Global Health will never be the same (and maybe it's not a bad thing.)

During my time overseas I got tapped to assist with a training session of sorts for the resident physicians at the hospital. A handful of people had flown in from the U.S. to facilitate the sessions, and they ended up staying at the same complex as me and inviting me out to dinner a couple times.

On one night out in particular, one of the visitors casually mentioned over club beers that he was exasperated with his group of trainees. They just weren’t interested in the research topic he wanted them to get involved in. He complained that he wasn’t sure how his study was going to get off the ground in time if they didn’t get on board (and by ‘on time’ he meant before he returned home a few days later.)

I quietly sipped my beer and said nothing. These comments surprised me. I had been around a couple of months and gotten to know several of the resident physicians. Most of those involved in the training session were senior trainees who had their own ideas about what problems concerned them in their patient populations, and what they wanted to study. I also knew a little about this person’s study topic of interest, and from my brief time on the ground knew there were probably a dozen different research projects that, if pursued and funded, could have a much bigger impact on our ability to help our patients.

Fast forward several months and both me and this person are back in the United States, for the foreseeable future or until our government can get itself together and stop being the punch line of pandemic response jokes. I haven’t written about it much (between school and work and life changes I haven’t had much time to sit and write my feelings about the pandemic and global health out) but I have definitely thought about this a lot. How being forced out of so many poorer nations where we are used to being hands on and taking the lead has forced us all to take a step back, to slow down, and really reflect inwardly on what our motives are and how to best move forward if we truly want to be of service.

I am not a perfect global health worker. I have had my share of mistakes and white savior moments. I’d like to think I’ve learned from them, and from my time working with the pediatric team in Liberia, although there will always be room to improve. And I can’t help but think that being forced to stay home, having limited access to all but 14 other nationals in the world, is a good thing for Western global health workers.

For a long time, we’ve been flying in for short visits, trying to use that fleeting time to establish connections, and accomplish whatever teaching or research is on our agenda. But what about our colleagues on the ground? The doctors, nurses, and public health workers that work in these clinics and hospitals every single day, and know the health system like the back of their hand? They see when infants come in time and time again with birth asphyxia, or when their adult patients show up sick and dying from an AIDS-defining illness because of the cultural stigma that keeps them from seeking care for their HIV. They see these problems every day, up close and personal. Are these not the best people to decide where resources go for research, for interventions and system changes? Who are we (myself included) to arrive somewhere for a few short weeks of the year and decide that we know best what the problems are in this hospital, or system, or community? And who are we to decide we know best how to fix it?

I’m not trying to say I’m glad that Americans can’t go anywhere (though it’s definitely the right decision for the rest of the world to shut us out right now.) My time working with the doctors and staff in Liberia was invaluable; I learned so much from my colleagues, and hopefully was able to be of use to the residents and residency program as well. So much can be gained by both parties from long-term, on-the-ground collaborations involving face-to-face clinical time overseas.

But if the pandemic does anything, I hope it forces Western global health workers to take a back seat- let their partners and collaborators in their respective home countries take the wheel and direct the work towards the problems they see as most important. Let’s continue to share resources, but without the many caveats and contingencies we’ve become so hellbent on tacking onto delivery of global health care. Instead of barging in with that brilliant idea already written out into a proposal, work with a partner overseas – help them to draft a proposal of their own idea, to navigate the colonialist world of academia to get their own research ideas off the ground. Maybe this is the kind of work we should have been doing all along.

This is getting long so I’ll cap it here. For some more interesting perspectives on how global health may change in the post-pandemic era from people who are much smarter than I am, check out this link…hope everyone stays safe and well this week!