OP-ED
How to Engage in Health Cooperation in Africa (and How to Share Your Experience When You Return)
A brief, tongue-in-cheek guide to help readers navigate the prejudices and stereotypes inherited from the colonial mindset that weigh us down when we work in Africa, based on the authors’ on-the-ground experience

In the early 21st century, Kenyan writer Binyavanga Wainaina published an ironic and incisive article:How to Write About Africa. In it, he played on clichés about the continent to offer a kind of lucid guide to the prejudices that spring to mind spontaneously when we refer to it. Drawing inspiration from that text, Desmon T. Jumbam, a specialist at Harvard University, repeated the exercise, this time applying it to the field of global health, to denounce with similar rhetoric how we fall into the very same traps that Wainaina satirically exposed. Reading both articles is a difficult exercise for those of us who have been to Africa repeatedly, both as visitors and as workers.
In fact, this is the main arena where we carry out our work. And it is complicated because we are not immune to having made the vast majority (perhaps all) of the mistakes reflected in both articles. Yes, we have been those white people who have found themselves trapped in a vision of Africa where “the heart of darkness” beats. Those of us who, just a few days after arriving, thought we were capable of conducting a medical analysis of an unknown disease, or of understanding the social context to address the needs of those African populations we would henceforth call “vulnerable.” Based on the articles by Wainaiana and Jumbam, we have developed a brief introductory guide for anyone who wishes to tread the same paths we have. Let’s begin.
In your cover letter to the host organization, don’t forget to write something like, “This is my lifelong dream; I’ve always wanted to do this; I want to make a difference.” You can also mention the existential void you feel living in Spain and that you’re going to Africa to find yourself (rest assured you will find yourself, and you’ll likely be surprised by the result). Don’t worry if what you need is time. You don’t have to give up your life for several years; two or, at most, three weeks may be enough to change the world. In that time, you’ll have already come to understand many things, including the complex interactions that perpetuate the cycles of poverty.
In your cover letter to the host organization, don’t forget to include something like, “This is my lifelong dream; I’ve always wanted to do this, and I want to make a difference.”
Before you leave, pack your suitcase carefully. Don’t forget to gather some medical supplies. Bring all kinds of medications: it doesn’t matter if they’re expired or if all the package inserts are in Spanish and no one there understands them. Everything helps, of course. Even two loose pills of any medication, a frayed bandage, or a single latex glove. That said, make sure to pack quality footwear, pants, and shirts—preferably safari-style—that will help you maintain your dignity amid the sweat of the tropical heat and become the super-volunteer you’ve always dreamed of being.
Once you’ve packed your bags, you’re ready to go help out “with whatever needs doing”—as we all know, in Africa anything goes, so you don’t need any experience. If you’re a pediatrician, nurse, or epidemiologist—even if in Spain you’d never dare to perform a C-section, drain an abscess, set a fracture, prescribe treatment for an unknown illness, or criticize the decisions of more experienced colleagues—don’t worry: in Africa, all of that is possible. Because what’s needed there is knowledge and doctors—in general—regardless of what you’ve done before.
As for the paperwork beforehand, you don’t need to go through the long and tedious process of having your credentials validated and becoming licensed as a healthcare professional. You’re white, you’re from Europe, and that’s enough. So don’t overcomplicate things—just enter on a tourist visa. Use it to visit the children’s wards every day, with a somber expression and a nervous smile, but of course, don’t miss the chance to visit a lush natural park or a paradise-like beach over the weekend.
But for an aid worker, there are more exotic experiences than watching animals on the savanna or diving among whales. So once you’re there, don’t miss the chance to witness, for example, the reality of childbirth without medical equipment, without anesthesia, and with limited assistance—just as it was done here in the past. Don’t forget to take photos showing the mother’s face contorted with pain (and joy, of course) and the baby’s cries. Pick up the newborn baby and pose with it to post on social media with a caption like “there is light in the darkness” or “joy in the midst of sadness.” Of course, you don’t need to ask permission to take the photo or post it online (you’ll do it as soon as you can because you’ll be immensely grateful to be able to disconnect from your phone and social media).
But if that’s not possible because the baby was born in respiratory distress and needs resuscitation, focus and get to work: there’s no need to ask the parents what they want to do, since you know more than they do and what’s best for their child; you’ve already decided to go all out (not to mention that you won’t miss the chance to “get some hands-on experience”). In the other wards of the hospital, don’t ask your colleagues for help either. Remember that you’re always right; you’re a European healthcare professional and you know more than the doctor who was trained (precariously, of course) there. Even when it comes to those diseases you’ve only ever heard about in passing, like malaria, HIV, or tuberculosis. Don’t follow local protocols either; don’t waste your time getting to know them—you already know they’re, like, obsolete—so just apply your own, which are always better.
There’s no need to waste painkillers or overmedicate patients; Black people are tougher, and since they’re used to it, they can tolerate pain better. And when you’re faced with a skin lesion, forget that during your training you never even knew that skin tone existed—just be decisive. You’ll likely find a tattered colonial medical book lying around with a title something like “Dermatology in Black Skin, Dark Skin, or Non-Caucasian Races.” There you’ll find everything you need for a crash course that will spare you from having to say what you’re really thinking: “You can’t see erythema on black skin.”
There's no need to waste painkillers or give patients too much; Black people are tougher, and since they're used to it, they can tolerate pain better.
Is Africa the ideal place to conduct research? Perhaps. In any case, you might be surprised to learn that studies there must also be approved by ethics committees, and that patients are equally required to sign and understand what informed consent entails. And when preparing a study, be outraged by the customs procedures that always hinder its progress: it’s hard to understand why they won’t let you travel with medications for those studies on the outbound trip, or why they make it difficult to check in biological samples on the return trip. Because you’ve gone there to conduct research—something Africans don’t care about, as busy as they are with providing care.
As for attendance, he criticizes the apathy and lack of interest shown by your colleagues, who live there full-time, earn very little, and are subjected to the pressure of working with limited resources and in an unsafe environment. Call them lazy when you go there for 10 days and work 12 hours a day, while they’ve been dedicating more than eight hours a day for over 20 years and now refuse to work 12. If they ask you for money for overtime, talk to them about altruism and self-fulfillment. And while you’re with them, use them to help you collect data and make it as easy as possible for you to carry out those studies they so desperately need from you. Then, however, don’t worry about including them as authors of the article you’ll write—a simple thank-you will suffice. And if you do decide to add them, never place them first or last on the list.
When you return, talk about those who lacked motivation and neglected their work. But don’t talk about those who are revolutionizing their countries with their ideas, leading innovative projects, or putting their lives at risk by speaking out against injustice. On the contrary, keep portraying Africans as people without initiative, who are just waiting to be saved by white people and their redemptive missions. Because remember: keep in mind that in Africa there are few doctors, and those who are there have little training.
Don't waste your time looking for top-tier hospitals with state-of-the-art technology. And don't even mention the excellent surgeons who perform complex operations. They're nothing like those other white-coated surgeons who carry out intensive campaigns and save thousands of lives in just a few days. In fact, don't hesitate—if you ever get the chance, join one of their campaigns and go for your share of the saves.
Whatever you do, keep in mind the importance of giving back: if it isn’t shared, it hasn’t happened. You have a moral duty to the vulnerable. So give a talk at the hospital where you trained or at an NGO in your city; grant an interview to a newspaper or a TV station; and, if you can find the time, write an article or a book about that experience—one that, if not others’, has certainly changed your life. In any of these situations, maintain a dignified yet heartbroken demeanor, because you have been deeply affected by what you’ve seen and don’t know how to convey it fully.
Whatever you do, remember how important it is to speak up: if it isn't reported, it's as if it never happened. You have a moral duty to the vulnerable.
What’s clear is that you feel like “you could have stayed there.” But what matters is that you reflect on and thoroughly analyze what you’ve experienced. By now, you must know that the suffering of Africans stems from the misuse of power and privilege. And that can only be blamed on racism, the colonial legacy, and their patriarchal societies, condemned by their glaring lack of diversity. Under these conditions, the country’s progress can only be attributed to cooperation programs with the First World: if hunger has decreased in a region, for example, have no doubt that it is because of that white organization that has set up a vegetable garden or a nutrition center just a few meters away.
But whether or not you mention hunger, don’t forget to highlight the Africans’ smiles and reveal to the world that “they’re happy with nothing.” Don’t miss the chance to talk about the African rhythm, so slow and so different from ours, because “we have watches, but they have time.” And don’t forget to mention how grateful they are, because no matter what you do, they’ll always thank you and appreciate your efforts. For your part, ignore their progress resulting from local programs and community work (note: this is an indispensable term in any formal or informal conversation, both in the field and upon your return).
Back to the article, interview, or talk. End any of them with an African proverb, but don’t hesitate to include a quote from a contemporary African writer (Chimamanda Ngozi Adichie is a perfect choice); reference your musical knowledge by sharing what moves you, such as a traditional instrument like the kora; or acknowledge, in a moment of humility, that the continent’s diversity is beyond your grasp because it’s impossible to fully encompass it.
As for the proverb, here are a few suggestions (you don’t have to understand them): “If you want to go fast, go alone. If you want to go far, go together.” Or this one: “Until lions have their own historians, the stories of the hunt will always glorify the hunter.” In any case, if you don’t want to mess up, go with Nelson Mandela—it’s a sure thing: “Let freedom reign. The sun never sets on such a glorious human achievement.” One last thing, but no less important than all of this: never forget to show yourself in a photo surrounded by children.
All my articles on Planeta Futuro

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A brief, tongue-in-cheek guide to help readers navigate the prejudices and stereotypes inherited from the colonial mindset that weigh us down when we work in Africa, based on the authors’ on-the-ground experience

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