By Annie Boyoung Ahn, IGHS master’s student
Being born and raised in South Korea and further educated in Canada and the U.S., I developed a keen awareness of global health issues that span international borders. As an undergraduate at Dartmouth College, I volunteered at New Hope Foundation, a non-profit organization in China that cares for orphaned children with congenital abnormalities, which further sparked my interest in global health. I eagerly looked forward to the day when I could travel abroad as a physician to help children with special needs. Following graduation from college, I decided to pursue a master’s degree in Global Health at UCSF before pursuing medical school.
For the past year, I have been working with Dr. Nicolaus Glomb from UCSF on a needs assessment for pediatric critical and emergency care in Uganda. My capstone research project is focused on identifying the major barriers and facilitators to clinical practice in the pediatric acute care unit at Mulago Hospital. This past April, I was in Uganda with Dr. Glomb, conducting focus group discussions with a diverse cadre of healthcare providers ranging from doctors and nurses to pharmacists and laboratory technologists. One question we asked the focus group participants was regarding their experiences working with foreign institutions. One participant stated:
“They have a wider thought about approaching the patients. However, most of their thoughts may not be practicable in Mulago. They'll ask you, ‘Okay, bring this,’ then you're like, ‘Not here. Not here.’ We need to remember we're in Mulago, Uganda, East Africa.”
This participant’s feedback struck a personal chord. Since volunteering at New Hope, I have nurtured an ideal image of my future self as a physician traveling abroad with the ability to treat critically ill children. However, this participant reminded me that such an image neglects the challenges and complexities behind global health practice. U.S. physicians may bring the newest medical skills to a low-income country, only to find that adequate resources are not available on the ground. This can range from the lack of essential medical supplies and equipment to critical staff shortages.
Consequently, I was able to redefine what it means to practice global health. Previously, I naively thought that practicing global health meant transmitting one’s medical skills to less developed countries. I came to understand, however, that it is rooted in the active exchange with the local physicians for collective and sustainable impact. U.S. physicians are not only transmitting their medical skills, but also learning from the local physicians about the social, political, and economic factors underlying their medical practice. Only then can the two institutions effectively collaborate in adapting new knowledge to meet the needs of the local populations.
Therefore, as a future physician, I should approach my own work abroad with the mindset of humility and learning. As much as I will be contributing medical skills, I equally have to learn from my colleagues on the ground who are the true experts in the local context.
I also learned from the focus group participant that we need to dream big but focus small in practicing global health. Oftentimes, U.S. physicians travel to a low-income country, such as Uganda, with the anticipation of making breakthrough changes in a short period of time. When these physicians are on the ground, however, they find themselves faced with numerous hurdles, including the lack of resources, which severely delay or hinder their efforts. As a result, U.S. physicians often feel discouraged and frustrated, leaving the country without having initiated or followed through on their original plans. It is important to dream big, having a long-term vision for one’s global health practice five or ten years down the line. At the same time, it is equally important to focus small, working closely with local colleagues to identify the few key issues that can be tackled in stages.
I admire my mentor, Dr. Glomb, for reaffirming through his own example what it means to dream big but focus small. When Dr. Glomb first came to Uganda a few years ago, he identified the need to develop a pediatric acute care fellowship training for the local pediatricians. Instead of pushing for a new training curriculum in a short period of time, Dr. Glomb took a step back and started with a comprehensive needs assessment for pediatric acute care in close collaboration with the local leadership from Mulago Hospital. Although these initial efforts can be slow and sometimes frustrating, they will help identify the key areas of focus for the training and build up to tangible and sustainable changes in the long term. I am humbled and grateful to be part of this needs assessment, which is an important stepping stone in improving care for critically ill children in Uganda.