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I had a very upsetting experience today. It gave me a new perspective on my North American culture and I did not like what I saw. I attended a meeting where some North American health professionals were talking about their philanthropic medical work in another country. Unfortunately they presented details about that country’s health system that were both misleading and inaccurate. They reported only the worst possible statistics about health and development in that country. The conditions of sanitation and some practices of personal hygiene in the other country were described so as to imply that people in the host country did not know any better. The presenters showed sensational photos of patients with extreme medical conditions with a goal to demonstrate the lack of health screening in the country they had visited. They showed technically beautiful photographs taken in a moment of personal tragedy presumably to demonstrate the compassion of the visiting North American health professionals.

The North Americans criticized the health system of the country they visited and belittled what should actually be described as rather extraordinary efforts by the country’s leaders to address its profound health care needs. The situation in the meeting was particularly painful and embarrassing because a senior health professional from the country in question was in the audience and he heard his home being described in this light. I asked this man later how he felt about the description of his home country and the combined efforts of health professionals and public institutions there. He said “It made me feel like we didn’t exist.”

I grieved with him. I felt ashamed about what had been said. I wondered whether those of us who purport to contribute to health systems in a country that is not our own should just stop everything and get out of this work before we do any more damage. You see, the worst thing about the embarrassment that I felt in those circumstances was my fear that I too have surely been guilty of the same injustices that seemed so blatant when I saw them committed by others. In response to my own transgressions, I find some comfort in the words of Nigerian author Chinua Achebe:

 “Admission of guilt does not necessarily absolve the offender, but it may at least shorten the recital and reliving of painful evidence.”

I learned some big lessons today. It is a grave responsibility to attempt to describe the circumstances and needs of another place in a way that is accurate, respectful and unencumbered by self-promotion. I imagine that the speakers in this event were genuinely motivated by good intentions but clearly there was a significant measure of naïveté. Now that I have observed more vividly than ever before the pain and injustice that result from the false and unfair portrayal of others, I believe that my response needs to start with a personal commitment that from this day forward I hope to avoid indulging in the same errors that appeared so appalling when committed by others. I recognize that even in writing this reflection, I run the risk of sounding self-righteous or “holier than thou”. I do not pretend to be the first person who has made such observations. But I need to personalize them here.

For now, I will call this my Achebe Declaration.

  1. I henceforth refuse to present myself as an expert on any place, people group or culture that is not my own.
  2. When I describe another place, I commit to being meticulous in my search for accurate facts, and when I am unsure of the facts, I commit to announcing that proviso.
  3. I henceforth commit to describe all places where I work and visit in the best possible light.
  4. I repudiate the use of medical photos that diminish the humanity of the patients involved and disrespect their personal dignity.
  5. I renounce the exploitation of individuals and families in their most intimate personal moments by taking photographs that could be used without their explicit permission.
  6. I am sorry for any time in the past that I may have purposely or inadvertently committed any of the above offenses and I hope I may henceforth make amends.


I have written before about the topic of motivation in global health work. I cannot profess to know the motives underlying the disturbing presentation today. One must assume sincere good intentions, including perhaps a desire to recruit additional resources for the project being presented. But today I understood as never before that no motivation can justify an inaccurate and demeaning depiction another place. When we belittle or misrepresent others to serve our own goals, we are all losers in the end. As usual, Achebe has already said this better than I:

“We cannot trample on the humanity of others without devaluing our own. The Igbo, always practical, put it concretely in their proverb ‘Onye ji onye n-ani ju onwe ya’: ‘He who will hold another down in the mud must stay in the mud to keep him down.’”


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Discussion - 6 Comments
  1. Danyaal Raza

    Sep 09, 2012  at 10:33 PM

    Jane, thank you for writing this and posting it in a public forum. As you’ve already said, these experiences are far too common. Good intentions are never enough; they are far too often used as an excuse to circumvent critical self-inquiry. It is not unreasonable to ask whose best interests were at the heart of this presentation. Was it the individuals in the featured pictures or those whose camera snapped them? I struggle with how to bring these questions to bear. How do you challenge those advancing such damaging stereotypes without eliciting a defensive response? When their minds are closed, how do you open them? Altering one’s own behaviour is vital, but what about challenging others?


  2. Yelshaday Teklu

    Sep 18, 2012  at 10:33 PM

    Thanks Dr Jane for this. I’m always sharing your blogs which I think are relevant to Ethiopian medical students on our facebook page :)

    That is kind of disheartening. This is why everybody should check thoroughly what they’ve to say before they say it. Because they can’t take it back. It is good that these professionals have honest intentions but that matters half. I liked your declaration :) I mean, that is how we can be real professionals.


  3. Penny Parnes

    Dec 28, 2012  at 10:33 PM

    Jane….such profound comments. We need to follow the declaration and instill these values in health care workers of the future. Thank you. Penny Parnes


    • Jane

      Dec 28, 2012  at 10:33 PM

      Thank you Penny for your encouraging words. It makes me happy to know that other health workers will continue to reflect on these issues.


  4. QueenEsther

    Dec 28, 2012  at 10:33 PM

    Undoubtedly very insightful, Jane. This piece of writing further sheds light on how we may not touch people regardless of our effort and genuine interest in trying to serve humanity. I could connect to your reflection having shared part of the same culture as Chinua Achebe. The Igbo idioms drove your discussion home for me. Deeply, i have often asked that question in the past when I have listened or participated in symposium or events. However, having being privileged to share more than one culture, I see it differently sometimes. I know that everyone meant well. It may be due to curiosity or in the process to get the world to see the reality of issues in different places. The most challenging thing is whether it is possible to define motive or to engage individuals who engage in global health work in meaningful discussion to better understand that individuals who have lived a particular culture could be their own best expert and custodian on how their circumstances ought to be presented. Thanks Jane for shading light on this.


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