Global Health Collaborations: Justice, not Charity

Parisa Fallah and Mark Bernstein advocate for sustainable, educational, and collaborative approaches to global health work.

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People doing global health work are often regarded as altruistic, but perhaps we should pause and think about this. Is it possible that the way we view global health work is wrong? What if this mode of thinking is counterproductive to the very goal of addressing health inequities? Could an entirely different mindset allow our global health efforts to more effectively lead to positive change?

Global health work should not be viewed as a philanthropic, optional endeavor, but instead should be considered a necessary undertaking to combat systemic inequities and to restore justice. We must make healthcare equitable worldwide, and we must do so through sustainable, educational, and collaborative approaches.

Several centuries ago, colonialism ravaged the global south. Countries were robbed of their resources and were overtaken by the quickly-growing industrialized empires of the north. When these countries finally gained independence, they were impoverished. Their resources were gone, their economies ruined, and their healthcare systems destroyed. The consequences of colonialism were dire and still exist today. Fortunately, there are people ready to help tackle one of the world’s toughest issues – access to healthcare.

Winkel_triple_projection_SWHealth is a human right. It is not a luxury reserved for the few; rather, it is a necessity that should be available, accessible, and affordable to all at the best quality possible. We need to recognize that we are a global family – that we need to take care of one another simply because we are all fellow human beings. With this mindset, global health is no longer about helping a few people, giving back, or feeling accomplished and self-fulfilled in our lives. It becomes a mission to help restore justice to humanity.

In an effort to address global health problems, clinicians from high income countries have engaged in brief one- to two-week missions to provide clinical care and/or equipment and drugs. These charity missions only superficially address some of the problems. They do not tackle the root causes of healthcare inequities. This has led to many issues including: patients left without follow-up care; undermining of local healthcare infrastructure; demotivation of healthcare workers; perpetuation of brain drain; underutilized medical equipment due to lack of technical support; and expenditure of fiscal and human resources with minimal long-term gain. Ultimately, this type of charity work cannot be effective, because it is focused on an “us” giving to “them” model. There is insufficient empowerment, capacity-building, and collaboration. To take justice into our own hands requires taking ourselves out of the equation and looking at the bigger solution.

The Paris Declaration on Aid Effectiveness points out that “aid works when we work together” and outlines five major considerations when engaging in global health work: 1)  “ownership,” in which low- and middle-income countries set their own priorities and strategies; 2) “alignment,” in which high-income countries consolidate behind the goals set by low- and middle-income countries; 3) “harmonization,” in which high-income countries coordinate to ensure simplification and to avoid duplication of efforts; 4) “results,” in which high-income countries and low- and middle-income countries shift their focus to creating measurable progress; and 5) “mutual accountability,” in which countries collectively account for development results.

With the Paris Declaration in mind, international medical and surgical teaching collaborations are becoming the truly collaborative, sustainable, and community-centered approach for addressing global health issues, particularly the dire need for more healthcare workers and increased healthcare infrastructure. These teaching collaborations involve partnerships between groups or institutions in high-income countries and those in low- and middle-income countries  with a focus on building healthcare capacity for the long-term through education. As a part of these teaching collaborations, healthcare professionals teach relevant skills, build healthcare training programs, and use local resources available to the communities. These collaborations involve a true bidirectional exchange of knowledge, recognizing that people in high-income countries as well as low- and middle-income countries have much to learn from each other. No longer is the focus on how “we” can help “them.” Now the focus is on how we can all work together to build a better world.

“Justice is vital to the establishment of unity and harmony at all levels of society… A requirement for living a life of service to humanity, then… is ensuring that [justice] is ever-present in thought and action.” In the realm of global health, we need to question our every move and intention. We need to reflect on our actions and act on our reflections. We need to work as a global team to address our global health problem, and “Justice, not Charity” should be our mantra.

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Parisa Fallah is a MD Candidate at Harvard Medical School. Follow her @ParisaFallah.

Mark Bernstein is a Professor of Neurosurgery at University of Toronto.