Flipping the Script on Compassion in Global Health

Heather Buesseler

Heather Buesseler

Global health professional and FACE consultant

“Working with compassion is the first step toward someone’s healing. Your mind is at peace so the medicines can work properly.”​

You might expect this comment from a chaplain. Or perhaps a nurse or an idealistic future physician. But this comment came from a Finance and Admin Assistant during my trip to visit Nama Wellness Community Centre (NAWEC), a community health service provider in rural Uganda.

This finance assistant wasn’t the only one at NAWEC with such profound wisdom about compassion. Staff throughout the organization reflected on the role of compassion in their work:

“Healing is about more than just giving medicines. Sometimes [the patients] just need someone to talk to.”
“Compassion motivates a sense of belonging, and you find comfort with those you work with.”
“It helps clients feel more comfortable to open up and share more information so the treatment can be better."

As my visit unfolded, it became clear that the staff’s understanding of compassion extended far beyond their words. I saw this team truly embody compassion. I walked beside one of Nama’s community health workers along miles of red dirt roads under the sweat-drenching, noontime equatorial sun to check on the health of her neighbors’ children. I observed the intentionality of Nama’s community nurse as she modeled compassionate care to a government health worker, rather than deriding the worker for the impatient aloofness with which she treated the patient.

“Our facility is too far for them to reach,” explained the nurse. “If the government health workers are rude, they may not seek services at all.”

After a three-day visit in Uganda, I traveled to Lamu, Kenya, where the remote communities that pockmark the archipelago—some as small as 200 people—rely on boats to access basic goods and services, including healthcare.

There, I joined Safari Doctors, another community health service provider, on one of their “outreach weeks.” The team loads up a speedboat with staff and medicines to provide basic primary care and chronic disease management to these communities. They wade in and out of the boat several times throughout the day, hoisting heavy boxes of medicines up sand dunes, sometimes transferring to rusty 4x4s or donkeys (a primary mode of transport in Lamu). They deliver care to long lines of community members in oppressive heat and humidity without so much as a lunch break.

I was exhausted by the time we reached the guesthouse at the end of the day, and I hadn’t even taken a single blood pressure or doled out a single prescription. Over dinner, I asked the team why they do this work and what keeps them going.

“The happy faces,” said Harrison Kalu, a retired army nurse and wizened staff member. “When community members say, ‘Thank you for remembering us,’ it is enough.”

“The feeling is more than when I get paid,” explained Jonathan, another nurse. “We are their only hope.”

As we went around the table, I was astonished to learn that one of the nurses was a government health worker volunteering with Safari Doctors during his leave days. He said, “I get more energy working with the community than staying home.”

What became clear from the conversations at both organizations was that despite the extreme conditions and remote locations, these staff and volunteers sacrifice their personal comfort to alleviate the suffering of their fellow community members. But they don’t see it as sacrifice. They respond to suffering as much to improve their neighbors’ lives as for the good feelings generated internally in extending this deep compassion.

As the field of global health explores how to re-center, prioritize, and scale compassion, we’ve leaned on typical problem-solving approaches—conducting literature reviews, convening expert panels, and offering trainings in compassion cultivation. These efforts are typically organized by WEIRD (Western, educated, industrialized, rich, democratic—and predominantly White) institutions and are offered to those working in low- and middle-income countries in the global South.

There is value in these approaches. However, there is also a risk that relying only on these approaches to diffuse compassion will entrench it in the same colonial structures and power dynamics that still govern so much of global health—which is antithetical to the very nature of compassion. This will only cause more suffering, as it continues to perpetuate systems of oppression.

Instead of designing compassion cultivation trainings or initiatives for organizations like NAWEC and Safari Doctors, I couldn’t help but think that what we should really be doing is learning from these organizations.

How might we simultaneously re-center and diffuse compassion throughout our discipline while also designing new ways of working in our field that promote human flourishing? Compassion is inherently a relational process. So we need relational, emergent, co-creative approaches to design for it.

At the Focus Area for Compassion and Ethics, we are experimenting with new ways of operationalizing and systematizing compassion in health delivery organizations around the world. Through funding from IZUMI Foundation, we have embarked on a two-year human-centered design engagement with NAWEC and Safari Doctors to address the question: How might we strengthen the compassionate structure and systems of the organization and nurture compassionate engagement with those they serve?

Photo by Thomas Cole

We look forward to sharing our insights and observations about this unique experience in future installments!

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