Who and What Counts?

What and who counts? I found myself repeatedly asking this question during each distinct reading, converging the stories, separating them; piece by piece determining what and who counts. There are many different forms of contextual evidence to support what and who counts. If you look generally, of course, the people of impoverished, developing nations — benefiting exorbitantly from foreign and strange aid programs. Except, not very much. A large disconnect exists between what and who counts, whose agenda we are following, and why.

Chapter 1 of When People Come First alludes to a better future, where we have given up on the radical idea that singular-technology can “overcame any obstacle posed by social conditions and processes” (Biehl, 32). International agencies seemed to finally convene and agree upon their ignorance and lack of understanding (or desire to understand) regarding differing beliefs and ways of life. Basic power dynamics of International Givers are established, including the brief history of malariologists, and how “medical technology could only be administered by an elite group of experts.” This act made a clear distinction between ‘us’ and ‘them’ — allowing for critical knowledge and information to be kept private and isolated.

Historically, Sierra Leone has been a place of ramped colonialism and exploration — the birth ground of ‘us’ and ‘them’. In 1807, Sierra Leone became Britain’s first West African colony. At first, the location was idealized, but the rising and ferocious rate of deaths coined a new name — White Man’s Grave. Anyone who went could expect to die, or have something gravely wrong with them. I don’t believe our association between an uncivilized environment and people has ever gone away (Rankin, 3).

In 2005, when the author (Adia Benton) of HIV Exceptionalism attended a strategic-planning meeting for HIV/AIDS in Sierra Leone, she was struck by how prescribed and unoriginal the plan/information was. For example, there was one single reference to war, when refugees were mentioned, but besides that — nothing. This fact, in and of itself, is exceptional; considering the amount and degree of warfare ravaging the land.

This is is not the only issue with Sierra Leone’s AIDS work. 1% of the population is living with AIDS (18% of burden; 40% of disease), which is incredibly disproportional when analyzing others factors and determinants that lead to illness or death (whose agenda?). Additionally, the usual rhetoric for AIDS does not necessarily apply in Sierra Leone (poverty, etc.) — as AIDS does not disproportionally affect the poor. In fact, living with HIV is diversely spread across various socioeconomic classes — yet since this fact has not been taken into account, supports from the foreign and International aid highly favor the very poor individuals with HIV (Benton). As Benton states, “We are attempting to overlap poverty, social inequity, marginalization, etc. — which are not the primary determinants in Sierra Leone. There are different patterns of transmission, different strains. Factors like poverty affect where HIV-positive people seek care, the terms/quality/and efficacy of care, etc.

Benton introduces the concept of biotribalism, the carving up of spaces and distribution of resources according to presence/absence of HIV. At one Press Conference on the awareness and prevention of AID, a man stood up and stated, “How can you tell us that the disease is like any other disease but then treat it like it’s not? We’re having a press conference about it. There’s separate money for treating and dealing with the disease. Isn’t separating it also marginalizing the disease? Aren’t you marginalizing and causing discrimination by making it separate like this?” If social aspects like self-esteem and self-reliance create a healthier population (Biehl), then why are we attempting to control everything, down to there rationing of food?

So, the question begs, why do these efforts exist in isolation? Is it the generous stipends/unique benefits for workers? Is it the exceptionalist drive of living positively with HIV? Is it embedded reliance? Benton discusses how “HIV Exceptionalism amplifies existing disparities”, and I wonder if we have created a system that is un-functionable without foreign help and intervention. A report back to the World Bank in 2007 notes “projects are complex with many participants engaged in activities for which they have little … comparative advantage” (Benton, 46). Are food, natural supports, community supports, medical care, etc. not advantages in a war-torn country like Sierra Leone, with AIDS not nearly as large of a problem as starvation and poverty? Benton discusses those with HIV as a “special group” not necessarily ‘othered’ by stigma/their diagnoses, but because they have access to resources that no other individuals do. So, again, I ask the question, what and who counts?


In light of all the engaging and interesting comments, and the additional knowledge I have gained from class/readings, I am adding a short update to my blog. In the comment section, Methma asked, “I wonder how we can work to change these ideas of Africa as a “white man’s grave” and the association of an uncivilized environment and people, like you mentioned. Do you think these associations are mostly subconscious now or are they furthered by how we view aid in other countries?”  I believe it is mostly subconscious, but certain pressures and situations bring these inequities into the light. For example, many students chose to write about the difference in treatment between the foreign aid PIH worker who contracted Ebola (and was immediately sent to the US), and the community health worker for PIH (who had to wait two days before being taken to a clinic). This difference in treatment is pronounced and defined, and stands to support our historical notion of Africa being the ‘White Man’s Burden’, and the death of a white body meaning more, and being more of an ‘event’, than that of a black body.

Additionally, I want to clarify that I do not think that focusing on HIV/AIDS in Sierra Leone was a mistake — but wish these programs can be optimized, expanded, and executed properly — so as to reach the most amount of individuals, in the most successful manner. Shreya commented that “beggars can’t be choosers”, but I believe that viewing those in need of aid as ‘beggars’ meds itself to the colonialist view of the poor, desperate bodies in Africa. When discussing Improvising Medicine during Lecture, we spoke about how drastically different cancer is in the US/Botswana, yet those in Botswana were still deserving of decent, humane, and caring medical treatment. Of course, individuals will take what they can get, but we must never stop critically analyzing these interventions. We must continue to interrogate why it feels normalized and appropriate to provide Africans with no-frills care, but take extra caution to ease any ache and pain in a ‘suffering’ woman in the US. These tradeoffs are rooted deeply in colonialism, and have huge impacts and influences on the programs we provide, and the way we facilitate them.

Finally, in my blog post I state, “I wonder if we have created a system that is un-functionable without foreign help and intervention.” Through my continued learning of the PIH model, I am confident that there are solutions, however complex they may be, that can help lessen the dependence on foreign aid and international organizations. For example, PIH helped forge relations between Haiti and Rwanda, which serves as a south-south system of support and resources, capable of sustaining even after foreign aid has left. This is ultimately the goal, though utilizing services like PIH is definitely an essential part of that path.

Discussion Questions: 

1. To what extent is the newer influx/generation of Global Health worked influenced by colonialism and the original views/perceptions of Africa and the African body?

2. In terms of Global Health work, have we applied the concepts of ‘social determinants’ correctly? Biehl discusses a shift in Global Health work, acknowledging that social factors and institutions were not considered greatly enough in terms of disease (we once believe disease caused poverty, etc.), yet in terms of HIV Exceptionalism, it seems as though we are looking at and trying to overlap poverty, social inequity marginalization, etc. — which are not the primary determinants in Sierra Leone. How can we change the way we think about and apply the concept of social determinants?

3. To what extent have our AIDS-related efforts amplified existing disparities in Sierra Leone? Our are tracks traceable?


Benton, Adia. HIV Exceptionalism: Development through Disease in Sierra Leone. Minneapolis: U of Minnesota, 2015. Print.

Cueto, Marcos. “A Return to the Magic Bullet?” When People Come First: Critical Studies in Global Health. By Joao Biehl and Adriana Petryna. Princeton: UP, 2013. 30-54. Print.

Rankin, F. Harrison. The White Man’s Grave: A Visit to Sierra Leone, in 1834. London: R. Bentley, 1836. Print.

22 thoughts on “Who and What Counts?”

  1. Hi Stefanie,

    Thanks for your article. I thought your question of whether we have created a system that will not function without foreign help and intervention was really interesting. I think the concept of “otherness” is really important here – the idea of “us” coming in to give good health to “them”, the community that we are trying to help.

    I wonder how we can work to change these ideas of Africa as a “white man’s grave” and the association of an uncivilized environment and people, like you mentioned. Do you think these associations are mostly subconscious now or are they furthered by how we view aid in other countries? To go back to the idea of a system that won’t function without foreign aid, I think a lot of places where global health projects are occurring are definitely deserving of aid, with no strings attached, in their current state. However, I also believe that it is our responsibility to create systems that can work on their own – like how Partners in Health builds clinics that are staffed by a majority of local doctors. But is it easier to simply give money/things like mosquito nets/quick fixes over training the community? I think so, and this leads to another conflict, like that between vertical and horizontal approaches.

    I also thought it was really interesting to look at HIV/AIDS in the context of Sierra Leone, where it is considered an exceptional disease but doesn’t affect the percentages of the population like it does in other, harder-hit areas. The idea of the HIV support groups not being “othered” by stigma but their access to resources, like you mentioned in your last paragraph, is something that we should delve deeper into.

    1. Hi Metha! Thanks so much for your response. I think, like our own Western society, it is a combination of the two (but perhaps more pronounced in our foreign aid work). There is definitely an element of subconscious racism and colonialism that we aren’t always cognizant of, but I also believe that we do hold certain convictions and ‘beliefs’ true to us, and they absolutely influence and impact the nature and delivery of our work. I think, by allowing individuals in Africa to tell their own stories is an excellent place to start, and a way to direct conversation and change the ever-present pity narrative that runs rampant in our world.

      I too believe that it is our responsibility to help create sustainable systems, though it is much easier to simply send of quick, temporary fixes such as mosquito nets. Diagonal approaches can work extremely well, where a disease is viewed as a lens for achieving larger-scale primary health care. Of course, the balance is never completely right, but by being aware of unintended consequences and mistakes that stand to be made, NGOs can minimize their risk-factors and attempt to create the best program they possibly can.

  2. Hi Stephanie,
    You brought up a lot of good points in your post about what and who counts. As I was reading the first half of your post I related a lot of your ideas to those brought up by Paul Farmer in his book, “Infections and Inequalities”. Farmer talks about how emerging diseases are actually not emerging, just becoming a problem for people who hold power, and the impoverished individuals who have always had these diseases are largely ignored. The example that Farmer poses ties in perfectly with your question of who and what matters. In this case, the health of individuals higher socio-economic status matters more than the health of people in lower socio-economic status. This again, highlights how classist the healthcare system in fact is.
    Additionally, I think that something else to consider when bringing up the question of what and who matters is what role the media and foreign NGOs play in determining what it is that actually matters. In Adia Benton’s book, it was obvious that HIV was taking precedent over other disease that needed just as much attention. What was at the root of this HIV exceptionalism? I believe that much of the attention placed on HIV is caused by the NGOs and the media that portray this virus as a very African disease that fosters itself in settings of poverty. A disease that is worth putting foreign donor money into. These foreign organizations can put value on what they see fit and thus deem what and who counts.
    In response to your last paragraph about foreign aid picking individuals who are HIV positive as the people “who count” or who get the most help over those with other needs such as poverty and hunger. I believe that there is a danger in completely dismissing the pros of a campaign that is focused on treating HIV. I think that this is true especially in a place like Sierra Leon where access to antiretroviral drugs is not as wide spread as in developing countries. Much of the assistance in HIV is in fact needed, and if taken away can cause a great toll on the lives of the individuals afflicted with it.

    1. Hey Silvia – thanks so much for your response! I appreciate your discussion of emerging diseases, as discussed by Farmer, which is such an important idea when discussing these specific illnesses. Additionally, I did not mean at all to dismiss these programs entirely — I think they absolutely provide much needed services and are essential. However, every program must be subject to critique, and I felt it was necessary to highlight these important points from Adia Benton’s book. I do not think we should not have HIV programs, but wish these programs can be optimized, expanded, and executed properly — so as to reach the most amount of individuals, in the most successful manner.

  3. Hello Stefanie,

    I think you raise some very important questions in your post. One of these questions that stood out to me was to do with whether we have created a system that cannot function without foreign aid or intervention. I feel that to a large extent, the systems that exist in many places would likely grind to a halt if the funding or the personnel from overseas were retracted. But at the same time, I feel that while some of these systems may be unsustainable, their functioning in this dependent capacity is also important as in their absence, there is a possibility that a vacuum may exist. What do you think of this?

    1. Hi Harsh! Thank you so much for your comment. If one organization is trying to do too much, many things may fall through the gaps. This is why, I believe, partnerships and collaboration is so important to Farmer and the PIH Model – they are semi-cognizant of the fact that they cannot do this alone, and reach out to other resourceful agents of change. In this light, I do think a diagonal approach is often best (using a specific illness as a lens for obtaining stronger PHC), and should be utilized whenever possible. When there are many stakeholders, such as within the public sector, and the government, the program has a much higher chance of being sustained when foreign aid is gone. I agree that it is a give and take relationship, but primarily, we should be focusing on making these communities more independent.

      1. Thank you for following up Stefanie. I most certainly agree with you that partnerships are important and that a healthcare system can only be made sustainable if the community is actively engaged and given agency. Foreign aid cannot be expected to contribute in the long term and without taking the sustainable approach, any intervention is likely to dwindle. What I meant to express in my comment was that if the choice is between no intervention and an unsustainable one, then it might be better to go with the latter (I think I misunderstood something you said in your post).

        1. Hey, Harsh. I completely agree – an unsustainable solution is far better than no intervention; clearly shown by Doctors Without Borders. DWB is not expected to stay in a place long-term, but since their role is clearly defined, it makes it more acceptable to focus on short-term goals and temporary fixes. We’re on the same page!

  4. Hi Stefanie,

    Thanks for the insightful blog. You bring out some great points about donors and recipients and personal needs.

    First of all, in an area like Sierra Leone, every effort to improve their basic quality of life is important and welcome. In a region where there is no water or shelter, food or clothing, should an effort to treat AIDS and HIV be a priority? Is such a provision of resources to combat and treat HIV futile when the people infected by AIDS do not even have food and water to help them sustain life? These are ethical and moral questions that often go unanswered. This is because the laws and regulations that enable the funding dictate the apportionment of the funds and resources and not what the need demands. It is hard to cross the line and use the funds for other purposes, because it is possible that the misuse and embezzlement of funds would result.

    As far as your question about why HIV instead of other applications is concerned, I believe it stems from a personal preference of the donors. If you look at the population affected by HIV, it is not a disease of only underprivileged communities from developing nations, but a disease to which even many from elite societies of wealthy nations can succumb. So naturally, there is more funding towards the research and treatment of HIV and a greater element of empathy towards those who are HIV victims. This is a very important factor that is plays a role in the choice and distribution of funds for different causes globally.

    Lastly, it is a known fact that some under-developed nations are totally dependent on foreign aid and are therefore obligated in many ways to follow the provisions set by these countries that support them financially. But as the saying goes “beggars can’t be choosers”.

    1. Hi Shreya – thanks so much for your comment! I really appreciate your discussion of why AIDS is often more funded, and how that relates to the possibility of individuals from wealthy, elite societies contracting the illness. This situation reminds me of what has happened with TB, and I fear that once AIDS is no longer a detrimental issue in the United States, that we will slowly forget about it as a foreign issue.

      I totally understand the context of the quote, “Beggars can’t be choosers”, but I hope we can learn, as global health workers, not to look at those in developing countries as ‘beggars’. This can aid to the idea that these are weak, desperate people who will take whatever I give them, and I can treat them anyway I want. These are still human beings, worthy of a certain standard of care. In Improvising Medicine and Lecture, we talked a lot about how in the US, breast cancer treatment is about a lot more than chemo. Of course, when there are limited resources, most will take what is available, but we should not stop interrogating the forces that allow individuals to be cognizant of the discrepancies in care (i.e. colonialist beliefs that Africans deserve no-frills care, etc.).

  5. Hello Stefanie,
    Your affliction about essentially choosing “who dies” and “of what” really resonated with me. I think it is difficult to find this balance between treating a disease with clear mortality vs. addressing larger pressing issues of poverty and starvation. After all even if only 1% of the population is afflicted, that is still 61 thousand people suffering. My biggest fear in foreign aid allocation towards larger, pressing issues is reducing people and their illness to a cost benefit analysis.
    Moreover, I also wonder if exceptionalizing a disease for the means of globalizing health initiatives can actually have a place in global health. If popular zeal aligns health professionals, funders, public policy officials, epidemiologists, etc., then this can lead to some sort of base of infrastructural health systems. Arguably, collaboration can influence sustainability in the future. “Popular” diseases after all can get people to care about health and support efforts to reduce health inequity.

    1. Hi Nikisha! I did not mean to imply that I would prefer a cost-benefit analysis to be used here. I am simply referring to the exclusive nature of the program described in Benton’s book.

      For example, she described how individuals would attend multiple support groups to access food, and even though there was technically enough food for them to do this, and provide food for those not involved in the HIV program directly, they chose not to. Additionally, if the other 99% of the area of living with illnesses that are perceived to be worse in the community, with nowhere near the level of care and concern, is that exactly justified? I definitely do not have the answer!

      I agree that this can be a powerful starting point, and think what you are discussing aligns well with the diagonal approach, which allows an illness like HIV to be viewed through a lens, with an overarching goal of improving primary health care. There is absolutely power in utilizing these people and resources, which of course, must be taken into account.

  6. Hi Stefanie,
    Your blog brings up some good points. Paul Farmer once said “The idea that some lives matter less is the root of all that is wrong with the world”. I definitely think in the realm of global health there is a differential valuing for human lives. For example, in the past Ebola outbreak, countless Africans suffered and died. However, the only personal stories the media shared on TV were the stories of the few Americans who caught Ebola. It was assumed that Africans would die of the disease, but people only actually started to really care about Ebola when white Americans began to catch it.
    I think it’s also interesting to examine how aid organizations choose which people to help. As told in your article and the book HIV Exceptionalism, the aid donated to treated HIV/AIDS in Sierra Leone far exceeded the burden of the disease there. If we want donations to do the most benefit, it’s important that the aid organizations ask the community want they want, and also research the relative burdens of different diseases in different areas.

    1. Hi Sierra! Thanks so much for your comment, and for bringing up the situation with Ebola.

      As you stated in your comment, the media has an incredibly influential role in shaping opinions, raising attention to certain issues, and inspiring donors to get involved in the cause. During the “Ebola outbreak” I remember seeing a flash of CNN in the Ratty, which stated, “Can you can Ebola in a swimming pool?” I remember feeling embarrassed that this was our news, and appalled by the fact that we weren’t focusing on the far more concerning issues relating to Ebola.

      Though it is a tricky situation, I often wonder what correct balance media outlets can strike, to emote empathy but maintain respect and dignity/autonomy for the individuals and community being discussed. If the conversation and narrative were lead by individuals within the community, perhaps the need would be more properly met!

  7. Hi Stefanie, your article on “Who and What Counts?” really resonated with me. I enjoyed how you observe how colonialism has manifested itself to today’s society- now taking the shape and form of global health and international aid. It is interesting to think about how knowledge of science and technology can create a power dynamic between countries, and make one country feel superior to another.

    Furthermore, you brought up an excellent point about how our paternalistic attitudes can cause a great deal more harm than good. In targeting HIV/AIDS, we have effectively damaged the health care system in Sierra Leone by centering medical care and resources on treating one disease.

    In regards to the fundamental question of your article “What and who counts,” the answer is simple. It is decided by the wealthy and privileged. The example of HIV/AIDS in Sierra Leone causes us to ask an important question: Is self-interest and hunger for power masked in international aid and support?

    1. Hi Divya – thanks so much for your comment! I’m glad my post resonated with you, and I completely agree that we have damaged Sierra Leone’s healthcare system, by, as you state, centering resources around one certain illness. Of course, as some of the other comments have suggested, it is often better to do something than nothing — but these interventions are not out of our control! They are manmade and controlled by people, so with proper critique, we can always search for improvements, and be better in our work and our efforts.

      I do not believe that every person involved in global health and international aid is there for self-interest and power, but I do believe that ethos and mindset runs rampant in the field, and comes with the territory of power players, stakeholders, large amounts of money, and big, important decisions.

  8. Hi Stefanie,

    Thanks for your post. You presented some really intriguing ideas!

    I think the influence of colonialism still remains. Let us look at the example of Ebola. To an extent it was viewed as a “dirty African disease.” There was definitely some racial tension in the way it was portrayed in the media and accepted by certain individuals. The foreign nurses who got infected were presented as unfortunate victims. But not much media attention was placed on Africans who got the disease. In fact it felt almost expected. This further propagates the divide between “us” and “them” which I find very unfortunate and I think a lot of these uneasiness stems back to colonialism.

    I like the conversation around how exceptionalism may amplify existing disparities. Although I do not necessarily have an answer, I think it is a very thought provoking question. As to the matter of whether or not we have created systems that are dependent on foreign help, I think that is true. It is often easier that way. Implementing more sustainable programs are often more expensive and results are only see in the long term. However, this goes to show that there needs to be more focus on these kinds or programs else there will never be a more permanent fix.

    1. Hi Derana! Thanks for your comment. In the example of Ebola you presented, I think it was fairly easy and simple for the US to blame foreigners as ‘disease carriers’ — enabling the transmission of colonialist ideal through many generations of global health efforts. The United States often does not want to recognize or deal with an illness or infection until it becomes a problem for us, and it’s easy and simple to place blame on poor, “dirtier” nations, and forget to address the historical context and spread of these re-emerging diseases.

      Additionally, as you hinted at in your post, the media can have an incredibly influential role in shaping opinions, raising attention to certain issues, and inspiring donors to get involved in the cause. During the “Ebola outbreak” I remember seeing a flash of CNN in the Ratty, which stated, “Can you can Ebola in a swimming pool?” I remember feeling embarrassed that this was our news, and appalled by the fact that we weren’t focusing on the far more concerning issues relating to Ebola.

      As Partners in Health shows, I believe there is a delicate balance between solving temporary crises, and instituting long-lasting healthcare solutions.

  9. Hi Stefanie,

    Thank you for your post. I’ve found myself wondering a lot about the preferential treatment that certain diseases and places get, and why. I also worry about how colonial legacies tie into modern day interventions in those places. For my interview paper, I talked to a Peace Corps volunteer who did her service in Burkina Faso in West Africa. I asked her about any grievances she had with Peace Corps as an organization, and one thing she did say was that sometimes she worried about the ways in which sites were chosen as service sites. It was often through connection to someone working in the Peace Corps offices, through a family member, or a friend-of-a-friend. Is this really the best way to find the communities that are most in need? Unfortunately, this is often the way the world works–we can only reach as far as our connections take us. That being said, I think that evidence-based decisions about where, how, and when to intervene can minimize those bad decisions. Of course, as we have discussed, it is necessary to gain full pictures of places through qualitative research as well, but just at a basic level, knowing that the disease (like in the case of AIDS in Sierra Leone) is actually at some critical mass where it needs to be treated with exception.

    Any organization that is going in and intervening needs to do their epidemiological research. Helping people should not be contingent upon their diagnosis of AIDS. It’s interesting because I think that evidence-based medicine may be the actual solution to this problem–if it was better known what the burden of disease in a particular place was, there wouldn’t be a problem in deciding what disease to treat in an exceptional manner. If the prevalence of a particular disease (say for example it is AIDS) is extremely high, then treating that disease exceptionally would be very beneficial to many people, and providing nutritional and financial support to supplement and boost the treatment to those with that disease would benefit many more people. I think that treating a disease exceptionally in a place with low prevalence creates an incredibly difficult dynamic between those with similarly compromising diseases but some with no access to supplemental aid, and those with the disease with access to the aid. As much as trying to attack a disease with everything we have can seem noble at first, not only will not be helpful to the majority of people in certain places, but it might also damage the social or cultural dynamics within a place, putting certain people at what may seem like an unfair advantage just because those providing the intervention are not well-enough informed.

    1. Hi Zoe! Thanks so much for your comment. I really appreciated the anecdote of your experience interviewing the Peace Core volunteer, and her answer regarding how certain locations are selected. It reminded me of Partner’s in Healths’ location in Rwanda, and how it is so generously funded through Harvard’s Global Funding. Though it almost the reverse of the situation, Paul Farmer being a graduate from Harvard had a lot to do with a) where the funds were going and b) how they were being allocated. Again, supporting your idea that it truly is about who you know; which definitely isn’t the best, most equitable way to get things done.

      Additionally, I completely agree with your comments on epidemiological research and it’s importance, and often wonder why we do not simply conduct more needs assessments before beginning fieldwork, and engaging in full-on programming. Perhaps it has to do with bureaucratic constraints, applications, grants, etc. — but this should definitely be accounted for, and a trial period for field workers should exist, where needs are assessed and community members can place their input and ideas.

  10. Hi Stefanie,

    Thank you for your post! I really liked reading your blog and it draws upon several serious issues regarding who and what counts. Your reference to Benton’s work with HIV/AIDS in Sierra Leone truly highlights the most pressing issues of this situation. It is important to draw upon inequality factors when determining the spreads and strains of these diseases.
    You pose the question of whether we have created a system that is un-functional without foreign help and intervention. Unfortunately, I think this is true. Many developing countries that carry the heaviest burdens of such diseases often do not have the resources to treat such illnesses. The intervention of foreign aid from more developed countries will have heavy significance when treating such issues. However, the problem with this is that these more developed countries may lack cultural sensitivity, imposing a sense of patriarchy upon those they are helping. As you mentioned in your post, this will add to the issue of us versus them.

    1. Hi Julianne – thanks so much for your comment! I completely agree that more developed nations often lack cultural sensitivity in their work and efforts, and may behave in a colonialist, paternalistic manner. This can possibly be addressed by working alongside, in partnership with individuals and community health workers from on the ground. That way, the learning is reciprocal, and workers are not acting from shear ideal.

      Additionally, when giving foreign aid so much power, we must be careful of their interests, of their goals, intents, and plans. For example, it would be incredibly helpful to know how long an AIDS NGO plans to stick around, for medication purposes, etc. Of course, this knowledge is not always available, but if an NGO is on a 5 year grant, that is definitely something to consider.

      Finally, to aid with the issue of cultural sensitivity, I believe should fund more service-oriented projects, as opposed to research-focused projects. The latter views foreign individuals (ex. African bodies) as a subject to be studied and analyzed, while the former puts foreigners (the African body) in a position of power/collaboration with the volunteer/worker – allowing for an in depth education of cultural norms, values, ethics, traditions, etc.

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