It’s no secret that I am not a big proponent of health camps – for all the obvious reasons. Despite the very quantifiable benefit of a rapid delivery of emergency care in remote places, we’re working in a different space, trying to uproot transience, lack of accountability, saviorism, and the indignity that in the final reckoning still goes with things like…well, health camps in rural developing world communities.
I know this seems unrelated, but I remember a day back in 2004 when I had made my morning run to the junction at Naudanda, and a bus was just pulling up along the Bagloon Highway. Some tourists got out and they had a collection of enormous plastic bags from which they began extracting articles of clothing. A crowd of people gathered around, reaching for the anonymous pieces, irrespective of size or relevance or history or purpose. Just in case something was useful. As I stood watching, my running shoes expelling wafty dust from the dry road, there was no analysis or judgement that went through my head; I was just frozen by a wave of shame in my heart. For the indignity, the dehumanization, the unspeakable power differential before my eyes, in which I was complicit. For the participation we are all assigned before we’ve even arrived: savior, beggar, observer.
There was never a time in my life when I thought, you know what my passion is? Dentistry! Working in oral health was something that grew out of being assigned the observer role, which turned out to be very uncomfortable. I’m more in the business of looking at casting and lines, of trying to rewrite parts of the script. Oral health is an ideal area to be working on this because disease is so prevalent, chronic, and preventable, with services disproportionately skewed toward upper classes (globally, not just in Nepal). This is an area where it is entirely possible to create a system that does not rely on helicopter interventions organized to address the greatest volume of teeth, but relies, instead, on structural accessibility and strong public health policies.
I’ve had a decade and a half to grapple with the problem of myself as a white person working in an underprivileged country. What I realized pretty early on is that the only way to handle that is to embrace it with all four of your limbs and hang on tight for the whole ride. Centuries of colonialism have conferred on my skin and nationality a power and predicament that none of us, in the current act, created or can do away with, which only leaves us the option to be honest about the whole clumsy issue. The way this translates is that I think carefully about when and how I show my white face, and in fact, this is not an uncommon topic of discussion in our office when we are planning fieldwork. Over the years I have mostly built myself into a behind-the-scenes role, while Nepali people fill all the stage characters. But when it’s strategic, our team openly brainstorms over how my whiteness and Americanness (two, not one, power plays) can be leveraged to bring legitimacy to others or bend things in favor of a local agenda. That is what these privileges should be used for. In fact, shirking that opportunity seems almost as problematic as not knowing when to stay out of the way.
So, if you are staying with me here, we have on one spoon some peanut butter (health camps, with their historic problems) and on the other some jelly (colonialism, lending power and privilege to white foreigners), and we are about to make a kickass sandwich. Are you ready? Welcome to the promotional community-based dental camp. We did this last year in Hansapur, almost by accident, when we arranged for fifteen foreigners to go do a survey, while six Nepali dental technicians set up a field clinic and treated 300 people. The result was that Hansapur asked us to help them start a local dental clinic and school-based oral health programs with providers of their own.
YOU GUYS, we thought. This is a good idea. This is an excellent use of a brigade of white people.
So this year, for Nepal Smiles 2.0, we flipped the agenda. The purpose of the camp is promotional, and in the mean time, we’ll do a survey, treat some patients, get extra supervised field training for our technicians to cap off their week of professional development. But the primary goal is to expose a rural community to resources we can help them develop, while a large group of outsiders adds legitimacy by being part of the process.
Welcome to the village of Dhital.
In the promotional community-based dental camp, our agenda was explicitly not to save all the teeth in Dhital. This is quite a different stance than your typical health camp. We limited patients to fifty, so that technicians would be able to properly go through the entire respectful assessment and treatment planning process they had practiced all week. We invited politicians and social leaders in Dhital to observe the treatment room and meet our field teams from other villages. All services at the camp were provided by technicians and assistants from surrounding villages while Dr. Bethy consulted on the learning from the week, lending her stature as well as her expertise. As patients came through the camp, we treated a limited number within the constraints of this approach, and then provided referrals to our partner hospital in Pokhara. We accept these limitations because we are also laying out a pathway for Dhital to launch its own similar services.
I have been mulling over this quite a bit and would love to see this conversation happening out in the world. What do you think? How do we negotiate a racial story that has been hundreds of years in the making, and leverage it to make a more equitable world? Surely, there are people out there ready to rip this conversation to pieces. But we should have it. What I see daily is that, for rural Nepali health care providers like those we train, being associated with people from California and New Zealand confers legitimacy. Hand-wringing over this is less useful than taking responsibility for these roles we’ve been cast in, and unflinchingly examining how we play them in a way that ultimately deconstructs them, chips away at the hard shell of racism and colonialism, and eventually, creates new a revised and more just theater. This is not something that happens by accident, or quickly or easily, or without mistakes. And definitely not without calling it out in the first place.
Here’s us, having our imperfect go.
Thank you for reading, Nancy!
Hi! Reading this I now understand why you liked my post about my horse and the equine dentist. I live in such a privileged world that even my horse can have a dentist. Best wishes to you and your group for the work you are doing.
Hi Anne – yes, and horses with dentists are considerably more delightful than dentistry alone! Thanks for stopping by here. 🙂
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Colour is something one has to acknowledge first and then go beyond.
I’m French, I was born in Pakistan, and raised in Africa… 🙂 It is always interesting to find oneself in the “minority”. The (white) colour of your skin matters far less than the work you do.
Thank you for this post.
Hi Brian, I imagine you must have started grappling with these questions from an earlier age than I did! To experience oneself as a minority during early adulthood, when one has been raised to see minority status in others, is quite powerful, even without the burden of structural oppression on top of it. Your upbringing sounds wonderfully colorful in all respects. 🙂
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Hi Laura (?), indeed it places things in perspective. Which is basically to “get over it”. Let’s I go (back) to Kenya. I still speak a bit of Swahili. So, ok, I’m a mzungu. (White in Swahili). So? Let’s have a beer. Or play soccer. Or do something. And to top that my personal experience is that there is an equal proportion of morons in every… culture to put it that way. But, there is the same proportion of fantastic people. Cheers.
Thanks for sharing:)
This is such a great title.
Brilliant, brilliant! Brilliant! Brilliant ideas, brilliant actions, brilliant writing!
With your blog you step out of the role of observer in a BIG WAY!…
But what I am reading between the lines here is that even from your “observer” role you have already been managing to make intelligent, compassionate changes in the world around you.
I call this both worthiness and humility. And I respect it deeply. You go, girl! 😘
Wow, thank you so much for the lovely feedback, Ana! I hope you are able to keep reading and/or share and get more people involved in grappling with this convo…and again thank you, your comment brightened my day!
I’ve encountered a number of people over time who have a sense of “white guilt”, sometimes it almost seems as though there is a promotional aspect to it meaning there are and have been those among my people who prey upon it for personal enrichment.
My response has always been guilt is accrued on an individual and governmental basis, if
it is a sin of the father it isn’t genetically encoded, it is acquired through deed, words, and
attitude – a person is either part of the problem or part of the solution.
History is more than decades or centuries past, it is the very moment I spend typing this and
your reading of it – something people should be aware of but seldom are. As we write our individual history we should take note of what is being written and live accordingly., I will not
be judged by what others have done nor should anyone else.
Live like you mean it, be well, and stay strong.
Thank you so much for your thoughtful response. Indeed it is very tempting to fall in to “guilt” and a lot of what we see in aid-states like Nepal is a bipolar spasm between guilt and saviorsm. Neither one is particularly useful or grounded. Both contribute to a detrimental environment that undermines meaningful social justice. At the end of the day guilt is quite indulgent! (And yes, contributes to a “promotional,” capitalistic, self-serving approach to basic rights like health equity in poor countries).
However, those in racially privileged categories may be left with a feeling of responsibility, and that should be cultivated. That is not about individual morals or beliefs or whether I am a good person or have friends who are racial minorities, but about the inherited power dynamic of both race and nationality. It is not about me being a bad person either. It is about understanding power structures. For example, you don’t see people in my village in Nepal keeping a blog about me that is read by other rural Nepali people, who get to design ‘programs’ that influence my health care.
So glad you raised this point and curious about your thoughts.
You right – being white with the privilege that comes with it – we didn’t create it, but it is up to us to understand what it means and how many people have been oppressed because it, past and present. Now my family is split. 3 of grandchildren are half black – which means they are black because some people would feel today that these grandchildren are now not as good my other 4 grandchildren. They are inferior, not as intelligent and have been born with a propensity to be criminals. How can that be? So I devote my time to research and educating people. Helping then learn they have been brainwashed over time to think that being white makes them special. Unfortunately, it is long uphill battle.
HI Sonni, what a painful situation it must be to have divisions inside your family over racial differences. I think this is why it’s important that we see ourselves as players in a script that started long ago. We come in to the current situation with baggage that none of us had control over, and nevertheless we are responsible for how we deal with it now. This helps to make the issue less personal on one hand, and the solution very personal on the other. What kind of research and education are you involved in? Thank you for sharing!
Without disagreeing with anything you’ve said, I’d add that part of my experience is that after I’ve acknowledged what being what means in this world of ours, I also need to forget it so I don’t let it separate me.
Hi Ellen, thanks for this important point. I guess that is always the challenge – how we celebrate our differences in a way that brings us together in a rich and honest connection. It’s such a fine line between embracing our identities (and harder still, the power dynamics built in to them) and digging our heels in to rigid categories that build barriers and make us more isolated. For me I find that it’s not about forgetting so much as transcending these things, and learning to build my world view on the many, many things that we all have in common.
This is a brilliant meditation on the whole whiteness question. I’ve thought similar thoughts when pondering how I might help out in poorer neighborhoods here stateside. Working behind the scenes and letting the local people, whatever stripe they be, take the stage~that is very elegant, I think.
Hi Melissa, thank you for the positive comment!
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Going to India and Napal next year.
I am white, but as a one time practitioner of Zen, rather than a right, perhaps it might be a blessing ?
But then again … who’s counting ?
Being of Caledonian descent , I consider
the legacy of colonialism some other anglophile’s burden.
May God bless all your endeavors.
Hi David, thanks for reading and commenting. Ultimately I would argue that colonialism is every anglophile’s burden. Its legacy is ours because we are here, and in the footprint of colonialism we still operate in the colonist’s world–even when we practice individual works of kindness and tolerance and peaceful personal development. Those things are also good; they just don’t absolve us of context, history, and the enormous power imbalances we are left with in the present.
Really enjoyed reading this – insightful and sensitive. Plus constructive, collaborative work.
Thank you! I’m always so interested to hear what people have to say in response to some of these ideas and I appreciate your comment!