“'Wanna Play Doctor?'” Lauren Kascak’s article in Intima Spring 2014, describes the same country (Ghana) and same province (Central Region) as the one in “The Death of the Old Farmer” (Intima Fall 2014). My article chronicles the final day of a man who lived near a rural hospital where I completed observations in 2007. Hers describes a student trip to a different rural town, where she completed training in gynecological techniques. The articles relate the same observation of medical care in the developing world: a jarring roughness in how patients are treated. As the two unrelated but closely aligned articles imply, this is not an uncommon observation.
Nor is it the phenomenon only found in Ghana. Anthropologist Catherine Maternowska’s Reproducing Inequities gives accounts of gynecologists in Haiti braying insults at patients during pelvic exams: “What’s the matter with you? You’re cowardly, come on madame!” “No! Put your feet here! Here! Like you’re on a donkey. What’s your problem, you’ve never been on a donkey before?” Like Kascak’s article, the book describes sexual and reproductive healthcare – but Maternowska portrays patient disenfranchisement far more sweeping and severe than the unintended coarseness of Kascak’s experience in Ghana.
Kascak’s article asks, “What does it mean for students like me to fly around the world ‘playing doctor’? What impressions are we giving to those we seek to ‘save’ with our improvisational care?”
My perspective is rather close to Maternowska’s. The roughness does not begin with students or with a savior complex. Nor could it be ameliorated by well-intended young people ceasing to visit developing nations. (In fact, realism among aspiring global professionals is a boon which might begin with these eye-opening direct experiences abroad.) Students are far downstream of such problems’ sources. Rather, the maltreatment and disrespect of patients in the clinic is a byproduct of economic and social inequalities. Where deprivation is constant and adequate responses too scarce, healthcare practitioners perhaps inevitably begin to respond as everyone else does: with apathy, exhaustion, frustration. The problem is that human kindness is too often distributed in the same way money is: ridiculously abundant for those at the top, and sparing to the point of bleak cruelty for those at bottom. As Paul Farmer, Maternowska’s anthropological contemporary in Haiti, says: “The idea that some lives are worth less than others is the root of all that is wrong with this world.”
Sadly, the old farmer who died might have expected nothing more. His family certainly found my kindness unexpected and foreign, perhaps even comically naive. (That is the impression we give them, Lauren.) In a way, their surprise made sense. They lived in an extreme poverty from which the world could easily rescue them – but in which the world, for lack of political willpower, has allowed them to languish unassisted until death.
This does not, of course, make healthcare unimportant. As Farmer has also said, “[Since] we don’t necessarily have good responses to the root causes of poverty and social inequality, we have to take on the symptoms at the same time.”
M. Sophia Newman, MPH, has worked with Pacific Standard Magazine and Beacon Reader to return to West Africa to cover stories related to Ebola, food insecurity, and other health issues.Read more at https://www.beaconreader.com/m-sophia-newman/on-the-ebola-outbreaks-anniversary-a-reflection-on-the-disease-of-journalism. Her piece, "Death of an Old Farmer" appeared in the Fall 2014 Intima.
© 2015 Intima: A Journal of Narrative Medicine