Such a Time of It They Had: Global Health Pioneers in Africa

Book Title: Such a Time of It They Had: Global Health Pioneers in Africa

Book Author: Raymond Downing

Publication Information: Nairobi, Kenya, Manqa Books, 2018, 350 pp., Kindle: $3.50, paperback: $12.63

Humility and an open mind are two necessary characteristics for true success in any physician’s career, but particularly one in global health. Raymond Downing, MD has both of these qualities, and uses them as a lens through which to view the long and sordid history of medical missions and global health in Africa up to present day. Through his collection of snapshots of mostly white European doctors coming to Africa on missions to “save the natives,” he draws striking parallels between 1 to 2 centuries ago and now, forcing the reader to face the distasteful—but familiar for many of us—notion that not much has changed. From colonialism to donor-driven health campaigns, how much of the global health work that is done is helpful and how much is harmful; and even when we deign to ask this question in earnest, how often do we seek an answer that comes from the African and not the western perspective? Given how little of what we do has changed in 200 years, the answer has got to be, “Not nearly often enough.”

Dr Downing, a family medicine physician, has decades of global health experience on which to reflect. Although my own global health experience only started in 2007, since my very first time working abroad I’ve questioned the utility of what we do as global health workers. The past decade for me has included working domestically in west, and northeast Philadelphia, east Baltimore with homeless populations, with immigrant populations, and abroad in southern Africa, South America, and the Carribean, multiple courses in bioethics, dozens of lectures and books on global health, and work with two of the most ethical institutions in the world, and yet the same question remains in my mind.

Such a Time of It They Had is uniquely written in punctuated style with short modern anecdotes of Dr Downing’s personal experiences, juxtaposed with selected poignant excerpts from history. In this way, while it might have been easy for the reader to dismiss the insanity of what was done centuries ago as the ignorance of the times, when faced with the similarities of what is being done in our own time, the reader is forced to acknowledge that not much has changed. The book is not meant to be a comprehensive history of global health in Africa, nor is it meant to be a medical text, although without knowing it the reader will certainly learn a bit of history and medicine. Each chapter is its own story, but the stories are woven together with the touch of an experienced writer and come together at the end to reveal the larger picture to the reader. It is quite beautifully done.

While eager medical students and residents might not find this to be the most “high yield” study text, they will find it enjoyable, and as a faculty member preparing students for global health experiences, I will add this to my must-read list. It is one of those rare books, that if the reader pays attention and internalizes the message, they will be blessed with wisdom beyond their years and will be spared some of the growing pains that necessarily come with global health for those who truly wish to practice it in an ethical and thoughtful manner.

White westerners have made, and continue to make many missteps in our quest to “help” Africans. I fear that this will not end with the publishing of this valuable text, yet I hope that it will be one more roadblock to those who might otherwise barrel recklessly forward in their own attempts to “save the natives,” as it is clear from both this text and centuries of experience that with this sort of global health, we sometimes do much more damage than good.

On a positive note however, it is my guess that in spite of what this book says about the state of global health over the past few centuries, as one of a handful of recent thoughtful publications on this issue it signals a ray of hope that perhaps we white westerners are truly starting to rethink our approach to global health.