Forming and sustaining equitable partnerships with international colleagues is a challenging endeavor. It requires passion, leadership, transparency, cultural sensitivity, friendship, and endurance. All the time and effort spent is an investment toward something valuable, and mistakes and miscommunication are unavoidable. Pain is an inherent part of any growth process.
What we gain from a global health partnership is clear: a reminder to our medical students, residents, and faculty that empathy has called us to medicine. We want to connect with patients and families from diverse backgrounds. We care about human stories. We are patient advocates and have been licensed to serve. We want to teach them that we are all connected genetically, across all boundaries, political or otherwise. We want to teach them to celebrate diversity and eliminate boundaries. But it is not our place to define the wants of our international partners. Instead we must understand their wants through transparent communication. We can make known our resources, and leave it to them to choose how to use the resources to the potential they envision. It is our responsibility in the Global North to share our abundance of resources toward fair, equal access for all.
At the heart of any true collaboration is preservation of the dignity of host institutions. We only do harm by trying to teach locals how to do things “the right way.” We do not know what “the right way” is for them. We can only understand the issues by power of observation and by asking questions to learn. This is about them, and only then can it be about us. Partnership in global health is not a business model, but a love story. Both sides are in love with a philosophy. Collaboration grows around a beautiful, unified humanitarian concept. Although the Memorandum of Understanding establishes the “rules of the road,” they are insufficient in securing sustainability. With time, the relationship evolves into a true friendship that binds partners together in ways that transcend business. This allows for a deeper understanding of each side’s needs and barriers, promoting cultural understanding and integration. When friendship binds the players, creative solutions can be found to sustain the program and support friends through difficult times. These are the principles we follow wherever we are.
The infrastructure of a successful global health program consists of a home site and a host country site. At home, an emphasis must be placed on the selection and preparation of American participants interested in global health, and in the support of guests in education and research. In the host country, support systems will be in place for participants sent to elective sites, as well as the alumni of the program—those who have completed the rotation and have returned to their home countries in new positions. The program in the host country must also focus on selection of new candidates.
I would like to share a few lessons learned through decades of work in global health. Seek to partner and work together for mutual benefit and equity. Graciously embrace immersion into the new culture and landscape. Commit to empowering the host country through capacity building. Fight for social justice and equity of resources. Create a co-nurturing environment by recognizing cultural and social factors and adapting to local needs and priorities.
Service, training, and research should work in concert. While many engage in global health with the goal of research, its impact is compounded by service and training. All research endeavors should be centered on how to better serve patients and communities.
To meaningfully advocate for anyone, one must approach the cause free of assumption, bias, and condescension. One must simply ask, from a place of candor, what their needs might be. They have something to teach you, and you have things to learn from them. This truth lies at the heart of global health.
Act with intention and understanding. An international collaboration is akin to a marriage between a plant and a human, with similarities and dissimilarities. If you are patient, committed, and focused on the mission, the partnership will thrive like the Lobelia that blooms only every fourteen to sixteen years. Its beautiful flowers are worth the wait, as is the flourishing of a truly equitable partnership. A global health program is essentially a bridge connecting two beautiful islands to allow an equal exchange of complementary resources.