There is something obvious and critical that I have come to realize through the opportunities I have had to live and travel for work and play in LMICs… relationships matter more than anything else we accomplish. Of course, we all say we believe that “actions speak louder than words.” But what does it take to live out that truth? Often times, it just means taking enough time and energy to notice, listen and ask questions.
I have the privilege of taking some time away from my General Surgery residency to be a Paul Farmer Global Surgery Fellow, a role which has supported my participation in high-quality research in Rwanda benefiting from experienced mentors and existing strong organizational partnerships. Through this, I have taken 4 trips to Rwanda this year to support a RCT in a district hospital in the eastern province. The team there is incredibly competent, adept at problem-solving and hungry for research education. Collaboration between an American academic institution and an international NGO enables sharing of ideas and resources and facilitates IRB approvals and conference presentations. Certainly, I have learned much about the unique challenges of research and healthcare delivery in that particular setting.
However, what has made the experience most valuable is getting to know the team on the ground. Sharing innumerable meals of beans and rice, teaching each other how to eat sugar cane and floss teeth, going for sunset runs after work, talking about our families and current events. It’s amazing how many similarities there are in the things that frustrate us or cause us anxiety, our dreams, our views of the world.
In a world that spends a lot of time talking about peace and love but is actually full of division and even hatred for one another, I am beyond grateful for the opportunity to go and for a time become part of a world that looks different from mine. Academic global surgery can never be accomplished from an air-conditioned office in US. Certainly, clinical, educational and research endeavors benefit from remaining connected to our networks and resources here. But we cannot expect to understand and conduct valid or meaningful research without showing up and seeing what the nuances in data collection mean and are due to, what the current practices really are (as opposed to what is reported by ministries of health or country-wide surveys) and the obstacles faced. We must build trust with our teams and sometimes this is best done by taking the same cramped transportation they do week in and week out, cold bucket baths and eating the same foods.
Sure, I have spent plenty of moments frustrated by the slow internet and frequent power cuts. Work is less efficient than what we have come to expect, and there are days that feel “wasted”. But the solidarity built with my colleagues even on those days is still a valuable investment.
I recognize that most clinical surgeons cannot afford to spend open-ended days in a research context, particularly when many give up vacation time in order to participate in global surgical work. However, I posit that unless this has been done at some point and maintained, the value of our contributions in a particular context is limited. We are in danger of becoming just one more affluent visitor who has the luxury of popping in and out of countries for a few days, bringing money, sure, but also highlighting how vast the difference between our worlds is.
Even as I write these words, I feel guilty, knowing that I often value my comfort and insist on my agenda being completed in a timely fashion. I honestly don’t yet know how I will incorporate global surgery into my future career. But I do know that I must never lose the focus on getting to know the community I am working in and the colleagues with whom I am working. After all, academic global surgery is not about padding my CV, doing something “cool” or making a name for myself, it’s about recognizing that we are all human with equal rights to health and healthcare and finding a way to help bring justice. And the best way to recognize our humanness is often to just be humans together.
Research team preparing to see patients.
Research team at biweekly “gym class”