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Abstract

Trans Abstract

Introduction

On the day of the launch ceremony for KoreaAID, a new global health initiative by the Korean government emphasizing mobile clinics, I caught a ride with a driver of the Korean International Cooperation Agency (KOICA) on his way to deliver Korean food to the Korean medical volunteers at the Adama Science and Technology University (ASTU) in Ethiopia. The road from Addis Ababa to Adama, the second biggest city in Ethiopia, was a recently paved highway because Adama is a busy transportation center that connects the capital to the Red Sea. After making our way through a traffic jam filled with three-wheeled bajajis, trucks, horse carriages, fumes, and dust in down-town Adama, we passed by the Adama General Hospital, a newly built modern hospital with its own medical school. At the main gate of the ASTU, there was a huge marquee designating it as the waiting area for patients. A temporary shuttle bus was running because the main gate was far from the ASTU stadium, where the Korean mobile clinic was being demonstrated as part of the KoreaAID program.

Arriving at the stadium, I beheld a mobile clinic, a large, enclosed truck capable of carrying people and equipment, and seven other vehicles all with the conspicuous logo of KoreaAID (Figure 1). There were two ambulances, two SUVs, a truck for a rice nutrition project, a truck for Korean food (K-meals), and a truck with a stage for the performance of K-pop, or Korean pop songs (K-culture). Behind this parade of vehicles, there was a gigantic placard for KoreaAID over half the spectator seating in the stadium. Medical doctors, volunteers, and Korean aid workers, all wearing white T-shirts with the KoreaAID logo, were very busy taking care of patients and guiding them. In the waiting area at the entrance of the stadium, there were roughly fifty patients: government bureaucrats in suits, policemen in uniform, ASTU students with KoreaAID T-shirts, and farmers from villages where the Korean government was implementing rural development projects under the name of the New Village Movement (NVM, Saemaul Undong). Why was this mobile clinic—designed for outreach activities in rural Ethiopia with limited healthcare access—providing healthcare in the middle of a university campus next to an urban hospital? Why were the rural residents from different parts of Ethiopia being mobilized to attend the clinic here, instead of the mobile clinic being mobilized to visit them in their villages?

Figure 1

The Mobile Clinic of KoreaAID

In this study, I trace the legacies of the Korean Developmental State, revealed in the process of preparing and launching KoreaAID in Ethiopia. I conducted ethnographic fieldwork in Ethiopia among the Korean NGO workers in Addis Ababa who ran international development projects in rural towns in the Oromia Regional State in Ethiopia through Korean NGOs and bilateral aid agencies of the South Korean government. My ethnographic research site was the social world of Korean aid workers in Addis Ababa and their project sites in Ethiopia between 2014 and 2017. As a medical doctor with previous research experience in health policy planning, I was accepted as an outside expert by the community of Korean expatriates. I could closely observe the aid workers’ daily activities by participating in discussions about project design in the office, observing meetings with Ethiopian bureaucrats, and providing feedback for their project proposals. I accompanied them on visits to project sites and spoke with Ethiopian bureaucrats, NGO staff, healthcare providers, and local residents.

Long-distance health projects inserted into Africa have a lengthy genealogy: from missionary medicine to colonial tropical medicine to international health and global health. First, missionaries provided healthcare in many parts of Africa for evangelism and paternalistic civilizing missions, preparing the grounds for the colonial penetration and biomedical interventions later mapped onto bodies of Africans as well as countering coercive labor extraction through colonial capitalism.^2, Second, advances in tropical medicine facilitated the imperial expansion to colonies, formerly the “white man’s grave,” enabling transnational movements in labor, military, and goods.^3, Third, in the postcolonial Cold War period, international health programming on malaria control and family planning were undertaken as ideological competitions to curtail the expansion of communist insurgencies and to promote the economic advancement and political stability of favored regimes.^4, Last, the latest global health programs diversified and reconfigured long-distance healthcare projects in Africa as being humanitarian activities, scientific research, commercial businesses and social justice movements.⁵

The beginning of the South Korean overseas aid program dates back to the USAID-entrusted workshop for trainees from developing countries in 1963. In order to rally for the membership of the United Nations in the face of competitions with North Korea, the South Korean government dispatched medical doctors to East African countries via KODCO (Korean Overseas Development Cooperation), the predecessor of KOICA, in the 1960s and 70s.^6, The South Korean developmental state found its political legitimacy in the strong government drive for national economic development, using mobilization and violence to discipline its national subjects and to undermine democratization efforts and labor movements. Urgency for economic development, goal-driven mobilization, and discipline characterize governing rationalities and temporalities of the developmental state in South Korea. Taiwan is another example of the “East Asian Development Model” during the Cold War that initiated with the US aid, consolidated through strong authoritarian state, and replicated elsewhere as a model for rapid economic growth.^7, Exporting this South Korean developmental state model in the name of Global Saemaul Undong not only renders complex political conditions “technical,”^8, but also reinforces state control and power over “ethical” lives of its subjects, beneficiaries of the Korean overseas aid programs in authoritarian regimes such as Myanmar.⁹ Based on an ethnographic examination of KoreaAID, I propose to describe these processes as the mode of rationalizing of the Korean Developmental State and to present their consequences: the voluntary mobilization for the target number expected to be reported to the Korean government, regardless of the associated human cost.

KoreaAID: Global Health for Whom?

Inside a tent arranged in front of the mobile clinic, five Korean medical doctors were having clinical examinations with Ethiopian patients with the aid of translations by Ethiopian doctors from St. Paul Hospital, the tertiary public hospital in Addis Ababa. To my surprise, the doctors I met there were renowned professors from the top medical schools in South Korea. Although these doctors had provided specialized tertiary care at a 2000-bed university hospital for their entire clinical careers, that experience was proving to be of little help in providing primary care for unfamiliar patients in Ethiopia. The infection specialist asked about the dosage of antiparasitic medicine because he rarely treated parasitic diseases at the Korean university hospital. The pulmonologist who specialized in the intensive care unit (ICU) prescribed pain medications that were readily available in local pharmacies. The neonatal ICU specialist took the role of dispensing prescribed medications because she did not have many pediatric patients to tend to. The gynecologist had to refer to a medical textbook in order to conduct a fetal ultrasonography, which she had not practiced for more than twenty years. Due to a lack of diagnostic equipment and pharmaceuticals, these doctors could not provide any truly specialized care, except writing referral letters to St. Paul Hospital or Adama General Hospital. Pointing out the huge discrepancy between the expertise of these doctors and their meager role in this week-long medical trip, a Korean global health expert in Ethiopia described this situation as “brandishing a saber to catch a fly.”

Above all, the mobile clinic seemed immobile. The bottom part of the body of the vehicle was too close to the ground. Designed by Korean engineers who had never visited Africa, electric generators had been installed under the bottom parts of the mobile clinic because they were worried about the lack of stable access to electricity in Ethiopia. This addition, however, significantly hampered the mobility of the clinic. On the vast majority of Ethiopian roads, there are numerous unexpected bumps, holes, cracks, mud, and sunken parts. Because of these road conditions, Land-cruisers with high clearances operate as ambulances. Thus, this mobile clinic could not actually be mobile unless it was shipped by other trucks to visit the rural areas only accessible through unpaved roads. This is a truly novel invention of mobile care in global health: patients are mobilized to receive healthcare rather than the mobile clinic moving to their villages!

KOICA officers urged the doctors to accelerate the pace of treatment. They were supposed to mobilize eight hundred patients in two days. However, the doctors could treat only one hundred patients during the morning session. Although they worked very hard all day long without even sufficient time for restroom breaks or lunch, delays were inevitable because they had to make differential diagnoses based on history-taking and physical exams in the absence of any laboratory results or radiologic imaging. The Ethiopian doctors began to lose patience because they had never been pushed to take care of such a large number of patients in a day without proper diagnostic tools. A tired and annoyed Ethiopian doctor prescribed administering fluid for a cachexic patient with tachycardia. Although it was an unnecessary treatment for that patient, a Korean physician whispered to a staff to follow this order, so as to alleviate the frustration of the Ethiopian doctor on this absurd environment for medical practice. The next day, the Ethiopian doctors and the medical student volunteers left before 3PM, without forgetting to take gifts that had been intended for patients, as their bonus. The Korean doctors were then left alone to care for the rest of the patients. They simplified their practice and minimized the time for conversation with Ethiopian patients and differential diagnosis in order to speed up patient turnover to process a larger number of patients.

The Ethiopian patients also expressed their disappointment and frustration. They expected a higher level of care from Korean medical doctors, but only received basic medication and referral letters. There were patients asked for treatment by psychiatrists or ophthalmologists, only to be turned away for lack of those specialists. A patient from a rural village remarked, “I did not come all the way to Adama only to receive psychological support.” In response to complaints from patients and Ethiopian doctors, a Korean global health expat had to defend for Korean medical doctors, claiming their medical care as evidence-based scientific medicine of global standard.

After the completion of their medical care, patients were escorted to receive a hygiene kit. This package contained soap, toothpaste, a toothbrush, masks, gauze, alcohol swabs, and bandages. Patients repeatedly asked what these materials were because the only descriptions included in the kit were in Han'gŭl, the Korean script, which had been intended to promote the products of Korean companies.

In addition, campaign booklets titled, “Girls Love Yourself” were distributed. Patients were asked to watch a short video clip about girls’ health, which was composed of materials on washing hands, going to school, sex education, and healthy exercise. This “Girls’ Exercise” reminded me of the Korean National Exercise which I participated in during my elementary and middle school years in Korea. At that time, hundreds of students would form rows and columns perpendicular to each other in their school’s playground. Then, everyone would follow a series of simple body movements together, listening to the same music projected from a megaphone. One of the legacies of the developmental state in raising healthy, productive national bodies in Korea was reincarnated through exercises promoting adolescent health in Ethiopia.

This unsustainable event involving a single video clip as well as a souvenir hygiene package was advertised as one of the key accomplishments of then-president Park Geun-Hye’s promise of the Korean government’s initiative for the “Better Life for Girls” in the United Nations Sustainable Development Summit of 2015. With a budget of two hundred million dollars, this initiative was designed to help girls in the sociocultural context of developing countries, which offered limited access to healthcare and education. It portrayed Ethiopian female students as independent agents who chose to go to school, actively adopted hygienic behavior, and made decisions on their bodies. It focused squarely on individual responsibility and cognitive behavioral interventions for marginalized female youth, while neglecting the vast social and historical structure of poverty and gender inequality entrenched in Ethiopia.

Before patients took the shuttle bus back to their villages, they made a final stop by the K-meal truck. As a nutritional project for malnourished pregnant women and infants in Africa, it distributed a pack of rice crackers and Misugaru, a Korean roasted grain powder. For Africans who had never consumed this powder, an African lady appeared in a video clip to explain in English how to mix it with water for a delicious drinking experience. The K-meal truck was prepared by the Korean Ministry of Agriculture under a special directive from the president to make this nutritional project using only rice produced in Korea. A Korean aid worker in charge of the K-meal truck explained, “It was designed as a comprehensive global health model that combined medical care with behavioral change and nutritional support, as well as the globalization of Korean food and K-pop.” In Ethiopia, the staple food is injera made out of teff, a gluten-free, iron-rich grain. Why would any impoverished people bother to seek rice—an expensive imported product for the rich minority—as a solution for malnutrition when their staple food offered more nutrition? Moreover, South Korea does not have a surplus of rice, and must import the rice before it could then export it to Ethiopia.

Following the healthcare showcase event, the stage for K-culture was set up. Initially, the healthcare and K-pop events had been planned to occur concurrently. But some aid workers suggested that it might be awkward to play festive music in front of patients suffering from sickness. Thus, the K-culture stage was set up only after the mobile clinic team had completed their tasks. In preparation, a group of Ethiopian high school students were busy practicing K-pop dances and listening to the song, Gangnam Style.

Hundreds of ASTU students were also gathered together. It was unclear whether it was safe to mobilize ASTU students on campus because the ASTU was closed for months due to nationwide student protests against state violence and military tanks were operating at the front gate.¹⁰ They received yellow and blue T-shirts with KoreaAID logos, and were arranged in ordered rows and columns according to the color of their T-shirts. When they ran out of T-shirts, they prevented additional students from joining in the event, thus preserving the image of perfect harmony and unity that would be sent back to Korea by the media. Students complained about missing the opportunity to attend the event.

The K-culture stage began to show several video clips that advertised Korean food and culture and the PyeongChang 2018 Winter Olympics, set to be held in Korea. Students looked perplexed because English narration and subtitles were not provided. After a couple of minutes of silence and confusion, the screen aired a Korean movie, Ode to My Father, a movie that arouses nostalgia for the “development generations” that experienced the heyday of their lives during the period of the developmental state in South Korea.¹¹

Two more vehicles arrived with a K-food banner. Students queued to receive dinner: bibimbab, Korean mixed rice with meat and assorted vegetables. The driver was using the vehicle for the first time, and lost the key to the door of the food truck; the lock had to be broken to open the door. To make matters worse, he had forgotten to turn on the cold storage of the truck that stored the meat for the bibimbab. Although many Ethiopian students and I enjoyed the taste of bibimbab that day, I heard that the students experienced diarrhea after a few days.

The Korean government claimed that this one-time event was designed to meet the SDGs (Sustainable Development Goals) by “Leaving no one behind.” However, the Blue House, the presidential office in Korea, did not shy away from advertising the economic motives behind KoreaAID. Its official website proudly boasted that KoreaAID and the presidential visit laid down the foundation for the commercial expansion of Korean corporations into Africa, calling it “the Last Blue Ocean.” It claimed that sharing South Korean developmental experiences with African countries would facilitate further economic cooperation and cultural exchange.

With its unsustainability, commercial and political motives, cultural imperialism, and brazen neglect of the sociocultural contexts of its beneficiaries, KoreaAID was one of the strongest counterexamples of common sense of the contemporary world of international aid. My observations of KoreaAID urged me to ask more questions: For whom was this KoreaAID event actually staged? And why had it been designed and implemented in this way?

Calculation for Mobilization

This ethnographic inquiry needs to be situated within the scholarly conversation on governmentality, specifically its numerical aspects. According to Foucault, numbers, specifically “forecasts, statistical estimates, and overall measures” at the population level, were an indispensable element of modern statecraft.^12, Foucault defined governmentality as “an ensemble formed by the institutions, procedures, analyses, and reflections, the calculations and tactics that allow the exercise of this very specific albeit complex form of power, which has as its target population.”^13, He argued that this specific apparatus and art of government emerged in the modern state to solve unprecedented problems presented at the level of populations to produce and reproduce its subjects suitable for capitalist societies. Expanding on Foucault’s definition of governmentality as “governmental rationality,” Gordon explains this as “a way or system of thinking about the nature of the practice of government…capable of making some form of that activity thinkable and practicable both to its practitioners and to those upon whom it was practiced.”^14, This notion helps to explain both the logic of government from the perspective of agents of the state and the subjectivities produced by this governmentality. In Governmentality, calculation, territory, Elden underscores calculation “as modes of rationalising and regulating the art of governing.” Calculation is one of political strategies to render previously uncontrolled apolitical categories—such as space—imaginable and intelligible, by turning certain qualities of a state into measurable and manageable form.¹⁵

To understand KoreaAID, the notion of governmentality needs to be situated within its specific historical and transnational context. To describe the spatial configuration of neoliberal phenomena at the global scale, Ferguson and Gupta proposed the notion of “transnational governmentality.”¹⁶ Expanding the conceptual horizon of governmentality beyond the nation-state, transnational governmentality grasps new practices of government by international organizations and transnational grassroots NGOs, which cannot be captured by the nation-state’s spatialization, including verticality (the state is above society) and encompassment (the state encompasses its localities). However, the Korean government for KoreaAID is neither a supranational organization nor a grassroots movement of the type Ferguson and Gupta suggest as agents of transnational governmentality. It is not an extension of the verticality of nation states to the geographically distant area, either. Further, it is not transnational because it is a unilateral intervention lacking conversation or mutual exchange. It only framed its language with the idioms of the international aid community.

Sonn and Gimm propose that the South Korean developmental state of the 1960s to the 1970s had a particular governmentality, namely a “developmentalist governmentality.”^17, A developmentalist governmentality is a combination of the hegemonic discourses of developmentalism along with anticommunism and nationalism as well as its non-discursive “apparatus,” which were instrumental in transforming the mentalities and bodies of its national subjects to be a productive and subordinate working class for the developmental state of South Korea. Sonn and Gimm show how the New Village Movement leaders—dual agents of the state and the village—mobilized rural residents with various non-discursive organization technologies, including the dissemination of practical knowledge, self-sacrifice, peer pressure, and violent confrontation.¹⁸ Building on the notion of developmentalist governmentality, I suggest that what is unique about the Korean aid workers’ mobilization for KoreaAID and the mobilization of the Korean developmental state in general is the rationalizing role of numbers in the formation of the governmentality.

In the politics of global health, Adams suggests that metrics, “technologies of counting that form global knowledge,” are instrumental in the governance of global health participants and target populations.^19, Contemporary global health projects are designed as randomized controlled trials to calculate the burden of disease expressed largely in economic terms—such as the disability-adjusted life year (DALY)—in order to fit into the neoliberal architecture of the “global sovereign”. The global sovereign is “a flexible assemblage of data production, number crunching, and scale-up profit sourcing that … orchestrates biopolitical health interventions so that they work within capitalism’s terms and limits and so that they serve the global architecture of neoliberal debt and profit economies.”²⁰ Korean aid workers strived to meet this global golden standard of global health projects and were eager to learn the evaluation and monitoring methods to produce the desired scientific evidence. But KoreaAID did not meet any of these global trends. The Korean aid workers in Ethiopia felt personal and national shame over KoreaAid because it did not have any baseline survey or control group that would measure the quantifiable impact of the initiative. The numbers KoreaAID produced are not legitimate idioms that speak to the “Global Sovereign”

In Calculating without numbers, Ghertner argues that the political control can be achieved even in the “absence of numerical accuracy or ‘the rule of evidence’.”²¹ Based on the historical shift of evidence for slum clearance and urban renewal in India from survey to photograph, he shows that a numerical mode of government can be supplanted by an aesthetic one. This conspicuous unknowing demonstrates that calculative practice is one of the replaceable modes of rationalizing for the exercise of political power. In the KoreaAID project, the absence of the proper technical number for global health does not prevent achieving its political aim for mobilization. Staging a photogenic scene of large gathering of Ethiopian beneficiaries in line for the parade of ‘K-’themed trucks and mobile clinic will suffice the requirement of visual evidence for KoreaAID.

Regarding the role of numbers in biomedical interventions, Sangaramoorthy suggests that “numerical considerations play a critical role in how life is both imagined and lived” among HIV/AIDS patients in the United States.^22, The target mobilization numbers for KoreaAID may reveal the impoverished imagination of Ethiopian lives on the part of government bureaucrats in Korea. The beneficiaries of KoreaAID existed only as numbers to legitimize KoreaAID and those in Korea who might profit from this new initiative. Advancing the notion of “numerical subjectivity,” Sangaramoorthy showed how HIV/AIDS patients “communicate ways of being and belonging, imagining bodies as objects of medical knowledge, and numbers as markers of suffering, personal triumph, and achievement.”²³ In contrast, Ethiopian participants do not frame their experiences of the body with numbers from KoreaAID. They do not share rationalities of global health nor numerical modes of government among Korean subjects. They are not aware of circumstances that their presence is a part of calculative strategies for political mobilization of KoreaAID.

For a conservative Korean political audience, mobile clinics in Ethiopia evoke memories of the mass mobilization of family planning under the Korean developmental dictatorship in the 1970s. Mobilizing mobile clinics on terrains without infrastructure has historical precedents in mobile surgical units during the Korean War (Mobile Army Surgical Hospital, MASH) and the Vietnam War (the ROK MASH).^24, In 1972, the Korean Ministry of Health and Social Affairs took over thirteen mobile clinics for family planning handed over by USAID, at twenty thousand dollars per vehicle (Figure 2). At the time, mobile clinics were instrumental in sweeping the entire nation for mobilizing rural women for the purpose of family planning.^25, These mobile clinics worked even with the poor road conditions and fragile healthcare infrastructure of South Korea. This campaign was fashioned with urgent temporal idioms, in an all-out war to meet the target number assigned by the government: half a million procedures per year.²⁶ Many Korean women suffered from complications of bleeding and pain, and lack of access to IUD removal or post-surgical follow-ups. Despite their critical stances towards promoting the Korean developmental state model in Ethiopia, Korean aid workers still voluntarily sacrificed their personal lives and morals in an effort to replicate this model in Ethiopia.

Figure 2

Mobile Family Planning Clinics in 1972, South Korea

Temporal narratives of survival, urgency, and crisis in the economic race with North Korea and anticommunism sentiments were frequently mobilized to justify the ostensibly indispensable state-driven economic development, and oppression of the labor movement in South Korea.^27, To a certain extent, the United States paved the way for the Korean developmental dictatorship through its involvement in intensive civil war and its eradication of leftist politics, as well as its bringing back of the colonial government machinery in postcolonial Korea.^28, This regimented anticommunism formed the basis of the developmental state and of labor discipline. In the aftermath of the American occupation and the Korean War, anti-communism laid the foundation for a militarized modernity with the aim of producing anti-communist subjects who would serve in the militarization and industrialization of the anti-communist state.^29, In other words, the governmentality of the Korean developmental state produced its distinct subjectivities among Korean workers: kungmin, disciplined and dutiful anticommunist subjects of the state. Koo uses a Foucauldian perspective to explain that mandatory military service and public education, in conjunction with Confucian values, disciplined the bodies of Koreans to meet the needs of the state-backed capital.^30, Mandatory military service for men, and the preferential employment of those males with military experience, resulted in the militarized culture of the Korean workplace, which in turn enforced a unidirectional pattern of communication, one of command and obedience, and justified the sacrifice of the individual for the sake of group.^31, The “joyful submission” and goal-directed mobilization of Korean national subjects reflected discipline and militarism—influences from the ruling elite of the military dictatorship.^32, The subordination of individual welfare for the common good under the threat of state violence represented the idiosyncratic governmentality of the South Korean developmental state. Anti-communism and economic nationalism became embodied in the social body of Koreans through the military dictatorship.³³ Consciously and unconsciously, Koreans still continually monitor their stances toward communism and the state, voluntarily mobilizing themselves to achieve whatever target number is assigned by the developmental state.

Mobilizing for Numbers

The Korean developmental state’s anxiety and drive for numbers was on display throughout KoreaAID. On the second day of the KoreaAID launching event in Ethiopia, KOICA officers expressed concern about reaching target number of patients. They were assigned to process eight hundred patients over two days. To prepare for this event, the KOICA Ethiopia office asked the Adama health authorities to screen patients in advance and send four hundred patients each day to KoreaAID. Thus, all of the health centers in Adama were mobilized to send large numbers of patients to KoreaAID. Furthermore, KOICA officers pushed aid workers and volunteers to send rural residents who lived in the villages where the Korean government had implemented the New Village Movement (NVM). Although Korean aid workers doubted the sustainability of KoreaAID, they asked village leaders to prepare fifty residents from each of these villages to attend KoreaAID. Since it takes a very long time to reach Adama from the rural villages via public transportation, Korean aid workers rented a bus to transport these villagers to the ASTU. The budget for this medical trip was not financed by KoreaAID, but by the rural development projects the NVM had implemented in those villages. Some residents from nearby villages had to pay for their own bus fees to attend the KoreaAID event.

However, after the first day of the event, it was clear that the upper limit of patient loading was three hundred per day in such suboptimal conditions, despite the ceaseless efforts of the mobile healthcare team. Thus, a KOICA officer unilaterally notified Korean aid workers to cancel the plans to bring rural residents from a few of the villages. It was just one day before they were supposed to escort them to Adama. Korean aid workers did not know how to explain this sudden change to the local bureaucrats and community members. As a result of this temporary event, they lost face to the very people they had to work with for the next couple of years.

One week following the event, when I visited one of these villages, the director of the health center expressed his frustration with the sudden cancellation of their mobilization plan. He showed me a document he had prepared: the list of the 45 patients screened out of the 122 residents of the small village. To fulfill the numbers requested by KoreaAID, the Ethiopian healthcare providers had carefully selected patients in need of upper-level care. Villagers had to travel more than thirty minutes on mini-buses to reach the health center in order to receive this preliminary screening. The local health authorities took risks in facilitating this mobilization because KOICA officers did not send letters of request for cooperation to their higher-level officials at the Oromia Regional Health Bureau. If there had been any problems that happened during this massive movement of rural residents to Adama, they would have had to take full responsibility for the unexpected consequences. All their efforts were rendered futile with the cancellation order. The director said that he would be cautious in cooperating with public health activities led by unreliable Korean agencies in the future.

Unfortunately, when a higher-level KOICA official learned of the cancellation at the KoreaAID event, she rebuked the Korean aid workers for not bringing the rural villagers. She was angry because the target number could not be achieved without them. She said that the aid workers should have insisted on bringing patients from their assigned villages, regardless of KOICA’s cancellation orders. The aid workers were left perplexed because they had to cancel the mobilization they had spent months preparing for, only to be reprimanded for failing to mobilize the mandated target numbers.

At the same time, delegates from the Korean Ministry of Foreign Affairs kept asking for numbers, stories, and nice pictures to be reported to the Blue House. They upbraided Korean global health experts in Ethiopia for not preparing Korean pharmaceuticals for KoreaAID. Although Korean pharmaceutical companies did not export drugs to Ethiopia, they wanted a scene with Korean-labeled drug distribution via KoreaAID. Thus, Korean residents in Ethiopia had to contribute their spared Korean drugs from first-aid kits for this photo. There was not even enough to form two rows. Only one row could be displayed with the Korean-labeled drugs, while the second row had to be filled with English-labeled drugs. Korean delegates had difficulty in making decisions as to whether these drugs should be displayed towards the president, who would look at the labels, or towards cameramen, who would take photos of the smiling president surrounded by the Korean drugs. Aside from the drugs displayed only for photography purposes, the drugs distributed at the KoreaAID event were produced by pharmaceutical companies in Europe and India, not Korea. This irony of visually displaying Korean drugs that were not sold in Ethiopia demonstrates the purpose of the KoreaAID event: a showcase of Korean business and export in the name of international aid cooperation.

The Korean bureaucrats asked me to interview patients to extract moving stories. But I mostly found stories of disappointment. For instance, a 39-year-old housewife from Adama mentioned, “there was nothing new to me. I received the same prescription and the same diagnosis that I received from the hospital I went to in Adama. I already knew I had an ovarian cyst because I did ultrasonography last year. I could not receive the medication I wanted because they ran out.”

In contrast, the headlines of the Korean newspapers were filled with representations of KoreaAID’s numerical success. “2,250 became beneficiaries of KoreaAID: 1,550 in Ethiopia and 700 in Uganda. 800 expected in Kenya. In total, 3,050 will be recipients of synergistic effect of health, food, and culture programs of KoreaAID.”^34, “In Ethiopia, KoreaAID attracted 1,400.”^35, In addition, 18,000 packs of rice products were distributed. I could not understand how they came up with these numbers. They barely processed six hundred patients, and student attendance at the K-Pop event who received Korean food did not exceed two hundred, at best. Perhaps they were counted as attendants of two separate events. Technologies of mass mobilization turned “the people into the objects, participants, and audience.”³⁶

All in all, what was most critical was the number reportable to the Korean government, and ultimately to the Korean president. It was not important whether Ethiopian patients were disappointed with the low quality of care, complained about lack of medicine, or that they traveled from distant villages only to receive referral letters to return to local hospitals. Only the number of people who tasted Korean food, watched a Korean movie, or received Korean medicine mattered. If the target number, 800, was achieved by any means, it was fashioned to be a successful achievement of the president. One of the Korean aid workers remarked,

Ethiopian beneficiaries existed as mere numbers, mobilized for the public relations machine of the Korean government, as much as recipients of nationwide family planning projects in Korea in the 1970’s were numbers mobilized for the Korean developmental state. They served as numerical and visual evidence for the politics of calculation within the exercise of governmental power.

The K-Project: Voluntary Mobilization among Korean Aid Workers

Calculative strategies for political rationalization produces productive subjects who internalize the mentalities of the developmental state and subsequently voluntarily mobilize themselves and other members of society to achieve the target numbers dictated by the state and its political leader. The preparation process for KoreaAID illuminated the unexpected continuing legacy of the Korean developmental state entrenched within the younger generation of Korean aid workers in Ethiopia. This was demonstrated through their voluntary mobilization to accomplish the national project.

For the first six months of 2016, all ongoing activities of the Korean bureaucratic agencies in Ethiopia were halted and redirected to prepare for KoreaAID. For the confidentiality and security of the Korean president’s visit to Ethiopia, this secret preparation process was code-named K-Project. The K-Project was first introduced as planning and arrangement for the president, but evolved into launching KoreaAID as a novel international development initiative. Every day at the Korean Embassy in Addis Ababa during this time, the Korean ambassador held meetings with representatives from KOICA, the Korea Trade-Investment Promotion Agency (KOTRA), the Korea Program on International Agriculture (KOPIA), and the Korea Foundation for International Healthcare (KOFIH). These representatives did not go to their respective offices, but went instead to the Korean Embassy to work for several months. When I met one of them, who had until recently been athletic and healthy prior to the K-Project, he looked tired because of the ceaseless series of meetings and drinking together after work for several months.

As an adverse effect of the K-Project, all the administration procedures for Korean healthcare projects in Ethiopia was tentatively suspended. Korean global health specialists in Ethiopia expressed their frustrations over the disruption of their ongoing global health projects by the K-project. The maternal and child health project and the tuberculosis control project, which had already been delayed for one year due to administrative processes at headquarters in Korea, were further postponed another half year. Although they went to work, no administrative staff were available for the progression of projects because of the unexpected mobilization needs of the K-Project in the Korean Embassy. Likely, as a result of the administrative absence resulting in an unintended lack of work, one of Korean global health expatriates went on an early vacation trip to South Africa. However, they became busier following the KoreaAID launch event, because they had to plan and implement the unexpected project of running mobile clinics in rural areas, in addition to their preexisting duties. One of the very few positive ramifications of KoreaAID was the extension of job contracts for these Korean global health experts because their understanding of the projects and social networks in the Ethiopian bureaucracy could not be replaced by novice officers. These veteran global health experts were indispensable in preparing the K-Project without the need for an adjustment period and were able to answer the unexpected questions raised by the VIP, the then Korean president, Park Geun-Hye.

For the healthcare part of K-Project, the mobile clinic was central from the initial planning stage. In March 2016, three months before the KoreaAID event, the mobile clinic had already been shipped from Korea, without a single consultation with the Korean global health practitioners in Ethiopia. The mobile clinic was designed to stage a specific scene where the VIP would inoculate African children with a polio vaccine. However, Korean agencies did not have any vaccination projects in Ethiopia. Access to vaccinations was not severely limited because the Ethiopian government had already implemented many health centers and health posts across the country in rural areas for vaccinations.

As soon as news of the shipment reached Ethiopia, Korean aid workers began to worry about the aftermath of the mobile clinic. There were several vehicles donated by other foreign aid agencies that still stood in front of government offices in Ethiopia because of design flaws and financial constraints. These included Korean ambulances at fire stations and the Korean mobile family planning clinic resting in the parking lot of the Myungsung Christian Medical Center, the Korean Hospital in Addis Ababa. These vehicles had a lower clearance, which was not suitable for road conditions in Ethiopia. Moreover, the Ethiopian public agencies did not have the budget for a huge amount of tax levied on imported vehicles, or for their fuel and maintenance. Thus, all they could do was occupy already limited parking lot space in government complexes. It reminded me of a time-worn Land Rover Defender that sat, surrounded by tall grass, in front of the rural district office near my fieldwork site.

One of the Korean global health experts was assigned to contact the Addis Ababa University in order to gain access to the mobile clinics on the campus. Since the VIP did not want to go down to the rural areas, the vaccination scene had to be staged in Addis Ababa. The global health expert could not understand why on earth Ethiopian children would go to an urban university campus, surrounded by tertiary hospitals, for their basic vaccinations. As it turned out, Addis Ababa University shuffled the responsibility of hosting this awkward on-campus vaccination event onto the shoulders of Adama University, headed by a Korean dean. But there was another problem. The VIP refused to show up anywhere outside the capital, so only the mobile clinic team was sent to Adama. The Korean global health expat was also in charge of the VIP’s potential visit to the Korean Hospital. Though he did not have any ongoing projects with the Korean Hospital, he visited it three times to plan the VIP’s walking path. In addition to the flow diagram of her walk, he was asked to write the speech the VIP would give at the Korean Hospital.

As a cultural anthropologist, I was also asked to prepare for the VIP’s possible visit to the National Museum or the monumental orthodox churches in Addis Ababa. With the agriculture specialist from KOPIA, I visited the National Museum ahead of the VIP’s visit to listen to the guided tour and to draw a flow diagram of the VIP’s movements through these spaces. I prepared an introductory report about the museum that listed interesting artifacts and provided explanations about them.

I was also asked to review the VIP’s speech to the African Union. The draft described in detail why the New Village Movement in South Korea during the reign of the VIP’s father was successful. It urged Africans to discard their sense of helplessness and instead adopt a “We Can Do It!” spirit. In my edits, I suggested correcting a few stereo-types regarding Africa: the speech emphasized the beauty of African nature rather than the historical depth of its civilizations, and its depiction of African youths as mere technology trainees and employees in contrast to Korean youths as entrepreneurial investors in Africa in the future. Later on, on the day of her speech, May 27, 2016, I beheld the huge audience mobilized by tourist buses prepared by Korean aid agencies in order to fill the empty seats of the spacious auditorium in the African Union. They were composed of Korean residents in Ethiopia, Ethiopian bureaucrats affiliated with Korean projects, and students of the TVET (Technical and Vocational Education and Training) schools built and run by the Korean government.

One month before the event, an intergovernmental planning team composed of high-ranking Korean officials visited Ethiopia, together with officers from the Blue House, the Korean presidential office. Korean aid workers were surprised by the rank of these visitors because this level of official had never visited Ethiopia on behalf of the international development projects before, had instead sent their subordinates as proxies. To escort this prestigious team, Korean global health practitioners working in Addis Ababa cancelled their planned visits to rural project sites. The planning team cancelled all events planned to be held outside the capital due to security issues. They unilaterally informed the K-Project team that the VIP would not visit the Korea hospital or any of the cultural sites I had prearranged because of the lack of accessible emergency exits in those buildings.

Korean aid workers became demoralized by the K-Project. They had to revise the scenario of the VIP’s visit more than forty times over the course of six months. One of the Korean aid workers had to increase the dosage of his medication due to an exacerbation of symptoms during this stressful period. But, one week before the event, there was an order from above to reconsider everything again and start over from the beginning. A Korean aid worker burst into complaints about the K-Project:

The voluntary mobilization of the K-Project among Korean aid workers left me pondering the spirit of the New Village Movement (NVM) in the 1970s under the developmental dictatorship in Korea, which had been promoted as the Korean overseas development assistance (ODA) model for rural development. The NVM endorsed the mentality of “self-help” in principle. In reality, however, it was a mobilization system under the “direction” of bureaucrats. Under it, at first, reluctant rural residents were forced into communal labor under pressure from the local bureaucrats. Slowly, local leaders of the NVM (Saemaul Jidoja) internalized the values of the developmental state and became vanguards of it, and strong supporters of the conservative party in Korea.³⁷ In contemporary Korean workplaces, many employees seem to passively obey orders from their superiors at first, regardless of their critical stances. But later on, they go further than they were originally ordered to do. Likewise, as the K-Project revealed, many Korean workers actually voluntarily suggested ideas and implemented them according to what they thought would be pleasing under the gaze of their boss or ultimately, the VIP. Without any violence exercised by the government, or any forced mobilization, they had internalized the mentality desired by the government and voluntarily mobilized themselves and others for the state.

The Mir Foundation: Corruption Scandals and Impeachment

A few days after the KoreaAID launch event, I had conversations with several Korean global health experts over a dinner at home until midnight. The topic of conversation spontaneously converged on the background of KoreaAID and the problems associated with it. One global health expert questioned why the VIP had to come all the way to Ethiopia. The VIP had been invited as an observer for the G7 Summit in Japan to discuss a grave security issue regarding North Korea’s nuclear weapons. Considering her strong stance towards North Korea, it was somewhat mysterious that she chose to come to Ethiopia at the expense of missing this opportunity to shine in influential political circles. Furthermore, she showed great interest in the nitty-gritty details of KoreaAID. She even offered feedback on the logo and slogan phrase of KoreaAID. Korean aid workers wondered why the VIP cared so much about this minor overseas project with its small budget rather than dealing with the weightier political subjects in desperate need of her attention in Korea.

Another global health expert talked about a rumor regarding a suspicious organization behind this project: the Mir Foundation. The Mir Foundation was established by the Federation of Korean Industries to facilitate the globalization of K-Pop and the Korean Wave. Though it did not meet the prerequisites for official registration, it registered as an official organization even before the approval of the Korean Ministry of Culture, Sports and Tourism. In doing so, it bypassed a yearlong bureaucratic procedure in just one day. From its inception, it attracted multimillion dollar donations from Korean conglomerates such as Samsung and Hyundai Motors. A rumor circulated among Korean aid workers that there must be a highly influential figure supporting this foundation, who might have a direct connection with the VIP.

The idea of the mobile clinic was conceived by the chairperson of the Mir Foundation, a professor of Media and Communications. Korean aid workers believed that he planned and designed all the vehicles, including the mobile clinic, the K-Food truck, and the K-Pop moving stage. Hyundai motors volunteered to donate several vehicles to KoreaAID. From the birth of the KoreaAID project, vehicles were the default component of the project. Gossip insinuated that the VIP was fascinated by this idea of a parade of vehicles in Africa.

The Mir Foundation closely collaborated with government agencies from the initial stages of KoreaAID. After a few months of its beginning, representatives of the Mir Foundation took part in all governmental Task Force meetings for the planning of KoreaAID. Even before the first Task Force meeting, the Mir Foundation officially requested a research team at Ewha Women’s University to create rice product packages to be used for the K-Meal projects of KoreaAID in November 2015. The Mir Foundation won a huge national contract for designing KoreaAID, without any previous record of international development projects. One of the team leaders of the Mir Foundation participated in the bid for an implementing agency and, in turn, this agency selected the Mir Foundation as the company to produce the rice powder and cracker for KoreaAID. Foreign partners of KoreaAID projects understood the Mir Foundation as the Korean governmental agency, which was mentioned in the memorandum of understanding that they signed.

The new KOICA president was the person who worked in the Frankfurt branch of KOTRA (Korea Trade-Investment Promotion Agency). Before him, every KOICA president had been a former ambassador. Korean international development NGOs criticized this new employment because hiring a person with an international trade background might signal a shift towards the misuse of foreign aid for economic interest. The process of hiring was also suspicious. The vacancy notice was on the public board for only three business days and he was the only candidate, one who had conveniently already worked with the Mir Foundation. Korean aid workers called it a “parachute” appointment: hiring a person through influence from above, probably the Blue House, in this case. The newly hired KOICA president proclaimed with great resolution that KoreaAID must be successful at any rate. Now KOICA officers had to reluctantly implement KoreaAID plans they opposed — projects that were determined and designed from above. As Doucette observed “awkward engagement and practitioner anxiety” among Korean aid workers who questioned NVM as alternative model of development promoted in the Knowledge Sharing Program, KoreaAID is not an isolated event that “entertain the ambitions of ruling political bloc.”³⁸

Because of the politically charged nature of KoreaAID, KOICA officers avoided open criticism of the initiative. On the day of the KoreaAID launch ceremony, a former aid worker uploaded a picture of an immobile “mobile” clinic on Facebook, asking, “Why is shame always our lot?” As soon as it was discovered, a higher-level KOICA official rebuked her and forced her to remove her posting, so as not to draw the attention of the Blue House.

Despite government efforts to conceal the limitations of KoreaAID, civil society organizations could not remain silent. People’s Initiative for Development Alternatives (PIDA), a former ODA Watch—a Korean international development research and implementation NGO—raised several concerns about the limitations of KoreaAID, including the commercialization of foreign aid and the promotion of the Korean ODA Model without considering the context of Africa.^39, The legacy of the South Korean developmental state persisted in the form of strong state involvement and close state-business relationships in development cooperation in African countries such as Mozambique and Rwanda.^40, PIDA called for the complete reconsideration of KoreaAID, pointing out the rash planning and implementation process, as well as the lack of feasibility studies, sustainability, and transparency. Chamyeoyeondae — People’s Solidarity for Participatory Democracy — one of the most influential, progressive civil society organizations in South Korea, followed suit and criticized a breach of international consensus on aid effectiveness in an English statement. It published reports about KoreaAID, calling it “the Worst ODA.”^41, The People’s Health Institute, a progressive non-profit research institute in Korea, took the first initiative of questioning KoreaAID and lambasted the unsustainability of the mobile clinics, which only disrupted the existing healthcare system in developing countries rather than strengthening it.⁴² Its commentary poignantly prophesied that KoreaAID was the mobilization and consumption of foreign aid for Korean domestic politics, as well as a disastrous event caused by the privatization of political power, resulting from the making of critical national decisions based on personal preferences and tastes.

Six months after the KoreaAID launch event, it was revealed that KoreaAID was abused by cronies of the president to legitimize bribes from conglomerates through the Mir Foundation. President Park Geun-Hye held private meetings with the owners of the conglomerates and pushed them to donate millions of dollars to the Mir foundation in exchange for government policies favorable for their corporate profit. For instance, Samsung donated two million dollars to the Mir Foundation in exchange for the approval of shareholders on the merger of its companies to evade the inheritance tax because the biggest shareholder was the Korean National Pension Service under the Ministry of Health and Welfare. The Mir Foundation, along with its sister organization, the K-Sports Foundation, was also found to be a money laundering channel for paper companies in Germany. Choi Soon-Sil, a lifelong confidante of President Park Geun-Hye, was the owner of these companies in Germany. The new KOICA president was her acquaintance from Germany. The “Girl’s Exercise” was produced in only eight days via a private contract with Playground Communications, an advertising agency owned by Cha Eun-Taek, a pop music director and personal friend of Choi. Cha controlled the Mir Foundation through employees he hired, including the chairperson, his doctoral advisor.

These non-elected private individuals had inappropriate backchannel access to critical governmental affairs, including KoreaAID, the selection of cabinet members, the blacklisting of progressives, and the revising of presidential speeches. This influence-peddling scandal ignited the fury of Korean citizens. Millions of Koreans took to the streets and lit candles, calling for the resignation of President Park. The South Korean “Candlelight Revolution” was the strongest driving force that led to her impeachment. Nostalgia for her father’s heyday declined along with her political status.

Conclusion

After the impeachment, all plans to scale up KoreaAID were cancelled. To erase the memory of the political scandals, the title of the project was changed to the “Outreach Project for Maternal and Child Health.” Mobile clinics were parked in the lot of Jimma University, a leading public university in the southwestern region of Ethiopia. After the launch event, no Korean doctors or nurses from Korean medical schools remained in mobile clinics of KoreaAID. Instead, Ethiopian doctors who participated in the occasional outreach activities of the mobile clinics kept asking for an increase in their per diem, which was already equal to their monthly income. University officials showed great interest as to when the Korean government would hand over these expensive vehicles to their university. Korean aid workers kept asking themselves whether they should continue to carry out these failed experiments of KoreaAID, which had to be rephrased to appear on their resumes. In the 1970’s, New Village Movement was expanded upon the material conditions of distributing overproduced cement to rural villages and improved rural infrastructure in South Korea.⁴³ In contrast to these conditions, mobile clinics were material fragments of the Korean Developmental State that failed to be mobilized due to absence of medical equipment, pharmaceuticals and overall health care infrastructure in Ethiopia.

Despite deploying the transnational frames of international development and global health projects, KoreaAID reflected the continuing legacy of the Korean Developmental State in its planning and implementation processes. This historically specific phenomenon could not be easily grasped by the notion of transnational governmentality because it is not practiced by transnational organizations, nor the extension of apparatus of nation states. The efforts of the Korean aid workers for K-Project, the preparation of KoreaAID, revealed the ways in which they had internalized the expectations and mentalities that are thinkable and practicable from the perspective of the Developmental State, namely developmentalist governmentality. Notwithstanding their critical stance against the Korean development model and its export as the Korean ODA model, they voluntarily suggested ideas, prepared blueprints, sacrificed themselves, and mobilized others for the national project of KoreaAID.

Numbers played a critical role in the process of mobilization for KoreaAID, creating temporalities for the Korean developmental state. KoreaAID did not produce any acceptable evidence that fit into the “metrics” of global health, nor did it provide any profitable potential business for the global neoliberal market. Ethiopian beneficiaries of KoreaAID did not understand their subjectivities in the numerical terms suggested by the KoreaAID projects. The number was summoned “for public consumption in order to forge a sense of political transparency and legitimacy… to turn potentially perilous political issues into information commodities and to manage public sentiments.”⁴⁴ Target numbers and the drive to meet these numbers provided a sense of urgency and a rationale of self-sacrifice and mobilization for Korean aid workers.

These urgent temporalities, couched in numerical terms and violent government interventions under the state of emergency, were exceptions, which then became the rule throughout the military dictatorships of the 1970s and 1980s in South Korea in the name of national economic development and regime competition with North Korea during the Cold War. Despite its suboptimal qualities to meet the international standards of aid effectiveness, KoreaAID had a domestic audience of conservative politics in South Korea, bringing back memories of mass mobilization under the developmental dictatorship among “development generations.”⁴⁵ Although Korean national subjects imagine themselves sacrificing their lives and mobilizing others for the lofty goals of the public good, modernization, and national economic development, a large sum of the fruit of their labor have been enjoyed by the owners of conglomerates and political leaders who privatized national power. The mode of rationalizing of the Korean developmental state produced distinctively productive subjects, many of whom dedicated their own lives and mobilized others, resulting in lasting consequences for contemporary Korean international development and global health practices.

Media and Online Resources

1. “K'oriaeidŭ(KoreaAID)nŭn chinjŏng han'gung wŏnjoin'ga? [Is KoreaAID really a Korean aid?],” ODA Watch, June 1, 2016, http://www.odawatch.net/voice/470043.

2. “‘Korea Aid’, nonsensical development cooperation and diplomacy must be repealed.” Chamyeoyeondae, July 26, 2016. https://www.peoplepower21.org/english/1438060.

3. Yun, T'aehyŏng. “K'oriaeidŭ, pogŏn mmunhwa ŭmshing shinŏji hyogwa gŏdwŏ … 2250myŏng hyet'aek [KoreaAID achieved the synergistic effect of health, culture and food…2250 beneficiaries].” News 1, June 1, 2016. http://news1.kr/articles/?2678890.

4. "Taet'ongnyŏngŭi ap'ŭrik'a sunbang, k'oria eidŭŭi chŏngch'e [Presidential Visit to Africa, the real nature of ‘KoreaAID’]." Shimin gŏn'gang yŏn'guso [People’s Health Institute], May 30, 2016. http://health.re.kr/?p=2971.

5. Kim, Sujin. “Et'iop'iasŏ 'k'oria eidŭo shidong… shibŏm saŏbe 1ch'ŏn 500myŏng [Launching ‘KoreaAID’ in Ethiopia…1,400 beneficiaries in the pilot project].” Yonhap News, June 3, 2016. https://www.yna.co.kr/view/AKR20160603002500009.

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