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Speaking in Tongues

Some of our evening conversations and my experiences made me think about those occasions where I’m asked how one should do global health, to which I’ve now developed a packaged response: find a niche, and find a partner.

Hyderabad has provided ample opportunity to reflect on this as I navigate a country quite foreign to me, one where essentially all doctors speak English but often the patients do not.  That gap between myself as a clinician and the patients is one I feel even more acutely when in Haiti, where the lingua franca of the health care professional is French (which I do not speak), and that of the patient is Kreyol (which I’m slowly learning).  Even when leaving aside vast differences in culture and life style that loom between me and my Haitian colleagues, I am dependent on them to bridge the vital gap of basic communication when dealing with education or with patients.

Which brings me to the notion of “find a niche.” I grant that there is a role for foreign providers to give direct care in emergency situations, where the local health infrastructure has fallen into disarray or been overwhelmed by refugees (though this book does a good job of damning the humanitarian aid industry – quite biting, and worth a look).  For the majority of situations, however, the impoverished patient who is ultimately the target of global health endeavors is far better off with a clinician who is from their culture, speaks their language, and knows the local resources.  The ideal role of those of us from high-resource settings, then, is to work in partnership with local providers and health organizations, providing support and expertise in areas (or, perhaps, niches) where they request support – in other words, to “find a partner.”

Partnership itself is a very difficult thing (in general in all aspects of life), but all the more when it attempts to bridge these gaps of culture, life style, and language (not to mention geography).  We have frequently discussed the question of how well NGOs do their work during our trip to date, with Gopal and I both expressing a somewhat negative opinion of how many comport themselves.  The Crisis Caravan, referenced above, paints a damning picture of humanitarian NGOs, and both India and Haiti are replete with examples of NGOs gone astray.  Which is a shame, as a) the most likely venue for most health professionals to engage in global health is an NGO and b) the ill poor who are the prospective partners (…or targets) of NGOs have enough going on without people messing up attempts to help them.

No easy answers or pithy phrases to close with, sadly.  Just a reminder that those of us who practice global health should constantly be checking to make sure that our efforts are actually helping (or at the very least not harming!) those who we aim to assist; that we should strive to be partners in solidarity, over purveyors of charity, and that this is very difficult to do well; and that every moment a health system employee spends dealing with you is a moment they spend away from their patients or families, so it behooves us to treasure their time as much as we do our own when working within the clinics and hospitals that we consider ours.  Something myself and my colleagues at Physicians for Haiti constantly check to see if we’re achieving.

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(an impressively unlikely shot in a game of karrom)

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