11 No. 3
December 2008/January 2009
Unraveling healthcare's knottiest problems
Researcher’s alleged transgressions lead to more ethics oversight
“Is it reasonable for [a patient] to be able to demand everything be done regardless of what that does to the healthcare system financially, or to its ability to serve a wider population?”
“I don’t think the main role of the ethicist is to tell people what’s right and wrong. One who does that in my opinion abdicates one’s responsibility.”
Medicine and Compassion
Reaching across the silos to teach the "art" of healing
Things I've learned while I couldn't do my research
Egypt and Emory
Small collection, large footprint
In June 2008, Emory’s Institute for Developing Nations (IDN) organized a workshop on the persistent problem of gender-based violence in Liberia, a nation in the process of rebuilding after fourteen years of civil war. Around the table were researchers, international development practitioners, and representatives from a variety of Liberian government ministries, organizations, and institutions.
“There was lots of energy in bringing together people from law, history, women’s studies, public health, non-governmental organizations, the Liberian government,” says Sita Ranchod-Nilsson, IDN director and a specialist in sub-Saharan Africa and women in politics. “Rural women offered accounts of influencing customary authorities to support [Liberia’s] new anti-rape law. Their initiatives raise many questions about the limits of the judiciary, the possibility of harmonizing customary and civil law, and the women’s ways of influencing social change.”
But at the final session, as they outlined their next steps, discussion ground to a halt. “An influential Liberian government representative said, ‘We have a plan; we just need more resources for our plan,’” Ranchod-Nilssen recalls. “Here we come up against the political reality that what is being funded, what the government is committed to, is the civil legal system.”
That experience illustrated for many academics present the complexities of what Ranchod-Nilssen calls “engaged” research and international development. “It’s not enough just to say, here’s the information, here’s the analysis—now go do it.”
The IDN, a joint venture with The Carter Center established in 2006 as part of the university’s strategic plan, has set out to promote research that redefines both the scholarship and practice of international development.
“We’re at a moment where there’s a lot of disillusion with development studies and practice,” says Ranchod-Nilsson. “The theoretical frameworks and principles of practice that have guided development activities for the past fifty years have not yielded the intended outcomes. So there is a need to re-think them on multiple levels—with the university, non-governmental organizations engaged in development, policy makers who work on foreign aid, and also with counterparts in developing countries. Our job is to bring university researchers’ expertise, development practitioners’ experience, and the perspective of local researchers, policy makers, and communities into
the same conversation.”
It is not always an easy conversation. “The center’s capacity to partner is linked to how beneficial an activity will be to the Liberian people,” says Tom Crick, associate director of The Carter Center’s Conflict Resolution Program. “If it benefits scholarship and Emory students, that’s good too. But there’s a tension: if you’re conducting research, you need to keep the distance of a researcher, and so, in effect, you can be working hard not to have an impact.”
The immediacy and unpredictability of engaged scholarship requires a disconcerting shift for many researchers. “At its best, it tests your theoretical knowledge and shows you its limits,” says theology school professor Liz Bounds, who with her students has gotten involved with the Liberian diaspora in Atlanta.
“It also raises serious questions about the ongoing struggle with what scholarly objectivity really is,” Bounds continues. “Objectivity is a lens that we’re always accountable to. We constantly bring it in to check our own work. But we’ve made a fetish of objectivity, so that it precludes any engagement at all. And for scholars in those parts of the world where there is not the same economic privilege of academic life that we have here, that kind of complete objectivity is neither possible nor desirable. Engagement doesn’t mean unthinking partisanship, but we’ve gone too far in the other direction. It’s a delicate balance.”
For women’s studies and African studies scholar Pamela Scully, who has an IDN-funded project in Liberia, finding that balance has changed her understanding of what constitutes scholarship. “What has come repeatedly from people all over Africa,” she says, “is that capacity is not extraneous to research. It might be that building capacity is the most important thing we can do in partnership. I want to think about ways of building capacity that aren’t necessarily about spending money so that an institution is stressed. For example, how can we work with the University of Liberia to help construct courses or really enhance their students’ ability to develop their skills over the long term?”
For the Carter Center, the IDN offers the potential to complement its work in places where it has sustained involvement. The center has a program in Liberia, on invitation from the Ministry of Justice, to help rebuild the nation’s justice system in a post-conflict society.
“The Carter Center made a decision to be [in Liberia] not only for elections, which is our principal expertise, but between elections,” Crick says. “It would be very helpful to our rule of law programming, for example, to have a broad, empirical understanding of what works in gender violence prevention which could help guide program design.”
Ranchod-Nilsson explains how Emory researchers might contribute to that understanding. “Like a number of African countries, Liberia has a dual system of civil law and customary law. The colonial legacy of dual legal systems, building justice systems and state structures with local legitimacy, and identifying social changes that support peace building—these are issues that have engaged a number of Emory scholars.”
Professor of Law Paul Zwier is one such scholar. He first traveled to Liberia in 2006 with the group Lawyers Without Borders to help with a training program for magistrates, prosecutors, and defense lawyers. “At the end of it they were very grateful for the training,” he says. “But I’ll never forget this one fellow: his eyes welled up with tears, and he said, ‘This is all well and good, but it’s just not realistic.’ The corruption in the system is completely endemic.”
Zwier returned from that trip “overwhelmed by what Liberia is facing,” he says. “We saw competition between formal legal structures and traditional community groups. It confirmed both—that there is a need for formal structures, but that it is a long way removed from what people are dealing with every day.”
He has proposed to IDN what he calls a “pathways to justice” study. “Especially in the area of gender-based violence,” he explains, “we could document by numbers and interviews the failures at every step of the process, from the hospital and collection of evidence to the police’s failure to be able to investigate, to the prosecutors and judges who really aren’t interested in these cases, to the failings of the system being in any way able to expedite trials.”
Zwier also thinks the formal and traditional systems could be integrated. “Maybe there are some ways to create some alternative dispute resolution capacities,” he says, “by training community leaders and mediators to form a kind of triage between those cases that really do need the criminal justice system and those that could be resolved at the informal, local level.”
Power and resources
The IDN aims to facilitate faculty collaborations with in-country non-governmental organizations (NGOs) and African scholars in ways that are “reciprocal and mutually beneficial” and that produce both policy outcomes and scholarship that is publishable in top-tier journals.
As noble as it is, this goal can raise uncomfortable questions around power and resources. For instance, anthropologist Bruce Knauft, executive director of Emory’s Institute for Critical International Studies, co-led an IDN-supported workshop in Liberia in June 2008 with Liberia Democracy Watch, a small, government watchdog NGO in Monrovia. Twenty-two attendees—professionals from Liberia-based NGOs and scholars from the University of Liberia—held lively discussions on challenges to their own professional lives, dissatisfaction with international funding for their organizations, and tensions between Liberians who remained during the civil war and those who went abroad. Toward the end, however, several participants carefully voiced a question: Who controls these ideas? If all twenty-two participants are brainstorming and helping formulate a research proposal, how do they share in its ownership?
There are no clear answers. “The exact way they would be put together in a research plan, I don’t know,” Knauft said at the workshop. “But ultimately as a researcher at Emory University, I have to be responsible as the principal investigator to sign off on a grant that comes through the university.” Yet as Ranchod-Nilsson has written, “Too often funding is linked to power to define research agendas, select project participants, and specify outcomes. In these circumstances, partnerships can reproduce colonial hierarchies, albeit in subtle ways.”
Scully is also just beginning to test the agility of these newly defined partnerships. She will also host an IDN-sponsored workshop in Monrovia this spring. “I thought it would be very interesting to get a conversation together with South African and Liberian academics and practitioners, and a few of us from Emory, to craft a research agenda. It struck me that these two societies would be really interesting to compare. They’ve both seen terrible conflict of various sorts and they both have really good constitutions with regard to gender issues, yet both have extraordinary levels of sexual violence. Both countries pose questions about the limits of the state and the ongoing presence of sexual violence and ways of dealing with these issues.”
She stops short, however, of describing a research agenda. “We really want it to be a partnership, not to say, Here are the ideas; now you go work on them, yet to say, What are the important ideas?
“I’ve always been interested in issues of the law, the state, sexual violence, and how women experience it. But my on-the-ground work is sitting in archives, reading cases and criminal records. This is extremely new for me, to speak to living people.”—A.O.A.