There is a concept at the heart of the SNF Paideia Program called humility, defined not as self-deprecation but as a genuine recognition of one’s own limitations and a willingness to reflect on how one’s presence affects others. I did not fully understand what that meant until I was standing in a maternity ward in Santo Domingo and realized that our group was being photographed.
I was in the Dominican Republic as part of a nursing course focused on lactation, maternal health, and breastfeeding. I am not a nursing student. I am a political science major, and I was one of the only non pre-health students on a trip otherwise full of people training to become nurses. I had no clinical role, no checklist, no patient to attend to. What I had, instead, was time to watch the room. And what I watched, in hospitals and community clinics and barrios across the country, left me thinking about something that has nothing to do with breastfeeding rates or C-section statistics, and everything to do with what it means to show up somewhere as an American.
Throughout the trip, our group was photographed constantly by tour organizers and hospital staff. This felt unremarkable at first. We were visitors, and documentation felt like a natural part of the experience, a record of partnership, of exchange, of a visit that meant something to both sides. But somewhere along the way, in the NICU, in the labor ward, in rooms where teenage mothers sat waiting to give birth, the cameras kept coming out. I am not writing this to assign blame to any individual. I am writing it because the moment I noticed it, I could not stop noticing it, and I think that discomfort is worth sitting with rather than smoothing over. The mothers in those rooms, the infants, the young women barely older than me, had not agreed to be backdrops for documentation of our visit. And yet there we were, being photographed among them, our presence recorded as though it were the point.
The Dominican Republic is a country with a complicated relationship to American presence. The hospital walls we walked through were lined with USAID posters, which meant that American foreign aid had been quietly funding parts of the maternal health infrastructure we were there to observe, including the milk bank, the neonatal care programs, and the community health education initiatives. The people we met, the mothers, the nurses, the community health workers, did not know what was happening to that funding back home while we were visiting. And yet many of them welcomed us warmly. A man we met at a yogurt shop spoke about American healthcare with a kind of reverence that surprised me, given how much the American system struggles with the very issues we were there to study. There was an admiration directed at us that felt, at times, difficult to hold.
This is not a piece about which political party is responsible for foreign aid cuts or what the right level of international development spending should be. Reasonable people disagree about those questions, and those debates belong in a different forum. What I am writing about is something more personal and more immediate, which is the experience of being welcomed into spaces of profound vulnerability and having to ask yourself whether you are behaving like a guest or like a tourist.
What made the discomfort more layered was how much I genuinely admired what I saw inside those hospitals. Visiting the milk bank at the public hospital in Santo Domingo was one of the most surprising experiences of the trip. I had not expected the level of rigor I found there: the careful screening of donors, the storage protocols, the organized distribution of donor milk to infants who needed it. There was real expertise and real commitment in that room, and it challenged assumptions I had not even known I was carrying about what public healthcare in a lower-income country would look like.
At the same time, walking through the labor and delivery ward made visible a different set of realities. The environment was intense, privacy was limited, and the country’s very high rate of cesarean sections hung over the whole visit as a reminder that a system can do some things extraordinarily well and still place women in situations where their autonomy and dignity are constrained. I found myself thinking about informed consent not as a legal formality but as something that either exists or does not exist in the texture of daily clinical life.
What also stayed with me was how support for breastfeeding and maternal health in the Dominican Republic did not flow only from medical professionals. Community health workers and educators, people embedded in neighborhoods and relationships rather than institutions, were doing enormous amounts of work to make sure mothers felt informed and accompanied. The boundary between clinical expertise and community wisdom felt far more permeable there than it often does in the United States, where professional knowledge and lived knowledge tend to occupy separate lanes. That observation matters beyond maternal health. It points to something broader about how trust is built between institutions and the people they are supposed to serve, and how much is lost when that trust is absent.
Paideia’s definition of humility includes the idea of reflecting on your own identity and reactions, and taking accountability. Being photographed alongside patients who had not consented to our presence being documented is not a simple thing to sit with. The teenage mothers we spoke with were generous with their time and their stories. The community health workers like Mirabal, who laughed with us and hugged us when we left and taught us how to say her name properly, gave us something real. The question I kept returning to was what we were giving in return, and whether our presence, our American passports, and the foreign aid dollars stenciled onto the walls around us added up to a relationship or just an itinerary.
I am still working out the answer. I think that is the honest thing to say. What the SNF Paideia framework of humility asks of us is not that we arrive at conclusions but that we stay in the difficulty of the question long enough to let it change us. I want to work in foreign policy and diplomacy, which means I will spend my career navigating exactly this kind of tension: showing up in places where American presence carries enormous weight, where American funding shapes what is possible and American withdrawal reshapes it again, where people extend warmth and trust that can be honored or squandered.
The Dominican Republic taught me that doing that work well begins long before any negotiation or policy decision. It begins in how you enter a room, whether you recognize that being welcomed is not the same as being understood, and whether you are willing to sit with the discomfort of your own position long enough to let it make you more careful. That is what I am trying to carry forward.
Tanisha Agrawal (C’28) is an SNF Paideia Fellow majoring in International Relations and Cognitive Science.
