Adrift Just Off the Islets of Langerhans

I have been working on a DrPH - doctor of public health, the applied version of a doctorate (parallel to a MD instead of a PhD) - in global health practice.  I’m a year and a half into it, but as I have a background in psychology, not public health, it’s going to take me longer to get through all the prerequisites.  It hasn’t been working out well.  I haven’t been able to find any opportunities to get on-the-ground experience and have come to realize that generally speaking, global health isn’t the best place for my training, which is in theories of behavior change and the like.  For the low-income countries, there’s still a need for basic infrastructure, and for the middle-income countries getting hit by both infectious and chronic diseases, they want to hire from their own citizens, not some ex-pat.  So I applied for a mental health promotion position doing primary prevention (i.e. keeping healthy people healthy) at the counseling center on campus at my university and I’m much happier.  I only took a leave of absence from my classes, though, meaning in two years I’ll be re-enrolled in that DrPH.

I’ve recently realized that my entire motivation to go into global health was due to a mega case of the White Savior complex - I can admit this well-intentioned but arrogant attitude. Altruism is noble, but it won’t keep you from inadvertently doing damage, just the same.  The more I meditate on this, the more I lean toward transferring from a doctorate to a second masters instead, and doing whatever it takes to finish the program quickest. I’m in a good job now; I could happily turn this into a career, I think.  Plus, it’s with a population I know well (university students) on issues I know well (stress management, mental health stigma reduction, etc).

I just don’t feel good about going any place where I haven’t explicitly been invited, and asked to help - anything less feels like an attempt to save the community or an attempt to do public health *at* them rather than *with* them. How can we say that we are empowering communities if they aren’t the ones starting off the process?  Not to say that it’s impossible to do good global health, but I feel like we do it all backwards - we go places with the intention of specific outcomes - even if in a more general sense (reduce under five mortality) and then try to establish relations with the community. It seems like the only way to genuinely do good global health is to get to know the community first, in a deep way. I feel like the anthropologists have it right when they insist that their students live in the community for a full year before they attempt to do anything.

My generation is more enthusiastic about being activists, especially in the social justice / global health arena, than previous generations.  There’s an incredible amount of impassioned interest in things like the Peace Corps and other similar programs - altruistic intentions, but ultimately an incredibly demeaning and arrogant attitude.  I fully admit to having been one of those people. 

So: now what?  Not sure yet, but the old phrase “think globally, act locally” is really resonating with me.