Whose nation is it anyway? Decolonizing global health narratives

By Christine Kamamia
Sister

On a recent flight to Malawi, I came across a group of young American college students. I asked them what they were doing in Malawi, and they said they’re here to “eradicate poverty.” As altruistic as it sounded, I couldn’t help but want to laugh. These 19-year-old Caucasian students who are stepping into African soil for the very first time, are here to solve our problems.

This is the crux of the issue with “aid” coming from the global north. The mentality that they are the ones to solve Africa’s problems, with limited understanding and input from the people on the ground, and no acknowledgement of the role the global north has played in destabilizing African nations. Colonialists have been crafty with controlling the narrative of those they conquered. They came, stole, raped, killed, and after destroying the best of the land and the people, they changed the narrative. Now when they come to the global south, they come to “help.” To eradicate the poverty they systematically created and are sustaining. 

Now when they come to the global south, they come to “help.” To eradicate the poverty they systematically created and are sustaining. 

In my decade-long experience working in global health epidemiology, I have come across researchers in the global north who are considered experts in global health, yet have never spent more than a few weeks at a time in the field in their entire professional career. In contrast, many global south researchers have repeatedly been denied visas to notable conferences and meetings in the global north, essentially excluding them from global dialogues that influence global health practice.  

In the field, I have witnessed many local organizations, including the government, stuck in the middle of serving the interest of the donor and the country—whose interests don’t always align. More often than not, the one who holds the purse strings is the one that gets to control what happens. It becomes glaringly obvious when in some government meetings, there is a strong international NGO presence and influence.  

There have been many instances where individuals coming from the global north, even some with limited professional experience, have conducted harmful practices, yet because of the power imbalance stemming from colonialism, they continue unchecked. The most recent example happened in Uganda, where an unlicensed young woman provided health care that led to many children dying. The story caught media attention, but it was already too late. The “mzungu (white person in many African dialects) knows best” attitude and lax laws have made it challenging to fight these harmful practices locally and globally.

In many cases, it seems necessary to have these bodies present; still, how much is the country actually controlling the narrative? Are they allowed to say “this doesn’t work for our people” without jeopardizing their funding? Funding that has created thousands of jobs? African nations have reached a point where international aid is critical to the countryies’ economies a notion that prominent Zambian economist Dambisa Moyo has characterized as the cause of the paralysis of the African economy.

How much is the country actually controlling the narrative? Are they allowed to say “this doesn’t work for our people” without jeopardizing their funding?

Nigerian author Chimnamanda Adichie gave a powerful TED Talk on the danger of a single story. This can be tied to the colonization of global health aid. There is a single story that has been sold to the world about Africa’s desperate need for the global north to come and save it from itself. This narrative was created by the same individuals who used and abused Africa, It is so embedded into the global north mentality about Africa, so woven into their donor policies, that to dismantle it, they would have to unthink and unlearn long-known “facts” about Africa that weren’t authored by Africans. Just like slavery in the Americas, the impact of colonization of African nations is barely taught and white-washed in the global north. In fact, many are unaware of the horrors experienced by Africans at the hands of the colonizers before and after achieving independence.

To combat some of these attitudes, significant systemic changes are needed in both the global north and global south in terms of law, education, and media portrayal. In the meantime, global health organizations from the global north should establish a strict educational training before implementing programs and sending their staff to work in the field. The training should include an honest understanding of the colonial impact on the nation including the power imbalance that still exists, and the history of aid in the nation. 

The training should include an honest understanding of the colonial impact on the nation including the power imbalance that still exists, and the history of aid in the nation. 

Furthermore, these organizations are still primarily led by white men. The global health workforce is primarily driven by women and people of color, thus real change cannot be properly effected if they continue to be underrepresented in leadership roles. It is critical for the organization to ask itself whether it will be part of the problem or part of the solution in decolonization. 

Every global health organization should ensure that decolonization is at the center of the organization’s core mission.