Social transformation. How does it happen?

This is a question we commonly encounter in the global health world. How do we reduce disease burden in low resourced settings? How do we decrease health disparities so that everyone, worldwide, is empowered and has resources for well-being?

Making the world a better place is a goal that is instilled in us at a young age. In my family, my brother and I were encouraged to visit nursing homes and play cards with the elderly – to connect with people who didn’t have others to connect with. Everyone was happy to see us show up with our Uno deck, even though my brother cheated and always won. We shoveled the walks of our neighbors, helped clean up the trash on the roadside and in parks, and road our bikes to raise money for muscular dystrophy.

As I got older and traveled the world, my desire to help others merged with my profession. Global health became a priority.

My initial foray into global health was not pretty. I witnessed children outside the Taj Mahal who had been mutilated by their relatives because they were more likely to get money when they begged for dollars if they were missing an arm or leg. In Nepal, I met and volunteered with an organization that worked with young women (under 16) who had been released from sexual slavery because they were HIV+ and dying. I rode with the community health worker on the back of a motorcycle as he tallied each day the number of people who had died of HIV in the villages of Uganda.

I brainstormed ideas to make a difference. As I was teaching medical school, it seemed a natural place to start. We needed to build medical schools in Africa, I thought. And then I did more research. Most African nations had plenty of medical schools. The issue was that of medical migration, also called “Brain Drain.”(1) When people had been trained in western medicine, they left the country. Why? It seemed the simple reason was that they could make more money in other countries. However, there was another reason. They’d been trained to do surgery and pharmaceutical medicine. However, when they were stationed in rural areas, there were no surgical suites and no access to medicines. So there was nothing they could do.

To me, this illustrates a common problem that we see. When we ‘westerners’ (for lack of a better word) try to change the world with western solutions, we are not acting with cultural humility. Sometimes our desire to help can actually cause more damage. By moving from ‘traditional medicine’ to ‘western medicine,’I don’t think anyone predicted that some of the best and brightest minds in these countries would leave. Perhaps engaging in discussions of a more integrated medicine approach would have been helpful.

I now oversee a Master of Science in Global Health program at the National College of Natural Medicine. In this role, I have become acutely aware of wanting to approach things differently. I hope that our students will engage in reciprocal relationships with their global colleagues to share ideas and make an impact.

Why this rant on global health?

This weekend, I’ve been attending an excellent global health conference at the University of Washington. The theme of the conference is glocalization. In other words, put into action the concept of ‘think globally, act locally.’ The conference was unlike any other global health conference I’ve been to because the organizers, students from the global health program at UW, invited speakers across a broad range of disciplines. We discussed common global health topics like infectious disease and immigration. But we also discussed human rights issues like human trafficking, Islamaphobia, and climate change.

While are many things I will take away from the conference, there are two that I want to share here. The first is the amazing work of Dr. Paul Yager. Yager is a bioengineer who has been working to develop low cost ways to test for infectious disease. Having taught an introductory course on tropical disease for the past several years, I am thrilled for this new technology. When you’re on the ground in Tanzania and there is someone with a fever in front of you, there is no good clinical way to differentiate between several possibilities: malaria, chickungunya, typhoid, yellow fever, rickettsia, or flu. The technology works on the same premise as a pregnancy test. It’s simple and elegant. The trick is going to be making this test affordable for people in low resourced settings.

Another highlight of the conference for me was a panel discussion entitled, “Social Movements, Glocal Perspectives, and Coalition Building for Change.” The discussion was rich and the panel members were thoughtful as they shared their varied experience. During the question period, an audience member posed the challenge of trying to change an antiquated system in Africa and being extremely frustrated by the lack of success. Dr. Rachel Chapman, who chaired the panel, eloquently addressed the comment. “Come home,” she said. “There are plenty of issues here that need you.”

This simple exchange illustrates a discussion that we have with our students on global health trips regularly. It is not our job to ‘fix Africa.’ Africa isn’t broken. It’s different than the US. And there are people who struggle, just as there are people who struggle in the US. In attempting to help solve health equity and work toward social justice, it’s important that we pay attention to cultural humility. Think globally, act locally.

There’s an organization that I greatly appreciate called Child Family Health International (CFHI) that shares this perspective. I discovered them when I stumbled across their slogan: Let the world change you. It was very similar to what I said to students when we would travel to Tanzania together. I would say, “Your job is not to change Africa. You let Africa change you.”

So back to my original question: How do we start to make a difference? It starts with each of us. We need to teach each other what we know. We need to be kinder to each other. We need to check our biases and prejudices. We need to volunteer. We need to not turn our heads when something bad is happening, but to witness it and, if appropriate, stop it. We need to introduce our friends and colleagues to each other to build networks and organizations that can affect policies. But it starts with me, and it starts with you.

“If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. … We need not wait to see what others do.” Ghandi.

This quote has been shortened over the years to “Be the change you wish to see in the world.”

Whether you connect with the longer quote, or it’s bumper-sticker ready sister, the message is the same. Rather than trying to change the world, let the world change you.


1 Amy Hagopian,corresponding author1 Matthew J Thompson,2 Meredith Fordyce,1 Karin E Johnson,1 and L Gary Hart1. The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain. Hum Resour Health. 2004; 2: 17. Published online 2004 Dec 14. doi: 10.1186/1478-4491-2-17 PMCID: PMC544595