Sunday, December 15, 2013

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 whatIt 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.