By guest contributor Tom Wein
In times of crisis, advises the American educationalist Fred Rogers, seek comfort by looking for the helpers. Ṣẹ̀yẹ Abímbọ́lá would rather have us seek truth by looking deeper still at the helped, in all their full dignity. In this new book entitled ‘The Foreign Gaze’, collecting seven essays and addresses, he gives guidance on how.
At the heart of his work lie the ministrations of a particular nurse or doctor, in a particular moment, in front of a particular patient. Does everyone in that room have the tools, especially the knowledge and nous, to act well? Have the knowledge arms of medicine done all they ought to have done, to yield health there and then?
Of course, they have not. Global health, he says, is a discipline defined by the moral distance between scholar and patient. Its feted thinkers design formulaic studies that deliver cliches back to others like them. Aiming to produce globally useful knowledge, such studies wash out context, and thereby never even clear the first hurdle of local accuracy. Any useful truths that emerge are channeled off to fill disciplinary lagoons, rather than flowing back to those charged with the actual work of healing. Scholars are too busy offering “colonial love” to perform their duty to connect the system back to more of itself.
What Abímbọ́lá terms the “complaint literature” has drawn similarly dispiriting conclusions elsewhere. This book is first of all an eloquent and usefully brief summary of the author’s and others’ reflections so far. Given the profusion of essays on this theme, that is a helpful service.
Much of that complaint literature stops with blandishments to approach knowledge humbly and to think and work politically. The particular contribution this book makes lies in the analytical tools Abímbọ́lá advances to begin the work of repair. He aims to suggest ways of thinking to achieve these aims. To do so, he introduces three ideas: pose and gaze; representative thinking; and two triangles.
Pose refers to where we stand; gaze refers to who we write for. Each may be local, or foreign. We should of course seek and respect work that adopts a local gaze and is written from a local pose, though the book allows that those from a foreign pose may still write consequential work when adopting a local gaze, and it will often be necessary to write from a foreign pose for a foreign gaze – indeed, this book aspires to speak to a global public. Therefore he would have us be much more deliberate about which pose and gaze we choose. That requires us to be frank about the limitations of our experience, but it is not something to be defined only by the happenstance of citizenships of the authors. Nigerians are not to be limited only to writing for their compatriots, nor Americans only for theirs. This is where he introduces the second idea, of representative thinking. Abímbọ́lá is cautiously hopeful that we may imagine ourselves into the lives of others. Indeed, he and many researchers have often had to imagine themselves into the foreign pose, ignoring plenty that their local pose might tell them about their subjects in order to publish in the right career-advancing journals. He infers that the reverse can also be done. The third of these ideas comes in his twin triangles, which he uses to diagnose the politics of a situation. Borrowing from Ostrom, he suggests that health systems are made up of policymakers, providers and people. They are governed by three corresponding types of rules: constitutional, collective and operational. The tensions between these, he says, explain the behaviour of a health system.
As any consultant knows, such tools thrive in their application – and there are many other frameworks available for those plumbing the politics of their subjects of study, as well as thriving subfields of political science built upon Ostrom’s foundations. We may guess that application in specific cases is where the work will go next – a task perhaps beyond the remit of this slim book.
Abímbọ́lá continually argues for the local and the specific. He is accordingly wary of general prescriptions. He advises us to seek (and study) interventions that open up freedom to local agency. He hopes we will find “rules that default to justice”. He offers some guidance on writing papers and administering journals, but one detects unease; he would rather advocate a set of analytic modes for adaptation, generating a plurality of ways to understand the world. The work sings most melodically when he roots it in the specific experiences of his own training and practice, or that of his mother, a midwife nicknamed S.O. from whom he as a watchful child learned his first lessons in the politics of health. That comes through in his recurrent discussion of better and worse ways to lead and study group antenatal care.
I write from a pose deep in the ranks of the helpers. I am perhaps most comfortable in a Nairobi restaurant with friends from five countries, debating evidence and aid. I and my peers already aspire to moral proximity, and hope we can know which bits of a system are already known by their practitioners, and which can be usefully studied. To do so, we must practice subsidiarity – putting our skills and resources as evidentiary plumbers at the service of the least powerful person, at their request as knowers of their own lives. The hungry do not need to be told they are hungry; it is only the morally distant institutions around them that are slow to notice. When their individual groans – and songs, and peals of laughter – reverberate without delay in the ears of those whose decisions affect their lives, the knowledge arms of development and global health will have done their job at last. Abímbọ́lá’s project, trenchantly summarised in ‘The Foreign Gaze’, will help guide the flow of knowledge back to where it belongs – to those whose lives and work shape health systems from within.
About the book: The Foreign Gaze. Essays on Global Health. Seye Abimbola. IRD Éditions, 2024. PDF version is freely available at: https://www.editions.ird.fr/produit/728/9782709930437/the-foreign-gaze
About the author:
Tom Wein leads the Dignity Initiative at IDinsight, building more respectful bureaucracies of development. He is co-author of the book Marketplace Dignity. He can be found on LinkedIn.
Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.
The post Where We Stand, Where We Look: A book review of The Foreign Gaze by Ṣẹ̀yẹ Abímbọ́lá appeared first on Speaking of Medicine and Health.
