Recap — Rethinking Good Intentions: Storytelling and Epistemic Humility as Critical Interventions in Global Health

Recap written by Dahdaleh Global Health Graduate Scholar Alexandra Frankel.

Dr. Nancy Edwards’ one-woman performance Rethinking Good Intentions opens with two lines she meticulously deconstructs throughout her play: “There is not much of anything here” and “I just want to help.” Rethinking Good Intentions is a critical and moving reflection on Edwards’ own experiences as a white Canadian public health nurse in Sierra Leone in the 1970s and ’80s. Her performance — a collage of reenactments, commentaries, and asides to the audience — articulates a deep process of unlearning that, for Edwards, gained momentum in Sierra Leone.  

Rethinking Good Intentions interrogates and wrestles with this desire “to help.” Rather than traditional academic critique, her critique unfolds through embodied and emotional storytelling that grapples with the interwoven—and uneven—geographies of authoritative knowledge, power, and capital in global health and development fields. Edwards invited the York University audience to rethink good intentions as connected to 1) the production of authoritative knowledge in global health and development institutions, and 2) histories of domination and violence.

Edwards organized her performance around multiple iterations of not knowing. She reenacted her difficulty with Mende, affecting a thick Canadian accent. When Edwards first arrived in the Bumpe Chiefdom, she recounted refusing the gift from the chief whose village she was visiting, much to the consternation of her colleagues. She received a reassignment—no longer would she be training public health nurses in the clinic but would be supervising student fieldwork, an area fully new to her. In one telling vignette, we learn that on one of her field visits, a village chief explained that produce had to be carried from the farms and through a swamp to the village: “We need a bridge over the swamp.” Edwards reflected that she was a public health nurse equipped to answer questions about malaria, not bridges.

Throughout the performance, moments such as these hung in the air without resolution. These moments pushed the audience to confront the epistemological siloing that global and public health institutions simultaneously reflect and produce. As it is these siloes, taken for granted as natural orderings of knowledge, that produce bridges over swamps as distinct from malaria responses and interventions.

This focus on not knowing creates space for simultaneously learning and unlearning. In the panel discussion following Edwards’ performance, Dr. Agnès Berthelot-Raffard, Associate Professor in the School of Health Policy and Management at York University, described Edwards’ Rethinking Good Intentions as a “journey through her own epistemic humility.” Here, not knowing manifests as a reflexive practice of learning and unlearning rather than ignorance. Edwards’s reflection on the early days of her career demonstrates how public health knowledge is itself “situated” (Haraway 1988) within multiple institutional and global histories. Fellow panelist Omosalewa O. Olawoye, Associate Professor in the Business and Society and director of the Harriet Tubman Institute for Research on Africa and Its Diasporas, similarly explained that participating in global aid ought not to be approached as “I’m just going to help those people there,” but rather, “going to offer assistance…on their terms.”

Storytelling is central to Edwards’ practice of epistemic humility. Panelists Dr. Oghenowede Eyawo, Associate Professor of Global Health Epidemiology, and Dr. James Orbinski, professor and the inaugural Director of the Dahdaleh Institute for Global Health Research, underscored Edwards’ performance as evidence of deep un/learning in her time in Sierra Leone. In Rethinking Good Intentions, Edwards recalls efforts she, her students, and colleagues undertook to disseminate information on malaria intervention. Having tried public presentations with projectors and puppet shows, the team experienced an “aha moment” while listening to a village chief telling stories. Rethinking Good Intentions unfolds in multiple rhetorical and somatic registers. She oscillated between speaking in the present and past tenses. Her choreography reinforced those temporal oscillations as she walked back and forth between the two sets of chairs. Although the story carries the audience forward in time, it does so with loops, critiquing linear configurations of time and progress (Escobar 2012).Orbinski similarly drew attention to how scientific language tends to treat contemporary reality as ahistorical. Rethinking Good Intentions counters these harmful discourses by centreing deeply contextual forms of knowledge and knowledge production that are often neglected, undervalued, or underutilized in global health institutions and milieus. In a way, she flips the script.    

One of the performance’s most powerful moments came when Edwards turned toward the audience with her arms outstretched. She was recounting a pop-up clinic she and her colleagues were running when the mother of an infant ran toward them crying—the child’s spasms were a clear indication of a tetanus infection. But all the pop-clinic workers could ask is, did she have her husband’s permission to send the child to the hospital? Edwards explained that the woman did not answer. And none of the health workers spoke on their drive back. Olawoye named Edwards’ attention to issues of patriarchy in women’s health a key contribution of Rethinking Good Intentions. (Indeed, contestations over the misoprostol in global health discourse and ongoing debates around reproductive rights in the United States attest to the necessity of attending to patriarchal norms and institutions in women’s health.) Edwards approached these moments by bearing witness to them, rather than theorizing, abstracting, or reproducing what Sociologist Chandra Mohanty (1991) describes as a tendency in white Western feminist scholarship to cast women in the developing world as an ahistorical, monolithic category.

Her performance concluded with another looping of time. Describing a dinner in which she had been invited to speak, Edwards recounted standing up to deliver a speech, when she felt the midwives and many women she had worked with and learned from in these villages standing beside her, their hands on her shoulders. They urged her to tell the stories they had shared: the midwife berated by and barred from a clinic, being told she took too long to bring the birthing woman in despite critical and painstaking work to get her there; the eighty-year-old traditional birth attendant who still sought training; the Bundu grandmother who made tetanus vaccinations as part of rite of passage rituals.  

Rethinking Good Intentions creates space for such hauntings—the absent presence of friends, colleagues, students, and experiences. Not knowings continued throughout the performance. As she reflected on her experience at the Door of No Return, where she confronted the intersections of the Atlantic Slave Trade with Canadian history (see Browne 2015), Edwards asked, “How could I know nothing about this history?” and noted that she began to “feel the tentacles of the slave trade reach Nova Scotia.” Good intentions are implicated in the knowledge-power nexus. Edwards’ epistemic humility did not resolve in mastery. Instead, Rethinking Good Intentions shows knowledge is highly contextual and situated, requiring as much learning as unlearning to see that there is so “much of everything here.”

Watch the play and panel below: https://youtu.be/RXsg3O_p5BM

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