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Medical Propaganda and Cultural Revolution in Soviet Kazakhstan, 1928-41 Author(s): Paula A. Michaels Reviewed work(s): Source: Russian Review, Vol. 59, No. 2 (Apr., 2000), pp. 159-178 Published by: Wiley-Blackwell on behalf of The Editors and Board of Trustees of the Russian Review Stable URL: http://www.jstor.org/stable/2679751 . Accessed: 29/10/2012 02:03
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and MedicalPropaganda in Cultural Revolution SovietKazakhstan,928-41 1

PAULA A. MICHAELS

of he hundreds other physicians to theregion, camebearing sent information aboutgerm the diseasetransmission, waystoimprove Kazakhs'health well-being. and and He theory, found world a from south SiberiaandeastoftheCaspian different hisown. Lying of very aridsteppes boreno resemblance thedensebirch to his Sea, these forests eyesknewwell. TheTurkic-speaking, Muslim, nomadic Kazakhsneither physically culturally nor reminded himof theRussianvillagers that can imagine grewup withor visited we he during the summers hisyouth. of after the summoned the Shortly setting shopina felt up tent, doctor to on from to care to villagers heara seriesof lectures topicsranging syphilis prenatal Somewhat and Kazakhmenandwomen sanitation. skeptical attimes quitereluctant, gathto the assistant into eredand listened thesetalksthat doctor's haltingly interpreted their in native tongue.In reports backtohis superiors, physician the noted filth squalor the and he which would-be his their resistance thenotions brought him, to with and patients lived, I thedistrust forged gulf a him he that between andthose served. wereunfamiliar, appearance wayof his Whilehismedical methods theories and and in lifeprobably werenotentirely unknown thelocal population.Beginning thelate to of in nineteenth century, numbers Russians Ukrainians large and settled northern Kazakhstan, where established Their traditional routes Kazakhs they largefarms. migratory disrupted,

In thespring 1928 a doctorentered remote a Kazakhstan.Like of villagein southern

Research this for article supported grants was by from International the Research Exchanges & Board,with funds for provided theNational by Endowment theHumanities, U.S. Information the and Agency, theU.S. Department ofState, the from Title VIII Program theSocial ScienceResearch of and American of Council the Council Learned Societies, from University Iowa's CollegeofLiberal and of the Arts.Noneofthese is for organizationsresponsible theviewsexpressed. earlier of at An version this conference paperwaspresented Indiana University's "Inventing I theSoviet Union:Language, Power, Representation, and 1917-45"inNovember 1]997. appreciate criticisms the andinsights theconference of I am participants. grateful TheRussiani to Review's and editors anonymous readers, DanielColeman, Steven and for and Hoch,Veronica Magar, DonaldRaleigh their comments suggestions. arkhiv Iuzhno-Kazakhstanskoi oblasti 'Gosudarstvennyi (GAIuKO),f. 812,op. 1, sv.4, d. 23,11.1-7ob. TheRussian Review (April2000): 159-78 59 Copyright 7heRussian 2000 Review

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beganto abandon nomadism takeup sedentary and agriculture.2 KazakhsandEuropeans Only livedinseparate settlements, they notexist total but did in isolation from another. one own inthelate1920sandearly1930sdidRussian efforts reshape to Kazakhsintheir image It becomesystematic. was intothisatmosphere medicalactivists that brought European biomedical traditional of practices, propaganda denouncing healers, praise thesocialist and that of medicine accessible theindigenous to population. system madethemiracles modern like times across Doctor-patient encounters theonedescribed aboveoccurred countless in theCentral Asiansteppe the during late 1920sand 1930s. Beginning 1928,theSoviet which Unionembarked what on cametobe known theStalinRevolution, as encompassed a of for rapidindustrialization collectivization agriculture thesakeofbuilding strong, and of socialist nation. The expansion biomedical services servedtwofuncself-sufficient, motions: keepindustrial agricultural to and workers and healthy on thejob, andtobring there to Pilotstookpeasants airplane on ridesto provethat dernity theSoviethinterland. was no God in heaven, whiledoctors used modern to that pharmaceuticals demonstrate servedas a pillarin theCultural not caused disease.3 Biomedicine germs, evil spirits, in a to Revolution which, Russianandnon-Russian regions alike,strove forge pan-Soviet of notions progress. Devoid of superstition a and identity based on European, positivist of the in believer thepower science, NewSovietMan (andWoman) in wouldhavefaith the Sovietstate's Communist and to ever-higher stages party's ability leadthecitizenry toward ofeconomic cultural and development. in readyto Like his fellowmedicalworkers, doctor theKazakhvillagearrived the morethan meremedicalservices.Newlytrained nurses, midwives, dispense physicians, in and other medicalpersonnel werefootsoldiers thisCultural armed with a Revolution, in world viewthat socialandeconomic saw terms. With masits organization hierarchical of the of Russiancivilization tery biomedical knowledge, represented pinnacle cultural while non-Russian sorted out lower territories themselves onvarious rungs development, the sent of thisladder. In theeyes of theSovietleadership themedicalworkers to the and level. While Asia's nomadsclearlyoccupiedthelowestdevelopmental region, Central rates disease of theideasthat medical workers toCentral Asia couldanddidlower brought and improve population's of came bundled witha worldview that the quality life,they In Kazakhsocial,cultural, economic and structures. medical encountraditional denigrated tersand in thedissemination healthand hygiene of medicalprofessionals information, to linked death diseasedirectly virtually and of every aspect Kazakhlife.By understanding in Kazakhsociety theseterms, and medicalcadresnotonlysupEuropean Europeanized state's to but the the effort spread biomedical ported Soviet knowledge alsofurthered regime's

2SeeGeorge Demko,TheRussianColonization Kazakhstan, of 1896-1916(Bloomington, 1969). Fora thor1995). A oughsurvey Kazakhstan's of political history Martha see BrillOlcott, Kazakhs, ed. (Stanford, The 2d in From briefer survey available Shirin is Akiner, Foimation ofKazakh Identity. Tribe tolation-State (Washington, in Smith DC, 1995);andIngvar Svanberg, "Kazaks," 7heNationalities Question theSovietUnion, Graham iz ed. (New York,1990), 318-33. For a look at contemporary Kazakhstan Ingvar see Svanberg, ContemporaryZ ed., Kazak/hs: CulturalandSocialPerspectives (London,1999). "The Struggle and 3SeeShoshana Keller, against IslaminUzbekistan, 1921-1941:Policy, Bureaucracy, Reality"(Ph.D. diss.,IndianaUniversity, 1995); and Daniel Peris,Storming Heavens. TheSovietLeague ofthe the Militant Godless(Ithaca,1998).

in MedicalPropagandaand Cultural Revolution K~azakhstan 161 of diseased, political economic and agendaas well. The construction Kazakhlifeas dirty, clean,healthy socialist future these that mediandbackward stoodincontrast thebright, to officials believedthat medicalworkers if cal cadresrepresented. Government party and in succeeded imparting viewto theKazakhs, they wouldopenthedoorto modernizathis tionandEuropeanization theregion. of in Central Howhealth hygiene Asianrepublic Kazakhstan of and propaganda spread the to a identity transand is central understanding thestate to how attempted forge pan-Soviet the form non-Russian into part Sovietstate.Characterperiphery an integral ofa modern Fivechange, period the from start theFirst the of izedbydramatic economic political and the YearPlanin 1928totheSovietUnion'sentry World into WarII in 1941wellillustrates state's efforts forge New SovietMan through to a interventionist cultural policies. As the Kazakhstan a of sceneof a violent collectivization provides vividportrait the campaign, a famine clashesbetween andnewways. In 1932-33,Kazakhstan old endured devastating and that the 50 through outmigration starvareduced Kazakhpopulation nearly percent by the of the to tion.4 disaster, stateattempted underAgainst background thisdemographic with focuses minetraditional them biomedical workers. Thisarticle healers supplant and constructed image Kazakhs Kazakhstan an of and onthe the wayinwhich Soviet government inbiomedical the and political goalsintheregion tobuttress propaganda further regime's to hereis necessarily limitations, emphasis the itsEurocentric world view.Becauseofsource on thestate's of and rather on theequally than representationsdisease,medicine, culture, of important question audience reception. for the Decreesandresolutions theCommissariat PublicHealth both republic from at levelandKazakhCommunist documents voicetothestate's underandnational party give of in of newspapers standing itsobjectives andperceptions theregion.Local andregional of in manuals for echomany these samenotions thepublicsphere.Though innumber, few and health education as propaganda pamphlets, postworkers, well as antireligious health into aimedatthegeneral insight theviewscirculaters,andlectures publicgiveimportant other official to and sources. It is difficult ing in themedicalcommunity complement in estimate widely how these weredisseminated Kazakhstan, they but werepubwritings in that to lished runs ranged from hundred onehundred thousand copies.5 anywhere several how to Thoughit is impossible determine manyfellintothehandsof Kazakh readers

BrillOlcott, "TheCollectivization 4SeeMartha DriveinKazakhstan," RussianReview40 (April1981): 122-42. manual training health in hundred 'One Kazakhstani for educators published a run fifteen was of copies. See A. Polianskii, Metodic/zeskie ukazanlia ksostavIleniiutpIansasanitarno-prosvetitel'noiraboty 1941). Cen(Alma-Ata, thoutrally published pamphlets massdistribution for enjoyed runs ranging from twenty thousand onehundred to sandcopies. At thelow endofthis rangeis S. Rostovskii, zvakhaar'i vrach: Pop, Reigiia imeditsita(Moscow, 1925);that sameyearonehundred thousand copieswere published V. Dmitrieva, of isueverie (Moscow, Tenmnota to 1925). It is impossible knowhowmany thesemadetheir of wayto Kazakhstan. thousand Ten copiesofone brochure prenatal in on care appeared 1934. See S. M. Dukenbaiuli, Jukti tazal/yghy Kazakh-language qael in [Hygiene thepregnant for woman](Kzyl Orda, 1934). Almostall thepamphlets locatedwerepublished I in Russian a time at when fewKazakhswereliterate evenfewer and couldreadRussian.After thorough searches I identified twoKazakh-language It local libraries archives both and in Almaty Shymkent, and only brochures. is notsurprising this that kind popular of pamphlet wouldnotbe preserved I do notthink reflects absence and this an of from their nameswe can surmise almost wereethnically that all ofpublications thistype.As fortheauthors, wereandwhat little aboutwhothey motivated them. Slavs,butunfortunately else is known

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during 1930s,thesewritings the mirror milieu the that produced biomedical the practitioners serving Kazakhvillages.Ifnotdirectly indirectly, ideascontained these the then the in brochures madetheir wayto theremotest parts theUSSR. of In Soviet CentralAsia the politicsof biomedicine during Stalin Revolution the provides striking a exampleof thecultural meanings implications health and of care,a question explored historians other by of parts thecolonialworld.Around globe,the of the of export biomedicine European by physicians, nurses, missionaries, others and supported thestate'ssubjugation thepopulation reinforced of and notions cultural of and European scientific an link Western techsuperiority. DanielHeadrick demonstrates intricate between nology, including modern medicine, Europe'sability spreadits control and to overthe as colonialworld. Headrick sees steamships rifles, and quinineand railroads some of In the"toolsof empire" madecolonization that bothpossibleandprofitable. thecase of at the the of that without discovery this quinine, drug effectively malaria bay, European kept of of penetration Africawould not have been possible regardless how economically lucrative politically or desirable David Arnoldbuilds Europeansfoundthatprospect.6 howmedical not on Headrick's work showing colonialexpanby knowledge onlyenabled sionbut also served a siteofnegotiation as the between colonizers thecolonized. and Arnold their exploreshow medicalauthorities acted as agentsof colonialism through efforts to extend British control colonialIndianbodies. Medicinebecamea tool of Indian to national resistance well. Whileefforts introduce expand as to and sanitation biomediand cine to theindigenous ruleas benevolent British population helpedto legitimate and on progressive, limits theseefforts the of gave Indiannationalists humanitarian grounds whichto attacktheir colonial rulersfornothavingdone moreto improve lot of the Indians.' exploited, impoverished In thecase oftheSovietempire, officials hopesfor had biomedical knowldeploying to the viewedas backward into edge in similar waysin an effort transform societies they in of construction. Sovietofficials the partners socialist Certainly hopedthat expansion facilities cadres, thespread European and biomedical and of ideasabout and hygiene methods of disease control, wouldtranslate lowerratesof disease and increased into health the the of Asians. Indeed, dissemination biomedicine reduced among Central significantly in but took with on epidemics theregion, this program shapeentangled an attack a wayof lifethat Sovietauthorities as thefoundation disease. In theviewofSovietofficials, saw for and as a The religious practices, poverty, illiteracy played great roleinillnessas microbes. state medical with diseasenotonlythrough application the charged professionals fighting ofscientific aboutmicrobes vectors also through struggle but a and the knowledge against socialconditions inwhich viewed fundamentalcreating environment as to an diseasethrived. Likenineteenth-century andFrench British sanitarians before riseofgerm the who, theory, attributed diseaseto "bad air" and other environmental factors withEurope's associated

6SeeDanielR. Headrick, ToolsofEmpire.:echnology European The and Imperialism tie Nineteenth ihn Cento in of medicine suggested DavidArnold, is tuly (NewYork, 1981). The applicability Headrick's concept colonial the Disease inineteenth-Century (Berkeley, India Colonizing Body.StateMediciie and Epidemic 1993), 15. 'Arnold, Colonizing Body.Another the important ofthe study relationship between colonialism medicine and is MeganVaughan, Curing their Ills. ColonialPower andAfican Illness(Stanford, 1994).

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urban in slums, Sovietofficials blamed illness large part patients' oflife.8 on way Disease becamea product destitution, justgerms. of not The Marxist framework informed policiesof Sovietpoliticaland medical that the authorities well with fit Marxism asnotions linked that diseaseto economic conditions. serts that economic an substructure servesas thefoundation thesocial,political, for and cultural that superstructures spring from Alteration that it. of economic substructure reverin berates every aspectofsociety fundamentally and changes everyday Although life. Sovietofficials knew germs such that causeddisease, stressed environmental that they factors, as nutrition sanitation, an role and played equally important ina disease'scourse spread. and Sovietmedical theorists these saw environmental as products theeconomic forces of structure. There bynomeans was consensus acrosstime placeas tothe and between relationship but werenotalone in their beliefs. economic and environmental factors, Soviettheorists French for "tuberculosis tobe seenas a came Among turn-of-the-century radicals, example, of overwork low wages.9Like their French sideeffect industrial and capitalism" through predecessors, Soviettheorists believedthat would changesin theeconomicsubstructure lead ofthe conditions affect trajecthat the naturally to transformation socialandcultural of diseases. Rationaleconomicorganization tory infectious along socialistlineswould advanced cultural the contheoretically risetomore give practices, eroding environmental in ditions supported spread disease. Physicians researchers Western that the of and Europe this also recognized roleofenvironmental andtheUnited States the during period factors, butSovietmedical on substructureon as etiology placedas much importance theeconomic microbial causes. Whileitis scientifically toassert environmental valid that factors a play roleindisease,this on causesreflects unique a strong emphasis environmental characteristicofSovietmedicine. ORIGINS AND METHODS OF BIOMEDICAL PROPAGANDA in Revolution intended facilitate was to the Beginning 1928,theSovietUnion'sCultural transformation cultural ofthe ata when industrialization collectivand superstructure time for izationprovided fundamental Therewas no changesin theeconomicsubstructure. for of unscientific place in thisneworder vestiges a superstitious, irrational, past. Traditionalhealers, who included and foundthemselves the shamans, mullahs, folkdoctors, of meant drive indigenous targets a vigorous propaganda campaign to the population into thehandsofnewly trained biomedical doctors, nurses, midwives.Forthemostpart, and consisted various of efforts persuade population distrust to the to agitation traditional healthe resorted coercive to suchas arrest imprisoners,butoccasionally state methods, and ment.Officials worried abouttheauthority shamans, mullahs, folkdoctors and exerted at thelocallevel. In this the to in biomedical institutionsCentral way, drive develop Asia was
80n Western Europeand thesanitary movement Anthony Wohl,Endazgered see S. Lives. PublicHealthin Victoriaiz Britfain (Cambridge, MA, 1983); andWilliam Coleman, Death irv Social Disease: PublicHealthand a Political Econony2in Eacrly Indutstrial France(Madison,1982). 9DavidS. Barnes,TheMakingof a Social Divease. Tuberculosis Nineteenth in Century, France (Berkeley, 1995),217.

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a clearexpression power control, notsolelythehealth well-being potenof and and and of tialcontributorsthesocialist to economy. Tending merely themedical, also thespiritual not to but needsof thecommunity, traditional healersserved cornerstones Kazakhculture.Undermining healers as of these was essential both expansion biomedicine thesecuring thestate's to the of and of exclusive authority thelocal level. Threetypes traditional at of healers served medical the needsof theKazakhpopulation, are unclear thepractitioners' although divisions often and methods to overlapped. Mullahs usedprayer, chants, holywater, and among other approaches, treat theill. Shamans, often contained and whoseincantations bothpre-Islamic Islamicelements, reliedon a variety practices, of including exorcisms herbalremedies.Folk and and doctors on derived from depended primarily medicines plant animal prod(darigerler) milk was usedtotreat includucts;for example, fermented mare's (kuinyz) widely illnesses, These approaches shouldnotbe dismissed completely as ingtuberculosis.'0 ineffectual, variolation in of of especially light thelimitations contemporary pharmaceuticals. Smallpox was widely and so in tuberculosis appliedby darzgerler kuinyz proved effective treating to of the its that, prior theadvent antibiotics, Sovietgovernment sponsored massproductionfor that the express purpose.Though they maynothaveunderstood meansbywhich diseasesspread, ethnomedical used observations learn to contagious practitioners empirical a of somesuccess. howtotreat variety diseaseswith The experiences Kazakhstan Central of and Asia mirror ofother that regions, includingrural Russia. "Sanitation education" (sanitarnzoe prosveshc/enie)-basic health and in hygiene education-haditsorigins theprerevolutionary period, when doctors employed to Russianpeasants abandontheir to folkmedicalpracby zemstvos attempted persuade ticesand to embrace educated to biomedicine." Urban, doctors fought ridtheRussian of beliefs they that These peasantry superstitious thought Russiapoorandbackward. kept medicalworkers a modest had on of the impact thehealth Russianpeasants through disand care. Thisprosemination information sanitation, of about personal hygiene, neonatal their them to to intoabandoning customs teaching pagandaattempted coax peasants by viewtheir oflifeas dirty a relicofthepremodern WhentheOctober and Revoluway past. tionarrived, zemstvos' the work was still muchofrural Russiaremained wedunfinished, ded to old practices superstitions, itwas left theBolsheviks finish camand and to to this similar of territories theUSSR. paignwhilethey pursued policiesin thenon-Russian Inrural Russia across and medical workers the worked Europe, during nineteenth century toexpand their exclusive control medical over andauthority, this but effort took knowledge inthe onunique characteristics colonial context placeslikeSovietCentral of Asia orBritish India. DavidArnold notes that British the traditional Indian medicine "in was fight against ... extension Indiaoftheattack folk to on in medicine and part the already underway Europe
'"Fora moredetailed discussion traditional of Kazakhmedicine R. M. Mustafina, see Predstavleniia, kul't) it i (Alma-Ata, 1992); K. Sh. Shulembaev, obri-idy kazakhov Obrazzhizni, Obshchee osobennoe ateizrm. /eligi?a, v obrazezhizti iire/igiozizkh veiovaniiakh kazakhov voiprosy i ateisticheskogo vospitaniia (Alma-Ata, 1983); andmy"Shamans Surgeons: Politics Health and The of CareinSoviet Kazakhstan, 1928-41"(Ph.D. diss.,Univerof Carolina ChapelHill, 1997),28-81. at sity North "Ia. I. Akodus, ochzerk F. Kratk#i rnelodiki sanitazinogo prosveshchenii (Tashkent, 1927), 7. See also John Hutchinson, Politics and PublicHealthin Revolutionairy Russia,1890-1918 (Baltimore, 1990); and NancyM. Frieden, RussianPhysicians an Era ofReform in anzdRevolution, 1856-1905(Princeton, 1981).

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of in the jealous defense medicine themonopoly qualified of as professionals."'2Similarly, Kazakhstan efforts expand to biomedical authority notunlike were Imperial Russianand, Sovietefforts bring to biomedicine rural to colonial later, Russia,butin theinterethnic, to excontext modernization this project becamelinked thestate's political economic and ploitation theregion.Subjugation Kazakhbodiesto state of of medical authority brought Soviet into farthest corners the of USSR andplayed part establishing in Moscow's power the a
domination.

and the of the Against background theindustrialization collectivization campaigns, into cadcentral considerable resources thedevelopment biomedical of government poured was reresto meetthepopulation's needs. Special attention paid to so-calledbackward officials identified inparticularly needofmedias acute gions, suchas Central Asia,which the of In for from in 1927to 452 cal workers. Kazakhstan, example, number doctors grew in the KazakhMedicalInstitute 1,571in 1937. Until founding 1931oftheV. M. Molotov doctors to receive had outside republic.Evenafter the (KazMI), all Kazakhstani training of continued comefrom to outside republic, the theinstitute the opened, majority doctors there for One of transferred by theUSSR Commissariat PublicHealth(Narkomzdrav). missions thecreation a cadreofindigenous was of medical workers. As KazMI's primary of 1931,only30 to 35 Kazakhphysicians served indigenous the Evenafter population.'3 students 1935,the in number Central of KazMI began graduating Asiangraduates remained in prewar were more quitesmall the years.Kazakhs numerous lower at rungs the of medical profession, working nurses, as midwives, physician's and assistants, atnoleveldidthey but of of reflect number Kazakhsas a percentage thegeneral the population. During 1930s the cametopredominate women among practicing physicians, almost theexclusion men, to of in whilemalesretained most administrative facilities medical and educapositions clinical in of tionalinstitutions. Growth thenumber medicalworkers couldbarely keepup with of efforts expandfacilities.Continual to ruralto urbanareas outmigration cadresfrom within and from republic Russiaandother the to of Kazakhstan, flight European regions the and of USSR madefora transient often medicalworkforce. number The inexperienced bedsexpanded from wereconcenhospital 3,767in 1928to 16,290in 1941,butsincemost in and trated Slavicurban industrial the areas,they beyond reachoftheregion's lay indigenouspopulation, which was often served itinerant medicalteamsthat by passedthrough 14 nomadic seminomadic and for encampments a few daysorweeksata time. Inagricultural to established clinicalfacilities servecollective areas,thestate temporary farmers during critical and harvesting sowingseasons. Amongotherduties,theseyoung,temporary
12Arnold, 51. the Colonizing Body, '3Tsentral'nyi gosudarstvennyi Respubliki arkhiv Kazakhstana (TsGA RK), f.30,op. 2, d. 603,1. 15 (reprinted in Kh. Kh. Khabiev, Kul'turnoe v ed. stroitel'stvoKazak/hstane, 1933-iun' 1941 gg.: Sbornik dokumentov i materialov [Alma-Ata, 1965],1:458). 14S. S. Baigazin, "Formironvanie meditsinskikh kadrov 1917-41gg."(Candidate Kazakhhstana, diss.,Republic of Arkhiv ofKazakhstan Kazakhstana Academy Sciences,1992),117; prezidenta Respubliki (APRK), f. 141,op. 1,d. 7706,1.11,andd. 10137,1.133;TsGA RK,f.815,op. 2, d. 7a, 1.6; "Kratkii obzordeiatel'nosti uchrezhdenii Kaznarkomzdrava1928-29g.," za Zdravookhranenie 1930, Kraevogo vKazakhhstane(ZVA), no.5-6:26;"Rezoliutsii soveshchaniia rabotnikov zdravookhraneniia 1934g.,"Meditsinskiizhurnal KASSR, 20-23 marta Kazakhhstana komissara zdravookhraneniia KazASSR tov.Kulsartova IX na (MZhA),1934,no. 7-8:74; "Doklad narodnogo vsekazakhskom s"ezde sovetov," MZhK,1935,no. 1-2:1.

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medical cadres boreresponsibility transmitting propaganda Kazakhstan's for health to villages,ifonlyon an infrequent irregular and basis. As theranks Kazakhstan's of medicalcadresslowly grew, too did efforts disso to seminate health and hygiene propaganda thepopulation.In Central to the Asia, where cultural between gap mostly Europeanmedicalworkers Kazakhpatients wide, and was suchpropaganda efforts have playeda particularly may important in eroding role local reluctance accept to biomedical approaches. Sanitation education found expression writin ten, visual, oralmedia.Activists and appear haverelied to most on means to heavily written convey their vision cleanliness culture thelate1920sandearly of and in cadres 1930s,when andresources and an wereparticularly scarce,and newspapers pamphlets provided inexthe workpensive waytoreach broadest audience.By themid-1930s, whenmore medical erswereavailableto conduct and oral lectures, discussions, one-on-one agitation, propawereemployed a greater to extent. radios As available gandamethods becamemore widely inthe1930s, distant of werewithin earshot sanitation eventhemost corners Kazakhstan of In of and education lectures.'5 thelargely illiterate society theKazakhnomads seminomads, 16 effective.Needlesstosay, and films posters, slides, educational mayhavebeenespecially intheKazakhCommissariat PublicHealth all activists for (Kaznarkomzdrav) incorporated in in with health education methods their work throughout 1928-41,usually conjunction oneanother. To mobilizethepublicaround issue of health the and hygiene education, officials forms written, and visualpropaof that various staged publicspectacles integrated oral, as Narkomzdrav ganda.As early themid-1920s, sponsored week-long publichealth drives in schoolsandworkplaces, where teachers health and rallied raisepublic to careworkers on consciousness about heath The focused health hygiene its and efforts questions.'7 state the International Kazakhwomen during weeksbetween Women's Day (8 March)andBan on BridePriceandPolygamy (22 March).In urban HousesofHealth Day areas,so-called Education advanced causeofhygiene the (Doma sanitarnogo prosveshcheniia) propaganda and to through exhibits, lectures, outreach programs local schoolsandfactories.' THE CONSTRUCTION OF KAZAKH CULTURE IN BIOMEDICAL PROPAGANDA and of life Propaganda depicted poorsanitation practices customs everyday as fundamental to thespreadof diseasein Kazakhstan.Questions hygiene of becameintertwined with in with viewthat the diseasesweremerely manifesa issuesofculture, keeping widespread of backward economic In Sovietphysicians tation Kazakhstan's substructure. particular, socialandcultural factors supposedly that created environment an favorable to emphasized of disease. In a 1928report his regional to thespread infectious Narkomzdrav superiors,
gosudarstvennyi arkhiv RossiiskoiSovetskoiFederativnoi '5Akodus, Kratkii ocherk, 45-46; Tsentral'nyi Sotsialisticheskoi Respubliki (TsGA RSFSR), f.482, op. 24, d. 64, 1.22ob. '6Akodus, Kratkii ocherk, TsGA RK, f. 82, op. 2, d. 164,1.97. 28; kprovedeniiui sineizu nedeliza zdorvuuii (Moscow,1928),3, 5. vserossiiskoi '7Materialy vSSSR 8L. S. Bogolepova, Saizitarnoeprosveshchetzie (Moscow,1952),49.

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oneunnamed European doctor a Southern in Kazakhstan village heldthat Kazakhs"do not observe general rulesformaintaininghygienic a home. Theykeepboththemselves and their quarters filthy, whichis theprimary sourceforspreading disease,as are their bad In habits."'9 theeyesofthis physician, is thefilth theKazakhs'wayoflifethat it and cause disease. Microbes theroot illnessareovershadowed thesocialandcultural at of by conditionshe observes. Bothprerevolutionary Sovietobservers lifein Kazakhstan and of so their with generalized disgust every aspect Kazakhcustoms itseemed ifthreats of that as to Kazakhhealth wellbeing and penetrated every aspect dailylife.20 of Medicalprofessionals emphasized, example, "theordinary of life"was a primary for that way cause of miscarriagesamong Kazakhwomen, whileearly marriage to a variety gynecological led of probin in lemslater life.2'Dr.Bykov, prominent a Russian physician working Chimkent (now that levelofthepopulaShyinkent, Southern Kazakhstan oblast), asserted the"lowcultural tion"fostered spread so-calledsocial diseasessuchas syphilis, theabsenceof the of and the KazakhCommissar regular accesstobiomedical carecompounded problem.22 Deputy of forPublicHealthM. K. Tleugabylov reiterated notion this whenpainting picture a with not Kazakhstan teeming "poverty, as need,andsocialdiseases."23 Though physicians, other authors wrote theKazakhs'"nightmarish whiledescribing of Kazakhsthempast," their selvesas "lazy"and"uncultured."24 Kazakhshadtochange and daily practices fundatheir socialorganization lead healthier to lives. An "extraordinarily immentally reshape of work Kazakhstan in became"thestruggle uproot custo ancient portant aspect" medical which thegreatest are toms prejudices, and to for impediment support all cultural development."25 somepractices contributed thespread contagious to of Certainly disease,butthe battle these customs becamea fight destroy Kazakhculture pavethewayfor and to against in state over that launched attack its greater control theregion.Itis nocoincidence thestate with economic demands theregion. on conjunction increased

f. remarks TsGA RK, f. 82, op. 2, d. 165,1.24; M. A. see '9GAIuKO, 812,op. 1, sv.4, d. 23, 1. 1. Forsimilar vraionakh Bykov, Sanitano-gigienichieskie oclzerkiizdlravookhranejzle Syr-lDarinskogo okruga (Chirnkent, 1931), o sifilisa Kazakhstane," v 47, 129;V. Serebriakov, "Materialy voprosu rasprostranenii 1935,no. 3:96; po MZIWK and OtchetKazaklistanskoiekspedits#iza 1926god(Leningrad, 1927),11. Urban physicians madesimilar observationsaboutRussianpeasanthabitsand customs. See, forexample,S. L. Lopatina,Nuzizmo borot'sicso v deievne znakharstvom (Moscow,1926),3; andL. Vasilevskii, Refigiaizdorov'e(Leningrad, 1928), 13. with 20For prerevolutionary commentators almost identical observations medicine, on and health, culture among theKazakhssee A. K. Geins, ocherki Stianasvobodnykl zelnel'(St. PetersKirgizskie (n.p.,1866),237; Bertov, burg, 1908),39; amdKrebel',Narodnaiameditsina narodnye i sredstvaz raz/ichnykh plemenRusskogo tsars/va trans. Blumentaev S. (n.p.,1868),36. protivazllichnykh boleznei, f. 21APRK, 141,op. 1,d. 2378,11. 4; Briskin, 2, StepiKazakhskie. Ocherkistepnogo Kazaklstleia(Kzyl-Orda, 1929),109; Dzhetysuiskaia (Dl), 29 March1928,3. iskra 22Bykov, ocherki, 103. See also Otchet 48, 11. Kazakhstanskoi ekspeditsii, Sanitalnio-gigienicheskie 23M. Tleugabylov, K. "Kadry zdravookhraneniia Kazakhskoi za 25 let SSR Velikogo Oktiabria," Zdizvookhlzmelie Kazakhhstana (ZA), 1942,no. 11-12:27. 241.Kuramysov, Leninskuiu Za natsionaInuiu politikuv Kazak/istane (Alma-Ata, 1932), 89; V. Gorbunov, Putevoditel'po (Moscow,1932),20. Forother comments "Ot Kazakhsstanu alongthesesamelinessee Pliushch, Khivinskikh tsarskoi kolonii,ot votchiny feodalov-dosotsialisticheskoi Kara-kalpakii," Prosveshclienie natsionda/'uostei(March-April 60; andR. I. Samarin, 1934): Ocher-kiistoriizdravookirziimeliiia Kazaklistana (AlmaAta,1958),105. f. 25APRK, 141,op. 2, d. 2819,1. 177.

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Propagandists singled religion having particularly out as a negative effect the on health andwell-being thepopulation Kazakhstan throughout USSR. Islam,Chrisin the of and tianity, Judaism, other and religions wereattacked throughout Soviet the Unionfor promotingunsanitary practices threatened health Sovietworkers. that the of Official arguments to offeredscientific, a foundation lent that authoritythese claims. against religion biomedical A. Rostovskii, antireligious an activist, argued Christian that practices as kissing such crosses that andicons,anddrinking water holy from common vessels, spread germs causedtuberHe that culosis, syphilis, diphtheria, influenza, other and contagious diseases.26 claimed the and of health byexposing risk infants Muslim Jewish practice circumcision poseda serious other of torisk infection hemorrhage.27 of and Rostovskii several and authors health pamand caused stomach phlets asserted fasting, that observed Muslims, by Christians, Jews, andintestinal in Godless'sjournal disorders.28 Writing theLeagueofMilitant Bezbozhnik, ofRamadan, which an activist named Salimstated theMuslim that holiday requires thirty offito taxed body.29 the Kaznarkomzdrav from sunrise sunset, daysoffasting excessively in cials saw "religious fanaticism" factor thespreadof amongtheKazakhsas a primary wentso faras to claimthat, "in disease.30 Russianantireligious propagandist Vasilievskii nerbelief gods andzealousparticipation religious in in is general, rituals closelytiedto and illness. Religion makesa healthy individual vousailments mental psychotic."3' to of Medicalpropaganda offered opportunity convince an Kazakhsof thedangers their traditional healers. Regional republic-level and newspapers described shamans, mullahs, andother folkhealers greedy charlatans willfully who deceived ignorant the masses.32 as and all Lectures, posters, pamphlets encouraged Kazakhsto becomedependent Soviet on medical practitioners byinference, theSoviet and, on state.Inonelecture conducted among theseminomadic of doctor the population Southern Kazakhstan, unidentified an implored to nomads"notto listen yourKazakhhealers (taups)whofailto heal thesickwiththeir for and effective medicines; all illnesses always tothedoctor, there willreceive go you free, the medicine."33 health education from 1930contrasts unscientific methods of One poster
1 26A. echothis theme. Minlos, See isovetskaia Rostovskii, znakhar'ivrach, 1. Others Pop, rneditsina: Re/ig4iia Ob "iasnitel'nyi k i tekst seri diapozitivov (Moscow,1936), 10; L. Vasilevskii, Re/igiia zdorov'e(Leningrad, 1928), 8-9; and G. Ia. Kiselev, Ob tekst pod Religziai meditsina.- "iasnitel'nPzy diapozitivziogofil'ma obshchei in to the redaktsieiTsSSVB (Moscow, 1934),9. In addition lamenting roleofreligion spreading infectious disease, on health activists expressed concern aboutRussianOrthodoxy promoting drinking Sundays and holidays.Not bouts haveadverse effects health, contributed worker on to absenteeism onlydidthese drinking they (Vasilevskii, Pop, vrac/i, 13-14). Religiiaizdorov'e,5; Rostovskii, znakhar'i 6-7. Perhaps fact theRussian the that Orthodox themselves never 27Rostovskii, znakhlar'i Pop, vrach, practiced circumcision madethis custom particularly repulsive ethnically to Russian biomedical workers, ifthey even were notChristians. Vasilevskii observed "inrecent that decades, more the cultured oftheJewish part community" had abandoned that circumcision, suggesting assimilation is,Russification) (that signaled incorporation a supposinto edlyhigher culture (Religiiaizdorov'e,7). 28Rostovskii, znakhar'i Pop, vracch,Dr.Nikol'skii, 4; Sueveriia, ztiakha1rsvo, leligiozn)'epredrassudkiisovetskaia meditsina (Moscow,1926),23; Vasilevskii, 3. izdorvV'e, Re/igiia "Musul'manskii uraza, Bezbozhnik(16 29Salim, post January 1930):2. See alsoVasilevskii, izdorov'e, Religiia 4. in 30TsGA RK, f. 30, op. 2, d. 603,1. 12 (reprinted Khabiev, Kul'turnoe stroitel'stvo 1:455). 3"Vasilevskii, izdorov'e,6. Re/igiia 23 32DI, February 1928,3; Kazakhstiaskaiapiravda (KP), 2 December1938,3. f. 33GAIuKO, 812,op. 1, sv. 11,d. 23,1. 20Ob. See also ibid.,11. 27ob. 26,

in Revolution K~azakhstan 169 MedicalPropagandaand Cultural usedbybiomedical methods diagnosis of enlightened healers with accurate, the traditional Asians of downon a crowd Central a manshining flashlight a It workers. depicts Russian tubes, and instruments, test laboratory dress. On hisdesksitsa microscope, in traditional across and a pathtoward hospital thebanner their He authority. lights of markers scientific destroy health the and healers, (tabibs), mullahs leaders (ishans), thetopreads"Religious !"14 suchas hospitals Posters at GettreatmentSoviet their tricks! Don'tfallfor ofworkers. associatmedical practitioners, traditional Kazakhsagainst to sought rally one this clearly the attire, massesstood Dressedintraditional with and backwardness ignorance. ingthem enlightened by (personified theRussiandoctor) the until Sovietgovernment in darkness with miracles modern of medicine. the them propaganda biomedical antireligious to attention spreading paid Authorities particular in to with position Central whom believed be disaffected their they Muslim women, among CommitIn message.35 1928theKazakhRegional to and Asiansociety receptive thestate's "massive agitation with Kaznarkomzdrav developing charged party teeoftheCommunist of the the against influence mullahs, and strengthening struggle andpropaganda generally of of system clinicalandOMM [Defense Motherand usingtheexisting tabibs, shamans lecturers brought evenings," special"women's Through hoodandInfancy] institutions."36 Gynecohealth consequences.37 carried negative the old to women messagethat customs to authorities attributed the which from childmarriage, sprang allegedly logicalproblems into at daughters marriage a very fathers "sell" their to of prompting price, practice bride age. young tradifrom dangerous liberation and for its pledged concern women their Theregime Bothmedicaladwithchildbirth. thoseassociated tionalmedicalpractices, particularly effects laymidof bemoaned detrimental the propagandists ministrators antireligious and in the whiletrumpeting state'sstrides and well beingof newborns, wiveson thehealth in that One health education poster circulated Semipalatinsk OMM facilities.38 expanding use that a of parents professional demanding their 1929-30,depicts parade toddlers during air also signscallingforfresh and The children holdprotest not midwives, laymidwives. In and parents.39 a 1928memototheKazakhCouncil sunshine, cleandiapers, healthy dry, and of schoolsin Semipalatinsk the ofPeople'sCommissars regarding opening midwifery
in appeared Uzbek,andmayhavebeen P4 Biblioteka, XXI.5/2.I. Thisposter Gosudarstvennaia 34Rossiiskaia as to Theremayhavebeena Kazakhversion well. Kazakhstan addition Uzbekistan. in usedin southern Massell,The Surrogate Central Asian womensee Gregory further on reading Sovietpoliciestoward 35For 1974); 1919-1929(Princeton, Strategies SovietCentralAsia, i/z and MoslemWomen Revolutionaiy P1roletariat.: of Uzbek Women"(Ph.D. diss.,University Chicago,1998); and Douglas Taylor Marianne Kamp,"Unveiling Univerin Asia,"(Ph.D. diss.,Stanford Central and Women the and Veil:Gender Power Stalinist "Uzbek Northrop, to in little authorities colonialIndiapaidrelatively attention theneedsofindigBritish 1999). By contrast, sity, rates infant mortality Indianmidwives attack thecause of high as cameunder enouswomen.As in Kazakhstan, in wards, womenwerenot but of homebirthing favor maternity womento abandon and thestateencouraged the of Colonizing Body, in werein all corners theUSSR (Arnold, as to drive general they central thebiomedical 254-68). f. i Noveishei Istorii, 17,op. 25, d. 22, 1. 150. Tsentr KhraneniiaDokumentatsii 36Rossiiskii f. arkhiv Federatsii, 5465,op. 10,d. 181,1.5. 37Gosudarstvennyi Rossiiskoi uli, 9. Refi~giia isovetskaiam 38TsGA neditsina, See also Dukenbai Julti RK, f. 82, op. 1,d. 557, 1.44; Minlos, i vrach,31; and 30; "Kadryzdravookhraneniia," Rostovskii, Pop, znaikdliar ajel tazailghi,5; Tleugabylov, arkhiv Alma-Atinskoi f. oblasti, 385,op. 1,d. 83, 1.2ob. Gosudarstvennyi f. arkhiv Kazakhstana, 5-2675. Respubliki 39Gosudarstvennyi kino-foto-fonodokumentov

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KzylOrda, KazakhCommissar PublicHealth the for asserted from moment birth that the of Kazakhinfants wereinjeopardy thehandsofshamans laymidwives at and whodidmore harm than good.40 ThatsameyearKazakhstan's OMM announced planfor a hygiene education that stressed importance propagandizing the of against midwives lay becauseofthe danger they posedduring childbirth failing provide cleanenvironment.41 by to a Hygiene propaganda antireligious and leaflets published the at center echoed these accusations against in laymidwives, emphasizing danger bothmother childofinfection the to and contracted an unsanitary homeenvironment.42 According Lopatina, Russian, to a female writer who in the of healers thecountryside, midwives jeopardized also fought influence traditional lay trainthe livesofwomen difficult becausethey labor lacked formal biomedical experiencing in manner ing. The failure laymidwives call for biomedical of to a physician a timely led topatients' and Medicalization childbirth thepotenof had illness, infertility, evendeath.43 the to tialto lower risks the associated with but childbirth, itis questionable degree which in rural birthing facilities Kazakhstan the a environduring 1930soffered moresanitary ment.Forourpurposes, however, significance suchassertions notintheir the of lies accuracy, inthestate's but effort usemedical to discourse undermine influence locallay to the of midwives draw and Kazakhwomen's bodiesintothehandsofstate-authorized biomedical workers. Alongwith cultural religious and Sovietpropagandists stressed linkbethe factors, tween economics health.As notedabove,writers bothKazakhstan Russiaasand in and that whilegerms causedinfectious of serted diseases,theeconomicsubstructure society the to these oncethat was determined degree which and substructure organisms thrived, that in diseaseswoulddeclineand,ultimately, transformed, disappear. Writing a 1927manual forCentral Asia's hygiene la. that propagandists, I. Akodusstated "thefundamental prinlies medicine that is illness notonly is ciplethat atthebaseofSoviet biological, depeni.e., of on dentupontheforces nature, is subject social influence, dependent the but to i.e., life conditions labor everyday ina particular of and economic the society, conditions, distribution poverty wealth, of etc."' Akodus and underscored whileexposure thetuberthat to culosisvirus occurs more causedTB, infection and frequently has a greater impact among thepoor, "wholivein crowded eat work lotandrestlittle-this the a is conditions, poorly, In socialessence the of disease."45 thetext accompany LeagueofMilitant to a Godlessslide

42Rostovskii, znakhar vrach, Vasilevskii, Pop, i 26; izdorov'e,12;A. A. Khrustalev, Znakhar'idok/orRefligia 4. (Moscow,1923),19-20;Dmitrieva, Tetnnota., 43Lopatina, borot'sia, 18,27. Lopatina 17, also attempted discourage to women from utilizing back the Nazhno that alleyabortions laymidwives offered. Though an issueinKazakhareas,medical not workers urban, in Slavic regions fought end thispractice well,particularly therecriminalization abortion 1936. For a to as after in of discussion theabortion of issuein Kazakhstan my"Ethnicity, see and Patriotism, Womanhood: Kazakhstan and the1936Ban onAbortion," FeminiistStudies (forthcoming 2000). On the1936banonabortion thenational at level seeWendy Goldman, Z. the andRevolutioi.n SovietFamVily andSoca/life, 1917-1936(New Womnez, State, Policy of York), 254-95; andJanet Evans,"TheCommunist Party theSoviet Unionandthe Women's The Question: Case ofthe1936Decree 'In DefenseofMother Child,"'Joulrnal Conteniporary and of History (1981): 757-75. 16 44Akodus, Krt/kii oc/zerk, 5. 45Ibid., 6.

4'Ibid., d. 2378,1.2.

40APRK, 141,op. 1, d. 2375,1. 19. f.

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lecture, author Kiselevmakes similar a assertion when stating "socialconditions, that which provide favorable conditions these for microbes enter organism a decisive to the are factor in epidemic disease."46 According theantireligious to propagandist Minlos,"themajority ofillnesses connected are the adverse conditions under with workers' living capitalism."47 in Low wages,poorhousing, arduous and work contributedhealth all to ailments. Writing an official a health official named N. Matveev N. attributed Kaznarkomzdrav organ, public of and thespread infectious diseasesamong Kazakhstoimpoverishment to"capitalism, the of which all of life."48 There a certain is amount penetrated aspects thenomads' patriarchal but on of medicaltruth theseassertions, theemphasis theoverriding to significance ecothe nomic conditions reflects peculiarity Sovietmedicine served political a of that purpose and ofbuttressing regime's the economic agendain Kazakhstan acrosstheUSSR, andof the of overcapitalism. asserting superiority socialism of In biomedical propaganda, Sovietgovernment as thesavior thenon-Rusthe stood Bothat thecenter in theperiphery, and sianpeoplesfrom tsarist, capitalist exploitation. native leaders carrying clan for out numerous authors blamed tsarist the system wealthy and minorities a policy neglect of to designed keeptheKazakhsandother ignorant, uncultured, weak forthesake of colonialdomination.49 inroads and physically Despitethelimited in a biomedicine made in Kazakhstan to that up point, 1935 article a Russian-language newspaper from Southern Kazakhstan claimedthat, although Kazakhswere"ignorant of to Revolution, Kazakhstan's and doctors nomadic at prior the encampments villages present of While haveanenormous health institutions."50 itis true fewKazakhs that network public to the with had contact with doctors prior theRevolution, contrast themid1930swas far from dramatic the transformation suggested this by writer. Kazakhstan's popular pressand at official Kaznarkomzdrav directed medicalprofessionals stressed free the publications carethat available was after Revolution, ignored problems theSoviet the of medical but the aimedat thegeneral medicalsystem.Centrally published pamphlets publicemphasized howmany and served to hospital beds,doctors, hospitals, midwives Kazakhstan, testifying men theparty's devotion ordinary, to Sovietpower seemhad working-class andwomen.5' from Kazakhstan the ingly banished poverty, disease,andclassenemies forever, liberating and Kazakhstoriseup from their cultural economic morass.N. N. Popov, director deputy of noted evenfrom early that the the ofKazMI's Department Hygiene, daysofSoviet power to had the of diseases.52 Akodus regime madeita high priority fight against spread infectious

i 4. 46Kiselev, Relligiiamedittsiza, 47Minlos, 6. See 3. identical isovetskaia i nzeditsfina, also Rostovskii, znlakharv',ic/;, Foralmost Pop, Rellgdicl made at of century Barnes, Afa/kioig Socc/tlDisease, arguments byFrench syndicalists theturn the The see ofa 21546. 48N. Matveev, N. "Ocherednye zadachina fronte zdravookhraneniiaKazASSR,"A/ZlzK(October po 1933): 6. See also Otc/?etazak/lhsaziaskoi 11; ekspedftsi, andAPRK, f. 141,op. 1, d. 2378,1.4. 49Minlos, isovetskaia 19; "Kadry zdravookhraneniia," 27; "Rezoliutsii Kraevogo Ineditsina, Tleugabylov, Rellgiia, in soveshchaniia," TsGA RK, f. 30, op. 2, d. 603, 1. 12 (reprinted Khabiev, 80; Kul'turnoe stroitel'stvo 1:455; Serebriakov, "Materialy voprosu," N. Propper-Grashchenkov, HealthPlvtectio;, tIieUSSR(Mos97; Pitblic ini po cow,1939),34, 38; andKR,20 March1934,1. 50Pravda Juzimogo Kazak/stlana 1935,3. (PItik),6 June 5"Matveev, "Ocherednye zadachi," Pzut, 6 June 6; 3. 1935,3; Minlos, Relig&iisovetskaiamneditsnza, 52Popov, "Razvitie sanitarnogo," 43.

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emphasized that, "onlyfrom beginning Sovietpower public the of did health started get on theright track."53 Propaganda the 1920s and early1930s attributed limitations failures in any and of in Sovietpublichealth largepartto thelegacyofprerevolutionary times.Sovietmedical officials lamented theregime to cope with byproducts tsarist that had the of indifference on andneglect. Without elaborating theprecise connection, Narkomzdrav complained that, era "the prerevolutionarybequeathed us tens thousands deafmutes, thelegacy to of of as of In of for thebourgeois capitalist system socialrelations."54 a manual designed antireligious propagandists, writer Polinskii claimedthat persistence diseasesliketuberculosis the of and syphilis, bothof which werewidespread couldbe understood under amongKazakhs, of left a thedictatorship theproletariat onlyas "vestiges to us by tsarism, semifeudal, activa on and semicapitalist system."55 During slideshowpresentation medicine religion, occuistsacrossthecountry stressed medical that services wereespecially poor"inregions to ... ownindustries, piedbyminorities subjugated tsarism. Now these peopleshavetheir in owncollectivized and ownblossoming 'national form, their agriculture, their culture, in A number national of cadres beenformed has and socialist content.' significant medical of of is This continues grow....Butthelegacy centuries oppression still to evident today."56 of a Asian shaman a a portion thetextaccompanied slide depicting Central performing ritual to from the intended heala woman suffering rabies exorcising diseaseandtransferby it ring to a chicken.57 The lecturer presented slideshowto a Central who this Asianaudience accomplished twoobjectives. orshenotonlyasserted theshamanic He that ritual a barbaric was vestige of than ofthepastbutalso attributed survival thelegacy theprevious its to rather to regime of one. To a Russianaudience thistext and slidereinforced anyshortcoming thepresent notions theprimitiveness Central of of Asians whileemphasizing efforts the prevailing wellillustrates ways the madebytheSovietregime modernize region. to that Thisexample in whichthestatedeployed scientific for ends. Without discourse political the question in ritual ineffectivecombating but highlighted theslidewasindeed by rabies, thetext clearly in the between efficacy thestate's the of biomedical efforts emphasizes interconnectedness of that theregion itspolitical and the legitimacy. contrasting failure methods thrived By the withthegrowing of under the services during tsarist regime availability biomedical Sovietregime, speaker the transcended meretransmission scientific the of information to linkdiseaseandsuffering thetsarist andvestiges that with of era. past By theclose ofthe1930s,health hygiene and propaganda declared thestate that had its of rates infectious of diseaseby doingbattle accomplished objective lowering against traces the of pastdisappeared public from and discourse. Public religion tradition. Surviving to the health officials of drive began rewrite history their against customary suggesting life, that folk all ceasedwhentheBolsheviks on medical arrived Kazakhsoil. On the practices

54TsGA RSFSR, f.482, op. 24, d. 5,1. 164. kak 55Polinskii, Sanitarnoeprosveshchenie nzetodantireligioznoipropaganddy 1930), 12. (Odessa,

53Akodus, Kratkii och/erk, 5.

56Minlos, i 14. meditsina, Re/igiia sovetskaia 57Ibid.

Re in MedicalPropagandaand Cultural volution Kazakhsstan 173 Revolution 1942,numerous in puboccasionofthetwenty-fifth anniversarytheOctober of lic health officials asserted theRevolution washedawayall theevilsofthetsarist that had claimed the"TheGreat that past. S. A. Chesnokov, KazakhCommissar PublicHealth, for of October socialist revolution the transformed faceof old Russia. Colonialexploitation backwardness has Kazakhstan, itsdarkness, with ignorance, cultural and (bezkul'Xurnost'), off forever."58 Chesnokov's Tleugabylov, enthused that, "casting the disappeared deputy, chainsof their of Ukrainians, Uzbeks, damnable past,a friendly family Kazakhs,Kirgiz, and others marched the Russian peoplealong Tatars, Tajiks, many handinhandwith great of a vast, The and health envisioned bright [tothefuture]."59 discourse medicine public path constructionfree conflict, as ajoyouspartnership as of and between Russian elders socialist of nationalities. Officials wrote vicissitudes ofthestory public the out health and andlesser in and path 1917totheeve of medicine Kazakhstan acrosstheUSSR. A straight led from World War II,with setbacks, no or alongtheway. diversions, missteps LIMITS AND IMPACT OF THE BIOMEDICAL DRIVE to to successthat Needless say, health the education failed enjoytheunmitigated campaign of the of plagued popularization health public health officials claimed.A number problems in andhygiene acrosstheUSSR, particularly thenon-Russian regions.Evipropaganda that the no education was dencesuggests before mid1930svirtually sanitation propaganda in rural to in disseminated Kazakhstan's areas. According a 1931newspaper article, addiand education tionto theabsenceof maternal childhealth care,"no hygiene [was] conin Kazakhstan notalonein failing bring was to ducted" theErkinshilinsk overly region.60 on to resolution hygiene ambitious education life. A 1932Narkomzdrav plansforhealth of in minorities literature and education hygiene among complained shortages specialized in noted that ofthemost one needswas pressing posters native languages.The resolution in of for for and "visualmaterial thestruggle against sorcery shamanism, support maternal of andchild and basicsanitation thegeneral and improvementliving conditions, health, for with life of national to and regions."'I specialattention domestic daily peculiarities particular In 1935 a prominent total Kazakhparty official cultural and leaderobserved "almost the in lackofposters, which continued undermine work to the especially theKazakhlanguage," in ofhealth activists.62 Officials bemoaned needto close HousesofHealthEducation the trained to thecourse the1930sbecausethey nothaveenough of did medical professionals to with staff them.63 EvenAlma-Ata's HouseofHealth Education much be desired, left no

remarks Popov, 4358Chesnokov, "Zdravookhranenie Kazakhstana," Forsimilar 6. see "Razvitie sanitarnogo," 54; I. S. Koriakin, "Blagoustroistvo naselennykh Kazakhstana 25 letsovetskoi mest za vlasti"; ZK, 1942,no. and 11-12:33-42. 59Tleugabylov, "Kadry zdravookhraneniia," 27. 60Novyi step',30 July 1931,3. 61TsGA RSFSR, f. 482, op. 24, d. 64,1. 22. 0 rabotev aule isele (Alma-Ata, Ikul'turzol 1935),42. 62S. Nurpeisov, massovolpoliticheskoi "Zadachisanitarno-prosvetitel'noi v Kazakhstane," 63"Doklad Narodnogo komissara," N. Zhravleva, 17; raboty MZhK(November-December 1933): 17.

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exhibits anatomy, on physiology, infectious diseases,or theso-calledsocial diseases,inand cluding alcoholism, prostitution, syphilis, TB. It also lackedfilm slideprojectors, and callingintoquestion degree which ofthepropaganda the to any literature analyzed above was disseminated urban, alone rural in let areas.64 an autonomous As region within the RussianSovietFederated SocialistRepublic(RSFSR) until December1936,Kazakhstan was one of many regions criticized theRSFSR's Narkomzdrav failing makeadby for to for to equateuse of radioand theater disseminating propaganda as wide an audienceas to possible.65 Reflecting state'sefforts compensate theseshortages squeezing the for by in moreoutof theresources did have,one local newspaper Southern it Kazakhstan took aboveandbeyond their medical workers taskin 1935for to refusing devote to time regular to lectures distributing education and health literature.66 lateas As duties conducting public 1939,Southern Kazakhstan party officials conceded that "health education preventaand in work the and tivemedical propaganda among massesis organized conducted an extraorIn weak manner."67 1940,Kazakhstan's asserted thathealth dinarily leadingnewspaper had the or education failed influence population's oflifein thecountryside sanitato way in In tionconditions thecities.68 1941,Narkomzdrav officials instead of complained that, health used theblankreverse distributing education literature, medicalworkers sidesfor internal memorandums, budgets, evaluations, and presumably because of a papershortage.69

of The limits health education work combined with inaccessibility biomedical the of facilities perpetuate population's to the reliance traditional on medicine. Regardless of their in as ethnicity, women Kazakhstan of 1931weretwenty-three lesslikely seek times to thanwomen prerevolutionary in biomedical attention Russia. during deliveries European in Whilelanguage culture havediscouraged and Kazakhwomen particular, shortthe may withinadequate left access to biomedical age of clinicalfacilities theSlavic population in services well. Russianand Kazakhwomenalikereliedon lay midwives theearly as the of health 1930stodeliver their babies, despite disapproval public officials biomediand cal workers.70 Kazakhwomentookfarless advantage biomedical That of services than in Russianwomen Kazakhstan reflected problems: two of inaccessibility clinical facilities to Kazakhpopulation in centers a lackoftrust European and biomedical workers their and unfamiliar methods.71 did and Thus,evenifhealth propaganda reachKazakhwomen convincethem thebenefits biomedicine, hadlittle of of of to they opportunityavailthemselves biomedical services. any
64TsGA RK, f. 82, op. 1, d. 797, 1.3. 65TsGA RSFSR, f.482, op. 24, d. 295,1. 1. 66PluK', June1935,3. 6 f. 67GAIuKO, 121,op. 1, sv. 116,d. 1240,1.21. 68KT,8 March1940, Evenin 1941,complaints 4. circulated particular ofsanitation that areas education continuedtosuffer neglect, from of particularly questions first andworker aid safety (Polianskii, Metoditc/zeskie ilakzanziia, 2). to 69TsGA f. 1473,op. 1,d. 188,1.19. In response this RK, Narkomzdrav forbade use of the problem, strictly than health education literature anypurpose for other distributionthepopulation threatened refer to and to those whoviolated ruletocriminal this prosecutors. 38. 70Bykov, ocherik, Sanitarno-gigienicheskie 7Ibid., 95.

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Officials recognized importance physical the of proximity biomedical to facilities, but believed theunfamiliaritybiomedical that of methods madeKazakhsreluctant seekbioto medical attention when was accessible.72 even it Medicalprofessionals tobe accessible had in order provide to opportunities them convince for to Kazakhsthat they couldtrust them andrely their on methods. Probably moreso than health propaganda, positive experiences an on workwith biomedicine played important in cultivating role reliance Sovietmedical ers. Whenofficials openeda clinicor hospital, local population notimmediately the did flock medicalprofessionals assistance.Rather, to for medicalworkers to buildtrust had within community demonstrating effectivenessbiomedicine of the of and gradually by the A their skills. 1936newspaper own article states a hospital that ward maternity inAktiubinsk helpedonlysix Kazakhwomen deliver their babiesin 1933,whilemostKazakhs"ranto much the workers eroded had of community's shamans help."73 for Within years two hospital distrust assisted and twohundred womenperannum. In Enbekshilder region (Southern in a over population."74 Kazakhstan oblast) hospital opened 1931"heldnoinfluence the that biomedical medicalpersonnel Through propaganda against shamans effective and work, won thesupport theKazakhs. According official of to statesources, allegedly growing with in constituted mostimportant the factor convincing familiarity biomedical practices A of Kazakhsto takeadvantage clinicalfacilities.75 deputy of director Kaznarkomzdrav visits from medical rural observed periodic that personnel traveling through Kazakhareas in interest scientific whichhad won the had "awakened local population's the medicine, of for workand a rising number of faith thispopulation thedoctor."76 Healtheducation in Kazakhmedical as thesedifferent contributed well,though whatratio forces personnel cannot determined.is clear, be It that did take operated however, Kazakhs indeed increasing of advantage clinical facilities during 1930s,andthat the sanitation education work played somerolein thisshift. in these medical Kazakhscontinued rely to on Despite changing patterns their choices, the shamans and other folkhealersthroughout 1930s and early1940s. UntilthemidIn the of Kazakhs.77 1938,Kazakh 1930s, newspapers reported persistence shamans among that Commissar PublicHealthI. Karakulov for stated

on 72For a held to but example, 1928redyurt expedition demonstrations howproperly bathe children, parents their Theirrefusal submit didnotbring children. to their children thesedemonstrations to did suggests they not the trust biomedical workers methods motives or (GAIuKO,f. 812,op. 1, sv.4, d. 23,1. 3). 1936,4. 731P, 4 January 1936,3. 74K1,5 January 75For workers a Kokchetav in venereal treatment center of example, medical that reported thenumber patients the from indigenous treatment gonorrhea for morethandoubledfrom1929 to 1933. This population seeking not rate was on therise, that but more Central Asianwereturning biomedito development suggests that ofillness to cal approaches health problems (TsGA RK, f.81,op. 1,d. 164,1.94). See also Briskin, StepiKazakhskie, 110; DI, 12 January 1928, 3; DI, 29 March 1928, 3; AP, 15 January 105. 1938, 3; and Samarin, Ocherki istorii, Languagebarriers doubt no retarded effectiveness health the of education workandcontributed theKazakhs' to wereestablished thecommunity. in initial reluctance use biomedical to facilities whenthey Biomedical workers and in had to conduct health education lectures discussions Kazakhvillagesthrough translators. occasion On activists tocancellectures had becauseno adequate translator couldbe found.See TsGA RK, f.30,op. 2, d. 603, 1. 16 (reprinted Khabiev, in Kul'tu; oestoitel'stvo 1:458); andGAIuKO,f. 812,op. 1, sv.4, d. 23, 1.3. in 76TsGA stroitel'stvo RK, f. 30, op. 2, d. 603, 1. 13 (reprinted Khabiev, uil'tuinoe 1:456). 77For example, P&uK, June1935,3. see 16

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Paula A. Michaels of of thetotalabsenceof medicalhelpfacilitates development all types sorthe law cling Islamic andIslam, to cery shamans. by Illiterate, ignorant witch doctors in the patients'] mouths, beating perpetuating savage customs-spitting [their from person, With the etc. the severely with goal of"expelling" illness ill the the withall sortsof help of thesewitchdoctors population been infected the has socialillnesses.78

to biomedical facilities not had Yearsofdisseminating propaganda ofworking expand and medicalpersonnel working among the relegated medicine thepast. Forexample, folk to for Kazakhnomadsin 1936 reported villagers that sought treatment syphilis exclusively Godless As Kazakhstan oblast'sLeague of Militant from shamans.79 of 1939,Southern believed still Authorities that asserted mullahs performed that healings.80 greater spiritual an methods would combined with increasing understandingbiomedical of accesstoclinics their reliance folk on medical practitioners. medical What inevitably Kazakhs abandon lead to officials notanticipated that had was Kazakhscouldrelyincreasingly workers health and their in on Soviet facilities thesametime they at that preserved faith traditional biomedical healers. a Healtheducation literature wherea diseased,dirty presents worldof blackand white, Kazakhpastgavewaytothehealthy, cleanSovietlifestyle. year1917stands a rigid The as and illnessand wellness. border between primitive modern, and backwardness progress, in Health hygiene and and to propaganda depicts religion medicine opposition oneanother, the and biomedicine incompatible as withfolkmedicine.81 to According thisscenario, the in whilethe Revolution sounded deathknellforfolkmedicine Kazakhstan, October from moment without that on or Sovietpublichealth setbacks system developed steadily medical the of and officials, compromises. Reflecting mentality theparty publichealth activists produced that and them, newspapers, pamphlets, training workers, antireligious all of manualsformedicalcadres,lectures, slide shows,and posters tellthesame story In that biomedicine. subsequent Kazakhlife and decades, progress civilization camewith infectious and rose diseasessubsided, diseasesdeclined, thegenexpectancy andepidemic in eralhealth thepopulation of to of improved largepartthanks theefficacy biomedical imintroduced these tumultuous biomedicine's methods years.Butbeyond during prewar of it the of Kazakhs pacton thehealth theKazakhpopulation, also served purpose drawing intostate control legitimating in and Sovietpower theregion. folk the Ofcourse, medicine biomedicine and remained contested arenas between Sowith vietstate theindigenous and from neither as population, thetransition onetotheother nor wouldlead us to believe. Biomedicine complete as seamlessas medicalpropaganda
78KP, August 3 1938,2. Several months later, Deputy Commissar PublicHealth Tazhiev for I. reiterated these sentiments stressed negative and the effect mullahs shamans health of and on conditions Kazakhstan in (KP, 2 in December 1938,3). Apparently "spitting mouths" refers occasions to when shaman chewsa medication the first of or somecomponent thehealing ceremony, then and passesitto thepatient's mouth. 79TsGA RK, f. 82, op. 2, d. 165,1.24. filial arkhiva Iuzhno-Kazakhstanskoi f. 80Shymkentskii gosudarstvennogo oblasti, 40, op. 2, d. 1055,1.6. in 8"For similar representationslaterSoviethealth education literature P. Denisenko, see Medilsinai religiia din and (Moscow,1961),76; andK. Shulembaev, (Alma-Ata, 1973). Meditsinajane [Medicine religion]

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tookroot Kazakhstan fits starts, in in and at gaining particular momentum theclose ofthe 1930s,onlyto suffer setbacks during war. Biomedicine the never completely supplanted of folk medicine Kazakhstan inrural in the (or Russia). Kazakhsresisted eradication their traditional the viewedas abpractices continuing by underground customs Sovietofficials in horrent. Whenaskedaboutthepersistence folkmedicine their of villagesduring the to in 1930sandafter, respondents a 1995survey Southern Kazakhstan oblastalmost unanito mously asserted shamans mullahs that and continued servethepopulation, albeit sein As the the cret.82 noted above,archival evidence from late 1930sandearly1940ssupports notion traditional Kazakhmedicine a that persisted despite vigorous propaganda campaign it against anda risein accesstobiomedical facilities. Its relatively limited impact during prewar the yearsaside,health propaganda highthe of to to lights political dimension thestate's drive bring biomedicine Kazakhstan. As health in and the usedpublic and hadhappened earlier Western Europe North America, state bodies. Unmedical initiatives exert to and over greater authority surveillance itscitizens' conviction aboutits achievements a strong not derneath Sovietregime's the bravado lay of but and onlyin theefficacy biomedical techniques also in theentire cultural, economic, on socialsystem with which biomedicine entangled. was its Through emphasis thesocial a andeconomic, rather microbial, than causesofinfectious the asserted vision disease, state over ofitspower authority Kazakhbodiesandlives. Health and constructed a propaganda in knew world which state the better Kazakhsthemselves tocarefor than how their physical the their and sincere desire imto selves, domiciles, their villages.Beneath state's largely the was that the and prove Kazakhs'health a political economic agenda undergirded spread ofbiomedicine. Biomedicine as Kazakhbodiesunder served a toolofempire bringing by state and the economic increasing surveillance control, supporting regime's by agendafor and local of to development theregion, by undermining challenges thecentral regime's of of the madean important monopoly power.Without question, introductionbiomedicine andpositive on and for of impact Kazakhlives, inexchange thebenefits modern medicine, theKazakhstraded degree personal community a of The benefits biomediof and control. cinefortheKazakhscame at a costcalculablein terms political of autonomy, economic of and organization, culture.Giventherising quality life,thatwas likelya priceworth but To the of paying, a pricewas exactednonetheless. understand Sovietdevelopment in biomedicine Kazakhstan merely benign as a modernization or process a benevolent gift from Russians to tellonlyhalfthestory. the is in Biomedicine could have been introduced Kazakhstan without attempted the destruction theindigenous of medicalculture, was thecase elsewhere as around globe. the Forexample, thecase ofnorthern eastern in and Indiainthe1870s, British the to attempted the vaccination which reliedon a had spread smallpox amongtheindigenous population, British variolation authorities to medico-religious ceremony. wageda campaign recruit and train variolators administer smallpox to the traditional vaccine. Thoughabandoned

three in out with local research assistants March1995. We distributed 82Icarried this to survey questionnaires who in 65 addressed 106. Informants approximately respondents, ranged age from to allegedly fifty questions abouttraditional medicine biomedicine Kazakhstan and in the the during 1920s,1930s,and 1940s. Though group was small, their offer somecounterbalance official answers to sources.

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after modest success,thisstrategy attempted co-opt to rather suppress traditional than the healers.83 effort The suggests of thewaysin which one biomedicine couldbe introduced less extensive with cultural disruption. British biomedical policiesin Indiawereno more in SovietCentral benign than those Asia,butwhereas British efforts toward indigenous the population couldbe described "often as lukewarm half-heartedhedged," ... or Sovietpolicy wasunrelentingitsdrive stamp traditional in to medical In out practices practitioners.84 and to Indiaandother the comparison British cases,theSovietexample illustrates vividly politicalunderpinning thestate'saggressive, notwhollysuccessful if to biomedical drive. The desireto destroy in to of Kazakhethnomedicine order end theinfluence traditional efforts Central in Asia. healersat thelocal level was absolutely central theregime's to that bioAlternatives more existed, including gradualist approaches, couldhavedeveloped without alienation or attack ethnomedical the on The medicine of practitioners. Soviet ran to at stateeschewed theseoptions becausethey counter thepolitical motivations the heart thebiomedical of propaganda campaign. for never The Cultural Revolution whichtheregime transformed fought completely official theKazakhs'collective conKazakhdailylife, but propaganda nonetheless shaped in sciousness.The degree which Sovietgovernment to the succeeded redefining Kazakh to identity impossible measure, theimpact thispropaganda is but of continues be felt to as with pastandforges new, a today Kazakhstan grapples its future. deFor independent cadestheSovietstate itstood progress. for buttressed authority arguing its by that Officials not laudedSovietachievements onlyin medicine also in thearts, but and education, all of and The cumulative effect thesemesof spheres political, economic, social endeavor. Kazakhswith conviction Soviet the that "civisageshasbeentoleavemany power brought lization" thesteppes Central to of Asia. Echoing propaganda the1930s,older, the of EuroKazakhs remain in Sovietpower Kazakhstan. willno doubt It take peanized quicktopraise an of for decadestoinculcate appreciation andrespect theprecolonial civilization their of ancestors to temper representationSovietpower and the of with balancedassessment a of itsrealbenefits costs. and

the in 83Arnold, to the failed part becausemany variolators Colonizing Bod)y147. According Arnold, project "were unwilling forgo profit prestige their to the and of calling become to state vaccinators." Anthropologist Judith Farquhar provides another example co-optation, oneinwhich of but ethnomedicine than rather biomedicine offered thedominant etiology. China'sCommunist regime emphasized legitimated and traditional Chinese herbal media cine,which symbolized Chinese pastfree from European influence supported and at post-1949 efforts national Overtimea pluralistic identity construction. medicalsystem that emerged movedfreely between herbalist and biomedical how neednoteclipsetheother, approaches.Demonstrating one system writes "blood that Farquhar and are pressures X-rays addedto pulseand tongue images;classicformulae modified are with acetyl-salicylic acid andvitamin Where C." ethnomedicine andbiomedicine ends in not begins Chinaappears onlydifficult, but irrelevant delineate.The Chinesecase demonstrates theEuropean to that modelof biomedicine's triumph over other is or healing techniques by no meansinevitable universal.See Judith The Farquhar, Knowing PrIactice. ClinicalEncounter Chinese Medicine of (Boulder, 1994),224. 84Arnold, Colonizing Body, the 288.