A welcome report on the health system provided to the Yanomami in Venezuela, this book analyses the merits and drawbacks of public policies that affect this Amazonian people. It shows the overt concern of the Chávez administration with the inclusion of indigenous peoples in his ‘Bolivarian revolution’, but also points out the government's inclination to deny cultural diversity through refusal to acknowledge indigenous specificity, reluctance to demarcate indigenous lands and co-option of indigenous agents.

Looking at the Venezuelan side of the Yanomami's suffering, primarily caused by continuous invasions by illegal placer miners, is valuable for an appraisal of these Indians’ situation as a whole, as they straddle the border region between Brazil and Venezuela and are equally affected by multiple epidemics and social disruption. Comparison with the Brazilian situation can clarify some points. Severe health problems hit the Yanomami on the Brazilian side in the late 1980s and were aggravated throughout the 1990s (see I. A. Menegola, I. Varga and Alcida Rita Ramos, Primeiro relatório do Distrito Sanitário Yanomami: avaliação das atividades e diagnóstico de saúde (Fundação Nacional de Saúde, 1991), and Alcida Rita Ramos, Sanumá Memories: Yanomami Ethnography in Times of Crisis (University of Wisconsin Press, 1995)). Inefficient government actions prevailed through the 1990s until the Fernando Henrique Cardoso administration (1995–2002). During his presidency, Cardoso's health ministry entrusted the NGO URIHI – Saúde Yanomami with providing publicly funded health services to a large number of communities in the states of Roraima and Amazonas. Those were the golden days of Yanomami health care, and they achieved impressive results. Whereas in 1998, under the Fundação Nacional de Saúde (National Health Foundation, FUNASA), the death rate by falciparum malaria was 16.2 per 1,000 cases, from 2001 to mid-2003 it was zero among the 7,200 Yanomami assisted by URIHI, 52 per cent of the total Yanomami population in Brazil. Child mortality dropped from 161.1 in 1998 to 38.5 in 2001. The combination of federal funding with the efficiency and commitment of private personnel demonstrated how far a health programme could go to eradicate endemic and epidemic diseases in the Amazon. The sustained decline of morbidity among the Brazilian Yanomami, however, came to an end with the Lula administration (2003–10). The return of state-only activities brought back corruption, incompetence and unaccountability, with the result that in a few months malaria epidemics were back in Yanomami communities. Chronic state inefficiency, corruption and general indifference to the well-being of populations on the fringes of national society are common to both Brazil and Venezuela. During the URIHI phase and even afterwards, many Yanomami in Venezuela crossed the border looking for health care at Brazilian outposts.

State Healthcare and Yanomami Transformations exposes the thorny issue of communication between medical personnel and Yanomami assistants and patients. Most often at cross purposes, both sides of the health care system create a grey area of misunderstandings that is appropriately emphasised in the book. Two authors come to mind on this subject: Gregory Bateson, in his book Naven (Cambridge University Press, 1936), deploys the concept of ‘schismogenesis’, while Erving Goffman, in The Presentation of Self in Everyday Life (Doubleday, 1959), uses the term ‘impression management’. Kelly prefers ‘equivocation’, following and elaborating on Viveiros de Castro's notion of ‘controlled equivocation’. The configuration of a field of equivocations – or what João de Pina-Cabral, in Between China and Europe: Person, Culture and Emotion in Macao (Continuum, 2002), calls ‘equivocal compatibilities’ – has structural qualities that any ethnographer who has spent some time among indigenous peoples can appreciate. Equivocation, working misunderstandings and cross purposes all point to the major cross-cultural conundrum: namely, the quandary of imperfect communication. Kelly's merit is to identify and analyse how the grey zone of flawed communication, in its various degrees of muteness and intentionality, can create working understandings when the common goal is to cure the sick. In other words, depending on the context, miscommunication operates as both a centrifugal and a centripetal force, pushing apart or bringing together the parties involved. Also important is his decoding of each party's (mis)understandings at the service of distinct, even opposing, agendas: the doctor's imposition of medical protocols, the Yanomami either affirming their shamanic knowledge or advancing their napë prou (‘become like whites’) project. Equally fine is his description of the internal differences of the Yanomami along the Ocamo River and the continuum of experience with whites.

Also important is Kelly's description of the state health apparatus under Chávez, its achievements and its contradictions. We get the impression that, for all the popular (populist?) ambitions and social conquests of Chavismo, with regard to indigenous affairs and the Yanomami in particular the situation is one of ‘plus ça change, plus c'est la même chose’, give or take a few concessions. Medical assistance is precarious, indigenous territories are not demarcated, and respect for the Indians’ cultural diversity is anathema to Chavista nationalist ideology.

Some aspects of the book are less appealing, however. One is the author's over-reliance on other ethnographers’ work, as though descriptions and analyses of a Yanomami subgroup were applicable to all, which is not the case. Perhaps as a corollary, in dealing with mutual perceptions between doctors and Yanomami nurses and patients, Kelly's description of the former's point of view is not accompanied by an equivalent attention to the latter's position. The author's tenacious allegiance to one single theoretical model, perspectivism, is in part responsible for his insistence that the Yanomami take doctors and whites in general as affines, although his arguments are scarcely convincing. Such theoretical commitment has the effect of turning the Yanomami into hostages of alien theories: they seem to suffocate within the narrow walls of perspectivism. Between a Yanomami rendering and a generic academic schema, Kelly seems to prefer the latter. A contrasting example is the thoroughly shared project of Yanomami Davi Kopenawa and anthropologist Bruce Albert which resulted in La chute du ciel: paroles d'un chaman yanomami (Plon, 2010). Between narrator and writer there is no undue interference of extraneous theoretical models.

Vital statistics such as community size, gender balance (or lack of it) and age distribution are sadly absent. Also unclear is the profile of the ‘civilised’ Yanomami regarding status, gender, training, fluency in Spanish, family commitments and so forth. As a consequence, the Ocamo Yanomami appear to the reader to be rather faceless. One final note on the book's subtitle, A Symmetrical Ethnography: apart from the perspectivist jargon that pervades the text, one wonders what is symmetrical about it, and strictly speaking, the book is not actually an ethnography but in fact a long report on the Venezuelan health system in Yanomami territory. The book's intrinsic value, however, is sufficient reason to welcome it.