Thoughts on Cultural Relativism and Some Pictures
Trip Start
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Trip End
Ongoing
Limuru, Kenya
Tuesday, March 2, 2010
I spent last Saturday night involved in an interesting conversation with a member of the Maasai tribe. The Maasai are an African tribe located in southern Kenya and northern Tanzania. They are familiar to most westerners because of their distinctive dress (bright red and blue clothes), their elongated earlobes, and the fact that they live in the most popular game reserves (They are also well-known for their participation in female circumcision, a clearly controversial issue that I won't get into here). This particular tribesman was very engaging and between lamenting the fact that he only had one wife and was not a "breeder" (he had only three children), he mentioned his disapproval over Bill Gates’ attempt to vaccinate every child in Africa.
In January Bill and Melinda Gates pledged “$10 billion over the next 10 years to help research, develop and deliver vaccines for the world’s poorest countries.” Through their focus on vaccination they plan to save more than 8 million children by 2020. Now this seems pretty fantastic to me and I have difficulty imagining that anyone would have any substantive issues with their goal. However, this tribesman did and it soon became clear that he was also opposed to the entire concept of preventative medicine.
His argument was centered on idea that Kenya does not have the resources or space to support a dramatic increase in the population. He provided a simple example to back his point. The average Maasia woman is expected to have eight children in her life. Before the introduction of preventative medicine, it was accepted that at least four of them would die. This ensured that the tribe would have a consistent population. However, currently, because of medical interventions and the fact that woman are still expected to have many offspring there has been a dramatic population increase within the tribes. Consequently, many Maasai are forced out of their ancestral lands searching for work. Many of them end up in the slums.
The tribesman believed that death was a useful tool for keeping the size of his community appropriate. He even went as far as to claim that untimely deaths were an important part of his culture. I completely understand this idea, even if I do not necessarily agree with it. We discuss a similar concept in biology when discussing ecological systems and the carrying capacity of animal populations (the carrying capacity is the point at which any increase in population is not sustainable within the environment). Back home this served as a useful tool when examining hypothetical environments, but the idea was never extended to humans or to real situations. Such an extension crosses all sorts of fairly obvious ethical and moral boundaries. I have to admit his argument forced me to look at medical intervention from a different perspective. However, I was at loss for determining how much serious attention such a perspective should deserve.
Don’t get me wrong; I have great admiration for the idea of cultural relativism. Every culture has inherent value and should be respected. Societal understanding not only sounds nice, but also is necessary in order to provide effective intervention. Already, I have been confronted with many instances where interventions have been hampered because of a lack of cultural appreciation. Such examples include dismissals of a father’s concern over a “cursed” child, the attempted implementation of western financial model for a local school, and teaching a group of women the importance of meditation in the face of hunger and HIV/AIDS. Each of these cases started with the best intentions yet ultimately were ineffective because of a lack of societal/cultural understanding.
However there are important limits to cultural relativism. I tend to agree with Paul Farmer when he says that he is “unwilling to condone social inequality merely because it was buttressed by cultural beliefs, no matter how ancient or picturesque.” (I apologize for constantly quoting Dr Farmer, but as I am currently reading one of his books I expect this to happen frequently) One of the most important things I have been surprised by after two weeks is how connected I have felt with the local people and their lives. Back home, I found it easy to conflate poverty and the developing world with “otherness” and to perhaps justify suffering as a cultural norm to which I simply couldn’t relate. This is not an uncommon guilt avoidance mechanism. You constantly hear westerners discussing how “happy” the poor people of the developing world seem to be, despite their destitute circumstances. While this may or may not be true, I fear that all too often it is used as an excuse for inaction. It is not hard to imagine that the happiness of impoverished people is an indication that they are content with their situation. We as rich westerners could not possible understand the fulfillment found from living in poverty, we simply can’t relate to their alien “culture.” Consequently we feel no obligation towards helping the poor. This line of thinking is too convenient. Poverty and inequity should not be considered as important culturally. Additionally, just because the poor have adjusted their lifestyles in order to survive does not mean that their “culture” needs to be respected at the expense of their own advancement.
Ultimately, this is why I take issue with the argument of the Maasai tribesman. I understand that the idea of preventative medicine is potentially destructive to certain aspects of his culture. However, the benefits of vaccinations and the potential of those eight million African children far outweigh these concerns. For me, poor people have a have a fundamental right to good health and cultural sensitivity should be a secondary concern.
An Overview of Home Based Care and My Trip to the Masai Mara:
Most of my time during the week is spent working in a local village called Kawaida. In Kawaida I am assisting a local pharmacist with setting up a basic health care system. Although the health issues presented in the town are significant (I have already come across TB, HIV/AIDS, Malaria, Breast Cancer, and Elephantitis), we are starting by focusing on basic wound care, treatment of burns and the eradication of Chiggers. Chiggers (or sand fleas) have infested many of the houses in the area and usually cause problems by entering the feet of unsuspecting children. The process of removing Chiggers involves soaking one’s feet in antiseptic and then manually removing the parasites (usually with a needle). I have included some pictures of the village and our treatment procedures. There are two women who were helping me with this project: Essi from Finland and Karin from Germany. They are both nurses and extremely well qualified.
Additionally there are three pictures from my trip to the Masai Mara, a large national park, last weekend.
Comments
David,
What a transformational experience you are having. I would be interested in your reflections on the role and place of women in the Massai society, and how they feel about having 8 children, access to education, etc. etc. . I attended a very interesting summit organized by the Global Fund for Women, and a grantee who conducts leadership programs in Uganda spoke very forcefully about the dominating role of men in Ugandan households, its impact on the ability of women to have a voice both inside and outside of the home and the importance of leadership, education, health and skills training for young women.
David, I am so thrilled and amazed at the work you are doing. Your blog is informative and thoughtful. I have a comment about the tribesman who sees infant death as a means of population control. He says that the typical woman in his tribe is expected to have eight children. It seems to me that, with the continuing vaccinations, two things will happen - more kids will live and the population will correct itself. As the tribe grows, and the children thrive, the men and women will see that it is not beneficial to bear eight children, thus the population will adjust to a supportable level. When America was founded and then during the great western expansion, families sought to have many children - boys to work the land and hunt, girls to help raise and care for the family. A high rate of infant mortality was expected. This pattern continued into relatively modern times. My great grandfather was one of 14 kids, and his son (my grandfather, born in 1900) was one of 9. But by the early twentieth century, the infant survival rate was dramatically higher than previous generations. And the necessity of bearing many kids in order for the family to prosper had been reduced greatly. My mother, born in the 1920's, was one of only two kids. The turnaround had occurred quickly - in essentially one generation. I expect the same will happen among the people who are now receiving vaccinations for the first time. Thoughts??