Looking beyond face value: Neoliberal practices in a cleft lip and palate NGO by Hilary Ho B.Soc.Sci., National University of Singapore, 2018 A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF ARTS in the Department of Anthropology ã Hilary Ho, 2020 University of Victoria All rights reserved. This Thesis may not be reproduced in whole or in part, by photocopy or other means, without the permission of the author. ii Supervisory Committee Looking beyond face value: Neoliberal practices in a cleft lip and palate NGO by Hilary Ho B.Soc.Sci, National University of Singapore, 2018 Supervisory Committee Dr. Leslie Butt, Department of Anthropology Supervisor Dr. Daromir Rudnyckyj, Department of Anthropology Departmental Member iii Abstract There has been a rise non-governmental organizations (NGOs) as part of a global health system that seeks to treat children with cleft lip and palate (CLP) in resource-poor countries. As a craniofacial abnormality, CLP affects a child’s ability to communicate and consume food, and the stigma associated with the condition leads to both social and physiological suffering. International NGOs use an apolitical humanitarian rhetoric to justify the need to provide this life-saving surgery. This thesis assesses CLP interventions by applying a critique of neoliberalism to explore the ways economic rationalities are extended to the domain of humanitarianism. By employing an ethnographic approach of “studying up,” this thesis critiques a North American NGO, referred to as Mission Smile. To reveal how neoliberal rationalities are embedded within the organization, this research draws on data from media analysis, participant observation, and interviews with medical volunteers and employees at Mission Smile. This thesis argues that neoliberal rationalities permeate throughout the organization. Economic calculus are not only embedded in the organization’s goal to provide surgery to “as many children as possible,” but also undergirds the distribution of humanitarian aid. Moreover, the surgery Mission Smile provides is described as an “investment in a child’s future” that enable children with CLP to become a contributing member of society. While this study reveals how neoliberal rationalities can converge with values of humanitarianism, it also shows that the extension of neoliberal rationalities into new domains is not a cohesive process. Volunteers describe an emergence of communitas, a feeling of bubbling joy and a shared humanity, and a development of a moral relationship with their recipients that lies partially outside the domain of market rationalities. iv Table of Contents Supervisory Committee ...................................................................................................... ii Abstract .............................................................................................................................. iii Table of Contents ............................................................................................................... iv List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Acknowledgments ............................................................................................................ viii Dedication .......................................................................................................................... ix Chapter 1: Problematizing the moral need to help .............................................................. 1 1.1 Research Question .................................................................................................... 5 1.2 Neoliberalism in global health .................................................................................. 7 1.2.1 Metrics ............................................................................................................. 10 1.3 The appeal of children in humanitarian aid ............................................................ 12 1.4 Orchestrating an affective call to action ................................................................. 15 1.5 Outline of thesis ...................................................................................................... 18 Chapter 2: Research Methodology in Studying Up Mission Smile .................................. 21 2.1 Research Protocol ................................................................................................... 23 2.2 Participants and Recruitment .................................................................................. 24 2.3 Getting Access ........................................................................................................ 26 2.3.1. Becoming a “competent idiot” ........................................................................ 27 2.3.2 Negotiating power as a competent idiot ........................................................... 29 2.4 Methodology ........................................................................................................... 31 2.4.1 Studying up: conducting interviews ................................................................. 32 2.4.2 Interviews conducted over video calls ............................................................. 34 2.4.3 Participant observation ..................................................................................... 35 2.4.4 Film and media analysis ................................................................................... 35 2.4.5 Additional literature ......................................................................................... 37 2.5 Analysis and data management ............................................................................... 37 2.6 Reflexivity ............................................................................................................... 38 2.7 Conclusion .............................................................................................................. 41 Chapter 3: “Doing as much as possible”- when performance indicators and humanitarian goals conjugate .................................................................................................................. 42 3.1 Mission Smile ......................................................................................................... 42 3.2 Mission Smile’s goals: helping those in need ......................................................... 46 3.3 “Providing patient-centred care” – ensuring good patient outcome ....................... 50 3.4 “Trying to do as much as possible” – Counting social good .................................. 53 3.5 “But we can't do that in a short period of time” – Thinning out dimensions of health outcomes ............................................................................................................ 56 3.6 “Do I do three kids, or do I do six?” – A utilitarian approach to humanitarian aid 58 3.6 Conclusion .............................................................................................................. 61 Chapter 4: “A real-world fairy tale” - Surgery as an investment in a child’s future ........ 63 4.1 “Can you count up to ten?” – Embodying an abnormal body ................................ 66 4.2 “They're hideous looking”- the perceived loss of humanity ................................... 69 4.3 “It's fixable anatomical difference” – Surgery as a normalizing project ................ 73 4.4 “A child has much more opportunity to benefit” – Surgery as an investment ....... 76 v 4.5 Conclusion .............................................................................................................. 79 Chapter 5: “They have been zapped by Thor’s hammer” – the generative joy of helping children in need. ................................................................................................................ 81 5.1 “You can't change the world, but you can help”: Locating volunteers’ affective call to action ......................................................................................................................... 85 5.2 “They mesh together and become one entity:” Teamwork as an affective social glue ................................................................................................................................ 87 5.3 “Doing free charity work at cost:” The cost of volunteering .................................. 92 5.4 “Let's put this in perspective, and do your feet hurt now?” Humanizing medical care ................................................................................................................................ 96 5.4.1 “It’s magic”: The joyful and magical aspect to volunteering ........................ 100 5.5 Conclusion ............................................................................................................ 104 Chapter 6: Conclusion ..................................................................................................... 106 Limitations of research: .............................................................................................. 107 Future directions: ........................................................................................................ 108 Bibliography ..................................................................................................................