A Pyramid of Disarray: Discovering Global Health Challenges in Hidden Places

Egypt had been on Mom’s bucket list for 10 years, and we finally had the opportunity to behold the Great Pyramid together. We began our adventure in Cairo, continued to Luxor, traveled along the river Nile and returned to Cairo to at last visit the pyramids, explore the Egyptian Museum and pay our respects at various mosques and churches scattered throughout the city. Our conversation about travel safety only occurred while initially planning our trip and, unexpectedly, upon arriving home. But as my family and I explored, tasted and absorbed the beauty of this ancient place, we never once considered the reality of unrest and pain hidden among the ruins, monuments and history.

One day after departing Cairo, I learned troubling news while waiting to board a connecting flight home. A gunman had opened fire at a church near Cairo; nine people lost their lives. Within minutes of hearing the news report, our boarding began as my mind was driven into disarray. We had visited a nearby church just one day prior, without the slightest indication of the coming terror. While I understood that tension and turmoil were current residents of Egypt, and in Cairo specifically, my trip was one of excitement and true joy, without clear reminders of the violence and recent attacks that showered the streets. As a tourist, I was taken by Egypt’s beauty, but as a burgeoning global health scientist, I had missed the hidden issues. The attack on December 29, 2017, was one of several recent ISIS attacks on minority churches in Egypt, following a multitude of deadly attacks by extremists linked to Daesh-Sinai. Community violence was becoming a trend, but an unpredictable one.

Is this global health?

Well, certainly tangible poverty and inequality, observable infrastructure challenges, and clinical signs and symptoms clearly indicate global health concerns. Thus, one could assume that global health initiatives are driven by what can be seen and therefore addressed. I remember traveling to India and witnessing the pain of poverty everywhere, as children begged on the streets barefoot, cachectic, yet singing. I remember breathing the thick, polluted air in Nepal, observing the tattered face masks of local children and adults alike. I remember locking eyes with homeless individuals near 16th and Mission Streets in San Francisco, recognizing that the stop for my daily shuttle to Mission Bay was a home to so many in the city. These challenges are public and constant, challenges that follow a trend, challenges that cannot be ignored by tourists and locals alike.

But what about the prevalence of rape and abuse on trains in India? What about the lack of opportunity and health access that affects all Nepalis living outside of Kathmandu city? And what about the history and practice of redlining in San Francisco and continued bias in employment, education and real estate? These realities are not clearly visible, but they are nonetheless true and pressing global health challenges. So how may we address them? How does our understanding of a global health challenge shift when it is hidden and unpredictable? Is it even possible to engage with and react to such challenges effectively?

These are the questions that now propel me on my global health path, as I prepare to broaden my perspective and see the hidden issues. So, as I return to my original question—Is this global health?—I nod yes. The devastation in Egypt is a concern of global health, the lives lost encourage action, and the unpredictability of the violence demands new and progressive approaches. But perhaps my greatest takeaway is that global health challenges live in many places, obvious or hidden, within regions of history or innovation, among the young and the old, and in the shadow of the Golden Gate Bridge or even the Great Pyramid of ancient Egypt.