Setting out on a new adventure

Welcome back to the latest incarnation of my blog, which I hope will be more active than the last. I write this from my new apartment in Gaborone, Botswana, where I will be living and working for the next year. Before we dive into Gaborone and my plans for the coming year, though, let me back up and explain why I’m here.

During my year in Ghana working with students trying to go to college in the U.S., I had a chance to finally dip my toes into something approaching “development work” in Africa—just what I always wanted. Over the course of the year, I had my share of disillusionment with the project (though I also came to see why the organization had chosen the strategies that it did), but there were a couple of things that I found particularly rewarding. I loved getting to know the students, through conversations and their essays and their aspirations for college. It was also a job that played to my strengths: I understand far more of the American college admissions process than your average African student, and I can comfortably say I wasn’t doing work that a local person who better understood the nuances of the local social, political and cultural context could have done better (more on this later).

So as I began to think about future directions, I knew I wanted to have a skill set that would make me valuable even as a foreigner, and that I’d like to work directly with people. On a recommendation and a whim, I checked out a public health master’s program, and realized it was exactly what I wanted. There’s something very concrete about working in medical fields, but I hope that there will also be room in public health for attention to the political and cultural influences/outcomes.

This year, I will be working with HIV-positive teenagers at a clinic in Botswana. Many of my roles and responsibilities will likely change over the course of the year, but generally my job will be to support the teenagers in building healthy, happy, productive lives.

I’m entering this new stage with a lot of questions in mind, mainly about how to do the best job possible. I’ve recently read Susan Wicklund’s This Common Secret: My Journey as an Abortion Doctor and Tracy Kidder’s Mountains Beyond Mountains. The first is the memoir of an abortion doctor working in Wisconsin, Minnesota and Montana, and the second is a biography of/love letter to Paul Farmer, the public health superstar physician who began Partners in Health.

At one point in the second book, Farmer is quoted as saying that “it’s not about a quest for personal efficacy” —that is, we should focus not on improving ourselves, but on improving the lives of others. Of course, true selflessness is impossible, since we gain something from helping others, even if it’s just a brief easing of moral discomfort, but the quotation struck me. If we’re focused on improving the lives of others, shouldn’t we make sure we are doing the best job of it as possible, and isn’t that a question of personal efficacy?

Kidder follows up with an explanation from one of Farmer’s colleagues, who says that the doctor represents a model of what should be done—proof that extremely difficult problems can and should be addressed—rather than a model for how it must be done. I think the same could be said of the abortion doctor. Focusing on trying to be Paul Farmer or Susan Wicklund is not important (and certainly there are many criticisms to be made of both). Nevertheless, they do both present a model for improving the lives of others, and share an intensity in their passion for caring wholly and specifically for the individual patients in front of them that I would like to carry with me as I begin this new job.

It’s really important to think about systemic problems and large-scale changes that need to be made (and, indeed, both doctors are engaged on this level as well), but without a focus on the individual, you perhaps risk allowing those systemic problems to overwhelm you. They might become an excuse not to act at all. Both doctors share concerns about the costs of losing sight of the individual, and Farmer in particular is presented as being afraid of allowing work on large-scale issues—like international advocacy on treatment procedures—to crowd out seemingly less impactful tasks, like day-long trips to see a single patient. At least as a starting point, I think it’s worthwhile to have a grounding in the personal and the specific from which to build a broader political awareness/advocacy agenda.

It will be hard, much harder than I’d like to admit, to fully relate to the patients I will work with and to consistently see through their eyes. I come from a vastly different cultural background, and from a position of both absolute and relative privilege: can I really hope to understand the perspectives of HIV-positive Motswana teenagers? I look forward to holding myself to the challenge of doing my absolute best to listen and learn from them, and to use what I learn to make whatever improvements for them possible.

This clinic is at the top of its field, and I know I have so much to learn from my experiences here. I hope that the lessons I learn will help me wherever and with whomever I end up working, but for now I would like to put thoughts of my own future aside to concentrate on the lives of these teenagers. Wish me luck!