CategoryHealth care

Philanthrocapitalism a means to Soft Power in Global Health, by Henrietta Ezegbe

In this era of global rise in charity spending, and dependence on donor aid particularly in the spheres of global health by developing nations, It is interesting to see how wealthy philanthropists gain an incredible amount of influence, and basically purchase soft power through mega donations that sometimes even supersede the place of domestic governments. A case in point is the Bill and Melinda Gates Foundation; a powerhouse that plays an incredibly solid role in structuring and governing policies at top levels of international decision-making in the spheres of global health. One cannot help but wonder how a privately owned organization attained such magnitude of power that allows it actually dabble into the affairs of global health governance.

As crucial as donor aids are, they are not without problems as no one holds philanthropists who dole out huge sums of capital and resources accountable. Consequently, the personal principles and ideologies of a few mega donors end up structuring and shaping societies to which they donate, a proof that power lies in the potential to attractively influence the inclinations of others.

Philanthrocapitalism threatens health sovereignty in my opinion. The use of donor aid to structure public institutions often results in directly or indirectly ceding parts of a nations health sovereignty rights to mega donors. For instance, in my experience as a physician providing primary care for People Living with HIV/AIDS in Nigeria, we are faced with evidences of wealthy philanthropists micromanaging global health affairs that should be prerogatives of the government. I argue that these are some of the reasons for extensive zones of abandonment and its resultant health effects particularly among people living with HIV/AIDS in Nigeria. This is as a result of poor coordination by folks with inadequate knowledge of local norms and traditions, and not to mention the issue of internal brain drain.

Philanthropy in my opinion weakens political commitment, and I dare say, the extremes of Philanthrocapitalism indirectly reduce receiving governments to mere placeholders. Corruption, unwillingness to research new grounds, and reluctance to step out of comfort zones are some of the major barriers to thriving governmental sectors in many developing nations. Revitalizing credible governments is a task that developing nations must not take for granted. These nations must work hard to create functional and effective national health care, which I argue, is the building block for establishing health sovereignty and a means to achieving sustained social welfare, and less dependence on donor aid. In conclusion, I wish to reflect on what the stand of wealthy philanthropists would be assuming developing nations move towards achieving total health sovereignty. Will the mega donors be allies to this “movement”?

Dr. Henrietta Ezegbe is a physician and public health practitioner. A fresh graduate from the Simon Fraser University Master of Public Health Program in the Global Health concentration, Henrietta is interested in HIV/AIDS research specifically among underserved population in high and lower middle-income settings. 

Sierra Leone’s laws to protect women have unintended consequences, by Luisa Schneider

Age-of-consent law is complex. If it is set too high, there’s a risk that it will undercut young people’s agency. If it is set too low, it does not offer enough protection for vulnerable young people.

This is a conundrum Sierra Leone has faced in the last decade. In the aftermath of its civil war, the country has focused on ways to address sexual violence and protect young girls from sexual harassment and grooming. One approach was to create and enact laws designed to criminalise violence and empower women and girls.

The Sexual Offences Act is one example of such legislation. Here, the work of the country’s lawmakers has yielded some positive results: the act protects children, especially girls, who are abused by adults.

But it also circumscribes teenagers’ autonomy. The act raised the age of consent for girls and boys to 18. This effectively criminalises sexual activity between consenting young adults.

As I repeatedly witnessed in court cases during more than a year of fieldwork in the capital city, Freetown, it often results in boys from economically marginalised families being imprisoned after their consensual sexual relationships lead to a young woman falling pregnant. It is presumed by the girls’ families and the wider community that such boys cannot afford to support his partner and their child.

This law, along with the country’s ban on pregnant girls attending school, actually harms young women rather than protecting them.

Violence is not just a private matter between people. Regulating it is not the duty of communities or the state alone. Rather, it is the dialogue and the tensions between these different forces which expose not only how things are “supposed to work”, but also how they “really work”.

Lawmakers and those who craft policy that’s meant to empower and protect women need to consider and take seriously the knowledge of grassroots women’s groups and the criticism voiced by citizens and law enforcement. In this way, Sierra Leone can amend what doesn’t work in its legal framework and strengthen what does, to engender real change.

Criminalising relationships

The Sexual Offences Act was passed in 2012. It raised the age to give sexual consent to 18: the idea was that since girls younger than 18 cannot consent to sex, they cannot be coerced into sexual relationships by much older, powerful men.

However, while conducting my research and observing court cases stemming from the law, I realised that the act’s rigidity often undercuts the agency of young Sierra Leoneans and threatens their futures.

Under the act, men can receive a prison sentence of up to 15 years for having sex with a minor. Since consent is no longer considered, both rape and sexual acts that both parties have agreed to fall into the same category.

This meant some of the cases in Sierra Leone’s courts involved 17-year-old girls (the alleged victim) and 19-year-old boys (the accused) who told the court they were in love. In these instances, the sexual relationship had often been reported by one of the teenagers’ relatives, someone in their community, or a pastor or teacher when the girl became pregnant.

One lawyer I spoke to explained why this was the case:

… Usually the families knew and accepted the relationship but then report when the girl gets pregnant. It is mostly poor boys who are convicted, not rapists, because these boys do not have any money to offer the family of the girl. Often the families think that these boys cannot support their daughter and seek revenge for a spoiled future.

The boy’s conviction and imprisonment sets off a chain of events that leaves young women compromised by the very laws that were apparently designed to help them.

Time to reframe

In cases like those I’ve described, the 19-year-old almost always goes to prison. His 17-year-old girlfriend loses her partner and cannot rely on his help to raise their child.

On top of this, she is also prevented from continuing her education. This is because of Sierra Leone’s pregnancy ban, which was declared by the Ministry of Education, Science and Technology when schools re-opened after the Ebola pandemic in 2015.

According to Amnesty International and human rights lawyer Sabrina Mahtani, the ban – which may be enforced through physical checks – aims to protect “innocent girls” by separating them from pregnant girls, who are seen as negative influences. Temporary alternative classes are provided for pregnant girls, but these are limited and increase girls’ feeling of stigma by isolating them from their peers who aren’t pregnant. Many girls don’t return to school once they’ve given birth.

In the example I’ve outlined here, the law has led to the policing of a young couple’s relationship and put both their futures at risk. However, if the law would include these considerations it could refocus on criminalising rape and would not have to send boyfriends who are barely over 18 to prison.

But it can only include such considerations if it goes beyond reporting statistics and the law’s theoretical intention. Local experts can expose the law’s actual effects in relation to increasing existing inequality and power structures. For instance, a health worker at a Rape Crisis Centre told me

..If the SOA would allow people within a certain age range, like 16-21, to consent to sex and criminalise sex between persons of very different age groups and with very young people, it would stop stigmatising pregnant women, stop sending poor boys to prison but continue to protect small girls.

Through community meetings, focus group discussions and the knowledge of local grassroots organisations, law enforcement and service providers, such effects could be made visible and addressed. In this way Sierra Leone’s laws would become both fairer and more relevant.

Luisa T. Schneider is a Postdoctoral research fellow at Max Planck Institute for Social Anthropology. This post has previously appeared on www.theconversation.com

Death, fieldwork, and the personal, by Caitlin Ryan

I suppose that the first thing I did when I sat to write this piece probably underlines the problems we have in academia with emotions and fieldwork. Using my institution’s electronic library search, I typed ‘fieldwork and death’ into the search bar. The results were, predictably, disappointing.

In January 2018, eleven weeks into my twelve-week research trip in Northern Sierra Leone, one of the local researchers I was working with died. She died in the government hospital in Freetown, after a prolonged illness, the details of which are unknown to me. I was mid-breakfast when I got a phone call from Joaque, a man who had been helping me with contacts and access. I didn’t pick up the first time he called, because my mouth was full of bread, but when he called back immediately, I knew.

I want this piece to come flowing out of me, but it’s stuck in my throat like the bread I hastily swallowed as I picked up my phone. “We’ve lost Mafudia” he said.

The day before, I thought I had wrapped-up my project. I left the district town where I’d been for most of the last 11 weeks, and had my driver drop me off at my partner university for a seminar. The other local researcher I was working with, Osman, had come with as well, because we’d had one more meeting on the way back to the university. I’d hugged him goodbye, said that I’d see him soon. I’d meant it, I was already thinking of how I could come back to Sierra Leone. I didn’t mean that I would see him the following day, at a funeral.

I knew she’d been sick when we were working. Long days in remote communities made it clear that she was not well. I asked her every morning how she was feeling. The reply was always the same – ‘thank God.’ She took a day off and went to hospital once while we were working. I expected her to be out for a few days. I called her to say this. She was back the next morning. On several occasions, Osman and Joaque said that she was not well. That she had always been sickly. I assumed that if I kept checking in with her every morning, that she would tell me if she was too ill to work. I didn’t know what her illness was, and it’s not that I didn’t believe she needed medical treatment, but I never assumed that it was life-threatening, and I never pressed her. Just before Christmas, we finished the part of the project I’d hired her for, and she went into hospital two days later. A few days before her birthday. For the next two and half weeks, she was in hospital, first in the district town, then in Freetown. I called Osman. I called her daughter. The week before she died, everyone said she was improving. The doctors were pleased. I planned to stop in to the hospital in between interviews one day when I was in Freetown, but the visiting hours were later. I didn’t go back.

When we talk about fieldwork, the preparations, the joys, the challenges, the logistics of dealing with arranging meetings and dealing with transportation, and eating things you’d normally not eat, and hearing hard stories, no one tells you about how to go to a funeral for a person you’ve worked with for 3 months. No one tells you how to pick out the right kind of clothing, or how much money to give the family. No one tells you that there is no other experience you’ll ever have in field that will make you feel like more of an outsider than not knowing how to behave and grieve in the ‘right’ way. When we talk about coming back from the field, about readjusting and finding our footing again, and sorting through interview notes, no one talks about what to tell your colleagues who ask ‘how was it?’ There’s no good way to answer this when all you can think about is standing outside the boundary of the cemetery with the other women as your colleague, guide, friend, is buried, So, I didn’t really tell my colleagues – only the two who I’m really close to, and my supervisor. As for the rest, when they ask ‘How did it go?’ Any problems?’ I say ‘It went well! I have so much data.’ The words almost get stuck in my throat as I rush to get them out. Mostly, no one talks about how all of this will leave you with feelings of guilt so intense that in some moments, you cannot think of anything else – What if I’d insisted that she go to hospital earlier? Or insisted that she was too ill to keep working? Or paid to have her admitted to private hospital? Or? Or? Or…………

Weeks later, I went to give advice to a colleague’s project team about how I’d dealt with the university’s finance office and logistics and receipts. One of her PhD students raises a great question – in light of the university’s policy that research assistants have to have university contracts, what is the university’s policy about liability to our hired research assistant? I’d expected questions about these contracts, and so I’d brought my copies. When he asked the question, I was looking at Mafudia’s handwriting on her contract. I covered it with another piece of paper, lost my voice, and struggled to get out that the university had no liability, but that we had a responsibility to think of what our own moral liability was. Feeling obligated to explain my spluttering, I told them briefly what had happened, and then left.

My guilt, my feelings of obligation – to her family, to academic discussions about fieldwork – are tangled in my project. I feel pressure to get publications out as soon as possible so Mafudia wouldn’t be disappointed – or so I can tell Osman that I’ve kept my word. But reading the interviews she conducted is a struggle. I can hear her voice in the notes she took at meetings. And then I feel guilt for feeling so upset – I am not her daughter. She was not my daughter, sister, wife. I am not grieving in the right way.

At her funeral, I sat – straight-backed – in a borrowed shirt, by hair tightly wrapped in a scarf. I dug my nails into my palms. I bit the inside of my mouth, set my jaw, curled my toes into balls in my shoes. I was not supposed to cry. I started to cry a few times – and was told (kindly) to ‘bear it up’ because it was God’s will.

Some kindly American missionaries drove massively out of their way to drop me back in the district town after I got the news in the university. I’d packed a bag in 10 minutes – cash, phone charger, toothbrush. I don’t know what I was thinking about clothes, I left the university in a filthy t-shirt and stained pants. I had to borrow clothes when I got to the district town several hours later. Of all the things I could have brought that would have made sense, for some reason, rushing out of my room at the university, I’d grabbed the pineapple I’d bought the day before. I arrived back at the guest house I’d checked out of 24 hours previously, sweaty, not clothed for a funeral, and clutching a pineapple. Mercifully, it’s a small town, and Mafudia was well-loved, and I didn’t have to tell anyone why I was back. One of the cooks tied my hair in a scarf. There were so many small kindnesses – the barman took me to the funeral on his motorbike, the guesthouse manager refused to charge me, a woman I knew loaned me clothes, and the next morning, her husband dropped me to a major road junction so I could get shared transport back to the university. Two shared taxis and a motorbike – 4 hours crammed into the passenger seat of the taxi with another person, seat molding digging into my hip – exhausted – drained – felt like some sort of penance. That night, I told my mom what had happened. The guilt – of not doing more – of making Mafudia work too much – of not seeing how sick she was – of pushing her too hard – came out in sobs. My mom was so alarmed about my mental state that she emailed a friend of mine who’d spent a lot of time in West Africa and asked her to call me. When she called, I felt like I could finally explain to someone who understood – that a research assistant is never just an employee or colleague – but that they become, for a time, the person you trust most in the world. The intensity of the relationship cannot be brushed off. She told me that if the same thing had happened to her when she’d done fieldwork, that she would feel the same guilt. That I wasn’t guilty, but that my feelings of guilt were legitimate. My feelings of guilt are legitimate.

I am not guilty of causing Mafudia’s death.

There is nothing in any training for fieldwork that prepares you for this. Over the years, I’ve had excellent conversations, mostly informal, about how fieldwork training is inadequate, how emotions play a huge role, how fieldwork is hard. None of those prepared me for this. My friends and colleagues – the ones I’ve told – have been kind and supportive since I’ve been back, but I have this enduring feeling that something needs to come of this that creates a space for academics can talk about death in the field. I know that I cannot be the only one who has had this experience, and I cannot let this slide without forcing a broader conversation about our moral liability, Maybe if I’d have this conversation before, I would have given more thought to how to offer private hospital admission to Mafudia, or I would have insisted that the whole research team take a few days off. Maybe this couldn’t have changed anything, but I also feel like I owe it to her to say her name, and talk about her death.

It’s been a year now. Sometimes, I collide with a thought about Mafudia like I’ve walked into a wall. Once, it was walking into a grocery store and seeing a woman with a look of intense concentration that reminded me of her. Just before Christmas, I was out for a run and realized that it had been exactly a year to the day that I’d last seen her, and the thought stopped me in my tracks. I know that these are feelings that anyone could have when dealing with loss. These feelings are not about emotions and fieldwork. But they also are, because I can’t find the precise place where the personal breaks from the field.

The questions I have for myself now are mostly about Mafudia’s daughter, and what if, if anything, I can do for her. Mostly, I’m grappling with why I feel like I need to do something. If I offer to pay for her school, am I doing it to make myself feel better? If doing something makes a material difference in her life, does it matter why I did it? How are my feelings of needing to do something tied up relations of race and colonialism? If I think about this in terms of ‘responsibility’ to her, it feels patronizing, and if I think about it in terms of ‘debt’ – to Mafudia – is that better or does it imply that at some point the ‘debt’ is repaid? Or maybe my feelings about this don’t matter, and what does matter is that I could be in a position to contribute financially to the daughter of someone I cared about? These questions get tangled in other questions about doing fieldwork – about how it can be done with justice and human dignity at the forefront, and also, if this is enough.

I don’t know if writing this is right, or if I have dislodged the right words from my throat. I don’t know if it is too self-centered or too introspective or too much of rambling narrative. I do know that Mafudia was kind, hard-working, strong-minded, independent, and cared deeply about the rights of marginalized people in her country. She worked as an advocate for prisoners, for human rights, she took testimony from survivors of the war during the truth and reconciliation commission, she was so well-loved and admired, there were hundreds of people at her funeral, and you could feel the grief cutting through everyone. She helped people wherever she went but never took shit from anyone. I know that the world is better place for her being here, and a worse place in her absence.

Caitlin Ryan is an Assistant Professor at the University of Groningen. Her work focuses on gender and land deals, and the Women, Peace and Security Agenda.

Elective Affinities: Fragility and Injustice in the Field, by Luisa Enria

2017

They say they can’t tell if I have malaria or not, maybe it’s something else. “Just lie down, try the drip, and see if it helps”. I am in the hospital in the North of Sierra Leone, I have a headache of a magnitude I have never experienced before, I have a high fever and joint pains, the fans are not working and to get through a huge number of patients in the overcrowded district hospitals the nurses are injecting strong antibiotics straight into the veins in my hand. In the evening the pain is slightly subsiding thanks to the drugs, as they bring in Kadiatu. She is about 14, she is incredibly thin but is brought in kicking and screaming and it takes three adults to keep her down on the bed and to stop her from ripping out the IVs once they are put in. Her family don’t speak English so I translate between them and the foreign doctor: “They say they haven’t used any traditional medicine on her”. Her screams are making me shiver, “I don’t think I can do this, I don’t think I can do this” I keep repeating to myself. By the next morning Kadiatu has died—my own illness worsens and I am transferred to the capital where I get better treatment.

2012

I am doing my PhD research with unemployed youth in Freetown, studying violence in the aftermath of war. I hang out in “ghettos”, I sit endlessly as young men drink, smoke, listen to music, and we talk about “the system”. It’s intense, but rewarding work, I’m learning every day, I think it’s what I have been trained to do, the full immersion experience. Then, one day the violence I am researching comes very close, too close, it rips my world apart. Continue reading

Media Myopia and the Image of Africa, by Paul Stoller

There seems to be no limit to the media’s unwitting capacity to mischaracterize the African continent. Given the often inaccurate and superficial stories that emerge from Africa, is it any wonder that many people in the U.S., for example, think that Africa is one country? Is it any wonder that many Americans believe that the Africa is routinely ruled by greedy despots who live in extravagant luxury while their people suffer in the grip of poverty?

As I mentioned in several previous blogs on this sad subject, the print and broadcast media have usually constructed an African narrative of endless ethnic warfare, incessant drought, tragic famine, unspeakable epidemics, rampant rape and chilling child abuse. The narrative also underscores dysfunctional family relations in which elderly patriarchs brutalize young women some of whom may be their wives, some of who may be their daughters or nieces. In short, the media narrative about Africa makes it seem like a brutal place where people lead miserable lives, a place that is so destitute and hopeless, that “we” need to “help” them.

Continue reading

© 2019 Mats Utas

Theme by Anders NorénUp ↑