Among my professor’s stories from Lima, the chicken dinner story haunts me most. It features two students from his time as a middle school teacher in one of Lima’s most dangerous outskirt neighborhoods. A young teacher working at a Fe y Alegria school in North Lima, my professor, Kyle, had promised to take them anywhere they desired for dinner in exchange for exam success. The students requested chicken, standard Peruvian celebratory fare. Rather than a local polleria, they had chosen an address in the heart of downtown Lima, three hours by bus. Kyle had begrudgingly agreed. Four bus rides later, he recalled walking the final mile to the restaurant and realizing he was alone. Turning around, he saw the girls, over a block away, slowing down and staring in awe at the lights and skyscrapers.
Kyle recalled how striking it was that girls who had lived for twelve years in the capital of Peru had never seen skyscrapers. I was told this story in an effort to help me understand structural inequality. My undergraduate experience as a student in my professor’s social inequality and stratification class became my own jumping-off point for interest in global communities. My own time as a middle school educator for a year in Lima and involvement in coordinating the Creighton School of Medicine’s service-learning program led me to attend the Consortium of Universities in Global Health Conference (CUGH) in San Francisco this year.
My understanding of advocacy continues to evolve; this commentary will share how a weekend at CUGH influenced this understanding. The mission of CUGH holds high promise: “creating equity and reducing health disparities everywhere.” With the faces of friends and “global” peers from many communities in mind, I was excited to attend the conference. This excitement was quickly replaced by awe and uncertainty at arrival in downtown San Francisco. The shiny, energetic tide of lanyards and suits was not what my experience as an educator on the sandy outskirts of Lima had prepared me to associate with global health. Standing at the doors of the opulent opening speeches, I felt a bit like the girls in downtown Lima. I could not help but wonder if those most impacted by global health were present.
The Saturday afternoon conference session called “Failed States” dispelled the misgivings I had about conferences as a form of advocacy. Prior sessions focused on dates, facts and science — diagnosing problems and presenting research, but not action items. In “Failed States,” a young doctor from Médecins Sans Frontières (MSF), also known as Doctors Without Borders, quietly rose to the podium and questioned the academic world’s response to Ebola a year earlier. He questioned the global hesitancy to respond to one of the world’s true global health emergencies and the repercussions faced by university faculty who chose to assist. He expressed frank frustration to an audience of renowned global health scholars at the inaction of their academic community to an event of global need and crisis. He called attention to the abandonment he saw as a doctor on the ground in West Africa by international organizations as a failure of global health leadership. As he asked questions to a silent room, my heart responded — wrapped in his message were questions I had asked myself as a service-learning program coordinator, when our board had decided against sending students to Ghana the year before, a country peripheral to the Ebola outbreak, due to risk-management concerns.
This MSF doctor had not come to tell war stories for his benefit. He had not come to showcase himself as a paternalistic savior or hero. He had come to advocate. While patients suffering the effects of Ebola were not physically present, their stories were conveyed in the painful truth told by the MSF doctor. He acknowledged the limits of institutions with student and faculty safety concerns, he was forceful and honest that the academic world of global health could do better. He pushed for a creative solution, one that acknowledged the unique obligations of an academic environment, but that could utilize institutional capacity for research and evaluation of relief efforts to improve alleviation of future global crises.
His words spoke to the personal tension of advocacy I felt since first going to Peru, the tension of living in two worlds. One world is in solidarity with those made marginalized, standing in an uncomfortable and unfamiliar reality outside my own. The other is of the inherent privilege I carry with me as an educated, English-speaking Asian-American woman raised in an upper middle class family in a developed country, as a medical student, and a US citizen.
The experiences of the girls from Lima are only relatable to me in the sense of the lack of belonging from moving as a child, but I never experienced the systemic exclusion, unmerited glass ceiling and moments of self-deprecating limitation their story encompassed. I am not ashamed to admit that as a girl who grew up with everything she could ask for and more, I often want to run to the comfort of privilege, conformity, familiarity and silence.
For this reason, the MSF doctor’s honest critique was the conference’s most prophetic moment for me. I drew the familiar lesson from CUGH that no checklist exists for advocacy and solidarity. Learning how to be an advocate is a process. There is a tension between advocacy and abandonment — knowing when to challenge, stand with and speak out, and when to sit and listen. When the time to speak comes, advocacy means asking hard questions — of yourself, institutions, communities and societies.
In a memoir of his life in East Baltimore, The Beast Side: Living and Dying While Black in America, D. Watkins shares a conversation with Pache, co-founder of a feminist group in Philidelphia who has worked to create an empowering and safe space for women to be creative. In response to how progress could be made to improve the violation of women’s rights through street harassment and shaming, Pache answered:
“If you are in privileged group, and you want to help oppressed people, one of the best things you can do is teach other people in your privileged group. As a person of privilege, you do not actually face the oppression, so you have time to teach. Oppressed people do not have the energy to teach everyone about [the] oppression they have to live through every day…”
She also shared advice applicable to all groups hoping to bring awareness and change in a world of inequality and injustice: “If you care about the people around you, you’ll do the work to educate yourself.”
Even if it’s painful.
Advocacy thus not only encompasses privilege awareness, but knowing the right time to access and use privilege — speaking up at the right time, even if there is a social price. Without this boldness, I am just another mid-twenty something who still looks like a college kid with a backpack doing things because they are trendy and hip. As a young student, I have to believe humility and self-insight are potentially our greatest gifts for change — action items we can take to understand and exist with this tension and continue to challenge ourselves to understand more.
The saddest piece of my professor’s story was the ending; when Kyle and his two students arrived at the restaurant in downtown Lima, the girls stared at the price of chicken. Despite his insistence, they had refused to eat at the restaurant, because the prices were too expensive. Together, they journeyed four buses back to their neighborhood, and ate chicken at a local polleria. Since my professor’s story was told, Lima has grown into an intersecting metropolitan city; there are air-conditioned aerial trains transporting distances that used to take half a day by bus in a half and a hour. This growth further complicated structural inequalities — simultaneously bridging and reinforcing. There is much work to be done to bring all parties to the table of conversation and to move towards inclusion.
This article is not meant to be advice, but a calling, well articulated by Dr. Tom Kelly, a professor of theology at Creighton University and founder of a service-learning accompaniment program in Villa El Salvador, Lima, Peru, to “live life as a question.” Advocacy is the courageous questioning of the things we love. It is reflection and bravery in feeling the tensions surrounding inequality and injustice. It is the sharing of our own personal reflection of what needs to be done, and keeping those we love at the center. Through long-term vision and relationships, we can replace the tension between advocacy and abandonment with accompaniment. The globalization of advocacy networks is an exciting opportunity for us to learn and participate in the conversation surrounding important issues and be moved to act. While the overwhelming tension between the two worlds is intimidating, CUGH challenged me to look at advocacy as I do today — to view each question and conviction reached as a practice of fearlessness and renewal of commitment to communities.