A Letter to a Young Global Health Professional

I was in the middle of packing my bags for another cross-the-world move.  As I was dusting a wooden figurine of a mother and child before placing in my suitcase, I was trying to remember how many times I have struggled to fit everything I value into 2, 50 lb. suitcases.  It then occurred to me that this is most likely the last time I will face this dilemma, as my years of living abroad have come to an end.  In less than a month I will start a new job as an Associate Professor at Liberty University.   I will switch from living in Cameroon and visiting America periodically to living in America and visiting Cameroon periodically.  With that transition brings a sense of mourning at the end of my lifestyle as an expatriate in a country I love and appreciate as well as a reflection of all that I’ve learned and experienced since I arrived in Cameroon 8 years ago.  Part of my new job will be to mentor students who are embarking on careers in global health.  As I packed up my things in Cameroon  and moved to Virginia I’ve been thinking about what I will tell my future students and this is the condensed list:   

1. Be aware of the edifice complex.  Americans and Westerners in general, could be described as product-driven people.  After months of planning, meeting, discussing, and writing we want something tangible as a demonstration of our hard work and commitment. When I first started working in Cameroon as a Peace Corps Volunteer, our Country Director at the time described this phenomenon as “edifice complex.” We want a physical sign that shows that somewhere, somehow we helped a community develop.   It causes us to give ourselves over to irrational frenzy, repeatedly forgiving others who fail to honor their commitments, and focus so much on a final project that we forget about the process and the people involved.  I few years ago I  had the opportunity to return to the village where I was engulfed in my own edifice complex—helping 2 villages rehabilitate their depilated water system.  When I returned a year later, I was surprised that the people didn’t talk about the water system.  They recalled conversations we had that I had forgotten about because I thought they were insignificant at the time.  They asked about my family and wanted me to ask them about theirs.   Although the relationships built through sharing your knowledge and listening to theirs may not have any tangible benefits, I believe it has more lasting value then any edifice project you will ever manage or participate. 
2. Your job is to build trust and add value.   Recently, much more seasoned global health technical advisors then myself, wrote a commentary in the journal Global Health: Science and Practice  and offered this excellent advice.   They make a pertinent point that as an outsider, host country nationals will be polite and respectful to you, but that is different then trusting.  Building trust happens over time and being straightforward about your agenda.  You will add value by assembling evidence-based options, presenting it to your counterparts and allowing them to choose which ones best fit their country's needs.  
3. The question isn’t why but what.  It was hot.  Rain was pouring down.  Armed guards were standing close by.  My heart was aching.  My colleagues and I were visiting a uranium-mining town in Niger.  We were some of the few foreigners who had visited this town in the southern tip of the Sahara Desert since 5 Frenchmen were kidnapped just a few years prior to our visit.  While trying to process the number of malnourished children I saw earlier in a part of the world that is considered off-limits to foreigners, a colleague offered me this excellent piece of advice.  He told me that the questions of why is there such inequality in the world or why does a mother watch her child die of disease that is completely preventable will kill me.  Instead the better question to ask is what can you do?  There will never be answers to the why questions, but there will answers be to the what questions.  It takes some time, it takes some listening, it takes some reflection, but the answers will come.  And those answers will be more life-giving and practical then any possible answer to the why questions.   
4.  Its always worth it to love.  One of the perennial questions I’ve faced is how much do I invest in people when I will only be there for a short time?  I invested a lot in my friend Eunice when I was a Peace Corps Volunteer and she died.  Life is fragile and riskier in Cameroon. I learned early in my time in Cameroon that the people who become some of your closest friends might not be there when you return the next time.   I once heard of a Returned Peace Corps Volunteer who returned to his village for a visit a few years after he left and everyone was either dead or had moved away.  For many years I’ve wrestled with the question how close to become to Cameroonians and risk the sadness of saying goodbye either because of distance or unexpected death.  About two years ago I met a 77-year-old woman who was born in Cameroon, spent most of her professional life in Cameroon working as a nurse, retired to the United States, and now semi-annually returns to Cameroon.  I asked her how she approaches her relationships with Cameroonians and she responded simply, “You can’t stop caring for people.”  And she is right.    One of the greatest blessings of this profession is being a part of people's lives around the world.  But you can't do that if you don't first love and care for them.  People can tell if you are there because it is a job or because you care and are invested in them as people. It is seen in simple things such as greetings and questions about their lives and families.   Yes, you will eventually leave and yes, you may lose someone close to you because of unforeseen circumstances.  But the joy of their friendship and sharing in their lives, whether for a short time or a lifetime, far outweighs the sadness.
5. Take care of yourself so you can take care of others.  After I graduated from my doctoral program, one of my professors gave me this piece of advice.  Burn out and cynicism is very high amongst global health professionals.  I’ve learned that if I keep a daily routine of journaling, praying, and exercising I can live almost anywhere.  Find your rhythm and what rejuvenates you.    You will need this to maintain inner balance and peace when you live in a place where schedules are flexible and daily living feels overwhelming.    
6.  It will always work out, just not the way you think it will.  One of the skills you will learn as a public health professional is to plan and evaluate programs.  But at the end of the day you will have to just trust.  You are not in control.  It will all work out, just not the way you think it will.  So plan that innovative project, write out the budget justification to last penny, find the most talented staff, and then trust that it will all work out completely different then you anticipated. 
7. Travel light.  Always be ready for the car to break down and you have to carry all of your belongings and hitchhike.  Invest in a good pair of Chacos, a scarf, a lightweight dress, and a backpack and you'll be fine.  For a much better (and funnier) advice on this topic and why it is important, read this blog post.  
8.   Saudade.  After you have been in another country for awhile, a common question arises, do you build on what you already know and stay here or start someplace new?  There are positives and negatives to both situations.  Whatever you decide, if you have done your job well, when you are leaving you can share with your friends this Brazilian word, saudade, which means, even though you are far from me, you are close to my heart.  I will take what you have taught me and share it with others, either back in this country or in another country.    
9.  Learning can never be undone.  At some point you will have to go home and reintegrate to your home culture after you have experienced and changed much.  This can be unexpected challenge.  Life is full of paradoxes and this is magnified when you live in two very different cultures.   Be patient with your fellow Americans and remember that they haven’t seen or experienced what you have.  In her book The Dance, Oriah wrote, Once you recognize within yourself a hunger for something beyond just continuing, once you taste even the possibility of touching the meaning enfolded in your life, you can never completely be content with just going through the motions.  There is no going back.  Learning cannot be undone.  Your learning and experiences in another culture cannot be undone.  It may make you feel out of place when you return to your home culture. But if it has refined the meaning of your life and deepened the core of who you are, it is worth it.  
10. And finally, the best quote/words of advice that I received from a seasoned global health professional when I first set out on this journey,  God has been profoundly real to me in recent years.  In the midst of outer dangers, I have felt an inner calm.  In the midst of lonely days and dreary night I have heard the voice saying, "Lo I will be with you always."  Martin Luther King, Jr. 

Small Time I Di Go, But For Now I Go Over Enjoy

I was talking with a friend when I spoke this Pidgin phrase, meaning, “Soon I am going, but for now I am really enjoying being here.”  

Little Stone Lodge in Kumbo

 I was in Kumbo last week facilitating a workshop with 30 peer educators on promotion of exclusive breastfeeding.  I lived in Kumbo from 2011-2012 when I was doing research for my doctorate.  When I arrived last Monday I walked into the Little Stone Lodge where I lived in 2011,  immediately the smell and sight of the place brought back memories of the people I met, the struggles, joy, and lessons learned during that year.  I laughed and was filled with delight as I saw people again who were a big part of my life when I lived there.  Like, Doris, who neatly packed away my earrings and peanut butter that I accidentally left in the house 6 months earlier.  Nothing says friendship like someone who packs peanut butter inside a cardboard box with the words written, “Sister Kate’s things, DO NOT TOUCH!!” and hides it in a cupboard for six months.  

Facilitating the workshop brought my life and work full circle.  The first phrase of my research in 2011 involved asking a variety of people in Kumbo about breastfeeding practices, knowledge, and beliefs.  I quickly learned that the women knew a lot about breastfeeding and were provided with good information at the antenatal clinics, but their husbands and grandmothers did not and often influenced the women, or they themselves, gave the baby other foods or liquids before six months.  There was a need to develop tools to educate other people about the importance of exclusive breastfeeding instead of only pregnant and lactating women.

One of the first people In interviewed in 2011 and still meet each time I go back to Kumbo

When I returned to Cameroon last April as a Nutrition Advisor for an HIV grant, one of my goals was to promote exclusive breastfeeding in the community.  I desired to do this because research has shown that if an HIV positive woman exclusively breastfeeds her child for six months and takes her anti-retroviral drugs the risk of her transmitting HIV from mother to child is almost zero.   So there I was almost 3 years later telling peer educators, people respected in their communities, that sex does NOT spoil breastmilk nor does palm wine stimulate breastmilk flow, beliefs that I learned earlier that negatively influence breastfeeding practices.  I think they were surprised that a “white man” knew of such beliefs and openly spoke against it.  That or they enjoyed my attempts at explaining why the beliefs are not true in Pidgin.

One of the Peer Educators learning about proper positioning and attachment for breastfeeding

Some of the Peer Educators and Life Abundant Primary Health Care Health Promoters 

Song about breastfeeding that the Peer Educators wrote to sing in their communities to promote exclusive breastfeeding and women's nutrition

  Each morning as I watched the sunrise from the upper window in the Little Stone Lodge I reflected on my life and work in Cameroon in the past and in the future.  I continue to be amazed at how my past experiences have prepared me for what I’m doing now in Cameroon and what I will be doing in the United States in a few short months.   A couple of months ago I was offered a position as Associate Professor in the Masters of Public Health Program at Liberty University.  After a lot of prayer and thought I accepted the position with the stipulation that I could continue my work in Cameroon.  The school administration agreed and I signed a contract to start January 2014.  I have tried twice to completely leave Cameroon and have failed both times.  This time I am trying a new approach of simultaneously working in both continents, but with a home in the US and yearly visits to Cameroon.  The opportunity also enables me to work towards my goal of bringing students to Cameroon and exposing them to the realities of health and life in developing countries.  When I was in college I was able to visit a couple of developing countries with my professors and it strongly influenced my lifestyle and career choices, I hope to provide the same opportunities for my students. During the five years that I have lived and worked in Cameroon I have learned so much from the people, not just about breastfeeding, but about life.  In the future I hope to continue learning from them while also sharing what I have learned with my future colleagues and students.      

 

All is grace.  Light and water, shelter and food, work and free time, children, parents, and grandparents, birth and death--it is all given to us.  Our vocation is to receive these gifts and say thanks.  If I have any vocation it is to receive from the people the gifts they have to offer to us and to bring these gifts back up North for our own conversion and healing.
Henri Nouwen,  Discernment

Belly No Di Bite

After my discussion with my friend Peter about his visit to the traditional doctor, he promised to take me to meet Dr. Moses.  After buying boxed wine and bread for the doctor, we took a taxi and then a motorbike to his house about 30 minutes outside of Bamenda.   When we arrived at his house, we were warmly greeted and given bamboo stools to sit on inside his mud brick home.  After some brief introductions, Dr. Moses looked at me and said, "You have stomach problems and you have terrible dreams that worry you so much that you sweat in the night."  I was flabbergasted.  How could he know this after only telling him my name and my relationship to Peter?  He was right, my stomach was bothering me that morning and a few days earlier I had a terrible nightmare about one of my friends that   was disconcerning.  I asked Dr. Moses how he knew this and he said that he had four eyes and he could see spiritual causes of sickness that other people cannot see.  

Dr. Moses and his son in front of his house

He then walked across the room and reached inside two rice bags and pulled out two different kinds of powders,  one was reddish in color and the other greenish.  He placed the powders in my hands and told me to eat it.  Both tasted like sawdust and dirt. 

Dr. Moses' pharmacy

After drinking half my water bottle to rid my mouth of the taste, Dr. Moses showed us around his farm where he cultivates the medicine.  Before we looked at the different plants, we walked past his father's grave.  His father taught him everything he knows and when someone is very sick, he asks that person to stand on top of his father's grave so he can invoke his father's spirit to aide in the healing.  

Dr. Moses' farm

One of the leaves Dr. Moses uses to treat stomach pain

One of the pods Dr. Moses grinds and mixes to treat "man pikin" (male) problems

Berries!  An unusual site in Cameroon.  The leaves of the berries are used in medicine.  

After visiting the farm we returned to Dr. Moses' parlor/consultation room where he showed us the traditional bags that he uses in treatment.  The bags were made by his father out of animal skins.  Before he uses them they are warmed in front of a fire and then medicine is placed inside.   He will then hit the sick person with the bags wherever they feel pain.  Next, he lit a fire inside of a clay pot so that the smoke would drive away any evil spirits that were seeking to harm us.  

 

While the fire was burning we talked a bit more about my "belly pain".  Dr. Moses told me that it was the result of someone in the United States casting a curse upon me and there was an evil spirit inside.  He told me to hold my stomach while he held out his hand, closed his hands, and uttered some words.  He then promised me that the pain would be gone forever.  Was he right?  Does my "belly no di bite" as is said in Pidgin, meaning no more stomach pain?  Time will tell.  

I No Be Fine

As a Nutritionist I talk often with Cameroonian friends and health professionals about sickness, disease, and wellness.  Last week I had a particularly interesting conversation with my friend Peter:

“Sister Kate, I was really down.  I no be fine.  For five weeks I couldn’t eat a-n-y-thing.  My figure was like this” (pinky finger pops up to demonstrate his thinness) “I went and consulted at the hospital and they told me it was malaria and gave me drugs.  I took the drugs, but didn’t get better.  I went me back to the house.  My stomach was worrying me! I was just down.  I finally had to go see a traditional doctor.  The doctor told me I had food poisoning.”

“But Peter,” I said, “If it was food poisoning that wouldn’t last for five weeks.  Usually that passes in 24-48 hours.”

“No, Kate, someone poisoned my food.”

I quickly learned about the existence of traditional doctors and medicine in Cameroon when I first arrived in Cameroon in 2005.  They are omnipresent and exist in parallel to the biomedical system of hospitals and clinics with nurses and doctors trained in the germ theory of disease.  I still remember years ago as a Peace Corps Volunteer seeing a child admitted into the hospital because of severe anemia.  She had an enlarged spleen and her parents thought this was because of an evil spirit and brought her to a traditional doctor for exhortation.  The traditional doctor tried to rid her of the evil spirit by cutting her spleen with a razorblade.  After this didn’t work, her parents brought her to the hospital. I’ve observed that there are a number of factors that determine whether Cameroonians will consult traditional doctors, Western doctors, or use both when they are sick.  Generally, I’ve seen that they use both. However, if they believe that their illness is the result of spiritual forces, only a traditional doctor can cure them. 

Peter believes that someone was jealous of him and so this person tried to harm him by poisoning his food.  I asked Peter if he knew whom this person could be and he said that the traditional doctor told him that the person would appear to him in a vision.  Shortly thereafter he had a dream about a co-worker with whom he had a disagreement a few weeks prior to his sickness.  Peter went on to tell me about how the traditional doctor treated him by having sit on top of a clay pot with traditional medicine burning inside while the doctor laid his hands upon him and called out names of ancestors, hitting his stomach with a pouch full of powder, and then using a razor blade to make small cuts throughout his body and rubbing powder inside the cuts.   The traditional doctor gave Peter rubbing oil with traditional medicine to be rubbing on himself and Lord, Babila, and Kate to protect them from future attacks.

The day after Peter told me all of this I woke up sick.  The sudden onset of headache, lower back pain, nausea, cyclical fever 14 days after being bit by a mosquito could only indicate one thing—malaria.  I’ve had malaria before and keep treatment with me so I can start taking the drugs immediately.  I went to the hospital the next day for a confirmatory malaria test and see a doctor.  Three days later, I’m feeling fine and almost back to normal.  However, after the long discussion with Peter it crossed my mind that what if my sickness was the result of an evil curse on me?  I asked an anthropologist friend this question and she told me, “Your malaria is only a result of a curse if you believe that is the cause.”