This is the second part of a multi-part look into ‘To Hell with Good Intentions,’ Ivan Illich’s biting 1968 critique of CIASP, a college summer-break volunteer group in the 1960s, which had invited Illich to address their annual gathering. In the name of getting some further context about all the harsh words and their applicability to the students of global health who still read them today, I had left off last time intending to look up a little of the history of the parties involved in THWGI. CIASP is up first.
It turns out that there is not a whole lot out there to learn about the Conference for Inter-American Student Projects. After scrolling through 3 pages of Google results, I don’t think it’s unfair to say that the project’s main legacy was having absorbed Illich’s harangue in 1968. Some details are available through several web sites1,6 created by ex-members commemorating the group and its alums. CIASP started in 1963 as an offshoot of something in southern California called Amigos Anonymous. In CIASP college kids from the US and Canada went to Mexico for the summer and primarily spent time building things – a road is the only firm example given. The group was moderately sized at its peak with ‘hundreds’ of volunteers per summer. The organization no longer exists. It existed, in fact, for only 2 years after the famous Illich speech, and interestingly, the two brief histories I read credit the internal debate stirred by Illich as having a sizeable role in the group’s decision in 1970 to disband (along with the unfortunate death of two volunteers, due to illness and accident, as well as civil unrest in Mexico).
Of course, it’s pretty clear in the tone of THWGI, and in its overt reference to other groups, such as the Peace Corps, that Illich was using the speech as a pulpit, speaking beyond the audience in front of him to address something he saw as a trend. In light of this, I looked a little more into where 1960s international projects such as CIASP sat historically. I think the results bring to light a lot about where global health is in its thinking today, as a field.
The most modern concept of “overseas volunteering” dates to the 1930s5. Its early decades had interesting tie-ins with post-war reconstruction and post-colonial nation building. The youth component to the movement began in the mid-1960s. The Peace Corps falls into this group of government sponsored international youth volunteerism, and it’s worth noting that 22 governments around the world had some sort of similar program in that era. There was also youth involvement through non-governmental agencies and universities. This is where you would find CIASP. It wasn’t until the 1970s and into the 1980s, though, that the youth numbers in international volunteerism really began to swell. At the same time politicized, government-backed programs fell off in favor of smaller nonprofits. The late 1980s were the high water mark in terms of sheer volume of people jetting abroad, which gave way to some pull-back and re-evaluation in the 1990s.
With that first little bit of history in mind, it does feel as though a critique of CIASP can function for the whole era Illich was railing against. Here are some noteworthy characteristics:
– CIASP was student initiated and led, with what was characterized as restraint on the part of the older generation, “with confidence to allow young people make their own way”.1
– There was a definite helicoptering in effect; no one seems to have stayed once school kicked back into gear with fall semester.
– The projects were along the lines of building structures and some informal tutoring; all were items that feel pretty contained in their scope – ie, nothing that would continue to propagate itself after everyone went home.
Having all these features of CIASP in listed form, what popped first to mind was an image that I remembered from Chiapas, Mexico during my PGY-2 clinical rotation with Partners in Health affiliate Compañeros en Salud. Every morning I would see the CES coffee mugs with a small block of text that was eventually stamped on my brain:
‘We go. We make house calls. We build health systems. We stay.’
These are the blunt, opening sentences of the PIH mission statement, which in this context feel like an itemized rebuke to all the ways CIASP missed the mark in their campaigns fifty years ago. Systems are valued over discrete projects. Longitudinal relationships are essential. They leave ‘we’ undefined, but the median age of PIHer’s certainly is much older than the 19-20 year olds that organized CIASP. Basically the only part that is retained is the ‘we go’.
Getting back to the historical sequence, the UN Volunteer report presents the turn of the millennium as a bit of a fork between the PIH’s and those that don’t live up to their standards. There re-emerged something (on a smaller scale) that feels like a worse of a version of CIASP: brief, corporate international volunteering excursions whose branding appeals to a vaguer and more superficial impulse towards altruism2,3,4. It’s encouraged by the perception that this makes for good experience or CV material2,3. There’s a lot that was wrong with CIASP, but I feel that the personal initiative of those that organized it speaks at least to their sincerity. A quick couple of searches for international volunteering opportunities today reveals plenty of options that skew towards the empty calorie good intentions of CIASP, with most of 50 years’ worth of evolution poured more into the buzz-wording than the execution. There are ample references to ‘adventure’ and ‘making a difference’. One organization that gets an endorsement from several sites is something called ‘Volunteer Solutions,’ whose name seems to imply that the main issue to be solved is where and how to volunteer, as opposed to whatever is going on when you get there. Appropriately, it’s easy to find plenty of skepticism about the value of these forms of volunteerism. It’s probably best encapsulated by some of the terms you find coined in academic articles and editorials: ‘voluntourist’5, ‘poverty tourist’2, and my favorite, ‘aid cowboy’7, to designate someone who swoops in for the thrill of being there without much in the way of cultural curiosity or humility. Illich would have been annoyed he didn’t think of that one himself.
Getting back to the timeline, though, there’s a happy ending. The bigger branch to come from the soul-searching of the ‘80s and ‘90s was the one based on the principles we study in global health: system-building, local buy-in, outcomes measures. The organizations built on these principles are the best instances of today’s global health efforts and the ones with budgets in the billions of dollars collectively. It’s heartening to see so many of the pitfalls of the CIASP excursions are accounted for. There’s even a chance that Illich might have felt differently about the global health of today (or maybe not; I have an upcoming post about Illich).
It’s worth noting in compiling this history that I’ve homogenized some of the types of organizations discussed – medical and non-, enormous and rinky-dink. A lot of this repeated talk about volunteering fudges out the many people in global health who are working professionally abroad and may have transplanted themselves semi-permanently or permanently. What’s written here may not apply as much to those who have taken the plunge. Or it might. I’ve written thinking mostly of those of us who are on the threshold, early in careers or finishing training and still sorting out our goals in global health. None of us might really be guilty of the exact brand of youth-driven do-gooding mindset that Illich takes to task, but I think the point is that THWGI is in our curriculum, we treat it as though he has something to say to us, and as I say in the last post, there’s plenty about Illich’s message that I use to check myself.
And after taking a look back at who he was speaking to, I think that there is evidence that we’ve come a ways since 1968.
- “About CIASP”. Accessed 27 July 2017. http://www.ciasp.ca/history.html
- Barhat, Vikrim. “Is gap-year volunteering a luxury for the rich?” BBC: capital. Published 16 July 2016. Accessed 27 July 2017. http://www.bbc.com/capital/story/20160714-is-gap-year-volunteering-a-luxury-for-the-rich?ocid=twcptl
- Butcher, Jim and Peter Smith. “’Making a difference’: Volunteer Tourism and Development”. Tourism Recreation Research. 2010, 35(1). 27-36. http://research.smuc.ac.uk/280/1/04-Butcher%20and%20Smith.pdf
- Citrin, D. “The anatomy of ephemeral health care: “health camps” and medical voluntourism in remote Nepal”. Studies in Nepali History and Society (2010) 15(1): 27-72. http://hsdg.partners.org/wp-content/uploads/2014/10/Citrin-2010-SINHAS.pdf
- Lough, Benjamin. “The Evolution of International Volunteering.” United Nations Volunteer programme. Bonn, Germany: 2015. http://www.ventao.org/cms/images/EvolutionInternationalVolunteering.pdf
- Lynch, Joe. “CIASP”. Accessed: 27 July 2017. http://ciasp.blogspot.in
- Pfeiffer, J. “International NGOs and primary health care in Mozambique: The Need for a New Model of Collaboration”. Social Science and Medicine. 2003; 56(4): 725-738