The aid industrial complex and crises of conscience

When I was leaving for PC, most people were supportive. You kind of get treated like a hero, as if you're sacrificing a huge amount to go live as people in the developing world live. It is certainly a sacrifice. You miss big events -- weddings, the arrival of babies, birthdays, graduations -- and you have to take a bath in a basin. But it isn't heroic, and I go back and forth about whether we as a nation should be doing this at all.

My feelings on my time here have varied wildly of late. I go from deep cynicism about aid and development work to a feeling of personal joy when I spend time singing with and teaching girls in my community. The best way to describe it is ambivalence, a strong love and a strong hate for the aid structures that are in place.

A problem with aid work is that it is difficult to avoid being patronizing. In a sense, anyone who comes in from another country to teach or train people is suggesting that the people in the developing country need help from outside their borders. It suggests that they aren't adequately addressing their own problems, whether that's attributed to a lack of money or a lack of knowledge/training/skills. Then, when you come in as the outsider, it's assumed that you do have the money and the skills. Your presence alone suggests that you think -- or your sponsoring agency thinks -- you know best.

Many volunteers and development workers don't believe this. Many want to come in with humility and learn from and share information with local communities; they don't want to be paternalistic. I've been told that it's far better to think about Peace Corps service as sharing information rather than as "helping." I think about how I would feel if someone from another country came to America and started telling me that I ought to use a condom or eat more vegetables. I'd want to know just who the hell she thought she was, coming in and thinking she knew more than me about my life, culture and country. I'd want to know why she thought I needed her help. There are educated people everywhere. Legions of skilled, intelligent Swazis are already trying to provide public health information to their neighbors.

So, what am I doing?

Truth be told, I'm not sure. It feels a bit repugnant to be here, whatever my intentions were when I arrived. Have I affected the lives of some people in my community? Perhaps. I only hope I haven't done more damage than good. I hope I haven't reinforced that developed-developing country hierarchical dynamic. I hope I've been more than a sign of white privilege and wealth, an ignorant, arrogant outsider who flits in for two years and uses terms like "girls empowerment" and "permaculture" and then watches American movies on her MacBook all night.

On top of my personal moral quandaries are those related to the big picture of development. The vast majority of the work is being done in developing countries. The vast majority of the money comes from developed countries. This creates a power imbalance. Can a Swazi health official truly stand up to an American aid official if he or she disagrees with how U.S. money is being spent? When Western organizations seek community input, are they truly listening? Do they trust the feedback they get? Or is it more of an act of courtesy? Sure, tell us what you want, but we already know what we intend to do. It's also difficult because funding and grant writing often precede those community conversations. How much flexibility is there, really, when you've already made promises to funders back home?

By and large, I think organizations that seek community input do hope to use that input to inform their work. But regardless, most of the money is coming from outside the country and is being spent by outsiders. Reports go back to Washington; there are numerical targets and legislators to answer to. Is that the best way for us to work toward improved global health and development outcomes?

There's a big push now toward capacity building and sustainability. Organizations want to train people on the ground to do the development work they're doing and to perform the research that foreign academics are performing. That's laudable, I believe. The people who live in these countries, whose lives will be affected by the research, programs and policies in place, ought to be a major part of setting the research agenda and determining how development moves forward. But that presents difficulties of its own, which I won't explore here.

At the end of the day, I have more questions than answers. People often say that in public health, the goal is to work yourself out of a job. Are we that altruistic? I hope so. That's a question related more to human nature than development, however. This field is ballooning. The future of public health workers, to an extent, will depend on people NOT having what they need to be healthy. Seems like a tenuous system.

These are the thoughts floating around my head as I prepare to look for a job back home. Do I attempt to plug myself into this system? Do I believe in it enough? Are we doing it right, or do we need to blow it up and start afresh? I haven't even touched on colonialism and how its legacy ties in with what the West is doing in the developing world now. And then there's aid as foreign policy, which represents another strand of the web.

Many others before me have considered these issues at length and more coherently. I'm nothing if not unoriginal, friends. Perhaps what I need to do is read more about how others have found their way through this maze of concerns and out the other side. Insights, article and book suggestions welcome.