Arjun in Kakamega

Note:  While this post was uploaded on June 22, 2009, it was written on June 21, 2009.

RECAP OF THE DAY: Woke up, went to town, worked out, went to the market, went to Yakos, bought a bunch of DVDs to watch, came home, relaxed, talked to everyone at home, watched a chicken get slaughtered, feathered, cut up, and cooked, I was still hungry, ate it, work, sleep.

REFLECTION

First of all, I’d like to thank profusely the donors to my project that have already showed overwhelming support for the emergency responsiveness program.  I assure you, your donation will make a difference, and I’ll be sure to keep you updated about what is happening at Iguhu District Hospital.  For those who would like to donate, a project description and online donation link can be found here.

Second order of business – my grant decision came back on Saturday, and unfortunately it was not funded.  As promised, a detailed evaluation has been filled out by the grant review committee, and I am scheduled to meet with Angie tomorrow to look over this evaluation.  I’ll be sure to post it here.  Moving forward, though, this makes my online fundraising even more critical.  The original $500 fundraising goal has been raised to $1000.  Every bit counts – again, a dollar goes a long way here – so anything you can contribute would be extremely helpful.

Because the grant decision came out negatively, I’m also in the process of deeply re-thinking the project and re-assessing the needs of the hospital.  Perhaps you can help me; I’ll talk about my dilemma here.  The original project was designed to train Iguhu staff on all the major practices they need to be trained on in order to respond to emergency situations, so the ultimate goal was to leave Iguhu with at least one set of trained staff ready to respond to either trauma cases (like a car accident) or medical cases (like chest pain).  As it turns out, most of the equipment required for trauma cases is much cheaper than the equipment that medical cases require.  My dilemma is whether to go ahead and purchase these things for the hospital and train them on their use or to just focus primarily on trauma cases.  The reason why this is a debate, in my mind, is because your normal 911 system whereby people can call for ambulatory assistance from their home is at least 10 years away, given the massive shortage of monetary and human resources.  That means that what the hospital is really going to be seeing will be trauma cases (and specifically, car accidents).  So is it worth it to buy supplies for medical cases?

This question is complicated when you consider some of the other needs that could be fulfilled in the hospital.  I’ve talked about the admirable CCC staff before; they need a laptop to log patients electronically, especially if I succeed in my mission of getting them permission to use hospital vehicles for village visits.  So, nebulizer to treat severe asthma in an ambulance, or laptop for CCC use?

I think what this goes to show is that it’s difficult to focus on the long term (10+ years) when you see so many short term needs that could be filled.  What I’m leaning towards is biting the bullet and doing everything for the emergency training, because I feel like it’s unfair to me to judge whether the capacity to handle medical cases is needed by the community before the capacity itself is there.  It’s one of those things where you’re never really sure how many people would call an emergency vehicle from their home in response to a medical condition until people have the option of calling such an emergency vehicle.  While there might be other needs – just as pressing, maybe – that could be filled, focusing on one task and making sure the hospital is equipped for the long term is in the best interests of everyone involved.

But I’m still not sure.  I need to write up a new budget for my online fundraising by tonight, so hopefully I’ll have it figured out by then…

Now I’d like to turn to a highly controversial, ongoing discussion in international development work.  I’ll take this time to present the topic here, because I think it’s something that everyone involved or interested in international development should think about.  Most of all, I’m greatly interested in what your opinion is on the matter.

The origins of the issue stretch as far back as the first (and sometimes the most offensive) question:  Why is it that we citizens of “developed” countries should care about or be motivated to act upon the conditions in the “developing” world?  When we read about hunger, poverty, AIDS, or malaria, why should we do anything about it?  What makes these things our problems, and why should we feel the need to send some of our own resources to the developing world to alleviate them?

Answer this question for yourself – it’s more difficult to articulate an answer than you might think!  Most of us take this question for granted and consider it too horrifying to even consider.  “Of course we should help,” people say.  But why?

There are two answers that I’ve heard to this question.  The first is based upon human emotion.  When we hear about millions of people dying of starvation of malaria, we are outraged.  Given that there is something we can do about it, we are motivated to act upon these problems by the idea that every human deserves some basic level of freedoms, and among those are freedom from hunger and freedom from disease.  It’s a valid point.  The roots of our desire to alleviate these problems stem from a belief in charity – we say that since these people are unable to help themselves, we should help them because doing so preserves the sanctity of life and maintains the human rights that we believe should be afforded to everyone on the earth.

The second answer is virtually the same as the first but adds that we have the obligation to perform development work because all we are really doing is undoing the detrimental effects of colonialism; in other words, given that many countries in the Western world played a large role in slowing or stopping the infrastructural growth of developing countries during the colonial period, it is only fair that we now help build the infrastructure that we prevented from sprouting.

Both of these responses fall under the umbrella of the concept of a “moral obligation” to help.  We have a moral obligation to assist and sponsor development work, so we do.  And up until now, everyone is basically on the same page, including myself.

But the question I would like to leave you with is this:  when does our moral obligation end?

A big example is the HIV epidemic.  Even after setting up free testing centers and offering free ARV treatment to those individuals found positive, we find that people still choose not to get tested for a variety of reasons, all of which center around a cultural stigma associated with the disease.  Jonny Steinberg, in his work Sizwe’s Test (2008), says, “When people die en masse within walking distance of treatment, my inclination is to believe that there must be a mistake somewhere, a miscalibration between institutions and people.”  Steinberg searches for this “miscalibration,” and makes for key realizations:  The first is a reaffirmation of Edwin Cameron’s conclusion – that people are scared of getting tested for HIV because of the stigma associated with having the disease (see Witness to AIDS, 2005).  Second, he finds that this stigma is greatly exacerbated by the fact that this stigma is applied onto you by people you know very well.  Third, he realizes that hesitancy to be treated sometimes springs from a feeling of cultural humiliation associated with adopting “white medicine.”  Finally, he discovers that procreation plays a critical role in the religion and culture of many societies, and that HIV is feared and ignored because it undermines a man’s virility and thus his spiritual success.

Sure, these findings are significant and elucidate many interesting aspects of the epidemic in Africa, but here’s the million-dollar question:  What should we do about it?

So here’s the question to ponder – after setting up free testing centers galore, offering free ARV treatment, having testing caravans go to individual villages, and urging the incorporation of HIV education in schooling, if we still find people refuse to get tested and deal with the disease, is there more to be done, or have we fulfilled our “moral obligation?”  Steinberg, Cameron, and many others have uncovered the real roots of the problem, which are largely cultural.  Addressing this problem at its roots will require a complete overhaul of the culture itself.  Is it our place to do such a thing?  Is it our responsibility?  Is it our obligation to do something about the “miscalibration between institutions and people?”  What if those institutions are Western constructs, and the people are locals whose culture and beliefs are unlike anything we know?

The more I think about it, the more circular the discussion becomes.  Yes, we have a moral obligation, and yes, we have set up institutions all over Africa (testing centers, counseling, ARV distribution networks) that we believe would work.  If they don’t, we have done everything we know to try and address the issue, so maybe our obligation ends there.  But what if we got the institutions wrong?  What if the institutions we established are badly “miscalibrated?”  Is it our obligation to rethink them?  If so, how can we redesign them to fit a culture different from anything we know or truly understand?  And how can we rely on people of a culture in denial about HIV to invent these institutions, if we must have them do it for themselves?

Essentially, the question is this – if an aspect of a culture needs to be changed, who should change it?  Is that a change that needs to come from within, or are our efforts required?

I’m terribly interested to hear what others think on this issue.  It’s important to answer these questions because the answers have massive implications in foreign policy around the world and might serve to point developing countries in the right directions in terms of long-term development.  Be sure to comment on this post to dish out your opinions!