Kenya and Tanzania: Re-Thinking Environment, Medicine, and Development

This trip to East Africa has been mind-numbingly miraculous. We flew into Nairobi and from there visited seven different game reserves in Kenya and Tanzania – Samburu, Lake Nakuru, Maasai Mara, Ngorongoro Crater, Serengetti, Lake Manyara, and Amboselli. The most magical element has been my ability to question the values I once clung to. My ideas about the earth and the environment are shifting; my opinion about medicine being a liberty and fundamental right of all people is now shaken; and my general belief that development traces a linear model has been uprooted.

The EARTH:
Amer told me I would fall in love with the country and I resisted that idea knowing that I would have limited interactions with the people and with the country itself, but as I was driving between parks, I realized a country is not only made up of its people. How Western an idea that countries are defined by their economies, citizens, infrastructure and policies. Have we moved so far away from the ground we stand on, from the earth that sustains us that it no longer bears any relation to us, our identities, and our lives?

Traveling through both countries, our jeeps faltered along the disheveled roads and broke- our tires popped and the fenders of our vehicles fell off. It wasn’t even then that we recognized the vitality and strength of the earth. Being modern and obsessed with development, we have contorted the earth and the land to fit our needs. We have razed down forests and laid down oceans of tar so that we can move quickly from place to place, focusing on our destinations and goals instead of our journeys. Our buildings reach from the earth to the clouds as we control and contort every inch of space that man can reach and yet we forget how uncontrollable the earth is.

I just read After the Quake, a book of short stories by Haruki Murakami and one of his stories emphasized this point. In the story, he personifies an earthquake as a worm who lives below the surface. The worm is an embodiment of negative energies that course through the earth as men tear apart the surface and erect edifices. Then, once a certain threshold has been reached, the worm releases all that negative energy back to the earth’s surface in the form of natural disasters such as volcanoes, earthquakes, tsunamis, etc.

It makes me wonder because we as human beings want to believe that our actions matter and have ramifications; this ties us to our mortality. And so this story seems to be in keeping with the idea of karma and other similar philosophies. Instead of analyzing these events as reflections of our morality and personal actions/decisions, maybe we should shift the focus onto the consequences of our actions on the earth. Maybe the Earth should be considered reactive instead of stagnant; like all entities it cannot keep absorbing without an expulsion.

I have never been particularly passionate about environmental issues, but perhaps it has been because my life has been so far removed from nature. But as I reflect on some of the reasons this trip has been so moving I come to the realization that much of what I admire about Kenya and Tanzania are similar to the things I love about India. In India, you smell cow manure, you taste the dust that rises in clouds from the streets, you feel the grit of pollution on your face and you make eyes with the people in cars next to you. But in the States, we rush from our homes to our destinations without being jolted from our daydreams by rocks in the road, without smiling at the people around us, and without interacting with our environment.

The game parks were so particularly beautiful because the landscape is completely void of human life. There are mountains that climb slowly to the skies, winds that amble through the tall grasses, animals that bound across roads and babies that rest in the shadows of their mothers’ bodies. Being so close to animals is an indescribable experience. I completely forgot that a) I wasn’t a wildebeest and 2) that other humans existed. Planet Earth – the term takes on a different meaning. It’s a good reminder that humans are only one of the species that live on the planet; we have been able to control it to suit our lifestyles but that doesn’t mean that it is our right. In fact, being as capable as we are, it should be our responsibility to understand the delicate nature of the resources and preserve them in a way that the Earth can continue to sustain itself and endure for even longer.
MEDICINE: A RIGHT OR A CULTURE?

One of the days on our trip we went to a Maasai village. I got an opportunity to talk to the chief’s son and asked about cultural opinions towards medicine, vaccines, birth control, etc. And while I was listening to his responses, all I could think about was ways to explain, in culturally adaptive terms and conceptual models, why and how medicine was important. I found a renewed passion for medical anthropology and thought that I could spend my life working with organizations/ doctors to disguise medicine as cultural solutions to medical problems.

For example, an anthropologist working in rural areas of Bangladesh found that many mothers whose children were dying of dysentery believed the deaths were due to the “evil eye.” Once having realized this, a slew of ethical dilemmas arise for doctors in the area. The cure for diarrhea is vitamin A drops – a simple solution, but one that comes attached to a Western viewpoint of medicine, sickness, health, and life. The way I see it, the doctors had three main alternatives. They could explain to the mothers the causes of diarrhea and explain why vitamin A helps; they could pretend that vitamin A was a solution to the negative effects of the “evil eye”, or they could join with a local medicine-man and introduce Vitamin A to him as a cure for the evil eye without attaching Western notions of medicine to it. It is easy to find merit in all three of the possibilities, but it is more difficult for me to choose one method as a general rule; one of the tenets of medical anthropology is accepting the lack of universals. So, accepting this, I thought a great job for me would be to work within local cultures and find the best way to advertize medicine in a culturally adaptive manner. And then I talked to Alissa.

What if it isn't our job, obligation, or responsibility to introduce the concept and culture of medicine into societies? Medicine – it is a culture. The western concept of medicine assumes certain ideological tenets – the value we place on life, how we view and analyze death, how we understand our role in the universe. Western medicine has similarities to its philosophies and religions. It places great importance on life, on individualism and humanity.

Yet, other belief systems around the world view death as a welcome relief from suffering; they view energy as something borrowed, something that binds all matter together. Life is not the ultimate destination or experience. So is it right to teach populations and cultures to avoid death. Death for some is not the end; it is not terrifying. Is it our right or even our place to alter these views?

Some could argue that by delivering medicine we are altering nature, that we are modifying processes of natural selection. Survival of the fittest – the fittest no longer have to be those wealthy enough to discover, manufacture and afford medicines. The fit can now become those whom medicine is distributed to, although their capabilities of enabling their own survival is limited and suppressed because of the manner in which they receive.

But this argument raises many questions for me - is it natural for us to be prolonging life? Is it our right, as humans, to battle epidemics? Disease has always been a threat to humanity, but because it has been a means of population control. From the Bible to the Black Plague, disease has controlled our growth, balanced us, and allowed the Earth to sustain us. But now our resources are being unscrupulously wasted and we have only ourselves to blame.

As medical anthropologists, we should aim to minimize suffering, not alter the understanding of disease, or of life and death. We should not define medicine couched in our own philosophical or scientific terms.

DEVELOPMENT: A LINEAR MODEL?
Driving from Kenya to Tanzania I saw dozens of painted signs noting the presence of various organizations, particularly USAID. And it made me think – Western academic thought is largely propelled by the idea that we have achieved a certain level of development because of modernization and that those countries and societies that eschew technology and more “civilized” forms of government are backward and in need of guidance. It is common for critics to question the role of the West in teaching other countries (whose histories, cultures, politics, and societies are different) the best way to govern and service their people. But how many people question whether development is actually a good thing? How progressive is it? And what are we progressing/advancing towards?

We assume that all countries should follow a similar trajectory as we (the West) have done. It assumes that with technological advancements and medicine that we somehow become better – better, perhaps, in the way we can control external circumstances. Capitalist, democratic institutions are heralded as ideal but with the progression towards this end, the possibility for violence, suffering, inequity, and conflict increase. More and more countries are testing nuclear weapons; national pride is being weakened as certain domestic regions race ahead of others, increasing the gap between the rich and poor.

The concept of development has been degraded into a model of binaries, equating development with all things positive. (Even in using the language of this model, our arguments become distorted by the connotations and implications of certain words.) But having observed people in under-developed countries and the local Maasai culture, I find that these “primitive” societies are so much closer to the idyllic state of man.

With technology comes better productivity, and with productivity comes competition and capitalism, and so comes the onslaught of man's greed and desire for success. We alienate our selves from each other because we prioritize our success, and success is measured in comparison to the failures and weakness of others. Even now, the most developed countries are obsessed with control and power; they amass weapons to defend our claims to this power and strengthen their economies so that they may dictate/influence the circumstances of others'.

By forcing societies into structures of pre-approved order and implying that development brings with it a certain type of governance we have unleashed a force upon the world that is uncontrollable. Men now vie for power over areas that may better flourish outside the realms of control. I think of dictators or political parties in countries where societies exist, ignorant of government and political processes –even, I daresay, some regions of Afghanistan. What is the need for the government or international institutions to reach their tentacles into these areas? I admit the government CAN bring with it services, liberties, and justice, but is there a need for foreign actors to introduce these concepts into a society where they exist naturally without being cognitively recognized?

I do not pretend that these elements do not exist even in under-developed societies, but it seems to me that life in societies that are more or less socioeconomically equal in makeup is …. Is what? The word I am looking for is crucial, and so I hesitate to choose one. Maybe simpler. Simpler because individuals live to survive; the quest of success is to meet basic needs. Or fulfilled. Perhaps the word is fulfilled.

My Identity (?)

A professor once asked me to describe my identity in five words or less. I wrote: woman, Indian-American, privileged, compassionate, and logical. The first is simple and indistinguishing. The second: Indian-American. I put Indian first because my heart and soul are Indian, but I chose to bridge this word with American because my ideals are American. America has given me (and my parents) the opportunities to be who I want to be. I have had the freedom and dignity to define myself and choose the options that would strengthen us without many limitations. The hyphen acts as a bridge between the two words, implying my place as both a part of, and stuck between, these two cultures.

Privileged – it is something that has allowed me to cultivate the worldview with which I can appreciate what it means to have money, education, the access to power and the ability to make the choices I want. Choice is a symptom of privilege; the freedom to decide between choices that are beneficial to us is a rare advantage. Being privileged has left with me a sense of guilt – why is it that I have so much when others have so little?

I have been given every opportunity, freedom, and liberty possible. I was once a seven-year-old tourist in her homeland, who sat besides her uncle in an air-conditioned Mercedes and leapt back from the tinted window when withered hands pressed themselves against it in requests for money. I am now twenty-two years old and I ride in auto-rickshaws so that I don’t have to roll down windows; I can reach out and touch those tired hands. My heart goes out to the women who walk barefoot on the sun soaked tarry roads, leading their children behind them, wandering between the lanes of honking cars who live their lives off others’ moments of sympathy. We have been endowed with the righteous fists of justice and it is our obligation to use our privilege to help others.

Compassion and logic. I think the greatest and most aggravating facet of my identity is comprised of two antagonistic elements: one is my compassion for others – the ability to empathize and transcend the boundaries which segregate people – socioeconomic privelige, religion, culture, language, etc; and the other is my logic.

I am always able to see, understand, and sympathize with multiple perspectives on any situation. It is because of this I find myself less opinionated, something I pride myself on. I once met an astrologer in Jaipur who told me my future was defined by a “double life.” He explained to me that I would always be of a “double-mind” – and I take this to mean the constant war that is waged between compassion and logic in my mind. Simply, it is the battle between following your head and heart. I am grateful for that open-mindedness that allows me evaluate situations so thoroughly while considering the predicaments and emotions of others, but it often leaves me feeling hesitant to act. It is this hesitancy that makes me question my strength and conviction.

My father chose the name Komal for me. It means delicate in Hindi. And for so many years, I thought he made a mistake; the name of his choosing had no bearing on my personality. I resented the fact that my name had the connotations of weakness, and perhaps that is why as I grew older, I placed greater value and significance on the ideals of independence and strength. And I still do. But the more I confront the world and the more I engage myself in various relationships, I find that the one ideal I place above them is compassion.

Compassion does not come easily to many; it is often stricken down by apathy and self-interest. And apathy is humanity’s greatest plague. But compassion and the conviction to fight for what we love is made possible by hope. Hope is so powerful because it is ignorant of the chances for success; it vilifies the idea that some things are worth fighting for and believing in, regardless of the consequences.

In a way, I have found that compassion reinforces our strength; it dignifies our convictions and allows us, in turn, to be strong. But delicacy implies sensitivity and I choose to define the “delicacy” implied in my name, as sensitivity to others’ pain and suffering. It is this sensitivity that makes us strong – we are able to see and appreciate the differences between ourselves and others, and appreciating them allows us to consider and fight for change. It is easy to be hurt, to get lost in pain and to complain about the static, sluggishness that feeds on helplessness but it takes strength to wage battles that may not end in victory. It takes strength to take on the burdens of others and forego the privilege and benefits that we feel so entitled to and deserving of – and I don’t know if I am so strong yet, but it is certainly an ideal that I hope to be defined by at the end of my life.