Grant Callen is a student at IU School of Medicine and recently arrived back in Indianapolis from Eldoret, Kenya where his year as an NPGH Fogarty Global Health Scholar was interrupted by the COVID-19 pandemic. He shares his reflections on global health in a time of pandemic:
“I am not an advocate for global health…” Joe (Mamlin) said flatly, gesturing to the small crowd gathered around the fire. An odd thing to hear from a founding father of (AMPATH) one of the largest and most successful HIV & AIDS treatment programs and global health partnerships in sub-Saharan Africa. “What the World needs most,” he went on to say, “is people who look at the people around them a certain way - whether you’re in Kokomo, Indiana, here in Eldoret, or wherever. If global health just means you’ve gone abroad, well then you’ve missed the point.” It seems only fitting that this fireside chat, our last before the COVID-19 pandemic truly impacted our AMPATH family in Kenya, would be the inspiration for this blog.
I returned to the United States three weeks ago today with little more than 48 hours forewarning. As the coronavirus reached Kenya with its first confirmed case and the situation stateside became increasingly foreboding, the decision was made that I should be sent back home along with my North American friends and colleagues. It was a dramatic upheaval, a feeling of life interrupted, as we all made our way across the globe. To say we had a choice or that our leaving was something we wanted would be untrue; to say that it was the right decision, though, would not be.
When I was asked to write a blog about how my experience in global health had prepared me to face this pandemic I laughed aloud. Had it? And if so, what good had that preparation done me now that I was social distancing from the confines of my childhood bedroom? After allowing myself some time to wallow in self-pity, I realized why I had been asked in the first place. We are all experiencing a new and collective unknown. In times like these we are supposed to be able to trust elected officials and global leaders to share relevant, evidence-based information that we can rely on. Unfortunately, we have very few leaders in global health at the table anymore.
In this period of uncertainty, it is critical we hear from those who know that the key to mutual survival is our ability to come together and work toward common goals. No one understands this better than those who experience and overcome cultural and linguistic barriers to create global health partnerships. Now I am by no means a global public health expert, nor would I want to play one on TV; touting my individual experiences as expertise would be disingenuous and dangerous during these times. But, it has been the great honor of my personal and professional life to live and work alongside experts in this field. So, from the perspective of one North American trainee, here is how I view global health in the time of a pandemic.
Global health professionals are masters of flexibility. They know how to quickly assess a situation, recognize acute needs, develop workarounds for scarcity, and provide guidance that is appropriate to the realities of the setting they are in. To work in a “resource-limited” setting is to know ingenuity and expect its necessity. But if we are any of these things it is not because there is some inherent trait amongst us that draws us to global health. Instead, we are taught these skills firsthand through our relationships with those for whom “global health” is just health. That would be the doctors, nurses, and support staff too numerous to name who live and work in settings that many North Americans only visit.
To leave our colleagues and partners during this global crisis feels very invalidating. If we have built something together, how could we pack up and leave just as the pandemic arrives? It’s a difficult question to answer, but then again, we are living in difficult times. So instead of a definitive answer, I’ve asked more questions. What resources would we have consumed by staying? Who would be unnecessarily exposed to the virus while trying to support us at IU House? If we were to become severally symptomatic, would it be ethical to seek intubation and supportive care when there are some 21 ICU beds and limited ventilators at the only tertiary care facility in Western Kenya? Understanding the ethics and allocation of resources in scarcity is key to sustainable, appropriate global health work.
But working in resource-limited settings also means identifying what entities, stakeholders, and key players are at work and how their actions have led to the unequal distribution of resources. It requires accountability and advocacy on the part of the workforce and transparency and leadership from health departments/ministries and governing bodies. This means that it is the role and responsibility of global health professionals to guide policy development and implementation while remaining critical of the disparate impacts those same policies may have. Most importantly, it is our job to be advocates for the most vulnerable among us by calling out systems of inequity within which we have been raised, educated, and taught to practice. There are few greater barriers to our long-term success in improving the health of every person everywhere than acceptance of inequality.
As long as African countries are seen as testing grounds for novel vaccines and not as partners in a global public health response, we are ensuring our susceptibly to the next pandemic. As long as people of Asian descent are subjected to stigma, discrimination, and racial injustice because of the origin of disease, we allow ourselves to ostracize global partners in pandemic responsiveness. As long as we view disproportionate outcomes amongst our African American, Hispanic, and minority communities as a product of their racial identity and not as a direct result of systemic racism and inequity, then we will be passive audiences to the suffering of our fellow Americans. Global health is nothing if it is not a confrontation of the concepts of individualism and exceptionalism. Global health prepares us for pandemics because it teaches us how to see other people as we see ourselves and to know that we are never alone in this World. What a comforting thing to hold onto as we move through these unprecedented times together.