Setting the Limits of Knowledge
Setting the Limits of Knowledge
Abstract and Keywords
Chapter 6 describes the transformation of Belarusian post-Chernobyl research efforts, from the systematic development of radiological research infrastructures in the last years of the Soviet Union to massive restructuring and reframing of Chernobyl-related research ten years later, as a result of changing political and economic interests of the Belarusian government. Infrastructural disruptions to data collection and analysis created the conditions for research relying on theoretically, rather than empirically, driven approaches, and this bias supports minimizing the scope of Chernobyl-related health effects. The chapter observes that restructuring and reframing of Chernobyl-related research led to the near disappearance of the radiation factor as an object of inquiry, and to the greater invisibility of local experts who would claim expertise in the health effects of radiation exposure due to the Chernobyl accident.
Professor Yuri Bandazhevsky relocated from Grodno to Gomel to become, in 1990, the first rector of the Gomel State Medical Institute, a position he held until 1999.1 A pathologist by training, he led a group of researchers studying the effects of the internal accumulation of radionuclides—that is, radionuclides consumed with contaminated food products—on pathogenesis in the cardiovascular, nervous, endocrine, reproductive, and other systems.2
Bandazhevsky conducted autopsies to show that the concentration of Cesium-137 in vital organs, including the heart, was higher than average in the organism. He found that children residing in contaminated communities had higher dose burdens than adults from the same communities.3 His research demonstrated that children's organs began displaying pathologies at Cesium-137 levels of 30–50 becquerels per kilogram, a level much lower than what was generally considered dangerous.4
Using a different methodological approach, he and his wife, cardiologist Galina Bandazhevskaya, examined cardiograms of children and the concentration of Cesium-137 in their bodies, showing a dose-effect dependence between the accumulations of Cesium-137 and disturbances of the cardiac rhythm in children. Galina Bandazhevskaya explained to me in an interview that the sorts of heart problems observed with low doses may progress and become irreversible with chronic exposure—when children living in the affected areas continuously consume contaminated food products.
In the late 1990s, Bandazhevsky criticized the government approach to mitigating the consequences of Chernobyl and the wasteful spending of the limited state resources for medical research after Chernobyl.5 This landed him in trouble. As one local scientist put it, “The only impact his message had was on prosecutors” who began hounding him. Bandazhevsky was arrested in 1999, and in 2001 he was convicted of taking bribes and sentenced to eight years in prison. Amnesty International declared him a (p.138) Prisoner of Conscience and demanded his release, relating his arrest to his critique of the Belarusian government's Chernobyl policies. Bandazhevsky was conditionally released in 2005, and later he left the country, his ability to work in Belarus appearing impossible.6 Two years after his release, when an interviewer asked him who the leading Chernobyl researchers in Belarus were, he answered, “I would like to know that myself.”7
Although Bandazhevsky's treatment was extreme, it does illustrate the government's commitment to the policies of rehabilitation of the areas affected by Chernobyl. The case of Bandazhevsky, whose work and imprisonment made him arguably the best known Chernobyl scholar in Belarus, also sets the context for analyzing the historical emergence and then disappearance of opportunities for research on the biological effects of radiation in Belarus. My focus will be not on the explicit harassment of researchers but on disruptions to the institutional and infrastructural foundations of research.
The history of radiological research in Belarus is largely coextensive with the history of Chernobyl-related research, which emerged here in the last years of the Soviet Union and the first years of independence. A number of research institutes were established in 1987–1992, mostly in the capital, Minsk: the Institute of Radiobiology, the Institute of Radiation Medicine (with branches in Gomel, Mogilev, and Vitebsk), the Institute of Radioecological Problems, the Institute of Agricultural Radiology (in Gomel), and the Sakharov International Institute of Radioecology, which provided radiological training. Several other research institutes had departments or laboratories that also conducted radiological research.8
This systematic development of radiological research capacity was part of the state program to mitigate the consequences of the accident. The new state policies of normalization and rehabilitation (introduced in the second half of the 1990s) brought changes to the organization of radiological research in Belarus. Certain research directions were encouraged and others discouraged; leadership positions changed hands; and capabilities for data collection and analysis were maintained, added, or dropped. An even more dramatic reorganization of research institutes and priorities took place in the first decade of this century. For studies on health consequences of the accident (one of several key areas of Chernobyl-related research), changes in state policies resulted in a loss of qualified personnel and some subject populations and caused disruptions in data accumulation (a process exacerbated by existing problems with Chernobyl-related databases and classification categories). This in turn increased the likelihood that empirical data would be unavailable and that researchers would focus (p.139) on theoretical assessments that are not as reflective of the complex realities of the Chernobyl effects.
The absence of adequate infrastructural conditions for data collection and analysis constrains what observations about radiation effects can be articulated in the course of conducting research, thus creating particular areas of public invisibility of Chernobyl's consequences and ultimately areas of ignorance. The restructuring and refocusing of Chernobyl-related science in the 1990s and after 2000 disrupted the infrastructure of scientific data collection and analysis, with consequences that are potentially irreversible. The most pronounced result has been the disappearance of the category of radiation health effects as an object of knowledge, and a dearth of scientists who would publicly claim expertise in Chernobyl-related research.
By suggesting that infrastructural transformations were consequential for the development of Chernobyl-related research in Belarus, I do not mean to question the integrity of the scientists conducting this research. Instead, I am observing how the government has shaped research in the context of pervasive and chronic environmental contamination. The work and achievements of individual scientists should not be underestimated.9
Science in the Flux and the Chronic Disaster
A major effort to establish local capacities for research on the consequences of Chernobyl began in the Byelorussian Soviet Socialist Republic (BSSR) in the last years of the Soviet Union. Soviet science, as sociologist Gennadi Nesvetailov describes, had “a degree of scientific self-sufficiency and some isolation from world science, although [it] … was on the periphery in intellectual terms to Western centres of world science.”10 Within the Soviet science infrastructure, Moscow had the largest concentration of research institutions and programs, the most technical equipment and resources, the most qualified scientists, and the leading academic journals.
The geographic distribution of Soviet nuclear research followed this pattern, with Ukraine's nuclear research program the second most developed.11 Belarusian research on the consequences of Chernobyl thus began from a position on the periphery. The Belarusian republic had no nuclear power plants of its own, and its participation in the Soviet nuclear research program was marginal. (One project to construct a mobile nuclear power plant was headed by Vassily Nesterenko at the Institute of Nuclear Energy.) State secrecy, especially the fact that all research related to radiation was classified, added to the exclusiveness of radiation-related research. Tamara Belookaya noted, “Belarusians were not in the loop.”12 Studying the consequences (p.140) of Chernobyl's fallout and mitigating its effects would require building a research infrastructure from the ground up.
But despite the uneven organization of Soviet science, the Belarusian republic still had a considerable capacity for science and technology through its own Academy of Sciences, as the result of a limited political commitment in the Soviet Union to foster the scientific base of the constituent republics.13 After the Chernobyl accident, these research capabilities served as a foundation for establishing new institutes and departments specializing in radiation medicine, radiobiology, and agricultural radiology. The Academy of Sciences drew on the personnel and resources of the existing institutes. Some of the figures that emerged in these efforts came from related fields.
Consider, for example, the role of Evgeni Konoplya (1939–2010), who at the time of the accident was one of the few researchers in the Belarusian Academy of Sciences with expertise close to the topic of radioactive iodine. His earlier research had been on methods of hormone therapy, chemotherapy, and radiation therapy for breast cancer; from 1965 to 1980 he worked at the Institute of Oncology and Medical Radiology of the Ministry of Health. Konoplya proposed the creation of the Institute of Radiobiology to Nikolai A. Borisevich, the president of the Academy of Sciences of the BSSR; when the Belarusian and Soviet Academies of Sciences and Councils of Ministers approved the decision in 1987, the Institute of Radiobiology was established with Konoplya as its director.14
Evgeni Demidchik (1925–2010), whose research established the radiation-induced nature of the rise in thyroid cancer in Belarus, was particularly well-positioned for this post-Chernobyl work. He had been conducting research on thyroid pathologies since 1972, and he served as the head of the Department of Oncology at Minsk State Medical Institute from 1974 to 1996.15 Children with thyroid cancer, rare in the republic, were typically sent to Demidchik. In 1990 he initiated the establishment of the Center for Cancers of the Thyroid Gland under the Ministry of Health.
The last years of the Soviet Union also witnessed efforts at independent radiological research and radiation protection. In 1990 Vassily Nesterenko (1934–2008) established the Institute for Radiation Safety “Belrad” and became its first director. Nesterenko had previously served as the director of the Institute of Nuclear Energy of the Academy of Sciences of BSSR (1977–1987) and the chief engineer of the mobile nuclear plant Pamir (1971–1987). He was part of the Belarusian committee of experts formed in early May 1986 to assess the situation, and under him the Institute of Nuclear Energy conducted an analysis of soil samples and created early (p.141) maps of the scope of contamination. Nesterenko was later released from his duties as the director because of the “alarmist” letters he wrote to the BSSR government in which he attempted to warn the government of the scope of radiation fallout in the republic and the need for radiation protection measures. In 1990, he became the chairman of the joint expert committee on nuclear energy and radiation protection for Belarus, Ukraine, and the Russian Federation, a position that he held until 1994.
The Program for Overcoming the Consequences of the Catastrophe at the Chernobyl Nuclear Power Plant (known as the Chernobyl Program) was adopted by the republic in 1989, and it included provisions for developing scientific research.16 A separate section of the program described “systematic planned research” for the purposes of developing measures of “minimization of the consequences of the accident.”17
The Chernobyl Program outlined scientific research and development in four key areas: (1) studies of radioactive contamination of the environment (including genetic, physiological, and biochemical consequences of this contamination); (2) technologies and methods of agricultural production under conditions of radiological contamination; (3) the effects of radiation on human health, as well as methods of diagnostics and treatment; and (4) technologies for mitigating radioactive contamination, including methods and technologies of radiometric and dosimetric control.18 Scientific research was envisioned as systematic, planned, and coordinated.
By the mid-1990s, Belarus—now a newly independent country—had sufficient personnel working in the field and had achieved scientific results in all key research areas. By 1996, eighteen institutes of the Academy of Sciences and more than twenty scientific and educational establishments were participating in the implementation of the Chernobyl Program.19 By that time, research on post-Chernobyl health effects in the affected populations included epidemiological studies, studies of the effects of radiation on the body's functional systems (endocrine, immune, cardiovascular, and reproductive), and research on the combined effects of radiation and nonradiation factors on health of the exposed populations.20
The development of such an extensive system of radiological research was accomplished despite the extraordinary challenges of the early post-Soviet period. After the collapse of the Soviet Union at the end of 1991, Belarus's already difficult economic condition worsened dramatically. Spending on science decreased significantly (before generally being restored in the second half of the 1990s); lack of funding made it difficult for research institutes to maintain their equipment and their professional activities. The number of employees in science and technology fields decreased by half (p.142) from 1990 to 1994.21 Official descriptions from the period note that the majority of research teams working on Chernobyl-related issues were not paid salaries but continued to perform their tasks “on a voluntary basis.”22 Nevertheless, during this period, which featured severe economic crisis and political turbulence as well as greater political openness, much was achieved—from establishing scientific institutions and programs of study to obtaining some key results (including the demonstration of radiation-induced thyroid cancer in children).
The government assumed more active control over the development of science and technology after the 1994 election of President Alexandr Lukashenko, the adoption of a new Constitution, and the reform of executive power.23 The new state leadership still deemed government control and planning necessary for the long-term progress of science. The government repeatedly attempted to optimize its management of scientific research and of technoscientific development—adjusting, for example, the hierarchy and responsibilities of science-related administrative bodies.24 All areas of Chernobyl research were coordinated by the State Committee on Chernobyl, following the outline in the five-year Chernobyl Program. Annual research proposals were approved by the Academy of Sciences and the State Committee on Chernobyl.25
As a relatively small and economically struggling country with limited resources for scientific research, Belarus faced particular challenges in managing and optimizing its scientific capabilities. Nesvetailov uses the concept of peripheral science to describe the general priorities and tensions of scientific development in Belarus in the first years after independence. In economically developed and politically dominant centers, “national research” overlaps with “world research.” In the periphery, a significant commitment to research can be sustained only in a few selected fields, and national research in those fields is affected by research in the center.26
The key issue for a peripheral country like Belarus, then, was the direction of technoscientific research amid limited resources. For Nesvetailov, writing in 1995, it appeared “inevitable” that the science and technology policies in Belarus would refocus on more applied research, prioritizing short-term objectives.27 Indeed, Belarus, as a newly independent country, faced questions about the general orientation of Chernobyl research, the role of the state in shaping this research, and its relationship to international radiological expertise. Furthermore, in the case of Chernobyl's consequences, science appeared to be closely related to the hope of international assistance and cooperation. The state appeared to have little incentive to fund scientific research just for the sake of science, especially when this (p.143) science was not recognized internationally, when such research might discourage rather than attract international assistance, and when it sustained the economically costly national visibility of the Chernobyl problem.28
What Nesvetailov correctly predicted as a growing emphasis on applied research that would justify its costs was, paradoxically, at odds with the nature of the consequences of the Chernobyl accident. In Ravi Rajan's terms, the consequences of Chernobyl were emergent problems of a “chronic disaster.”29 They were not revealed in their entirety at any given moment; rather their scope emerged, and continues to emerge, gradually. Studying the consequences of chronic disasters requires stable, continuously sustained research infrastructures.
However, the emerging, evolving nature of Chernobyl's consequences also made it difficult to estimate the necessary scope of scientific effort and to sustain it over time. The prospective assessment of the required resources may have been particularly difficult in the absence of a tradition of radiological research predating Chernobyl; as we have seen, radiological research in Belarus had few accumulated institutional resources and entrenched practices.
As a result, research on the radiological effects of Chernobyl proved particularly vulnerable to the state government's attempts to optimize the organization of scientific institutions and put science in the service of its policies of rehabilitation of the Chernobyl-affected areas.
Restructuring Chernobyl Research
Less than a decade after the establishment of the Institute of Radiobiology, Konoplya expressed his concern that support for research on the radiological effects of Chernobyl was on the wane. In 1996 he argued, “Unfortunately, the situation in the Republic today is such that we are not able not only to broaden and deepen the studies, but even maintain them at the same level.”30 He pointed to vanishing opportunities for targeted screening of the affected populations (performed by trips of doctors traveling to the affected areas) and even the dissolution of research collectives.
The new state policies of normalization and rehabilitation of the affected areas were echoed in a number of both gradual and dramatic changes to the structure and agenda of research institutes, which in turn transformed what data were collected and from which populations, what databases were maintained and how, and what kind of research was ultimately possible.
The transformations that were under way at the Institute of Radiation Medicine are instructive. This institute, established in 1987 under the (p.144) Ministry of Health, served as a lead organization for studying the health consequences of Chernobyl.31 The institute studied mechanisms of radiation-induced damage, conducted dose monitoring, forecast changes in the health effects of the population, and provided policy recommendations.32
The institute had an outpatient clinic in Minsk and an inpatient clinic in
Aksakovshchina near Minsk (established in 1989), which provided health care specifically for the Chernobyl cleanup workers, the evacuees, and the population of the affected areas. In the mid-to late 1990s, the institute's structure and function experienced multiple revisions (leading one former employee of the institute to refer to it as the “Institute of Political Medicine”).33
Changes to the institute's leadership were one sign of political struggles. In 1993, Vladimir Matukhin, the founding head of the institute, was replaced by Aleksandr Stozharov. Just three years later, Stozharov too was removed from his position. According to one critic of the Ministry of Health and its approaches to post-Chernobyl research, Stozharov's removal may have been related to his opposition to the reorganization of radiation medicine in Belarus and to the revised concept of radiation protection (see chapter 4). On December 17, 1996, the Institute of Radiation Medicine was transformed into the Institute of Radiation Medicine and Endocrinology—even though, as the same critic cited above pointed out, the country already had a developed network of endocrinology centers, departments, and laboratories.34 Another researcher, who interpreted these changes as related to the “official” position that the only health effect definitely linked to Chernobyl radiation was thyroid cancer, told me, “All radiation medicine has become about endocrinology. I wonder if it is going to be just endocrinology soon.”35 Nor was the policy of deemphasizing radiological research limited to a single institute. In 1999, the Sakharov International Institute of Radioecology was renamed the Sakharov Ecological University.36
During this period of reorganizing, the Institute of Radiation Medicine and Endocrinology also lost some of its laboratories. Personnel and equipment alike were transferred to other institutes. The Mogilev branch of the Institute of Radiation Medicine became the Institute of Ecology and Occupational Pathology. The outpatient center in downtown Minsk, originally located close to the railway station (making it easier for patients from outside Minsk to reach it), moved to a different building, farther away from downtown and the railway station. According to a former physician from the center, “They [the officials] told us the building was in unsafe condition.… I think it was all done to fault Chernobyl science. There was no renovation in the original building after we were moved from there.”37
(p.145) More transformations followed after 2000. A presidential decree issued on April 14, 2003, relocated all Chernobyl-related institutions to Gomel on the premise that such research should be concentrated “in the most affected area.” This approach was in keeping with the new policy of rehabilitation of the affected areas. Researchers also faced new requirements of “practical value” and “economic and social efficiency.” The government emphasized scientific support for agricultural production, even in the newly reclaimed areas; it was hoped that scientific findings could offer guidance on growing techniques that would minimize contamination and thereby keep produce in line with the existing norms for radiation protection.38
The new policies streamlined directions for Chernobyl research into three subject blocks, each with a corresponding institute located in Gomel. The Institute of Radiology—the former Institute of Agricultural Radiology—conducted research on the rehabilitation of the contaminated territories and agricultural production techniques. The Center for Radiation Medicine and Human Ecology, Gomel, became the head institution for medical research on the consequences of Chernobyl (the Institute for Radiation Medicine and Endocrinology in Minsk effectively ceased to exist in the spring of 2003). Long-term radiobiological and radioecological consequences were the responsibilities of the Institute of Radiobiology, relocated from Minsk.39
Developing a research base in Gomel, closer to the most affected areas, could certainly have aided studies on the consequences of Chernobyl. At the same time, the decision to relocate all research to Gomel involved tremendous infrastructural costs, including the loss of qualified personnel who remained in Minsk and the loss of continuity in data collection and analysis. Moreover, Belarusian research institutes generally were concentrated in Minsk (the capital), and many physicians had left the Gomel region after Chernobyl.40 The move also brought changes concerning which groups of the affected populations were observed and what methodological approaches were used. In at least some areas of Chernobyl-related research, this loss of continuity in terms of data collection and analysis resulted in the shift away from empirically based research and toward more theoretical calculations.
According to Evgeni Konoplya, who relocated with the Institute of Radiobiology to Gomel, the institute had 165 faculty members while in Minsk. Two years after the relocation, it had only 75. Mostly two groups of researchers were willing to relocate from Minsk to Gomel: young scientists and faculty members nearing retirement age who, as a former physician from the Center for Radiation Medicine told me, “might not have been able to find work elsewhere.”
(p.146) Other experienced personnel stayed in Minsk, thereby leaving Chernobyl-related research and patient observation. According to one scientist who stayed, the government's decision to relocate Chernobyl science “might have been adopted without realizing what it would mean. There are big names in Gomel: Konoplya, [Eleonora] Kapitonova [the former head of the Center for Radiation Medicine and Human Ecology in Gomel] … but losing all that faculty is a loss of knowledge.” Konoplya explained to me:
We have to hire new faculty, they have to learn the research methods, it's a complicated and long process. Everything was set here, we had well-trained faculty. Everything has been smoothed out during these years, from 1987 until 2003, about fifteen years, not [the] full seventeen years, since it took time to organize everything in 1987, as well. Much has to be recovered now. We have new, young faculty, they have to get trained until they enter science [voidut v nauku].
But two years after the relocation, Konoplya remained optimistic: “We already have first dissertations and first conference presentations, so some things are happening faster than I had expected. And overall, what we have is a serious research complex.”41
Research on radiation effects appeared to be discouraged at institutions outside Gomel. One faculty member at the Sakharov Ecological University told me in 2004 that she and her colleagues had to remove any references to “radiation effects” from their research project proposals: “One can study radiation only in Gomel now, where there is a special center for that. Here, one can study chemical or physical processes, as long as they are not radiological.” (Even though she no longer did research on explicitly radiation-related topics, she still feared that the university itself might be relocated to Gomel.) Another scientist commented on similar expectations for research proposals at the National Academy of Sciences (as the Academy of Sciences was now called).
The Center for Radiation Medicine and Human Ecology, now the lead organization on studying Chernobyl's health effects, opened in Gomel in 2003 after more than a decade of construction of its building.42 The center—with both an outpatient center and an inpatient clinic—was commonly described as a state-of-the-art facility. I was told repeatedly that it had exceptional equipment and capabilities, complete with an attractive hotel for visitors from outside Gomel that even the residents of rural areas could afford.
The expectations for the center were in line with the state reorientation of science toward practical results and economic efficiency. In 2007, when the minister of health introduced Aleksandr Rozhko as the Center's newly (p.147) appointed head (replacing the former director, Eleonora Kapitonova, and then the former acting director, Elena Sosnovskaya), the minister noted that the center was also supposed to know how to earn money: “You have good ophthalmology—so create regional ophthalmology and earn money.”43
Whatever the virtues of the building's state-of-the-art features, transferring all medical research on the implications of Chernobyl to Gomel and closing the leading institute in Minsk had negative implications for sustaining the continuity of data collection and analysis and for maintaining the necessary level of faculty expertise. Vassily Nesterenko offers an example. Until the research reconfiguration, the Institute of Radiation Medicine and Endocrinology in Minsk had produced the Catalog of Doses of the population of Belarus, which listed the current annual exposure doses for the residents of the affected communities and informed the decision making about the necessary radiation protection measures required for these communities.
When the institute was closed, the team of experts assessing dose burdens also stopped their work. In 2004, when the time came for another edition of the catalog, its production was delegated to the Center for Radiation Medicine and Human Ecology. Nesterenko writes that “the accumulated experience was lost, and new experts proposed to create the catalog based on the proportional relationship of annual exposure doses from the density of soil contamination with cesium-137.”44 This approach theoretically derived annual doses and made little use of empirical data describing, for example, actual internal doses in various communities. The center thus generally estimated lower doses of population exposure; by its calculations, only 220 villages required radiation protection measures. The National Committee for Radiation Protection of Belarus created a group of experts who, using Belrad's WBC testing results for 250,000 people, demonstrated that the annual doses estimated by the Gomel center were 40 percent lower than the actual measurements, Nesterenko reports. The Ministry of Health accepted most of the data, and the new catalog included 775 localities as requiring radiation protection.
The Belarusian State Registry of individuals affected by the Chernobyl accident is also now maintained by the center in Gomel, assisted by seven regional departments of the registry.45 Collection of data for the registry began in 1993; according to the official records, by 2005 it included 1.7 million individuals.46 The data is collected through annual medical examinations, which provide the foundation for health-care provisions for the affected groups.47
(p.148) In the early 1990s, some of this screening was conducted by teams of physicians traveling from the Institute for Radiation Medicine in Minsk, but that practice was soon discontinued because of a lack of funding.48 According to a former physician of the institute in Minsk, the institute's database included data on every child observed by Minsk physicians since the establishment of the institute. It is not clear to what extent this (and other) medical observation data was transferred to and used in Gomel; according to the same physician, “Nobody has asked for it, nobody needs it in Gomel.… All the statistics used to come here; what kind of information comes there is difficult to tell. There is no information now.”
Considering the many problems with the current health care system, the idea that most of the affected population receive annual medical examinations—especially when those examinations are done in outpatient centers (poliklinika) and not by designated teams of physicians—is a “bureaucratic fiction.” A physician from the former outpatient center of the Institute of Radiation Medicine and Endocrinology, who used this term in her interview with me, recounted what the annual examination might entail:
I called a local poliklinika , inviting children to come and be examined here, since it is still free and we don't have much of a workload. They tell me, “What are you talking about? We submitted our annual data reports for clinical examinations [dispanserizaciya] a few months ago.” I ask them, “Have you examined everybody already?” They laughed [and said], “We examined some people and wrote in some more people.” The staff there [in the local outpatient centers] is overloaded dealing with acute problems.49
In the continuing absence of dedicated screening programs for the affected populations and of reliable general health care, other physicians and scientists I spoke with generally agreed that in the words of the same doctor, “they would see few patients at the Center for Radiation Medicine in Gomel; the rest were going to have to cope at home however they could.” The infrastructural challenges brought on by the reorganization of Chernobyl-related medical research exacerbated the existing problems with the completeness of the Chernobyl registry and the politics of Chernobyl-related categories used for data collection. For example, the Chernobyl registry does not include all the cleanup workers, one of the most exposed groups.50 According to Tamara Belookaya, 300,000 children were born in 1986–1987, but only 2,500 are in the registry.51 Another researcher pointed out to me that there is also no separate medical category “children of Chernobyl” in Belarus. Children are particularly vulnerable to radiation exposure; presumably, those who were exposed to the highest postaccident doses (p.149) prenatally or as children are at more risk of developing radiation-induced effects than those exposed as adults.52 Without a “children of Chernobyl” category, the group of adults who were children at the time of the accident are statistically invisible, and since they are no longer under age 14 and thus “children” according to the general classification, they blend into the larger pool of potentially less affected adults. The term “children of Chernobyl” itself is commonly used by the media and humanitarian organizations to refer to those who are children now and are exposed to significantly lower doses than the earlier generation was.
Defining categories too narrowly can also render radiation-related health effects invisible. Establishing and maintaining consistent categories for reporting health effects—categories that are also uniform across various departments and institutions—requires significant work.53 Although some efforts have been made to ensure quality control of the information sent to the Chernobyl registry, the exact scope and nature of these efforts is not clear.54 Tamara Belookaya argued to me, “There are no good statistics; everybody is doing them their own way. I was looking through reports in a hospital in the Gomel region. I looked under ‘hereditary development defects’ (poroki razvitiya), and it listed six cases. I looked under “hereditary anomalies of development” (anomalii razvitiya), which is the same thing, and it listed thirty cases.” She went even further in characterizing the problems surrounding the epidemiological analyses of the health effects of Chernobyl:
- Statistics are corruptible. They can be turned whichever way, and it completely depends on who is doing it. Say there is a girl, [and] she was twelve at the time of the accident. She grows up, and it turns out she has endocrine problems. Later she has a stillbirth and then two miscarriages. Then finally she gives birth to a baby girl who has health problems. But who would ever count her or any of her problems if, for example, she lives in Minsk? Where would she be counted? There are no statistics, only anecdotal cases. That's the sense of the games with statistics. When we talk to people here, they tell us, “We are dying off.” This one lost her brother, that one has a disabled husband, but nobody can do anything.55
Belookaya demonstrated an awareness that political and socioeconomic conditions affect what becomes visible and what can be counted. She gave me several examples from her Russian colleagues, related to, for instance, the job and social security conditions in a Russian town with military uranium production where jobs had multiple benefits and “becoming sick” meant losing these benefits and having no security.56 Another example illustrated how the visibility of genetic effects was erased when a town did (p.150) not have a local orphanage. Children with genetic problems were more likely to be put in orphanages, so in a town without an orphanage, the children had to be distributed to other places, which helped erase the numbers.
Thus, research and data collection on the consequences of an imperceptible, chronic, low-dose hazard with delayed effects requires significant infrastructural resources that are sustained over time. It requires funding streams to sustain them, as well as dedicated work efforts (see “The Invisible Work of Making Visible” section in chapter 4). Furthermore, the direction of these efforts may also become misaligned—or even in conflict—with the government's (or other responsible bodies’) changing interests and policies over time.57
Compared to international assessments, the Belarusian state recognized more Chernobyl-related health effects—such as in providing “disabled of Chernobyl” status for those who could claim that their health has been affected by the accident. At the same time, the Belarusian Committee on Connection with Radiation Exposure, which oversees individual claims on the relation of radiation to the individuals' health effects, also follows notoriously stringent definitions of which diseases have been induced by radiation. Even two Chernobyl experts, Vassily Nesterenko and Ivan Nikitchenko, had to struggle to get their own health problems recognized as being related to their extensive past exposures.58 Excessively restrictive, discontinuous, and inconsistent categories are just some examples of the infrastructural conditions that potentially obscure health effects that could be made observable otherwise.
Reframing Chernobyl Research
New state approaches to Chernobyl became reflected not only in the organization of Chernobyl-related institutions but also in their agenda. Galina Bandazhevskaya commented to me that Belarusian science “is not connecting” health effects—that is, morbidity in highly contaminated areas—to radiation (as Yuri Bandazhevsky had done in his research).59 Bandazhevskaya is not the only researcher who told me that “nothing concrete” is published on Chernobyl health effects in the medical journals and that the “effects of the radiation factor are described in passing, without conviction.” Radiation is associated only with thyroid cancers and no other risks, and research questions are asked about unspecific ecological factors that might lead to health problems in the contaminated areas of the Gomel, Mogilev, and Brest regions.
(p.151) Evgeni Konoplya has observed the same tendency to explain health problems in the most affected populations with references to ecological factors. According to him, radiation is considered to a lesser degree, and references to broader environmental factors do not clarify how these factors, including radiation, interact. Konoplya argues that “such synergetic action [of different factors together] is too serious. The effects are not just additive, but instead aggravated in this case.”60 Clearly, radiation is not the only thing affecting the health of the populations, even in the most affected areas, and it would be beneficial for Chernobyl-related research to take wider issues into consideration. Yet the kind of research that Konoplya criticizes, with its emphasis on tendencies rather than causes, does little to clarify the exact mechanisms of influence. The ecological approach blends all possible negative influences on health indiscriminately, producing not a better understanding of the complex situated reality of factors and effects but instead an invisibility of the radiation factor.
Bandazhevskaya summarized the situation as follows to me: “The money is spent, the programs are completed, but conclusions just prove what they have to prove. The practitioners, physicians, say, ‘We see unusual things, but studying them is the prerogative of scientists.’ And scientists say, ‘We've looked, but it is hard to single out the radiation factor here’.”
Bandazhevskaya connects this practice of not singling out the radiation factor to a fear of being snubbed by the IAEA. “The IAEA is a powerful organization against weak Belarusian scientists,” she asserts. “Belarusian scientists won't be able to do much without the help of international researchers.” As a solution, she proposes launching international programs for basic scientific research on the effects of low-dose (especially internal) exposure to radiation. According to her, this research would collect evidence and provide the grounds for organizing preventative measures for people living in the contaminated areas (as well as, presumably, inform approaches to treatment). The current lack of scientific results affects what preventative measures are adopted, and, Bandazhevskaya notes, “The person's life is not endless.” In her opinion, radiation could and should be treated as a risk factor in public health issues, in the same way as, for example, smoking or obesity. She argues, “When a person is treated, radiation exposure should not be forgotten. Patients, for example, can be checked for their internal accumulation of radiocesium with whole body radiation counters.”61
A brief look at the national reports on the consequences of Chernobyl and the mitigation of those consequences illustrates how this sidestepping of causal explanations plays out. The reports have been prepared by a (p.152) collective of a few dozen scientists and administrators and published by the State Committee on Chernobyl. These analytical reports provide an overview of the existing national research and administrative data on the topic. Reports from different years consistently emphasize that the consequences of Chernobyl extend well beyond radiological effects—they also include significant social and economic consequences. Yet in their discussion of Chernobyl's health effects, these reports primarily describe trends.62 The discussion of causal explanations is far more cautious and appears to be in dialogue with assessments by the IAEA, WHO, and UNSCEAR.
These reports describe increases in all classes of diseases, including somatic diseases, some type of cancers, and congenital defects.63 The radiation factor is mentioned most explicitly in connection to children's thyroid cancer, but in 1996 it also appears in the report's section on hereditary defects (written by Gennady Lasijuk, whose studies on the topic were sometimes referred to by the Belarusian scientists I interviewed).64 The 2006 report also refers to radiation in connection with the significant increase in breast cancer among relatively younger women of the Gomel region.65
The reports' position on international research on the effects of Chernobyl is somewhat ambivalent. Reports from the 1990s and the first few years after 2000 criticize international experts for minimizing or ignoring the consequences of the disaster. The 1996 report argues (without mentioning a specific organization) that “there is a tendency for underestimation of the catastrophe consequences, bringing it down to the ordinary [nuclear power plant] incident.”66 The 2001 report addresses WHO's reluctance to acknowledge radiation-related health effects after Chernobyl: “With the example of the thyroid gland cancer [in children] it became clear that the risks of morbidity and mortality in case of radiation impact are undervalued, especially at chronic exposure to small doses.”67 Similarly, the conclusion to the 2001 report refers to UNSCEAR's assessment as a “vivid example of a prejudiced attitude to the consequences of the Chernobyl catastrophe.” The statement is unequivocal: “Based on arbitrary selection of data, on individual publications, which included practically no works of Belarusian scientists, the [UNSCEAR] report treats incompletely and pretentiously the post-Chernobyl situation in the three affected states.”68 The 2003 report argues that “the perception of the existing problems of the Chernobyl disaster” by “the international community is not fully adequate to their real size and importance.”69
Despite these explicit criticisms, the later national reports increasingly echo the language of international assessments in their discussion of causality. For example, in the 2001 report, two groups of factors are said to (p.153) affect health after Chernobyl: radiation factors (including both external and internal irradiation) and nonradiation factors, which are described as “social, economic factors; stress; [and] risk perception” (no other ecological factors besides radiation are mentioned). The mechanisms of the influence of the nonradiological factors are not explained, and the report points out that “It's not quite clear today … how long it will take to prove the radiation origin of … pathologies [other than thyroid cancer in children], and to conduct an impartial assessment of the risk factors which may not be directly connected to the radiation effect.”70 The 2003 report expresses great expectations for the UN Chernobyl Forum to produce “proof” of Chernobyl's effects and to overcome the disagreements in estimating Chernobyl's consequences; these disagreements, it says, continue to cause “difficulties in attracting international assistance.” In similar language to the UN reports on Chernobyl described in chapter 5, this national report also mentions the “Chernobyl victim” syndrome, which supposedly prevents the “active involvement of the population in social and economic activities”; it similarly recommends education programs to mediate the misperception of radiation risks. The misperception of radiation's danger “leads to persistent psychological discomfort.”71
Similar comments—that the misperception of risks and “psychological discomfort,” along with radiation, affect people's health—appear in the 2006 report. It generally emphasizes the rehabilitation of the affected areas, both as a focus of state policies and as a new focus of international cooperation and assistance. The report mentions “a combined influence of radiation and non-radiation factors of the Chernobyl accident” but never considers the question of causality in more detail.72 After all, a better estimation of the radiological health effects, as well as of the synergetic effects of radiation and other factors, might be counterproductive to obtaining international cooperation and assistance (see chapter 5).
Whereas the national reports produced by the State Committee on Chernobyl appear to be highly conscious of the international assessments of Chernobyl's consequences, individual scientists appear equally concerned about the directions of state policies. After Yuri Bandazhevsky's imprisonment, his Gomel school of researchers collapsed; according to Galina Bandazhevskaya, “There are studies, but no enthusiasm.” Scientists are explicitly aware that the government is no longer investing in Chernobyl research. One scientist from the Sakharov Institute told me, “We've known for a long time which way the wind is blowing.” Another researcher, who continues working and publishing on Chernobyl-related health effects, called my attention to a series of media interviews with Yakov Kenigsberg (p.154) (the head of the National Committee on Radiation Protection and a representative of the government of Belarus in UNSCEAR) in which Kenigsberg flatly denied that any other diseases, besides thyroid cancer, were caused by the Chernobyl accident.73 A physician from the former Institute of Radiation Medicine and Endocrinology in Minsk also told me:
I have heard [the head of the State Committee on Chernobyl] on TV saying that we are a poor country, so the programs are going to fold.… I would never have believed that we would stop working [on Chernobyl] so soon. We thought that we would have enough Chernobyl problems to last us for a hundred years.74
In April 2009, journalists writing for the Vecherni Grodno newspaper conveyed a similar impression of the directions of the post-Chernobyl research in Belarus:
In the studies related to health effects, Chernobyl has become an unpopular topic.… We heard that for several years now dissertations on this topic are considered unpromising. We reached the director of the Center for Radiation Medicine and Human Ecology Aleksandr Rozhko, who used to work in Grodno. Yet he refused to sound any topics of scientific research. Another direction of research is riding the wave at the moment—how to return contaminated areas into use.… Eleven such pilot projects started for the period 2006–2010.75
In 2012, my experience was similar to that of Vecherni Grondo's journalists: Aleksandr Rozhko refused my attempts to interview him about research at the center.
The health effects of the Chernobyl accident have become increasingly obscured in scientific research in Belarus, both as a result of the conscious politics of the state management of science and, as Matthew Cresnon put it in his study on the “un-politics of air pollution,” as a result of scientists “taking cues.”76 The perception of the position of those in power can be a determining influence even in the absence of actual intimidation. It appears that Belarusian scientists also “take cues” from administrative discourse; explicit directives to reframe research might not be necessary.
Missing Experts and the Radiation Factor
Despite multiple infrastructural challenges, including the reorganization and refocusing of science related to Chernobyl radiation, there is little doubt that in some theoretical and applied areas, Belarusian scientists have accumulated unique experience, what Konoplya referred to as “intimate knowledge” of Chernobyl's consequences (see chapter 4). It is not surprising that the clearest examples come from thyroid cancer research and (p.155) treatment, where accumulated theoretical knowledge (which is also sensitive to the local context and the particularities of local cases) translated into better standards of care.
A physician who was one of Demidchik's colleagues highlights the unique Belarusian experience and knowledge by contrasting cases of children who have been treated in Belarus with those whose parents took them for treatment in the United States, Germany, or Sweden, motivated by their belief in the power of Western medicine and medical technologies. The cases show that “Western doctors simply don't know these patients” in terms of the projected courses of their illness, risks, and optimal treatment. This also holds true for specific issues of thyroid cancer and pregnancy: “these types of problems are a rarity there [in the West]. For us, it's routine.”77 Outcomes for children who underwent treatment abroad compare poorly to patients treated in Belarus, she explains:
One case is the mother who arranged for the child to be operated on and treated in Germany. They even removed his thymus and did not give him the right treatment. When they were in Aksakovshchina, the mother asked me why her son is doing so badly compared to other children with the same original problems. I asked her, “Why did you take him to have his surgery in Germany?”
Examples from this physician also illustrate that the lack of observation of health problems doesn't mean the absence of health problems. Screening for thyroid problems was cut because of lack of funding; as a result, thyroid problems are usually discovered early only in rare groups still routinely examined, such as pregnant women and (ironically) young medical students:
Those who were small children at the time of the accident are particularly at risk for thyroid cancer; they are now young people ages twenty to twenty-five. They come to us as students and find out their own thyroid problems. And many young women, since all pregnant women get tested, and their thyroids are checked. Some of them are pretty far along. We currently have thirty such patients. We have made about twenty-five to twenty-six surgeries after sixteen weeks of pregnancy.… If you don't do a surgery, the cancer can spread.
Adequate screening might not even be the biggest problem with the current state of Chernobyl-related science in Belarus. Despite dedicated research institutions and centers (and clear leadership in understanding and treating pediatric thyroid cancer), there are now very few publicly and professionally visible, publishing experts who publicly claim expertise on the health consequences of Chernobyl.78 Some of the most prominent experts who resisted the growing invisibility of Chernobyl's consequences (p.156) died in the first decade of this century: Vassily Nesterenko, Evgeni Konoplya, Ivan Nikitchenko, and Tamara Belookaya, among others. Some, like Yuri Bandazhevsky, left the country. A few others, while continuing their research, prefer to keep a low profile. Galina Bandazhevskaya works as a pediatrician and is no longer involved with radiation-related research. During my first interview with him, Nesterenko asked me if I could help an established Chernobyl scholar who had lost his job. A number of scientists and administrators I attempted to speak to in Minsk claimed to be “not competent” or “no longer” involved with this field. Top officials at the Ministry of Health advised me to talk to the director of the international CORE program, claiming lack of relevant expertise.
Radiation as a morbidity or mortality factor has also been rendered less visible. Depending on personal views, most scientists I approached on the topic of Chernobyl either claim that “nothing has been found” (and, for example, that “radiation effects on the cardiovascular system seem to be too far-fetched”) or describe anecdotal evidence to prove the reality of Chernobyl effects. For example, on two separate occasions, different experts told me the story of a known female surgeon who worked in the Gomel region and later was diagnosed with potentially radiation-induced cancer. The invisibility of both experts and radiation effects is further exacerbated by the relative information vacuum and lack of space devoted to scientific discussion of the effects of Chernobyl. Only one annual publication was devoted to Chernobyl, and several researchers commented on the lack of Chernobyl studies in regular medical journals.79
One scholar still working on Chernobyl told me, “It is all so clear here—all the consequences are very clear—but it is too bad that the science is so political.” Another researcher insisted, “There is good, fundamental science, but everybody is very cautious about it. It is received very carefully.” Belookaya, when asked whether she felt hopelessness because of the difficulties in making the effects of the accident visible or recognized, replied, “Often. Pretty badly.”
What we know about the consequences of an invisible, pervasive, and chronic environmental hazard with delayed health effects cannot be assumed to be a straightforward reflection of the extent of contamination or the severity of its effects. This knowledge depends on infrastructures of data collection and analysis, on observational practices, and on already established knowledge. Obviously, then, this raises the question of what kinds of (p.157) health effects, under what kinds of circumstances, can become knowable. What conditions (i.e., features of disease and its incidence, structural conditions of research, methodological approaches, and, perhaps, political savvy of researchers) can make the link between radiation and particular effects become visible?
Belarusian research on Chernobyl's consequences followed an up-and-down trajectory. In its current state—after the loss of faculty, when the observed populations have shrunk, and when previously collected empirical data about doses and effects are no longer available—research runs the danger of becoming less empirically based and empirically sensitive, as we saw in the example of estimating dose burdens. As Konoplya said at a Chernobyl conference in 2005, “Theory and practice are inseparable, but practice introduces its own corrections”; the turn away from empirical data obscures the complexity of radiation health effects. Furthermore, scientific assessments of the consequences of Chernobyl determine the scope and extent of radioprotective efforts, treatment sensibilities, and specialized treatment programs—and this means that both our knowledge and the ongoing reality of the consequences of the accident are in a kind of interaction with infrastructural conditions for research, radiation protection, and opportunities for articulating this knowledge.
The Belarusian government's efforts at rehabilitating the affected areas are reaching into the heart of the contaminated land: in 2011, President Lukashenko announced the revival of agricultural production in the areas immediately adjacent to the “zone of alienation”—that is, the Polesski State Radioecological Reserve. Indeed, “rehabilitation” has not been an entirely empty promise. Infrastructural solutions implemented by the state helped lower the doses experienced by resident populations (as measured by Belrad radiologists). These efforts included state radiological control of food processing, free school lunches, health recuperation programs for children, and, in many areas, gasification (see chapter 2). More recently, providing clean pastures for cow gazing has eased the problem of contaminated milk, one of the main sources of high doses in some areas. In 2010, the government extended the Chernobyl Program for five more years; many people had believed that it would not be extended because the Chernobyl problem in Belarus has officially been fixed.
New reasons have emerged for rendering Chernobyl increasingly invisible. The Belarusian government has been considering the possibility of building its own nuclear power plant since the 1990s. The plans were revived again in 2006 and became definite in 2011, after the government obtained a credit from Russia and signed a construction contract with a (p.158) foreign wing of the Russian nuclear corporation Rosatom. Despite strong objections from Lithuanian authorities, the protests of environmental groups, and public disapproval at home, the nuclear power plant will be built in the northern region of the country, near Ostrovets. In the words of one ecologist in Minsk, “The country most affected after the Chernobyl accident is building its own nuclear power plant. The IAEA has just gotten a great argument,” referring to the supposed insignificance of chronic exposure to low-dose radiation.80 One might assume that the Belarusian government is not interested in making the establishment of post-Chernobyl health effects a priority in the national and international arenas.
(1) . SB, February 26, 1999.
(3) . Bandazhevsky (1999, 2003).
(4) . Nesterenko and Nesterenko (2006), 196; Nesterenko and Nesterenko (2009), 304.
(5) . Bandazhevsky's critique appeared in his report on the directions of research in the Institute of Radiation Medicine of the Ministry of Health. His concerns about the state's policies of rehabilitation and agricultural production in the most affected areas appear again in the conclusion of Bandazhevsky (2003), 490, in which he argues that studying the effects of internal accumulation of Cesium-137 on pathogenesis in children is
an urgent need, as radiocontaminated agricultural land is being increasingly cultivated and radiocontaminated food is circulating countrywide [in Belarus]. Schoolchildren in contaminated areas received radiologically clean food free of charge in school canteens and spent a month in a sanatorium, in a clean environment, each year. For reasons of economy the annual sanatorium stay has been shortened, and communities in some contaminated areas have been classified as “clean,” thus ending the supply of clean food from the state.
(7) . Nasha Niva, April 23, 2007.
(8) . Konoplya and Rolevich (1996a), 76; Matsko and Imanaka (1998), 28–39; Shevchouk and Gourachevsky (2001). The Institute of Radiobiology and the Institute of Radioecological Problems were institutes of the National Academy of Sciences of Belarus. The Institute of Agricultural Radiology later became the Institute of Radiology under the State Committee on Chernobyl. Other selected institutes with departments or laboratories conducting Chernobyl-related research included the Institute of Nuclear Power Energy; the Belarusian Scientific Research Institute of Hematology and Blood Transfusion; the Institute of Oncology and Medical Radiology; the Institute of Soil Science and Agrochemistry; the Belarus Center of Medical Technologies, Information, Direction and Economy of Public Health; and the Institute for Genetics and Cytology.
(9) . Belarus inherited the Soviet vertical concentration of power, and the state administration has been particularly centralized since the election of the first (and as I am writing this, only) Belarusian president in 1994. Consequently, this analysis refers to the state as a single and rather coherent actor and not as a set of different agencies with potentially competing interests, which would be more appropriate in other contexts.
(12) . Tamara Belookaya, interview, Minsk, 2005.
(14) . Evgeni Konoplya, interview, Minsk, 2005; see also NASB (1999). Konoplya was the director of the Institute of Radiobiology until 2009.
(15) . Marples (1996a), 104–109; NASB (2010). Demidchik identified the clinical-biological specificity of radiation-induced thyroid cancer in children.
(16) . Belarus Ministry of Emergencies (2011), 21.
(17) . Konoplya and Rolevich (1996a), 77. In addition to this plan for scientific research and development, in 1990 the republic adopted a separate program that outlined the monitoring and forecasting of the radiological situation.
(22) . Konoplya and Rolevich (1996a), 77.
(24) . For example, a presidential decree, “On Improving State Management in the Area of Science,” issued on March 5, 2002, adjusted the hierarchy and responsibilities of some science-related administrative bodies, including the National Academy of Sciences. Korshunov, Artuhin, Elsukov, Kostukovich, Nikonovich, Rudenkov, Tamashevich, and Hartonik (2006).
(25) . Konoplya and Rolevich (1996a), 77.
(31) . Sovetskaya Byelorussiya, February 9, 1989.
(33) . Narodnaya Gazeta, January 24, 1997. The clinic in Aksakovshchina provided health-care services for the Chernobyl-affected populations. It was first designed to accommodate 190 patients (95 children and 95 adults) but was then expanded to 250, half of which were endocrine patients.
(35) . Former employee of the Institute of Radiation Medicine and Endocrinology in Minsk, interview, Minsk, 2005. On July 5, 1994, the clinic in Aksakovshchina was (p.202) transformed into the Institute of Endocrinology, then transformed back after 43 days. Narodnaya Gazeta, January 24, 1997.
(36) . The University was first established in 1992 as the Sakharov International College of Radioecology, a subdivision of Belarusian State University. In 1994, it became an independent institute with two departments. Shevchouk and Gourachevsky (2001), 97.
(37) . Former employee of the Institute of Radiation Medicine and Endocrinology in Minsk, interview, Minsk, 2005. The establishment was originally part of the Institute for Radiation Medicine but later became independent. The original building was also close to the hospital for the president's administration.
(40) . Sovetskaya Byelorussiya, February 26, 1999.
(41) . Evgeni Konoplya, interview, Minsk, 2005.
(42) . The creation of the center was specified by the 1990–1995 Chernobyl Program. Yet when the center opened in 1990, it did so without its own building. The construction of the building for the center stopped altogether in 1994 because of insufficient funds. Efforts to renew the construction began again in the late 1990s, under the patronage of the president. Sovetskaya Byelorussiya, February 20, 1997, and June 11, 1998.
(43) . BelaPAN, July 5, 2007, http://naviny.by/rubrics/society/2007/07/05/ic_news_116_273394.
(44) . Nesterenko (n.d.).
(45) . Belarus Ministry of Emergencies, (2011), 39.
(47) . This point about the role of annual examinations was emphasized to me during a 2004 interview in the Department of Science, Ministry of Health. For their examination, residents can go to their local medical facilities or travel to the administrative center of their region. A number of groups of individuals are subject to annual medical examinations: cleanup workers, evacuees, residents of the affected areas, children of the most heavily exposed individuals (cleanup workers, evacuees, and residents of the zones of primary and secondary resettlement), and children under 18 with radiation-induced diseases that had been established as such (typically (p.203) leukemia and thyroid cancer but also other cancers). Shevchouk and Gourachevsky (2006), 69–70; Belarus Ministry of Emergencies, (2011), 38–39.
(48) . Marples (1996a).
(49) . Former physician of the outpatient center of the Institute of Radiation Medicine in Minsk, interview, Minsk, 2004. The next quote is from the same interview. The outpatient center no longer performed any Chernobyl-related functions at the time of this interview, though some of its personnel still remained. For a discussion of the inadequacies of the general healthcare system, especially in the affected rural areas, see Marples (1996a), UNDP and UNICEF (2002), and World Bank (2002).
(50) . Marples (1996a); Tamara Belookaya, interview, Minsk, 2005. Although the registry is not a perfect reflection of the reality, a blanket invalidation of the Belarusian data because of this would make even more data invisible.
(51) . Tamara Belookaya, interview, Minsk, 2005.
(52) . Shevchouk and Gourachevsky (2006), 71; Belarus Ministry of Emergencies, (2011), 40. Although these national reports note that this group is at risk, there is no separate category for them, and it is not clear whether the screening for them remains focused on thyroid pathology.
(53) . Bowker and Star (1999). Ensuring that categories are consistent and uniform is work that must be done in the actual practice of using categories. See chapter 4 for a discussion on aligning categories.
(54) . NRC (2006), 202. A separate registry of cancers has been functioning in the republic since 1970s.
(55) . Tamara Belookaya, interview, Minsk, 2005.
(57) . State power relies not only on the collection of data but also on strategic ignorance and a lack of usable data in particular areas. These dimensions of power, as Mathews (2005) demonstrates, tended to be overlooked by social sciences influenced by Michel Foucault's concept of power/knowledge.
(59) . Galina Bandazhevskaya, interview, Minsk, 2004. All subsequent quotes are from this interview.
(60) . Evgeni Konoplya, interview, Minsk, 2005.
(61) . Bandazhevskaya's view of the radiation factor is different from that advocated by the IAEA experts who make no distinction between internal and external exposures.
(62) . Reports from different years are fairly consistent in their descriptiosn of these trends, even though some researchers (and members of Chernobyl-related organizations) that I have interviewed distinguished among reports from different years, noting that some are far more descriptive than others.
(64) . Konoplya and Rolevich (1996a), 53.
(65) . Shevchouk and Gourachevsky (2006), 43. The report refers to “a linear dependence between accumulated radiation dose and realized relative risk of breast cancer development” for the female population of the Gomel region.
(66) . Konoplya and Rolevich (1996a), 85.
(68) . Ibid., 107. The assessment in question is UNSCEAR (2000). The Belarusian report points out that although cancers have traditionally been considered the main health effect of radiation, more data have appeared in the last few years indicating the “radiation origin” of a range of noncancer diseases.
(72) . Shevchouk and Gourachevsky (2006), 92,101, 102. The troubling state of children's health in the affected areas is addressed outside the discussion of causality. This report, like the earlier reports, calls for long-term radiation-epidemiological studies to demonstrate the role of radiation in the increase of the number of cancers and noncancer diseases. In conclusion, the report argues that “efforts of the Belarusian scientists should be directed to obtaining the reliable data recognized by the international community and capable to be a basis for … effective actions at both national and international levels.”
(73) . Gomel'skaya Pravda, March 13, 2009. See also Belta, December 27, 2012, http://news.tut.by/health/328251.html. Kenigsberg is one of the coauthors, with Evgeni Petryaev and others, of the 1995 revised concept of radiation protection.
(74) . Former physician of the outpatient center of the Institute of Radiation Medicine in Minsk, interview, Minsk, 2004.
(75) . Vecherni Grodno, April 26, 2009.
(76) . Crenson (1971).
(77) . Physician of the Center for Cancers of the Thyroid Gland, interview, Minsk, 2004. All subsequent quotes are from this interview.
(78) . I have encountered similar reactions among experts from the Sakharov International Ecological University, the former Center for Radiation Medicine, the State Pediatric Center for Oncology, and even the science department of the Ministry of Health.
(79) . One journal devoted to Chernobyl research, Ecological Anthropology, was being published on the basis of the proceedings of an annual Chernobyl conference organized by the Belarusian Committee “Children of Chernobyl” (it was published under the name Chernobyl Catastrophe from 1992 to 1995). According to its editor, Tamara Belookaya, the fact that scientific publications from the neighboring Ukraine and Russia rarely made it to researchers in Belarus explained its popularity.
(80) . Interview, Minsk, August 2011.