Internal Deliberations: Who Should be Working in Global Health?

Me and my coworkers at a launch for the First Lady’s Elimination of Mother to Child Transmission of HIV Campaign in Eastern Uganda

I’m here. I’ve done it. I’m living the life and am in the career that I’ve dreamed of for the past 10 years. Ever since my first extended international trip living in the Dominican Republic — and admittedly my clichéd but sincere introduction into the field of international development and global health after reading Mountains Beyond Mountains about Paul Farmer and Partners in Health — I have imagined myself living abroad working in international development/global health. Despite this fantasy that has imbued all of my professional and personal aspirations, I have never really been sure what it would actually look like, or really feel like, to be living this life.

I’ve been living and working in Uganda as a Global Health Corps (GHC) fellow for seven months now, and my experiences here have been perhaps equally predictable and unpredictable. One thing that I certainly expected — but was hoping deep down might not actually occur — is the existential dissonance I am grappling with as I face the reality of my life as a foreigner working in Uganda. My anxieties have manifested around two primary issues: first, the idea of being a foreigner working in a developing country and what that means in the evolving field of international development; and second, a mostly hidden but simmering self-doubt about my capacity to maintain this career path.

I was talking recently with another American GHC fellow here who said that after a dynamic and inspiring past few months with her placement organization, she thinks she’s figured out what she wants to do with her career: become a fistula surgeon, so that she can continue to support the thousands of disempowered and stigmatized women with the debilitating medical condition in countries like Uganda. But she’s torn, she said, because she knows that her career would be based on her coming into such countries as an outsider. One of the most important and compelling parts of her organization’s approach to addressing fistula is that the women who themselves have overcome fistula do outreach to help other affected women in their communities. With the organization’s help, these “fistula ambassadors” have risen, despite their medical condition, to become empowered leaders who support their communities and peers. Empowering community members to address critical health issues affecting their community is exactly the type of participatory programming that my friend thinks is appropriate and most effective in development and health.

While there is still so far to go in achieving global development goals, many developing countries are growing their local human resource capacity to meet the demand and now have an in-country talent pipeline that is increasingly capable of meeting domestic health sector needs. This is a good and necessary development, but where do actors like myself and my friend fit into this new reality? How does this change fit within the often (and perhaps regrettably — a separate discussion for another time) romanticized idea of working “in the field”? Or within the realities of people who sincerely want to provide the support within their capacity to those most in need (which is not regrettable in any way).

One of the ART clinics that Baylor-Uganda supports in Western Region.

After actually entering into the international development workforce, I’ve realized that the image I had of myself at the peak of my career is shifting — I likely won’t be doing health or development work in another country. As more and more local young leaders are trained in-country, there simply won’t be a need for me there. This changing reality is in no way a bad thing; in fact, it’s the ultimate goal that should under-gird all development work, often described as organizations “working themselves out of a job.” And some of the most intellectually and emotionally connected development workers who are invested in sustainability, like my friend, understand this to the core. They also understand the reality that no matter how good our intentions are for doing international development work, our personal views of how things should be will almost always impact how we prioritize certain interventions.

Through conversations this year with other fellows about this very issue, I think I’ve come to terms with the fact that I cannot predict where my career will be or where the world will be in 20, 30, or 40 years. Nobody can. I now realize that, while it’s hard to resist the impulse to try to plan my life and career in advance, it might be best for me to simply continue to try to find the place where I can have the most positive impact now and work year by year, job by job, as my life and the world around me push ahead in an ever-changing and unpredictable fashion. If my focus remains the same — to help those in need — and I stay honest and true to that goal and continue to think critically about the sociopolitical factors that permeate the very existence of my participation in this field, the rest will hopefully fall into place.

“I now realize that, while it’s hard to resist the impulse to try to plan my life and career in advance, it might be best for me to simply continue to try to find the place where I can have the most positive impact now and work year by year, job by job, as my life and the world around me push ahead in an ever-changing and unpredictable fashion.”

Kampala, Uganda

Muzungu is the name that Ugandans call foreigners. As you walk down the street, boda drivers will yell, “muzungu, we go?” and vendors will yell, “muzungu, sweet potatoes?” Little kids will just yell, “muzungu!” and wave.

Very soon after I got to Uganda, I had an interesting conversation with a Ugandan man, who asked if I even knew what the word muzungu meant. I told I him that I assumed it meant something like “white person.” He explained that, yes, essentially, that’s the modern day usage, but that it actually means something more like “someone who leaves home often and wanders and doesn’t really have a home.” The young man explained to me that he had never been out of the country and had barely even traveled outside the region of Uganda he grew up in. To him, the idea that I and other foreigners would choose to leave home and our families for months or years at a time was hard to understand.

In so many ways, as I described earlier, I think I’ve romanticized the idea of living and working abroad, as many do, and it has also just seemed like a normal idea considering the career path I’ve chosen. But I admit that recently, I’ve been feeling a little homesick, and this idea of myself as the muzungu, the person who leaves home and wanders away from my family and friends, has really resonated with me. I’m happy here: I have a comfortable life, engaging work, and wonderful friends. With modern-day technology, I can talk to my family and friends from home all I want and stay connected to U.S. current events. But it’s still hard. It’s hard not actually getting to sit with someone and have the comfort of their being there, physically, beside you — actually getting to look them in the eyes and not just strain to see a blurry image of them on a screen. I don’t regret coming here or choosing this line of work, but I wonder sometimes if this separation is something I can handle in the long term, and the idea of being a muzungu starts to seem kind of crazy.

Talking on Google Hangouts with my incredible family

This anxiety builds into a sense of shame that I might not actually want to pursue the life of the development worker living abroad as I always thought I did. What does this say about my commitment to my work? Or my stamina and perseverance working in this incredibly nuanced and complex field? How do I prioritize the things that matter most to me in both my professional and personal worlds? My approach now, while I’m still at the start of my career and adult life, is to think about my experiences as opportunities to find out how I can combine my skills and interests to make positive change, while keeping myself open to all of the possibilities this broad career path that I’ve chosen allows for.


Baylor-Uganda Clinical Center of Excellence in Kampala, which provides some of the highest quality HIV/AIDS care in the country

In many ways, my placement organization, Baylor-Uganda, is the ultimate demonstration of successful indigenous capacity in global health. I am the only non-Ugandan employee out of nearly 400, and we are one of the most successful and well-respected HIV/AIDS organizations in the country. Interestingly, Baylor-Uganda decided that the position I currently hold — Resource Mobilization Officer — will be held by the Ugandan GHC fellow next year (each organization has one American and one Ugandan fellow in positions that might vary from year to year depending on the organization’s need). This is fantastic news, as I’ve been eager to see Baylor build the resource mobilization capacity of a Ugandan, who is more knowledgeable about Uganda and is more likely to stay on for the long term. This news feels fitting, representing the very shift in global health/international development that I have just discussed. It brings both a twinge of anxiety — where do I fit in now? — and a sigh of relief that Baylor and other organizations are moving in the right direction, and the future of global health and development will ultimately lie in the hands of the very people they are intended to support.

“It brings both a twinge of anxiety — where do I fit in now? — and a sigh of relief that Baylor and other organizations are moving in the right direction, and the future of global health and development will ultimately lie in the hands of the very people they are intended to support.”
Baylor-Uganda Teens Got Talent Day at our Pediatric HIV Clinical Center of Excellence, Kampala, Uganda

Emily Ausubel is a 2015–2016 Global Health Corps fellow at Baylor-Uganda in Kampala. All GHC fellows, partners and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. Join the movement today.