In my previous posts, Happiness and Neema, I wrote about the tragic state of health care in Tanzania, where I am currently working in a clinic, telling the stories of two young girls I helped treat. I believe many students and health professionals desiring to work within majority nations such as Tanzania struggle to identify what they believe is an appropriate context of care: “Should I work in a clinic putting my specialized medical skills to work, or should I focus on capacity-building programs aimed at training and educating local health care workers? Which will have the greatest impact? Which will be the most sustainable? Given the limited time that I am able to spend here, how can my skills best complement and contribute to the existing health care infrastructure?” These are all tough questions, but my service this summer has shown me they are beside the point.
In the medical field we are constantly driven to maximize utility and impact of service and thus are forced to ask ourselves these questions before we begin any sort of health service. This obsession can easily lead to paralysis if we try to apply these principles within existing health systems because it forces us to ask ourselves, “Where do we begin?” It is important to realize that the work has already begun and is unfolding within a vastly different cultural, economic, and social context than the health system that we are used to. I urge you to shake off the rational paralysis that stems from your perception of the hugeness of the health problems at home and abroad. Take simple and practical steps that allow you to simply work where there is need with an open heart. Recognize that your skills as a medical student or health professional are valuable and will have positive impact regardless of whether you decide to work in health education, research, or a clinic.
In An Imperfect Offering: Humanitarian Action in for the Twenty-First Century, Dr. James Orbinski, past international President of Médecins Sans Fontiés, reflects:
“In being with the [sick], one refuses to accept what is an unacceptable assault on the dignity of the other, and thus on the self…Solidarity implies a willingness to confront the causes and condition of suffering that persist in destroying dignity, and to demand a minimum respect for human life.”
Many of you are hoping to rotate abroad, thinking about how to integrate international work into your career, but are bothered by the quandary of not knowing what exactly this will look like, or where you should go and what type of medicine you will be doing here. In my view it is not important what you do or how you are involved. What is important is, firstly, that you do it, and secondly, that within whatever you choose to do you be present enough to not only treat the immediate needs of your patients, but to also confront the root causes of their illness and disease. People get sick with specific illnesses for specific and, more often-than-not, very complex reasons. Wherever you train or practice, especially if it is in a country or culture foreign to you, discover what those reasons are and seek to understand their social, economic, and cultural undertones. In doing so, I believe that you are able to stand closer in solidarity with your patients and peers, and are not as likely to be bothered and blinded by a myriad of bureaucratic obstacles and resource limitations to the point that you loose sight of these true ‘causes and conditions of suffering.’
Neema will always need someone who knows how to dress her wound and Happiness’ mother can always benefit from increased education on preventing diarrheal disease and dehydration. But even more pressing than treating these wounds and addressing these immediate concerns is the even greater need for simple acts of solidarity, for us to be a unifying and consistently present voice against that which destroys dignity by practically working towards improving access to health care around the world in every way we are able.