Colonial medicine and global health
In a series of articles, Rosauro Varo Cobos offers his perspective on racism, colonialism and global health
In the last year, Rosauro Varo Cobos, paediatrician, researcher, aid worker, and writer, has extensively explored the ideas of decolonization in global health. His conclusions can be found in three enticing articles written in Spanish and published in El País, Frontera Digital, and Fundació Grífols’s website.
The topic is of direct interest to the Ersilia community. After all, as a small actor in global health, Ersilia needs to carve out its position and ethical standing in this landscape. Here, I offer a faithful translation of Rosauro’s writing into English. Therefore, my contribution to the blog post is negligible. Discussing global health is delicately complex and it’s not a topic to be broached lightly. Ersilia has not yet entirely earned the right to engage in this discourse — so, the best we can do is amplify the voices of others. Some of you may recall that we even did this by prompting an AI large language model.
I first met Rosauro in 2015, in Manhiça, near Maputo, Mozambique. He is an outstanding conversationalist, and a stellar friend — I ask you to allow me to recast his articles in the form of an interview, which feels more natural to me. This is an interview that, while it never actually took place, can be imagined unfolding on the balcony of his apartment in Rabat, Morocco. On the table, he has laid out some peanuts.
Recently, you have taken a particular interest in the topic of racism.
Yes, specifically, its effects on research and global health on the African continent. I dare say that there is no thornier or more complicated issue to raise than racism. When this topic is brought up, people tend to adopt a defensive stance, their bodies tensed and their attention poised to prevent any backlash against themselves: the most important thing is self-preservation, and if necessary, to broaden or redirect the accusations.
Indeed.
When I share my interest in studying racism with others, I’ve noticed two distinct types of responses.
…
The first challenges my own validity to discuss this topic based on what I am presumed to represent: a white, heterosexual, cis-gender, upper-middle-class man… How can a speaker with that background have a legitimate opinion on the matter? The question is complex and not easy to answer, but the main issue is not its complexity, but rather the way it’s used to nullify a potential opinion.
And the second?
The second is the denial of the problem, but also the attempt to distribute responsibilities and to assert that its foundations and consequences are well understood. As examples, here are some responses (from white-skinned individuals, I should clarify) that I received when explaining that I was trying to analyse the effects of racism on health research in Africa: “I have felt racism here in X (an African country), and I am racialized. And I am aware of white privilege”; “The problem is not racism, it’s other things like classism; How can racism exist if race doesn’t?”. All of this is couched in warnings about the riskiness of probing such a matter.
But you continue to take this risk, in at least three ways, as far as I’m aware. Through fiction, as seen in your latest novel Lugar Común. Through praxis, in your work as a paediatrician, especially in Africa. And through historical revision, to which you have dedicated so many hours of reading. Fiction, practice, and memory — I can’t think of a more thorough way to investigate an issue. Let’s talk about history.
The African continent was, at the end of the 19th and beginning of the 20th century, the last to be colonised on a large scale by Europeans. The imperialist expansion, fueled by the powerful racist energy that legitimised it, led to a troubled ethical and moral crossroads that affected the interventions that, at all levels (including health), were carried out on African soil.
Tell me a little more.
Medical practice during the colonial period was the result of the European view of Africa, affected by racism and the oppressive mechanisms of colonisation. What we know today as global health, as Ṣẹ̀yẹ Abímbọ́lá assures [Rosauro quotes or paraphrases from memory], “emerged as a necessary collaborator of European colonisation. Since then it has mutated into different forms — for example, colonial medicine, missionary medicine, tropical medicine, and international health — but it has not yet abandoned its colonial origins and structures.”
You mean to say that the impact of colonialism reaches all levels of what we call global health.
Yes, from the patients to the healthcare professionals themselves, from clinical practice to the most strategic financial investments.
The strategy part is interesting.
There is an inherent paradox in global health itself: this discipline, which was born parallel to the expansion of racism and colonialism, is the very one that aims to reduce the inequalities generated by these two practices. Therefore, it seems evident that, beyond the necessary introspection at this point, any commitment to combat racism and its colonial legacy must be accompanied by a willingness to relinquish the power (either wholly or partially) held by its major institutions. This would entail, among other things, a redistribution of funding.
And what else?
A limitation on acting in poor countries, including African ones, as they currently do.
Sounds utopian. Where to start?
To achieve this, it is essential to also listen to the voices from these countries, those who live the day-to-day reality and are capable of providing a close and real insight of what is happening there. Like that of Catherine Kyobutungi, Executive Director of the African Centre for Population and Health Research in Kenya. She denounces that the institutions of the continent have serious difficulties in receiving and managing funding without it first going through Western organizations, something that distances Africans themselves from the policies that define their future.
That is, African countries should have the capacity to take the initiative in larger-scale projects…
…while at the same time relationships between organisations develop based on mutual respect and cooperation. Moreover, researchers from these countries should actively participate in decision-making processes that truly benefit their own people.
Makes sense.
Perhaps, the unavoidable exercise is to rethink the concept of global health from its root, a process in which actors from both the North and the South must be involved. This discipline should cease to be seen as an act of charity or salvation and instead become a fight for health as a fundamental right, both locally and globally, accepting that its achievements, wherever they are attained, are valuable for everyone.
It is tempting to fall into do-gooderism or advocate for cultural relativism.
Not necessarily. We can appeal to our own tradition of thought. This has taught us that there is a potency of universality housed in every culture and that there can be a global society based on justice, built beyond categories such as class, sex, and of course, race.
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The change that manages to reconstruct global health will be collective or it won’t be at all. And success will come if we achieve a fair redistribution of resources and power, but above all if we are capable of placing the values of equity, care, and compassion at the centre of our shared humanity.
More about Rosauro Varo Cobos
Born in Cordoba in 1982, Rosauro is a paediatrician, researcher, and aid worker. He has worked in countries such as India, Peru, Costa Rica, South Africa, Malawi, Central African Republic, and Mozambique. He also holds a Doctorate in Medicine from the University of Barcelona. He has completed a Master’s in Creative Writing and a Master’s in Comparative Studies of Literature, Art, and Thought, both from Pompeu Fabra University. In his hometown, he co-founded the literary magazine Café con Letras and the eponymous discussion group. He has published various articles and stories in local and national media (such as Granta, Mercurio, Frontera Digital, or El País), and writes literature reviews for ‘Revista de Letras’. He has published a book of stories titled El embudo (Andrómina, 2014) and two novels: Plagio (Ediciones en Huida, 2018) and Lugar común (Mixtura Editorial, 2022).
- Twitter: @rvarocobos
- Professional profile: ISGlobal
- Blog in Frontera Digital: Planetas paralelos
- Literary Critic: Revista de Letras
- Lugar común: catalogue Mixtura Editorial
- Plagio: catalogue Ediciones en Huída
