I had a doctor’s appointment a couple months ago, and my doctor asked me if it was OK for a student to do the prep work, you know, the usual: height, weight, temperature, blood pressure, the like. I said sure.
What I didn’t expect though, was that the student intern was going to read through a list of health questions to try to find out if I was menopausal. Nothing against menopause – it’s a natural thing and I think some women even look forward to it. But I just turned 42, and no, I’m not having hot flashes quite yet.
I suppose it’s some kind of mandatory thing to ask a woman who is in her 40s a series of questions like that. And to be honest, I probably wouldn’t have minded if it had been my doctor asking me. I’ve been seeing her for years now, she knows me, and she knows how to ask questions in the right way. I trust her.
But sitting up on an examination table in a sterile room, clothes off save for an oversized paper gown that keeps falling off my shoulder, with a 20-something I’ve never met sitting in front of me asking if I’m incontinent, suffer from bouts of depression, and have loss of libido was a bit off putting.
It made me want to lie to her. To not reveal any sign of potential menopausal weakness. To tell her that I never feel fatigued. That I never, ever forget anything, and that I am never ever ever distracted or unfocused. I secretly shunned all her suggestions. Calcium? nope, not taking it. Multi vitamins, pah, I feel fine. Let’s get this interview over with STAT.
It felt disempowering to have this young woman, who I don’t know and haven’t developed any trust in, asking me very personal questions about myself and my life and offering scripted solutions to something she imagined I might have, and that she’d obviously never experienced herself. Since then, I’ve been thinking about it off and on, and related life stories come to mind.
—–
Julia*, someone I was very close to in my Barrio in El Salvador (where I lived for most of the 90s) had a long history of domestic abuse. She would talk to me about it all the time – she still lived with the man, who had tapered off a bit as he got older but who was still not entirely pleasant to her. She would get depressed sometimes and talk about leaving, but she never did. As I got to know her better, I realized my role in the relationship was not trying to find solutions, or criticizing the man, or feeling enraged. It was listening and not judging. An older woman, with a small pension. Where would she go? She believed that she would be seen by the neighbors as weak, and that people would lose respect for her. She really didn’t have a lot of options. So she’d tell me and I’d listen, and that was enough. I’d tell her my work troubles too, and she’d listen, and that was also enough for me. I realize as I write this how much I miss her.
About 15 years ago at work, while still in El Salvador, I was responsible for overseeing a study on gender violence that a partner organization was carrying out and that we were funding. It was going to be a door-to-door survey mixed with some focus group discussions. I immediately thought of Julia; of all the women in the Barrio. I thought ‘Julia would never tell anyone the truth if they came knocking on her door to interview her about domestic violence.’ She would say no, that doesn’t happen here, and close the door until they went away. I doubt any of the other women in the Barrio would have acted any differently.
I felt pretty sure that the information that was produced in that study on domestic violence was not going to be valid, even though it was being managed by a group of well-known, well-educated Salvadoran feminists. But I felt like I couldn’t say anything, because I wasn’t a well known local feminist. And after all, they’d often imply, what did I know about El Salvador? I was a foreigner. What I did feel certain about was that no one in the Barrios where they wanted to do their study was going to tell them the truth.
—–
And somehow related to that, I started thinking about the time I went to the doctor’s office with my mother-in-law, a brilliant, strong and upright woman from the Barrio, with a 6th grade education, who would be considered ‘impoverished’ by most standards. I remember vividly a young male doctor who addressed her using the familiar form of ‘you’ (vos) instead of using the respectful form of ‘you’ (Usted). I remember being furious. I don’t even use vos with my mother-in-law, out of respect. What was this young, wealthy doctor doing using it? I hated seeing her stripped of her well-earned Barrio respect once she entered the doctor’s office, just because she was poor.
—–
What am I trying to say here? I’m not entirely sure, but I guess I’m thinking about respect and the hierarchies of information and education and offices, and the importance of developing a rapport with people before you go prying around in their personal lives and offering solutions.
I’m relating that to ‘aid’ and ‘development’ work, which in my world, is an intensely personal thing. I try to work from the heart, and I hope I’m never making people feel belittled, judged, or like they need to lie to me or conceal things from me because I haven’t taken the time to get to know them. I hope I’m not disrespecting anyone, knowingly or unknowingly, and that I’m not messing around in things that are none of my business or where I haven’t got an invitation. I hope I’m not always trying to offer solutions, but rather listening and supporting people to come to their own conclusions. I hope I don’t make people feel like they are sitting, half naked on an examination table, while someone who knows nothing about them or their life politely asks them some standard questions and comes up with some generic recommendations for how to prevent or cure something they may or may not have or may not think is an illness.
*Not her real name
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Thanks so much for this.
I came back from a village yesterday extremely frustrated, because there were four women who were presenting with classic symptoms of pelvic inflammatory disease, but none of them wanted to go to the doctor. I knew that it was because of a lack of trust between them and the medical system — these women would likely be treated like your mother-in-law was. But I was still upset, even angry, that they wouldn’t go.
This post was a much needed reality check, so thank you!
Glad it helped somewhat…. and I think your reaction is normal. It’s a feeling of frustration too with how the systems work, and how hard it seems to change them. BTW – I really liked your post ‘Privileged’.
I feel you on every part of this post… I also work on gender-based violence issues. Noone would ever normally walk into a medical clinic and say “Hey I’ve been raped” or answer a survey with “yes, i am a victim of domestic violence” . I spend a lot of time trying to train nurses, doctors, and mental health counselors to look for silent signs or calls for help -to read the silent vocabulary of these women and treat them with respect.
Unfortunately, the org I work for is always looking for numbers of women treated as an indicator of a quality program rather than quality of care offered. Once we start looking at our patients as equal to us – demanding human dignity and respect, only then will we be able to reach the ones that need us the most.
Ah numbers, numbers, numbers. That training you’re mentioning is *so* important. You just reminded of what my colleagues were saying a couple weeks ago in Kenya about how police treat people who are reporting defilement or abuse, the kinds of rote questions asked, and how the bad experiences when reporting violence (among many other factors) have a direct impact on the low rates of reporting on violence.
This is a great post. I think aid/development workers should be given more time to get to know the people they work with, create relationships and then go asking personal questions upon which they will build their interventions etc.
As an anthropologist who has worked in the same place for 10 years, I know that there are certain questions that I still cannot ask some of the people in my family compound. Age hierarchy is particularly important in that respect.
(on another note, you have a weird google add below your post, picutures of women with their age/name and little kiss signs- what is that all about?)
thanks Fatou – I’m schooled as an anthropologist too, so maybe that’s part of why I see things as I do. Or maybe people with that mindset are drawn to anthropology. 🙂 I’m not sure what the weird google ad is — it doesn’t show up when I’m looking at my page — in fact on my version of my page there aren’t any ads at all! That’s strange…. going to look into that….
Thanks for this very personal and honest post that reminds us all that it’s our compassion and empathy that make us effective in our role as aid workers. In our rush to “help,” we often forget that people are making very rational decisions and that they have absolutely no obligation to give us information. Just “showing up” and being present for people to ask their own questions and to find their own answers can often be exhausting, time-consuming and frustrating, but is also intensely rewarding, sustainable and impactful.
thanks Jennifer, I’m thinking too that we somehow owe people more than ‘just showing up’ when it goes beyond a personal relationship, eg., when it’s part of a job, because people’s expectations may be different.
Thank you for the post!
I was in South Africa with my school two years ago, and we did a service project at a battered women’s shelter outside Cape Town. The previous year the program had cleaned up the back yard so the kids could play in it. When we got there my year it was full of trash again and some of the work they had put in had been torn up. It was very confusing for me at first, because it had sounded like such a “good thing” for the previous year to have done. But the project wasn’t sustainable for the shelter and it wasn’t something they had a stake in. There had been no engagement. I think that’s a major challenge for development work.
Your post reminded me of that situation a lot and I appreciate it. It is as important to remember I think in development work as it is with social security and urban revitalization in the United States. Respect for the dignity of each individual and their right to have a say in the changes we make to their communities and lives is crucial, and providing aid that matches and springs from community need is important.
So true, so true. I’d even go further and change your last sentence. We shouldn’t be making changes in people’s lives and communities. We should be supporting people to make changes in their own lives and communities. Residents need to own the process :-).
Really excellent post.
“What am I trying to say here? I’m not entirely sure…”
A few key point spring to my mind:
– Relationships matter. They matter more than we think they do.
– We frequently overestimate the extent to which what we have to offer is a) recognized and b) actually valued by those we say we’re trying to help.
– Being from the same “group” (ethnicity, gender, nationality, etc.) as the beneficiaries is no guarantee that they’ll trust you. And on the other hand, being from outside the group (different ethnicity, different gender, different nationality) does not exclude you from being trusted by beneficiaries.
– Lying or witholding information (like you did with the intern), even when it objectively goes against one’s own best interests in a particular context, is a weapon of the weak. No matter how much we might want it to be otherwise, there is a power differential between us and “our beneficiaries.” They perceive it very clearly, even if we don’t.
Just thinking out loud…
Thanks J, for finding the key points in there. 🙂 I think you nailed them. Especially key for me is number 3 — the trust gap between urban/rural, rich/poor, less/more educated, right/left, Catholic/Protestant, etc., *within* a country.
Your post resonated with me, even though we travel in different worlds. In my research on trust, I have found four components to trust–reliability, openness, competence and compassion. We call this the ROCC of Trust. What you are describing–the part that is missing from your interaction with that intern, is compassion. She might be competent because of her training, she might be reliable in terms of knowing how to ask questions and what order to ask them. She might even be open and honest by providing you with good information. But if she does not exhibit compassion to you as a patient, then you will not embrace her young expertise and she will ultimately not be able to completely help you with whatever you need help with. The interaction is not complete because there is not total trust.
This is a good lesson for all of us.
Thank you.
Karen Mishra
http://www.totaltrust.wordpress.com
thanks Karen – Your breakdown into the 4 components does totally resonate in the field of ‘aid’ and ‘development’. Thanks for sharing it!
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