Volume 200 - Issue 1
Leaders in disguise — the unexpected tomorrows of global health
Author: Kylie Ngu
Med J Aust 2014; 200 (1): 54-55. || doi: 10.5694/mja13.10581
Published online: 20 January 2014
Published online: 20 January 2014
What does it mean to be a leader in global health today?
I’m so glad that you’re here”, are words that you don’t expect to hear as a medical student. You mean me? When a newly arrived, keen, Mandarin-speaking immigrant, excited to start a new life, finds work in the remote town of Tennant Creek (a town with a population of about 3000 in the Northern Territory of Australia and with a four-bed emergency department serving the whole of the Barkly Region — an area that covers 240 000 square kilometres), access to health care is unlikely to be the first thing on her mind. She doesn’t speak English and she is worried about bowel cancer. She sees I am Chinese-looking but she has no idea that I was born here in Australia and how lacking in confidence I am in speaking Mandarin. This was not what I expected. I came to Tennant Creek to work in Aboriginal health in a remote setting. I had read the harrowing statistics of physical abuse, sexual abuse and alcohol misuse in Aboriginal communities. I had heard the saddening anecdotal stories. I had seen the ongoing news headlines splashed across the media. However, I had no idea how I would feel once I actually arrived and witnessed the poverty in the Aboriginal communities and the lack of health services for the Indigenous and non-Indigenous people of Tennant Creek. I had not expected to find a gently spoken albeit anxious Mandarin-speaking woman here. Her story imprinted in my mind how we are all fighting the same health problems, regardless of what our roots are, and how frighteningly difficult it can be in remote communities like Tennant Creek.
I felt deeply appreciative that the situation in Tennant Creek, in my homeland, is shockingly similar to that in “third-world countries”. I was still in the same land that I had grown to call home, but what echoed in my mind were the same health challenges as when I volunteered in rural villages of Ghana 2 years prior, accompanying the local ophthalmologists delivering eye health care.
My time in both places has been heart-wrenching and sobering as well as awe-inspiring and deeply motivating. Yes, there is a lack of medications, and yes, equipment is minimal and failing. And yes, there are low staff numbers and low levels of support. But the health care teams were certainly abundant on one measure — an intense desire to aid the sick and vulnerable, even at the cost of their own sleep, their own relationships and their own time.
Tennant Creek and the remote communities of Ghana share the same fundamental issues. How can we promote and maintain fairness and equality in the provision of and accessibility to quality health care? How can we integrate the community and empower them so that the directions and growth in health care originate from them? How can we optimise local natural and human resources in innovative and creative ways to engage the community in a sustainable primary health care model that addresses the needs of the local people? These questions buzzed in my head for weeks on end. I desperately tried to find answers.
It ultimately begs me to question how can we, as health care workers, advocate and enact positive developments for the health of our fellow humans, whether close to home or separated by oceans? What does it mean to be a leader in global health today?
I was amazed to find hope and inspiration from the stories of a bright-eyed Aboriginal girl of about 10 years of age. She shared stories with me of a world where she continues to go out bush like her traditional Aboriginal Elders, hunting and eating kangaroos, goannas and bush turkeys. It was refreshing that, unlike her parents and much of the community around her, this young girl saw the importance of attending school, of seeking medical care, of enjoying a healthy diet and exercise, and of extricating the next generation from abuse, smoking and alcohol. I went home with renewed joy and motivation because children like her are the leaders of tomorrow, of uplifting the health status of their community, of promoting global health from local beginnings. Her optimism about the future was contagious.
I reminisced about my entrenched sense of optimism after travelling to Ghana, a place many had initially warned me to avoid because they thought it was rife with danger and uncertainties. The misperceptions that arise from fear and ignorance only pave the way for deepening of the chasm that divides a humanity that is essentially the same. I reminisced about venturing out for hours on a daily basis to run eye health checks in rural villages, to provide low-cost spectacles and medication that could save the sight of the breadwinner of the family and to identify appropriate patients for cataract and pterygium operation referrals, fully funded by volunteer fundraising in Australia, Canada and America. The passionate and dedicated local ophthalmologists, committed to running outreach clinics regardless of whether they have volunteer assistance, and facing each day with love and kindness despite the social and medical challenges thrust upon them, taught me the importance of reaching out with your smile, with your heart. They taught me to start local, to garner support and resources and to educate, and to spread my experiences to elevate the lives of as many as I could possibly reach.
This was one of the most considered and sustainable grassroots operations to uplift global health I had been involved in. It was about combining resources, separated by distance, to support local communities — communities abundant with a desire to extricate themselves from the constraints of limited access to health services and underpinning social issues. These social determinants comprised insufficient and inequitable distribution of funds, underdeveloped infrastructure and limited resources, and difficulty accessing opportunities for education, employment and empowerment.
I was able to draw parallels between the worlds of Ghana and Australia and I have come to realise these are not separate worlds. I became acutely aware of how interconnected all our lives have become. I am an Australian-born Chinese who worked with doctors from around Australia in a remote Aboriginal town, trying to provide quality medical care to a newly arrived Mandarin-speaking immigrant. I was a fresh medical student working with a team of dedicated local Ghanaian ophthalmologists. Global health is about the intricate ties in our continually evolving global community, how we affect each other and, more importantly, how we can take this as an opportunity to be a wave committed to the long-term improvement of health outcomes and experiences for our global community.
Leaders in global health are those who can create connections, map roads and build bridges to connect and uplift the lives of others with an embracing vision for their local community that addresses not only the medical needs but the sociocultural barriers to optimal health care. Such leaders can arise from the most unexpected of individuals, like a 10-year-old Aboriginal girl who teaches her parents to not smoke and to not drink alcohol, and a local ophthalmologist in Ghana who returns to the clinic in the dark to serve more patients after a full day of rural outreaches. We need to support these local leaders in disguise and help them lead by transfer of knowledge, wisdom and compassion, not just by machines and fly-in fly-out, bandaid approaches to delivering health care. For these leaders of tomorrow, global health starts locally.
Competing interests
No relevant disclosures.