Moving toward a radical medicine: on bringing international experiences home
The first time I walked into a supermarket in Iganga, Uganda, the man behind the counter immediately started speaking to me in Hindi. I was in Uganda for two months with the Uganda Village Project, working on public health interventions with other young people.
I found myself bantering in Gujarati, my mother tongue, with many other shopkeepers, including at a supermarket I frequented, where I would chitchat with the owners’ young daughters each time I purchased packets of Maggi noodles. I even brought my friend to their home for lunch. We spoke in mixed Gujarati and English over rotli, daal, bhaath, shaak, pickles, and sweets.
Though they initially took me by surprise, the ease of these exchanges was a testament to the years of polite conversations my mother had forced me to make with friends and distant family members I barely knew, building connections over a sense of shared belonging.
Through my parents’ network, we found family friends in Kampala, and I visited their home several times. After many South Asians were expelled in the 1970s, they were among a handful of families who returned to Uganda with the help of tax benefits offered by the current president. This was our family home, they told me.
They invited my friends over for lunch one weekend, and our group included one of the Ugandan team members. Normally very friendly and outgoing, he seemed particularly reserved that day, and later someone told me that he had said that no mahindi had ever treated him that well before.
It was through these experiences that I began to understand the connections between the country’s racial and economic landscapes and its concomitant racial tensions.
Assimilation
White foreigners, especially Americans, were referred to as mzungus. I was told that the word translated to “someone who keeps time,” a reference to the differences in etiquette between the colonizers and the colonized.
As part of a group of largely American volunteers spread out between several villages outside of Iganga, I was initially branded as a mzungu. It quickly became clear, however, that while I sounded like a mzungu, I looked like a mahindi, someone of South Asian descent. People who saw me on my own were often confused—which was I? Mzungu or mahindi?
As I picked up the mellifluous lilt of Ugandan English, I took advantage of this uncertainty, occasionally taking matatus by myself because I felt more secure that people would not try to steal from someone who appeared local, yet able to traverse back into mzungu territory at the bar where we watched the World Cup games.
I could order off the menu at Indian restaurants, I knew which snacks to buy at the supermarket, and I blended in at the expatriate bar in Jinja. Intuitively, I sensed that safety, security, agency, and access were all tied into my appearance and identity.
Neocolonialism
There were dimensions of race that I learned from my colleagues as well. Many of the volunteers were “just there to help.”
Though well-intentioned, these comments characterized countries in the global South, such as Uganda, as backward and underdeveloped, reflecting a mentality which stripped the global South of the histories of colonization and neoliberalism that were crucial to the basic fact of our participation in the program.
The semester prior to this trip, I had read an analysis in my anthropology class comparing international development to neocolonialism.
As I spent time in Kampala, Iganga, and our village, I could see that my presence as a foreigner was effectively superfluous. I had picked up a newspaper in Kampala when I arrived and found that every fourth article was about HIV, tuberculosis, or malaria.
People in the villages may not have had electricity, but everyone had a radio, and programs were constantly broadcast about topics such as sanitation, malaria, and AIDS. As a result, the villagers already knew most of the health-related information we had set out to teach.
Assuming that I had skills or knowledge that were not already present reinforced a narrative employed by colonial and imperial powers that the group of people being acted upon were backwards or uncivilized, thus needing intervention.
I came to understand whiteness not as an inherent personal quality, but as a mentality which reproduced this power dynamic.
Migration
Growing up in San Jose, California, among the ethnoburbs of the Bay Area, I was lucky to be surrounded by people who looked like me.
My parents sent me to a small school that was two-thirds Asian American, and weekends were filled with family friends and cultural gatherings. Undergrad at U.C. Berkeley was a similarly protected space.
Many of my friends and I had transcontinental families, so we placed ourselves in a global consciousness. We spoke different languages at home and at school, balancing the cultural expectations we inherited with growing up in 1990s and 2000s West coast America.
My experiences in Uganda challenged these conceptions of my identity.
My racial identity in East Africa had been specific to histories of colonization and forced and economically motivated migrations, and the dependence of my identity on this context demonstrated to me that race was not an immutable trait but in fact a malleable aspect of one’s experience.
An ethnic studies education
Ultimately, going abroad sensitized me to issues at home.
My undergraduate coursework afforded me the space to unpack my reflections and develop the language to understand the broader phenomena of race and racism. When we talked about meanings of race being socially constructed, I said to myself, yes! I witnessed this!
I gained a frame of reference from which to delve into the connected histories that had shaped my family. I traced my roots across American court cases and policies, from the early quests for citizenship by people like Bhagat Singh Thind and Takao Ozawa, to the Immigration and Nationality Act of 1965, which allowed my parents to migrate to California in 1980, to post-9/11 Islamophobia.
I learned about the construction of whiteness and blackness through the critical analysis of housing discrimination and mass incarceration, the model minority myth, cultural commodification and appropriation, and more. I began to understand that being a South Asian American woman was a political identity.
Moving toward a more radical medicine
I carry this knowledge with me into my clinical training and it directly informs my work.
Like the Black Panther Party put into practice with its survival programs, I would like to see “medical services [linked] to a program of societal transformation” (Nelson, 2013).
I want to see a more radical medicine, one where improving health outcomes means dismantling the prison system and working toward economic justice. One where we move beyond the gender binary and decolonize both mental and reproductive health. One where my job includes cultivating a relationship with our food and the environment.
There are so many paths toward these aspirations. Naming racism as structural, instead of as a symptom of interpersonal relationships, is one starting place.
Maybe then we can finally explain the increased burden of disease states like diabetes and hypertension among black Americans by structural racism, rather than genetics, or we can treat pain appropriately.
As Dorothy Roberts writes in the first chapter of "Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twentieth Century" (2012):
To this day, the delusion that race is a biological inheritance rather than a political relationship leads plenty of intelligent people to make the most ludicrous statements about black biological traits. Worse yet, this delusion permits a majority of Americans to live in perfect comfort with a host of barbaric practices and condition that befall blacks primarily—infant deaths at numbers worse than in developing countries, locking up children in adult prisons for life, the highest incarceration rate in the history of the free world—and still view their country as a bastion of freedom and equality for all.
Some people argue that continuing to treat race as a biological category in genetic research, medicine, and technology is not harmful by itself, as long as safeguards are in place to prevent its abuse by bigoted people. Understanding race as a political classification that supports racism exposes the flaw in this view. British sociologist Paul Gilroy underscores this key premise of the relationship between race and racism: “For me, ‘race’ refers primarily to an impersonal, discursive arrangement, the brutal result of the raciological ordering of the world, not its cause.” In less academic terms, race is the product of racism, racism is not the product of race.
Mansi Shah is a first-year resident with the Duke Family Medicine Residency Program. Email mansi.shah@duke.edu with questions.
Editor’s note: Duke Family Medicine residents guest blog every month. Blogs represent the opinion of the author, not the Duke Family Medicine Residency Program, the Department of Community and Family Medicine, the Duke University School of Medicine or Duke University.