IU School of Medicine 2nd-year student Ryan McArdle reflects on his experience in Bangladesh prior to medical school, his summer spent in Kenya as an AMPATH Slemenda Scholar and the importance of local leadership in defining development.
Almost two years prior to being selected as a Slemenda Scholar and spending two months in Eldoret, Kenya, witnessing the AMPATH partnership, I spent 6 weeks between my undergraduate studies and medical school in Bangladesh, where I worked with malaria elimination experts from the International Center for Diarrheal Disease Research, Bangladesh (icddr,b).
At that time, I was staying at a hotel on the edge of Gulshan, an area in the capital city of Dhaka that could perhaps best be described as the Manhattan of Bangladesh. Despite the cultural differences, Gulshan felt more like the world I knew—a world of skyscrapers and Pizza Huts and the only traffic lights in a city with the worst traffic jams in the world.
During my daily commute to the icddr,b offices in nearby Mohakhali, I would walk down Gulshan’s freshly paved, well-lit streets until reaching a gate. Composed of fortified metal sheets painted the same shade of rich green as the country’s flag, the gate completely blocked the road and allowed passage only on foot through a small porthole that could be closed at night. Every day, as I looked up after stooping to pass through the tiny opening, I would find an entirely foreign scene. The clean, orderly grid of Gulshan streets were replaced by a dusty web of half-cobbled paths; the perfect geometry of upscale apartment buildings by the disarray of street vendors selling their wares; the clean, air-conditioned, citrus-smelling interior of imported cars by the smoke of street food and rickshaws. It felt as though I had literally passed through a portal into another world.
My time in Bangladesh—my first real experience outside of the United States—proved difficult in many ways, challenging my understanding of the world and conception of self. But as I struggled to pull meaning out of the sweat and commotion of Dhaka, I kept returning to that gate as a symbol for development. It felt to me that Bangladesh was a country on the verge of breaking through to a better standard of life. All that the country needed to do was pass through the gate.
That image flashed in my head once more as I watched the verdant, green mountains bordering the Rift Valley unfurl beneath me during my flight to Eldoret. I had spent the past 10 months buried in my first year of medical studies, whisked away to a new continent only two days after my last final exam. As I stepped off the plane and took my first breath of the cool mountain air, I felt equal parts excited and anxious, knowing that my time in Kenya might very well rock the foundations of my worldview once more.
As a Slemenda Scholar, I was privileged with a broad scope, spending the time outside of an overarching research project in oncology exploring life in Kenya: directly witnessing care in cancer clinics and on the wards at Moi Teaching and Referral Hospital, reading and thinking critically about global health partnerships, reflecting on global health topics at weekly fireside chats, reading Kenyan literature and news, and talking to Kenyans—medical colleagues and strangers alike. I did my best to remain as open as possible, to listen more than I spoke, and to reflect on what I was seeing along the way.
The sum of those experiences quickly began to challenge my notions of development. I spoke with many Kenyans deeply concerned about the future of their country, lamenting the destructive urbanization resulting from the modernization that I had unquestionably accepted as “progress.” I read Kenyan literature, like Ngugi Wa Thiong’o’s inflammatory and visceral Petals of Blood, that vividly portrayed how a Westernized concept of “development” had been historically weaponized as a tool of suppression. I saw vast inequities in wealth amongst Kenyans, signaling that the everyday benefits of economic growth were not spread equally. And I heard the voice of a generation of young Kenyans pushing back against a future they felt was being written by financial experts on another continent without their input.
In a now-famous 2009 TED Talk, Chimamanda Ngozi Adichie warns about the danger of accepting a single story when exploring settings foreign to oneself. My time in Kenya showed me that I had been making a similar, yet distinct, mistake: embracing a single story of development.
“Development”—a term I am still not fully sure I understand—is not, and cannot be, a simple march “through the gate” towards a Westernized standard. In Bangladesh, I had equated what I knew, what was familiar to me, with an absolute good. And while there are certainly some goals, such as reduced infant mortality, that likely stretch across all definitions of “progress”, there is real danger in allowing outsiders to define the path forward for another people or culture. The goal should not be to push, or even “help”, others “through the gate”; rather, it should be to knock down the gate, elevate local voices, and allow cultures to create their own dialogue on the best path forwards.
AMPATH provides countless examples of what “knocking down the gate” looks like in practice. Rather than imposing Western ideals on Kenyan health problems, AMPATH programs are intentionally and structurally designed around Kenyan expertise. Some AMPATH programs have gone even further, transitioning successful interventions from Kenya to the United States and vice-versa in a bidirectional flow of knowledge known as “reciprocal innovation.” Perhaps most importantly, Kenyan colleagues are leading partners in AMPATH, setting healthcare priorities and thus central in deciding the best steps forward.
That process—of navigating true partnership in the face of massive power imbalances—naturally features challenges and bumps along the way. But it is only by embracing and elevating that uncomfortable discourse that we can shift paradigms and build a future that works not only for the West, but for peoples and cultures around the globe.
The view toward Gulshan.
The view on the other side of the gate.
