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.
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All The Pieces 