Dr. Sriram Shamasunder has a beautiful and moving short essay about his time working at the PIH supported hospital in St. Marc, Haiti. A great quote:
International Solidarity: Nothing beautiful and lasting can be done alone. It also cannot be done immediately at scale nor should it. We need human relationships, built over time to transform systems. In global health the people we are trying to serve are by definition poor and sick. They are not the best constituency to organize themselves. This leads to policies and programs that don’t really have the people we serve at the table. I recently saw the film “Dallas Buyers Club” about the early days of HIV. Matthew McConaughey plays Ron Woodroof, a cowboy who contracts AIDS in an era where the FDA had not yet approved any medication. He goes on a personal mission to travel around the world and gain access to medications in the early 1980s. He is fearless, aggressive, and does not yield to the medical establishment. The story of the HIV movement has been told so many times, in so many elegant ways. Almost all versions detail how the afflicted pushed the establishment. Populations most devastated raised their collective voice and pushed. They had some political power because many were White or middle class. When they gained access, they aligned themselves with other HIV patients around the planet. Of course this is a simplified version of the story, but it illustrates to some degree what is happening in the immigration reform movement in the United States. Think tanks, policy advocates, academic scholars, and NGOs are certainly shaping the conversation. But the most compelling immigrant rights advocates I have witnessed are the “DREAMers” – the undocumented youth who came here when they were very young through no decision of their own. Like the protagonist in Dallas Buyers Club, the DREAMers are fearless and have the most to gain or lose. Their fight is intimate, personal and profound in a way that a Global Health movement confined to the walls of academia, or halls of the Gates foundation, or board rooms of the World Bank can never be. Those of us who are front-line workers but straddle the globe and work closely with our colleagues from Haiti to Liberia who have dedicated their lives to healing poor, sick patients and poor, sick systems would do well to imbibe their stories and tell them again and again and make sure they have the space to tell their story themselves. It is a small piece of having the most afflicted and the most poor at the table in a Global Health context that is almost inherently hierarchical, exclusionary, and fragmented.
Whatever this movement is, we need to continue to find ways of collapsing the enormous chasms of inequality and geography that currently exist between those bearing the brunt of ill health and disease and those working to create policies and systems to protect rights.