What Medicine and International Development Can Learn From Each Other

welcome

to the future

my name is salaha ali i’m here

to break down barriers

what see nobody likes a narcissist

but once in a while being able to look

at ourselves

from the outsider’s eye can be

incredibly

powerful in fact

one of the first stories ever told was

the greek myth

of narcissus legend has it

that narcissus was the most beautiful

hunter

that ever lived so beautiful was he

that anyone who saw him immediately

fell in love with him this was the case

for the nymph echo but when echo

finally confessed her love for

narcissists

he responded with disdain and contempt

shunning her until she faded away

as punishment for this the gods led

narcissus to a pool as he leaned

over the water gazing for the very first

time

at what he didn’t realize was his

reflection

narcissus fell in love

but when he finally realized that the

object of his love

was merely an image that would not

materialize

he wasted away and in his place

a flower which we know today as the

narcissus flower

blossomed

as children we learned that the story of

narcissus

is a warning against narcissism

we learn that narcissist

self-destruction

stems from his self-obsession

but what many don’t realize is that this

is a story of transformation

because ultimately narcissus is not

totally destroyed

he is transformed into a flower

and the source of that transformation

is self-reflection

so i want to take you back four years

back to the beginning of my undergrad

and

i’ll admit it i was kind of the classic

example of a pre-med student

i studied life sciences i participated

in health care clubs

shout out to hosa i conducted medical

research at the center for addiction and

mental health

and every week i would put on my scrubs

and i would drive to centenary hospital

just up the road

where i would spend hours shadowing

physicians

and supporting patients oh and i

kind of may have dressed up as a doctor

for halloween once

okay twice but medicine as i saw it

was an avenue to save and meaningfully

improve

lives and the goodness of that endeavor

was really what drew me in

yet in the fourth in my fourth year of

study

that same desire to save and to

meaningfully improve lives

led me down another path the path

of international development wait

did she say international development

yes

international development the study of

global issues

of poverty social inequality and

oppression

under a queen elizabeth scholarship i

was selected to spend the summer in

ghana

where i would work with an international

ngo

to economically empower women and youth

i embarked on that journey with shining

optimism i was

so excited to be part of an initiative

that was giving back to less privileged

communities

but as i attended training after

training

class after class i was astounded

by the criticisms i encountered

international development profits from

poverty they said

international development reproduces

colonialism

they said international development

promotes dependency

they said international development

should be stopped

altogether

it was difficult to accept these

criticisms

see i was raised by a father who worked

in development and yes he’s right here

in the audience he’s the guy who’s

smiling a little too widely

because he didn’t know i was going to

talk about him

i was raised in a home where i was

taught to always remember the less

fortunate

to never waste a dinner that my parents

provided

i was raised practicing a religion

that preached charity and giving

i had never fathomed the idea that my

innocent

almost altruistic actions could be so

controversial

but as i completed more and more

coursework in the field

the grounding for these criticisms

became clearer

see international development which was

focused

primarily on improving the quality of

life

for those in developing countries was

born out of a colonialist

ideal to civilize the backward peoples

of the non-white world foreign aid was

often used by governments

as a way to negotiate unfair trade

agreements

turning development into a way of

profiting

from poverty and finally

the focus of too many projects on doing

for rather than with had led developing

countries

to become dependent on their benefactors

in the long run so i began to understand

the controversy around development

but i started to wonder was this field

just problematic

should i just go back to medicine as i

had started

or did medicine this field i had only

ever

revered also have the same challenges

was medicine a modern colonial force did

doctors

profit from vulnerability and could

medical practice

promote dependency

i had never encountered this sort of

criticism

about this field so i went down the

rabbit hole

researching this further and i really

had to go down the rabbit hole because

there wasn’t a whole lot

see during colonialism western medicine

was imposed on the colonies as superior

to traditional healing practices

and sadly this imposition continues

today

even within national borders with

indigenous healing

often quickly dismissed as inferior

to evidence-based intervention

the capitalistic system in which

medicine

operates where patients pay for

treatment and sometimes

consultation allow doctors to profit

from vulnerability

and illness and finally

our over-reliance on medical advice and

treatment

even in areas where we can care for

ourselves

has raised questions about medicine

promoting

doctor dependency

so as i began to understand it medicine

and international development

were really fraught with the same

challenges

but there was one question that lingered

why had these difficulties

led development practitioners to

consider totally denouncing their field

but had not led doctors to say oh let’s

stop practicing

what were the key differences between

these disciplines

that led one to be far more criticized

than the other

and was there perhaps a way to use these

differences

to ultimately improve both fields

so i sat down and i got to work

after months of research consultation

and reflecting on my personal

experiences i arrived at some answers

but today i want to share three

differences

between medicine and international

development that explained

this disproportionate level of criticism

the first their approach to intervention

the second their professional standards

and the third their willingness to

engage in self-criticism

so the first point of departure between

medicine and international development

was in their approach to intervention

so in medicine we improve health

outcomes

by primarily addressing the individual

factors

that shape health

so we’ve all been to the doctor at some

point in our lives

for a cold a flu a virus

did she say virus i see some panic

spreading across the room

put the masks down i’m not talking about

coronavirus

but what does your doctor do well

she most likely will prescribe some

medication

that manages the symptoms of that

infection a cough

or a runny nose but what no physician

will tell you to do

is to stage a protest against

environmental pollution because honey

that is a contributor to the spread of

influenza

but an international development

practitioner might and no it’s not

because we’re all social justice

warriors

but because the development approach

to solving problems is not to simply

change

some aspect of ourselves rather to

address the wide variety of factors

the political the economic the social

that shape our well-being

yet this dichotomy provides some insight

into why development is so much more

challenged than medicine because

tackling broad issues

like climate change economic inequality

education and access

on an international scale possibly

required

far greater resources far greater time

far greater collaboration than changing

the makeup

of a single person

the second point of departure between

medicine and international development

was in their professional standards so

as many of us

know it takes about 10 years to earn a

medical degree

even i’m dreading it

but the same cannot be said for

international development while some

people will have degrees in the

discipline

there’s no formal education required to

work in the field

but that fact has led to disastrous

outcomes

one story that recently made headlines

was that of an american woman

named renee bach she’s pictured in this

photo

at the age of 20 with absolutely no

medical training

she decided to start an ngo in uganda to

help malnourished children

what this culminated in was bach

posing as a physician and conducting

dangerous medical procedures

blood transfusions on the kids

the result 105

children died

and that is exactly the problem with

development

that anybody regardless of their

expertise

can run any project with absolutely no

centralized oversight

bach is now being prosecuted under

ugandan laws

thankfully but i ask

where are the safeguards that prevent

these atrocities

from happening in the first place when

our good intentions

can have such grave consequences the

need

for regulation and restriction could not

be clearer

the same dichotomy in professional

standards can also be seen

in the interventions used by medicine

and development

in medicine for a drug to be approved

for the treatment of a condition

it must pass several stages of research

and testing yet there’s no required

amount of research

that must be conducted before an

intervention and development

is applied from my personal experience

in ghana

most of the projects which by the way

involve millions of dollars of funding

are based on very limited research

conducted on small

samples and using very weak

methodologies

and yes i agree there are limitations to

what we can know from research

but it’s still important that we

understand the communities we serve

and the interventions we use before we

blindly

take action

and finally perhaps the best explanation

for why international development was

far more criticized than medicine

was that we were more willing to look at

ourselves critically

in development see

the development studies program at most

institutions

is fundamentally critical in fact ours

is called the center for critical

development studies it’s in the name

students are encouraged to question the

motivations the strategies

and the outcomes of their field

criticism

is celebrated as a force for ethical

awareness

and improvement but there is no center

for critical medical studies

yes medical students are encouraged to

think critically about research

and about treatment but they’re not

asked to question medicine

as a practice to criticize the

philosophy

of medicine critical theorizing

is deemphasized in the medical

curriculum in favor

of advancing solutions

yet medicine remains ripe with

controversy about over

treatment over diagnosis over antagonism

of death

so medicine like development is

fundamentally controversial

but doctors just seem a little less

inclined to see their field as such

so what can we do with this divergence

well the difference between these fields

i think

points to a way that we can help both

improve

from development medicine must learn to

address

the broad variety of factors outside of

the individual

that shape health outcomes and yes there

has been a trend towards this

but this is still a very underdeveloped

part of the curriculum

from medicine development must learn to

increase professional standards

preventing atrocities like the one we

saw in uganda

from development medicine must learn to

increase

self-criticism using this as another

driver

of improvement and ethical awareness

and finally from medicine development

must learn

to balance critical theorizing with the

generation of solutions

allowing the field to improve rather

than be completely denounced

so you’re probably wondering why i care

about all of this

well when i was abroad i saw a lot of

development projects

that failed but what i also saw

were people people who lacked access

to basic necessities who had so much

less than i did

and there is a problem with that

discrepancy regardless of whether we

know the way to address it

i recently started an ngo with some of

my colleagues in ghana

we focus on providing reproductive

health education

economic opportunities and mentorship

to young women one of our projects

involved organizing the very first

reproductive health seminar

in a community with a 60 percent rate of

teenage pregnancy

as a result 400 residents were able to

benefit

from free health education

what i’ve learned is that there is a way

to do development right and i think with

greater crosstalk

between fields greater interdisciplinary

dialogue

we can get closer to understanding how

my desire to be a physician also hasn’t

faded

even despite understanding all the

controversy around it

as i prepare to start medical school in

the fall

i want to keep the insights i have

gained from my development work

close they provide a different

perspective

on how i should think about medicine

broadly

reflexively

and as i continue to pursue both fields

i want there to be ongoing dialogue

between medicine and development not

just in this wild head of mine

but out here in classrooms like this

around the world

as i close i want to bring us back to

that image of our friend narcissus

hovering at a pool in all of his

reflection

he reminds us that we are indeed

self-absorbed creatures who can become

engrossed

in our lives and our fields of study

but he also shows us how looking at

ourselves

reflexively can help us transform

into something beautiful and just like

narcissists

medicine and international development

can grow

by examining themselves from the eyes

of each other but first we must be

willing to head down by the water

to sit and to ponder to stare

curiously for what we might learn

that willingness requires tremendous

courage

and strength and i wish us all

exactly that thank you

you