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From Eh to Z(ambia) – Reflections of Canadian’s First Time in the Field

Photo by Gautham Krishnaraj in Kapiri Mposhi, Zambia


Gautham Krishnaraj is a 2017–2018 Aga Khan Foundation Canada International Youth Fellow, 2016–2017 RBC Students Leading Change Scholar, and recent MSc Global Health Graduate (McMaster University). He currently resides in Mombasa, Kenya where he is working with the Madrasa Early Childhood Program, an Aga Khan Development Network Initiative.


There’s something special about the “Z” countries. Often overlooked despite tremendous sights for tourists and rich potential for cultural exchange, they are unique places that not everyone sets out to see. Zambia was an unexpected destination (with a layover in Zimbabwe, but I’m not quite crossing that off my list) during my eight month journey as an Aga Khan Foundation Canada (AKFC) International Youth Fellow, working with the Madrasa Early Childhood Program – Kenya (MECP-K). I am here to provide documentation and reporting support while two MECP-K colleagues are conducting the final support visit in a Care for Childhood Development (CCD) consultancy project with the Luapula and Firelight Foundations. Our work centres around teaching new caregivers (with children 0-3 years old) the importance of play, touch, and stimulation in the critical early years of life. We do so through community based CCD Counsellors, who have been trained in CCD and have engaged their local communities over the past year.

Over the past two weeks, we have observed and mentored our CCD Counsellors interacting with caregivers in Lusaka, Kitwe & Kabwe, as well as more rural communities in Ndola, Rufansa, and Kapiri Mposhi. Covering three provinces and hundreds of kilometers, I can attest to the fact that Zambia is very much, as our local partners have noted, a country under construction. Crimson sunsets are dazzling through the copper dust of the daily grind. It is a beautiful place to have my first true “field experience” of conducting research, although it has not been without its challenges.

On Aid

This is an internal ethical dilemma that long predates my arrival in the field. My aspirations are, primarily, humanitarian. I believe that humanitarian health care is the bleeding edge of the aid sector, engaging when local systems are completely overwhelmed by a disaster; man-made or natural. It feels somewhat easier to justify the thousands of dollars spent on humanitarians’ travel, insurance, prophylaxis, R&R, lodging etc., when you know that the local providers are acutely in need of immediate external support.While I recognize and grapple with the challenges of this short-term dialogue of urgency, I struggle far more with the challenges that arise in the context of International Development. Many large organizations, even those starting with the good intentions of building sustainable programs, inevitably fill roles that make it impossible to leave. But eventually they must. Vacuums follow. While I am certain that these questions have have been raised countless times prior, and will be raised countless times to come, it begs the question of a better alternative. I remember reading once that Aid is a sector we all wish didn’t exist, because it recognizes our collective failure to create an equitous global society. Can we do more than wish? How do we contribute without feeling/being complicit?

On Breastfeeding

My role here of documenting feedback on the CCD program involves conducting video recorded interviews, and taking plenty of photos. I’ll discuss consent shortly, but every caregiver and counselor signed consent forms before I pulled out my camera. One challenge I did not expect was that during the vast majority of interviews, with the camera clearly visible and me indicating that I had started recording, many  women start to breastfeed. I fully support and believe in the importance of de-stigmatizing and normalizing breastfeeding, as it is a most natural part of life. However, all but one of the participants were interviewed were young (16-21 year old) mothers, so using video footage that very clearly shows the whole breast introduces some problems. Am I complicit in the stigmatization of breastfeeding by not using that footage, especially as breastfeeding is a critically important aspect of care for Early Childhood Development? The legal age of consent here is 16, but what happens if the reporting video I will make is circulated elsewhere in the larger Aga Khan Development Network (AKDN)?

On Communicating Consent

Finally, and most critically, few of the rural caregivers had a strong grasp of English. Despite the consistent presence of a translator, and despite all of the CCD Counsellors speaking English fluently, one cannot help but wonder how much is lost in translation. This is particularly important when considering consent. Explaining the purpose and/or potential applications of research can be difficult even in a common language; add in translation and the situation is rife with chances of miscommunication. I have never felt entirely sure that the participant understood why three people had come all the way from Kenya “just to see how they play with their baby”. Indeed, the mere fact that we had come from afar may pressure the participant’s perceived ability to decline participation, further exacerbated by a potential sense of obligation based on existing relationships with the CCD Counsellors. It is hard enough to rapidly build rapport and comfort between researcher and participant in English, and immeasurably more so in a few scattered words of Bemba.

While it’s not possible to fully address ethical challenges A-Z, I did my best to keep my camera stowed until the forms were signed, to sit on the ground with the participants, and to capture them in their best light. Under the brilliant Zambian sun, the latter wasn’t hard at all.

The views expressed here are entirely those of the author, and do not represent the views or opinions of the Humanitarian Health Ethics Network, Aga Khan Development Network, Aga Khan Foundation Canada, Madrasa Early Childhood Program Kenya,

 

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Of Textbooks and Well-Buried Bones – Sonya de Laat

Of Textbooks and Well-Buried Bones:

Humanitarianism, human rights and the unintended settlers of the twenty-first century

(Or, The twenty-first century’s unintended settlers and access to community)

by Sonya de Laat

Featured Image: Hannah Mintek

 

At the end of March, McMaster University happened to host, on successive days in separate events, two speakers presenting talks on experiences of settlement by people recently displaced by conflict or forced expulsion. The first talk, by Elizabeth Dunn, was entitled “Displaced people, humanitarian aid and the secret lives of corpses,” and was hosted by the Department of Anthropology. The second talk, by Keith Watenpaugh, was entitled “Refugees, human rights and the Syrian War” and was part of the Hannah History of Medicine and Medical Humanities Speaker Series. Both of these separate but interrelated talks dispiritingly reinforced the growing reality that displacement is fast becoming the new normal. While Syria presents what Watenpaugh rightly characterises as the defining humanitarian crisis of this generation, the refugee crisis created by the protracted violence in that country is but a small part of the massive forced displacement of people around the globe. Recent figures released by the UN put the numbers of forcible relocated people to 65 million, twenty million of whom are officially classified as refugees (UNHRC). This is a three-fold increase in just twenty years (Dunn). Both talks made the case, in their own ways, that in this world of flux, uprootedness, and displacement, Hannah Arendt’s claims made in 1949 of the need to agree on and protect the fundamental human right to have right—as a member of a community with associated rights to political participation in that community—has more relevance today than at any other point in history.

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NOV 2, 2016 SAVE THE DATE – CERAH Panel on Health Care in Danger

When healthcare is in danger, what can we do?”

Time:  Wednesday November 2, 18:30 – 20:30
Location: Medical Faculty UNIGE, Auditorium A250, avenue de Champel 9, 1206 Genève

Attacks on medical facilities in conflict zones have killed and injured countless patients and healthcare professionals in recent years, destroying infrastructures and depriving people of access to medical care.
Moderator Prof Doris SCHOPPER, Director of CERAH, medical doctor and professor at the Medical Faculty of Geneva University will ask representatives of ICRC, WHO and MSF, who are exposed in the field together with affected populations: When healthcare is in danger, what can we do?”

Panelists

  • Erin Kenney, Technical Officer, Stop Attacks on Health Care Workers, WHO
  • Marine Buissonière, Not A Target Senior Coordinator, MSF
  • Ali Naraghi, Head of the Health Care in Danger project, ICRC
Denunciating that medical facilities are #NotATarget, MSF will also present a short film and expose their expo booth in front of the auditorium.

Panel Discussion “When healthcare is in danger, what can we do?”

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On captions

640px-Oxfam_East_Africa_-_A_mass_grave_for_children_in_Dadaab

Children have walked for weeks across the desert to get to Dadaab, and many perish on the way. Others have died shortly after arrival. On the edge of the camp, a young girl stands amid the freshly made graves of 70 children, many of whom died of malnutrition. Photo: Andy Hall/Oxfam. From: https://commons.wikimedia.org/wiki/File:Oxfam_East_Africa_-_A_mass_grave_for_children_in_Dadaab.jpg

On captions

Susan Sontag, in explaining the way a single photograph can be used to support any number of points of view, stated that “all photographs wait to be explained or falsified by their captions” (2003: 10).  Photographs are ambiguous. This might seem counterintuitive because of the realism represented by pictures made with a camera. But photography does not provide meaning, it provides data. The surfeit of information that photographs contain require narratives to assign meaning, to develop understanding. More often that not, these narratives come in the short text called captions.

When a photograph is believed to be able to speak for itself, the captions are often limited to information on the time and place when then image was made. In this case, meaning comes through the narrative surrounding the use of the picture: articles, presentations, juxtaposed images. The ambiguity of a photograph allows it to be repurposed for many different ends. The ambiguity of a photograph also means that it has mutable relevance and force across space and time.

The affective elements of the photograph selected for the Summer 2016 edition of Reflections (Vol.4 No.2)—a lone child standing in an arid landscape, in front of numerous fresh-looking graves—draws viewers in. If used in other instances, that emotional grab might be taken advantage of and used to manipulate a donation out of people (Berger 2013). The photograph  would have a different meaning had it been on an aid agency donor-solicitation pamphlet, and different again between rights-based or religious-based aid agencies. In our case, the picture quickly turns to an educational moment because of the caption, which was the caption provided for this photograph in its original source location on the Wikipedia page about the 2011 East Africa drought. Given the wider context of the focus of this edition of Reflections on palliative care in humanitarian crises, the meaning becomes much more specific about the reality of death in certain crisis situations, thus supporting the recognition of the moral and practical imperative for humanitarian organizations to support palliative care.

 

Photograph:

Andy Hall/Oxfam; source, https://commons.wikimedia.org/wiki/File:Oxfam_East_Africa_-_A_mass_grave_for_children_in_Dadaab.jpg

 

Reference:

Sontag, S. 2003. Regarding the Pain of Others. Picador

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Critical history of humanitarian photography on display

From 23-24 May, 2016, as part of the World Humanitarian Summit in Istanbul, Turkey, an exhibition that takes a critical historical approach to looking at humanitarian photography. This exhibit is part of the ODI-HPG ‘Global history of modern humanitarian action’ project.

Beyond icons: subjects and stereotypes in humanitarian photography

Description

Looking at photographs of humanitarian crises, we often get a sense of déjà vu.

This familiarity stems from the repeated use of stereotypical depictions of people-in-crisis over the course of 150 years of humanitarian imagery.

This photo exhibit features a range of ‘icons’, or visual tropes, such as ‘The mother and child’ and ‘The boat people’.

Featuring both historical and contemporary photographs, this exhibit invites critical reflection on how people in emergency settings — from refugees to aid workers to famine victims — are typically portrayed. It also explores the purposes, aims and power dynamics underpinning humanitarian images.

This exhibit is one in a series organised by the World Humanitarian Summit, on the theme of ‘reflections’. It forms part of our ‘Global history of modern humanitarian action’ project and was curated by Valérie Gorin (University of Geneva) and Sonya de Laat (Western University/McMaster University).

Photo credit: Joe Wenkoff/joewenkoff.com

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The Humanitarian Visual Landscape of 2015

by Sonya de Laat

Miserable images of the ravages of Ebola Virus Disease in West Africa (thankfully, on a downward trajectory by that point) were at the forefront of the humanitarian visual landscape of 2015. These pictures were swiftly overtaken in the spring (and for the bulk of the year) with heart wrenching images of the perilous journeys taken by (im)migrants en route to Europe. The vast majority of these images are undoubtedly shocking. Photographs such as Samuel Aranda’s picture for the New York Times of a four-year-old girl lying on the urine soaked floor of a Sierra Leone health facility, and Nilufer Demir’s photograph of the tiny, lifeless body of 3-year-old Aylan Kurdi washed up on the beach in Bodrum, Turkey and countless others contributed to the ongoing debates about the ethics of showing pain and suffering. Such debates are longstanding, reaching back to the early days of the medium, and have focused on: what is acceptable to display under what circumstances or in what forms or forums; when is the circulation or display exploitation, appropriation or commodification; at what point does the representation of suffering render the phenomenon a spectacle?

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Pandemic Heroes: Saving Humankind on the Big Screen

by Christos Lynteris

Even in the midst of widely publicized public health emergencies, like the recent Ebola outbreak, epidemiologists largely remain invisible to the general public. Though the figure of hazmated healthcare and epidemic control staff has become perennial, the only glimpse we get of the epidemiologists is the odd press conference clip. This renders fictional representations of epidemiologists the most readily available source for public culture configurations of their role in contemporary emergencies. Films like Outbreak and Contagion, which revolve around the story of a infectious disease pandemic, as well as World War Z or the recent remakes of The Planet of the Apes, which would be more readily recognized as belonging to the sphere of science fiction, have all in their time achieved blockbuster levels of success.

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From ‘suffering others’ to ‘aspiring mothers’: the contemporary image world of global maternal health campaigns

by Margaret MacDonald

Maternal mortality was once described as the neglected tragedy of global health. Though it was estimated in the 1980s that nearly half a million women died each year from pregnancy and birth related causes – 99% of them in the global south – little attention was paid and little progress was made for many years. Recently, however, the problem of maternal mortality has become somewhat of a cause célèbre attracting the attention of world leaders, billionaire philanthropists, celebrity journalists, and filmmakers. Former supermodel Christy Turlington, for example, made a documentary film about maternal mortality in 2010 and launched her own NGO, Every Mother Counts. Melinda Gates has become a key advocate and donor, gracing the podium of most significant global meetings on the topic. Canadian Prime Minister Stephen Harper, for his part, has made global maternal and child health his legacy issue, launching the Muskoka Initiatives I and II which garnered billions of dollars in funding commitments from G8 and G20 nations, and holding an international summit in Toronto in 2014.

As the global campaign to reduce maternal mortality has been scaled up, so has its ‘image world’ (Sontag 1977) in order to meet the expectations of this new era of high profile humanitarianism.  In this brief blog post I share a few insights about this image world from my anthropological research, starting with the photo below.

Schoolgirl WD foyer 2013
Photo by Margaret MacDonald

I took this photo at the Women Deliver conference in Kuala Lumpur in May 2013. (Women Deliver is perhaps the most influential women’s health advocacy organization in the world). It is one of a series by American photographer Mark Tuschman, commissioned especially for display at the conference. This photo and the others in Tuschman’s series speak to the viewer of a social injustice overcome or medical disaster averted: the teenage girl in the photo is still in school; a nurse talks to a pregnant woman in a functioning health facility; a smiling new mother holds her healthy baby.

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Two Tweets, Two Different Takes on People

by Sonya de Laat

The Tweets:

UN Refugee Agency @Refugees Refugees. Ordinary people living through extraordinary times. Share Tahir’s story this #‎WRD trib.al/AaBPuqW pic.twitter.com/aOFOjAFPPc

Maptia @Maptia The Dani still wear penis sheaths, but they also keep their savings in banks: http://bit.ly/1e62clk by @Vlad_Sokhin

On June 11, two tweets came through my feed in close succession. Initially, both struck me as encouraging: they appeared to be moving toward more nuanced representations and away from flat, one-dimensional stereotypes. Upon closer inspection, the UN Refugee post about an “Architect. Husband. Builder.” is indeed about rendering refugees less hopeless and different. The photos of the Dani, on the other hand, continue the tradition in many photographic practices of exaggerating exoticism. The photographs by Vald Sokhin, a photographer represented by Panos, an agency dedicated to photography for social justice, are carefully composed portraits of individual Dani in traditional dress along with a prop of contemporary globalized life, e.g., can of pop or bank machine.

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The Unwelcome Return of Development Porn

by John Hilary

For 35 years now, there has been a raging debate within international NGO circles around the use of images of starving black children in fundraising materials. One seminal piece by Jorgen Lissner in the New Internationalist accused aid agencies of ‘social pornography’ in stripping individual children of their dignity and presenting them to the Western viewer as helpless objects isolated from any social or historical context, and called for an end to the racist distortion that this perpetuated in people’s conception of the majority world.