Global Health Means Listening

Book Title: Global Health Means Listening

Book Author: Raymond Downing

Publication Information: Nairobi, Kenya, Manqa Books, 2018, 163 pp., $7.80, paperback

The title of this book says it all: global health means listening.

Listening. This is the lesson Dr Raymond Downing has for anyone from the United States working in global health, in any setting, wherever in the world they may be. Listen to the “other peoples” of the world. Hear their stories. Value their perspectives. Learn from their histories.

Who are these “other peoples?” In Africa, where the author has spent almost all of his family medicine career in various practice, educational, and administrative capacities, this means Africans living and working in Africa. In other parts of the world, this means those living and working in their home countries, including local professionals who are engaged in direct patient care, health systems development, and daily life in all its complexities.

Why is listening important? Dr Downing explores this question repeatedly in his book, giving insights from four distinct points of view emergent from his 30 years’ work on the African continent. First, based on his own personal experiences, listening is crucial to understanding interpersonal and cultural differences. Second, based on the politics of HIV in the particular context of Africa, it is vital to grasping that our Western technological fixes address only one facet of the AIDS epidemic there. This rigid focus of attention has severely limited our ability to appreciate other social and structural aspects of the problem. Third, based on the early development of family medicine in Africa, it is essential to envisioning and promoting a discipline rooted in local values and needs. Last, based on his own spiritual foundations—for many years Mennonite or Quaker congregations have supported his work in Africa—listening is necessary to grasping the shared significance of suffering, the value of collective well-being, and the profound sense of worth that healing in community with others offers.

How can we best listen? Dr Downing suggests we might best accomplish this task by paying less attention to measurable goals in health outcomes and relying less on our technological capabilities as ends in themselves. Instead, he advises, we might do better by paying more attention to our relationships with others, noticing how those relationships change our perspectives. We might listen better by relying more on finding meaning through the expression of appreciative respect as we work to fulfill our calling as physicians.

Readers expecting stories of a heroic adventurer guided by missionary zeal–someone out to save the world—will be disappointed by this book’s contents. Throughout, Dr Downing portrays himself more as attentive observer than interventionalist actor. His words shed more light on his attempts to comprehend health care in Africa than on any answers about how to improve it. More than anything, they convey a certain reflective sadness. We miss so many opportunities to listen because of the ethnocentric belief that we have what everyone else in the world wants, and taking it upon ourselves, through the guise of medicine, to be deliverers of those supposed gifts.

Dr Downing sums up his lesson of listening using words that thoughtful family medicine clinicians and educators involved in global health activities will readily identify with:

Health means wholeness—the words have the same root—and people are whole only when their physical lives are in harmony with the routine of life in their families and their communities. Global health does well in understanding physical lives, because that part is more or less the same throughout the world. But societies and cultures are very different, and global health can only understand these by listening.

Those who want to understand this perspective, and grasp what lies behind Dr Downing’s conclusion that “global health that listens is truly global,” would be wise to read this book. Others looking to enter into any kind of global health activity would be wise to read it, too. It just might help us all open our ears to hearing what wisdoms exist around the world and learn how we can grow our wisdom, as well.