Leading and Letting Go: The Paradox of Fieldwork

The team relaxes a few days after the health fair.

The team relaxes a few days after the health fair.

By the Student Research Training team in Uganda: "Bbossa" Nathan Lam '17,"Nanyonjo" Brooke Whitfield '17, "Nakaliisa" Noelani Ho '17, and "Nassozi" Kathryn Benson '16

Published July 11, 2016, last updated on April 7, 2020 under Voices of DGHI

One of the biggest challenges in our fieldwork experience has also been one of the most rewarding elements—balancing leading and following. 

When walking past global health classes at Duke, you will likely hear the word “sustainability” reverberating off of the walls. We are told that sustainability in global health work stems from having the local community take ownership of projects. This has been cemented into each of our minds. We cannot count the number of times our team has uttered the phrase “but is that sustainable?” in these past seven weeks. What we did not fully comprehend, however, is the difficultly of navigating the gray area of leading effectively while also facilitating leadership of another entity. 

This difficulty is compounded by the fact that our partners, who are supposed to be our equals in these projects, have decades of healthcare experience, knowledge of the culture, and relationships with the community members.

Our immediate reaction to this disparity in experience and knowledge was to discount any insights we might bring to situations, to grasp at any possible chance to follow, and to yearn for opportunities to merely carry out instructions. As we gained confidence on the ground and began to get our footing in the culture, we observed shifts in our attitudes and initiatives. We began to see that, although we may not have the same experience as our local partners, we did have valuable insights to bring to the drawing board. We have been able to challenge ineffective dogmas and offer new plans to streamline processes. 

These realizations came to a head at our annual Naama Health Fair last week. Each year, the Uganda SRT team collaborates with various healthcare organizations and NGOs to put on a day of totally free medical services for anyone that attends. We hired 46 healthcare personnel and obtained all the necessary medications and supplies. The planning for this big event was in the works all last semester and intensified immensely once we were on the ground. 

The week leading up to the fair was extremely hectic. Various local partners stepped up into leadership positions, organizing their healthcare workers and consulting our supply list. However, it became clear that if we did not push and assume primary leadership of the event, it would not happen. As we juggled the personnel, supply, advertising, financial and transportation logistics, the weight of total culpability for the event increased. 

When the much-anticipated day of the health fair arrived, we awoke early with anxiety of how the day would play out. We carried out last minute errands and organized … and then organized some more (the theme of all the health fair preparations). After what seemed like an eternity, everyone was there and people circulated in and out of the different health stations including: cervical cancer screening, lab and counseling services, skin clinic, eye clinic, ENT clinic, dental services, nutrition and hygiene, water and sanitation, mental health, family planning, cardiovascular disease, immunizations, deworming, antenatal care/maternal and child health and general care.

Once everyone was signed in and registered we arrived in another interesting space: there was little for us to do. We don’t speak Luganda, and we don’t have medical expertise to help with the stations and various odd jobs had already been delegated. After months of preparations, we had to give up the reigns of leadership and totally rely on our local partners. Now don’t get me wrong, we ran errands and carried out miscellaneous tasks. At one point on a journey to the pharmacy to fetch injectable epinephrine, two of us were caught in a torrential downpour that miraculously did not hit the site of the health fair. We moved around supplies and carried lunches to different providers. But all the tasks and errands seemed minute. We went from primary supervisors to merely worker bees, ironically what we originally yearned for on the ground. Everything did not go flawlessly as anyone could anticipate, but our local partners did an incredible job providing the needed services to everyone attending the health fair.

This experience revealed to us a truly interesting element of fieldwork. You evolve into a micromanaging control freak in many respects, making sure consent and confidentiality are carried out to the utmost quality. You hawk details in your research methods to ensure everything is done to the highest standard possible. However, you are then put in situations where everything is out of your hands. The new "type A" person you have evolved to be tranforms to your worst nightmare. The dichotomy is startling and challenges you to strengthen your adaptability above all else. 

By the end of the day, more than 700 people received free healthcare. Participants, healthcare workers, our team and our advisors deemed the day a success. We left the site with a great mixture of happiness, relief and exhaustion. We learned quite a few lessons we didn’t expect to learn, and we were in awe of the collaboration of so many diverse organizations. Everyone came together for the common goal of benefiting the community that we all love, and we learned the maze of leading with other people is an honor. 

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