The Time Is Now: Global Health Starts Right Here in Durham

By Nicole Jadue, MD, second-year MSc-GH student

I grew up a dreamer. As years went by I was always excited about “when this thing happens” and when “I get to do this other thing.” It might have started as “when I get a driver’s license” or “when I am done with medical training” but it was is a thought that dies hard.  

But the greatest lesson about trashing the “what ifs” and “when this happens” thoughts in favor of the “just do it” thoughts came from my grandparents. I grew up seeing them help and develop projects with little knowledge. They were involved 24/7 in helping an underserved population in the south of Chile. 

With no college degrees, they just believed that education and opportunities could help the population rise over poverty. So they did their thing: networking with the Major, starting a business to hire people that didn´t have a job, teaching skills to uneducated people and just telling people that hard work pays off. With a new bakery in town, new supermarket employing hard working people willing to learn and other services being established, people started thriving. 

Alcoholism was still there, broken families still existed, poverty was slowly changing and maybe the big issues that were holding people down were not solved yet. But as my seven-year old self roller-skated to the supermarket, I remember that I was surrounded by people that felt their own worth. I could go to the bakery and see people proud of themselves. Someone had opened up a way in the midst of their struggles. Someone went head-to-head. Someone sacrificed and gave of themselves to meet a community need.

More than 20 years later, those feelings are still drivers for me. I thought that I could “do something” “when I finished medical school”—the same parasitic thought that “when this happens, I’ll get to be involved.” I guess every soon-to-be doctor feels full of hope, like looking at the light at the end of the tunnel.  

When I started working, I thought I was seeing the dream come true. “Now I will finally do something about it,” I told myself the first day of work. But working as a family physician in a low-income population in one of the toughest neighborhoods in town was more than hard.  

After a year, I felt like I was not enough. My patients were getting treatment and many of them were doing amazingly well, so things were absolutely improving. But every single day, it killed me to not fully understand and articulate solutions that could actually work to  “go and walk the extra mile” to restore things in their neighborhood. 

That is when, after seven years of medical school and two years working as a doctor, I came to the dreadful realization that I wanted to go back to school. I feared the likely disconnection to the world and the new realities that would surround me, because I would be consumed by reading books and online publications.

Then, I landed in Durham. I lived off campus and navigated the challenge of being a complete outsider in a new country with a new language. My first lessons came in public transportation. I began to see the brokenness of this town while taking three buses to get home. Only the working class rode buses—people with different skin tones, languages and clothes. That was the reality. 

Why wasn´t I involved with that reality as a so-called “global health professional in the making”? What was I waiting for? When I started diving in deeper, my first excuse was that I wasn't a citizen. How can I be involved with the struggles of this city if this is not even my country? 

“My time will come when I finish this degree and I will find ‘my place’ in this fight,” I told myself. I struggled with that thought for months. Deep down, I felt a commitment to humanity—not just a particular nation—but at the same time, I felt I didn’t know enough about the suffering people were facing in this town. I didn´t even know the school system—how could I care about the affordable housing project? 

Unexpectedly (which I am eternally grateful for), I had a glimpse of courage, and looked for a place to be actively connected with the global side of the local struggle. I started volunteering to be a medical translator for uninsured non-English speaking families. 

I learned about the reality of the hard-working undocumented people in Durham. I listened to the oppression some women of color described as part of their job description as a janitor in a renowned company. I opened my eyes to how the refugee community was trying to create stable and safe lives for their families in a little city in North Carolina. 

How was I so naïve? When did I buy into the horrible and deadly idea that life begins “somewhere”? It occurred to me that perhaps waiting for that moment is how we comfort ourselves until we find more courage to actually let go of excuses and get involved. 

After my thoughts were renewed, I saw Durham as a thriving place. Duke and DGHI became an opportunity to influence and speak out so others could jump on the train with me. That was when my global commitment became a local reality for my current circumstance. Durham was my home now.  

There was nothing to wait for—no degree to finish, no “ideal scenario” in which I could get involved. Just as I did for years at work back in Chile, now I was meant to replicate my efforts. I shouldn´t wait for my life to start. Life is now. Global health career? Yes, now. 

That’s how I became part of “Dwell,” a group of 12 (soon to be 13) young professionals and graduate students living intentionally as members of a community. Different people—even basketball rivals!—living together in community in a low-income neighborhood in different apartments in a housing complex.

I discovered that moving to a new community can be a powerful tool to engage with disparities as a daily practice—to avoid the disengagement that I tried to run from as a doctor, given the example I had seen in other professionals around me.

Relocating comes with a price. Closeness comes with a price. It is beautiful, but it is overwhelming. To understand the consequences of poverty, you just have to experience them, learn from them, see the faces of people living in poverty and hear its discourse. You have to do things like open the door to an Iraqi woman that doesn´t know how to pay her bills. 

Do you feel frustrated when you can't communicate properly? That's how she feels while trying to navigate this new world. Hate cockroaches? These people hate them too, but they live around them, and they just kill them. Feel angered at the system because a 16-year-old refugee dropped out of school? Think they’re not fighting hard enough? Not embracing this new chance? Try to go to high school without speaking English and wearing the right clothing. Try handing in homework when you cannot say the numbers in English. Or imagine coming from Burundi and having six kids as a single mother and working two jobs to try to make a living. 

That is why we decided to “dwell.” Stay. Do not run. And sacrificially set time apart to open our home and act upon the local need. I’m not saying it’s easy, but it’s part of the commitment I see necessary for the world to change—normal people going head-to-head and giving of themselves as necessary to meet the needs. 

Between homework club, dinners with new refugees, undocumented immigrants (who are now like family) getting stopped by the police and kids coming and going for books and games, our house is a mad one, but it’s a beautiful madness. I’ve learned so many new English words by studying the flashcards with Somali girls in elementary school. I saw the reality in schools when I visited the ESL teachers that taught my neighbors so we could join efforts. 

This neighborhood woke me up to the reality that people need each other and should do whatever they can, wherever they are, for as long as they can, with whatever they have to try and make a difference (as Bill Gates posted on Facebook last week).

My home reminds me that we’re global citizens. In our fridge, I see the plate Zahida made for us with chicken and rice to show love after we celebrated the baby’s birthday. My neighbor Justina drops by to invite us all for homemade pozole so spicy it makes my nose runny. We take turns on Tuesday and Wednesday to give breakfast to Zenabú and take her to day care because her mom starts work at 5 am. 

Community engagement is a way of facing our fears and staring struggles in the face. There’s no “moment” to wait for to start setting our own agendas aside. Assignments and homework are not sufficient excuses. If excuses prevent us from opening up our lives now, there will be forever excuses, and that “moment” we wait for will never happen. 

There are multiple moments of frustration, especially when our lives are driven by so many responsibilities. I questioned my humanity when I felt annoyed about staying six hours at night in the ER because Mohammed had an asthma attack and needed company with his mother because they don´t speak English. That is real. But that is what makes this vision beautiful. 

I get to see my limitations, my selfishness, the obliviousness that pushes me daily to disengage, to not care—especially as I read multiple publications on the burden of disease and social determinants that are breaking our world. When my learning becomes just information is when I need my life to be in tune with people. 

That’s why Durham is a powerful place to be learning. I get to hear from excellent professors opening up a way, and I get to sit with the protagonists of the struggles when I get home. Global health is about that balance. 

There’s no evidence that can be enough of a driver, no breakthrough that can encourage you enough to push through. There’s only people: stories, families, struggles. They ignite the flame and restore the purpose. They shape the ideas, because ultimately, it is for them, and for us becoming more human with them, that we want to make things happen.