Global Health: Where to begin?

Often times, when I tell someone that I am getting my degree in medical anthropology and global health, they give me a very intrigued expression. Not only does it sound quite complex and different than anything else, but they also question the concept of “global health.” I explain that it is similar to public health, only on a global level.  Though the initial concept of the field is simple, the initiatives that fall under “global health” are wide.  In the United States alone, for example, there are so many public health initiatives and projects that are on the back burner, how can a field, such as global health, cover so much ground?

The World Health Organization devised 8 Millennium Development Goals (MDGs) to keep global health avantages on track. The goals were created with all 191 United Nation members in agreement to have them achieved by the year 2015. Though there has been success, organizing a to-do list is not the only thing needed to solve the collections of problems of global health. The 2012 World Health Statistics discusses “although this rate of progress is close to the rate required to meet the relevant MDG target, improvements have been unevenly distributed between and within different regions (12).” We can make a list of what needs to be done, but it is not as simple to prioritize nations and villages on a list. 

Besides there being so many regions to cover, I don’t believe the major issue is necessarily the fact that places are being ignored, but that plans aren’t being as successful as they had hoped. In class, we watched a video about The Play Pump, which was made to provide a clean water supply to villages with a pump that doubled as play equipment for kids. On paper, and at the beginning of the program, it seemed like it would be perfect and solve the world’s water crisis. No matter how genius and ideal something seems, plans don’t always pan out the way it seems. An important aspect that was also evident in film was whether we are talking to the “key players,” as they were refereed to in class. One village received the Play Pump, but the population was mostly older women, rather than children who the Play Pump was aimed for. The plan would have been more successful, perhaps, if the villages were asked if they would use a Play Pump, rather than the Play Pump organization assuming it would be what the village wants. Money would not have been wasted, some may say, on a village that did not want that help.

I went on Semester at Sea in the fall of 2012. One of our stops was Ghana, where I visited Tema General Hospital. Their resources were sparse and the facilities were rundown. The most alarming thing to me was that there were only 2 maternity ward doctors who were capable of doing deliveries. Expecting mothers waited an average of 8 hours to speak to a nurse for prenatal checkups, and facilities were so tight everyone in labor would share one room. The nurses we spoke with were very intelligent, well educated, and aware of their conditions. They explained how what they desperately needed was doctors. Many doctors are educated in Tema despite the fact it is a developing city. The backfire is that they move to places where they can get more money and higher quality of life. The nurses said that though materials are useful, appreciated, and helpful when aid is sent from organizations, doctors are what they desperately need. No matter how many supplies we send and to whatever extent we believe that we are helping, they are still understaffed and in dire need of people. I am not trying to undermine some of the charitable organizations this world has, especially the non-profit ones, but there is no point in investing and sending goods when we don’t even get to know who we are helping, and whether or not we are actually helping. For all we know, the materials the hospital receives could just be congesting their small spaces even more.

This is just one example of how good intentions and helpful thoughts might not be as effective as one thinks. In some cases it is demining in a way, I believe. We, the developed world, think we have everything figured out, but in reality we don’t know what is needed in situations such as theirs. 

The picture shown is containers with hand printed labels of medical materials. It is evident that there are not many supplies, but there is also not much space. If an organization sends them a dozen packages of gauze, where are they going to put it? Instead, wouldn’t it be more effective to contact them, ask what they would benefit from the most, and then give that to them, rather than assuming we know best?

I think that the medical and socio-cultural anthropology mindset would help the MDGs be obtained and more regions be relieved. We, as a global health discipline, need to recognize the audience we are trying to help in order to make a positive impact. If the Tema General Hospital maternity ward had more doctors, there would be more help with deliveries and pregnancy complication, and in turn improve maternal health and decrease child deaths (MDG 4 & 5).

Global health is a very wide field of study. Intentions aren’t the sole part of the practice though. There needs to be adequate knowledge, fieldwork, and relationships to the key players in who we are trying to help. Without them, there will be no success.

-Monica Huelga-

http://www.who.int/topics/millennium_development_goals/about/en/index.html    (Millennium Development Goals)

http://www.un.org/Pubs/CyberSchoolBus/mdgs/flash/index.asp   (Progress of Millennium Development Goal)

Picture by Monica Huelga, Tema General Hopsital, Tema, Ghana, 2012.

World Health Organization- World Health Statistics 2012.