The Global Citizen: Amaka

On this week’s episode Victoria revists the idea of the Global Citizen, as she is joined in conversation by Amaka, Global Health Fellow and obstetrician gynecologist. They talk about their experiences globally and their journeys into the field. From Naija to Cyprus to Greece and beyond, the ladies recount some of their most interesting experiences as Americans, black women, and clinicians “abroad”.

Listen now to the penultimate episode of Season 1.


Welcome to our shift 🩺 🎙 




Follow us on  Twitter @deliriumshift and Instagram @NightShiftDelirium 

FOLLOW US ON IG @NIGHTSHIFTDELIRIUM FOR MORE!


https://linktr.ee/Nightshiftdelirium?utm_source=linktree_profile_share&ltsid=f5ef1512-eca8-44f6-879f-21ff9144d4ad

Transcript

Victoria [00:00:04] Hey, welcome to Night Shift Delirium, a podcast about junior doctors and the world that surrounds them. 

Victoria [00:00:12] I'm Victoria, your host, a junior doctor based in England. And on this week's episode, we'll be chatting with Amaka who you all heard from earlier this season on our covid-19 episode with Theresa. We'll talk about what it means to be a Global Citizen and what led each of us to our current roles in global health. This is a long one, y'all, but it's our second to last one. So enjoy and welcome to our shift. 

Victoria [00:00:43] Welcome to night shift delirium. Today, we're doing an episode on the Global Citizen with Amaka. Do you want to introduce a bit of yourself? I think people have already heard you in previous episodes, but in case this is their first episode.. 

Amaka [00:01:01] Absolutely. So my name is Amaka. I'm currently living in Boston in the United States, and I am doing a two year fellowship in global obstetrics and gynecology after having completed my obstetrics and gynecology residency. 

Victoria [00:01:16] Awesome. OK, great. So how would you describe the global citizen? 

Amaka [00:01:24] So I think being a global citizen is really a lot about a curiosity and an awareness. And I think those are the two things that have motivated me and driven me in this path that I've been on. I think in so many ways how much of who a person is, whether it's their gender, their race, their religion, their culture, impacts their health to health outcomes and as well as their health care seeking behaviors and the ways that we deliver care. 

Amaka [00:01:56] And so that curiosity to understand that and use that as a way to improve the way that we deliver care to various communities is what has sort of motivated me to pursue a career in global health. 

Amaka [00:02:08] And I really think that awareness or that and the curiosity about people who are from different parts of this world, whether it's within our country or in other countries, is the primary driver of that for me personally. 

Victoria [00:02:22] Amazing answer. I have nothing to add. 

Amaka [00:02:27] Hahaha, literally, never heard those words from you before. 

Victoria [00:02:37] OK, I see your point and again, nothing. So where have you been? Globally. 

Amaka [00:02:48] So of course, I was born and raised in the United States. I have lived in various parts of the country. I grew up in the Detroit area and Michigan. I went to college in St. Louis, Medical School in Philadelphia, residency in Chicago... And now I'm in Boston for for my fellowship. So at every stage of my training and education I have relocated. And through that, I think been a part of our delivered care in multiple different settings as part of my medical education and training as far as places outside of the United States have been and almost every continent except for Antarctica. But as far as in health care delivery, I have spent some time in Ghana. I have spent some time in Nigeria and then spent time in Uganda, as well, so mostly on the continent of Africa. 

Victoria [00:03:41] Are there any sort of, I guess, themes that you've noticed in each of these communities of disparity or I mean, you've been in cities, in the States and a lot of different types of, I don't know, presentations of cases of interpretation cases and things like that, as well as your experiences outside of the states. Is there anything that you've noticed that sort of, no matter what in certain communities, are some things that are more true? 

Amaka [00:04:14] I don't know. 

Amaka [00:04:14] I mean, I think that a lot of times the challenges of health care delivery, if you like, boil them down to their core, are often the same in different countries. The communities affected look different, but the same issues are there at their core. And the way that it manifests may look different, but they're really all the same. I think one thing that drove me to be interested in obstetrics and gynecology is that I'm really interested in the health of women. 

Amaka [00:04:47] And so often women's health is really affected by women's status in a community and a culture and a society. And unfortunately, in a lot of ways that is the same around the world, that women are often times to various degrees or second class citizens, and that extends into their health. And also, women are often in charge of the health of their households, including their children, and so are often an excellent way to target health related interventions at the household level, too. 

Amaka [00:05:23] And I think that that is true to some extent in every place in the world that I have been. 

Victoria [00:05:30] Amazing. I definitely I definitely resonate.. Some of what you said really resonates with what I also think and sort of have been exposed to in terms of women's health being...not a priority culturally, and yet they hold so much power and I think that they really serve as a good access point to a community. On a micro level to a macro level. There isn't a place where a woman's place is absolutely key to the success of the region or whatever. So I definitely, definitely agree with that. Are there any things that inspire you to go to certain communities? Like you spent a lot of time in Africa...  

Amaka [00:06:23] Yeah.

Victoria [00:06:24] When you are looking for a project or you're looking for a community to get involved in, what calls you there? 

Amaka [00:06:30] Yeah, I think that's a good question. And I think that that has sort of changes with time. I think there is a combination of responding to a call or to an area where there is need and thinking about what are your best, your skills that you have that you can potentially share with that community. But also like, what are you potentially going to get out of that community as well? It's always a two way street for me. I am the Nigerian. I'm the daughter of Nigerian immigrants. And so in a lot of ways, Africa and West Africa. But like that that history is part of my history and my personal family history. So I know that I do feel a personal connection there just because it's so close to my personal identity and a huge part of who I am today. 

Amaka [00:07:24] So I think that has been part of that call for me is is a connection to that part of the world for that reason. 

Victoria [00:07:34] Yeah, definitely, again, have a similar approach to where I'm interested in working, I'm from Ghana, where my parents were born and raised in Ghana. I was born in the States. And I definitely feel a call. In many ways to return to Ghana in some way, in some capacity, not because I've got the answers to anything at all, in fact, I'm one hundred percent certainty the people that can teach me a lot more than anything that I could bring to them. But I definitely feel a connection to the culture. So I have done a little bit of work in other places. And in Peru is probably where I spent the most amount of time. I'm outside of Ghana and while I absolutely love and adore Peru, like so much the people, the culture, the language, everything, there's something that is missing at times when you're foreign in a way in another country, it can be difficult to sort of bridge those gaps. And not that that doesn't happen because in time and with working with the right people, you can definitely very easily work and be useful in those communities. But it can be challenging initially and. [Absolutely.] And when I went to Peru after, you know, I'm a black woman and after several instances where people assumed that I was a prostitute or I would dance for them or I would cook for them, I made a conscious decision. I guess it was 10 years ago now. Yeah, I made a conscious decision to sort of focus my energy on the continent of Africa, where people look like me. People don't have to I don't have to go over the burden of like I don't have the burden of trying to prove myself in many ways. I mean, I am a woman. So that definitely still plays a role. But it's not an automatic dismissal. Just because they see me and they make decisions like life doesn't have to be that hard. And I just choose to and choose to focus on those communities. And quite frankly, I think that my physical presence can go quite far in Africa and in Ghana specifically. 

Victoria [00:10:06] What are some what are some ways in which you've had to sort of bridge cultural divisions or boundaries,. 

Amaka [00:10:17] Thinking a lot about what you've said really resonates with me as well, like when you are walking into a country or community that's not your own. So this also applies within your own country. If you're walking into a community that isn't your own, you have to be cognizant of that, aware of it, acknowledge that and realize that you're not just walking into a random house, or a random place or a random clinic. You're walking into an entire culture and a social context that you need to actually learn. And my approach is always to like walk in with humility and start from a place of 'I'm trying to learn." I want to learn about this new environment, this new context before you go to like, let me tell you what I think this is what you need to do. You do this. You do this. I come from a place of humility. And first I want to learn. And I found that that really opens the door to like for me to be invited into communities. And while  in some ways you sort of just show up to a certain extent, you ultimately want to feel like you're being invited in those communities. I do think that being in Africa, among people who look like me and have to like I look similar to them gives me a little bit of an advantage in those situations for sure, because I think that a little bit less of that, like, why are you here and why do you care about what's going on here? Like, what's what's why is this why is this important to you or why are you here? And I think that that is an appropriate question for any community ask of a stranger who's coming in, even if the intentions are good. But why are you here? And I think we all are going to encounter that whenever you're in a community that's not your own and they're allowed to question that, you just have to have an answer for it. And so I challenge people to really to ask themselves, why am I choosing to go to this community or to this country? Like, what actually is it that is driving me there? Because you will be asked of others. And if not, you should be, for sure, asking yourself those questions. 

Victoria [00:12:39] Yeah, I couldn't agree with you more. I think that especially in the developing world, there's a very, very long history of exploitation. And so people are right when they question people's intentions and and even if someone feels that they're doing good. I think there's a difference between making yourself feel good about the fact that you're working in a low income country and the difference between building and working within a community to empower them to sort of work out their best. And that might not even be something that you contribute to them. Maybe you're just providing the manual labor, which is, I think, just as important as someone who's coming in with some big outline about what they're going to do. And it's absolutely essential that you approach it with humility. I mean, I think a lot of people travel to developing countries and automatically feel that because they are from a Westernized or we'll say like... a European or American kind of country, they feel that it's automatically better because at home this is what we do and they don't even have this. And look at that. And then you also can sort of easily drift into the into the area where you have pity for someone. And obviously to have pity for someone, you have to think that you're above them. You know, that's what we all learn in our training, the difference between sympathy and empathy. But I think often people don't see that. And for me, I mean, I think I don't know if you can speak to having any sort of coworkers or colleagues or in your experiences abroad where there were people. I mean, I think in global health, you see a lot of people who have savior complexes or people who travel all the way, you know, take long flights to different countries to empower, " empower communities." But within their own countries where there are many, many communities of disparity, they don't engage with them at all. And that's a very big disconnect for sure. 

Amaka [00:14:58] And I think that to me is like a big red flag on that individual. I think I've been lucky in that the mentors and people that I have worked with abroad have that is like their career. And it's not something that they do for like a week, a year they go and just like travel to X country and operate and do surgeries for a week and then just disappear. And then, you know, next October I'll be back at it again. And these are people who've done the work to embed themselves in the community and actually. 

Amaka [00:15:41] You are viewed by community members as a part of a permanent a big part, permanent part of their communities, and so I've really admired the ways in which people have done that. 

Amaka [00:15:51] But that takes time and it takes commitment. And it's not something that's done in a week or a month or two or three months, really. These are people who've spent decades working in a particular community. Do you have to be really interested in dedicated to putting in that time and doing the work? I do also think that you don't have to cross any body of water to find a vulnerable population. You don't need to do that to find health disparities. Those are in our country, in any city, in any rural, urban, wherever you go. Those communities exist. 

Amaka [00:16:33] And if you turn a blind eye to that, then I just question your motivation. And if you really get it, basically. 

Victoria [00:16:47] For sure, I think you've touched a bit on your mentors and people that you've worked with and along the way. What led you to to the field of global health, meaning like, was there someone that you saw? Was there an experience? How did you know it was a field that existed? And. Yeah, and that you could do it. 

Amaka [00:17:14] Yeah, I feel like that is sort of really intimately tied into my reason for pursuing medicine. So this may be a long answer, but they're just intimately linked together in a way that it's hard tease apart. 

Amaka [00:17:29] I think I said this to begin with, but I identify as Nigerian American being a Nigerian, being a child of immigrants is such a big part of who I am and my identity. And so that is something that I've always carried with me. I the majority of my family still lives in Nigeria. 

Amaka [00:17:50] And so I think from a young age, just having a global awareness that there are people whose experiences are different than my own, who live in places that are different than where I live. And some of those people are my relatives and people that I know very well. 

Amaka [00:18:07] And so I think that just opens your eyes to from a young age about how how much environment can affect what your life looks like. Because I have cousins who are the same age as me, who grew up in a very different country with different opportunities, different set of opportunities, whose lives just look different than mine. I think I also grew up in a very diverse environment in the Detroit area. I think it's a very diverse area. I went to schools with people from different parts of the world and different racial and ethnic and religious backgrounds. And so I think it just sort of from a young age breeds an awareness that I think is really critical to who I am and what I want to do. I my mother is a physician. She is a pediatric hematologist and oncologist. And I think being a doctor to me in the beginning was really linked to... I respect my mom so much. And I knew that a big part of her job was helping other people. And I so often as a child, remember multiple times where people would just tell me how wonderful my mother was as a person, as a physician, whether it was like she takes care of children. But like, I would go to work with her sometimes. And like the parents of her patients are just telling how wonderful she is, the like custodian at the hospital, like your mom. And so Doctor [redacted] is your mom. And I was like, oh, wow, that's apparently she's like a person who does touches people in a way that they feel so moved to talk about her all the time. And so I wanted to have that effect on other people. And so I think it was a privilege to see that. And so from a young age, sort of that was.. Those were my things. I wanted to touch people in the way that she seemed to be able to touch people. And I'm just aware of just other people's experiences and how do we pull these things together. So you do the things. You graduate high school, you go to college, you're premed. And for a while it's just you just are on the path. You just do the things, taking the bio, the chemistry, or go to medical school or do medical school. 

Amaka [00:20:21] And at a certain point and I don't think I ever like stopped to reassess, particularly as an adult, until I finished my third year of medical school. And at least in the US, that's your clerkship. Where you're rotating through all of the different specialties. 

Amaka [00:20:39] And at the end of that, you're supposed to pick one and then you apply to residency. And at my medical school at the end of your third year, there's this big meeting with all of the third year medical students who are all in one room with one of the deans. And he gives you this... He talks to you about applying for residency and gives you advice and all the stuff. And everyone in the room is buzzing and excited. And I did not feel that way at all. And I'm like. This isn't good. I'm supposed to be really excited about this new step and I'm finally going to be a doctor and I'm done with all of this, like this part of my training and education. And I just was like, I don't know if I'm supposed to be a doctor anymore. I don't know why I'm doing this anymore. I've never been someone who was fascinated by the science of medicine. I've had the mind for it. But that's not what motivates me. And I have classmates who are like, let's talk about physiology. Oh, my God, the heart and beta blockers and whatever, and get excited talking about pharmacology. And that's never been me. It's been like a means to an end. And so then I had to like, pause and be like, actually, maybe this is not I'm not supposed to do this. And so I actually made the decision to take a year off, which was a whole thing. I called my mom and she's like, what am I supposed to tell people that I'm like, tell them the truth. I'm taking a year off... Or don't, not my problem. 

Amaka [00:22:07] And I was like, I am going to use this year to explore things and like, remind myself why I wanted to be a physician in the first place. 

Amaka [00:22:17] Which is where global health came in for me in the first place and it came in as a global as a global is local sort of mentality, and so I reached out to a couple of people and ultimately got connected with the refugee clinic in Philadelphia at my medical school like Health System, which took care of refugees from all over the world who had been resettled and who'd resettled in Philadelphia area where I went to medical school and provided health care to them. And I spent some time in the clinic and we started talking about like, are we really doing a great job of taking care of women's health related issues? This clinic did a little research project and found out that we weren't and then actually just spent that you're designing a women's a refugee women's clinic where you would take care of cervical cancer screening with pap smears, breast cancer screening with mammograms, contraception, education and discussions. We held women's health groups where women would come together and facilitate a conversation just about health care issues with each other so that they could learn from each other and just have a space to have those conversations. 

[00:23:27] And so it's social but also educational. And I got to do some health care delivery and all this stuff. And I was like, actually, this is why I came to and this is what I want to do. And I was like, OK, I think this is the population that drives me. And I think I definitely am interested in women's health. I definitely want to be an obstetrician gynecologist and I'm really interested in catering to the caring for this particular population. But not everyone wants to take care of because there are a lot of challenges in delivering care to people who don't speak English as a primary language, who often either are publicly insured or uninsured. But this is.. This is why I'm here. So I, with that sort of spent that you're having that really sort of literally the best decision I've ever made for myself in my life. And I can do this medical school things. I finish med school apply to residency. 

Amaka [00:24:24] I got into residency. I went to a program that we spent almost a third of our time at a county hospital system in Chicago, also caring for a huge Hispanic immigrant population, which was like my favorite part of my residency training program, and I felt was really well rounded and ultimately decided that in order for me to feel like I could best care for that population in the United States, because that's what I want to do as well. 

Amaka [00:24:49] I needed to have some other information about how health care is delivered in other places in the world where a lot of these patients come from. And I think that that is not only do I want to help serve patients in other parts of the world, but I also want to get an education that I needed to feel like I could better care for those patients in the United States, which is an understanding of the health system. They come from how health care is delivered in other places and what lessons there are to learn actually from other health care delivery systems that we can adopt in our US health care system. So that is a long way to say that that is what is driving me to do what I'm doing today, and I think a lot of what I want to do also requires a little bit of like a public health background, because it's not just about clinical care delivery and also getting my master's in public health to go along with that. 

Amaka [00:25:40] So that's a long answer to your question, but hopefully I answered it my way. 

Victoria [00:25:45] I love it. 

Victoria [00:25:47] I will share with the listeners that I am obviously obsessed with you, we... Me and Amaka met many, many years ago in this summer camp. [laughter] So basically, it was a program for freshmen, I think, and sophomores who are in medicine. I don't know. There's some other stuff in there as well. It was very good, though. The girl that we did, the or the woman that we did the episode of covid-19 with was also someone that we met at the camp or whatever. 

Amaka [00:26:25] I mean, I want to refer to it as a camp, for me, it feels like it's just how many other people from the camp I've crossed paths with in various different ways. 

Amaka [00:26:38] And everyone is doing really amazing things with their lives. So that's also exciting. 

Victoria [00:26:42] But the thing is, Amaka is one of these very like humble, very, very low key like beats at like, you know, I have this tendency to be in a mid-level achiever. That's not a bad thing. There's nothing wrong with being right smack dab in the middle, you know, but I have this tendency to be around people who are like really high achievers, really amazing. And like, just get things done and don't brag about it, which is interesting because as a mid level gal, you know, I love to brag, I love to talk. I love to boast. But the people who are loudest in the room are usually the least accomplished right?

Victoria [00:27:25] So so anyway, I mean, needless to say, obviously at this summer camp, obviously on Amaka won all of these awards, I tell everyone this all the time, you know, we were just getting tacos at Armadillo Girl and, you know, kicking it and having fun. 

Victoria [00:27:42] Amaka, was hitting the books. 

Victoria [00:27:42] You know, when people say your friends are the ones that are studying, don't worry about what your friend is doing because they're probably going home and studying and stuff like it's true that because you got tired and went to sleep that your friend is the same because she stayed up. She killed all of her exams, she did really well and everything got all these awards. And it's a theme that I've seen literally in the last I don't know, however long we've been friends over a decade. She literally just kills it all the time. 

Victoria [00:28:13] I remember when she took that year out and I was like,okay! Let's try this restaurant because I was in Philadelphia. Let's try this, you know, let's go somewhere this weekend. And she's like, yeah, sure. Meanwhile, she's designing an entire clinic. 

Amaka [00:28:29] Hahaha, I mean, it's about balance, you know, it's all about balance.  

Victoria [00:28:33] When I tell you, I would have just been telling everyone, listen, I am so busy because anyway, I love that. I think that you are definitely an inspiration to me. And I think it's important to have that story out there. Or like not that story, but your story. 

Victoria [00:28:55] I think for me, like getting I think that we've we've come to sort of similar career paths in different ways. So like you, my dad is a physician and I grew up everyone like having the highest level of respect for him. Everyone telling me how lucky I was to have him as my father, primarily because of the services and advice that he may or may not have given them. And I was inspired by that as a kid and being a American and traveling to Ghana and seeing sort of just the world outside of America, I just had a different awareness. I moved differently, you know. And for me, I just knew that I wanted to work with all of these different people that had such a richness to them that was different than what I saw on a day to day basis in the states. And I had a very long and drawn out journey. And we will talk about it at another episode, like the full journey, full ish journey. But I think I came to Global Health in college because, you know, college was hard. I was a double major and I didn't really focus on the sciences and I really struggled. But I knew that I wanted to work with a certain type of community and a certain type of population. And I didn't know how I was going to get there without the traditional path of like being a doctor. And initially, I didn't know if I was going to make it ever and definitely if it was for me at some point, because if you struggle a lot with sciences, you start to say like, OK, maybe I don't want to be a doctor. Like maybe the path that I've chosen has not chosen me. And sometimes you have to listen to those signs. So I came across global health because I was very into Spanish and I did a lot of sort of research within various Spanish speaking communities in New Orleans. And really just the New Orleans community within itself has so much disparity and vulnerable populations. So I did my Googles and I came across this global health program. I knew that public health most likely is what I want it to do because I'm a big picture girl. And so public health made sense. So I ended up doing this program and seeing so many of my lectures. One, obviously, it was really important seeing people who are publishing a lot and like setting the standards, also lecturing you. That really influenced me because it wasn't something that I had experienced prior to my masters. And then also seeing that people can work for six months in the US and six months in a developing country and developing ground up sort of clinics or research centers or what have you over years and years and years, and then being integrated into whatever community that they're working in, in their daily life is really important for me to see that that was possible, even though, like. I guess even before that, seeing people like Kofi Annan, who I knew as a Ghanaian man and knew as this very worldly person, I realized that it was possible to be a global citizen and that there were no limits and that it was a new field in a way, so I could make my own journey. And I had already had such an untraditional path or nontraditional path that I just felt like, well, I mean, if I'm making my way...Anyhow, I get there.. If I'm making it up as I go along, I might as well continue and really get to do exactly what it is that I want to do. So once I saw that was possible and then I went abroad and I have these experiences that were life affirming and life changing, I realized I had to come back to medicine and even coming back to medicine, I felt, you know, I'm probably not going to get into school in the States. I'm going to apply abroad. And really at this point, I was getting to the point where I am now, where I want to live primarily in Africa and in Ghana. At the time, it was it slowly went from like 20 percent, Ghana, 80 percent America to like 40, 60 years from now. 

Amaka [00:33:40] It'll be like the other direction. 

Victoria [00:33:42] That's I'm all in like one hundred ninety five five, you know what I mean? But at the time I didn't have that, like, I didn't really know what was going on. So I ended up going abroad for medical school and. I mean, just I don't know, it's just it's a long and drawn out thing, but ultimately learning that you can build within a community without being like a medical imperialist was really important for me to understand and see, because I definitely have a lot of opinions about that. I am a, you know, opinionated lady, as we all know, and I didn't want to do more damage. 

Amaka [00:34:22] So now I think that while you describe your path as nontraditional and in the longer road, I will say from the outside looking in, at least it has always seemed like you have very like your clarity of vision has always been there. And that's something I've always respected and admired about you and your determination to accomplish that. So let me tell you, lots of people, myself included, would have been like that. But I think that that has always been. I've met you been very clear in your determination against lots of different challenges and obstacles along the way has been very impressive and something I respected my a lot about you, so. 

Victoria [00:35:09] Oh, thank youuuuu! Don't make me blush!! 

Amaka [00:35:10] Okay. The end.

Victoria [00:35:17] as I stated before, as a medium level person, you have to have people that keep you humble because it's really easy...Amaka will always bring it down and that's why our friendship has lasted like, OK, so I've spoken a lot about the journey and what being a global citizen is and sort of what we plan to do in some ways in the future in these communities. Tell us a little bit about the experiences that you've had in certain communities where maybe you had to check yourself or you just took a lesson from observing or seeing something else in your you're like, you know what? I'm going to move differently now. 

Amaka [00:36:09] Yeah, I mean, I think there are....So I I'm trying to give one good example so many different times, I think. 

Amaka [00:36:23] I will say,  who I am as a person, if a little bit more of a watch, observe before I jump into something, and I think that has served me well in this in this context for sure. I think that there have definitely been challenges that I faced. I think being a woman in a different culture can be challenging, particularly obstetrics and gynecology. I'm used to being around women all the time, not only my patients, but in the United States. My colleagues are predominantly women, particularly younger ones. And when I see women in leadership positions all the time and I have found it so fascinating because it's so different than the United States, how often obstetrics and gynecology is a very male dominated field and most of the rest of the world, I think partly probably because it's a surgical specialty. And I did realize that that would be a challenge for me, actually, and it really caught me off guard. I think that it can be difficult to assert yourself appropriately sometimes as a woman, particularly when you are the only woman in a room full of men, even at times when I am more senior have more training than those that I am having a conversation with or potentially even more knowledgeable about a particular subject that we're talking about and learning how to navigate that is I'm still trying to figure that out has definitely been a challenge. I do think that there's something special about women taking care of women. And I know that that's my bias. Not that men don't take great care of women, but I've actually found that to be the most uncomfortable. Those are the uncomfortable situations that I've been in and and not totally knowing how to navigate it. And yeah, I think men just have a different perspective on women's issues and partly because they don't experience a lot of them personally or have an intimate. Connection to some of those challenges and struggles. 

Amaka [00:38:51] So, yeah, I think that that for me has been the the biggest culture shock that I found in working in other communities. And then the second thing be, how do you make that transition from listening and observing and learning to trying to figure out how you can contribute in a way that is still respectful and will be well received as well, and I think that making that transition is challenging and the right way to do it is different for each context. But I think those are to me, are the two biggest challenges I face. 

Victoria [00:39:33] Yeah, I think yeah, I mean, I've heard some of your stories as well. And there are definitely, definitely some challenges. I would struggle with in a different way than you...because I struggle to not be vocal. 

Amaka [00:39:56] Yeah, I yeah, I you know, I think that that is that is my biggest hurdle that I know that it has to do, partly because of the context, partly because of who I am, and sometimes you're innate tendencies just aren't going to be effective and you just have to push against that. And so, you know, that is my my challenge. 

Victoria [00:40:25] I think that sort of things that I recognize when I'm abroad, I mean, at this point, like, I don't even know what a broad means for me, but not in America. I'll say something that I have to recognize is a lot of American privilege. A lot. A lot. A lot. Just based on the fact that I have an American accent, which is obviously very interesting, being a black person and being used to a level of perceived inferiority in the States. And then when you leave the states, you're still black. So that's still a very, very important I'm still a woman and that's very, very important. But also sometimes the American trumps all the rest. And I hate to have use the word trumps, but often people sort of forget about the rest and they're like, oh, my gosh, it's an American. Oh, my gosh. Like, let me tell you about friends or whatever. And so that's something that carries a great responsibility, because I don't want people to have the misconception that everything is easy peasy in America or because I have been been afforded the opportunity to work abroad or to study abroad or to live abroad or reach a certain level of education, that there isn't just a very clear struggle being a minority. So I think that that's something that's really important for me to communicate to people. As we know, America is just. It's been under a lot of pressure, there have been a lot of flames ignited instead of fire, and that's not anything that's new. 

Victoria [00:42:17] But definitely in my experiences abroad, usually even in Ghana or even among black people outside of America, most people don't think that, you know, like there's an issue with like blackness in America, like maybe black people are being dramatic. 

Victoria [00:42:33] And look at you, you're here and, you know, you have this title or you're working in this sort of capacity. And so it's it's difficult for me sometimes to one, not automatically dismiss someone because I'm like, well, why don't you know by now? But also they don't because it's a different country. It's different. Yeah. 

Amaka [00:42:54] I mean, I think what you said is so powerful and that being an American abroad is a whole thing and it's like very complex that a lot of things rolled into it. 

Amaka [00:43:12] I do think as black women that we are used to often representing not just ourselves as a person, but when you walk into a space for many people, you're representing so much more than just like you, Victoria, like you Amaka, like you're representing so much. So I think that there's some overlap or similarity with that experience. I think in medical settings or health care settings abroad, I often feel like people are like you're an American, you're supposed to know how to fix this, like you are the one with this, like great American expertize to fix this, do this. And you're like, wait a minute, I don't know everything. Like, let's let's work together on this. 

Amaka [00:43:56] And then as just a traveler abroad experience like this, you just interact with my family who lives abroad, they for sure think that everything, everything in America is perfect. It is like the ideal place where life is easy, like no struggle, and just have this very huge misconception. I do think it's interesting, just given the timing of us having this conversation that and with our current administration, that there has been a huge awakening, I think, globally about what the heck is going on in America in a very different view of like Americans and like our whole entire societal structure. 

Amaka [00:44:41] So it'll be interesting to see how that. Translates and impacts, but I think every time I've been abroad like a health care setting, Trump comes up in conversation like what are like political conversation. I like what the heck is going on in America has comes up. And this is actually the first time during this administration this and I've never really had that experience like that to this degree, having traveled internationally in any other time in my life. 

Victoria [00:45:09] I mean, I wish I just like the emotional labor of being an American abroad. Since Trump has even, like, you know, arrived on the scene since he started his campaign and things has been exhausted, I remember the day that he was elected and I am a very vocal person, obviously. So everyone knew my stance from the beginning because people thought it was funny, cute and or entertaining to engage with me in conversation. And this was before I realized that I had nothing to give in regards to that man. So like now if someone says, what's your opinion? I don't have one because there's nothing more to be said. But at the time, four years ago, five years ago, you know, I was a lot more vulnerable to invitations to debate and argue. And I remember the day that he was elected. I was devastated, as so many people were. And I came into hospital and there were a group like, you know, a group of people from a particular country who were they were supporters of Trump because of his, you know, pledged allegiance to this country or whatever. And they were just laughing. 

Victoria [00:46:29] And they were like, oh, he won, what are you going to do? 

Victoria [00:46:33] And I was just taken aback at how insensitive it was because it's not a matter of entertainment. I'm not interested in casual conversation because this has real life consequences. And and we're seeing those consequences now. But yeah, yeah. I think in terms of medical things, I'm I'm obviously new to the whole medicine thing. But, you know, since being in the UK, obviously everyone has their comments in terms of like sociopolitical issues. The moment I opened my mouth, they want to know my opinion about Trump or whatever outlandish thing that he says, which I think can be. Taxing when I'm trying to learn medicine, trying to provide for patients, and it's a lot of extra work when I'm supposed to see patients in 15 minutes or whatever their findings are and you're not, you're wasting time. But you're very curious about something that maybe is better suited for a coffee, not an examination. And that's true of even consultants and people that maybe I need advice for whatever and it's fine. I don't mind it always. And it is a nice way to sort of build a bridge, but it definitely is something that many of my colleagues don't have to think about. And by many, because most of America and I mean we definitely see a lot where it's the NHS that's socialized care. So any sort of frustration is blamed on the NHS. And I mean, it's not without reason, but they're like, oh, I bet if you were in America you wouldn't have this. And sometimes it's it's totally unrealistic. It's people who have literally no idea about what American health care is. They know about Gray's Anatomy or, you know, like Scrubs, if you're lucky. You know, I know it's it's very it can be very challenging because I also have a limited knowledge of the American health care system. I mean, I did a little bit of training there. Obviously, many of my friends and my family are in the medical world, but I can't speak to like. The cost of things or whatever, I mean, I can't speak to being a working as a doctor in America because I've not done it. So it's just a very interesting thing where everyone sort of dumps their frustrations and blames it on the fact that they're not in America and not really acknowledging that most people in America are frustrated as well. 

Amaka [00:49:03] So it's interesting because I've also had that experience abroad where it feels like for a lot of people that like standard for comparison, it's like the US health care system, which, let me tell you, is a broken system in so many different ways and a very frustrating system to work in. And having worked in very different types of settings, whether in like a big university teaching hospital or a county hospital system that's like government and state run or it's with different patient populations, it's just frustrating and challenging. And, you know, maybe there's just something about health care delivery that we just as a world have not figured out the best way to deliver care yet and need to continue to think about and innovate. 

Amaka [00:49:53] But let me tell you over here, it's not. Yeah, not ideal. 

Victoria [00:49:59] It's just a really it's a very interesting thing because either most people are of the latter where they idolize America. Yeah. And that's just excellent propaganda. 

Victoria [00:50:10] SPECIALTIES AS CLASSIC BLACK SITCOM CHARACTERS. 

Victoria [00:50:16] Tia and Tamera from Sister Sister are always up to shenanigans, very playful and very, very family friendly. Clearly they are our pediatricians. Then there's Maxine Shaw, attorney at law, happily overworked, deliberate, particular and living singles, resident feminist. She's definitely an OBGYN. Ashley Banks is beautiful, poised, clever and full of the energy needed to create a social media empire. There's no better choice for her than plastic surgery. I mean, what better zip code for clientele than nine 00 to one 00? And then we have Denise Huxtable, Denise is our resident free spirit, nontraditional in most ways and relatively intuitive. She has quite a journey, but she does sort of land herself somewhere. And I think she'd definitely become a psychiatrist. And then we have pum pum pum pum from Martin. We all know that if Pam went to professional school, she would let us all know. And yet somehow people around her would make her feel not completely included. I think she'd be a dentist. 

Victoria [00:51:36] So we're back and we've been talking a lot about our experiences abroad and things that have influenced our journeys to our path in medicine and in global health. I do want to talk a little bit about sort of advice that you'd have for others, be it people who are welcoming people into their communities or people who are interested in working in their community. 

Amaka [00:52:04] So I think for people who are interested in working other communities, I think what we talked about initially just entering with humility, I think it's like my biggest piece of advice. And I think that that if you start there, it just sets the tone for what the rest of the relationship and interaction is going to be. And setting the groundwork for partnership, because they think that that is really key is coming with humility and with the ideal. The goal being to partner with communities, local physicians or health care health care providers in those settings that you are entering into. I think good mentorship is key to finding mentors. The right mentors is key people who you respect to admire and who you think actually have had have had careers that you would respect and admire and relationships and can help facilitate your entry into a community or you doing, I guess, doing things in the right way. I just have to add in so many different ways so far in this episode. 

Amaka [00:53:11] I think the other thing, too, that I prioritize is having relationships also being reciprocal. And so I think just as much as you are giving to him, you are taking from my community whether it's a personal experience that you want or need for yourself, you should be giving and thinking about what the community wants and needs, not just from your perspective, from their own as well, or potentially even more importantly. 

Amaka [00:53:38] So I think that that sort of reciprocal partnership, reciprocal relationship and sort of partnership is is key to a successful experience for all involved. 

Victoria [00:53:51] I definitely agree with everything that you said. I'm reminded of my aunt, Auntie Bridget. 

Victoria [00:53:59] She was a woman who worked in a lot of different communities in Ghana. And I remember we once took a trip with her to the north of Ghana, which was I mean, it's a rarity for someone from the south to go to the north. There's a lot of difficulty even just thinking of how to plan it. But also, I mean, it's not as developed, so it's rare for people to go. So we were afforded the opportunity to go with her and she was working with a group of women within a village who were basket weavers. And she had organized a big order for Target and was teaching them about sort of making consistent work, understanding the prices for things and understanding how to charge. So I don't remember the exact numbers, but we'll say Target was offering to pay ten dollars per basket and they would provide all of the supplies and they were. So you don't have to worry about getting that and you get the, ten dollars. 

Victoria [00:55:10] The women sold their baskets for twelve dollars, but they went and got all of their supplies, so they didn't understand why it was a smaller number. And she went with an interpreter and the women knew how much they actually made her like a queen mother in the area because she'd been there for years and working with them and had built this really strong relationship. 

Victoria [00:55:38] I think we spent at least four hours going over the same principles that if you get rid of that cost, because the profit you would have made with that 12 dollar basket was about like two or three dollars as compared to the profit of the ten. And she spent so much time going over and over this principle, using different examples, using things that the people in their community would understand, having members of the community also speak on her behalf and things like that. And in the end, some of the women were a little bit more interested in it. But overall, they still felt that they wanted to do the twelve dollar approach, even though they weren't going to be making as much. And I didn't understand it. I think at the time I was probably like 18 or something and I just didn't understand why they couldn't understand that they were going to make so much more money and it would go so much further in their community than what they were doing, and she told me later on that this was the second or third time that she'd had this sort of long days with these women and she'd had it with other big sort of, I think peer peer one is that. Yeah. I saw here that she'd done in order for peer one similarly and eventually had convinced and sort of was negotiating on behalf of them and the corporation. And it was just I was so impressed by her commitment to collaboration, true collaboration, even though it was really, really challenging. 

Victoria [00:57:17] And there were a lot of hurdles, because if you tell Target that they're willing to make less of a profit, what corporation wouldn't take that? But she was she was committed to it and she didn't give up despite the challenge of getting there, the challenge of communication, the challenge of not being from the area, the challenge of having to get people to trust her. And I think all of those things are things that I try and and take with me in working in global health. It's definitely not an easy it's not an easy or glamorous field, really. And there's a lot of easier ways to go about it. But if you work towards integration, like you said, in true partnership and not sort of going in with your own approach to like what they should do and then speak on someone's behalf, and this is that this is that without really having a proper conversation, then you're not really going to have anything that's sustainable because her her whole approach and reasoning for it was that if it's not her and someone else comes, she wants to have a basic understanding so that they can make the decisions. She doesn't have to be the one presenting these opportunities. It can be anyone. And I think that's the the most ideal way to work in global health and in developing developing countries for sure. And within any sort of vulnerable community. 

Amaka [00:58:34] Yeah, I think that's a great example of also how with your lens, the obvious choice is get let them give you the materials you need and charts. And it's just like very obvious and straightforward. But from their perspective, it is obviously sort of the other way. And so you just can't come in and just like make decisions about what seems like very obvious to you is like the way what people would want because you actually have no idea and you can't know that without the conversation. So that is so critical. And I think we historically look back at how international our global health has gone wrong in the past. A lot of it is like that sort of behavior or strategy. 

Amaka [00:59:20] I also think establishing relationships is important. And, you know, your aunt has been in that community, had been going to that community for so long that she established that. 

Amaka [00:59:36] And I think also seen in people who made global health a part of their career, going back to the same community over time and years and years and maintaining relationships is so key to being productive when you're there and creating and maintaining trust him. That also involves, you know, trying to learn the language, even if it's just a few phrases or like going to where people socialize, whether it's, you know, a restaurant or bar or whatever the things people do in those communities to socialize and just really trying to actually, I'm not just here to do this thing. And then I go back to my apartment or wherever I'm staying, and I sort of isolate myself as separate, but really trying to become as much as you can a part of that community. And that includes outside of the health care setting, too. 

Victoria [01:00:30] Absolutely. I think immersion is an absolute requirement for working in any community and really, like, ideally, if you're going to experience any sort of culture, I think immersion is essential. So I really like not. What's the point? But yeah, what's the point if you're just going to, like, go somewhere and hang around all Americans, the team that you work with at home, while that's important for team building as well, you know, if at all possible, I think it's important for development as a person and understanding sort of that the world is filled with such a wide variety of people. Absolutely. So given sort of your global awareness and your upbringing and your experiences abroad, do you have any plans to live or work abroad in the long term? Significant way? And if so? Do you want to share them? 

Amaka [01:01:27] Yeah, so that was my goal for fellowship, I think. 

Amaka [01:01:34] Ultimately, I am going to practice as a generalist obstetrician gynecologist, since I'm not necessarily getting additional clinical training during my fellowship, but really just sort of expanding my sort of areas of knowledge and potentially expertize as well. And so I think I talked about my goals were one to gain more of a public health background, but also to have some dedicated and protective trying to spend like a immersed myself, is a good term that you utilized recently, in a community and do some work that I hope will become part of like a life or career long involvement. So for part of my fellowship, I was supposed to spend one of the two years abroad, covid-19 has, you know, affected those plans and sort of delayed them at this point, but I mentioned I'm interested in refugee and immigrant populations in the United States. 

Amaka [01:02:37] So my goal was actually to go work in a refugee settlement in Uganda and just see the other side of health care delivery that my patient to the United States have experienced often for decades prior to being resettled in the United States. 

Amaka [01:02:52] Only one percent of refugees actually get resettled to another country, and so often they live either in nearby countries and often in these refugee camps or settlements. 

Amaka [01:03:05] And so one of the largest in Africa is in Uganda, which is one of the most countries that receives the most refugees in the world. So I was going to go work in this refugee settlement, which is close to one hundred thousand refugees, and it's interesting and open since nineteen sixty. 

Amaka [01:03:23] So it's a really interesting sample of generations of Africans from various a sample of what East African conflict over the last six years, basically. 

Amaka [01:03:39] So I was going to go work on a project related to maternal health outcomes. There are four refugee there are four health centers in the refugee settlement and there is an US based NGO that runs all of the health care in the camp and in the last year. And they've had a huge spike in maternal deaths. So my project is one to go and do sort of an assessment of what is contributing to that and then based on those findings, design and intervention. 

Amaka [01:04:12] So that sort of delayed right now. But that's my area of interest with regards to global health internationally and really dovetailed well with my interest locally. 

Victoria [01:04:27] That is very interesting, as always. 

Victoria [01:04:36] I think everyone at this point knows that I want to live and work in Ghana. I think. Ideally, I mean, in a perfect, perfect world, I would develop a research center and either in the Kumasi area where my family is from or in the Cape Coast region or area where my grandmother is from, because it doesn't tend to be that much development outside of Accra. Things are now changing, but I think I definitely would want to be where things are going, not necessarily where things are. Not to say that anything in Accra is not important because it is equally important. But I think in an ideal world, and it's something that I've been dreaming of for a decade now, so like, you know, tick tock, I need to sort of work on on that development. I mean, obviously, the biggest challenge is my training because, you know, it's a means to an end. And where I finish my training depends on a lot of different things. But, I mean, I think the good thing about being in the UK is that there's actually quite a bit of. There's quite a bit of flexibility. I mean, I think people here might not agree, but I think compared to the states, there's a lot of flexibility. You can take your time. You can you can add half the time to develop some of these things. So, I mean, we'll see I don't know, maybe in a year or so I would have already started building something and, you know, working with some people and establishing establishing some relationships so far along this along the way with this journey, I've met so many people like you and other people who are just like on point. And so I think that, you know, I don't know, maybe in five, 10 years, I would love to see all of us connect in different ways and sort of continue to uplift and serve as resources for one another, even just bounce ideas off of. 

Amaka [01:06:46] I mean, I think I think one of the things that you're mentioning that I think is really important is that what global how people have made global health part of their career look so different in different ways. And one thing that I feel like is so important for someone who thinks that they might be interested in that is like asking everyone, how have you done it or how have you designed your how do you how do you set up your time? How have you designed your career around global health? And what that looks like looks so different. And it depends on where your home base is, depends on like what field of medicine your practice if you are still practicing clinical medicine or not. And so that's something that in the last few years I've been trying to do is just asking everyone, like, what is your how do you how have you made this a part of your career just so you got a different different idea. So this is fairly new and there's no clear path that is like this is the roadmap to do this. And where the destination is is different for each person. So there's just like there's no guide to follow, you're just sort of like figuring it out as you go along to just talking to people and connecting with people and just asking, like, what is this look like for you and have you gotten to where you are just so that you can start to build your personal toolkit of of of what the possibilities are, really, because there's just not that much out there. And then the other thing is just keeping in touch with people. I think we're all really growing in ways that are really great and beautiful and amazing and will hopefully, I think, be great connections for each other as we continue along on our paths. So as we grow up.. 

Victoria [01:08:29] Yeah, I fully, fully, fully agree with you, I think that's what you said about asking people about what they're doing and how they've made this possible, I think is really, really, really important because it doesn't some things don't add up, you know, like so I've got these big dreams of wanting to have, like, a research life and focus a lot on public health. But I've also always wanted to be a clinician, and I think..there's not really a blueprint yet that I've come across, but I also think that for people who don't necessarily know how all of the pieces are going to fit together, that like no one should be afraid to do things that they haven't seen, like you shouldn't be afraid to dream bigger than what has been presented to you because you just might be that first person. 

Victoria [01:09:22] You know, and I think just even looking at my own story in my own journey, like and being an undergrad and being told that, you know, I wouldn't be able to be a doctor or learning Spanish wasn't going to be useful. And it really changed the trajectory of my life. 

Victoria [01:09:40] But just because someone did it, someone that looked like me with the same interest as me didn't do it, didn't mean that I didn't I wasn't going to reach my goal. And it just was a different path. And that's OK. But I think that is, you know, as you said. In global health there, there aren't very clear paths, and I think that's part of what probably draws me to it, because I have always sort of taken a different way to get to different places that I care about, that I'm interested in. And like, you know, forget your biology undergrad, I wasn't interested in that I didn't do it. And you can have a nontraditional path. 

Amaka [01:10:22] So I think that message is so important, though, because I think so much of medical training historically has been like, this is the box and you must stay within the box. And this is the way to do this. You must do these things in this order period, or you're not going to make it or you're not going to be able to get where you need to get. And I think slowly but surely things are changing and people are actually looking for and respect a lot and admire a lot of the nontraditional route. And it looks glamorous a little bit when you look at it from the outside. But when you're in the trenches doing it, there's not a lot of support often along the way. And it feels sometimes like you're alone in that in that in that battle. But people want to be there for you at the end and be like, oh yeah great! 

Amaka [01:11:14] So for anyone who's listening, who might feel that way, just to know that to kind of believe in yourself and if this is something that you really want and believe in, that you can and will make it happen. 

Amaka [01:11:30] And sometimes it means patching together your mentors and your support system because one person's not going to be able to give you everything you need. I think that was the big advice I got along the way, too, is like especially when you're doing something that is not like in the box of things that are clear paths. Sometimes you have to collect your team of mentors and you just need a little bit of this from that person, a lot of times from that person and put it together and you get what you need because but one person who just not doesn't have it all. 

Victoria [01:11:58] Absolutely. 100 percent agree. 

Victoria [01:12:03] I have two questions. OK. Can you can you give your favorite city in the world that you've experienced or maybe that you look at and you admire for various reasons that you feel embodies you?  what city would it be and why? 

Amaka [01:12:24] That's a difficult question. 

Amaka [01:12:29] I have to think about that a little more. I just will say that I was able to go to Nigeria for the holidays this year. And it just feels like... It feels like home. And I hadn't been there in a very long time, and especially I did not grow up there at all. But that is that is my home and that is where my family is and that's where I'm from. And I just. There's just something about being there that just feels good and feels comfortable and feels like you're with your people and we're supposed to be and I think that caught me off guard a little because I hadn't been there in a while. And it also is not where I grew up at all, but in some ways feels at home more than any other place on the planet for me. So. My country. 

Victoria [01:13:17] I think equally, I would say Accra for me, and I am not an Accra girl, meaning like my heritage is not in Accra, it's in Kumasi which are two different cities in Ghana. It's the second largest city in Ghana. But it's not as it's not as developed as Accra. And at the end of the day, I'm kind of like a big city girl a little bit, you know. 

Victoria [01:13:42] And so Accra little chaotic, just like me. It's not always organized, just like me, but it's full of life. It's full of joy. It's full of hustle. 

Victoria [01:13:54] People do three different jobs. And not that I do three different jobs, but I always have to do something to keep me busy. It's very afropolitan, which is like, well, it's a very charged word anyway, but it's every conversation. 

Amaka [01:14:09] Yeah.

Victoria [01:14:11] You get like a little bit of the bouji, but you also get the people that are About it. 

Amaka [01:14:16] Yeah. Yeah. That's how I feel about Lagos. Like that is like literally like back to where I flew into. My family is not from there at all either. So I flew to the other country. My family is but I live with a plane and I was like, this is it. I hear the accent. I hear the language. I hear the confrontations that are happening left and right in the airport. I'm like, these are my people. 

Amaka [01:14:38] The smell, the food. It's just like, OK, perfect. I love it. I love it. I love it. 

Victoria [01:14:46] Oh, you know, Nigerians are always ready for it and like, if you stay ready, you don't have to get get ready,literally, like (TM) Nigeria. 

Victoria [01:14:57] I think we should close this episode in reflection. So very last question. What is the best experience you've had abroad and what is the worst experience? 

Amaka [01:15:11] Well, I think the I'll start with the worst and then we'll get better. 

Amaka [01:15:18] Honestly, overall, I've had really good experiences abroad. I think the knowing things have been like travel related issues like lost luggage or like delayed flight. Miss layover in another country for twenty four hours that you weren't supposed to be in for more than an hour sort of thing. So I think those have been like probably the most frustrating things. I think. I do think sometimes being a woman abroad in another country can be challenging, particularly because at times I travel by myself like I'm not with other people. And I think I think I've just had to just be careful about that and like where I go at certain places and all that sort of things, I think that that has probably been challenging. But I actually cannot say that I've had some horrific experience abroad at any point in time that at least I have not stepped away from my memory. 

Amaka [01:16:15] My best experience. 

Amaka [01:16:17] Yeah, I mean, I think for me, just in general, with travel not related to being like a health care provider, like, I think always going to Nigeria and being what a place where I consider to be home in so many ways. It's such a beautiful experience. I think this most recent trip I went with my family was really powerful for me and a lot of different ways. One like my entire immediate family, like my three other siblings, both my parents were all able to travel together and be together and connect with my wife, my extended family, who is still there. 

Amaka [01:16:52] And I, I feel like I learned I now and adults, of course. And so I think my experience there was so different than previous times that I had gone with my family. 

Amaka [01:17:05] I think a big part of it was a lot of like learning of your family history and things that I had no idea about. 

Amaka [01:17:14] My parents, just even like how they were children and the history of my family in their various communities where they grew up and where they have been for decades and decades. And it really highlighted for me how important, knowing your family history is and knowing where you come from is and that's something that's always guided me forward, was knowing my history. 

Amaka [01:17:41] And so it just and I just I loved that aspect of it. 

Amaka [01:17:45] And I think that that for a lot of people, I think for me, too, in life at times where I wasn't sure where the next step forward was, pausing and looking back from where I've come from, has always helped me go forward. So I sort of link those things together in a lot of ways. I think that I also had some like, meaningful experiences as a health care provider abroad, some positive and some negative. 

Amaka [01:18:11] I think as a resident, I went to Ghana and I was that was my first time abroad, actually, as a doctor and. I know maternal mortality is a thing and I know the numbers and the statistics, but it's very different to see it and to a frequency that I couldn't really fully conceptualize prior to being there in my four years in residency in the United States. I personally had never had a patient die, but our institution had had the two hospitals I work at had each had one maternal death in that four year period of time. And then when I was in Ghana, it felt like there was a maternal death every day or every other day. And that blew my mind and dying from things that women don't die of in the United States, ectopic pregnancy, postpartum hemorrhage, things and situations where I knew that if this patient was in an institution where I was doing my residency in the United States, she probably wouldn't have died. 

Amaka [01:19:23] And that the reality of that just hit me in a way that. Was painful and sad, but also moved me to act, but it's just something different to see that an experience that I've also had some really meaningful connections with patients and places where I felt like I really became part of that community. 

Amaka [01:19:46] And, you know, sometimes language barrier can be a challenge, but there is a way that you can connect with people even though you don't speak the same language. And so I've had a couple patient interactions where I just felt like I really was connected with that woman in that moment. And I think that's a special to me about a specialist in gynecology that I think you're with women in some of their most vulnerable moments and some of their best moments in their lives and some of the worst moments in their lives. And they can get the privilege to be at a woman's side throughout all of those things. That was a roundabout answer, but yeah. 

Victoria [01:20:19] That is a very powerful experiences I would say...a lot of what you said resonated with me. In learning the importance and not not that we don't have that importance, when we're in, America, but there's something so powerful about being with your family abroad or working abroad, home, being a first generation American, it can be difficult at times to put yourself into the culture because you don't really have the same history as other black Americans who generationally are black American. It's just a completely different experience. I mean, there are some things that are shared based on the fact that we have the same skin. But culturally, there are a lot of things that are different. 

Victoria [01:21:05] So I definitely agree and have similar experiences when I'm in Ghana, because usually when I'm in Ghana, or at least in the past, it was usually the whole family was coming into Ghana for a particular reason. 

Victoria [01:21:19] So now I go because my sister is there and things like that. But before we would all be going for someone's birthday or wedding or something like that. So it's not just me and my nuclear family, it's going but aunties and uncles from all over the states where we don't often connect in the states because we live in a different like different parts of America. 

Victoria [01:21:41] But somehow we all connect eight hours away and it's always just so rich hearing stories. And it's just like you feel nothing but love, joy. And like I mean, I'm not the biggest like one for, like, the power of the ancestors type thing. But I really do feel that there is a bit of the power of the, you know, the history. It's there and it's lived and it's living in us. So I think that's that tends to be a very powerful experience. I think for me, my best well, I guess my worst experiences are centered around either being isolated or being black. Not that being black as black is a bad thing. I love it. But being black in countries where blackness is not appreciated, I think in Cyprus, throughout my training, there were many, many, many instances where professors or preceptors didn't engage with me, literally didn't acknowledge my existence. And that's not really a comfortable feeling, especially when you're paying a lot of money for education. And I think that, you know, it's not unique to being outside of your native country because something like that could happen in America. But it is very obvious because in countries outside of America, there is not the same level of sensitivity for things. So because they don't have the history of civil rights and things like that, there's not a lot of shame sometimes in their racism or prejudice. So it's very in your face. It's very direct and without like the blunting of political correctness. Yeah, it cuts deep at times. So I definitely had many experiences like that in the state and in Cyprus from patients who disregard me to preceptors who disregard me to walking through the hospital and feeling like an alien because everyone's head is turning with you as you move. So that's definitely, I would say, amongst the worst and in terms of the best...? 

Victoria [01:23:56] Personally, like, definitely when Amaka and I took a trip to Greece last year and that was amazing. I felt very wealthy, even though I was and am not. 

Amaka [01:24:10] We got to celebrate the end of your medical school, like what are you talking about? 

Victoria [01:24:17] It was amazing! Like the day that I found out that I passed my exams, I was so overcome with emotion and like, it's just crazy. I mean, literally over a year later I still, like, can get choked up at it. But it was just nice being in, like a beautiful country with one of my closest friends, like just having a ball and really getting to like, celebrate, celebrate that with, like, a good friend after being sort of, you know, in a country where I felt quite isolated and things like that. And also you getting to celebrate the end of your residency. 

Amaka [01:24:49] That was a really good trip. 

Victoria [01:24:52] I think it's it's nice to celebrate with, like, people that have been on the journey with you. So that's like a personal thing. And then I think career career wise, when I finished collecting my data from my Masters, it was like just it was so amazing because I joined the program and most people sort of joined someone else's project. But me being me, I had to be a little extra create one project from the ground up, which was really, really hard when we finally started the research. It was an amazing experience and. All of our participants were happy, it was very rewarding and a self gratifying way and the work that the project itself. 

Amaka [01:25:37] This is one about mental health and yeah. Yeah, that's like what's also an impactful project like that. 

Victoria [01:25:46] It was. But it felt good that I was doing it. I won't lie. 

Victoria [01:25:54] And the day that we finished the data collection, which we like, somehow surpassed the necessary number because the people in the communities were so eager to speak with us and like really, really engaging with the research. And we gave them nothing. It was just out of goodwill that they answered the questions to our little survey. And it just was so nice to see something that you worked so hard for. 

Victoria [01:26:18] And I mean, I don't you know, I still believe that there's something that is powerful that can come from that project in these communities. That's sort of what public health is. So that definitely, I would say, is probably the best professional experience I've had. 

Victoria [01:26:35] Great. Well, this has been a wonderful episode Amaka. 

Amaka [01:26:40] Thanks for having me. 

Victoria [01:26:44] If you made it to the end of this podcast. Well done. Thank you so much for listening to this week's episode of Nightshift Delirium. Next week, we're going to end the season with my journey. Everyone has been so gracious to entrust their stories with me and with my platform, and it's only right that I share mine as well. Make sure you follow us on Instagram at @nightshiftdelirium and on Twitter at @deliriumshift. And let us know what you're thinking. If you have any questions, if you have anything that we'd like to answer for our last episode, then let us know. And we also have some other fun things that will be posting online in the coming weeks. Thank you. 

Victoria [01:27:32] And see you on our next shift. 

Tags: Global health, obgyn, obstetrics and gynecology, international health, fellowship, covid-19

Host: Dr. Victoria Kyerematen
Guest: Dr.  Amaka Onwuzurike