Global health work: Reflective practice and the joy of letter writing

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By Saqib Noor
I remember lying in a flimsy hammock, hung between two tall raphia palm trees, swinging gently under a glistening African night sky. I counted the stars as they popped in and out of focus, trying to gather a semblance of meaning in all that I was experiencing in my year-long work as an orthopaedic officer in KwaZulu-Natal, South Africa. The year was 2008 and it was my first real experience of working as a doctor abroad, far away from the smoggy urban areas of my homeland in the Midlands, UK.
As I swung, gazing upwards, I began recalling moments of my travels that had changed me, that I was unprepared for and all that I was learning. The unprecedented and mindless violence I witnessed on a daily basis, perpetrated by fellow men upon each other, or the consequences and complications of HIV amongst children were some of the more shocking scenes racing through my head. I also pondered on the wonderful people I had met along the way throughout the country and how I palpated similarities between all of us – that no matter our backgrounds and cultures, whether rich or poor, we shared the same heartfelt smiles, lofty laughter in happy moments or colourless tears in times of epic sadness.
Most of all, I recognised how I was growing during my time in South Africa, rapidly evolving from a young surgeon, still in the early flight of training, into a more hopeful, inspired man – despite witnessing the discrepancies of global inequality in healthcare and wary of the enormous challenges.
It was after that quiet contemplation, under thousands of dazzling stars and a thousand thoughts shooting within my head, that I began to write my letters home, to my friends and family, describing all that I was feeling and how my work abroad was changing me as a person.
Since those early days, I began to use letter-writing as a way of coping through the immense difficulties of the global health care projects I became involved in over the next ten years of my life. These difficulties are the same challenges that we must all face as we contemplate and embark on a career in global healthcare. The letters became a part of my journey, and without the ability to write outwardly, I felt trapped within my thoughts and emotions. Writing was my escape.
I remember in Haiti, lying awake each night, drowning in thoughts of the previous twenty-four hours, and could only find sleep when I had managed to type out all my thoughts onto a very old phone, sending out my letters like a giant text message.

Equally, in Pakistan, one of the moments I truly broke down was when my laptop had been corrupted by the power supply, meaning I could no longer write my letters home.

Within our own psyche as healthcare workers abroad, there are massive moral, physical, ethical, emotional, intellectual and legal challenges that we must continuously overcome. We all want to contribute to a better world, but we all are riddled with doubts – whether our work is truly meaningful, whether we are contributing at all or indeed a hindrance to any aid effort. We often transport ourselves into unknown cultures, inhospitable climates, unfamiliar surroundings and even as the joys of work may seem rewarding, we too find times like we are beaten.
These emotional highs and deflating lows are natural to all of us. As healthcare workers, the emphasis on reflective practice is highlighted now more then ever – to recognise our weaknesses, embrace our strengths and learn positively from all we are experiencing. Writing my letters allowed me to reflect personally, for I always knew the letters were truly written only for me to read again one day when I become a forgetful old man with a straggling beard and struggling memory. But they also allowed me to share the journey and my burden to anyone willing to join me on my travels, and was a form of reflective therapy I recommend to anyone who also wishes to release their innermost thoughts whilst gazing silently, in a swinging hammock, at a beautiful African sky.
About the Author: 
Saqib Noor is an orthopaedic surgeon from the UK and published author of the book, “Surgery on the Shoulders of Giants – Letters from a doctor abroad“, a heart-wrenching yet uplifting account describing his global health and surgical experiences in multiple countries, including the Haiti earthquake and Pakistan floods of 2010. He can be found on Twitter: @saqibnoorcom.