Provider Pulse Ep. 27: Bayle Conrad, MPH (Part 1) - The Voyeurism of Global Health

What's the difference between helping and voyeurism? Between witnessing and exploiting? These are the uncomfortable questions that nearly made Bayle Conrad quit her Master of Public Health program.

In this first part of our two-part conversation, Bayle takes us from her childhood in Spokane—struggling with debilitating anxiety that made her hyper-aware of power and agency—through her undergraduate years at the University of Washington, where she learned to view global health through a critical lens.

The pivotal moment came during a summer internship in Kibera, one of Nairobi's largest informal settlements. Tasked with escorting donors on "slum tours," Bayle found herself asking: What makes me different from them? What right do I have to be here? These questions led her to write an essay titled "The Voyeurism of Global Health" and to nearly abandon her career path entirely.

This episode explores the ethical tensions inherent in cross-cultural work, the journey from crippling self-doubt to self-awareness, and why some questions are more valuable when left unresolved.

Topics covered:

• Growing up with undiagnosed anxiety disorder
• Finding mental health support in college
• Learning critical perspectives on international development
• Working in Kibera's informal settlement
• Power dynamics in global health work
• The ethics of international development

The link to Bayle Conrad's essay can be found here at the following link (pages 38-39 as listed in the pdf, or 60-61 using search tab):

https://courses.edx.org/asset-v1:BUx+GlobalHealthX+3T2018+type@asset+block/ReflectionGlobalHealthPart1.pdf

Perfect for: Pre-health students, public health professionals, anyone working across cultures, and those navigating anxiety while pursuing meaningful work.

Visit EthnoMed.org for additional resources. Follow us on YouTube and Instagram @EthnoMedUW

Chapters

• 0:00 Bayle Conrad Opening Quote
• 0:47 Introduction: Voyeurism of Public Health
• 2:24 Growing Up with Anxiety: Growing up in Spokane
• 4:32 Family and Formation: Family background, childhood interests
• 7:19 Seattle and Mental Health: University of Washington, anxiety diagnosis
• 9:28 Support for Anxiety: Breakthrough moment
• 11:37 The Critical Lens: Academic focus, developing critical perspectives
• 13:44 Discovering Anthropology: What drew her to understanding "othering"
• 17:45 The Foreclosure Years: Post-graduation challenges, job search struggles
• 18:53 The Foreclosure Job: Working at a forceclosure law firm
• 23:01 MPH and Unmet Expectations: Emory University
• 27:20 Nairobi - Entering Kibera: Internship in Nairobi, Kenya
• 31:17 Donor Tourism: "Slum" tours in Kibera
• 34:34 The Mirror Moment: "What is the difference between them and me?"
• 37:50 Questioning th MPH: Contrast between Emory and Kibera, questioning her path
• 38:59 What the Teens Actually Wanted: Lessons learned about listening and community engagement
• 40:28 The Unresolved Tension: Reflecting on complex questions without easy answers
• 42:50 Episode Conclusion: End of Part 1

Transcript

Bayle Conrad 25_10_23 

Part 1: The Voyeurism of Public Health

​[00:00:00] 

Opening Quote

Duncan: And so they would have groups of white foreigners come who were donors to these clinics  who would wanna go on a home visit. Then we would get to the homes and I remember I was sitting there. Kind of annoyed that, this had a really voyeuristic feel to it because they were just coming in because they wanted to know what a slum looked like, really.

Bayle: And I sat there and I remember thinking, what is the difference between them and me right now? And so I wrote this essay in response to those [00:00:30] really complicated feelings, which led me to, almost quitting my program, but also just thinking about the ethics of international work or any sort of, work where you're working with marginalized communities and you're coming in as someone in a position of power

Duncan: Welcome to the EthnoMed Podcast, where we share the stories of healthcare professionals working at the intersection of culture, medicine, and human connection. My name is Dr. Duncan Reed, a primary care provider in Harborview's [00:01:00] International Medicine Clinic, and Medical Director of EthnoMed. Today we're beginning a two part conversation with Bailey Conrad, program director with the equity, diversity and Inclusion team at Harborview Medical Center in Seattle, where she works on the Refugee Health Promotion project. Her journey to this role is a story of transformation from a painfully shy teenager who could barely speak in class, to someone who now confidently navigates crisis situations advocates for some of our community's most vulnerable members.

 Her journey took her from [00:01:30] Spokane to Seattle, from Atlanta to Nairobi through moments of profound self-doubt, to hard won clarity. Along the way, she's grappled with questions many of us face when we want to help others. What gives us the right? Are we actually helping? And how do we work ethically across lines of power, privilege, and culture?

These aren't comfortable questions and they don't have easy answers, but asking them has made Bailey exceptionally good at what she does. Let's begin.

Bayle: My name's Bailey Conrad.

and my [00:02:00] current role is a program coordinator with equity, diversity, and inclusion team at Harborview Medical Center.

So I work on a specific refugee health project grant. my work is specifically with the International Medicine Clinic and working with refugee and other immigrant patients who have high medical needs and need a little bit more assistance than maybe your average patient at navigating the healthcare system. 

CHAPTER 1: Growing Up with Anxiety

Bayle: Before we get to Nairobi, before her crisis of conscience and her current role at Harborview, we need to [00:02:30] understand where Bayle started. The person she was as a child had a profound impact on how she navigates the world.

Duncan: So could we back up then? What led you to being a graduate student in Kiberra with this duty of being, kind of this cultural interpreter between donors and between people there, where are you from originally?

Bayle: I'm from Spokane, Washington. I grew up there, and I'm laughing because I always felt like, you know, if you just go to, college, you'll figure out what your path [00:03:00] is, you'll know what you want to do. Okay. You, you'll go to grad school, you'll figure it out.

And I have never figured out a path. I kind of just stumble into things, which is probably not the most helpful advice. But, yeah, I grew up in Spokane and I was always really interested in, international development and aid. And I think, early on, I was really focused on people's agency and the power dynamics that are inherent in any sort of, interaction you have with anyone really.

And I think some of this comes from the fact that when I grew up, [00:03:30] I was so excruciatingly shy and had pretty debilitating anxiety. And I think I felt like I was getting in the way of my own agency, if that makes sense. And I think those experiences really made me, as I became interested in working with more marginalized communities.

Really made me maybe like hyper aware of making sure people have their own agency because I felt like I didn't have my own for so many years. And so [00:04:00] yeah, I had really no idea what I was doing when I went into undergrad. I, I didn't have a pathway when I went to college, 

I just, had the privilege of, taking classes that interested me in sort of narrowing the focus down. And I actually really wanted to go into international development for a long time. And that's kind of how it turned into getting a degree in public health with a global health focus is sort of just matched all of my interests at that time.

But yeah, there was never, there was never a clear trajectory. It was just sort of, narrowing down what I was interested in to the point [00:04:30] of something that I thought I could maybe, turn into a career.

Chapter 2: Family and Formation

Bayle: Bailey grew up as a second of four children in Spokane. Her father was an architect. Her mother worked in schools first to volunteer later as an aide. The family wasn't wealthy, but they valued education. and Bailey, despite her crippling anxiety, excelled academically. 

Duncan: What did your parents do for work?

Bayle: Yeah. My dad he was an architect and then my mom kind of had different roles when we were, I'm one of of four, kids when we were growing up, [00:05:00] she stayed home with us but not really because my parents could afford it, but because childcare was so expensive that any job she had, which was, usually low paying or minimum wage work, wouldn't cover the cost of care.

 Now she's a, like an aide for, kids who have developmental and behavioral issues, and works in a classroom with a teacher.

Duncan: And what were you interested in growing up? So It sounds like you were very shy. Yeah, very reserved. 

Bayle: Probably funny now for anyone who knows me, that's not what [00:05:30] I, that's not how I come across, you know, I really wanted to be an artist. 

I just think I really like to draw and. I wasn't great at it, obviously. But I had a teacher who told me that I would never make a career out of that, and I needed to choose something different. This was like in third grade. So then I, as a kid who's that young, you just sort of think about what you like doing and that's kind of how you extrapolate your career.

So I really liked to read, still loved to read, and so I thought maybe a librarian, but I didn't really know. And then as I got older and into middle school and high school, really [00:06:00] enjoyed social studies and history classes, and so I knew something in that sphere, but I had no idea what type of career opportunities there were, I guess, other than really basic things like a history teacher, you know, or academic.

So I had little knowledge of where I would end up, but that's kind of just how that trajectory played itself out.

Duncan: And how was school for you?

Bayle: I was actually really good at school. I think because of my anxiety mostly, I put a lot of pressure on myself. I was actually valedictorian in high school. [00:06:30] But it's funny 'cause my parents didn't put the pressure on me to get A's I put the pressure on myself.

But I think it was also a lot of, being shy and the anxiety really was what pushed me to do well. I generally liked at school. I liked learning. I still like learning. So even subjects that I wasn't as strong in like science and math, I still enjoyed because I liked the challenge of learning something new.

Duncan: And what about the demographics in high school? Do you remember?

Bayle: Pretty much white. I mean, I wasn't as aware of that then as I am now, but [00:07:00] Spokane isn't a very diverse city, especially back then. You know, we had, we had some, students of color and the class, but almost everyone was, white. Yeah.

Duncan: So you were kind of mainstream in that way, but your own anxiety was what marginalized you in a

Bayle: Mm-hmm. Yeah. Yeah. That's an interesting way to

put it. And

CHAPTER 3: Seattle and Mental Health

Bayle: After graduating high school, Bailey came to the University of Washington in Seattle. Moving away from home without understanding that she had an anxiety disorder, made those first years [00:07:30] particularly difficult.

Duncan: And then where did you go to school for undergrad?

Bayle: undergrad I went to the University of Washington. In Seattle?

Duncan: So you came to the big city, to Seattle. What was that transition like coming from Spokane?

Bayle: It was really hard. I had a lot of anxiety. And it's funny because thinking back, I was so shy and had so much anxiety that would literally get in the way of functioning, but I was also really stubborn and I kind of still have that stubborn strength today. May, may maybe determined is a better way to put it, [00:08:00] but I was really stubborn.

 And so actually moving away from home was incredibly difficult. And this is, you know, this is a time when mental health wasn't really discussed in the way it is now. I didn't even know that I had an anxiety disorder, although it was pretty clear that that's what it was. And so I wasn't like medicated or going to therapy or anything like that.

And so, yeah, that transition was really difficult. And sometimes I look back and think, how did I do that? Because [00:08:30] it was physically really horrific. Um, mentally really horrific. But it was just this feeling of, okay, this is what you need to do, so do it.

Duncan: Why did you come out all the way to Seattle? It would've been easier to stay closer to home. Did you have some push.

Bayle: At the high school I went to, you were considered to really not be successful unless you went out of the city. And actually at that time, out of the state.

and so I think actually, and this is my perception of it, but I think I was kind of [00:09:00] considered settling because I went to an in-state school.

Duncan: But in a way it's a good expectation to have too, isn't it?

yeah, it's not a bad expectation. It makes sense. I mean, I, I think the reason I look back on it and I'm somewhat bemused, is because the amount of debt that you accrue going to some of these schools out of state is so high versus, you know, I had in-state tuition at UDub. And if anything it's becoming more and more relevant. Yeah. With, with a cost of education. were you getting any mental health [00:09:30] or no therapy in undergrad? So you're just muscling it out on your own?

Bayle: I think it was my sophomore year where I, I'm laughing because it's just so obvious now, but I was really struggling. I mean, I wasn't struggling academically. I was doing fine, but keeping it together with that level of anxiety and anyone who's had extreme anxiety can probably relate because you pretty much put a face on for the rest of the world because you have to keep it together, even though you feel like you're [00:10:00] about to vomit all the time, or whatever the case may be, have a panic attack.

And so I remember I was at work one day it was just too much and I, I left work and I just sat on the curb and cried and was just kind of like, I can't go on like this. This is, I just feel physically sick all the time because the way that, anxiety would physically manifest with me was like physical symptoms, like vomiting.

I'm so anxious about everything, like something's wrong. And then I remember [00:10:30] looking up anxiety and panic attacks and panic attack disorder and, uh, reading the description and, thinking, oh, I have that. I've had that since I was a very small child. And in fact, some of my first memories are what I now know are panic attacks, but I just, you just live with it, right?

 And so that's the point where I started seeking more mental health support and, It really changed the entire trajectory of my life, to be honest.

Duncan: That moment sitting on a curb [00:11:00] crying, finally reaching the point where she couldn't keep going the way she had been. That was Bailey's turning point,

Not because everything suddenly got better, but because she finally had a name for what she'd been experiencing her entire life.

And were those resources at the University of

Bayle: Yeah, yeah. Started out at Hall Health, um, 

Duncan: So a good message to undergrads is that there are resources available on campus 

and they can be very 

Bayle: Yeah. And I hope these days mental health is more accepted and people are more [00:11:30] open about it, because at that time I felt like it was a secret that I had to keep to myself that I was really struggling and, I think now that's changed a bit.

CHAPTER 4: The Critical Lens 

Bayle: With mental health support in place. Bailey could finally focus on what she came to university for: learning.

She majored in anthropology and African studies and minored in public health. But more importantly, she encountered a way of thinking that would shape everything that came after a critical lens on power, history, and international development. 

Duncan: And how was school then? So what were you studying?

Bayle: So I [00:12:00] was studying anthropology. That's what I ended up majoring in and African studies. and I think I minored in public health. I don't think there was a global health minor at that time. And I really appreciated the education I got at UDub because even back at this time, which was the mid to late two thousands, a lot of the classes I took that were in global health or in, international development, that type of sphere really took a [00:12:30] critical lens.

I remember one class I took, I think it was a global health class, but I remember one of the first presentations that the professor gave had this slide that listed all of the CIA coups and like intersections with other countries since the beginning of the 19 hundreds.

And just having that lens on studying something now, like global health or aid or development, really kind of changed how I saw that [00:13:00] whole field. And I think that was one of the reasons why it was really hard when I went to grad school because it, did not have that critical lens.

Duncan: That one slide had a profound impact. A professor showing students all the times United States had intervened in other countries governments, overthrown democratically elected leaders, destabilize regions for political or economic gain.

And then saying, now let's talk about global health work. Now let's talk about Americans going to work in the very countries we've destabilized. Understanding context matters. Understanding [00:13:30] history matters, and sometimes the most important thing an educator can do is help students see the systems they're about to enter with clear eyes.

And just getting back how you got interested in this, I'm guessing you're reading a lot on your own.

Bayle: Mm-hmm.

Duncan: And then part of the anthropology interest, do you think that had any connection to your own anxiety and your own introspection, or was it more of an academic interest?

Bayle: don't know. That's a really good question. when I was in high school, I was really interested in learning about the Holocaust and read a lot of books about that.[00:14:00] 

And I'm not Jewish and I don't have, you know, like family who experienced the genocide. But for a while I wanted to be a genocide historian. Um, yeah, I was really cool kid. Um, I

Duncan: Do you know what interested you about that?

Bayle: I think what interested me was just I couldn't, and I still can't, I couldn't figure out how someone could do something like that to another human being. And I was really, I guess, fascinated by the idea of othering a whole group of people because they're [00:14:30] different than you. And you could probably see the through line of that to the work I am doing now.

But, I think I felt like, okay, if I just keep reading about this, I'll figure out, you know, how this happened. but that led to reading about the Rwandan genocide and the Bosnian genocide and sort of how these events keep occurring. You know, I took that into undergrad and I I knew I was interested in sort of like human rights and, and that world.

Duncan: Bailey describes this othering the process of seeing other people as [00:15:00] fundamentally different from you, not just different in culture or language, but different in their very humanity. Once you have othered someone, it becomes easier to exploit them. Ignore them, even harm them.

Bailey was trying to understand how othering happens. She was looking for answers in history books in studies of genocide. What she didn't fully realize yet was a smaller way that othering happens in slum tours in international development work. Well-meaning people are going to help without questioning the power dynamics at play. 

Bayle: I took a couple history classes [00:15:30] and realized I don't want to be a historian, but I don't really know why I picked anthropology. When I was in high school, I had no idea what anthropology was. It wasn't, something I knew anything about.

And I remember the class I took, in anthropology, really made me see the world in a different way. Or just opened up other perspectives of seeing the world. And these classes weren't, they weren't like the history of anthropology. There was one about, language that was, you know, fascinating to me because it was just how, if you speak different language, you have a [00:16:00] totally different perception of the world, potentially.

And so I think it was more of, I had these interests going into college. I was just really interested by the interactions between human beings, I guess at a very baseline level and kind of the power dynamics between different groups of people. And then the fact that I, felt like the anthropology classes I took really expanded my own perception of the world.

It was something that I just really, it really resonated with me.

Duncan: And then why African [00:16:30] studies?

Bayle: You know? I don't know. Thinking back, it's, I was just really interested in Sub-Saharan Africa from pretty early on. I'm sure some of that was, being interested in kind of these human rights abuses and genocides. At the time that I was in school, there was like the Save Darfur campaign.

There was, invisible children. There were all of these kind of activist organizations that were In the news a lot and, pretty well known if you were looking for that type of thing. And so I [00:17:00] think maybe that had something to do with it. You know, just that these atrocities are being highlighted in news coverage.

Yeah, I just started taking a couple of African studies classes and it wasn't something I knew a lot about and just became really interested in it. And then that's what led to my interest in HIV, and wanting to potentially do HIV prevention work.

Duncan: At the end of undergrad, Bailey had degrees in anthropology and African studies. She had learned to think critically about power and history. She had gotten mental health support that changed [00:17:30] her life.

She was interested in HIV prevention work in Sub-Saharan Africa. She had all the pieces of what looked like a clear path forward, except she had no idea how to actually get on that path.

And the next few years would be about stumbling, struggling, and slowly figuring things out.

CHAPTER 5: The Foreclosure Years

Duncan: Like many young graduates, Bailey discovered that passion and education don't automatically translate into employment.

Her first job was at a foreclosure law firm following the 2008 housing crisis. So then you graduated with a degree in [00:18:00] anthropology with African studies, minor

Bayle: major Mm-hmm. 

Duncan: with a public health

Bayle: Minor, yeah. Mm-hmm.

Duncan: And then what were you thinking? Were you like, I'm gonna go out into the job force now?

Bayle: Yes, naively. I mean, and I don't know if this is still the case for people, but I graduated and had no idea what I was doing. And I think back then, but definitely now, it's really hard to just get a step or a foot into, any of those worlds, right? Unless you're able [00:18:30] to volunteer or intern for free, and then maybe you can, kind of weasel your way in or, get connections and network.

So I remember I applied for like a lot of, nonprofit jobs, honestly, in the Seattle area. I don't really know if I don't think I was applying for overseas jobs at that point, because I didn't have any experience, no one had any interest in hiring me fair.

And so that was a struggle and I ended up working for a law firm really randomly, for about a year [00:19:00] that focused on foreclosure law. And this was during the housing crisis, so they were very busy. But I remember my job was like a file clerk. And so they would get these letters from people that were just so heartbreaking about, you know, my mom has cancer and she lost her health insurance and I'm trying to make payments in my condo, but you know, can I get on a different payment plan?

And the law firm who was representing the condo association would write back and say, Nope, we're taking you to court. Like, good luck. It was a pretty [00:19:30] soul destroying job. It was not a job I wanted to pursue, but it was just more about having something to be able to pay rent.

Duncan: This is the part of the story we don't always tell about our own career paths. Sometimes you take jobs that feel wrong. Sometimes you do work that makes you feel complicit in systems you hate, not because you lack principles, but because you need to pay rent.

 Because the dream job isn't hiring and you're still paying off student loans. Even in a soul destroying job, you're learning something. [00:20:00] Bailey was learning about economic inequality. About structural violence and about how systems are designed to benefit some people while crushing others.

She was seeing up close. What it looks like when the safety net fails, those lessons mattered. They would shape her understanding of the work she'd eventually do.

Duncan: And this was during the subprime mortgage crisis, so this was a kind of the epicenter

of what, what was happening.

Bayle: Yep. This was in 2011 2010. Yeah.[00:20:30] 

Duncan: Did you have any mentorship in undergrad or when you were graduating? Were there any people in professions that were helping you along or that you were talking to?

Bayle: Not really. And I think that was more my fault than anyone else's, because I was so shy. The thought of going up to a professor and asking for mentorship was not even in this universe as an option. And I still struggle with that in the sense of trying to figure out like even how to ask someone to be a mentor or what am I actually trying to get [00:21:00] out of this, relationship potentially.

And so I've really never had a mentor, I would say. The couple times I've sort of awkwardly tried to do that, I've just sort of ended without it happening. and I, I do not like networking. I'm not great at it, so it's kind of fallen by the wayside. But I do think at that time there was just no world in which I was gonna go up to somebody and ask them to mentor me.

I mean, I had a couple professors who I think really saw, something in me. I [00:21:30] don't know what, but, who did kind of reach out and, had like a little bit more of a relationship with them, but nothing like a mentor. Yeah.

Duncan: For someone struggling with anxiety, reaching out, making yourself vulnerable, asking for help from someone with more power than you, that can feel impossible. And yet mentorship can make all the difference. Connections can open doors.

Sometimes the students who most need mentorship are the ones who find it hardest to ask for. So then you worked at this law firm [00:22:00] facilitating foreclosures for a year, and then what was your escape strategy from that?

Bayle: I'm laughing because the firm dissolved, which was really ironic at the time. 'cause like you said, it was at this height of like, they had more business than they knew what to do with, but there was infighting and we all got laid off, which was actually great because I didn't wanna work there. But I had applied to grad school partially because I couldn't find a job in anything remotely close to a field [00:22:30] that I wanted to go into. Right. And I still didn't really know, I was just kind of applying for nonprofits that do international work. You know, it was very vague. So I had applied for grad school and I knew I was leaving for grad school, a couple months later.

So you know, I, I had planned to work there until I left, but it wasn't like the end of the world. I had a little bit saved up to pay for rent and things like that. But yeah, I do find it kind of ironic that that's how I ended up getting out of it.

 Sometimes the universe does you a favor. Sometimes a door closes and you realize that you are [00:23:00] relieved, not disappointed.

CHAPTER 6: Emory and Unmet Expectations

Bayle: This brings us to Emory University in Atlanta to a master of public health program that was supposed to provide answers. Graduate school was supposed to be different. It was supposed to build on that critical lens Bailey had developed at the University of Washington.

It was supposed to give her the tools and the framework to do international development work ethically, thoughtfully, effectively, but ended up raising more questions.

Duncan: And then MPH it made sense because it was an extension of what you were [00:23:30] already studying as undergrad, and you were thinking about just going deeper into this with the idea of getting a job in that field later on.

Bayle: I think, I thought it was an extension of what I had been studying in undergrad. I don't really know actually what field would have been an extension, but it was actually very different than what I had anticipated, and that could be because of the school I went to and the focus of the programs there.

But in general, yes, it was kind of this intersection of all of these interests that I had [00:24:00] had. And, it was more of a, you know, I wanna build the skills to be able to do this instead of going into, like academia for example,

Duncan: did you apply to a bunch of programs or just a handful? I.

Bayle: I applied to, maybe four, not that many. And I did not apply to UDub on purpose because I, again, this is that stubborn streak in me.

I didn't want the option of staying here. I wanted to go outside of Washington state.

Duncan: And where did you end up

Bayle: I ended up in Emory, in Atlanta, Georgia. So very, [00:24:30] very different.

Duncan: and how was that?

Bayle: There were things I liked and things I didn't. I think, it's funny because when you, at least for me, when I went into grad school, I assumed the things I would get out of it would be all these public health skills and, you know, being able to actually apply what I had learned to a job.

And it's not that I didn't learn those things 'cause I did, but I think what actually happened is I learned a lot more about myself and kind of the moral and [00:25:00] ethical issues that I was not going to be able to compromise on. I think that's really something that came out of it. And to back up, the reason I say that is, like I said, it, when I went to the University of Washington, all of these classes I took were really with this critical lens on international development and health.

And the example I gave of that class I took where one of the slides was all of the, coups that the CIA had facilitated over the past a hundred years. So I think I expected it to be more like [00:25:30] that when I went to Emory. And it wasn't, because of course that's not really what public health is or global health, but it was really frustrating to me that within a global health track there was no consideration of critical development thinking.

Right. And there was a group of students at the time who recognized that and were really pushing for the curriculum to change. And so I don't know what it's like now. I mean, this again was a long time ago. But I think the fact that you know, there was no greater discussion about the worlds of development [00:26:00] and aid with global health was really jarring for me, because to me, those things cannot be separated. Right, any sort of global health work is going to be part of the aid industrial complex, what we call it today. And I think I was still really grappling and these feelings came to the forefront of just the ethics of doing this work.

And I think, I thought that by going to grad school in this field, I would figure that out. I would find the answer to this, [00:26:30] kind of, ethical conundrum that I had always been thinking about, which is how do you do international development ethically? How do you go into another community, as in my case, a white woman who's an English speaker or doesn't speak any other language.

And do development work and what are the motivations behind it? And is it really more about me than the community I'm working with? And this is just my experience. There's a lot of people who do really good work abroad, but I could just never, I could never resolve that tension. That tension was [00:27:00] there.

Duncan: The aid industrial complex is a provocative term,

But it points to how helping has become an industry where wealthy countries and individuals can help those less fortunate without changing the systems that create inequality in the first place.

Bailey was learning technical skills in graduate school without addressing the fundamental questions and tension she was feeling.

Chapter 7: Nairobi - Entering Kibera

Duncan: Between Bailey's first and second year of graduate school, she did an internship in Nairobi, Kenya. To understand what happened there, we need to understand where she was going.

Kibera is [00:27:30] one of the largest informal settlements on the African continent located in Nairobi. Estimates of its population vary widely from 170,000 to over a million people living in an area of about 600 acres.

It emerged in the early 19 hundreds and grew significantly after Kenyan independence in 1963. The settlement lacks formal infrastructure. Most residents don't have legal land tenure. Access to clean water, sanitation, and healthcare is limited, but Kibera is also a community with schools, [00:28:00] churches, mosques, small businesses, history and culture.

This complexity is at the heart of what Bailey was about to experience.

Duncan: One thing that you were really helpful is that you shared something that you wrote with us when you were doing your MPH

Bayle: Yes.

Duncan: and you were doing some work out in Nairobi,

Bayle: Yep.

Duncan: the title of it was The Voyeurism of Global Health.

Bayle: Yes, it was.

Duncan: So it's really this, you were questioning the idea between voyeurism and witnessing.

Bayle: Yeah. [00:28:30] Yeah. and I didn't really know what I wanted to do next, but I knew I was interested in health, so I thought, okay, maybe I should try to get my, MPH Master of Public Health.

So I went to grad school to get my, MPH and this internship in Nairobi was in between the two years. So kind of like the summer between the two years of getting my MPH. And when I wrote this, you know, I actually was thinking about quitting my program. So this was at a somewhat angsty point in my, education I guess.

But [00:29:00] when I went into public health, I realized that the field in general is very pragmatic and very practical, which makes sense. You're, learning skill sets for actually being a practitioner. And I think maybe, I thought it would have more of a critical or reflective lens toward the work that was being done, particularly in the global health track, which is the track I was in.

So the project I did was, working in one of the informal settlements or [00:29:30] slums in Nairobi called Kibera. And at this time I was really interested in HIV AIDS prevention, with youth specifically in Sub-Saharan Africa. And so I interned at a series of health clinics that were in many of the slums in the area.

And interestingly enough, and it, looking back, I'm actually kind of glad that this is the group I ended up working with. 'cause I think it did change my trajectory quite a bit. They had a cohort of teenagers who had been born with [00:30:00] HIV who weren't expected to survive, but with the advent of medications actually made it to being 18, 19 years old.

Duncan: These teenagers were the first generation to survive HIV. They were born in the 1990s when antiretroviral medications were just becoming available. They were not expected to survive beyond childhood, but they did. And now they were teenagers in a community with intense stigma and uncertain futures. This is the group Bailey sought to help.

Bayle: [00:30:30] And the clinic I worked with, they had some kind of programming for younger children, but they didn't really have anything for teens. 'cause again, they weren't expected to live as long as they had lived. And it was a children's clinic, so they had these groups of teenagers who were kind of about to leave the clinic to maybe move on to an adult clinic or maybe, move outta the area, to pursue other, things in their lives.

 And I was tasked with coming up with a curriculum that could be really flexible and used by the [00:31:00] nursing and social work staff who were really busy and didn't have time to think up ideas for what to do with these older teens. And so part of that, when I was, I say interning with quotes because I don't think I actually did much to assist, I didn't speak the language.

It was a culture that I was not super familiar with before going there. But they would have groups of donors come and the head agency, that funded these clinics would set up, for lack of better [00:31:30] term, a slum tour. And so they would have groups of white foreigners come who were donors to these clinics who would wanna go on a home visit.

Duncan: And pretty early on the clinic staff had me start, accompanying these donors onto these trips. And so when you asked your question about this essay I wrote, it was based on those experiences. Slum tours, the term itself is jarring. The clinic staff didn't want to do these tours. They found them uncomfortable, awkward, even [00:32:00] degrading. So they asked Bailey, another white foreigner, but one who was working alongside them to be the tour guide instead.

And Bailey went to be helpful to the clinic staff despite the discomfort.

Bayle: When you're working in an informal settlement, like Kibera, some of the homes that we were visiting were very deep in the informal settlement. I mean, it would take 20 plus minutes to just walk through raw sewage and trash and, homes and little kiosks where people were [00:32:30] selling things and it was just like a maze.

There was no way I could ever make it out, honestly, by myself without having a guide, just because everything was just built really on top of each other. And I could see why they asked me to do these visits for a couple reasons. One, because it took up time from the clinic and I was happy to be the person who had to go with these donors if it meant that like the nurses and social workers at the clinic could actually still be doing their work.

But also because the clinic staff, as we [00:33:00] started working together more and they trusted me more, they told me We don't know what to say to these foreigners. We don't really have anything in common with 'em. it's uncomfortable. And so, they'd have me go and when I went on these visits, first of all, you're going into the home of usually a single mother who has HIV.

Who has one or more children with HIV that was transmitted at birth because that was, the cohort of people this clinic was [00:33:30] serving. And, as someone coming from the outside and going into a slum, going into someone's home within the informal settlement, it was really jarring. And, I had at least had some preexisting knowledge of what I was going to be met with right from being in the program I was in.

And it was still jarring for me. But a lot of the conversation that I would have with these donors on the way in was, you know, they would ask me like, what should we do when we, get there? And I would just tell [00:34:00] them like, this is someone's home. And despite what your idea of a home looks like. This probably won't fit your image of that, but you need to respect that this is actually, that person's home and they're letting you come and visit.

And, when I went on home visits, I would just copy whoever from the clinic was with me at the time, what they would do. So if they took off their shoes to go into a dirt hut, I would take off my shoes to go into, you know, a dirt hut. I made, you know, made a point of like shaking the hands of the mothers, things like that, and sort of [00:34:30] trying to teach as much as I could on the way into these homes with these donors.

Then we would get to the homes and I remember the first time that this happened and I was sitting there. Kind of annoyed that, you know, there were these, foreign donors that were coming in and this had a really voyeuristic feel to it because they were just coming in because they wanted to know what a slum looked like, really.

And I sat there and I remember thinking, what is the difference between them and me right now? Because [00:35:00] when you do work in other communities that you're not a part of, I feel like there is always this voyeuristic component to an extent, maybe that's too strong of a word, but you are an outsider coming into a place where you have little to no knowledge.

You might have a lot of knowledge actually, but you can never really be part of that space. And so the inherent power that you have in that situation over the person or the community that you're working with is very stark. and it, it really made me think [00:35:30] because sure, I was in a grad program.

 This was an internship I was doing, I was learning things. I was working on this program, curriculum, but realistically, what is the difference and what are my motivations for being there and how do they differ from these foreign donors and to the mother that we're visiting or to the clinic that I'm interning with?

What is the difference between me and and them? And so I wrote this essay in response to those really complicated [00:36:00] feelings, which. Led me to, almost quitting my program, but also just thinking about the ethics of international work or any sort of, work where you're working with marginalized communities and you're coming in as someone in a position of power and your personal reasons behind that, because there's always going to be a selfish component no matter how hard you try.

Like a lot of people go into this work because they wanna help people, which might seem selfless, but that is also selfish in a way. And [00:36:30] so, that was a feeling I really grappled with and I still grapple with. And I think I expected the grad school experience to help solve that for me. And it, it, it did not.

You can find Bailey's essay, the Voyeurism of Global Health in the show notes. 

Here's part of what Bailey wrote in her essay, the Voyeurism of Global Health, which you can find in the show notes. My unease and discomfort will continue as I pursue a career in global health, and more importantly, should continue.

This is the greatest realization I take away [00:37:00] from my experience in Kibera. The blurry line between voyeurism as an outsider and observation as a global health practitioner will always remain because in reality, my role encompasses both.

Duncan: I think there was, in writing this essay and in struggling with these feelings, there was some self anger, maybe some self hate that's a little bit too strong of a word, but because, you know, at least the donors were giving money, I wasn't getting any money.

Bayle: I was there for my own purposes, really. and so [00:37:30] I think part of it was, it was kind of a mirror experience. Like I'm looking at these donors and I'm feeling kind of annoyed and sort of like, why are you here? But really those feelings were kind of about myself and what I was grappling with, with, being in a space as a, to be honest, completely unqualified and very naive grad student.

 part of the reason I wanted to quit my program is I just didn't understand the point. coming from Emory at the time, there were like new buildings being built for the public health [00:38:00] school. and contrasting the beauty and wealth of that campus with the informal settlement that I was working with, and realizing that this slum would not be here if there was enough political wealth, economic, uh, motivation to change it.

Not necessarily from Emory, right? Emory has nothing to do with this, but just seeing that dichotomy between those two places and realizing it really just became so clear that poverty is [00:38:30] created and it's there for a reason. And if there was the wherewithal to solve the issue, there's enough money in the world to solve the issue, right?

There's enough to solve that type of issue all over the world. It just really made me wonder, what do I possibly have to offer to change anything in this system when I am this grad student who has little to no skills, doesn't know what she's doing, and have come into this community with the privilege of being able to leave. [00:39:00] 

CHAPTER 8: What the Teens Actually Wanted

Bayle: But something unexpected happened during Bailey's time in Kibera, a lesson about listening rather than assuming. when I was in Kibera, I was working on this project to try to create a curriculum or programming for these teens.

And even though I tried to not go in with these preexisting ideas of what the needs would be. You know, it's hard to not go in with some kind of general idea of what you think is gonna come outta these conversations. And so I did like surveys and really [00:39:30] honestly a horrible data collection because I was really trying not to, take up the time of anybody.

I was trying to think of ways I could get feedback from the teens and most of 'em spoke English, but not disrupt the clinic flow. So I did not get great data, which is fine. But the thing that was really surprising to me, and looking back, it seems really obvious, is I thought, you know, these teens would want more like health education, I guess.

And overwhelmingly they said, no, we know we [00:40:00] have HIV, we don't need education like We know what it means to have this disease. We want economic opportunities, we want mentorship, we want it to be entrepreneurs. And so a part of the curriculum became more about trying to help the clinic get kind of mentorship or even having people from the clinic, talk about kind of like what we're talking about now, right?

Like what was their trajectory to becoming a nurse or a social worker. So that made it into the final curriculum, which I think the clinic actually used. 

CHAPTER 9: The Unresolved Tension

Duncan: So what was the resolution [00:40:30] of that? 

Bayle: in terms of the resolution to that, it's never been resolved. I think I've grown more comfortable with the fact that it's never going to be resolved.

And by that I mean

it is been a through line, I think for my entire experience of really thinking through what are the ethics of the work I'm doing and recognizing that there's always going to be a piece that is potentially unethical or whatever you wanna call it, that might be too strong of a word, but there's always going to be a piece of, should I be here and doing [00:41:00] this right now if I'm not part of this community?

And I think there's arguments to be made both sides. It's not, I'm not necessarily saying that you can't do good work if you're not part of the community that you're working within. I think for me, what the resolution that has come from that conundrum is more about trying to constantly check myself and be aware of the power dynamic, between myself and, the community or the client I'm trying to serve.

Duncan: So what I'm hearing from you is that you're describing and you're acutely aware of a world where there's power imbalance [00:41:30] and there's wealth imbalance, and that there's no way that you can escape that framework. By doing work that sounds like you're intrinsically, ethically driven to do, it's impossible for you to carry out your work without rubbing up against those contradictions of the system that is well entrenched and you feel powerless to question or to push against that system.

So then you are actually working within that system that you have a lot of questions about.

Bayle: right. Yes. And maybe someone else has [00:42:00] figured this out. I'm sure this is not an uncommon struggle that people face who go into any sort of helping position really. 

Duncan: And if you think about a lot of these service industries, I think a medicine, for example, is one where it's very clear cut power dynamic.

Bayle: Yeah.

Yeah. And I think a lot of the student, not a lot, I shouldn't generalize, but there were a number of students who were in my cohort who really did give off this feeling of, I am the expert because I have this grad degree and I am going to go overseas and be a white [00:42:30] savior. And that I think, just heightened this even more for me, to look at that and say, I don't wanna be like that.

And there's always gonna be a piece of me that will be like that because I'm a white woman and I'm interested in working with certain communities that are definitely have less power than I do. But I think that dynamic, really just heightened that tension for me.

EPISODE 1 Conclusion

Bayle: Bailey finished her MPH despite nearly quitting. The questions she wrestled within Kibera about power, privilege, motivation, and ethical [00:43:00] responsibility didn't get resolved, but they didn't paralyze her either. They became a compass, a way of constantly checking herself, constantly asking, why am I here?

Who does this serve? She graduated with skills, credentials, and experience, but she also had doubts, deep unresolved doubts about whether international health work was the right path. And so she made a surprising decision.

She turned down international job offers and came back to Seattle She couldn't resolve the ethical tension, so she decided that if she [00:43:30] was going to do this kind of work, she would do it in the United States, where the power dynamics might be navigable in different ways. It wasn't giving up. It was a different kind of courage. The courage to admit that the path she'd been on wasn't right for her.

And to find a different way. In our next episode, we'll follow Bailey as she discovers that different way, working as a caseworker for refugees at the International Rescue Committee, where she transformed her understanding of herself and her capabilities.

We'll explore the practical lessons she [00:44:00] learned about working cross cultures, and we'll hear her current work at Harborview Medical Center, where she works with healthcare providers to navigate the complex systems that refugees and immigrants face.

Join us next time for part two, finding Agency in the work. Thank you for listening to this episode of the EthnoMed Podcast.

If you enjoyed this episode, please share it with a friend. See you next time.

Additional resource: Bayle Conrad’s Essay, The Voyeurism of Global Health

"We have visitors coming this afternoon." I inwardly groaned hearing these words. In the weeks I had been interning as a global health graduate student at the HIV/AIDS pediatric care organization located in the Kibera informal settlement of Nairobi, Kenya, I had come to dread the arrival of tourists visiting the facility. The routine was the same during every visit. The visitors would arrive, the staff would greet them with a tour of the facility, and they would be taken to visit homes deep within Kibera. I had become used to the preparation surrounding these visits: the announcement at the beginning of the work day, the rearrangement of staff schedules to accommodate the visitors' site tour, and the strategic discussion among social workers of which families in the slum to visit with our guests. A few weeks into my internship, the social workers began asking me to come along as they escorted visitors around Kibera. When I asked one of the social workers whether my presence as an additional white Westerner would cause greater disruption in the slum, she answered honestly, saying, "Please come. We don't know what to say to them (the visitors)."

That comment stuck with me for the rest of my internship in Kibera. What do you say to foreigners, coming to visit a Nairobi slum in between their Kenyan safari and Mombasa beach vacation, shedding tears over tea in a tiny home where an HIV-positive woman lives with her four children? I found myself consistently annoyed by the presence of visitors and their disruption of daily work. But even more, I found myself disgusted at their voyeuristic presence because it reminded me of my own unease, the exploitation inherent in my observations in Kibera. I often felt uneasy just being in the slum, as though I had no right to be there, to see the people and their homes. While I was warmly accepted as a fellow coworker by the clinic staff, I knew that my existence there for a short summer had little measurable impact and was not necessarily needed by the organization, which hosted an endless rotation of Western interns. Even though I was a global health graduate student interested in working at the community level in East Africa, how different was my presence there from that of the visitors I scoffed at? I pondered this on my frequent visits with clinic social workers to homes within the informal settlement. To residents of the area, was there a difference between me and any other Westerner coming to "tour" the infamous slum? Where was the line between "voyeur/exploitation" and "witness/experiencing"? When I asked my Kenyan coworkers this question, one replied by saying "It's different. You are one of us." When I responded by saying that I could just as easily be a fellow Westerner on a slum tour, my coworker gave me a confused look, replying, "But you aren't. You are here, working beside us, teaching us as we teach you. You are not here to simply gaze."

It is now months later, and I still have not shaken the unease I feel when thinking about the privileged voyeurism inherent in global health. As global health practitioners, we work in some of the worst, most impoverished conditions in the world. We spend our trips abroad observing these conditions and those who live in them, even in places we may not belong, and then have the privilege to leave once our projects are over. In my struggle to come to terms with this unease, I am reminded of what it has brought me. By remaining aware of my own position as a Westerner in Kenya, and the power and privilege inherent in such a position, I was better able to connect with coworkers, clients, and community members, much more than I would have by presenting myself as a Western "expert." I was able to have several frank, critical discussions with coworkers in Kenya about the field of global health; its domination by young Westerners wanting to make a change in the world; and how it blurs the edges between voyeurism, aiding, and witnessing. These conversations became one of the most valuable aspects of my internship, and have altered the way I view myself and global health.

My experience working in Kibera threw me into an ethical conundrum that I had previously grappled with but had never felt so acutely. There is not much to differentiate myself from the constant stream of tourists at the clinic, other than a graduate degree in global health. In trying to find a solution to my unease as a global health practitioner and the power differentials inherent in the field, I have come to realize that there is little to no solution. My unease and discomfort will continue as I pursue a career in global health, and more importantly, should continue. This is the greatest realization I take away from my experience in Kibera. The blurry line between voyeurism as an outsider and observation as a global health practitioner will always remain because, in reality, my role encompasses both.

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