering, recog-
nised from the standpoint of the present and perceived
as persistent and inescapable, was a prevailing notion
throughout their narratives as was the sense of sharing
such suffering with their fellow rural workers. Suffer-
ing was perceived as inherent to their class and inescap-
able. It was only while recollecting their past experi-
ences in light of the presently dominant values; labour
laws; the current historical discourse about the dictato-
rial regime and its oppressive mechanisms; the democ-
ratization of health services – as well as in light of their
own socio-economic changes – that the interviewees
recognised suffering as a socially produced condition,
as defined by medical anthropology:
Social suffering […] brings into a single space an as-
semblage of human problems that have their origins
and consequences in the devastating injuries that social
force inflicts on human experience. Social suffering re-
sults from what political, economic, and institutional
power does to people, and, reciprocally, from how these
forms of power themselves influence responses to social
problems
(Kleinman, Das and Lock 1996, xi).
Suffering is a social condition as well as a category that
2 - On the connections between “vulnerability, malaria and health-seeking proces-
ses” see Ribera ans Hausmann-Muela (2011, 104).
3 - The interviewees’ names have been changed to protect their anonymity.