Making space for things you don’t know.

Medical tourism: Northern health care professionals travelling to Southern locales to provide short-term primary healthcare services to local populations.

A friend of mine recently asked me why I was so concerned about medical tourism. I have been wrestling with this question since way before being asked directly, but nonetheless I have been thinking hard about the response.

I receive an e-publication called the Drum Beat from the Communication Initiative. Besides being an excellent publication (in my opinion) it is constantly introducing me to hundreds of projects taking place worldwide. I read about many great projects, and some questionable projects. But for all of the projects, I don’t know the contexts in which they run, therefore it is hard to critically appraise them from afar. I also don’t know the people running the projects – whether they are community-based, NGO or donor-driven. The point is that all these projects and community initiatives are diverse, and it is impossible to even dream up the stuff that is happening around the globe. We are busy.

This type of diversity in initatives (and communities!) makes it nearly impossible to talk about “international development” or “global health”. Generalizations are increasingly unhelpful and often wrong. If not always wrong. Some medical tourism is probably very helpful, and other medical tourism is likely very harmful. So it is a matter of addressing situations individually. Then it comes down to addressing situations without bias, assumptions and pre-conceptions. And trying to cross cultural divides and differences to understand whether projects are harmful or helpful. The layers of complexity are deep, rarely straightforward and projects often have some harm and some help involved.

Essentially I’m answering, “I don’t know.” I think holding onto this aspect of “not knowing” is the most critical piece of working within the concepts of poverty, health inequity, cultural differences and power. As long as we can be certain that we are unsure that we know all of the potential strengths and short-comings of what we do, I think there is hope. Because we’ll tread lightly and we’ll listen and we’ll think.

As soon as we start congratulating ourselves for a project or “mission” well done, while forgetting about future implications, potential harm or imbalance created, we will start to do harm. So I want to hold space for not knowing and hope that it will keep me on the path of sensitive and ethical action.

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~ by kcanderson on June 3, 2008.

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