On the first day of lecture in my introductory global health course, the professor asked if Americans working in low-income settings abroad causes more harm than good. I know this is a basic question that we have all heard, but for me it caused a flashback.
It is three days until my flight out of Bangladesh, after a year of ethnographic research on postpartum depression in Dhaka, and I’m standing ankle deep in water in a four feet wide slum road. Trash and a dead rat float near by. Drenched in sweat, all I can think about is a shower and how I shouldn’t have come today. I didn’t have to give gifts to all my informants; I had come the week before but a few women had not been home. I look up and see three shredded pieces of tin that make the walls of some of the shacks appear as prison bars. Through them, the face of one of my informants, a seventeen-year-old named Teeptee, peered through, her baby slumped over her shoulder.
There are of course many different ways that “westerners” work in global health, and therefore many different ways to cause harm and good. For me, I was doing an exploratory, anthropological study on stigma towards mental health and the experience of post-birth stress. I was not providing services, but rather getting to know thirty-six women living in a slum on a very personal basis to understand their life struggles, with the goal being to generate knowledge of a generally neglected population. I did not have any connections with people who would make a program or intervention out of my findings. Is this harmful?
Teeptee and I shared our lives with each other over the course of months. I showed her
pictures of my family, my university, my parents’ house in Maine on the lake. She shared her story of marrying her drug-addicted husband without her parents’ consent, leaving her, a teenage mother, in a situation where her family refuses to help her because it was a love marriage rather than an arranged one. She told me about her husband’s abuse and the time he tried to kill her. My interpreter, an incredible Bangladeshi woman, and I knew that Teeptee enjoyed our company and consistently invited us to return. I consciously made my questions extremely open ended and vague so that she drove the dialog. We had a connection, and it was a safe space for her to open up about her life.
But was it harmful that I gave her a glimpse of my world? She saw my IPhone, and asked to see pictures of my life. She saw my wallet and the way I regularly bought scores of children treats. She saw the way I walked wherever I wanted, whenever I wanted, unaccompanied by a man.
And before we both realized it, it was time for me to go home. We had been in her space together and I had momentarily felt the harsh reality of her life sentence: and now I could leave. Leave to go back to a bedroom two times the size of her slum home that I share with no one, back to my restaurants, my libraries and theories and lecturers who claim ownership and scholarship of places they have never lived long-term – something I find myself doing all the time about Bangladesh. Is this harmful? There is an argument saying no: her story might not be heard if I don’t share it, her health problems not evaluated, her needs not assessed.
The true privilege that characterizes the global power dynamic is that I can have both my world and hers, but she can only have hers. I can go to her home and learn about the tragedies of humanity, but I can step out of it as soon as I want. I can cry with her; I can help her buy baby formula and medicine. She spoke with me, maybe because she wanted to, but it is naive to ignore the possibility that she only talked to me because she wanted economic assistance. I figured this was good for both of us- I get access to a secret world and people in her situation could benefit from research that will hopefully contribute to our general knowledge of how to make the world a better place for women.
But sometimes, when I think about it late at night, I feel like I was buying her world. I was taking it for my Fulbright stamp of approval, I was sharing it at conferences and in classrooms, I was using it to grow and feel passionate and successful and purposeful.
I feared my friend had become dependent on me, after months of sharing her struggle and me listening intently. Then I left, and I know from her words and her situation in a Dhaka slum, that there is no one else she can regularly share her emotional stress with. I know it was good for her to be heard- she told me she wanted her name and story in a book. But when I chose to leave, had the choice to leave, how did that make her feel? My presence undoubtedly gave her hope and demonstrated how there are people who care about her wellbeing. It gave her a glimpse of how things could get better, how there is a world out there that is better. What happened to that hope when I made my last slum visit, gave my last smile and parcel of fruit?
If I knew, I could more readily approach the question of if this kind of global health work causes more harm than good.