Haiti, January 17, 2018. This country and people taught me what I know about justice and injustice. I have dedicated my life to working with others to provide medical care to poor people in Africa, Haiti and other places that the President of the United States of America recently deemed “shithole” countries. The cries of outrage are deafening from the so-called left and inaudible from the so-called right. Yet, my Haitian friends, while disgusted, are not shocked. “Trump” they say, “is honest. He says what others think of us, how others treat us, but they say it in a softer way.”
As I examine the history in my own fields of expertise—global health, infectious disease, public health—I wholeheartedly agree with this analysis by my friends and colleagues. What we refer to as “Western civilization” was built from centuries of enslavement, murder, and willful impoverishment of people of color. Without using the word “shithole,” scores of academics, development professionals, and policy makers condemn whole countries as hopeless using terms such as “third world,” “heavily-indebted,” “unstable,” “fragile,” “resource-poor,” and “resource-limited.” Polite and intellectual dinner conversation call such places “failed states.” These terms, always deployed for countries with predominantly black or brown people, connote chaos as well as a lack of human capital, resources, infrastructure, and political will. While less vulgar than the president’s “shithole” characterization, these more endearing terms are as ahistorical and dismissive of the willful exploitation that has created this divide.
Countries at issue have been impoverished actively, intentionally, and at the point of guns, bombs, or missiles for centuries. Trillions of dollars of stolen labor from slavery, colonialism, discrimination and racism have built “stable” countries. Trillions of dollars of stolen resources—from gold to oil to coltan—capitalized the European and American empires. These riches continue to feed the faceless neo-empires of capitalism and militarism. A 2014 report, “Honest Accounts? The true story of Africa’s billion dollar losses” estimated that 192 billion dollars of capital and resources flow out of Africa each year. The paltry 30 billion dollars of aid that flows in allows wealthy countries to sanctimoniously fret about Africa’s “aid dependency.” But as the report states, “the idea that we are aiding Africa is flawed; it is Africa that is aiding the rest of the world.”
Perhaps even more insidious is that individuals from impoverished countries are seen by those in charge of development projects as ignorant, culturally exotic, or infantile—a fundamentally racist casting. Many health projects built with this framing present a narrative of the “ignorant native.” Billions of development dollars are spent on programs called Information, Education or Communication projects (IEC). One clear example is an oft seen poster in Haiti that says, more or less, “wash your hands to avoid cholera.” Never mind that cholera infected sewage was dumped into the river by United Nations (UN) forces in Haiti; that the UN system did not build adequate sewage treatment at their base; or that money for the development of Haiti’s water and sanitation infrastructure was blocked by George W. Bush’s administration because they were unhappy with the results of Haiti’s democratic elections. IEC programs are not concerned with these and the thousand other historical reasons that the Haitian poor are forced to use river water for drinking, washing and toileting. Rather than dissect, understand and remediate the basic problem—impoverishment—it is advantageous for imperialist powers to start from the assumption that Haitian people are ignorant.
Similar IEC programs postulate that children displaying signs of profound malnutrition are starving because their mothers are ignorant of the proper foods to give their children. Well-meaning (often white) volunteers show posters with the four food groups to the mothers of starving children, pointing out the deficit of protein in their children’s diets. Yet, one only has to walk with the mother to her home to see the true deficiencies plaguing her family: lack of water or sanitation, lack of land to grow food, lack of money to buy necessities such as soap. Claiming bad behavior or ignorance as the root cause of ill health rather than tying it to crushing material poverty is cultural exoticism that serves the interests of the so-called benefactors rather than the people they are claiming to help. This vulgar narrative is based on the false assumption that Western global domination can be attributed to the superiority of Western powers and their citizenry. This trope of the uncivilized native rescued by the white savior ignores the long violent history and ongoing impoverishment of black and brown peoples for the enrichment of the world’s white, European and American empires.
Shithole is a bad word. And oppressive global racism is a murderous deed. Sanitizing this reality with polite terms is complicity.
Dr. Joia Mukherjee is a physician, educator, and activist, trained in Infectious Disease, Internal Medicine, Pediatrics, and public health at the Massachusetts General Hospital and the Harvard School of Public Health. She is an Associate Professor at Harvard Medical School and teaches infectious disease, global health delivery and human rights to health professionals and students from around the world. She is the author of Introduction to Global Health Delivery: Practice, Equity, Human Rights, a textbook published in 2017 by Oxford University Press. Dr. Mukherjee’s scholarship focuses on the health delivery, Universal Health Coverage, and human rights. Since 2000, Dr. Mukherjee has served as the Chief Medical Officer of Partners In Health. Dr. Mukherjee is an activist, singer, and mother who believes the world can and must change.