Frictions of equity and gratitude in Nicaraguan humanitarian healthcare
Paper short abstract:
This paper probes the significance of gratitude as a dominant affective connector between North American providers of medical aid and Nicaraguan recipients of this aid.
Paper long abstract:
Poverty is a critical determinant of poor health. Medical humanitarian missions set up clinics and operating theatres for the poorest throughout the world with the intention of alleviating their health needs in the absence of adequate or affordable local health services and medicines. A core principle of humanitarianism, according to the International Committee of the Red Cross, is to alleviate suffering as part of a broader commitment to protect the dignity of every person. While ideally about affirming a shared humanity and a right to health, humanitarian healthcare's moral affirmation can grow blurry on the ground through the prevalence of gratitude amongst patients of medical missions. In this paper, I explore sentiments of gratitude dominating Nicaraguan patients', physicians', and nurses' ethical evaluations of North American surgical and primary care missions working in their communities drawing on 52 interviews (2013). As queer affect theorists have shown, it is often the most banal sentiments that are the most effective at normalizing structures of inequality and practices of exclusion (Ahmed 2010). I am particularly concerned that aid intended by mission volunteers and organizational commitments to translate ideals of global health equity into action, gets reconstituted through gratitude in Nicaragua as divine intervention and private ethics instead. While gratitude may not be entirely out of place in aid relationships, as a dominant affective connector between providers and recipients of medical aid, this sentiment may seriously undermine re-imaginings of healthcare as a right and national/global responsibility.
Reflections on moral sentiments within the anthropology of development