Global Health Careers: Part I

Tuesday, January 7, 2020

Crete, 2015

I was interested in global health and international work pretty much from the outside of my interest in medicine as a career. In the dozen or so years since then, the field has evolved tremendously, shifting towards more long-term and sustainable solutions and working in partnership with the local medical communities, rather than the short-term mission-style model.

Back when I started on this path I had no idea what a career like this entails; in many regards its still a learning curve and I’m figuring a lot of it out as I go. My first global health experiences in college were not great, though I didn’t realize it at the time. I joined a group of students to triage patients and distribute medications and vitamins during a couple of week-long missions in Central and South America. At best we were helping with workflow at a quarterly pop-up clinic, but at worst we were screening for diseases we didn’t have the medicines or resources to treat, without appropriate medical supervision. While we probably didn’t do any harm (something that can definitely happen in situations like this- see this new story for an extreme example), we certainly weren’t doing anyone any good.

The experiences left a bad enough taste in my mouth that I decided to stop working internationally and for the time being focus on learning good clinical medicine. I put the idea of international relief on the back burner until I had to skills to truly contribute something. But when the time came for that, I was a little lost as to how to go about pursuing a job in the field of global health. With a ton of guidance from mentors and acquaintances (and even more deep dives on the internet and google searches,) I found a few different career paths, job opportunities and fellowships that helped me formulate a much clearer plan for how to use my medical degree and pediatrics skills to serve others.

So for starters, here are a couple of things I learned during the last few years that I think are really important. I will get more into the nuts and bolts of global health careers in the next post.

With the medical director for one of BIPAI's many satellite clinics, Lesotho, 2017

1.     Approach work with humility. This is really rule number 1, 2 and 3 for doing good work in global health. While there are definitely things that can be brought to the table as a U.S.-trained physician, I guarantee my colleagues in Liberia are much more skilled than I am at dealing with malaria, malnutrition, other diseases we don’t see very often in our training. The history of global health is not so neat and pretty as you may think; its riddled with outdated, colonialist and often exploitative motives and strategies that are better off left behind as we move forward. I will be learning as much from the physicians and nurses in Liberia as they’ll learn from me. The absolute last thing many low and middle income countries need is another foreigner barging in, enforcing ‘better’ Western ideals and leaving a mess behind, or worse, gaining credit and fame for work and research done in these countries with no recognition for the health workers on the ground who were integral to getting this work done. As soon as you realize this work is not about you, you’ll already be in a better place to make a difference.

2.     Find a good mentor. Emphasis on good. I wish this had happened to me sooner. As a woman in medicine, pursuing a field that is somewhat atypical, I spent quite a few years feeling lost and rudderless, trying to figure out where I fit in to the big, messy picture that is global health work. I spent way too much time trying to fit myself into expectations of what a doctor’s career should be, and then feeling bad about myself for not really fitting that mold or being happy with who I was becoming as a physician. That all changed once I found a mentor who actually listened to me, tried to understand what I wanted to do, and then did everything in their power to get me to where I am today. I’ll never, ever forget that feeling of realizing this person was there to help me grow, advise me and achieve my own goals, rather than push me into a place or position I didn’t quite fit in. This is so, so crucial, really in any field, but especially for women in medicine and anyone interested in global health. (Sidebar: it may feel like you need to find someone who has a lot of global health experience, but I’d argue you should  pick a mentor based on their enthusiasm and investment in you; someone who is as passionate about your career as you are will be a much better mentor than a more experienced but indifferent person who happens to work in the field.)

3.     Be prepared for burn out. We all know medicine pushes humans to the absolute limits; the long hours, frustration of trying to navigate a broken system, and constant interface with human stress and suffering take a toll on everyone (and if someone says it doesn’t, they’re lying.) These challenges multiply when you enter a system with fewer resources and higher mortality than we are accustomed to as American health care specialists. You can’t help anyone if you develop compassion fatigue and burn out. Know what keeps you going and have an ‘emergency’ plan for those days that are really, really hard. For me its spending time outdoors and skype dates with friends and loved ones; for a colleague its Nutella, face masks and venting sessions with friends in the field. Set time limits to your work days, realize that you as a single person cannot fix every single problem you encounter, and give yourself the grace to accept it.

That’s it for now, I’ll try to write up some of the many, many career options I’ve found in global health in the next couple of days :)

Off to Liberia (next week.)

Friday, January 3, 2020

Since I have a couple days of downtime thanks to some surprise visa issues I figured now was a good time to share a little of what I've learned about Liberia in the months leading up to this trip. Apart from the usual resources such as the CIA world factbook, good old Wikipedia, and google news alerts, I learned a TON from Helene Cooper's Memoir The House at Sugar Beach (linked here). It was riveting and beautifully written, definitely a must-read if you are interested in this part of the world. I am currently reading her book Madame President: The Extraordinary Journey of Ellen Johnson Sirleaf, which you can find here.  I've also been following this blogger to get some insight into the culture and what daily life is like in Monrovia and elsewhere in the country.

I also feel its important to say you could write an entire textbook on this nation's history and I am in no way an expert on this subject; I am just sharing the major highlights and parts of Liberia's history, culture and traditions which I've found really interesting.

While the country was founded by American freed slaves, prior to their arrival over a dozen distinct tribes with their own kings, traditions and customs lived across the region for centuries. The American Colonization Society funded the emigration of a group of former slaves to the West coast of Africa between 1820 and 1843. Although it seemed like a beneficent idea to many, most African slaves at that time had lived in the United States for generations and were not prepared to re-settle on the humid, tropical West coast of Africa. Many became sick and died; just under half survived to 1843, while the ACS continued to fund the journey until the foundation because bankrupt and essentially abandoned the existing settlements to stay afloat. The Americo-Liberians, who came to be known as the Congo, declared their independence in 1847.

From that point until 1980 the Congo minority ruled over the indigenous groups of Liberia in a government model very similar to the United States; being Congo generally meant you were wealthier than the 'country people' and had far more agency than indigenous people of Liberia (does this sound familiar?) Ongoing corruption and skyrocketing prices of basic food and supplies in Liberia led to several often-violent political upheavals between 1980 and 2003. All told 250,000 lives were lost, and many more fled the country. By 2003 much of Liberia's infrastructure was destroyed.

From 2003 onward Liberia has experienced much more stability, but still faces challenges from corruption, exploitation from foreign companies such as Firestone (here's a well-done piece by the Washington Post on the topic and another multi-part longform article from Propublica) and the 2014-2016 Ebola epidemic.

By Sahmeditor - Own work, Public Domain,

In spite of these hurdles, Liberia is a beautiful, culturally diverse and naturally rich place with great potential for growth. While mortality rates remain very high due to diseases such as malaria, tuberculosis and diarrheal illness, a training program exists at the main hospital in Monrovia, where I'll be working, to produce more Liberian-born pediatricians to tackle issues in infant and child mortality such as neonatal disease, early childhood pneumonia and malaria, and malnutrition. Some other things you may not know about Liberia:

  • Most Liberians speak English- Liberian English, which is actually a collection of creolized dialects of English. Another 30 or so languages are also spoken in pockets throughout the country by various ethnic groups
  • Liberia's people consist of 16 ethnic groups, in addition to the Americo-Liberians (Congo) and several expat groups. 95% of the population is made up pf these indigenous peoples, including Kpelle, Bassa, Grebo, and many others. 
  • Due to the influence of the Congo people who came to Liberia from the U.S. in the 19th century, much of Liberia has influences of antebellum south, from the building styles to the religious culture. 
  • Liberia has some great literature- next on my reading list is Murder in the Cassava Patch by Bai T. Moore (see the wiki page here)
  • Something else I'm looking forward to trying is the FOOD. Rice is a staple as are cassava, fish, citrus, plantains, okra, coconut and sweet potatoes. Stews are often flavored with habanero and scotch bonnet chillies (insert flame emoji here) and eaten with fufu, a combination of plantain and cassava flour mixed with water. Check out Anthony Bourdain's No Reservations on Liberia for some mouth-watering visuals (linked here)
  • Liberia had a thriving tourist industry prior to the war. With gorgeous beaches to the West and tropical mountainous regions to the East, its natural beauty landed it on Lonely Planet's list of top 10 places to visit in 2020. There's even a growing surfing community at Robertsport. So if anyone's looking to escape the snow this spring, you know where to find me. (Bonus: the USD is widely accepted!) 
That's all for now. I