Africa is a continent not a country

Last month, October, I was teaching at an anesthetic meeting in Washington, DC. While I was there I attended several sessions relating to education and safety in Anesthesia. Some related to the use of simulation and checklists in western education; others related to teaching in low income settings. Most of these sessions were excellent, full of dedicated professional people, sharing ideas and desiring to see progress and equality for all in access to education and standards of healthcare that benefit all people everywhere. Much of it was hugely encouraging and inspiring.

There was also talk about standardising both training for the trainers so they were 'acreditted' before they taught overseas; as well as standardising what was taught ie the curriculum. While I unreservedly applaud these efforts, something in me is unsettled. I find myself wondering why people talk of Africa, or other 'low income countries' as all the same? Why do some people 'lump them all together under the same umbrella?' Africa, Asia, South America etc are vast continents with widely differing cultural values and expectations, resources and unmet needs. How can they, let-alone why would they, want to be treated the same? European countries have different standards of education and curricula, and these are different to the US and Canada; Australia and New Zealand etc. Standards are good, but 'standardisation' is not the same thing.

Furthermore, why should we in the West dictate what others need to learn? Western medicine has moved away from the paternalistic model of health care whereby the doctor tells the patient what is best for them and makes the decision. We now have an approach based on patient autonomy and informed choice. I find myself wondering if the doctors paternalistic approach is now manifesting in another format, dictating to Africa (or other low income countries) what they need and how they should be trained. Why not let Africa tell us how we can help?

It is easy to forget that Africa is a continent not a country. Africa is a huge place see the picture below. All the countries that make up the continent of Africa are vastly different, just like different European countries are different. I have spent time travelling in several countries in Southern African (including working in one) and have visited one country in North Africa.  With Mercy Ships I have worked in five West African countries, both the Francophone counties of Togo, Benin, and Guinea, as well as the English speaking ones of Liberia and Sierra Leone. Last month I made my first visit to Central Africa, visiting the Republic of Congo, otherwise known as Congo-Brazzaville to distinguish it from the Democratic Republic of Congo (DRC). Each one is very different. Yes, there is room to improve standards of healthcare, but I am not sure 'standardisation' is what is needed.

I was in Congo as part of a preparatory team for Mercy Ships visit in August 2013. We were doing some diplomatic and logistic work, as well as assessing their medical training needs in the areas where we have expertise, in order to see where we can best be of benefit. Mercy Ships has a lot of experience in West Africa, but one thing we were very aware of, was the culture in Central Africa is very different. Things which have not worked well in West African countries may indeed work well in Congo for a variety of reasons. The reverse is also true.

Mercy Ships and I, will need humility, courage and love to succeed in this new place. Humility to listen to what the Congolese tell us and accept when we get it wrong; courage to try different ways of working and change our existing practices where necessary; love for the people of Central Africa and especially Congo. Because if love is what motivates us, we will ultimately succeed, because 'love covers a multitude of sins'. Love overcomes the paternalistic attitude, the pride and boasting, and egotistical talk that says we know what is best.

"Love never gives up. Love cares more for others than for self. Love doesn't want what it doesn't have. Love doesn't strut, Doesn't have a swelled head, Doesn't force itself on others, Isn't always 'me first,' Doesn't fly off the handle, Doesn't keep score of the sins of others, Doesn't revel when others grovel, Takes pleasure in the flowering of truth, Puts up with anything, Trusts God always, Always looks for the best, Never looks back, But keeps going to the end." 1 Corinthians 13: 4-7 (Message version)

I want to help the countries where I serve to improve their standards not give them a standardised approach. I know I need humility, courage and love. And I think this probably applies not just to me in the continent of Africa, but to all our situations, wherever you are as you read this. Humility to admit our mistakes, courage to break new ground and overcome adversity, and loves that keeps going to the end.