Marc Le Pape
This article is about humanitarian exoticism and culturalist convictions: those to which members of NGOs currently adhere. They become apparent when NGO workers, motivated by empathy or the desire to explain certain types of behaviour, attempt to find cultural traits that are characteristic of the environments in which they work, of the patients they treat, of the institutional interlocutors they negotiate with and even of their colleagues. This is not then the scientific culturalism of anthropologists. Culturalist theories in disciplines such as anthropology, sociology, history have long been popular. They have also been and still are the subject of heated criticism and controversy. These reflections on "cultural codes" will only be mentioned here insofar as they help us to understand the cultural convictions to which aid workers adhere, especially in Africa - although this is no doubt verifiable on other continents.
In what way and with regard to what type of behaviour do aid workers, especially members of medical NGOS, most often seek a "culturalist explanation"? In my opinion, it is when they wish to explain the pejorative evaluation of a type of behaviour: "poor" adherence to treatment, "late" recourse to consultation of healthcare facilities, "at-risk" behaviour, abuse of authority within the medical hierarchy, corruption, etc. However, we also see some recourse to culturalist explanations to give nuance to certain pejorative evaluations: for example, in the case of theft or various forms of favouritism (or mutual assistance) and preferential treatment (or acts of community solidarity), etc. However, the aim in this case is not to justify tolerance of such behaviour, but simply to attenuate, if possible, the sanctions that it incurs.
A study described in a CRASH-MSF publication offers a clear example of this link between pejorative evaluations of behaviour and the search for a cultural explanation (cf. AIDS a new pandemic leading to new medical and political practices/ Paris, 2011). The study in question concerned AIDS treatment and care on MSF's Homa Bay project in Kenya. In 2010 the project's managers designed a survey for which they engaged an anthropologist, Vanja Kovacic. This survey had a number of objectives, including that of examining aspects of Luo culture (the locally-dominant ethnic group) which appeared to favour the transmission of HIV. Before the survey had even been conducted, its initiators already considered that a number of aspects of Luo culture could favour transmission, such as polygamy, the absence of circumcision and levirate marriage. However, epidemiological demonstrations and empirical observation provided no evidence to support these culturalist arguments, arguments which the Luo elders rejected, moreover, blaming living conditions and the social relations created by modern life. Another problem examined in the study was why patients took so long to consult western-style healthcare facilities. The common assumption among staff was that these patients preferred traditional treatment. The anthropological study revealed that the main reason for the "delay" was not cultural, but due to difficulties in obtaining a diagnosis and appropriate treatment from these healthcare services within a reasonable amount of time: "only half of the patients had been diagnosed by their fourth visit". Yet, the probability of the average patient in this district being infected by HIV when he or she comes for a consultation is enormous as, according to the latest epidemiological survey (2010), one in five adults is HIV-positive. These two examples justify criticism of scientific culturalism for the absolutely peremptory (and sometimes exclusive) explanatory power that it attributes to the symbolic codes characterising the cultural system of an ethnic group, country or even a continent in the case of Africa.
Providing a culturalist explanation for a pejorative evaluation of the behaviour of others has become so frequent that it now constitutes a sort of routine and conformism which is followed by many humanitarian workers in Africa. However, not all forms of interest in the cultural traits of the foreign environment in which NGOs operate should be put down to conformism, and this for two reasons (at least): first of all, because cultural curiosity reflects a desire to go beyond a strictly functional relationship with the operating environment; and secondly, it is a defence (or can be) against the certitudes that commonly surround medical practice, certitudes founded on the universal value of the biomedicine that humanitarian NGOs practice. In the field, this practice of biomedicine is also used as a means of legitimising an NGO's action; the members of its teams feel immune to criticism, safe in the knowledge that they belong to an institution of biomedicine. This membership of a legitimising body can lead to the certainty of superiority. And curiosity with regard to the environment and its culture can act as an antidote. And finally, we could add another form of interest in and curiosity about environments and cultures: anthropological or sociological observation that focuses on a limited context and on the representations and practices of a clearly delimited group. But this approach requires surveys and time, making it incompatible with emergency humanitarian action: so what remains for those who will is a personal sensitivity to and curiosity about the culture of "others" in their daily encounters and exchanges.
To cite this content :
Marc Le Pape, Humanitarian exoticism, 11 April 2012, URL : https://msf-crash.org/index.php/en/blog/medicine-and-public-health/humanitarian-exoticism
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