Eugene Smith, Albert Schweitzer, moral dilemmas, local knowledge

by David Week on 27 January 2011

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Eugene Smith

I’m in Amsterdam, and yesterday I went with my daughter, and with a friend, to see a Eugene Smith exhibition at FOAM, Amsterdam’s photographic museum.

Eugene Smith was an American photojournalist who documented WW2, and later worked for Life, and for Magnum. Some of his photographs are iconic, and you may recognise them:

Smith documented the life of the working class, the rural poor, war, and the effects of mercury pollution on the Japanese village of Minamata. He was obsessed with the art of the photo essay, and this cost him dearly in money (he would often spend his own money to get a particular assignment “right”), and in health (severely wounded in war, beaten by the employees of the Japanese firm Chisso Corporation, which polluted Minamata Bay with mercury, which the local fisherfolk then ingested to terrible effect.)

Albert Schweitzer

I was surprised to find that he’s also documented the work of Albert Schweitzer, that paradigm of another age of development, in which heroic figures ventured alone into “darkest Africa” to single-handedly build clinics, treat the sick, and immunise the population.

I carefully selected an image of Schweitzer which did not show him in that embarrassing white pith helmet.

What struck me is Smith’s commentary on Schweitzer, as recorded in a 1983 PBS documentary: W. Eugene Smith: Photography Made Difficult. In the doco, Smith told this story about Schweitzer (my paraphrase):

In his clinic, Schweitzer came across leg injuries and conditions that his medical training told him—without doubt—”amputate”. But he also knew that if he started amputating legs, he would soon become known as the doctor who cut off legs. This, in turn, would dissuade people from coming to him, and as a result, many more would die than would be saved by the amputations.

But this dilemma forced him to rethink his approach to leg injuries and conditions, and come up with new ways of dealing with them that saved the patient, without amputation.

Moral dilemmas and local knowledge

This story seems to me to encapsulate much of the promise and problematics of development work, and to offer a commentary too on Bill Easterly’s defense of local knowledge:

  • What we see here is a conflict between the dictates of universal knowledge (represented by Schweitzer’s medical training) and local knowledge (represented here by his understanding of what people’s reaction would be to amputations.)
  • This conflict is non-trivial, and morally complex. In fact, taken at face value, utilitarian consequentialist ethics (the greatest good for the most people) would demand that he sacrifice a few patients with leg injuries or conditions, to save the overall mission of the clinic.
  • This conflict can be productive: in this case it drove Schweitzer to modify, and improve, his “universal” knowledge, in order to avoid the conflict with the local. (He could have engaged in a “public awareness” campaign on the virtues of amputation, but good luck to him if he’d tried that…)

In my mind, it is just this kind of conflict which scuttles many a development project, which “should work” according to theoretical knowledge, but falls over because development deals with people, not billiard balls.

An example is the case cited by Esther Duflo in her TED talk, of local villagers who “misuse” their anti-malarial mosquito nets to catch fish. It’s misuse perhaps to a program manager, charged with a single outcome—reduce malaria. It may not be misuse according to the local knowledge of a fisherman, for whom to make a living today is more important than escaping endemic malaria.

Now, one can just decide that the fishermen are ill-informed, short-sighted, don’t understand, (insert your favourite neo-colonial epiphet here…), in which case, in my view, it’s time for you to unpack your white pith helmet, and strut around giving directions to the “natives”. But Schweitzer, despite his funny hat, did better: he took local perceptions seriously, and adjusted his knowledge accordingly.

Postscript

Just for my own records, here is the comment I made on Bill Easterly’s site, in support of his thesis:

Roger writes “Decentralising knowledge means fragmenting it not only locally, geographically but also at the individual level to a point where it becomes meaningless.” That’s just plain silly. I know my wife, and my children, at an individual level. That knowledge is central to my life. It is not “meaningless”. Also, I know how to write about my work in a way that no-one else on the planet does. Again: not meaningless.

This whole debate is best understood in terms of “universal knowledge”, which was invented by the Greeks, and “local knowledge”, the subject of a book of that title by Clifford Geertz, q.v. This distinction is also embodied in the awful-sounding postmodern neologism “knowledges”.

Both universal knowledge and local knowledge have domains and situations in which each is useful. Universal knowledge is useful in building bridges (though even there, a bit of local knowledge about foundations, and local workmanship, is absolutely necessary.) Local knowledge is useful in wooing a spouse (though “pickup artists” will try to tell you that they have universal knowledge to that effect.)

Local knowledge is never “useless”. It’s only ever useful, though, to the people that hold it, who are “local” people. Development requires local knowledge. That forces development funders to consider delegating expenditure authority to the field, and even to the beneficiaries. They don’t like this. Therefore, there is an enormous institutional thrust to generate universal knowledge for development. This thrust comes from the interest of funders, who want it for their own comfort and control: not from the beneficiaries, who usually have a pretty good idea of what needs to be done, being intimately familiar with the condition of their own lives.

That comment was originally posted here.

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