Paper short abstract:

Treatment seeking for club foot in Toliara is inhibited by the belief that incest was the cause. This paper explores outcomes based on solutions that do not attempt to change attitudes, working within the existing system to create a joint project that is locally owned and internationally supported.

Paper long abstract:

Medical aid, international bilateral funding, philanthropy and research into the health problems of the world's poor is broadly viewed as being well-entrenched within the realm of the good, the moral and the ethically sound. From the perspective of an anthropologist and medical student, this paper argues that there are several challenges to this unquestioned morality. Through case study with an Australian aid organisation (Australian Doctors for Africa), I sought to understand the beliefs, attitudes and understanding of club foot in order to implement a screening and treatment program that had previously been unsuccessful for many years. In Toliara, Madagascar, the collective cultural belief that incest causes club foot, prevents treatment seeking. This paper explores whether it is ethical to try to impact a belief that has existed, that will persist, and that has shaped behaviours and impacted identities, simply because it does not fit in with the aims, structure and projected results? A number of pragmatic solutions that did not seek to alter attitudes, but worked with beliefs to ensure a more sustainable outcome were implemented. This research rationalised the identification of the good, the right, and the ethically sound by working within the existing belief system to create a joint project that was both locally owned and internationally supported. From the fluid (beliefs, attitudes, and culture) to the Gantt chart (structured, micromanaged, shortsighted aims of funding bodies for aid organisations), This paper examines how we as a collective constructed and maintained 'good' aid.