Global health, a once-obscure discipline of practice and study, is quickly gaining popularity. Many training institutes have reacted to the increased demand for a global health “experience” by organizing short-term trips to exotic locations. This practice may be hazardous, contributing to what writer Teju Cole refers to as the White Savior Industrial Complex (WSIC). Teju Cole points out that WSIC is “not about justice.” Indeed, “it is about a big emotional experience that validates privilege.” The term “white savior” can apply to any individual or organization, regardless of race, who has an imbalance of power or privilege. Non-white persons, for example, can sustain WSIC by being in close proximity to whiteness, power, or privilege, which relies on these institutions to maintain inequity.
In the practice of global health, such persons include students, researchers, practitioners, and volunteers from high-resource settings (the Global North) working in low-resource ones (the Global South). Examples of WSIC in global health are clear. Many participants in these global health experiences are typically unqualified to operate securely in vulnerable regions, yet they do it regardless. However, there are many situations that are less extreme and do not always end in direct bodily injury. People who are properly trained in their native institutions but frequently operate overseas without the same responsibility as they do at home are likewise implicated in WSIC. In addition to these prominent instances, there are many subtler but as detrimental,
We are early-career physicians who trained in the United States (U.S.) and completed a global health fellowship in underserved areas in the U.S. and the Global South. Below, we relate our individual experiences in Uganda, India, and the United States to demonstrate how current global health practice maintains and feeds WSIC; experiences that are frequently mislabeled as “ethical dilemmas” during training. We will next propose strategies to overcome these issues in global health training and practice.
Individual encounters with White Saviorism
Uganda
While visiting Uganda with a surgical team, a Ugandan resident requested me to assist with an ultrasound of a pregnant woman.During the scan, we discovered that the fetal heart rate was quite low. Although I was concerned, the Ugandan resident seemed unconcerned. He inquired what we would typically do in this scenario, and I said that I would have already transported the patient back to the operating room, delivered the baby via cesarean section, and begun resuscitation measures. He pondered this calmly, and she was taken for a cesarean delivery.
The cesarean section was completed successfully. The same anesthetist who performed the cesarean also delivered a tiny, crying, healthy-looking baby. She shakes her head. I was perplexed. The anesthetist indicated that the baby would not live, and there was little we could do after the infant began to have problems breathing due to a lack of a neonatologist, drugs, and respirators. The infant died of respiratory difficulties overnight.
I advocated a cesarean section for this patient with good intentions, based on my training in the United States. Although I did not urge the treatment, I did not understand how being a white American physician could cause my Ugandan colleagues to question their training. Furthermore, my lack of expertise in context-specific medical knowledge left me uninformed that “viability” may be defined differently in different circumstances. All of my privileges, which fundamentally oppressed the patients I was treating in Uganda, allowed me to influence the decision. The more skilled Ugandan physicians were persuaded to proceed with a treatment that cost this woman needless surgery and a hard recovery following a tragic occurrence.
India
One night, while conducting research in a small indigenous community in India, a nurse requested that I accompany her to the home of a pregnant lady in lengthy labor. The laboring patient at home refused to see me since I am a man. The traditional birth attendant attempted to convey to her that I was a physician who was there to assist. The patient continued to refuse my assistance and refused to travel to the hospital, despite my guarantee that one of my female coworkers could take over her care.
Although the medical conclusion was favorable, I knew that chance made the difference between a well-intended negative consequence and a well-intended positive outcome. I imposed therapy on a lady who had most certainly experienced considerable institutional abuse at the hands of individuals like myself: educated, upper caste, male, and a foreigner in the region. Following the precedents of my authoritarian forebears, I exploited my authority and privilege to impose existing discriminatory gender stereotypes and exercise my paternalism as a physician.
How to Avoid White Saviorism.
The examples described here demonstrate the subtle yet ubiquitous nature of WSIC in global health. They demonstrate the complexities of power relations, as well as the medical and cultural circumstances that clinicians encounter while taking on the position of global health provider. Walking into this job unprepared might be destructive in unforeseen ways.
If the purpose of global health is to achieve universal health equality and social justice, we must agree to dismantle the WSIC. WSIC is widespread in global health practice at all levels: individual, interpersonal, structural, and across our global society (see Figure 1), hence we advocate the following activities to be taken across all levels:
Training: Many programs or experiences support the narrative taught in the Global North that nations in the Global South are unable to deliver decent healthcare to their own citizens for a variety of reasons. This creates an atmosphere in which medical trainees or practitioners taking part in global health experiences are unprepared to function safely in these contexts. These scenarios are frequently characterized as “ethical dilemmas” with “no right or wrong answers,” but framing them in this manner ignores the lack of contextual cultural and structural understanding and training required to practice equitably and with respect in resource-limited settings. We advocate that programs include competency-based training on power, privilege, and structural humility. All participants are trained on region-specific and worldwide criteria for LMICs.
Individual action: Practitioners should commit to seeking out local mentors for training in context-specific medicine. They should not work outside their stated area of practice. They must finish all necessary screening steps before working in their field in the location where they are practicing. They should attempt to increase their knowledge while also highlighting the work and agency of their local partners.
Regulation: The global health provider from the Global North frequently operates without adequate licensing and/or supervision, resulting in activity outside of their area of practice. There are several built-in measures of accountability for practitioners in the Global North, such as fear of lawsuit, licensure tests or certification, and hospital accreditation. This is frequently not the case when these providers travel to the Global South, where there is typically no regulatory board regulating these programs or the participants’ work in these environments. At its worst, this lack of responsibility can attract people who want to “hone [new] skills” without fear of repercussions, and at its most subtle, it can attract those with good intentions but, unprepared, do harm.