Working in the field of humanitarian medicine is something a lot of medical students and junior medical officers think about pursuing. But how and where to start is not always clear. There isn’t really a PBL lecture that covers it, and the director of Prevocational Training at your hospital may not be able to offer advice. The route to orthopaedic stardom or physicianly achievement are often clearly and discretely laid out before you, step by step. But ask about how to start a career in global health, and you might get some blank stares.
It seems the field is a burgeoning one. What exactly is global health? A mere ‘collection of problems?’ wonders Paul Farmer, founder of Partners In Health. Or, as said by Richard Horton of the Lancet, global health is an ‘attitude.’ What kind of work does it entail – working in warzones or eliminating malaria? Are you committing to emergency response or development aid? What courses or training should you undertake to prepare yourself?
A career in global health means different things to different people. For many, it is one or two field missions before returning home to continue training and their Australian careers. For others it’s a lifelong commitment. Before jumping in, it is good to think about which of these suits you best, and how it might impact you in terms of career, finances, family and quality of life. Below, I’ve outlined some considerations to help you work out if a career in global health is right for you and suggested some steps you can take to get you there.
One approach to a career in global health is to ask yourself – ‘what is it exactly that I am expecting to achieve?’ Some find the concept of emergency aid work hugely satisfying; others dislike the lack of sustainability of this work and veer more towards a development model. This should influence what kind of context and job you look for, and especially with what kind of organization.
Are you more inclined for short term, disaster zone work focused on saving lives in response to a specific incident; or a longer-term approach focusing on systematic problems and delivering social, economic and political development? Would you prefer working in an office or headquarter type scenario giving technical support to field teams or do you want to be in the field getting the work done? Each of these will have different work conditions, politics, lifestyles and rewards attached to them – so it is good to think about what you want before you start – but often, you won’t know until you go.
Thinking about what kind of organization you want to work with is important. There are many NGOs out there and navigating them can be confusing. Some have political affiliations or funding constraints that limit their activities. Others are independent and nonaligned. Consider what is the best fit for you – where and how they work, how they are funded, what is their mission statement and what are the politics of the organization. Who are they beholden to and how does it affect their work, and how sustainable are their activities? How do all of these affect you when you sign on to work for them? Having clear ideas about these issues often also helps in the job application process.
It also pays to anticipate the challenges you will face in the field. The well-known medical challenges – lack of resources for diagnostic and treatment options are usually quite obvious. How will you handle having no tests to run on your patients and making decisions clinically with no backup or person to ask for help? What about the social challenges – away from family and friends, stuck in close quarters with people you don’t know very well, living and working with the same small group day in and day out?
These may not seem like big challenges now, but small things are amplified when you are deprived of comforts, whether they be monotonous food, distance and isolation from family and friends, no bed, extremes of weather, heat exhaustion or squat toilets. Have a game plan of how you will deal with this and be realistic about what your limits are.
Perhaps the greatest challenge is adapting to different health systems, cultural values and ways of doing things. Being unfamiliar with systems or having to work within dysfunctional or broken ones can cause a lot of frustration and has ended the field career of more than one aid worker. One must be prepared to have their expectations and values challenged and be open to new ways of thinking.
Global health is a field that is still evolving which may explain why the career pathway it requires is correspondingly obscure. While some parts of the world have begun to set up schools of global health within their medical faculties, this does not seem to have quite hit Australian shores. An important consideration is pursuing further education in Public Health or International Public Health, usually through a Masters’s course. Doing one can broaden your educational horizons as well as bring you into contact with people and work in areas that might interest you. Think about other education too, maybe an ultrasound course or advanced life support, even online distance education in humanitarian responses in conflict zones – these could serve you well in the field.
Developing the right skill set as a medical student and junior doctor is maybe just as important. Ask for extra rural rotations and get some experience working in remote and Indigenous communities. Opt to do medical electives in under-resourced and challenging settings. Try and get some exposure to tropical medicine and infectious diseases, anaesthetics, obstetrics, primary health and other specialties that are important in the field. Think about broadening your travel and holiday horizons and buffing up your cross-cultural sensitivity and linguistic skills.
In the hospital – look for ways to get involved in leadership, quality improvement and development. Can you develop a global health arm to your Resident Medical Officer Association (RMOA), or set up a partnership with a hospital in the developing world? How can you work towards improved systems right here in Australia – whether they be Electronic Medical Records, or Clinical Innovations committees? Are there disadvantaged populations in your community whose health you can improve – whether it be refugees or Indigenous Australians?
Maybe one of the most important things is to talk to people who have done it. Ask them about their path and their experiences. You might find that a career in global health is not something you apply for and enter overnight. It is crafted over time, through a series of choices that ultimately lead you to the humanitarian space. All of these choices incrementally prepare you for humanitarian action and life in the field. And if you manage to get there and overcome the challenges, you will find a field of work that is hugely rewarding and satisfying, day after day. Get out there and do it.
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