We are in the
second decade of the 21st
century – an age of internet,
with its extraordinary influence in our daily life. Now, more than ever before,
we can easily talk of accountability, openness, transparency, equality, equity
and justice. This century is, therefore, an extraordinary time in the history
of human kind. However, we are at the crossroad of enormous global health
challenges that relate to population explosion, environmental devastation,
rapid urbanization with increased pandemic threats and civil unrest in all
corners of the globe. An example of
this in the global health landscape, which is an integral part of
broader socio-economic development, is
the “distinct but unhealthy” gaps that remain in terms of mindset, and practices. All these
gaps originate from the differential
nature of wealth, power and race dynamics. (Farmer, Jim Yong, Kleinman, & Basilico, 2013) We can share numerous examples, both visible and
invisible,
representing the legacies of colonial mindset and practices. We also need to
understand that the “historical” form of colonialism has metamorphosed into the
“newest” form of colonialism dictated by technology and wealth with use of both
hard and soft power through alliances and interest groups. (Farmer et al., 2013) Then, the question would be
rightly asked, “what are these practices and mindset prevalent even today?” In
this essay, we will delve into two legacies of colonial medicine. These are the
repetition of same colonial mindset in recent Ebola response in West Africa and
the other that relates to the persistence of vertical nature of programs
practiced even today in Africa and Asia.
First, let me walk you
through the repetition of the same colonial mindset through sensationalism of
sickness, as one of the legacies of colonial medicine, among African
population. The best example would be the recent “Ebola” crisis that
destabilized West Africa, particularly in Sierra Leone, Liberia and Guinea in
the year 2014. Over the years of Ebola crisis, the western international media
created worldwide alerts and fear concerned only with “sensationalism” and
“breaking news”. This trend in the social media intensified the social
suffering of those local people living in poverty stricken communities, as an
unintended consequence of their reporting. (Kleinman, 2010) There were lots of criticism
the way international organizations like World Health Organization (WHO)
approached this global health crisis. The process driven bureaucratic practices
and processes were felt to be insensitive of human dignity and social
suffering. (Farmer, 2015) The whole period of Ebola
crisis was perceived as a mixture of stark reality and cruel drama of
“unacceptable” human right violation. This was acutely felt by African people
who had to travel to Europe and other parts
of the globe. One of the example can be
the deaths of local health care professionals like Dr. Khan and Salia, which
depicts the bitter reality of socially constructed mindset. (Farmer, 2015) This lead to their exclusion from intensive care units in United States, which
could have saved them. The repetition of the same old mindset and practices was
visible and evident advocating for quick technical fixes to Ebola like
problems, which forgetting the socio-economic disparities that leads to abject
poverty and social instability. Also, the way western media projected the
crisis was itself not helpful in solving the bigger systemic issues that had historical roots in the colonial period. A vehement advocate
for global health and equity, Paul Farmer, in his article The Caregivers Disease guides us through the rough history of the “white men’s grave” through a story that connects us
to Graham Greene’s Journey without Maps.
(Farmer, 2015) With background history of
“identified” and “unidentified” deaths as a result of infectious diseases
prevalent in the early 1900s, Farmer argues that the persistence of colonial
legacies veiled as humanitarian assistance threaten the very principle of
global health equity and its ethical practices. (Farmer, 2015) In this regards, “the crisis
caravan” arrived in these “unstable” war torn countries with lots of noise full
of sound and fury with “stuffs” like money and “temporary” expertise. While,
the experts, specialists and bureaucrats either forgot “out of ignorance” or
neglected “out of arrogance”, the simple fact that these countries lacked
“staff”, “space” and “system” needed for sustainable health care delivery
practice. (Farmer, 2015)
Second reason
that I would like put forward, why the persistence of vertical nature of
programs practiced in Africa and Asia even today, could be a second example for
continuation of colonial medicine legacy.
While this can
be a bit of a controversial statement; it is fair to say that Global Polio
Eradication Initiative (GPEI), as another example, is not free of criticism
even though the endgame is just a
few years away. This global health initiative also has its roots in smallpox eradication, which
harbors the ghost of colonial medicine in terms of its funding mechanism. There are also mixed
opinions regarding
its use of political
maneuvering in both “sensitive” and “high risk” areas engaged in the
eradication efforts. Noteworthy, polio eradication is also vertical in nature
like small pox eradication. The effort relies heavily on “technological fix”
through vaccine and there is a strong criticism that very little efforts are
put on the
strengthening of health systems,
which can be sustainable and improve primary health care in the community. (Farmer et al., 2013) Now, there is also an
increasing criticism that WHO is mobilizing experts and consultants from low
income countries, in security compromised areas, while disregarding their
professional growth and physical security. Moreover, these experts are not given proper health
insurance coverage and salary. In contrast, the professionals from developed
countries are handsomely paid and adequately covered in terms of health
benefits with hardship allowances. This is purely an exploitation that is rooted
in mindset of using indentured laborers like colonialist exploited people of
Indians and African origin.
In summary, the above
explanations describe separately the legacies of colonial medicine in terms of
mindset and its practices that have persisted till today. One practice that
stands out and highly criticized is the “sensationalism” of sickness that
inflict the poverty stricken communities by western media. The other legacy that is ironically of global
importance is polio eradication initiative that is currently focused in
Nigeria, Afghanistan and Pakistan. This eradication program is rooted in
vertical nature with huge funding. However, this program has been criticized
for turning its blind eye in the health system strengthening of the country. Therefore, it is fair to say that the
legacies of colonial medicine is still persistent and practiced in low income
countries in various forms and sizes.
Reference:
Farmer, P. (2015). The Caregivers’ Disease. London Review
of Books, 37(10), 25–28. Retrieved from
http://www.lrb.co.uk/v37/n10/paul-farmer/the-caregivers-disease
Farmer, P., Jim Yong,
K., Kleinman, A., & Basilico, M. (2013). Colonial Medicine and Its Legacies.
In Reimagining Global Health: An Introduction (pp. 33–73). University of
California Press, Berkleyand Los Angeles, California.
Kleinman, A. (2010).
Four social theories for global health. Lancet, 375(9725),
1518–1519. http://doi.org/10.1016/S0140-6736(10)60646-0
