Thinking Globally - The Guiding Principles

Summer 2021


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CHA is celebrating the fifth anniversary of the Guiding Principles for Conducting Global Health Activities, reflecting on each of the six principles and how they are being lived today. In this column, we look at the principle of authenticity through the personal experiences of a good friend of mine, Dr. Shailey Prasad. He has had to consider his personal motivations for the global health work he's conducted and shares a story that begs us to question our own authenticity, our own motivations.

The personal desire to alleviate suffering is real for individuals as much as for our ministries as large entities trying to be of service to communities across the world. We, too, must be authentic in our actions, in stating our primary and secondary goals, and in our own discernment around how we behave as partners. Do we see our hosts as equals? Do we listen to their needs? Do we explain our own needs and purposes? Catholic health care in the U.S. was founded by brothers and sisters from foreign lands who came to this fledgling country on global health missions. Their authenticity was easy to see, as they came with one-way tickets and lived as a part of the communities they served. We, too, can be authentic in new and innovative ways, in the short-term medical missions, parish twinning for mutual capacity building and other partnerships. It's essential to being who we say we are as ministries of the church.




I remember the frustration; there was perhaps anger, too. In front of me was an elderly tribal leader, grizzled hair, deep creases on his face telling untold stories of life not recorded on any calendar. And I was letting him have it, essentially haranguing him for not coming in earlier. He had brought his wife to be examined since she was not eating well. My examination had revealed an emaciated, middle-aged woman with a rock hard mass in her abdomen. In this remote forest area of southern India, I had no specialized equipment to come to a diagnosis. I knew that this was quite likely a malignancy, and I was taking my frustrations out on this elderly man in front of me.

After I simmered down, as I was sitting at my desk, contemplating what I needed to do next, the elderly man approached me and asked me if I was OK. And just before my frustrations climbed up to the top again, he mentioned, "She is dying, right? We know it. We are at peace. We are forest dwellers, here one day, gone the next. I know you want to help, but we are fine." It was as if someone had hit a reset button inside me. I was thinking too technically during the encounter, looking at the woman with the specific skills that I had. I was not bringing my authentic self and was imparting an arrogance, built by my medical training and privilege.

Often in health care, and particularly in global health, we are faced with dire scenarios in which uncertainty and resource limitations are inherent. In such situations, we tend to lean toward technical skills; they are our solace, the concrete work that gives us a bearing. The "What?'' and "How?" light a path for the technical work we do. And, the technical work bulldozes all other thoughts and builds justifications for continued work. It is precisely in this phase that we need to pause and ask the deeper "Why?" questions.

Quite often the drivers that motivate us to engage in global health may start with an emotional response to a particularly dire situation or a compelling need to help. These are, after all, the best of emotions that define who we are as empathetic individuals. However, it has been the experience of a lot of those engaged in global health, including me, that many of these well-intentioned activities end up causing more problems. In this context, one has to look at the activities and ask the question "Why?" Why are we doing this? Why is this happening? And so on. I would posit that one of the main challenges could be that starting with the "to help" framework blinds one from asking the deeper "Why?" questions. It inherently creates a power dynamic that sets up a top-down approach. This power differential could then be a root of other problems, including creating dependency structures and boosting one's own ego. It would then behoove us to approach global health activities in the framework of a humble learner, where intellectual curiosity and genuine appreciation of individuals and communities in global health settings give us the opportunity to grow as people.

In the course of our growth and development as individuals, we are guided by a moral compass— the ability to differentiate between right and wrong. The full manifestation of this may be different in different people. The compass guides us through our choices as we look at various imputations of our actions and discern the path forward. It is also important to keep in mind that the more we look at these choices, the more we understand the nuances of the work in front of us.

This moral compass is the underpinning of one's authentic self. Our journey through life is one of discovering and re-evaluating our actions and choices. It is a wonderful journey on which we experience a host of emotions that give us information to shape our thoughts. But if those thoughts do not develop or are not guided by our moral compass, they tend to have a stunted existence, one that will let us continue to function purely from a technical skills viewpoint. Our authentic self manifests when our life aligns with the actions and there is a deep understanding of the "why" in the work that we do. It is then we can authentically express ourselves as who we are, not what we do.

I have found taking the path of self-discovery, of finding authenticity in the work that I do, important but not always clear. It is then that I remind myself of part of a David Whyte poem:

"Start close in,
don't take the second step
or the third,
start with the first
close in,
the step
you don't want to take."

And hopefully every such step that I take will allow me to understand and express my authentic self.

DR. SHAILEY PRASAD is the executive director of the University of Minnesota Center for Global Health and Social Responsibility and the vice chairman for education at the Department of Family Medicine and Community Health in Minneapolis.

Thinking Globally - The Guiding Principles

Copyright © 2021 by the Catholic Health Association of the United States

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