The Quandary of the Good Samaritan

The first thing I noticed in India before the plane had even landed was the slums. As the plane descended towards the runway, at first I thought what I was seeing was the debris of recent construction, because the houses were so small and low and were constructed from random collections of construction material: bricks, plywood, and roofs of tarp, or if the inhabitants were lucky, of corrugated tin and shingles. The structures seemed resigned to permanence despite their inherent instability.
The landing afforded me a closer view of the congested slums that clustered around the airport, but by the time I reached the house where I would be living for the next seven weeks, I had conveniently forgotten about them, until the family friend with whom I was staying showed me the view of the streets of Mumbai from one of her windows. I walked to the window directly opposite and noticed that the complex of apartments with names like “Mahal” attached to them was surrounded by a colony of slums. The back of the slums faced us, but the front of the colony mingled with stores selling granite and marble; the building blocks of the rich were a constant reminder to the colony of the things it could never afford.
I was reminded of the first time I had seen this type of poverty, a poverty so unmitigated that people devised desperate measures to ensure their meager survival. I was thirteen and was staying in a relatively posh area of Karachi. My room had a heavy floor-to-ceiling curtain that completely eclipsed the window, and it was only a few weeks into my stay in Karachi that I became sufficiently curious to ask what sort of view was behind the curtain. My cousin had nonchalantly responded that it wasn’t any sort of view that I wanted to see, but I drew back the curtains and saw a street—or rather, a muddy thoroughfare encrusted with donkey dung and debris. Rickety houses made of cardboard, tin, in fact, any material that people could get their hands on, leaned against one another in a haphazard fashion.
Facing that slum in Karachi, I felt that I had never been so close nor so far from poverty. I was secure in my nice flat with running water and Western toilets in a gated colony, while the people living across from me were starving. At the same time, though, I was just beginning to understand that poverty in a developing country was very different from poverty in a developed country. I was also beginning to recognize how incredibly sheltered I was from the realities of life.
That experience left in an indelible memory, one that was recalled when I saw the slums in Mumbai. Witnessing the depths of poverty from an outsider’s perspective in both Karachi and Mumbai made me question what my responsibility was towards members of society who most needed aid. It also made me extremely uncomfortable, because I will always remain an outsider. I will never fully understand this type of poverty, because no matter how much I work within these communities, I will always be in a more privileged position because I was born in America, was educated at an Ivy League institution, and will have a steady job with sufficient pay.
Before I arrived in Mumbai to work on a project sponsored by my medical school, my friend and I had talked about the quandary of international work. She had commented that work in the field of global health was appealing to many people and had mused that a part of the draw of global health was its glamour. When privileged people educated and brought up in wealthy countries sacrifice all these privileges to work in destitute areas of the world, one cannot help but be in awe of them. These people do deserve respect because they have contributed so much to the societies in which they work. Their unique privileges—an excellent education, connections to wealthy societies—have enabled them to do great work abroad but also set them apart from those among whom they work. Sometimes it even feels to me that by working internationally, I am propagating a benign form of colonialism. The message I am afraid of sending is that I come from a society that has been so successful at solving its problems that now I’ve come to your country to solve yours.
Of course, America hasn’t been successful at solving its problems, and the intentions which inspire people to work in global health are generally noble. Yet the uncomfortable disparities between those who work internationally and the people among whom they work persist and should be acknowledged. Global health is a necessary field, but the future lies in not just ameliorating the consequences of poverty but addressing its roots.