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PLOS BLOGS Speaking of Medicine and Health

The weight of my passport and my place in global health

By guest contributor Shashika Bandara

“Lying, thinking

Last night

How to find my soul a home

Where water is not thirsty

And bread loaf is not stone

I came up with one thing

And I don’t believe I’m wrong

That nobody,

But nobody

Can make it out here alone…”

Every instance I have gone through visa and passport challenges or witnessed someone else going through similar challenges, I recall this poem ‘Alone’ by Maya Angelou calling for solidarity in 1975. Visa and passport challenges, largely a problem impacting citizens of low- and middle-income countries (LMICs), are ones that we face alone as individuals and often remain unspoken for that reason. However, any change we envision to this inequity requires solidarity from all stakeholders, solidarity rooted in empathy.

In this essay, I want to highlight the debilitating impact on functional aspects in global health and to shed light on the pervasive impact these processes have on mental and emotional health. While affecting all regardless of position or institute, these experiences especially affect young and early career researchers with little or no institutional power.

Am I a burden to my team?

Visa processes for LMIC citizens regardless of their residency status often result in delays, additional costs and brings with it a guarantee of uncertainty. In 2019, after being granted work visa to work for the Duke Global Health Institute as a graduate of Duke University and after completing close to one year of work, I left for Sri Lanka and for other research related work meetings in the region. The US visa consulate officer, from whom I needed to get my visa stamped to travel back to the US, yelled at me without provocation during the interview and placed me under administrative processing. Administrative processing is a place of extreme uncertainty with no immediate timeline. Thus, I apologized to my team (who were very understanding) and had to cancel all my other important work-related meetings as my passport was held in the embassy. After repeated inquiries, I was invited for a second interview and the second interview started with the question “so are you a spy?” How do you respond to such a question with your future hanging in the balance? I said no, and after a few more questions, my visa was stamped. This experience was stressful and traumatizing – and injects a level of uncertainty that is not rooted in any logic or qualifications.

Fast forward to late 2022, now at McGill University conducting my doctoral studies, I needed to travel to South Africa for a meeting and then to Zimbabwe. For a high-income country citizen this would mean on arrival visa often with a very manageable cost. For a citizen from an LMIC this means collecting a significant list of documents including your bank statements – and in my case, traveling from Montreal to Toronto just to meet with a consulate officer. As a LMIC citizen trying to obtain a Zimbabwe visa, I had to face added layers of a visa process which often bring with it delays and uncertainties. It also means added costs due to these delays – such as high plane ticket prices.

This applies to research partnership building, conferences, high-level meetings and is not limited to high income country visas. Recent high profile examples can be seen from HIV/AIDS conference, 2022 to CUGH, 2023. So, we have to ask, how do we citizens of LMICs effectively manage careers in global health? At which point do you stop feeling like a burden to others? At which point do teams not hire you or want you because you are an administrative or a financial burden?

We as a community in global health lament the status quo with regards to visa inequities, but we have also to an extent normalized it by lack of resistance. This normalization dismisses the need for better support systems and asks students or researchers to continue as normal regardless of challenges.

An emotional rollercoaster

In his article on passport and visa privileges professor Madhu Pai describes the feelings related to his rejection of US visa had on him along with testimonies from many others. In addition to career and educational challenges, visa and passport inequities affect how we stay connected to our families, how they can share in our achievements and crises. For example, my parents, whose sacrifices provided me with the privilege of continuing my education, were denied the opportunity to attend my college graduation due to visa challenges. The US visa consulate officer thought my parents, both working citizens of Sri Lanka with strong roots in the country, apparently did not have enough evidence to prove they will return to Sri Lanka after attending my graduation.

The uncertainty of our personal visa challenges and interconnected setbacks require a higher emotional tolerance and regulation; many of us persevere, balancing the demands of our studies or work with what we have come to consider as ‘inevitabilities of the status quo.’ However, it is important to stop and ask, should this inevitability of the status quo persist?

My experiences are not unique to me. Visa processes, as currently designed, are often opaque and illogical, with space for humiliation that often invoke anxiety, fear, and shame all at once – a feeling that unless you have gone through the process, is difficult to understand. Fear and anxiety often stemming from questions of how the current results may affect your future visa applications. Also, shame of not being good enough, especially if you are a first-time applicant unaware of the pervasive inequities. You also fear additional layers of challenges, such as being flagged as a security threat. This mixture of fear, shame, and anxiety stops many from speaking truth to power about visa processes or how these unfair restrictions affect lives – masking the widespread impact it has. Severe inequities in Global North concentrated global health governance, employment and representation will continue, with claims of allyship ringing empty, if we fail to reimagine ways of addressing visa and passport challenges for Global South citizens to conduct research and to be heard in global fora.

Thus, my request to institutional leaders in academia, in government and non-governmental organizations in global health, in the development sector and in international relations policy is to recognize visa and passport inequities as a priority challenge to global health advancement. Sustaining passport and visa privilege system due to lack of resistance will only weaken research and implementation, and global health will be worse for it. Add your voice to address these inequities – it is time.

Shashika Bandara is a Sri Lankan doctoral candidate focusing on global health policy and governance at the Department of Family Medicine, McGill University. He holds a masters in global health from Duke University and is formerly a policy associate at the Center for Policy Impact in Global Health at the Duke Global Health Institute. He has conducted cancer immunology research at Johns Hopkins University and worked in the humanitarian sector with CARE International. He tweets at @shashikaLB

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

  1. In the 10 years between 2010-19, while I hadn’t yet become naturalized US citizen, I had to get visa to travel to Europe 3 times and Canada on 1 occasion. I had to separately travel to the concerned European country’s consulate with a travel itinerary that included air tickets, hotel reservations, meeting registration and travel health insurance so they will grant me the visa. Fortunately for me our department was extremely supportive. But I am totally in support of a process/system that can recognize and streamline a cost effective visa system for academics involved in healthcare related research activities with global health implications.

  2. Well said Shashika …a team from my institute was invited to present the findings of our study in Mexico …we have been trying to get a visa for over a month. But not successful yet

  3. I totally relate. I used to work for a famous medical humanitarian organisation ( whose name ironically makes a mockery of what we are discussing here) and that meant traveling a lot and with my passport, , literally every country I had to go to required a visa. Imagine being a Zimbabwean in South Sudan trying to get a visa to go France and onward to your next mission in Pakistan. Just the Logistics to line that up, And match with traveling dates, tickets , team travels and work plans. Sometimes I feel we miss out on employment opportunities because no employer wants to assume that…. Sadly even one of my supervisors said it once. Having gone through that for the last 15 years with no end in sight, I am now so used to it and am almost a professional visa applicant. I always have more documents than required just on the off-chance. I even volunteer information even when not asked. I go through the ‘red route’ at airports even when I have nothing to declare, just to avoid the embarrassment of being called out.

    This is my normal when I travel . I am now suspicious of normal visa process because it has become too good to be true. Beaten into submission I suppose by a system that assumes you are a spy, economic migrant, asylum seeker. …..until proven otherwise. And this from counties that claim to have super human rights records.

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