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C h a p t e r 8 Our Place in the World: Obligations Beyond Borders Power recalls the past not to remember but to sanctify; to justify the perpetuation of privilege. . . . Exoneration requires unremembering . . . . To turn infamies into feats, the memory of the North is divorced from the memory of the South, accumulation is detached from despoliation, opulence has nothing to do with plunder. Broken memory leads us to believe that wealth is innocent of poverty. —Eduardo Galeano, Upside Down: A Primer for the Looking-Glass World The donors come with their music and the government dances its jig. —Tanzanian health rights activist I was living in Tanzania when I first toured Temeke Hospital in early 2012. Temeke, which serves a large catchment area in a poor part of Dar es Salaam, has historically been the most dysfunctional of the city’s district hospitals. Unlike the other districts, Temeke, which includes some periurban and semirural areas as well, has few private facilities and, at the time, the hospital was invariably overcrowded. On that first visit, the labor ward had three or four women to a bed and women delivering on the floor with just a khanga spread beneath them. The overworked staff appeared numb to the chaos, the smells of blood and other fluids they were walking through on the floor, and the constant low-level of groaning that filled the air. Our Place in the World 207 Over decades of doing this work I have grown accustomed to the overcrowding , the filthy conditions, and the lack of basic supplies and running water of such labor wards, which typify but also seem to surpass the generalized unresponsiveness of many health systems. Indeed, there is often a Dante-esque quality to the very places where we ask women to come to bring life into the world, as though they were being condemned to suffer in some inner circle of Hell for the sin of having had sex, and for being women.1 In response to a woman crying out during contractions, something to the effect of “You weren’t complaining when you opened your legs the first time, were you?” is a refrain I’ve heard from facility staff more times than I can count. But perhaps the greatest evidence of misogyny is that governments and donors alike allow these conditions to persist. On that first visit to Temeke, I encountered something I had not seen before : a dead woman was lying smack in the middle of the delivery room. Misriya had died the day before, having required more blood than the two bags allotted to her. She was still hooked up to the intravenous drip, her body rotting in the unbearably steamy February heat of Dar es Salaam—amid at least a dozen other women who were struggling to bring forth life. And on a shelf nearby was a small bundle wrapped in a khanga cloth. I thought at first it was the dead baby, but later I saw it was alive. The baby had not been given any formula or even sugar water since it had been born; the family was outside but had not been notified of either the baby’s birth or Misriya’s death. When I related this story in a meeting with one of Tanzania’s largest donors a few weeks later, there were generalized expressions of dismay about the depths of indifference shown by Tanzanian health workers. Yet I noted that the health workers themselves were horrifically overstretched. Indeed, had the one nurse on duty left the ward to take the woman to the morgue and find the family to notify them, she would have been abandoning multiple women in labor. Both Misriya’s death and the treatment of her body immediately afterward stemmed from more systemic failures—for which they as donors were at least partly responsible. It is difficult to live for long in Tanzania without coming to feel that the entire global development enterprise is an elaborate charade. Tanzania is a “donor darling.” In the twenty-year period between 1990 and 2010, Tanzania received approximately USD 27 billion in aid from the United States alone. In 2010–2011, donors financed 28 percent of the national budget and more than 80 percent of the development budget.2 In contrast to its East African 208 Applying Human Rights Frameworks to Health neighbors, Tanzania has neither the deadly ethnic strife of Kenya, with its president and vice president indicted by the International Criminal...


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