always need categories. The challenge is to realize which of our simple
categories are misleading—like “developed” and “developing” countries—
and replace them with better categories, like the four levels.
One of the best ways to do this is to travel, if you possibly can. That’s why
I made my global health students from Karolinska Institutet, the medical
university in Stockholm, go on study visits to countries on Levels 1, 2, and 3,
where they
attended university courses, visited hospitals, and stayed with
local families. Nothing beats a firsthand experience.
Those students are usually privileged young Swedes who want to do good
in the world but don’t really know the world. Some of them say they have
traveled: often they have had a cappuccino at a café
next to an eco-tourism
agency, but never entered a single family home.
On day one of a trip to Thiruvananthapuram in Kerala in India, or Kampala
in Uganda, they usually express surprise that the city is so well organized.
There are traffic lights and sewage systems and no one is dying in the street.
On day two, we usually visit a public hospital. When they see that there is
no paint on the walls and no air-conditioning and 60 people to a room, my
students whisper to each other that this place must be extremely poor. I have
to explain that people living in extreme poverty have no hospitals at all. A
woman living in extreme poverty gives birth on a mud floor, attended by a
midwife with no training who has walked barefoot in the dark.
The hospital
administrator helps. She explains that not painting the walls can be a strategic
decision in countries on Levels 2 and 3. It’s not that they can’t afford the
paint. Flaking walls keep away the richer patients and their time-consuming
demands for costly treatments, allowing hospitals
to use their limited
resources to treat more people in more cost-effective ways.
My students then learn that one of the patients cannot afford to pay for the
insulin he has been prescribed for his newly diagnosed diabetes. The students
don’t understand: this must be an advanced hospital if it can diagnose
diabetes. But how bizarre if the patient cannot then afford the treatment. Yet
this is very common on Level 2: the public health system can pay for some
diagnosis, for emergency care, and for inexpensive drugs. This leads to great
improvements in survival rates. But there’s simply not enough money (unless
the costs come down) for expensive treatments for lifelong conditions like
diabetes.
On one particular occasion a student’s misunderstanding of life in countries
on Level 2 nearly cost her very dearly. We were
visiting a beautiful and
modern private hospital in Kerala, India, eight stories tall. We waited some
time in the lobby for a student in our group who was late. After 15 minutes,
we decided not to wait for her any longer and walked down a corridor and got
into a large elevator, big enough to take several hospital beds.
Our host, the
head of the intensive care unit, pressed the button for the sixth floor. Just as
the doors were sliding closed, we saw the young blond Swede rush into the
hospital lobby. “Come, run faster!” shouted her friend from the door of the
elevator, and she stretched her leg out to stop the doors from closing.
Everything then happened very quickly. The doors
just continued to close
tightly around my student’s leg. She cried out in pain and fear. The elevator
started moving upward. She cried out louder. Just as I realized this young
woman’s leg was going to get crushed against the top of the doorway, our host
leaped across the elevator and hit the red emergency stop button. He hissed at
me to help and between us we prised the doors far enough apart to release my
student’s bleeding limb.
Afterward, our host looked at me and said, “I have never seen that before.
How can you admit such stupid people for medical training?” I explained that
all elevators in Sweden had sensors on the doors. If something were put
between them, they would instantaneously stop closing and open instead. The
Indian doctor looked doubtful. “But how can you be sure that this advanced
mechanism is working every single time?” I felt stupid with my reply: “It just
always does. I suppose it’s because there are strict safety rules and regular
inspections.” He didn’t look convinced. “Hmmm.
So your country has
become so safe that when you go abroad the world is dangerous for you.”
I can assure you that the young woman was not at all stupid. She had
simply, and unwisely, generalized from her own Level 4 experience of
elevators to all elevators in all countries.
On
the last day, we have a little ceremony to say goodbye where I
sometimes learn something about the generalizations other people make about
us. On this particular occasion in India, my female students arrived on time,
beautifully dressed in colorful saris they had bought locally. (The elevator-
door leg injury was nicely healed.) They were followed ten minutes later by
the male students, evidently hungover and dressed in torn jeans and dirty T-
shirts. India’s leading professor of forensic medicine leaned over to me and
whispered, “I hear you have love marriages in your country but that must be a
lie. Look at these men. What woman would marry them if their parents didn’t
make them?”
When visiting reality in other countries, and not just the backpacker cafés,
you realize that generalizing from what is normal in your home environment
can be useless or even dangerous.
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