How to carry out health cooperation in Africa (and how to tell about it when you return)

At the beginning of the 21st century, the Kenyan writer Binyavanga Wainaina published an ironic and accurate article:

.

In it, he exploited the clichés about the continent to show in a kind of lucid guide about the prejudices that arise spontaneously when we refer to it.

Inspired by that text, Desmon T. Jumbam, a specialist at Harvard University, repeated the exercise, this time transferring it to his field of global health, to denounce with similar rhetoric how one falls into the same traps that Wainaina satirically denounced.

Reading both articles is a difficult exercise for those of us who have repeatedly been to Africa, both as visitors and workers.

In fact, it is the main field where we develop our work.

And it is complicated because we are not free from having made the vast majority (perhaps all) of the errors that both articles reflect.

Yes, we have been those whites who have been trapped in the vision of an Africa where "the heart of darkness" beats.

Those who, a few days after arriving, were able to carry out a medical analysis of an unknown disease, or to understand the social context to meet the needs of those African populations that we would henceforth call “vulnerable”.

Based on the articles by Wainaiana and Jumbam, we have developed a small initiation protocol for all those who wish to tread the same puddles as us.

Let's start.

In the cover letter for the organization that will host you, do not forget to write something like "it is the dream of my life, I have always wanted to do it, I want to be useful".

You can also refer to the existential emptiness that life in Spain supposes for you and that you are going to Africa to find yourself (don't doubt that you will find yourself, and the result will most likely surprise you).

Don't worry if what you need is time.

It is not necessary that you give up your life for several years, with two or, at most, three weeks it can already be enough to change the world.

In that time you will have already understood many things, among others, the complex interactions that perpetuate the circles of poverty.

In the cover letter for the organization that will host you, do not forget to write something like "it is the dream of my life, I have always wanted to do it, I want to be useful"

Before leaving, prepare your suitcase well.

Don't forget to collect medical supplies.

It accepts all kinds of medications: it doesn't matter if they are expired or if all the prospects are in Spanish and nobody understands them there.

It is clear that everything helps.

Even two loose tablets of any drug, a frayed bandage or a matchless latex glove.

Of course, prepare yourself with quality shoes, pants and shirts, preferably safari-type, that will allow you to maintain dignity amid the sweat of the tropical heat and become the

you've always dreamed of.

Once you've packed your bags, you can go help "whatever it takes", you know that in Africa anything goes, you don't need to have experience.

If you are a paediatrician, nurse or epidemiologist, although in Spain you would never dare to perform a caesarean section, drain an abscess, reduce a fracture, prescribe treatment for an unknown disease or criticize the decisions of more experienced colleagues.

Don't worry, in Africa all this is possible: because what is needed there is knowledge and doctors, and in general, you have done what you have done previously.

As for the previous bureaucracy, you do not need to carry out the long and cumbersome procedures to validate your qualifications and accredit yourself as a health professional.

You are white, you come from Europe and that is enough.

So don't get complicated and enter with a tourist visa.

Use it to visit the children's rooms on a daily basis, with a sad face and a nervous sneer, but of course, don't miss the opportunity to visit a lush natural park or a paradisiacal beach during the weekend.

But there are more exotic things for a volunteer than seeing animals in the savannah or diving among whales.

So once there, don't miss the chance to go and witness, for example, the essence of a birth without means, without anesthesia and with limited assistance, as was done here in the past.

Do not forget to take photographs in which you can see the face of pain (also of joy, of course) of the mother and the crying of the child.

Take the newborn baby and pose with it to hang it on nets with a title such as "there is light in the darkness" or "joy in the midst of sadness."

Of course, you don't need to ask for permission to take the snapshot or post it on networks (you will do it as soon as you can because you will be enormously grateful to be able to disconnect from your mobile and from them).

But if it is not possible because the baby was born depressed and needs resuscitation, focus and get to work: it is not necessary to ask the parents what they want to do, since you know more than them and what is best for their child;

you have already decided to go for it all (in addition to not missing the opportunity to "make hands").

In the rest of the hospital rooms, do not ask your colleagues for help either.

Remember that you are always right, you are a European health worker and you know more than the doctor who has been trained (precariously, of course) there.

Even of those diseases that you had only heard about sideways like malaria, HIV or tuberculosis.

Don't follow the local protocols either, don't waste time getting to know them, you already know in advance that they are, at the very least, obsolete;

so apply yours that are always better.

You don't have to waste analgesia and put too much on patients;

blacks are stronger and being used to it, they can take more pain.

And when you put yourself in front of a skin lesion, forget that during your training you did not even know that this tone existed and be resolute.

Surely you will find a parchment book on colonial medicine with a name titled something like "dermatology in black skin, dark skin, or non-Caucasian race".

There you will find what you need for an entire express specialization that prevents you from expressing what you are feeling: "You don't see erythema on black skin."

You don't need to waste analgesia and put too much on patients, blacks are stronger and being used to it, they endure more pain

Is Africa the ideal place to conduct research?

Can be.

In any case, be surprised when you discover that the studies there also need to go through the approval of the ethics committees, and that it is equally necessary that the patients sign and understand what an informed consent means.

And when it comes to preparing a study, you should also be indignant at the customs procedures that always hinder its development: it is difficult to understand why they do not allow you to travel with medicines for these studies on the outward journey, nor why they cause problems in billing biological samples at the back.

Because you have gone there to investigate, something that the Africans do not care about, as busy as they are with assistance.

Regarding attendance, criticize the laziness and lack of interest of your colleagues, who live there continuously, earn little and are subjected to the pressure of a job without resources and the insecurity of the environment.

Call them lazy when you go there 10 days and work 12 hours a day, and they who have spent more than 20 years dedicating more than eight hours a day, now refuse to do 12. If they ask you for money for overtime, talk to them about altruism and self-realization.

And since you are with them, use them to help you collect data and facilitate, as far as possible, the development of those studies that need you so much.

Then, however, do not worry and do not include them as authors of the article that you will write because a simple thank you will do.

And if you decide to add them,

Upon returning, he talks about those who did not find the motivation and disregarded their work.

But don't do it for those who are revolutionizing their countries with their ideas, leading innovative projects or putting their lives at risk by raising their voices against injustice.

On the contrary, he continues to show Africans as beings without initiative, who only wait to be saved by whites and their redemptive missions.

Because he remembers: we must bear in mind that in Africa there are few doctors and with little training.

Don't waste time looking for leading hospitals with the latest technology.

Also don't mention the excellent surgeons who perform complex operations.

They have nothing to do with those other white surgeons who carry out intensive campaigns and save thousands of lives in just a few days.

In fact, do not hesitate, if at any time you have the opportunity, be part of one of them and go for your quota of saves.

Whatever you do, think about the importance of the return: what is not counted has not been done.

You have a moral duty to the vulnerable.

So give a talk at the hospital where you trained or at an NGO in your city;

give an interview in a newspaper or on television;

and, if you find the time, write an article or a book about that experience that, if not that of others, has changed your life.

In any of the situations, maintain a dignified but disconsolate pose, because you have suffered with what you have seen and do not know how to transmit it in its entirety.

Whatever you do, think about the importance of the return: what is not counted has not been done.

You have a moral duty to the vulnerable

What is clear is that you feel that “you could have stayed there”.

But the important thing is that you do a recount and a good analysis of what has been experienced.

At this point, you already know that the suffering of Africans comes from a bad exercise of power and privileges.

And that can only be the fault of racism, of the colonial heritage and of its macho societies, condemned for their flagrant lack of diversity.

Under these conditions, the country's progress can only be due to cooperation programs with the first world: if hunger has decreased in a region, for example, do not doubt that it is because of that white organization that has set up a vegetable garden or a renutrition a few meters away.

But whether or not you talk about hunger, don't forget to underline the smile of the African and discover to the world that "they are happy with nothing."

Don't miss the opportunity to talk about the African rhythm, so slow and so different from ours, because "we have clocks, but they have the time".

Nor to remember how grateful they are, because whatever you do, they always thank you and will recognize your effort.

For your part, ignore their advances as a result of local programs and the work of the community (note, this is an essential word in any formal and informal conversation, both on the ground and when you return).

Returning to the article, the interview or the talk.

End any of them with an African proverb, but don't hesitate to include a quote from a current African writer (Chimamanda Ngozi Adichie is a perfect candidate);

refer to your musical knowledge by showing what excites you, for example a traditional instrument like the kora;

or recognize, in a fit of humility, that the diversity of the continent escapes you because it is impossible to encompass it.

As for the proverb, several proposals (you don't need to understand them): “If you want to go fast, go alone.

If you want to go far, go together”.

Or this one: "Until lions have their own historians, hunting stories will always glorify the hunter."

In any case, if you don't want to fail, turn to Nelson Mandela, it's life insurance: “Let freedom reign.

The sun never sets on such a glorious human achievement."

One last thing, but not less important than all this: never forget to show yourself in a photo surrounded by children.

We hope that this guide can help, even minimally, those who want to become great cooperators.

Also these words of the Cameroonian philosopher Achille Mbembe, who warns us of the dangerous distance from which we tread and believe we know his continent: "Since neither they nor we can share a common world, the African policy of our world can hardly be a similar policy.

On the contrary, it could only be a politics of difference: the politics of the Good Samaritan that feeds on feelings of guilt, resentment or pity, but never on justice and responsibility”.

Iñaki Alegría

is a pediatrician, specialized in international health and cooperation.

He is also coordinator of child health programs in the rural region of Gambo, Oromia, Ethiopia. 

You can follow PLANETA FUTURO on

to our 'newsletter'

.