Probably no surprise to anyone who knows anything about starting an NGO (or any sort of corporation not-for-profit or for-), my (our) new project has stagnated, probably not to be revived. I still feel mostly convinced that it was based on a good idea, it was supposed to operate in communities that have a lot of potential and energy that could otherwise be wasted, and was addressing actual needs with programs that were highly appropriate to the context. If anyone out there has a few thousand dollars and a lot of organizing energy laying around, and wants to invest it in slum communities in India, please let me know. Thoughts about that organization, and the one before it that I left in the spring, still hurt—a lot—but I can mostly avoid thinking of them. Lucky me.
Me, I’ve mostly retreated from the whole “program” thing, into a world of research and theories and proposals. Doing social science (of the RCT variety) in one of the biggest cities in India, it’s a relief to mostly write grants, write surveys, clean data, run do-files, and still go out at night with a group of friends (who are not my co-workers). Might be less of a relief in the next months as I’m managing survey and fieldwork teams 7am-9pm, 7 days a week, but honestly, and I’m a terrible person to both my current and previous job for saying this, it’s really great to be doing something I don’t actually care about.
It’s not that I don’t care at all. Intellectually, I really couldn’t be that much more engaged (at least, without someone forcing me to read 400 pages of theory each week in addition to my other work). I work with people who are pretty much universally agreed to be the biggest geniuses/rockstars/“experts” in their field, all of my coworkers (who, blessedly, each have their own projects so there is no toe-stepping) are mini-geniuses destined for great things, and our regular meets and drinking are deliciously nerdy. My project is full of interesting challenges, and I’ve found out I really like writing surveys (or, at least the first draft. The 8th draft after two months and one day before the launch is a little less fun), asking interesting questions, teasing out relationships and pathways and connections.
I got a motorcycle. I have friends, a stable place to live, time to myself, plenty to do with friends and visitors, I live in one of the world’s great cities, and I even have some time to travel (and a salary which is below the poverty line, but way more than I really need to get by). I’m content, maybe even happy.
Probably time to move on. I’ve gotten my applications for grad school (MPH) done, and this year I’m promising myself not to freak out a month before school starts, and actually attend (yeah I’ve got and will have even more loans, but who doesn’t). I do fantasize about my job literally being to sit and read and think and talk and write all day, and I’m going to really enjoy this degree. I’ve even made tentative plans to get a PhD afterwards, and hopefully never again need to leave school, but we’ll see how much I like it in two years. No need to rush into these kinds of things.
I’m in a very different place than I was three years ago, but at least I’m still in the same field. I think I’ve made more than my share of mistakes for a 25-year-old (thank god I don’t have kids, or I probably would have seriously fucked up. better to get it out of my system now), but I’m figuring out where I’m happy, and where I’m useful. The world probably doesn’t need another American fieldworker drinking in hotels in tropical cities, but hopefully there’s some room for one more clueless academic.
defining needs ii: defining community
yeah, so, started the "miniseries" a few months ago when i had an office job in dc and was getting pumped to go to grad school. then didn't go to grad school, got a job in delhi, and have been somewhat busy/distracted since.
but! the job involves a lot of academic research, into the effects of various types of voter education campaigns in slums in india's capital city, which while interesting in its own right, has me thinking a lot about defining community. chris blattman in a (quote in a) recent post touched on what i am going to say baldly: identities, whether individual or group, are created by exclusions. this is true whether you're defining your own (i am this because i am not that) or someone else (they are that because they are not this).
the logical analogy at this point would be to say that identity:individual :: community:group (roughly--i know it's not perfect). but the problem is that looking at even individual identity, one "identity" is actually composed of multiple overlapping identities--loose affiliations with different groups (language, gender, region, occupation, political, etc.) or one's relation to others (mother, loner, leader, etc.). individual identities always, by definition almost, relate a person to other people around him/her.
it would be great if you could extend that to the group/community level, saying everyone sharing one particular identity (language, for example) is a community. two problems with that are that first, it's hard to say who "shares" a specific (in this case linguistic) identity--do you need to speak it from birth, speak it fluently, speak it predominantly, speak it most comfortably, speak it in a certain way (even ignoring the blurry lines between different linguistic varieties); second, this identity is just one of many that the individuals in this group may have--they may be divided by religion, income, nationality, race, gender, education, occupation, etc.
the largest theoretical "problem" (for me) with community, though, is the exclusionary action of this definition. dominant groups (eg, white english-speaking males in the US) usually have the luxury of having their community defined at the most basic level of societal structure, allowing them to exist as the "unmarked" or the "norm", thus discursively becoming the only "neutral" observers, and in many ways becoming the ultimate arbiters of culture (and politics, etc). "ethnic" communities exist often in order to preserve or promote their community in the face of the normalisation of the dominant group, but in this way often cause their group to become, by definition, marked and subordinate (or think of the rite of "coming out" in the gay community, by which one marks oneself as "not-normal", with the assumed sexuality being heterosexual in the absence of such a process. but i digress).
so communities are problematic--but why are they useful, and how are they used? for me, in my work, they're useful because they are a way of segmenting the mass of "everyone in the world" into discrete, manageable groups, setting boundaries to my work or study. by defining one group as the "target population" (ignoring for the moment the way in which that designation is made), you can set boundaries to what you will and will not work on, and with whom you will and will not work. by naming one group as the target, you implicitly place another group or groups out of bounds.
usually, these groups are recognized (by me, the person who has really no business being there) by self-identification--if someone says they're one thing, they're that thing. this is really a great and not-great way to do things. on the plus side, at least you're not putting people in boxes that they wouldn't put themselves in (as long as you're not pressuring them to choose something when the distinction is meaningless to them--see the colonial history of nigeria (or a lot of the rest of africa) for examples of this).
on the negative, it takes a lot of time, and a lot of talking to people, and usually a lot of dead ends. i worked in pune for a couple years, in one slum, and with only two communities. in the end, i got to know pretty much everyone living within a couple of kilometers of there by sight, and got to know the boundaries between different self-identified groups there. but, i don't know the right word for these "groups" in marathi, hindi or even english. the point is, i couldn't go in there and simply ask "to which group do you belong in regards to x dimension?", but rather relied on knowledge passed to me from my colleagues and months of face-to-face discussions in homes, getting to know genealogies, accents, naming patterns and the historical memories of people. on top of that, there was never (ever) a clear and all-encompassing consensus on who was in one group and who was in another. sub-groups, groups that may or may not have been the same but broke off in the past, personal feelings, and the context of the conversation always affected answers, and couldn't really be taken into account.
for my job now, we're working on a "complete" descriptive accounting of the life of the urban poor in delhi (a city of between 12 and 15 million, depending on who and how you ask). this will take a lot of surveys, a lot of pseudo-ethnography, and eventually an identification of group "informants" to answer questions about the "community" as a whole. i've yet to wrap my head around a decent way to decide who is able to speak for a community, and apply that in 100 (at least) different areas of the city. defining a community is difficult enough, especially given that different overlapping communities may form for different purposes--linguistic communities of migrants living near one another, or a community of women who access services at the same community centre, or a community of men working at a cluster of mechanics shops, or a religious community comprised of persons speaking many different languages.
my colleagues have often said that this is going to be "fairly easy, if time consuming", that we can go into an area, generally ask around for the "leader", and once a consensus begins to emerge, interview that person. i'm afraid that that approach is going to leave out a lot of very interesting variation, especially if we prompt people by giving examples of leadership (in political affairs, for example).
at least that's a bridge to cross when we come to it.
-------------------------------------------------------------------------
related posts:
defining needs i: defining poverty
Burn it to the Ground; or, Defining Needs: The Miniseries
but! the job involves a lot of academic research, into the effects of various types of voter education campaigns in slums in india's capital city, which while interesting in its own right, has me thinking a lot about defining community. chris blattman in a (quote in a) recent post touched on what i am going to say baldly: identities, whether individual or group, are created by exclusions. this is true whether you're defining your own (i am this because i am not that) or someone else (they are that because they are not this).
the logical analogy at this point would be to say that identity:individual :: community:group (roughly--i know it's not perfect). but the problem is that looking at even individual identity, one "identity" is actually composed of multiple overlapping identities--loose affiliations with different groups (language, gender, region, occupation, political, etc.) or one's relation to others (mother, loner, leader, etc.). individual identities always, by definition almost, relate a person to other people around him/her.
it would be great if you could extend that to the group/community level, saying everyone sharing one particular identity (language, for example) is a community. two problems with that are that first, it's hard to say who "shares" a specific (in this case linguistic) identity--do you need to speak it from birth, speak it fluently, speak it predominantly, speak it most comfortably, speak it in a certain way (even ignoring the blurry lines between different linguistic varieties); second, this identity is just one of many that the individuals in this group may have--they may be divided by religion, income, nationality, race, gender, education, occupation, etc.
the largest theoretical "problem" (for me) with community, though, is the exclusionary action of this definition. dominant groups (eg, white english-speaking males in the US) usually have the luxury of having their community defined at the most basic level of societal structure, allowing them to exist as the "unmarked" or the "norm", thus discursively becoming the only "neutral" observers, and in many ways becoming the ultimate arbiters of culture (and politics, etc). "ethnic" communities exist often in order to preserve or promote their community in the face of the normalisation of the dominant group, but in this way often cause their group to become, by definition, marked and subordinate (or think of the rite of "coming out" in the gay community, by which one marks oneself as "not-normal", with the assumed sexuality being heterosexual in the absence of such a process. but i digress).
so communities are problematic--but why are they useful, and how are they used? for me, in my work, they're useful because they are a way of segmenting the mass of "everyone in the world" into discrete, manageable groups, setting boundaries to my work or study. by defining one group as the "target population" (ignoring for the moment the way in which that designation is made), you can set boundaries to what you will and will not work on, and with whom you will and will not work. by naming one group as the target, you implicitly place another group or groups out of bounds.
usually, these groups are recognized (by me, the person who has really no business being there) by self-identification--if someone says they're one thing, they're that thing. this is really a great and not-great way to do things. on the plus side, at least you're not putting people in boxes that they wouldn't put themselves in (as long as you're not pressuring them to choose something when the distinction is meaningless to them--see the colonial history of nigeria (or a lot of the rest of africa) for examples of this).
on the negative, it takes a lot of time, and a lot of talking to people, and usually a lot of dead ends. i worked in pune for a couple years, in one slum, and with only two communities. in the end, i got to know pretty much everyone living within a couple of kilometers of there by sight, and got to know the boundaries between different self-identified groups there. but, i don't know the right word for these "groups" in marathi, hindi or even english. the point is, i couldn't go in there and simply ask "to which group do you belong in regards to x dimension?", but rather relied on knowledge passed to me from my colleagues and months of face-to-face discussions in homes, getting to know genealogies, accents, naming patterns and the historical memories of people. on top of that, there was never (ever) a clear and all-encompassing consensus on who was in one group and who was in another. sub-groups, groups that may or may not have been the same but broke off in the past, personal feelings, and the context of the conversation always affected answers, and couldn't really be taken into account.
for my job now, we're working on a "complete" descriptive accounting of the life of the urban poor in delhi (a city of between 12 and 15 million, depending on who and how you ask). this will take a lot of surveys, a lot of pseudo-ethnography, and eventually an identification of group "informants" to answer questions about the "community" as a whole. i've yet to wrap my head around a decent way to decide who is able to speak for a community, and apply that in 100 (at least) different areas of the city. defining a community is difficult enough, especially given that different overlapping communities may form for different purposes--linguistic communities of migrants living near one another, or a community of women who access services at the same community centre, or a community of men working at a cluster of mechanics shops, or a religious community comprised of persons speaking many different languages.
my colleagues have often said that this is going to be "fairly easy, if time consuming", that we can go into an area, generally ask around for the "leader", and once a consensus begins to emerge, interview that person. i'm afraid that that approach is going to leave out a lot of very interesting variation, especially if we prompt people by giving examples of leadership (in political affairs, for example).
at least that's a bridge to cross when we come to it.
-------------------------------------------------------------------------
related posts:
defining needs i: defining poverty
Burn it to the Ground; or, Defining Needs: The Miniseries
Defining Needs I: Defining Poverty
So the first definition that needs to be dealt with (and the one that started me on this trail) is "poverty" (which I'm taking to be the noun form of the adjective "poor", without significantly changing the meaning). So it's not entirely easy to explain my thought process as I fell asleep last night, but it started at this post over at Alanna Shaikh's Blood and Milk blog, specifically the last comment (as of this writing) about the "conundrum"--giving Knicks jerseys to kids at refugee camps can be exploitative and degrading, but so can telling "poverty tourists" (which, already, I'd put right up there with the Smithsonian's placement of an exhibit on "African culture" in the natural history museum) not to share food or even eat in front of residents during their tours. So, basically, distributing excess can be/is problematic as can be/is not distributing it (even though you're trying to avoid the first problem--and round and round we go).
Stepping back, you can see this is all based on a certain definition of poverty as a lack of resources (whoah that was a jump, but stay with me here). We (you know the "we", us rich, usually white, often male people who are almost invariably healthy citizens of countries in the global north) shy away from both of these issues because it makes us uncomfortable (or, maybe not uncomfortable enough) that we're forced to dehumanize other humans in order to address their needs (as we perceive them) for more resources--they lack things, we should therefore give them things, but that causes problems, and therefore we feel bad either way. Still with me?
So yeah, I think the "poverty is a lack of resources" or even "poverty is a lack of access to resources" definition is somewhat problematic. I generally prefer a definition (that I by the way did not come up with, but cannot for the life of me remember who did, so I can't be a good person and correctly cite this) that states "poverty is a lack of freedom". "Freedom?!" you say, "But, doesn't that mean youre some sort of crazy Bush-y neo-imperialist neo-con?!" My response there would have to be a polite "No, and I'm not even a libertarian".
So what's up with that? Basically, poverty often (always is such an ugly word) stems from a lack of freedoms--freedom to live somewhere in peace, and freedom to move in search of greener pastures; freedom to eat a healthy diet, or access basic (or even not-so-basic) medical care; freedom to send your kids to school, and to work in a dignified and economically-rewarding way; generally the freedom to live or die where, when and under those conditions as you see fit. Lack of freedom is both a symptom and a cause of what we call poverty, or I think it can be stated that lack of freedom begets more lack of freedom, in a self-perpetuating cycle, and in many ways can be seen to be synonymous with poverty. Handily, lack of resources is one (but certainly not the only) cause of poverty, which means yes, at least not all is lost with a lot of current development-think. However, other possible causes of poverty (via lack of freedom) are (in NO PARTICULAR ORDER):
------------------------------------------------------------------------------------------------
Related Posts:
Introduction
Burn it to the Ground; or, Defining Needs: The Miniseries
- Being a woman
- Being not-white
- Being born on the wrong side of an imaginary line
- Speaking the wrong language
- Believing the wrong creation myth
- Juxtaposing your sexuality, external genitalia, manner of dress and/or manner of expression in a way that other find unappealing
- Otherwise being defined as "not normal"
- Et cetera, et cetera, et depressing cetera...
------------------------------------------------------------------------------------------------
Related Posts:
Introduction
Burn it to the Ground; or, Defining Needs: The Miniseries
Burn it to the Ground; or, Defining Needs: the miniseries
So I need to write a series of posts about my own process (which I'm trying to go through again, right now) of defining the place of an international NGO in a poor community without defining said community as needy or said NGO as some god-like expert figure. Obviously, that process starts with a definition of the terms I just used ("community", "poor", "expert", "needs" and "place" are gonna be key words here, since I'm pretty OK with the standard definitions of international and NGO, or at least, OK enough that it's not going to come into play here).
The partial disclaimer to this is that I'm working with a start-up NGO that's based in the US and India (unfortunately, I'll bet you can already guess the dynamic there), and specifically thinking about one community in one slum in one city, and I've not decided yet whether I can name any or all of them--at the very least, please assume there's a lot more concrete thinking going on behind the scenes than you're going to see here. So, yeah, quick update about what's going on, and now it's time to actually think.
The partial disclaimer to this is that I'm working with a start-up NGO that's based in the US and India (unfortunately, I'll bet you can already guess the dynamic there), and specifically thinking about one community in one slum in one city, and I've not decided yet whether I can name any or all of them--at the very least, please assume there's a lot more concrete thinking going on behind the scenes than you're going to see here. So, yeah, quick update about what's going on, and now it's time to actually think.
it's ok, just blog it out (health plan edition)
having issues coming up with this program plan for a new ngo...hopefully writing some notes here (and eliciting comments?) will help me put my mind in order.
--------------------------------------------------------------------------------
in case you don't know me or know exactly what i've been up to, after working for about two years in pune, india, studying quite a bit of public health stuff (mostly independently) and reading too much, i'm working with a friend/former colleague to create an ngo in pune, bombay, kamshet (sorta...it's near lonavala, in the mountains halway from bombay to pune) and possibly eventually up in gujarat to work with members of criminal tribes (mostly the waghris, though expanding from there) who, for a number of specific historical circumstances, are extremely well excluded from pretty much any government assistance. not necessarily the poorest of the poorest of the poor, but definitely up there, and since we see this as primarily a case of lack of access, hopefully this can be worked out mostly in one generation.
so, in broad strokes the organization will be concentrated on education, health and community organizing (not necessarily in that order). education will be a serious bolstering of the education of kids attending govt schools (4+ hours of trilingual tutoring each day, pre-school, etc.), health is working out really basic stuff (childhood diseases, diabetes, pre-natal care, etc.) with a special concentration on tb and mdrtb (something i saw a disturbing increase of over the spring of 2009)--seriously working with the govt rntcp, identifying possibly resistant cases in the surrounding slum community, testing and treating with as little delay as possible. might end up opening a lab (or three) for this in the future depending on cost/benefit analysis, and definitely doing a lot of the DO half of DOTS, which the govt basically ignores. community organizing, though probably not the best or definitive term for this, will be concerned with supporting self-help groups, microfinance and getting legal documentation/representation for members of the community (caste certificates, ration cards, possibly unionizing to protect their employment from the slum "development" plans, etc.).
while i recognize it's kinda a dumb thing to open up a new "development" shop, especially in this economic climate (uh, or just in general), all of us working directly on it (one american, one brit, two indians from pune) have significant ties to the community which we hope to serve, speak the three languages which are most necessary (english, hindi and marathi, and we're working on gujarati), have good relationships with similar orgs in the general area (actually working to set up a health centre/program for an allied organization, hence the thing in kamshet), and generally recognize that this is a community which has specific needs (as they've enunciated them to us) which aren't being met by anyone in the area. so...yeah, there's my little defensive paragraph.
me personally, i'm going to be bouncing back and forth from washington to london to pune/bombay the first year, attending grad school in london, fundraising like a madman in the us and developing plans with local staff/community members to be implemented in my absence (in the areas we know best, namely pune), and then work on expansion to bombay upon moving somewhat permanently to india july 2010.
so there's that, now what will this health program be?
--------------------------------------------------------------------------------
first order of business in health is to deal with primary care, specifically for kids and pregnant women, in an organized and systematic way. best way to do that would be to work through community health workers (CHWs) who could help them access mostly the government services that would be needed--pre-natal care, reminding about vaccination schedules, going with them to different hospitals/ngo offices to get services, and advocating on their behalf to doctors (perhaps one of the biggest barriers to healthcare in the area, ugh). they would be caseworkers, service coordinators, instructors and very basic healthcare providers--giving first-aid, recognizing when more care is needed, and generally checking in on people as needed.
we'll have a part-time doctor at our centre(s) (in pune to start, expanding in 6 months-1 year to bombay, then 2-3 years up to gujarat, somewhat north of ahmedebad, but i cant remember the name of the town right now) who will provide somewhat specialized primary care (prescribing antibiotics only when needed, checking in with diabetics, etc) and medical guidance for CHWs and other staff (when something comes up that nobody recognizes, where to go for specialized care, etc.).
we'll start work on health education in the realm of nutrition--promoting good foods (drumstick, yeah), talking about equal food distribution within a family, talking about practices that should be minimized (tobacco use, lots of chai especially adolescents who are kinda nuts in this area, eating crappy food as opposed to eating cheaper, more nutritious food at home--this will also have a lot to do with women's groups/women's empowerment, and will work closely with the organizing program in this area), that kind of thing. to expand from there to substance use/abuse, sexual health (female AND male), community clean-up campaigns during the monsoon to combat malaria and diarrheal diseases, all that. a lot of that is going to be fairly indistinguishable from the community organizing programs, but that's kinda ok in my mind.
tb will be sorta a strange-looking outgrowth on all this community stuff, since it doesn't make sense fighting tb in one small (~400 people) community and ignoring the entire surrounding slum. so we'll be working with the local govt tb clinic, which blatantly doesnt do the DO part of DOTS at all, to do real proper follow-up of (all? just some? this is starting to sound too ambitious) tb patients in the area, hopefully preventing a lot of acquired resistance and fighting (on our own dime, unfortunately) primary resistance, since the govt blatantly denies its existence in the rntcp plan. that's going to mean a LOT of foot work, carried out primarily by specialized CHWs from around the slum, and lots of culture/sensitivity testing and sometimes providing a lot of expensive medicine.
the point of all the expansion is to work continuously with the waghri community across the main areas in which they live (they're semi-nomadic), so that treatment and education don't have to stop when they go to bombay or the village for two months. we'll have a lot of coordination between CHWs across all sites (who will most likely know each other anyways, since this is a very closely-related community), and managers at all centres, to ensure that nobody falls through the cracks like they have in the past.
------------------------------------
alright, that's my super-short description of the program in my mind, hopefully now i can write that in a more detailed and even somewhat professional way in the actual plan. i havent included any specific targets or evaluation rubrics, which definitely needs to happen. what else am i missing? what is just plain dumb? thanks for your help in advance.
--------------------------------------------------------------------------------
in case you don't know me or know exactly what i've been up to, after working for about two years in pune, india, studying quite a bit of public health stuff (mostly independently) and reading too much, i'm working with a friend/former colleague to create an ngo in pune, bombay, kamshet (sorta...it's near lonavala, in the mountains halway from bombay to pune) and possibly eventually up in gujarat to work with members of criminal tribes (mostly the waghris, though expanding from there) who, for a number of specific historical circumstances, are extremely well excluded from pretty much any government assistance. not necessarily the poorest of the poorest of the poor, but definitely up there, and since we see this as primarily a case of lack of access, hopefully this can be worked out mostly in one generation.
so, in broad strokes the organization will be concentrated on education, health and community organizing (not necessarily in that order). education will be a serious bolstering of the education of kids attending govt schools (4+ hours of trilingual tutoring each day, pre-school, etc.), health is working out really basic stuff (childhood diseases, diabetes, pre-natal care, etc.) with a special concentration on tb and mdrtb (something i saw a disturbing increase of over the spring of 2009)--seriously working with the govt rntcp, identifying possibly resistant cases in the surrounding slum community, testing and treating with as little delay as possible. might end up opening a lab (or three) for this in the future depending on cost/benefit analysis, and definitely doing a lot of the DO half of DOTS, which the govt basically ignores. community organizing, though probably not the best or definitive term for this, will be concerned with supporting self-help groups, microfinance and getting legal documentation/representation for members of the community (caste certificates, ration cards, possibly unionizing to protect their employment from the slum "development" plans, etc.).
while i recognize it's kinda a dumb thing to open up a new "development" shop, especially in this economic climate (uh, or just in general), all of us working directly on it (one american, one brit, two indians from pune) have significant ties to the community which we hope to serve, speak the three languages which are most necessary (english, hindi and marathi, and we're working on gujarati), have good relationships with similar orgs in the general area (actually working to set up a health centre/program for an allied organization, hence the thing in kamshet), and generally recognize that this is a community which has specific needs (as they've enunciated them to us) which aren't being met by anyone in the area. so...yeah, there's my little defensive paragraph.
me personally, i'm going to be bouncing back and forth from washington to london to pune/bombay the first year, attending grad school in london, fundraising like a madman in the us and developing plans with local staff/community members to be implemented in my absence (in the areas we know best, namely pune), and then work on expansion to bombay upon moving somewhat permanently to india july 2010.
so there's that, now what will this health program be?
--------------------------------------------------------------------------------
first order of business in health is to deal with primary care, specifically for kids and pregnant women, in an organized and systematic way. best way to do that would be to work through community health workers (CHWs) who could help them access mostly the government services that would be needed--pre-natal care, reminding about vaccination schedules, going with them to different hospitals/ngo offices to get services, and advocating on their behalf to doctors (perhaps one of the biggest barriers to healthcare in the area, ugh). they would be caseworkers, service coordinators, instructors and very basic healthcare providers--giving first-aid, recognizing when more care is needed, and generally checking in on people as needed.
we'll have a part-time doctor at our centre(s) (in pune to start, expanding in 6 months-1 year to bombay, then 2-3 years up to gujarat, somewhat north of ahmedebad, but i cant remember the name of the town right now) who will provide somewhat specialized primary care (prescribing antibiotics only when needed, checking in with diabetics, etc) and medical guidance for CHWs and other staff (when something comes up that nobody recognizes, where to go for specialized care, etc.).
we'll start work on health education in the realm of nutrition--promoting good foods (drumstick, yeah), talking about equal food distribution within a family, talking about practices that should be minimized (tobacco use, lots of chai especially adolescents who are kinda nuts in this area, eating crappy food as opposed to eating cheaper, more nutritious food at home--this will also have a lot to do with women's groups/women's empowerment, and will work closely with the organizing program in this area), that kind of thing. to expand from there to substance use/abuse, sexual health (female AND male), community clean-up campaigns during the monsoon to combat malaria and diarrheal diseases, all that. a lot of that is going to be fairly indistinguishable from the community organizing programs, but that's kinda ok in my mind.
tb will be sorta a strange-looking outgrowth on all this community stuff, since it doesn't make sense fighting tb in one small (~400 people) community and ignoring the entire surrounding slum. so we'll be working with the local govt tb clinic, which blatantly doesnt do the DO part of DOTS at all, to do real proper follow-up of (all? just some? this is starting to sound too ambitious) tb patients in the area, hopefully preventing a lot of acquired resistance and fighting (on our own dime, unfortunately) primary resistance, since the govt blatantly denies its existence in the rntcp plan. that's going to mean a LOT of foot work, carried out primarily by specialized CHWs from around the slum, and lots of culture/sensitivity testing and sometimes providing a lot of expensive medicine.
the point of all the expansion is to work continuously with the waghri community across the main areas in which they live (they're semi-nomadic), so that treatment and education don't have to stop when they go to bombay or the village for two months. we'll have a lot of coordination between CHWs across all sites (who will most likely know each other anyways, since this is a very closely-related community), and managers at all centres, to ensure that nobody falls through the cracks like they have in the past.
------------------------------------
alright, that's my super-short description of the program in my mind, hopefully now i can write that in a more detailed and even somewhat professional way in the actual plan. i havent included any specific targets or evaluation rubrics, which definitely needs to happen. what else am i missing? what is just plain dumb? thanks for your help in advance.
What happens when you can't get your ideas straight
So, it was recently brought to my attention that the philosophical foundation that I’ve based my health program on is not actually one, but two separate ideas. So now I’m all “Fuck, what do I do?”, and meanwhile we’ve got patients/clients/community members/partners (what do I call them? That’s a whole separate can of worms) who continue to place demands on us, and I’m not entirely sure of what I’m doing.
So, to start with, the idea that I thought my program was founded upon was the idea that health (including healthcare, medical treatment, health education and, broadly, life itself) is not a commodity to be bought and sold, but rather is a human right. Therefore, access to high quality healthcare should be universal and have no regard for income, class, language, race, etc. And in the beginning it was good, and it all seemed so simple.
But then I found myself writing project descriptions—for grants, for the website, for newsletters, for individual donors. And I didn’t notice at the time, but I subtly shifted my writing and speech to the language of access. I wanted to increase access to medications, to medical treatment, to prevention programs, to concerned and genuinely compassionate doctors. Beyond generally believing that this was a good model, that this could significantly improve health outcomes, I think I did this as a way to water down my ideas about universal healthcare, as a way to make them palatable to donors and generally to the people whose support I need in order to reasonably (and by reasonably, I mean, “within my small organization’s budget”) make a difference in the lives of the people I work for.
Selling out, watering down my philosophy, I know. I’m not terribly proud that I would adjust something so basic as the reason that I do the work that I do so as to have more access to money, but hell, at least I’m honest about that.
Anyways, so, the thing is that generally these two ideas work fairly well together. The community we work for is marginalized, without access to health care, and in many ways shows a higher prevalence of a number of diseases because of this lack of access. Our record has generally shown that by increasing access to prompt healthcare, we’ve been able to (for example) reduce child mortality to zero (since mid-2007, where previously most women tell stories about at least one or two children dying) and successfully treat all new cases of tuberculosis, slowing the spread of the disease and decreasing the severity and length of morbidity. So far so good.
Our work has focused mainly on providing intensive follow-up, ensuring doctors and health institutions treat our patients respectfully and fairly, despite linguistic and socioeconomic markers which clearly label our patients as the migrant poor, and providing any necessary treatment. Notice, the first two go along with the “access” focus, while the last generally fits better with the “universal healthcare” aspect of my philosophy.
Where these ideas stop getting along is when we move to the borders of our target population, and begin working with the less poor, usually from other neighboring communities. Along these margins, access to healthcare is spotty, rather than completely absent. People will come to you with reports showing regular blood sugar testing over the past five years, with a few notable gaps, and ask for free testing and treatment for their diabetes.
There are two things you can do here. First, if you were strictly following the dogma that healthcare should be absolutely universal and free, regardless of ability or inability to pay, you would of course provide free testing and treatment. However, if you were looking at this from the perspective of providing universal access, you would see that these people already have some access, the way to ensure steadier access is to provide limited assistance, perhaps for testing or treatment, so that the family, with a reduced burden, will be able to consistently provide the rest.
So that’s what I did on Wednesday. Sounds eminently practical, and in an imperfect world of finite resources, where I work for a small NGO instead of running the world government, it’s probably the best I can do. I can’t, at the moment, handle another full-on diabetic patient (with testing, follow-up, home visits, doctor visits, and paperwork tracking prescriptions) and my organization’s modest budget will be quickly tapped out if we get in the business of giving free medicine to everyone who can in fact afford to buy it themselves. But it always feels shitty, turning someone away because they earn too much money.
I could now go on for a while about a few more things this brings to mind: first, whether we are, by giving medicine and healthcare away for free (but paying for it ourselves) are in fact making a firm stand about the universal necessity of free healthcare, or if we’re just buying into a system that we can’t see a way out of; second, whether, in the context of limited resources, if paying for a prescription of insulin, for example, should fall on the patient, if they are able to pay, or should always fall to the party better able to pay (in which case, it would almost always be the NGO); and finally, if it even makes sense to speak of the “context of limited resources” in a world where most infectious diseases and many chronic diseases would be easily managed by a relatively small redistribution of the world’s wealth—in which case, it might make more sense, then, to stop this “on the ground” work altogether and work only on the side of forcing or coercing a greater redistribution of resources.
But those are questions for another day. As always, I need to get back to the Sisyphean task of improving health, and making do with what we’ve got.
So, to start with, the idea that I thought my program was founded upon was the idea that health (including healthcare, medical treatment, health education and, broadly, life itself) is not a commodity to be bought and sold, but rather is a human right. Therefore, access to high quality healthcare should be universal and have no regard for income, class, language, race, etc. And in the beginning it was good, and it all seemed so simple.
But then I found myself writing project descriptions—for grants, for the website, for newsletters, for individual donors. And I didn’t notice at the time, but I subtly shifted my writing and speech to the language of access. I wanted to increase access to medications, to medical treatment, to prevention programs, to concerned and genuinely compassionate doctors. Beyond generally believing that this was a good model, that this could significantly improve health outcomes, I think I did this as a way to water down my ideas about universal healthcare, as a way to make them palatable to donors and generally to the people whose support I need in order to reasonably (and by reasonably, I mean, “within my small organization’s budget”) make a difference in the lives of the people I work for.
Selling out, watering down my philosophy, I know. I’m not terribly proud that I would adjust something so basic as the reason that I do the work that I do so as to have more access to money, but hell, at least I’m honest about that.
Anyways, so, the thing is that generally these two ideas work fairly well together. The community we work for is marginalized, without access to health care, and in many ways shows a higher prevalence of a number of diseases because of this lack of access. Our record has generally shown that by increasing access to prompt healthcare, we’ve been able to (for example) reduce child mortality to zero (since mid-2007, where previously most women tell stories about at least one or two children dying) and successfully treat all new cases of tuberculosis, slowing the spread of the disease and decreasing the severity and length of morbidity. So far so good.
Our work has focused mainly on providing intensive follow-up, ensuring doctors and health institutions treat our patients respectfully and fairly, despite linguistic and socioeconomic markers which clearly label our patients as the migrant poor, and providing any necessary treatment. Notice, the first two go along with the “access” focus, while the last generally fits better with the “universal healthcare” aspect of my philosophy.
Where these ideas stop getting along is when we move to the borders of our target population, and begin working with the less poor, usually from other neighboring communities. Along these margins, access to healthcare is spotty, rather than completely absent. People will come to you with reports showing regular blood sugar testing over the past five years, with a few notable gaps, and ask for free testing and treatment for their diabetes.
There are two things you can do here. First, if you were strictly following the dogma that healthcare should be absolutely universal and free, regardless of ability or inability to pay, you would of course provide free testing and treatment. However, if you were looking at this from the perspective of providing universal access, you would see that these people already have some access, the way to ensure steadier access is to provide limited assistance, perhaps for testing or treatment, so that the family, with a reduced burden, will be able to consistently provide the rest.
So that’s what I did on Wednesday. Sounds eminently practical, and in an imperfect world of finite resources, where I work for a small NGO instead of running the world government, it’s probably the best I can do. I can’t, at the moment, handle another full-on diabetic patient (with testing, follow-up, home visits, doctor visits, and paperwork tracking prescriptions) and my organization’s modest budget will be quickly tapped out if we get in the business of giving free medicine to everyone who can in fact afford to buy it themselves. But it always feels shitty, turning someone away because they earn too much money.
I could now go on for a while about a few more things this brings to mind: first, whether we are, by giving medicine and healthcare away for free (but paying for it ourselves) are in fact making a firm stand about the universal necessity of free healthcare, or if we’re just buying into a system that we can’t see a way out of; second, whether, in the context of limited resources, if paying for a prescription of insulin, for example, should fall on the patient, if they are able to pay, or should always fall to the party better able to pay (in which case, it would almost always be the NGO); and finally, if it even makes sense to speak of the “context of limited resources” in a world where most infectious diseases and many chronic diseases would be easily managed by a relatively small redistribution of the world’s wealth—in which case, it might make more sense, then, to stop this “on the ground” work altogether and work only on the side of forcing or coercing a greater redistribution of resources.
But those are questions for another day. As always, I need to get back to the Sisyphean task of improving health, and making do with what we’ve got.
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.
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!
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
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
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.
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:
..........................................................................................................................
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.
.......................................................................................................................
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
.................................................................................................................................
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.
..........................................................................................................................
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.
.......................................................................................................................
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
.................................................................................................................................
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.
atlanta-based charities give american agribusiness the finger
and in other news, this article is completely awesome. i know i wrote a lot of not flattering stuff about care below, but i really did like working for them, and i'm definitely not smart/perceptive enough to have picked up on that aspect of development. and of course, reading good things about care and the carter center makes me feel all warm and gooey inside. in a good way
of course i'm middle class, aren't you?
so this weekend, i was talking with a group of very intelligent friends of mine about progressivism, politics and america's class structure (among other topics). and an extremely intelligent, thoughtful, progressive and caring friend of mine said (and i paraphrase), "the middle class serves as a weight to prevent excessive volatility [which he understood as essentially bad] in the electoral cycle/politics. the current erosion of the middle class--the increased inequality/stratification of class structure in america--is possibly/probably leading to dictatorships of both the right and the left."
now because i'm picky and obsessed with discourse (and post-structuralism and all that), i immediately spoke up, basically saying that the middle class is both a myth and a rhetorical tool (or are these often the same thing? i'm not in a position to say), a grouping which lacks almost any unifying feature (and certainly anything that can be defined by the vast majority of those to whom it is applied) and an identity which both (nearly) everyone (in america) and no one applies to her/himself. you know, really succinct and well-phrased and -reasoned and all, just like that. anyways, i wasn't really satisfied with what i said at the time (i'd had a few drinks in me by then), so i would feel better if i wrote some of it out here, just to get it in written form, with proper grammar and un-slurred words and all that fun stuff.
so the first part is "what is the middle class?" in america, we're taught from a very early age all about self-reliance, how anything is possible if we try and how our (financial and social) failures are our own damn faults. we're taught about the acres of diamonds (sorry for the pop-ups, but i'm always surprised the number of people that have never heard of that, since i remember it very clearly from high school american history), pulling ourselves up from our bootstraps, social mobility and whatnot. the corollary of which being that if we're all able to completely change our standing in our own lives, by our own agency, we're neither impoverished (and thus stuck in a poverty so deep that we cannot escape) nor exceedingly wealthy (and thus so well off that we will never need to worry about our wealth, no matter how poorly we might spend it). we're all middle class. of course. now, mind you, i have no real statistical tests to back up my claims, but i've got some fancy excel-generated graphics from the folks over at wikipedia, which im for the sake of convenience going to assume to be accurate. anyways, what it basically shows, if you look at the graph right under "income distribution", is that rather than following any sort of "normal curve", the distribution is heavily skewed to the left (poverty), tapering off dramatically at the right (extreme wealth--also, keep in mind that the top two columns are actually in increments of $50k, rather than $10k, so there's not really a "bump" at the right). elsewhere on the page (actually, immediately above) it defines the "middle 33%" of income (i think this is the median rather than the mean, but its not really clearly stated) as between $30k and $62.5k. so that's theoretically the "middle class" there, i suppose, possibly including something on either end, or excluding, depending on how big a middle class you want there. looking at the graph, there's very little there to suggest that the middle class exists as a separate "population", or can even be at all statistically defined. well, duh, its a sociological term, right? the main point is, that there is no break, nor even a "bump" on the graph to suggest that there exists, in the distribution of incomes in the US, a distinctive tri-part division of "classes". it would have been nice to have found a normal curve, thus dividing it into the bump and two tails, but that's not happening. what we do see is, after an initial steep increase in incidence (denoting relatively few people in extreme poverty), a nice, gradual slope down from a large section of the population which is relatively poorer to a small segment that is relatively richer.
ok, so i even did a little background research (on wikipedia, again, sorry), and read a bit further down the table to the part about "social class". distilling it a bit, it basically assumes a strong correlation between occupation, education, income and some place on the "social hierarchy". which is probably fair enough, but it's good to note those assumptions, since i'm gonna pick on them a few paragraphs further on. anyways, the thing i wanted to note is the division between classes (four here)--upper, middle, working and lower (poor). anyways, the upper class are households with an income of "$500k or more", the middle class are those "with incomes considerably above-average [sic]", the working class are those with "little economic security" and the poor are those in poverty, basically (the national poverty line for a family of four (and of course we're assuming 2.5 kids here) in 2006 was $20k). so there's that.
ok, but what is the middle class meant to be? i would assume that most people would assume that "class" is some sort of identity, and that's a convenient (for my analysis, of course) assumption, i think. identities are things that link people--people sharing identities live in similar places, work in similar jobs, participate in similar activities, share a common worldview and socialize with each other (to the exclusion, of course, of those outside that identity). in many ways, the middle class is a perfect example of identity--the middle class can often be found in suburban and light-urban areas, they work in safe service-industry jobs, they often join athletic leagues, book clubs, neighborhood associations and, above all, work to raise the next generation (or at least say they do) and usually their friends are people they live near, people they work with and people they know through their activities. in america, i think it would be pretty easy to jump to the assumption that this middle class is overwhelmingly white, straight and english-speaking. so what is special about a class, relative to other identities (white, american, male, southern, gay, etc.)? the essential thing is that class is explicitly hierarchical. while it would be pretty easy to say that men are "ranked" above women in this society, and straights above gays, and whites above blacks, and so on and so forth, class is more than anything a way of telling you, explicitly and in no uncertain terms, where you stand in society. even more explicity, it is a way of ranking, from 1 to 280,000,000, how important each person is to society. someone of the extreme upper class is "more important" (to whom? to what? to society, and to all of us, it would seem) than someone living in a medium-sized home in a suburb, and then that person is more important again than someone living in a slum, or living on the street.
so, while all identities are hierarchical, this one which is both internally and externally ascribed (i believe i am of a certain class, and others, depending on their experiences, will believe i am of a certain class, and often these will align, though many times they will not) is the one for which it is most necessary to keep in mind the relative and exclusionary nature of identities--i am gay because i am not straight, i am woman because i am not man, i am white because i am not black, i am rich because i am not poor. i am middle class because i am not...either really wealthy or really poor? ok, so maybe the "middle class" then constitutes more a sort of "norm" than any sort of essntial "identity". maybe, perhaps in the way that all "norms" almost constitute some "unmarked identity", it's actually both (see the essay below about women and the Other, i guess, since i can't put footnotes in here easily). so its maybe a norm that acts like an identity, in some cases. which then i suppose accounts for the fact that it's in no way statistically the majority or even statistically visible. ok, fine. point conceded. but i think the more important thing is that it is thought of as something between both, in that it is certainly the "norm" in american society, but it is still something that is positively ascribed, many, many people actively assume themselves to be part of it while other facets of their lives--income, occupation, neighborhood, etc.--will tend to point them away from being "middle class".
so what does this say politically? i would assume that most other identities and norms tend to group people who vote similarly. the problem is that, in the american electorate, i would assume that income is a fairly poor indicator of political leanings. most blacks are more socially conservative than i, though they would disagree with whites with similar incomes on the topic of government expenditures and foreign policy, i would assume. those of the middle class are split geographically and racially, along the lines of religion, language and general upbringing. many have commented previously on how the "republicans have tricked the poor [whites] into voting against their economic interests". if economic interests are indeed the most important determinants of voting behavior, then the rich should invariably vote for conservatives espousing zero redistribution and the poor invariably for liberals espousing robin hood policies. and then the middle class should be left somewhere in the middle either opting for no redistribution, or maximum redistribution, or something in the middle, i guess, depending on their place in the middle class, their route to arrive there, their aspirations, their mood, and of course the prevailing winds, to name but a few. but that's not really the case, voting (and politics) is determined by ideology, not pure economic calculations. and, at least in my view, ideology is fundamentally not about someone's experience with the world, but the way in which that person has been taught to view the world. which is passed down between old and young, and young and young, and old and old, and young and old, through religion, through education, through casual chats at the supermarket.
so then what would a large middle class really have to do with promoting "moderation" in government? and what effect does the increase in inequality have on a middle class that is more an ideal than an actual fact? if we all believe we're middle class anyways, does it really matter if we are or not if we're actually voting with our heads and not our wallets? i'm gonna go ahead and say "not much, not much, and no".
so the middle class is a construction then, fine. i feel like i've proven it to myself, though the above essay seems a bit incoherent to actually convince many others, i guess. just because it's a construction, not an essential, "real" object, doesn't mean that it's not real. it's real because our culture gives it significance and weight and because that weight carries power. it's a discursive strategy, that allows for self-evident piece of "moderation". society is then defined, because of course the middle class must be the norm, as something which tends towards its center, needing balance between both the right and the left. if society were actually a binary division, rather than a two-tailed normal curve, the middle would need not exist, and thus neither would compromise, similarly, if society is skewed one way or another, it would detract from those who either advocate or fight against redistribution (depending on the skew of society). the "middle class" is thus a placation strategy. and because society then "tends towards its center", it inherently sustains its status quo. for me, in many ways, the "middle class" is complacency on a number of issues, usually revolving around/stemming from poverty and inequality, which really don't demand complacency or compromise, but action. radical revolution if you will, or if you won't, perhaps a large-scale redistribution of wealth. but the fact remains that the "middle class" remains a rhetorical strategy of postponement and maintenance of the status quo.
god, i sound like such a marxist, reading back on this. catch us next time for another exciting episode of "workers of the world, unite!"
now because i'm picky and obsessed with discourse (and post-structuralism and all that), i immediately spoke up, basically saying that the middle class is both a myth and a rhetorical tool (or are these often the same thing? i'm not in a position to say), a grouping which lacks almost any unifying feature (and certainly anything that can be defined by the vast majority of those to whom it is applied) and an identity which both (nearly) everyone (in america) and no one applies to her/himself. you know, really succinct and well-phrased and -reasoned and all, just like that. anyways, i wasn't really satisfied with what i said at the time (i'd had a few drinks in me by then), so i would feel better if i wrote some of it out here, just to get it in written form, with proper grammar and un-slurred words and all that fun stuff.
so the first part is "what is the middle class?" in america, we're taught from a very early age all about self-reliance, how anything is possible if we try and how our (financial and social) failures are our own damn faults. we're taught about the acres of diamonds (sorry for the pop-ups, but i'm always surprised the number of people that have never heard of that, since i remember it very clearly from high school american history), pulling ourselves up from our bootstraps, social mobility and whatnot. the corollary of which being that if we're all able to completely change our standing in our own lives, by our own agency, we're neither impoverished (and thus stuck in a poverty so deep that we cannot escape) nor exceedingly wealthy (and thus so well off that we will never need to worry about our wealth, no matter how poorly we might spend it). we're all middle class. of course. now, mind you, i have no real statistical tests to back up my claims, but i've got some fancy excel-generated graphics from the folks over at wikipedia, which im for the sake of convenience going to assume to be accurate. anyways, what it basically shows, if you look at the graph right under "income distribution", is that rather than following any sort of "normal curve", the distribution is heavily skewed to the left (poverty), tapering off dramatically at the right (extreme wealth--also, keep in mind that the top two columns are actually in increments of $50k, rather than $10k, so there's not really a "bump" at the right). elsewhere on the page (actually, immediately above) it defines the "middle 33%" of income (i think this is the median rather than the mean, but its not really clearly stated) as between $30k and $62.5k. so that's theoretically the "middle class" there, i suppose, possibly including something on either end, or excluding, depending on how big a middle class you want there. looking at the graph, there's very little there to suggest that the middle class exists as a separate "population", or can even be at all statistically defined. well, duh, its a sociological term, right? the main point is, that there is no break, nor even a "bump" on the graph to suggest that there exists, in the distribution of incomes in the US, a distinctive tri-part division of "classes". it would have been nice to have found a normal curve, thus dividing it into the bump and two tails, but that's not happening. what we do see is, after an initial steep increase in incidence (denoting relatively few people in extreme poverty), a nice, gradual slope down from a large section of the population which is relatively poorer to a small segment that is relatively richer.
ok, so i even did a little background research (on wikipedia, again, sorry), and read a bit further down the table to the part about "social class". distilling it a bit, it basically assumes a strong correlation between occupation, education, income and some place on the "social hierarchy". which is probably fair enough, but it's good to note those assumptions, since i'm gonna pick on them a few paragraphs further on. anyways, the thing i wanted to note is the division between classes (four here)--upper, middle, working and lower (poor). anyways, the upper class are households with an income of "$500k or more", the middle class are those "with incomes considerably above-average [sic]", the working class are those with "little economic security" and the poor are those in poverty, basically (the national poverty line for a family of four (and of course we're assuming 2.5 kids here) in 2006 was $20k). so there's that.
ok, but what is the middle class meant to be? i would assume that most people would assume that "class" is some sort of identity, and that's a convenient (for my analysis, of course) assumption, i think. identities are things that link people--people sharing identities live in similar places, work in similar jobs, participate in similar activities, share a common worldview and socialize with each other (to the exclusion, of course, of those outside that identity). in many ways, the middle class is a perfect example of identity--the middle class can often be found in suburban and light-urban areas, they work in safe service-industry jobs, they often join athletic leagues, book clubs, neighborhood associations and, above all, work to raise the next generation (or at least say they do) and usually their friends are people they live near, people they work with and people they know through their activities. in america, i think it would be pretty easy to jump to the assumption that this middle class is overwhelmingly white, straight and english-speaking. so what is special about a class, relative to other identities (white, american, male, southern, gay, etc.)? the essential thing is that class is explicitly hierarchical. while it would be pretty easy to say that men are "ranked" above women in this society, and straights above gays, and whites above blacks, and so on and so forth, class is more than anything a way of telling you, explicitly and in no uncertain terms, where you stand in society. even more explicity, it is a way of ranking, from 1 to 280,000,000, how important each person is to society. someone of the extreme upper class is "more important" (to whom? to what? to society, and to all of us, it would seem) than someone living in a medium-sized home in a suburb, and then that person is more important again than someone living in a slum, or living on the street.
so, while all identities are hierarchical, this one which is both internally and externally ascribed (i believe i am of a certain class, and others, depending on their experiences, will believe i am of a certain class, and often these will align, though many times they will not) is the one for which it is most necessary to keep in mind the relative and exclusionary nature of identities--i am gay because i am not straight, i am woman because i am not man, i am white because i am not black, i am rich because i am not poor. i am middle class because i am not...either really wealthy or really poor? ok, so maybe the "middle class" then constitutes more a sort of "norm" than any sort of essntial "identity". maybe, perhaps in the way that all "norms" almost constitute some "unmarked identity", it's actually both (see the essay below about women and the Other, i guess, since i can't put footnotes in here easily). so its maybe a norm that acts like an identity, in some cases. which then i suppose accounts for the fact that it's in no way statistically the majority or even statistically visible. ok, fine. point conceded. but i think the more important thing is that it is thought of as something between both, in that it is certainly the "norm" in american society, but it is still something that is positively ascribed, many, many people actively assume themselves to be part of it while other facets of their lives--income, occupation, neighborhood, etc.--will tend to point them away from being "middle class".
so what does this say politically? i would assume that most other identities and norms tend to group people who vote similarly. the problem is that, in the american electorate, i would assume that income is a fairly poor indicator of political leanings. most blacks are more socially conservative than i, though they would disagree with whites with similar incomes on the topic of government expenditures and foreign policy, i would assume. those of the middle class are split geographically and racially, along the lines of religion, language and general upbringing. many have commented previously on how the "republicans have tricked the poor [whites] into voting against their economic interests". if economic interests are indeed the most important determinants of voting behavior, then the rich should invariably vote for conservatives espousing zero redistribution and the poor invariably for liberals espousing robin hood policies. and then the middle class should be left somewhere in the middle either opting for no redistribution, or maximum redistribution, or something in the middle, i guess, depending on their place in the middle class, their route to arrive there, their aspirations, their mood, and of course the prevailing winds, to name but a few. but that's not really the case, voting (and politics) is determined by ideology, not pure economic calculations. and, at least in my view, ideology is fundamentally not about someone's experience with the world, but the way in which that person has been taught to view the world. which is passed down between old and young, and young and young, and old and old, and young and old, through religion, through education, through casual chats at the supermarket.
so then what would a large middle class really have to do with promoting "moderation" in government? and what effect does the increase in inequality have on a middle class that is more an ideal than an actual fact? if we all believe we're middle class anyways, does it really matter if we are or not if we're actually voting with our heads and not our wallets? i'm gonna go ahead and say "not much, not much, and no".
so the middle class is a construction then, fine. i feel like i've proven it to myself, though the above essay seems a bit incoherent to actually convince many others, i guess. just because it's a construction, not an essential, "real" object, doesn't mean that it's not real. it's real because our culture gives it significance and weight and because that weight carries power. it's a discursive strategy, that allows for self-evident piece of "moderation". society is then defined, because of course the middle class must be the norm, as something which tends towards its center, needing balance between both the right and the left. if society were actually a binary division, rather than a two-tailed normal curve, the middle would need not exist, and thus neither would compromise, similarly, if society is skewed one way or another, it would detract from those who either advocate or fight against redistribution (depending on the skew of society). the "middle class" is thus a placation strategy. and because society then "tends towards its center", it inherently sustains its status quo. for me, in many ways, the "middle class" is complacency on a number of issues, usually revolving around/stemming from poverty and inequality, which really don't demand complacency or compromise, but action. radical revolution if you will, or if you won't, perhaps a large-scale redistribution of wealth. but the fact remains that the "middle class" remains a rhetorical strategy of postponement and maintenance of the status quo.
god, i sound like such a marxist, reading back on this. catch us next time for another exciting episode of "workers of the world, unite!"
on "what the hell am i doing"?
so: health education is a load of shit.
well, maybe i should revise that: teaching people to be healthy is the most moronic idea ever.
but with this qualification: so, i'm, uh, gonna be working to run a health education and resource centre in a slum in india for the next few years. but i'm sure this time, i'll get it right where everyone else as failed. because this is going to be different.
yeah, right.
so the deal is that in a month or two im headed back to pune, india to work for the next few years to help get a "health education and resource centre" going and to work there day-to-day. it's with an organization i've been working on-and-off with for the last few years. they started a home for street children, run a program to encourage girls' education in the neighboring slum and now are branching out to do something about health there. tuberculosis, anemia, diarrheal disease and any other manner of preventable morbidity and mortality are pretty huge issues there, and to make things worse, the indian government programs that would theoretically make a huge dent in the incidence of all this are pretty much completely ineffective, simply not providing the services they are meant to provide as their raison d'etre.
but anyways, back to the health education is crap thing. yeah, it's good to impress upon people (and especially small children, but we'll get to that later) the importance of handwashing to prevent the spread of a lot of diseases (by the deliciously poetic (in spanish) cycle of ano-mano-boca). people should know that their diet should include a wide variety of nutrients, and in sufficient quantities.
but i can't teach how to avoid tuberculosis--the best way is really to not know anyone with tuberculosis. covering your mouth when you cough isnt sufficient, because the drops can hang in the air for hours, they don't need to be sucked up directly. and i can't teach you how to not get active tb once you've been infected, since that really depends on your nutrition and general "constitution" for lack of a better word. and teaching people nutrition in a "development" context is really just a joke. i mean, wtf, can you figure out a way to have a balanced diet when your ingredients consist of potatoes, some vegetable oil (that may or may not be fortified with vitamins A and E) and salt (that probably isn't iodized)? trust me, for most people in most of the places where nutrition is seriously lacking, no amount of education is going to make even the smallest difference in their diet, because they're already stretched to the limit of survival.
so basically, the best way to teach people to be healthy is to teach them not to be poor, right? and now that definitely sounds like a ridiculous idea. unless you're a republican and you believe that poor people are just lazy. but anyways, to look further at the example of tuberculosis (which i've been obsessing over quite a bit lately), let's think of the things that structure your risk of dying of tb. first you've got to get infected. let's leave that one alone for the time being (since its pretty much impossible to prevent someone from giving you tb, it's easier to look at it from the point of view of the already-infected person spreading it, rather than someone "catching" it). next, your infection has to become "active". ie, it has to go from a few mycobacteria harmlessly chilling in your lungs to a bunch of mycobacteria going crazy multiplying and punching holes in all manner of tissues and organs. a brief list of conditions that tend to increase the risk of tuberculosis progressing from "latent" to "active":
so i took the liberty of bolding the conditions that are way more likely to be present in marginalized, and especially impoverished, groups, for pretty obvious reasons. the conditions in italics can in a number of ways be linked to poverty, but i'm gonna leave them alone since they're less relevant to what i generally am working with. the others can basically be either attributed to medical treatments (and previous medical treatments are pretty much completely unknown where i'm working) or "other conditions" that aren't specific enough for me to actually know what's being talked about. but basically there are a few conditions--HIV, previous active TB disease and malnutrition--which are hugely more prevalent in poor populations, especially in Pune. so poor people are certainly more likely to progress to active tb disease once infected than most others. then, they're less likely to be treated at all, and if they are treated, treatment is like to be inconsistent, poorly-designed, poorly-implemented or implemented in such a way as to be completely insulting, or any combination of the above. there are financial and geographic barriers to treatment--medicines are expensive, hospitals are not located in slums and time off from work...well, only if you don't mind not getting paid that day. poor people (in india certainly) are often treated like shit in the hospital, made to wait long hours (8 hours, easily), insulted and generally treated without any human dignity. migrants (a large population in the yerwada slum) are further left out--the hospital signs are only in marathi and english, not hindi, which most migrants speak (english is the language of the educated and the wealthy, and marathi is the state language of maharashtra--hindi is spoken by most people, at least in northern and central india, as well as the language which is "local" to their place of origin). often service is even completely denied because a person is from a "criminal tribe" and thus "addicted to crime"--from birth, apparently. and the DOTS program, which demands that people are "directly observed" in taking their medications, thus ensuring compliance and completion, demands that the patients go to the DOTS office at least 3 times a week, if not every day, to take their medications, rather than health workers distributing medications even near their homes. so yeah, its an uphill climb for treatment. in such an environment, it's hard to imagine many poor people even beginning treatment, let alone finishing it successfully--which then leads to drug resistance. and any active, untreated case of pulmonary tuberculosis is contagious. so if you're poor, not only are you more likely to fall ill and not be treated, but you're also more likely to know other people who have fallen ill and have not been treated, thus leading you to be much more likely to be infected in the first place. it's pretty easy to see how tuberculosis has been relegated to the history books in affluent places, but is still rampant in most poor places, especially where people are highly concentrated.
and so it goes. so basically what i want to do, what i will do, is to interrupt that chain at every point. which doesn't really involve "health education" at all. we have to educate people, yes, to recognize sympoms of tb, but more we need to educate and mobilize them to demand treatment from already-estabilished government programs that theoretically provide free treatment but simply suck at it. we need to break down barriers to treatment, but also treat the conditions that put people at risk--poverty, lack of social mobility, lack of basic services, in essence, the lack of all the "basic necessities" that we learn about in first grade: food, water and shelter. we will be improving health by working to combat prejudice and discrimination and by working for women's empowerment. keeping kids in school through secondary and higher education will lessen their chances of dying of tuberculosis. as it will for most any other disease.
so then, are we actually going to teach? yeah, we will. we will teach people to wash their hands. fine, but to assume that by just pouring in this knowledge will improve anything is ridiculous. that could work with children, but to teach adults and even adolescents to simply wash their hands is treating them like children. there are very specific reasons that most of them have never washed their hands regularly--lack of soap, lack of water, and even that handwashing has simply never been a priority because there are much more immediate causes of morbidity and mortality to worry about. we're probably going to have to give out soap, and fight tooth and nail for more water connections in people's houses.
yeah, we're going to be teaching, but that's just the beginning of what we need to do. we need to provide for a basic level of subsistence sufficient so that they can apply what they've learned.
well, maybe i should revise that: teaching people to be healthy is the most moronic idea ever.
but with this qualification: so, i'm, uh, gonna be working to run a health education and resource centre in a slum in india for the next few years. but i'm sure this time, i'll get it right where everyone else as failed. because this is going to be different.
yeah, right.
so the deal is that in a month or two im headed back to pune, india to work for the next few years to help get a "health education and resource centre" going and to work there day-to-day. it's with an organization i've been working on-and-off with for the last few years. they started a home for street children, run a program to encourage girls' education in the neighboring slum and now are branching out to do something about health there. tuberculosis, anemia, diarrheal disease and any other manner of preventable morbidity and mortality are pretty huge issues there, and to make things worse, the indian government programs that would theoretically make a huge dent in the incidence of all this are pretty much completely ineffective, simply not providing the services they are meant to provide as their raison d'etre.
but anyways, back to the health education is crap thing. yeah, it's good to impress upon people (and especially small children, but we'll get to that later) the importance of handwashing to prevent the spread of a lot of diseases (by the deliciously poetic (in spanish) cycle of ano-mano-boca). people should know that their diet should include a wide variety of nutrients, and in sufficient quantities.
but i can't teach how to avoid tuberculosis--the best way is really to not know anyone with tuberculosis. covering your mouth when you cough isnt sufficient, because the drops can hang in the air for hours, they don't need to be sucked up directly. and i can't teach you how to not get active tb once you've been infected, since that really depends on your nutrition and general "constitution" for lack of a better word. and teaching people nutrition in a "development" context is really just a joke. i mean, wtf, can you figure out a way to have a balanced diet when your ingredients consist of potatoes, some vegetable oil (that may or may not be fortified with vitamins A and E) and salt (that probably isn't iodized)? trust me, for most people in most of the places where nutrition is seriously lacking, no amount of education is going to make even the smallest difference in their diet, because they're already stretched to the limit of survival.
so basically, the best way to teach people to be healthy is to teach them not to be poor, right? and now that definitely sounds like a ridiculous idea. unless you're a republican and you believe that poor people are just lazy. but anyways, to look further at the example of tuberculosis (which i've been obsessing over quite a bit lately), let's think of the things that structure your risk of dying of tb. first you've got to get infected. let's leave that one alone for the time being (since its pretty much impossible to prevent someone from giving you tb, it's easier to look at it from the point of view of the already-infected person spreading it, rather than someone "catching" it). next, your infection has to become "active". ie, it has to go from a few mycobacteria harmlessly chilling in your lungs to a bunch of mycobacteria going crazy multiplying and punching holes in all manner of tissues and organs. a brief list of conditions that tend to increase the risk of tuberculosis progressing from "latent" to "active":
- Infection with HIV, the virus that causes AIDS
- Injection of illicit drugs
- Recent TB infection (within the past 2 years)
- Chest x-ray findings suggestive of previous TB
- Diabetes mellitus
- Silicosis
- Prolonged therapy with corticosteroids
- Immunosuppressive therapy
- Certain types of cancer (e.g., leukemia, Hodgkin's disease, or cancer of the head and neck)
- Severe kidney disease
- Certain intestinal conditions
- Low body weight (10% or more below ideal)
so i took the liberty of bolding the conditions that are way more likely to be present in marginalized, and especially impoverished, groups, for pretty obvious reasons. the conditions in italics can in a number of ways be linked to poverty, but i'm gonna leave them alone since they're less relevant to what i generally am working with. the others can basically be either attributed to medical treatments (and previous medical treatments are pretty much completely unknown where i'm working) or "other conditions" that aren't specific enough for me to actually know what's being talked about. but basically there are a few conditions--HIV, previous active TB disease and malnutrition--which are hugely more prevalent in poor populations, especially in Pune. so poor people are certainly more likely to progress to active tb disease once infected than most others. then, they're less likely to be treated at all, and if they are treated, treatment is like to be inconsistent, poorly-designed, poorly-implemented or implemented in such a way as to be completely insulting, or any combination of the above. there are financial and geographic barriers to treatment--medicines are expensive, hospitals are not located in slums and time off from work...well, only if you don't mind not getting paid that day. poor people (in india certainly) are often treated like shit in the hospital, made to wait long hours (8 hours, easily), insulted and generally treated without any human dignity. migrants (a large population in the yerwada slum) are further left out--the hospital signs are only in marathi and english, not hindi, which most migrants speak (english is the language of the educated and the wealthy, and marathi is the state language of maharashtra--hindi is spoken by most people, at least in northern and central india, as well as the language which is "local" to their place of origin). often service is even completely denied because a person is from a "criminal tribe" and thus "addicted to crime"--from birth, apparently. and the DOTS program, which demands that people are "directly observed" in taking their medications, thus ensuring compliance and completion, demands that the patients go to the DOTS office at least 3 times a week, if not every day, to take their medications, rather than health workers distributing medications even near their homes. so yeah, its an uphill climb for treatment. in such an environment, it's hard to imagine many poor people even beginning treatment, let alone finishing it successfully--which then leads to drug resistance. and any active, untreated case of pulmonary tuberculosis is contagious. so if you're poor, not only are you more likely to fall ill and not be treated, but you're also more likely to know other people who have fallen ill and have not been treated, thus leading you to be much more likely to be infected in the first place. it's pretty easy to see how tuberculosis has been relegated to the history books in affluent places, but is still rampant in most poor places, especially where people are highly concentrated.
and so it goes. so basically what i want to do, what i will do, is to interrupt that chain at every point. which doesn't really involve "health education" at all. we have to educate people, yes, to recognize sympoms of tb, but more we need to educate and mobilize them to demand treatment from already-estabilished government programs that theoretically provide free treatment but simply suck at it. we need to break down barriers to treatment, but also treat the conditions that put people at risk--poverty, lack of social mobility, lack of basic services, in essence, the lack of all the "basic necessities" that we learn about in first grade: food, water and shelter. we will be improving health by working to combat prejudice and discrimination and by working for women's empowerment. keeping kids in school through secondary and higher education will lessen their chances of dying of tuberculosis. as it will for most any other disease.
so then, are we actually going to teach? yeah, we will. we will teach people to wash their hands. fine, but to assume that by just pouring in this knowledge will improve anything is ridiculous. that could work with children, but to teach adults and even adolescents to simply wash their hands is treating them like children. there are very specific reasons that most of them have never washed their hands regularly--lack of soap, lack of water, and even that handwashing has simply never been a priority because there are much more immediate causes of morbidity and mortality to worry about. we're probably going to have to give out soap, and fight tooth and nail for more water connections in people's houses.
yeah, we're going to be teaching, but that's just the beginning of what we need to do. we need to provide for a basic level of subsistence sufficient so that they can apply what they've learned.
Are you my Other? Alterity, Feminism and Identity Politics
Alterity, as a specific condition, cannot be said to exist. The Other, the mythical figure of “what one is not”, is not exactly a rigid category. To say what I myself am, I must look (first?) to what I am not. In defining myself, I demarcate my own boundaries, inscribing borders around that which is “not-me”, constituting the Other and thereby constituting myself in relation to what is my antithesis. I am tall because I am not short, I am white because I am not black (though “non-white” proves more troublesome), I am a man because I am not a woman. But by inscribing borders around the “not-me”, I also mark decisively what is neither me, nor the other, but beyond language and imagination (or at least beyond consideration in the matter at hand). To perhaps be more clear, there is the problem that in constituting my opposite, I map too directly my experience onto that of the other, assuming a strict(er) yes-no binarism of characteristics, separating the Other from the Not-Me by defining borders which are excessively self-reflexive.
Though these two very different conceptions of otherness—the defined, carefully circumscribed and bounded Other and the messier, infinite Not-Me—are found (often confused) throughout discussions of alterity (the postcolonial Other of Said and Spivak, the political other of ACT-UP in New York, the unknown Other of development discourse, etc.), I choose here to focus on the discursive space between Beauvoir’s (more conservative) definition of the Other[1] and Irigaray’s radical rejection of the Other as so much of the same, opting for a more radical notion of unbounded identity-space, the Not-Me, which is not automatically reflective of the subject (which is assumed, by both authors, to be the male). In taking these two authors as examples of types of alterity, I will obviously concentrate on the construction of woman as the marked Other or Not-Me, and the discursive space between these different constructions, leading to a discussion of the work done by this undefined discursive space in the construction of women as “at risk” (or not) in the American AIDS epidemic, as well as a brief look at the exportation of this discursive baggage abroad, especially to Africa since the early 1990’s (since Western Europe and North America entered a post-crisis period in their (responses to their) AIDS epidemics). The first two sections will necessarily consist of a close reading of Beauvoir’s and Irigaray’s works, especially The Second Sex and This Sex Which Is Not One, while employing a critical understanding of gener as made explicit by Butler in the opening chapters of Gender Troubles and other works in that field. After these, there will a look at the use of the Other and the Not-Me understandings of alterity in responses to the AIDS epidemics in the
“A matter of form”
Beauvoir, in opening The Second Sex, finds that she cannot write of women without writing of their eternal referent, men. After a brief discussion of the problems of defining women essentially, Beauvoir touches on the most problematic point of her treatise: the need for its explanation.
A man would never set out to write a book on the peculiar situation of the human male. But if I wish to define myself, I must first of all say: ‘I am a woman’; on this truth must be based all further discussion. A man never begins by presenting himself as an individual of a certain sex; it goes without saying that he is a man. The terms masculine and feminine are used symmetrically only as a matter of form, as on legal papers (1949: 15).
In stating her case from an initial point of specificity, Beauvoir (and the reader) is immediately aware of the reference which is made by the term woman: that which is not man. In marking its referent, the signifier “woman” always-already inscribes itself as an Other, just as it always-already implies the category of “man”. As such, these two terms can be seen as reflective, the one constituting the lack of the other and vice-versa (though this construction would seem to imply an equality of signification, that is certainly and emphatically not the case). The category “woman” is defined as a marked subset of humanity, inscribing all those to whom the category “man” (seen as the natural, ideal, or unmarked) does not apply with a marker of their difference: this person is not male because of this difference, this person must then be female. Beauvoir compares this to the definition of the oblique based on a concept of the absolute vertical (1949: 15), though later she expands this: the absolute vertical is also defined by the lack of obliqueness. “Thus it is that no group ever sets itself up as the One without at once setting up the Other over against itself” and “the subject can only be posed in being opposed—he sets himself up as the essential, as opposed to the other, the inessential, the object” (1949: 17). The two terms, the One and the Other, become inextricably linked, impossible to exist individually and ultimately reflections of each other: equally opposite if not equal and opposite.
Beauvoir’s woman is also inextricably linked to man:
The bond that unites her to her oppressors is not comparable to any other…The couple is a fundamental unity with its two halves riveted together, and the cleavage of society along the line of sex is impossible. Here is to be found the basic trait of woman: she is the Other in a totality of which the two components are necessary to one another (1949: 19-20).
Thus in constructing their highly relative identities, the One and the Other, these identities become indivisible, each existing to reflect and define the other while being completely dependent on each other, materially and existentially. Beauvoir constructs her marked Other (or occasionally, Object) as a definite foil which throws light and definition onto the characteristics of the Subject (man), that that construction may remain defined without being marked by its specificity: man is the universal, the “judge and party to the case” (1949: 27). Butler calls this the “closed circuit of signifier and signified” (1990: 15), in which the signifier “woman” refers directly to woman but also implies the masculine. To borrow the vocabulary of Irigaray (with more to come in the next section), the thoroughly patriarchal (or phallogocentric) language used to signify the feminine always-already implies and necessitates the masculine, locking the two (masculine/feminine) into a necessary and unavoidable binary, with each being defined by its reflection of the O/other. Beauvoir essentially limits her definition of the other to that which is useful for the production of a coherent identity, an Other which only exists with the One and vice versa.
Multiplying sex, exploding the Other
Irigaray categorically rejects this notion of the Other (as being untrue, as being unhelpful, as being un-whole). Through her analysis, the notion of the Other being always-already constituted as part of the One (to re-borrow Beauvoir’s terminology) is posed as extremely limiting. In examining the (sexual) relations between man and woman, Irigaray rejects the notion of woman’s Otherness being restricted to that which is analogous (and directly applicable) to the man:
the clitoris is conceived as a little penis…, and the vagina is valued for the ‘lodging” it offers the male organ…In these terms, woman’s erogenous zones never amount to anything but a clitoris-sex that is not comparable to the noble phallic organ, or a whole-envelope that serves to sheathe and massage the penis in intercourse… (1977: 23).
Interpreted metaphorically, Irigaray rails against the masculine appropriation of the female body/the feminine, or even the dictation of what should be under consideration for inclusion in this category. She maintains that woman (as the Other) is not fully represented, nor can she ever be, in such a pervasively phallogocentric symbolic economy: woman, consisting of only what is symbolically useful for the definition of man, can only ever be(come) a reflection (and thus an appropriation) of the masculine (Butler 1990: 16).
What Irigaray believes is the true femininity is an indefinable infinity of identity, an “epanding universe to which no limits could be fixed and would not be incoherence nonetheless” (1977: 31). This ideal of unbounded identity, which is such anathema to the Other, becomes Irigaray’s construction of the Not-Me: everything which is external to the Subject becomes possible, and thus the Subject (the One) is defined by these infinite relations, becoming the infinitely situated subject. The Not-Me, then, is analogous in its effects to Weeks’s “radical pluralism” (quoted in Bersani 1987: 218) and Butler’s “deconstruction of identity” (1990: 189), in that by destabilizing the essential core of subjecthood, by refusing the Subject its concrete reference, it presents the possibility of a liberation from a rigid “identity politics” which, by necessarily perpetuating the categories of difference around “identity groups”, can only go so far in advancing an equal (because separate can never be equal) multicultural (or –sexual or –ethnic or –national) society.
Stepping back towards Irigaray’s text, I emphasize that this is not her explicit aim, but rather her ideal extrapolated by later (poststructural) theorists. Irigaray, unlike
“Foucault in the Streets”? Not Quite
Though Beauvoir and Irigaray disagree on the nature (or implications) of feminine alterity, both writers assume the need for a dramatic re-equalizing of a society, through the assertion of women’s One-ness (or Subject-hood) alongside that of men’s, thus eliminating the unequal binary of sexual division. They in turn lament the lack of a coherent feminine political identity, citing instead women’s primary allegiance to class, race or religion above gender (Beauvoir 1949: 19-21; Irigaray 1977: 32), foreshadowing (at least in the case of Beauvoir writing at the end of World War II, though less Irigaray) the rise of identity politics, particularly the feminist movement, and particularly (for the sake of this essay and this segue) feminist and other subaltern (gay, especially) mobilizations around AIDS. Relying heavily on the accounts of Treichler (1999) and Stoller (1998), along with others (Bordowitz 2004; Crimp 1987; etc.), I will attempt to interrogate critically the formation of identity around genders and sexualities in response to the AIDS crisis, and their expression (or lack thereof) in the policies of both the state and of AIDS service organizations themselves.
From the first institutional reports on AIDS, seemingly due to an accident of history, women were excluded from the “risk groups”: AIDS as a clinical manifestation was simply first noticed in the male homosexual population, and was certainly most strongly expressed in that population in the first years of the epidemic. Early accounts, and even contemporary accounts (stemming mainly from Africa as North America is now seen as “post-crisis” and thus beyond research) generally position women in an inferior role, being mentioned only in the context of their relationship to men: partners of IV drug users, partners of bisexual men, mothers of infected infants, prostitutes (Farmer 1996; Stoller 1998; Treichler 1999). Treichler notes that even though women were supposedly “represented” on the earliest versions of the AIDS research agenda, they were “summarily bounced” from the list when their contact with men was not conclusively shown to be the mode of their infection (Treichler 1999: 53). Later, as it became apparent that male-to-female and female-to-male transmission was taking place (or more generally, that women were indeed being infected with HIV), circuitous theories were circulated as to why these women were not “normal” and thus were not “women”: they abused drugs, they received fertility treatments, they were from the Third World (Treichler 1999: 61-5). Women as an unmarked category continued their noted absence in the increasingly complex risk categories of the CDC reports.
Beyond soothing
were explicitly justified by arguing that HIV incidence in women provided a general index to the heterosexual spread of the virus and that the purpose of identifying women at risk and preventing ‘primary’ infection in them was to prevent cases of AIDS/HIV in their partners and children. Again, there was no intrinsic concern for women as women (Treichler 1999: 63).
In an interesting parallel to Irigaray’s Not-Me construction, women simply do not exist as such in the early years of the epidemic (and it is arguable about whether or not they exist today). They reflect men’s actions (by being defined by who fucked them or by being made pregnant), or else serve as markers of what can and can not be accepted into the norm (yes: heterosexuality; no: drug use, prostitution, association with non-heterosexual men, poverty; the jury’s still out: lesbianism). Either way, women provide the boundary, defining the Subject by being defined as the Other. Women who (and the parts of women’s lives which) simply have nothing to do with masculine agency are made to disappear, allowing them to serve as transparent boxes in which HIV is put in and pulled out with no interference from the box itself[2].
Reactions to this framing of the disease by the biomedical “experts” varied greatly, but generally women were sidelined in the activist response. ACT-UP, the most well-known of the activist groups, was essentially an outgrowth (or a response to the lack of effect) of Gay Men’s Health Crisis of New York City. Though not explicitly defined around a “gay” movement, the majority of members and “actions” were directly associated with a gay, middle-class, white male lifestyle. Women and racial minorities (not to mention drug users, and the poor) were poorly represented in advocacy efforts, being relegated to the marginal, the marked, the “special cases”. Interestingly, a movement which has explicitly mobilized around a minority identity in turn defines itself by its difference, not only from the norm, but also from other minority identities: “In these ACT-UP materials [produced for “actions”], we receive a complementary message that African Americans, Latinos, women, and the poor have less intrinsic value, as seen by the quality and quantity of materials and campaigns devoted to their concerns” (Stoller 1998: 131). Rather than the monolithic Other against which man is defined, woman had become another other in a list of others against which ACT-UP defined its agenda.
Conclusion
[1] Some terminology: throughout the remainder of this essay, “Other” will refer to the bounded notion of alterity as described above, while “Not-Me” will refer to the more infinite notion, encompassing all that is external to the self. “Alterity” (and the associated adjective, “subaltern”) will be used to describe the condition more generally, to the avoid confusion that might occur when using the term “otherness”.
[2] An interesting and very literal demonstration of this is the “dipping” hypothesis explaining the infection of American military personnel in
Bibliography
Beauvoir, Simone de (1949). The Second Sex. London: Vintage.
Bersani, Leo (1987). "Is the Rectum a Grave?" October 43(Winter): 197-222.
Butler, Judith (1990). Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge.
Farmer, Paul, M. Connors and J. Simmons, Ed. (1996). Women, poverty and AIDS: sex, drugs and structural violence. Monroe: Common Courage Press.
Irigaray, Luce (1977). This Sex Which Is Not One. Ithaca: Cornell University Press.
Stoller, Nancy E. (1998). Lessons From the Damned: Queers, Whores, and Junkies Respond to AIDS. New York: Routledge.
Treichler, Paula A. (1999). How to Have Theory in an Epidemic: Cultural Chronicles of AIDS. Durham: Duke University Press.