By Matt Whiteman
May 12, 2011 – An Episode of Moral Distress
Eldoret, Uasin Gishu, Kenya
What do you do when you witness something you believe to be unethical, but feel powerless to intervene?
In Eldoret today, as I am on my way back to campus after a meeting in town, I stop to listen to a man with a microphone shouting at a large gathering of people standing around him on a dusty street corner. I have passed by these kinds of episodes countless times but never participated and I almost continue on my way today, as though it were any other day, when I remind myself that it is late in the afternoon and I have nowhere to be. Why not, I say to myself.
When I join the crowd, many heads turn to look at me. They probably don’t often see a well-dressed white fellow with a beard at this kind of event. There is terrible microphone feedback, and the orator doesn’t seem to understand that it is caused by him standing too close to the speakers. Behind him there is a table covered in boxes and glass bottles of various shapes and sizes. There is another man and a woman standing quietly behind and next to this table, and behind them there are two big petrol trucks parked in a “V” formation, unrelated to the event, but nevertheless forming the back wall of the “stage”. Spread out on the dirt, there are a number of laminated newspaper articles held down by stones or empty glass bottles as paperweights. The red laterite soil that works its way into everything makes the pages look old and battered. They are all related in one way or another to health, but the headlines of the articles within range of me seem pseudo-scientific. Not wanting to draw too much attention to myself, I refrain from whipping out my notebook to take notes, and by the time I am far enough away that I feel I can do so, the specific titles have escaped me. As I recall they seem to draw some pretty suspicious causal connections between this behaviour and that condition, and seem to be of a calibre only marginally above the National Inquirer.
The man with the microphone paces around energetically, picking up various objects, gesturing dramatically, and asking individuals in the crowd to speak into the mic, reading from various packages and papers to confirm the things he says. He speaks in Swahili, and very quickly, I can only catch bits and pieces, but something makes me uneasy about his sermon. After a minute or two, he lobs a greeting my way, “ey, mzungu! How are you?” – confident and with a distinct tone of mistrust and hostility. He adds something I can’t catch that makes the audience laugh, I suspect to make me feel awkward so that I will leave.
This is something I am used to. My first night in Nairobi watching the 9 o’clock news, there was a story about how the new constitution provides press protection so that journalists could protect their sources of information – this amid a general climate of press problems of various kinds. Although there are some fairly strong media outlets in Kenya, some people are still used to bullying others into misreporting the news or looking the other way. Although I am not a journalist, I stay, not dissuaded by being made the centre of attention. I reply to the man in Swahili, perhaps so that he will think that I can understand him perfectly and will therefore be more careful about what he says. I realize I have just become a witness. I suddenly become very aware of myself witnessing something that feels unethical.
I arrive as the man is in the middle of a demonstration of what looks like birth control pills (I catch him saying that there is one for every day of the week so that you don’t have to keep track). He shows the crowd that the pills are multi-layered, rubbing some water over one in the palm of his hand to show that it had a coating which comes off.
I remember in 2008 driving past a huge gathering of Maasai in a field in Northern Tanzania, and someone standing on a wooden crate at the front of the crowd screaming passages from the Bible at them in the Maasai language. I recall feeling very angry, as the Maasai have, I’m told, in large part resisted outside cultural influences. This was the way the man now demonstrates the use of birth control. So although this is his manner of speaking, it appears as though perhaps he is trying to normalize this method of family planning, something much in need in the fastest growing city in Kenya, so initially I give him the benefit of the doubt.
He then picks up a glass bottle of translucent, bright green liquid from the table, in what looks like it had once been a mickey (375ml bottle) of liquor. I can see that there is a layer of plastic wrap poking out from under the cap, I assume to simulate a seal on the reused bottle. I lose much of what he says at this point, but this immediately looks and feels more suspicious. There are boxes of these bottles amid the clutter in front of the table, and as he speaks, his assistants start passing out bottles to the crowd. They charge around 1400 Kenyan shillings per bottle (nearly 17 Canadian dollars, not an insubstantial amount for the average resident of Eldoret). A few people eagerly dig into their pockets and fork over the cash. One man standing in the front row opposite me in the semi-circle opens the bottle right away and pours a dose into the cap. He examines it closely for a moment, and then throws the liquid into the back of his throat. For a moment he stands very still, eyes fixed on the ground as he experiences the taste, and he seems to be searching within himself for an effect. The orator continues to chirp in the background. The man distributing the bottles does not make eye contact with me and subtly but – I believe – intentionally passes me over. When I catch his eye, I gesture that I want to see one of the bottles. When he hands me one and I read the label I have to stifle a snort. The crowd notices this and the man with the microphone pauses to look at me, before carrying on with his shouting. The label reads something like “this herbal remedy will cure (and prevent?) malaria, typhoid, back pain, low libido, premature ejaculation, obesity and arthritis”, among a string of other ailments. This mixed with some wash about spiritual cleanliness and other wholesome nonsense. I hand it back to the assistant, chuckling sarcastically, shaking my head and sighing. Again, I think a number of people notice this. I feel my neck start to burn with anxiety. I wonder what they are thinking.
Now, I have a limited understanding of herbal medicine. I know that there have been studies done demonstrating the effectiveness of certain traditional medicines. And although I am sceptical, I try not to cast things off merely because they don’t fit my paradigm. But I also have a pretty good bullshit detector, and it now it sounds off louder than the man and the hissing feedback. Living a life where I get spam email every day, I am used to realizing that when something sounds too good to be true, it usually is. Perhaps I take for granted that I live in a country where there are strong marketing laws (e.g. the Competition Act for Misleading Advertising and Deceptive Marketing Practices) and a national commission set up to combat false advertising in the media (the Canadian Radio-television Telecommunications Commission), although I suppose neither has much control over what people say in the streets.
I feel the urge to speak up, to say that this man was probably spreading misinformation. I’m not sure what my motivation was. I know I don’t like seeing people get cheated. I have no way of being sure whether they are or not, but that’s the way it seems. I also feel it is unjust to take advantage of things that make people feel vulnerable like their body image or sexual performance. I know we do it all the time with advertising in Canada, but that is mostly passive advertising – this involves a human standing right in front of me that I can actually talk to. I suppose I also assume, rightly or not, that there are better things one could spend money on. I want to ask the crowd to be critical, to demand evidence. I want to say that they are probably being lied to and being swindled out of their money. Moreover, I wonder about the public health implications of all of this. Are they just selling aloe vera and turpentine? If the bottle contains no relevant medicinal ingredients, will people believe they are purchasing a suitable treatment and not change the behaviours responsible for the conditions they (believe they) are suffering from? Could there be a placebo effect? If there are relevant medicinal ingredients, are they present in a high enough concentration to be effective and not contribute to drug resistance? What other issues am I not considering?
I know I cannot not communicate any of this effectively to the crowd; my Swahili is useable, but not that good. And I don’t have a microphone. And in the heat of the moment I am overcome by ridiculous self-doubt – maybe I’m wrong – maybe this stuff really does everything it claims to. And who would listen to me anyway? Would they hear what I had to say or would they scoff at the arrogance of the rich foreigner who believes he knows everything? I don’t have the credentials to be an authority here. Could I cast doubt in people’s minds about the truthfulness of what this man was telling them, or would my actions have the opposite effect? I find myself thinking “Should I write all this down and try to make it news? Would it even matter? Am I just being arrogant or senselessly indignant? Where does this lead?”
I don’t know what to do. It’s not my job to play journalist. Or is it? A visitor is a witness, sometimes willingly and aware, sometimes not. Does that also imply a duty to act on what I witness? In all cases? I have witnessed violence here before: in the street; between adults and children; between men and women and once, through a window in Zanzibar, an episode of domestic violence. Each time I was conflicted by the urge, the sense of duty to intervene and the knowledge that I am usually powerless, I am on someone else’s turf and that perhaps it is none of my business. This is what is known as the bystander effect: the diffusion of responsibility to others, while others do the same, leaving responsibility in the hands of no one. So whose responsibility is global health and human security?
This episode is small, and certainly not as acute as one of those acts of violence; it represents a more chronic issue, and those often fly below the radar and more commonly go unaddressed. Maybe I should be taking notes as visibly as possible. I am here to do research on a completely different subject – I don’t have the appropriate time, training or resources to get involved in this kind of thing and be responsible and effective. Has the time passed? Is this incident just a drop in the bucket? Is that still a good enough reason to act?
I retroactively remember what I try to tell people as part of my last job, that ethics is messy, that in situations like this where there is no certain moral ground on which to stand, that we have to accept and expect lack of closure and all we can do is speak our truth and act for the best.
In the end, I walk away, feeling very angry and helpless.