“If you have come here to help me, you are wasting our time. But if you have come because your liberation is bound up with mine, then let us work together.” –Lilla Watson
This oft-cited quote is from Lilla Watson, a Gangulu aboriginal activist from Australia. The first time I read it I felt my heart quicken in recognition. One of the greatest problems with being interested in global health is my fear that I will do more harm than good. I have seen developing countries pockmarked by well intentioned NGO groups that ultimately create bitterness, corruption and false dependance. My stomach churns at the thought that I am participating in a system based on the model of a beneficent white man handing out superior resources to a supplicant native population. Or even worse, handing out resources but tied to an expectation of religion or political acquiescence or any one of the thousand strings that often are tied over aid packages.
I also hate the ego that can come from doing this sort of work– which is why I hate being “complimented” on my global health interest. Because this stirring quote by Ms. Watson really hits the nail on the head. It’s not about ME giving YOU a handout. It’s about US moving about the world with basic human decency. Even the old proverb about give a man a fish and he eats for a day, teach a man to fish and he eats forever is a bit problematic for me. While I agree that this is important, “capacity building” has acquired a feverish buzzword-y connotation of almost mythical status in many places. But teaching a man to fish also sort of implies that you are the great giver of knowledge and he, a country bumpkin eager to receive your aid. Maybe he knows how to fish in a different way. Or maybe he isn’t fishing at the moment and that is a good thing because your “superior” fishing techniques have caused devastation amongst the local fish population ultimately leading to a cascade of problems.
Because if you go into a developing country with the attitude that you are superior you will be disappointed– disappointed with the reactions of your colleagues and patients and frustrated by the limitations of the system you work in. I am often asked to compare the resources of a country I visit to the US. People seem to want to hear about how primitive it is and how brave I am for going there. And global health personnel often gripe about what they would do if we were in the US- seemingly wishing to transport every patient into our “superior health care system.” But guess what? Our system isn’t exactly something to brag about. We have created an economically unfeasible situation that so often does not act in the patient’s best interest. Unnecessary tests, defensive medicine, limited time with providers, frequent transitions of care. This is not to say that we don’t have amazing innovations- or that developing countries should operate with less than optimal resources at a lower standard of care. I’m not trying to glamorize poverty either. I simply use it as a caution before storming into a place armed with a false certainty of superiority. Because it is as much a learning experience as anything else. And innovations from developing countries have often been used in more developed countries with great success.
One of my best friends in the world recently lost her grandfather. So my family rallied, got tons of food and showed up for them. We came that day and every day for 4 days bringing food, attending the funeral and helping clean. While there we didn’t try to change how they loaded the dishwasher or ask them to subscribe to our beliefs. Why did we do this? Because we were great, superior people who took pity on them? No. Because they are a part of our community, a part of our heart and we did what little we could do for that moment. Because our liberation is bound with theirs. And I honestly feel that global health is similar in some ways.