Moving Closer to the Problem and Closer to the Solution

When I laid off five of my seven team members in February, I had no idea a global pandemic was about to hit. It was a tough enough decision even without that in the background: There is no pleasure in laying off good people, just as there is no pleasure in recognizing that the way we’ve been doing it the way I’ve been doing it runs contrary to PIVOT’s mission.
 
However, I saw no clearer way to shift our organization’s center of gravity from the United States to Madagascar. No clearer way to shift resources, responsibilities, and authority from the customary hub (here) to the rightful place (there) than by taking this kind of action. Even with 206 staff members in Ifanadiana, Madagascar, and only a handful in the US, undue deference was being paid to the US team including myself at the price of the local team’s power, despite anyone’s best intentions (not to mention the budgeted inequity of basic US salaries at five to 10 times those of key national staff). Decisions were too often made by US-based directors and board members, with only the national director representing the team at site, and the imbalance of power affected how meetings were conducted, how communication was handled, and how decisions were made. 
 
It wasn’t hard to understand how it got this way, nor is this kind of problem unique to PIVOT. But “decolonizing global health” is easier said than done. NGO headquarters, academic journals, and decision makers are too often removed from the problems they purport to solve, allowing the field of global health knowingly or not to perpetuate patterns of power and dominance that we must instead dismantle. Those living the reality of the problems have, regularly and structurally, been excluded from authoring the solutions. This must change.

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