Ida Whiteman is a paediatric registrar and Global Ideas volunteer alumnus. She wrote to us from Malawi to share stories from the coalface about what drives her work in global health.

Careers in global health so often start with seeing the raw face of social injustice up close and personal.

My global health journey began in the Port Moresby General Hospital, in Papua New Guinea, as a third year medical student. Walking into the ward on the first morning I saw a woman in labour, alone, the baby’s head crowning, and the mother in the grips of a violent eclamptic seizure. This just wouldn’t happen in Australia. I was confronted with this stark contrast in the experience of health between Australia and PNG, our closest geographical neighbour.

Within two weeks I had seen women bravely facing labour without pain relief or a birth assistant, placental insufficiency due to chronic malaria, and parents assisting to bag-mask ventilate their own children due to a lack of functioning equipment. I won’t forget the little girl who was eight years old, but due to untreated congenital hypothyroidism looked no older than three. And a boy dying of rheumatic heart disease whose family couldn’t afford to fly him to Cairns for life-saving heart surgery. I came home to Australia with a steely determination to work towards improving the lives of people left behind.

In 2015 the earthquake crisis in Nepal left almost 9,000 Nepalese dead. I attended with an NGO that had deployed in Nepal in the past and knew how to access severely affected Himalayan villages on foot. On day two in Suri, a village in which we had set up a makeshift clinic, I saw a nine-year-old girl with a large abdominal mass and weight loss, unrelated to the earthquake. Multiple discussions about how to approach her workup (further testing which was impossible locally given the resources in the village) resulted in the ultimate decision to provide her parents with some money to hike to the nearest hospital and obtain blood tests and imaging studies. A very clear referral letter was written. Several days later the healthcare worker who escorted the family to the hospital hiked two days further to Kathmandu to provide her test results to us by hand. Unfortunately, the wrong studies had been done, and the child and family had spent the money and hiked back to Suri.

This was a blow, but what did I expect? The problem here wasn’t only that this girl didn’t have a diagnosis, it was that a combination of poor infrastructure and lack of access to healthcare meant receiving basic healthcare services was two days difficult hiking away with no option to attend by road. This experience raised a lot of questions for me. What is the role of foreign aid in the crisis setting? Is it wrong to apply our expectations of healthcare in another country? When does foreign aid become a short-term solution that doesn’t address the underlying structural issues? I felt motivated to learn more about influencing the socio-economic factors driving poor health outcomes, rather than providing a temporary clinical service in times of need.

These upstream drivers of health inequities also operate right here in Australia. In 2014 I moved to Darwin feeling optimistic about working in indigenous health but quickly came to appreciate how difficult it really is to achieve lasting change. It takes time to understand the complexities of the situation. I believe solutions lie in programs that focus their efforts on children, engage local Indigenous leaders, and have a long-term approach. It is imperative to understand the needs of a community through local interaction over a long period of time, and I hope to return to the Northern Territory sometime soon to gain further insight into taking action on indigenous health inequities.

My career path has now led me to Africa where I’m working with Specialists Without Borders: an Australian-based organisation that runs health education programs in Malawi and Zimbabwe. We teach the topics local students and doctors request, and where they feel there is a gap in their own training. Two days ago, after running a neonatal resuscitation session with local nursing staff, one of them looked at us and said “I am often alone when babies have an arrest, and it is hard to get help. Now I have the skills to know what to do”. It’s feedback like this that makes a career in global health its own reward.