My Global Health "Specialty" | Psychology Today

“Hey, Uncle White Man!”

My driver gleefully pointed out that someone had just shouted this as we zoomed down the road after a day’s work in rural Liberia. He added that younger people in his country had taken to calling elders “uncle” or “auntie” as a sign of respect and laughed when I asked if I should take “Uncle White Man” in that spirit.

I am on a two-week medical trip to Liberia, where I am taking my turn teaching what is hoped to be a generation of nurses and physician assistants to be “mental health clinicians”—the providers of mental health care in a country of 4 million people, countless traumas, and one psychiatrist.

I am a white, Jewish psychiatrist from New York City. Back home, I am as unique as a parking meter. Here in Western Africa, I am an exotic import in all respects, from my profession to my skin color. In the car, the classroom, or the well-appointed house in which I am put up, I am the “Doc” who garners respect, security guards, and doting attention. But, who, really, am I to “them” and “them” to me?

When I defy the script and go jogging on the red clay roads, my runner’s high just never comes as I navigate not so much the uneven surfaces and unfamiliar routes but the people walking and riding. But, escaping collision feels easier than escaping attention. It feels to me like everyone looks at me.

What are they looking at? Here in rural Bong County where everyone seems to lead such a physically effortful life in order to just hold onto what they have, I want to explain how my days are largely cerebral ones and how I need to open up the engine a bit as they end. You are all on the road to get somewhere, but I am on it to get lost.

Or, what am I imagining they are looking at? I think kids wave, and I think men at bars shout who knows what. I also think one helmetless motorcycle passenger shouted, “Hey, white man running!” Another motorcyclist seemed to warn, “Be careful.” Were they referring to the gathering clouds in this rainy season? As darkness began to descend earlier than I expected, a mother gathered her children from the dirt yard of their home and announced, “It is getting late.” Did she say that to them or to me? Did she even say it?

Am I a totem, curiosity, or target?

In truth, I am probably more Uncle to some Liberians and more White Man to others. To think that the local Liberians see me in one light is to see them in one light. It is as prejudiced of me as it would be for “them.” After all, the mother’s warning of the late hour was not necessarily a hushed defection from the conspiracy I was facing… right? I, the psychiatrist here in Africa as a psychiatrist, had become paranoid.

My 22 students know almost nothing about me. They don’t know I have two children and a wife, and they definitely do not know how much I miss them. They don’t know how hard the heat bears down on me when the generator for our house is cut off each night at 11 p.m. sharp, quieting the house along with my overachieving fan.

But, why should they need to know these things or want to know? Having emerged from a savage civil war in the early 2000s and as of just recently the Ebola epidemic, they must have bigger things on their minds, if only I had asked. My two weeks of relative discomfort are a pittance in the context of this country’s struggles. Still, needing to flog myself for wanting my jog or my air conditioner hardly reflects a new sentiment for anyone who works in global health. We all come bearing our guilt alongside our aspirations in search of a healthy dose of self-sacrifice.

My students want to graduate from their program and hopefully want to learn in the process, but what exactly do I want out of this? I want the students to have my words in mind when they sit across from a patient with PTSD, to see my image when deciding how to handle a patient’s suicidality. I want to leave my mark, to be special.

But, if I really want to be special, I would not barnstorm through countries like Liberia for one to two weeks every year or so like a traveling extravaganza. I would immerse myself in them the way I immerse myself in the lives of my American patients. I am miserly when it comes to the time I give to Liberia and other international “partners” of the global mental health program I direct from a tower in New York with a view of the world.

Meanwhile, back in that city, I bask in a different kind of uniqueness that comes with being a global psychiatrist. My more earthbound American colleagues marvel at my globetrotting. But, I am just the frontman for the sacrifices made by my family, my patients, and my colleagues.

I am a performer on a stage situated between two audiences, with each serving as an eye-catcher of a backdrop for my performance to the other. And maybe this is more of a virtue than a confession. If I need the globe as much as it needs me, then maybe we are equals?

I hope such humility holds. Global health professionals like me who pivot back and forth between home and abroad risk megalomania. My capacity is finite, but my ambitions approach infinity. In wanting some “special-ty” and not just a specialty, I ought to beware of what I wish for. As long as I want it all, my Liberian students will not have a chance to learn about my family, nor I theirs. And, I will remain Uncle White Man.

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