Knowledge is Power? Expansions and Contractions of Professional Autonomy in International Nongovernmental Organizations

• In Event: Putting Sociology to Work for a More Equitable Global Health

Abstract

Transnational professionals are able to work within and move between organizations in disparate country contexts thanks to their portable expertise: they adapt knowledge and skills learned in one setting to diagnose and solve problems in another. But to what extent do professionals perceive their expertise as applicable in foreign contexts, and how does this shape their autonomy, power, and authority? This paper examines these questions through a comparative ethnography of two international nongovernmental organizations (INGOs) in Cambodia that host transnationally mobile healthcare professionals who come from various countries in the Global North to treat patients and train local healthcare professionals. The analysis reveals an irony: despite having a highly specialized, narrowly defined knowledge base, surgeons volunteering at one INGO understand their surgical expertise as universally applicable and, when applying it alongside local healthcare professionals, perpetuate power hierarchies that assign greater prestige and legitimacy to Northern experts and expertise. Meanwhile, volunteer primary care physicians at a separate INGO view their broader, more encompassing knowledge base as having limited applicability for treating patients in the local setting; consequently, their professional autonomy and authority is diminished vis-à-vis local healthcare professionals during clinical decision-making. The findings extend past research on professional power by providing a within profession, rather than between profession, account of expansions and contractions of professional power and challenge past research that portrays transnationally mobile professionals as unilaterally having, and capitalizing on, opportunities to expand professional power in foreign settings.

Author

• Derek Richardson, Indiana University-Bloomington