Cover image courtesy of Nahid Bhadelia, NPR.
Written by Sidvhi Reddy, The University of Oklahoma
Abstract
This article dissects the role of Western evangelical medicine and donations in foreign countries, exploring the ways in which medical interventions, while well-meaning, may not fully address the root of issues or only implement short-term solutions, leading to a cycle of inequality and exacerbated medical crises. The intention of evangelical missionaries to help in other countries is a direct result of the growth of White saviorism and paternalism. International Aid is a Christian relief medical organization that seeks to alleviate health challenges around the world through its Medical Equipment Services initiative. One such initiative highlights the need for medical devices and equipment in areas where access to adequate medical care and hygiene are limited. Medical devices are donated from hospitals and clinics to International Aid, who then refurbishes these devices and sends them to foreign countries. Contrary to popular belief, many of these devices end up in what are called “medical device graveyards,” in which devices rarely function properly and often break down immediately upon use in hospitals to which they are donated. Without the needed technicians, spare parts, and translations for how to use certain devices (as devices often contain instructions in languages that are not generally known in the countries they are donated to,) they often end up either unused or broken. The role of Western evangelical medicine, specifically medical equipment donations plays a part in contributing to inefficiency, wastefulness, overall frustration, and decreased health efficiency.
International Aid, an evangelical organization that donates used and second-hand medical equipment to countries in Africa, plays a role in contributing to the inefficiency of healthcare, wasteful inadequate donations, overall frustration, and decreased health efficiency [1].
Critique
The growth of evangelism and colonialization in Africa has birthed International Aid, an organization that possesses evangelical drives and motivations surrounding the intent to “help” in Western nations and individuals. Medicine, in particular, remains an area of interest in International Aid’s efforts to impact African nations as a Christian Relief ministry, which “seeks to tangibly demonstrate the love of Jesus Christ to those who are suffering,” for the purpose of donating used medical devices to countries such as Zambia, Niger, Ethiopia, and Uganda. The religious ideology underlying their mission to “help” nations through donating used technology is rife with ideas of colonialism and historical mistreatment of African nations. This critique of International Aid first explores evangelical and ethical issues that surround the actions of Christian medical technology donations. The motivations that underlie the religious foundations of International Aid date back to the first efforts to colonialize and spread Christianity in Africa at the expense of African culture, customs, and religion indigenous to the land, posing the question of whether the motivations of International Aid are ethical, due to the inadvertent harms it causes. The roots of colonialism have spread towards the medical field, as medical voluntourism and medical donations increase in popularity. As a result, International Aid’s motivations to donate medical equipment to African countries despite the negative impacts of both the device donations, as well as the religious intentions of International Aid, poses ethical issues.
The conception and spread of Christianity through colonization and slavery in Africa gave rise to present-day sentiments surrounding white saviorism, “helping” other countries, and giving used donations to African countries, all of which are missions that International Aid strives to fulfill. With the rise of slavery and colonization came a sort of precondition for the ways in which the Western world would continue to exert dominance, and later, white saviorism, over African countries. James Sweet states in The Iberian Roots of American Racist Thought that “aversion to black Africans permitted their exploitation in ways the colonists never considered for white slaves or servants” [2]. This racial discrimination imparted towards black slaves set forth precedence for centuries of slave trade and exploitation that paralleled religious intentions to spread Christianity in African nations. The development of religious thought that is now the basis of International Aid’s values led to a shift in the perceptions that surrounded missionary work, leading to the birth of the antislavery movement that created “new religious doctrines [that] created new possibilities for salvation and for seeing others as having humanity” [3]. The majority of those who founded the abolitionist movement were evangelicals who believed that all should be treated with decency and respect. The conception of the antislavery movement, while it sought to eradicate slavery, was also a double-edged sword that led to other harmful sentiments that later gave rise to evangelical organizations like International Aid, which seeks to paternalize African communities through used medical device donations, despite the stories and statistics that show the harm of their actions.
Through the antislavery movement, white saviorism arose, as missionaries “tried to reconcile their desire to convert the slaves with the barbaric treatment of the slaves by slave owners who were hardly demonstrating Christian virtues” [3]. Missionary humanitarianism, which, in its modern form, is the purpose of International Aid, provided the religious basis for the development of the white savior complex as leaders sought to “save the souls” of those who were nonbelievers. This belief was paternalistic, placing the ideas and beliefs of the Western world above non-Western individuals as it defined the lines between the “helped” and the “helper.” The “helped” were those who supposedly needed the aid of white missionaries, who were the “helpers” who have continued to maintain the white savior complex that developed from this. This is evident through the “unapologetic paternalism of the [colonial] period, with missionaries and liberal humanitarians sharing the belief that they had a duty to civilize and improve the lives of the native populations” [3]. International Aid’s Medical Equipment Services imposes the will and so-called “duty” of Western missionaries and do-gooders to “improve the lives of the native populations” [6]. During the colonial period, paternalism was a successful attempt to place Western white individuals over those from various African nations, therefore serving to place non-Western, non-evangelicals into an “other” category that was subsequently lower than those who were white. This same sense of paternalism can be seen in the intentions of International Aid’s mission in donating used and second-hand equipment to African countries.
The modern-day themes of white saviorism that can be seen in International Aid’s work have continued from the same paternalism that resulted from missionary work, evident in the medical work and volunteering that Western individuals seek to perform in African nations. Through its paternalistic approach, “Westerners decide what is good for poor locals and impose their own agendas” [4]. There is often the mentality that Western organizations like International Aid know better than the locals do, often pushing their own ideas, values, and practices upon those who do not need it. This paternalism is forced upon individuals and professionals who understand that “education and skills transfer, including appropriate technology, are the one product that is badly needed,” [4] and are pushed to accept these Western impositions in order to gain the technology and technological knowledge from Western volunteers and doctors that is necessary to help patients. The rise of medical mission trips and voluntourism has led to the growth in used medical technology donations that International Aid seeks to take part in. Hospitals are in need of medical technology and equipment, yet most of these donations are not viable. Recipients continue to take them because they have no choice but to accept these donations in the hopes that a select few devices will work sufficiently for patients.
Another issue of this paternalism that International Aid employs is the ethical concerns about donating medical equipment and medication as a way to remove unneeded materials from Western countries because “the habit of donating to ‘get rid of unwanted stuff’ has been longstanding” [4]. Many donations are made by donors to fulfill a “need to help” complex, yet, they generally do not aid recipients in any way. Not only are donations that are made by International Aid often unusable and offensive, but they also shift the burden of the disposal onto those who are least able to perform or afford it. These same donations feed into the white savior complex of those who support International Aid, in which Western voluntourists and doctors are views as a higher status than native people, which is shown through “the instruction not to touch the equipment left behind until the next set of volunteers arrives” [4]. The white savior complex not only condescends towards native doctors and nurses, but also demeans them further, harming them, the patients, and the community. Thus, International Aid’s motivations are unethical because their actions directly harm the communities and individuals they seek to help. Not only does its paternalism harm the community, but it also places an emotional, environmental, and physical burden of disposing of the equipment to prevent environmental hazards and to prevent placing the community at risk. Shifting the burden from a country with an exorbitant amount of resources at its disposal to a country with little to no resources, funds, or systems in place signifies an underlying sentiment that these countries are of a lower status than Western evangelical countries. It showcases a condescending white savior complex that is hidden through the intent of “helping” with ignorance in respect to the true consequences of the actions of “helping.”
This condescending nature that International Aid imposes on other countries permeates other sectors of the healthcare system in countries where white/Western doctors and voluntourists seek to exert their influence. Through this, the negative impacts of International Aid are far-reaching, as they not only directly negatively impact communities through device donations that do not work, they also indirectly impact communities by contributing to a hierarchy that places Western doctors over local doctors. In an example of self-serving neocolonialism, Western doctors traveled to other countries to perform cleft lip surgeries on individuals, often using these cases as a way to train their own residents. Local doctors were promised cooperation with these Western doctors but were refused by Western doctors in favor of the residents that needed training. “In exchange for equipment, local doctors were forced to accept this ‘help’” [4]. International Aid’s system feeds into the exploitation and use of non-Western communities under the guise of helping. The rise of white saviorism and neocolonialism that stems from the evangelical movement has made it socially acceptable for International Aid to utilize other communities in order to feel good under the belief that it is helping someone, despite the ultimate harm that it causes.
As the evangelical movement continues to operate within the medical and voluntourism sectors, it funnels voluntourists who believe that they are doing good by entering into African countries and communities through anecdotal evidence and statistics about how many people have been impacted by their actions through their own points of views. International Aid is a perfect example of this, preaching testimonials of children and recipients whom they have “helped” by posting a picture of the child along with a short story about how they helped that person. A testimonial, entitled, “We Helped Grace Smile,” describes her home as “a typical Liberian village with a mixture of mud-brick houses, tin shacks, and concrete buildings. Few of the houses have running water, so topical illnesses are prevalent” [5]. The depiction of her home portrays the communities that they seek to help as poor, or below the living standards of the West, employing a paternalistic tone in the way they describe the recipients of aid. The article describes how they donated cream to a Christian ministry that gave a young girl the cream for her itch/rash that allowed her to return to school. The organization that they donated to, Christian Aid Ministries, operates medical clinics in Haiti and Nicaragua while installing Gospel billboards, distributing Christian literature, and thus, seeking to gain converts to Christianity. The presence of evangelism in aid showcases the underlying motive of these organizations, which parallels the motives of antislavery missionaries and religious abolitionists who sought to “save the souls” of nonbelievers, who were mostly enslaved African individuals. Through the portrayal of these communities as needing help from the Western world, they are essentially othered by organizations like International Aid, placed on a lower level than Western countries to show that they need the help of white, evangelical individuals and groups.
With the intersection of evangelism, white-saviorism, and medical infrastructure and technology, International Aid professes faith-based motivations to donate medical technology from Western hospitals to Zambia, Niger, Ethiopia, and Uganda. They describe themselves as “one of the largest reconditioners of medical equipment in the faith-based, non-profit sector, providing anything from anesthesia machines to X-ray equipment” [6]. After refurbishing these devices, they then donate them to hospitals in Africa in order to “help hospitals in developing nations attain self-sufficiency.” The problem with this is multi-dimensional, with one of the issues being the lack of training and technical personnel specialized in the technology that is available in these hospitals. Though International Aid claims that they refurbish devices, “fixing up a donated machine may turn out to be impossible. ‘Many times the machines have just been phased out and are no longer supported by the company,’ said Lloyd Jenkins of International Aid” [1]. There is usually little to no support for technology in low-income countries, often leading to a build-up of non-functional devices in low-income countries, where at least 40% of equipment is nonfunctional, according to a 2011 study [7] while the WHO reports that up to 80% of equipment is nonfunctional [8]. The deposition of barely-functioning and/or non-functioning medical devices from Western countries to non-Western nations places the West in a superior context, affording them the luxury of viewing other lands as a so-called “dumping ground.” In Western nations, less than 1% of equipment is deemed nonfunctional, a far cry from the percentage of nonfunctional equipment in countries such as Zambia, Niger, Ethiopia, and Uganda.
The donation of equipment that cannot be used by hospitals gives rise to an additional variety of issues. Often, the types of equipment that are required or needed by the hospitals are not the same types of equipment that are donated to the hospital. Due to the international nature of donations, many devices have no manuals or have operating manuals that are in a different language or are unfamiliar to hospitals and their employees. Some equipment also require parts or mandate device requirements that are not carried by the hospital and would be costly to obtain, thus rendering it useless. Running devices also poses another issue, as “during setup and testing, hospital staff realize that the electrical plug needed to run the device is incompatible with their country’s electrical outlets…Even more problematic are devices that do not align with the frequency or voltage capacity of recipient facilities” [9]. The inability to utilize a device due to logistical or mechanical issues poses a key factor in understanding the reasons why equipment donation is often simply a barrier to high-quality donations that cannot be achieved through donating used or unneeded equipment. While these issues may seem minor, these are barriers that not only prevent hospitals from using these devices, but also contribute to growing piles of waste that result in the Western world essentially treating African nations as a dumping ground.
Equipment donations, even when they do work initially, require proper maintenance and overarching support systems to ensure that they run smoothly, a factor that many international donations organizations, such as International Aid, do not take into account. Hospitals require sufficient funds, maintenance staff, equipment parts, and medical personnel training to keep the equipment up and running. “Training of maintenance staff is particularly neglected by donors, with 60.0% to 82.5% of biomedical engineers receiving no maintenance training for donated equipment. Estimates suggest a 30% to 80% reduction in useful life of equipment due to inexperienced operators and lack of repair” [10]. The value of training in medical technology and maintenance is immeasurable, as these donated items could last much longer and function better with proper training and education about how the equipment and technology operate. The failure of donor organizations, such as International Aid, which provides only operation manuals and technical support but does not specify the extent, to provide proper training within hospitals to local engineers and maintenance staff has led to a build-up of excess medical equipment.
When medical equipment is donated without proper training and education, the sustainability of these donations diminishes. “Without this ensured sustainability, the value of donations is diminished” [9]. During a trial run performed by the Engineering World Health (EWH) in Rwanda to help train medical technicians to fix and maintain medical technology, it was found that “when medical equipment broke, hospitals would just request a new donation from another organization. ‘Basic things like the inventory of medical equipment were not even done, because most of the medical technicians didn’t even know the name of the equipment’” [11]. Through this it is evident that information pertaining to donated equipment is not well-known in the countries to which they are donated, resulting in an inability for hospitals to utilize these donations. Even after the training program successfully matriculated several students, the EWH reports that “there are devices in disrepair because technicians have trouble finding spare parts. ‘I think the big elephant in the room that nobody had really figured out is spare parts,’” reports Didier Mukama, the director of the EWH. Unsustainable equipment, therefore, remains not only unused but also undisposed of, as most health systems do not have the resources or funds to allocate towards disposal.
As these pieces of technology begin to accumulate in what is aptly named a “device graveyard.” Medical equipment donation agencies, such as International Aid, tend to portray a different picture of the impact of their donations than what can actually be observed in the hospitals. “Speaking with four major equipment donation organizations gave a vastly different impression than on-the-ground visits to 20 hospitals. Despite the best intentions of these organizations, the system is not working. Good intentions are not enough,” says Mike Miesen of The Atlantic [12]. Visits to hospitals reveal rooms filled with broken and unused medical devices that accumulate as a result of ‘good intentions.’ “The perception on the ground is that some donors ‘dump’ useless junk equipment,” states Miesen. A physician at the hospital that Miesen supported this perception, citing his own experiences with these organizations and the lack of proper aid. While some organizations do refurbish the devices, like International Aid, which does offer hospitals spare parts and materials needed to operate the devices, they also ask the hospitals to pay for them, according to The Atlantic. Parts are often too expensive for hospitals, forcing them to eventually relegate these devices to the graveyard. Even if the initial condition is adequate for usage, they require regular maintenance and repair, both of which are difficult to come across, especially if the equipment is newer. Thus, these devices are soon left to accumulate in these medical device graveyards which pose a large issue for countries that do not have funds to allocate towards these medical devices.
The accumulation of these medical devices poses an issue for these countries as there are no established disposal processes. This has been observed in many countries, one of which is Haiti, which experienced an enormous earthquake in 2010 that led to an influx in donations of medical equipment to help treat patients in the hospitals. While the hospitals were in dire need of the equipment, the majority of the donated equipment was deemed to be useless, with most equipment sent being damaged or unusable based on the resources of the hospital. “For this hospital, the donations were an overwhelming burden, with few good donations being delivered at the cost of disposal for countless other donations” [9]. International Aid contains the same motivations as these organizations that donated equipment, seeking to supply hospitals with equipment that will help in crises such as the one in Haiti.
The problem with device accumulation is that because there is no feasible way for them to be destroyed, there “are environmental concerns, including those surrounding equipment containing toxic components. Those disposing of equipment must also consider patient concerns” [9]. Not only does inadequate waste disposal lead to concerns about the environment as well as health and safety concerns, but it also leads to issues with patient medical information and data. Proper disposal of the equipment is necessary to maintain privacy since many equipment pieces can store patient information. Thus, the work of International Aid can prove burdensome to recipient countries, in which harm is caused through the donation of medical equipment in terms of the environment, patient health, and patient data.
The implementation of such programs, like that of International Aid, that aim to alleviate medical equipment shortages and supply hospitals with technology through refurbished and used instruments feeds into the harmful cycle of inequality and exacerbated medical crises. Implemented aid does not fully address the root of issues and only creates short-term solutions, leading to long-term issues of waste disposal and increasing paternalism. The exacerbation of these long-term issues is, unfortunately, a burden that is placed on low- and middle-income recipient countries, as the West continues to use these communities as their dumping grounds. As International Aid continues to send equipment overseas without addressing the root of these issues, efforts to improve the medical system in recipient countries will remain futile, since the cycle of donating and throwing away equipment that cannot be fixed or used due to a lack of knowledge or resources will continue.
The idea of utilizing non-Western countries as a dumping ground feeds back into the birth and growth of the white savior complex and neocolonialism as a way for International Aid and its supporters to spread the word of God under the belief that they are helping people. The growing complaints posed by recipient hospitals in relation to these donation organizations are largely unaddressed by these organizations, and International Aid is an organization that simply contributes to this issue. The issue of ineffective medical device donations has created a power difference in the medical sector between donors and recipients, making the continued exploitation of non-Western countries increasingly obvious. International Aid’s evangelical mission presents an additional layer of issues with their purpose of donating medical devices, as it demonstrates a continued desire for neocolonialism that is socially acceptable since they are supposedly helping people gain medical equipment that could save lives. Thus, the role of Western evangelical medicine, combined with medical equipment donations in International Aid plays a part in contributing to inefficiency, wastefulness, overall frustration, and decreased health efficiency.
This post may have been edited by admin for clarity and length.
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[1] Bhadelia, Nahid. “Rage Against The Busted Medical Machines.” NPR. NPR, September 8, 2016.
[2] Sweet, James Hoke. The Iberian Roots of American Racist Thought. 1994.
[3] Barnett, Michael N., and Thomas George Weiss. Humanitarianism in Question: Politics, Power, Ethics. Cornell University Press, 2008.
[4] Bauer, I. “More harm than good? The questionable ethics of medical volunteering and international student placements.” Trop Dis Travel Med Vaccines 3, 5 (2017). https://doi.org/10.1186/s40794-017-0048-y.
[5] “We Helped Grace SMILE!” International Aid, May 24, 2019. http://www.internationalaid.org/we-helped-grace-smile/.
[6] “Medical Equipment Services.” International Aid, August 3, 2017. http://www.internationalaid.org/what-we-do/medical-equipment/.
[7] Perry, Lora, and Robert Malkin. “Effectiveness of Medical Equipment Donations to Improve Health Systems: How Much Medical Equipment Is Broken in the Developing World?” Medical & Biological Engineering & Computing 49, no. 7 (2011): 719–22. https://doi.org/10.1007/s11517-011-0786-3.
[8] “Donations of Medicines and Medical Devices.” World Health Organization, World Health Organization, 20 Nov. 2015, www.who.int/medicines/areas/donations/en/.
[9] Compton, Bruce, David M. Barash, Jennifer Farrington, Cynthia Hall, Dale Herzog, Vikas Meka, Ellen Rafferty, Katherine Taylor, and Asha Varghese. “Access to Medical Devices in Low-Income Countries: Addressing Sustainability Challenges in Medical Device Donations.” NAM Perspectives 8, no. 7 (2018). https://doi.org/10.31478/201807a.
[10] Marks, I. H., Thomas, H., Bakhet, M., & Fitzgerald, E. Medical equipment donation in low-resource settings: a review of the literature and guidelines for surgery and anaesthesia in low-income and middle-income countries. BMJ global health, 4(5) (2019). e001785. https://doi.org/10.1136/bmjgh-2019-001785.
[11] Jones, Andrew. “Medical Equipment Donated to Developing Nations Usually Ends Up on the Junk Heap.” Scientific American. Scientific American, May 6, 2013. https://www.scientificamerican.com/article/medical-equipment-donated-developing-nations-junk-heap/.
[12] Miesen, Mike. “The Inadequacy of Donating Medical Devices to Africa.” The Atlantic. Atlantic Media Company, September 20, 2013. https://www.theatlantic.com/international/archive/2013/09/the-inadequacy-of-donating-medical-devices-to-africa/279855/.
