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