Doubts

I'm not going to tell you how it is, I'm going to tell you how I want it to be. I'm not going to tell you that every time I assess “needs” in the slum, I may be extending and consolidating colonialism in my own little way. I’m going to tell you that my colleagues and I constantly strive to act in responsible and empowering ways, giving agency back to our “disadvantaged” and “marginalized” target population. I’m not going to tell you that every time I go out of the house, getting a rickshaw, getting a meal, getting a coke, getting a check-up, getting our kids into school, I rely on my white face, my blonde hair, my blue eyes, my first language, that I use all these things as convenient stand-ins, as proxies, as a quick reference that I don’t belong, but what’s more, that I should be privileged for my difference, that my striking not-belonging is not a handicap, no, it’s something to be striven for and it’s a shortcut to accessing one last reserve of colonial power. No, I’d rather tell you that I constantly chafe at this, that being shouted at in the street, that gathering stares as I walk to work, that having people touch me, look at me, ask me for a hand-out, that these minor inconveniences more than make up for all the other minor and major hardships I am spared for the accident of my birth as a white, relatively well-off, Anglophone American male.

I will be one of the first to tell you that, by offering our children the opportunity to go to college (and even high school) in the United States and Europe, we are offering them the infinite possibilities that should be accorded to every person as a human right. What I’ll omit, however, is that behind this push for education, for travel, for a “global perspective”, lies the nagging implication that Indian education and even languages, by virtue of their local-ness, their particularity and their provinciality, are inferior and to be avoided whenever possible.

I won’t tell you that I worry that I’m lazy and ineffective, that I’m undertrained, underprepared and generally come from too privileged a background to know and get done what needs to be done. I’ll tell you that I’m doing the best I can. I’ll make grand statements about the “lessons I’ve learned” that I need to worry about my own mental health, my own physical health, and my own family. I’ll tell you that public health is a field you learn on the ground, that classrooms only serve to separate you from what you’re really supposed to be working on. I’ll tell you that my trips across the globe are necessary, that they’re something I just have to do. I’ll tell you that the days off I take when I feel shitty, run-down or otherwise decide that I don’t want to leave the house are necessary for my own well-being, and that without my own health, how can I improve the health of those around me? I’ll conveniently leave out the fact that I’m lucky enough that my next meal doesn’t depend on what kind of business I got in the market that day, that trips across the world (twice a year!) are something that a vanishingly small proportion of the global population can aspire to, that my cold wouldn’t even register on the sickness scale of those with whom I work.

I won’t tell you that my job is as much about me as it is about anything else. I’ll leave out the fact that I feel like a failure if I’ve not achieved a life outside of my country of origin. I won’t tell you about that certain macho pride I get when I talk about the worms, the germs and the bucket baths I take every morning. And of course I’ll completely ignore the fact that, even after years of moving between South America, the United States, Europe and India, I still feel the draw of the “exotic” and wish I could travel to the Taj, the lakes of Kerala, the bathing ghats of Varanasi and the ridiculous glitziness of Bombay. Of course I’m a tourist in my own home, but that’s not something I’ll admit to readily.

Instead I’ll feign boredom when I tell you about the buffalo herds I duck through on the way to work. I’ll pretend that the festivals, feasts and processions that I don’t understand are pure everyday annoyance, just something that prevents me from completing my “very important work”. I’ll tell you that my reasons for traveling to India have nothing to do with all those Salman Rushdie, Arundhati Roy and Rohinton Mistry novels I read in high school, oh no, I go to India because I want to right the wrongs of that seemingly-limitless procession that has beaten a well-worn path northwest to southeast for unknown ages. I don’t go to gawk, to exploit, to “find myself”, to export or to feel superior to those around me. No, I go for a genuine desire to leave the world a bit better than I found it, I go out of solidarity and compassion, and above all I go for well-thought-out reasons. I think therefore I am different. I won’t tell you that I doubt my own reasons. I won’t tell you that much of the previous horde held similar ideals. I won’t tell you that I’m terrified to find out how my “good intentions” are being twisted, perverted into providing just a nicer shade of paint for the old pesky power dynamic.

Of course I worry out loud that I’m forgetting the lessons taught in my universities. I don’t remember as much comparative health, statistics or critical theory as I used to. There is a worry that I keep inside, however, that these things never meant anything, that they don’t go far enough, that they don’t see the whole problem, that they don’t strive hard enough for the right solutions. That they’re descriptive, and I need something prescriptive to give my life structure. That maybe I’ve learned the wrong things, and there’s no university in the world that teaches the skills I need for my self-appointed position.

I’m not going to tell you that I constantly second-guess my conversations, my education and my career choices. I’m going to tell you that this is the best job I’ve ever had. I’m not going to tell you how it is, because honestly, I’m not sure myself.

benefits for whom?

that's a weak title. sorry.

anyways, a professor of mine, actually the first professor of mine that ever even mentioned that "development" might not be a universally positive force (and he did a lot more than mention it--that's what the entire class was about. imagine how eye-opening that was after learning for 3.5 years of university that development is awesome because it always helps the poor [fill in the blank]), said that the only thing that development can universally be shown to do is to produce more developers. or something along those lines. a mere two years later, i think i could list a couple more things that development (i'm gonna omit the scare quotes throughout this post and the rest of this blog from now on, but just imagine they're there) usually does (in my experience), but that's pretty tangential to what i'm on about right now.

what i'm on about is being produced as a developer.

so a lot of this can probably go under the heading of "pseudo-guilty whinings of an over-educated guy with too much time on his hands", so i might as well get that out of the way first. i'm currently going through the song-and-dance of getting a work visa so that i can get paid for the work i do in india. so there's that direct benefit: i get enough cash to pay for my cokes and a couple dinners out every month. which is cool, that i don't have to constantly watch my savings drop and drop. but i mean, that just underlines the first problem: the type of work i do (and, let's be honest, a lot of corporate jobs too) might as well have a minimum parental income as part of the job description, with all the free work (internships, volunteering, working hard at lots of random extracurriculars) that you need to do before you actually start getting paid.

i mean, its not to say that development is the exclusive domain of the upper end of the class scale, but in many ways it might as well be. i don't deny that there are a lot of great grassroots organizations out there (TASO is a great example of this), but the mere fact that you have to qualify it with "grassroots" tells you something: it's not the norm (and we all know about norms and power dynamics), and as the "marked" and "particular", grassroots organizations have a lot of trouble being taken seriously. anyways, the point is, i use my class and my parent's wealth to my advantage in order to "finance" my employment. the same is true of a lot of other fields of work (to get a job as a lawyer, and usually even to get into law school in the first place, you need to be interning a law firm for a few summers), and development is maybe even better than most, but also has the effect of preventing social mobility in the end.

so on top of that, above and beyond who gets the job, it often weirds me out just thinking about getting this job at all. i mean, who am i (and by extension, who is anyone) to get paid to dispense something that i fervently believe should be free to people to whom my salary would seem like a small fortune? i mean, maybe my money could be better spent hiring and training someone from the busti to do my job. whoever got hired would certainly have an easier time of it, and would probably/possibly bring a more "authentic" viewpoint to it, however you want to define that. but again, ignoring who gets the job, its strange to be essentially living off of other people's misfortunes. i'm not a collection agency or anything, but in theory i have a selfish financial incentive not to eliminate poverty and/or poor health outcomes, as i would then be obsolete. i think my motives are separate enough (enough) from pure profit motive that i would still work to eliminate poverty and/or poor health outcomes, and anyways there's very little danger of me personally working myself out of a job. which gets back around to the original statement of my professor, my work isn't necessarily good at "developing" people (or improving health outcomes or anything on a large scale) but really about producing myself and the people with whom i work as the developer and the developees: they are created in an image (that they wouldn't necessarily have been created in had i not ever landed in india) that sets them in a very particular place in a number of global power dynamics.

so that's been a lot of fairly negative posts lately. in the next few posts, i really hope to put forth a few of our proposals, a bit of what we're doing, as a positive alternative to normal "development". i'll do my best to stay fairly critical (in the theoretical sense) of our actions, but i think it is necessary to make proposals rather than just critiquing existing programs/past/future actions if you're working in any sort of applied setting. so: stay tuned!

my life as a dinosaur

there's a guy who rocks out while playing his keyboard near my house every weekend, but the great part is the keyboard is clearly playing itself on "demo mode". nice!please click to read it larger, i promise it's worth it. here's the transcript if you're lazy:

T-Rex: So this homeless guy asked me for change yesterday.
T-Rex: The first thing I thought was "Sure!".
T-Rex: But THEN I thought well, wait, if I really want to fight homelessness wouldn't this money be better spent on community programs that fight it, both through helping the homeless and through political change? But then I thought, well, this guy's right here, you know, and saying I'm gonna to make a donation isn't gonna cut it. And then I thought, wait, this guy looks pretty out of it - is he going to spend my money on drugs? Do I want to tacitly support addiction?
Dromiceiomimus: And then you thought how prejudiced that was?
T-Rex: Sure did!
T-Rex: Then I thought, even if he is going to spend it on drugs, is it my job to deny him money? Should I go around enforcing my morality on others? Then I thought, geez man, how ridiculous am I that a guy asking for change throws me into these throes of self-doubt and analysis?
Utahraptor: Pretty ridiculous?
T-Rex: Pretty ridiculous! But then I recalled Socrates' "the unexamined life is not worth living" and at that point my head pretty much exploded.
Dromiceiomimus: Did you give the guy anything?
T-Rex: I gave him all my change and whispered "DON'T TELL ANYONE UNTIL I CAN FIGURE US OUT"?

quick gripe

I realize that a big part of the reason I’m often unhappy with what I do is that, in many ways, my job is incredibly negative. Unfortunately, our project is at a stage where we’re (and by we, I mostly mean I, as I’m the only one working on health projects full-time) struggling to keep our (my) heads above water. We do what we can for the people we’ve already “taken” as patients, try to treat the most urgent needs of those we haven’t “taken”, and pretty much turn away the rest. So it’s become that at least half of my interactions with people in the centre and in the street are them asking me for things that I just don’t think I can do (or don’t want to deal with, or there’s not even a difference, I don’t know).

And there are basically two ways to look at that: either me turning them away isn’t really going to affect there health much, as they’ll just go pay for it themselves somewhere; or me turning them away is pretty much the end of the line, and they go back home and wait out (or don’t) whatever their malady is. Neither of those is particularly palatable, from my point of view. If the former is true, then my job isn’t really necessary, and I’m risking imperialism/perpetuating the current oppressive societal structures for no good reason. If it’s the latter, I’m no longer acting as an agent of change and have turned into just another health access point that is blocked. In which case, my job isn’t really necessary and I’m risking imperialism/perpetuating the current oppressive societal structures for no good reason.

It’s not like both of those are true all the time, and I’m sure often enough it’s not even that me turning them away is really going to negatively affect their health in any major way (it’s not like we normally give out basic pain medication or decongestants anyways). But I can’t always help the sneaking suspicion that every time I tell someone I’m too busy, or I don’t go up to their home because they missed a BSL, or I wait until they come to me for meds when I know they need a refill, I’m not quite doing the very thing that I explicitly came to do.

And fine. My excuses are in general legitimate. I’m stretched beyond thin, doing the majority of the health stuff on my own. I can’t just indiscriminately take everyone that comes in off the street, take them at their word for where they live, what their need is, how much of our time they need. If I did that, AIC would be broke and I would be crazy. But there’s the nagging thought that I could do more, I could rest less, I don’t need a day off every week. Still...

Still, where does the line come where I’m just another barrier to healthcare? I mean, fine, there’s a fair amount of “maybe if I’m super inefficient then you’ll just give up and go away” in the bureaucracy in pretty much every institution we’ve dealt with here, but in general, I think people are doing the best work they can under the circumstances.

It comes down to the fact that in a lot of ways I identify a lot more closely with people working at the hospitals that with the people I take to the hospital.

no, really, abortion does affect your daily life

i sit reading (and now writing about) Said's Orientalism in this coffee shop, mocha, in pune, india. i realize the irony here (or maybe that's an alanis morisette definition, i honestly don't remember anymore): this cafe is ostensibly a hookah bar, and the menu is full of fun things like the word "sheesha" written to look like ةاي ققاي, some crazy take on arabic. and, of course, the fact that i'm probably, in some way, engaging in orientalism myself by just being here, categorizing, judging and working to improve the "other" (the poor, poor indians) by witnessing their ills, feeling moderately outraged, and helping them to use free services already in existence. andi've been struggling a lot (see my other posts) with both the quality of work i'm doing and the premise behind it. but that's neither here nor there. i'm here to Blog For Choice, apparently.

so obviously, abortion exists here in india. and not always in the good, "it's a woman's right to her body" kind of way, but a lot of time sin the "it's my right as a man to have sons" kind of way. the at-birth sex ratio is something ridiculous like 1.2:1 males:females, and sex-linked abortions, though illegal (it's illegal to tell the sex of a fetus), are certainly not uncommon. so yeah, ilet's not pretend that even the right to end an unwanted pregnancy is always and necessarily an empowering thing for a woman. but don't worry, i don't think anyone was. so abortion is also sometimes a tool of the patriarchy. brilliant.

but i wanted to really write about how i see personal control of fertility (of which abortion is certainly a part) as necessarily empowering. india is, by many standards, a very conservative place (bla bla generalizing reducing essentializing ok fine). tubal ligation (TL) and abortion can only be done with the consent of both husband and wife (god only knows what would happen outside of marriage), though i suspect a vasectomy only requires one signature. sterilization is actually highly promoted around here, and there are some pretty good incentives in place (everything free at the hospital, and they hand you cash at the end). but dozens of women have approached s in the past month telling us that they want us to help them out with their TL's, rather than they doing it on their own.

well, generally government services aren't of the highest standard (though i do believe that in almost all cases they are completely acceptable at least). the sassoon general hospital is more akin to a bus station than an american hospital, honestly. but we've found this gem of a public hospital about 8km away (so transport is a bit of a hassle), but in general it's quiet, clean has a good patient to attendant ratio and is served by some of th e best doctors in the city. so we've been taking patients there, especially for gynaecological surgeries. it requires a lot of effort and time on our part (and a fair bit of money for rickshaws), but the women are generally quite happy with the lebvel of services they get there. so there's one barrier overcome, mostly: the goverment services near us ar crappy (and our patients haven't had good experiences there), but the good government services are too far away to be realistically accessible.

so the next barrier to free reproductive choice (and this is not in order of importance or in what order they affect people, just in the order that i happen to be writing) has in general been a pervasive and rigid patriarchy that prevents women from exvercising free agency over their reproductive system. though this varies pretty drastically and is expressed differently in the three communities in which we work, there's a definite pressure on women to produce a large number of children, male children in particular. we've got one woman who cried when she saw her fetus on the sonogram, because "it looks too big, they'll never take that out" (she already has three young boys). another woman is younger than me and has eight (!!!!!!!!) children, but her husband would "never agree to an operation [for her]". a third has three girls, had an abortion last year (you can guess why) and is constantly asking us to put her on fertility medications, as she hasn't had her period in months. the first's husband didn't agree to an abortion (there's still plenty of time), but said she can get a TL when she delivers. the second finally got her TL after her husband was to embarrassed to discuss the matter with us. the third has no known reason for her current amennorhea, so there's not even a discussion about what we're doing there.

so yeah, wtf. i hope that the three quick sketches above illustrate pretty well (without much commentary) why i'm pro-choice, in all matters. banning or unnecessarily restricting abortion (for any reason) is just another step into treating women as walking incubators/baby factories. women (and men, of course) should have complete control of what goes in and out of their bodies, and when. i don't care who helped put it there, or wants to see it once it's out, if it's in you or there is the prospect of it going into you, it's your choice, period.

half/half/half

so i've been meaning to write something here, but i havent because i've been busy/irregularly inspired. which causes me to write half posts, and then leave them, and pick up something else a few weeks later. anyways, so i've decided to post a couple of half posts with maybe another half for a wrap up, to at least document my state of mind over the past few months (god has it already nearly been 5 months?). without further ado:

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6/10/07: "i lasted an entire month, that's not bad"

"sometimes in the morning, i am petrified and can't move,
awake, but cannot open my eyes
...
but you'll smile, you'll make it through,
you'll fake it, if you have to"
-Rilo Kiley, A Better Son/Daughter

so i don't usually start this blog with an epigraph, like i sometimes do with the photo blog, because it seems, well, really cheesy. but i guess this one seemed to really fit my current mood, so i figured why the hell not. it's not like anyone is gonna notice except me.

so it's been exactly a month since arriving in india, and the wall must have come at some point in the past 72 hours. i guess i probably don't have much profound to say except to report what i did, since i haven't had time to think much less read for myself in the past month.

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13/11/07: "what's eating me"

"sometimes in the morning, i am petrified and can't move,
awake, but cannot open my eyes
...
but you'll smile, you'll make it through,
you'll fake it, if you have to"
-Rilo Kiley, A Better Son/Daughter

so i was gonna use that epigraph for the beginning of a post about a month ago that i never got around to finishing, but then i never got around to finishing it, and anyways, it seems fitting again. which is depressing, but maybe i'll get to my own personal issues later on. right now i wanted to talk out (to myself, i suppose) some of the more philosophical issues i've been having with stuff as it's been going on here.

i guess i should start with the standard disclaimer i had for that piece about care, that this is more a criticism of the theoretical underpinnings of a project and not really about the execution, and certainly not about the beliefs and attitudes of those carrying it out. and i really want to add now that this isn't even so much a critique of the theoretical underpinnings of the project i'm working on, as much as me talking out via the internet the possible future problems with possible future projects, since most of the stuff i have the larger problems with still hasn't happened yet, and might not happen (and almost certainly won't happen in the forms i'm envisioning, since nothing ever does).

and a further caveat being that i'm academically severely out of shape, and my english is even beginning to suck.

and begin:

my first and biggest issue lately is with a possible feeding program that we're beginning. in the community we're working with (funny, even though i've forgotten most of what i've learned in the last year or two, i still instinctively cringe at the word "community". but i guess i might as well use it, since i can't remember clearly why i'm not supposed to), there are a number of elderly folks that for one reason or another completely lack any support. either they don't have kids around, or their kids don't support them, or their kids can't even support themselves. but generally, they're unable to work themselves, the don't receive outside help, and thus basically they don't eat. and thus basically they're slowly starving. so yeah, severe malnutrition in a vulnerable and generally necessarily dependent group. it seems like a no-brainer i guess, but for some reason the

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14/01/08: [cut back to the present]

so there i am. or was. fun little trip through my psyche, or whatever. now, in january, 4.5 months, nearly, since i arrived here to start my "job" im feeling a lot better about it. my hindi is at least passable, i'm finding a bit more agency/feeling a bit more empowered in my current role, and i may even start getting paid soon. basically a symbolic salary, but at least it will pay for my caffeine. and get me a work visa, which is a bit more secure than my current entry visa (which i'm not even supposed to have, making it especially fun to extend). the downside is i have to get back to the states to get that worked out, and before that, i need to get stuff worked out here. i'll be leaving my work for at least a month, assuming nothing goes even minorly wrong, and leaving hindi for the same period. which might be a bit scarier. because i'll come back and feel like i felt in early october, which was not a great place to be in, mentally.

anyways, i've been feeling guilty about my work lately. it used to be, especially in the beginning, work from sun up to almost sun up again. lately, ive put in my 8-10 hours a day, but in a spotty way. and much more of my work has been the administrative/managerial work that i just didn't have to do before. sorting out volunteer timetables/job descriptions, fighting tooth and nail for concessions at hospitals, making budgets and keeping track of our accounts, writing reports about what i've been doing. and yeah, i spend 3-4 hours every day working in the centre or the hospital or the slum, but it doesn't feel like enough. i feel like i have all this free time (like writing now on this bloody blog) and i'm not doing enough to expand our programs, or open them to more people. at least half my time sitting in the centre talking to people is taken up explaining to people that come in off the streets that no, we're not just going to take them to the hospital or the pharmacy right now, we're going to go about constructing our program in our own slow and methodical (or at least we tell ourselves) way.

so, here' s a checklist of things i want to do before i have to get the hell out of india in a month:

....... work out lesson plans for the month/month-and-a-half that i'll be gone for health education
....... get my february (and january, for that matter) cataract surgeries done, so that i can pick up march when i get back
....... get a bit of actual data/data sets going, so i can do some useful analysis while im away (as well as getting the gis data sets from shelter associates)
....... figure out a few points for easy government/free clinic medical access, to send people to in my absence

and stepping back, it looks like i'm incredibly bought into the idea of myself as indispensable. and i know that people are becoming too reliant on my/our agency and less on their own. or maybe they're not. i guess it really shouldn't be for me to say.

ugh, and now im getting ridiculously regressive in my thinking. not really helpful. but i've got excuses, at least. my dog is really sick and i get to give it little 2.5ml squirts in the mouth of egg whites and electrolytes every 30 minutes or so. and my computer's dying, meaning the power cord is now broken more often than not, therefore i may not accomplish any of the above tasks, ever. AND my visa is expiring in under a month and i still don't know if i'm even going to extend it or just head back to the states to get an entirely new one.

ok, so fuck coherence, im too fucking stressed. this post is officially over.