Case Study – Emily

Emily is currently a Principal Investigator and Senior Lead for a project in the Middle East between the UN (United Nations) and an INGO (International Non-Governmental Organisation) called Humanity and Inclusion (HI). She has travelled widely in her career to date. In 2013, at her early to mid-career stage, she was offered a position in the Improving Global Health (IGH) fellowship scheme. Prior to this she had been working as a specialist physiotherapist and team leader in the UK for a decade. She didn’t choose her placement in South Africa expressly but rather departed on very short notice on her fellowship due to the opportunity that had arisen. She had been to South Africa previously for a short-term work experience. 

At the time she was at the beginning of a National Institute of Health Research (NIHR) pathway and had just completed an Internship with the University of Oxford. She was exploring future prospects for her career and whilst considering the options of development of an NIHR proposal for Masters/PhD, was becoming more and more interested in global health, and was seeking further learning and development opportunities, with a particular focus on how international communities work together to strengthen health systems. She was recommended to consider applying for the IGH program, which she did. She describes it as the catalyst for a mid-career shift.

Whilst she had already undertaken quite a lot of international work, mainly with NGO’s, and had lived, worked and travelled overseas quite a bit in her personal life, she recognised that she wanted to refine her project management and quality improvement skills, understand more about how different health systems worked and what opportunity there might be to learn from that. She also wanted to learn and understand more about the impact of culture and people’s different perspectives on how healthcare was delivered and received.

Quote / Testimonial:

“So it was very much about personal learning, but also what I could gain that might be useful for me and my role in the UK. I think I was also intrigued by the fact that the person that I would be placed with wouldn’t necessarily come from the same professional background as me, so I felt that there was another opportunity for learning. We learned a lot from each other about the different aspects of project management and delivery.”

Despite the short notice she attended the preparation training, and felt well prepared. She also had some personal preparation in terms of having travelled widely before, and had some prior exposure to aspects of local culture. This has improved in recent years in the global programme in terms of preparing candidate for travel and placement, and different topics including cultural awareness.

Quote / Testimonial:

“Obviously with hindsight, I think that maybe I could have done more thinking about local language. I could have understood a little bit more about the faith and traditions of the community that I was going to visit. Generally, I feel I was well prepared, but I think it’s probably an even stronger experience now.”

Emily deliberately didn’t take on a global travel project until she was developed in her career and felt ready to make a contribution in terms of clinical expertise, patient pathway, leadership and management, research, and quality improvement methodology and audit.

Quote / Testimonial:

“I personally felt that I wanted to be in a position to actually offer something useful. So I, as I say, was nearly ten years into my career. At that point, I had not only run my own clinical services, but I had also developed and led teams.”

She reflected that the local professionals were the experts.

Quote / Testimonial:

“The key thing we offered, I think was time and time that the local professionals didn’t necessarily have to deliver what they knew needed to be done. So I think that was our unique skill set was having the time kind of protected time to deliver these kind of projects.”

In Emily’s opinion on reflection the key factors to having a successful and meaningful international placement include early engagement, preparation and spending time understanding the requirements of the project, but also the host organisation and partners. With the ambition to co-develop an approach, working as peers to deliver a project.

Quote / Testimonial:

“There is nothing unique or special about someone coming from an external context to deliver or offer to deliver projects. The reason that you’re there is normally to do with capacity rather than solely expertise, skill or experience. The work is a response to gaps in skills and experience that have been locally identified. So I think it is key to ensure that any program or project that’s delivered is useful and identified by the host country or the host partner as being a priority for them, to ensure engagement, sustainability and that there is meaningful implementation. I think that there has to be space for reflexivity. So for things to change along the way, and it has to be underpinned by a sense of humility from both perspectives. That this is a mutual learning opportunity.”

Taking time to assess and develop relationships is important as well as awareness, gender roles and cultural adaption where required of one’s own positionality. She feels it is important to reflect what is important to the community that you’re working with and understand how to best interact (like a chameleon). On reflection Emily stated that:

Quote / Testimonial:

“I think now with a few more years of experience working in the sector, I probably would have taken a bit more time at the beginning to build relationships. I think the UK is a very efficiency driven culture and for me personally, I’m arriving in a community that prioritises different aspects of relationship, and I think I didn’t necessarily prioritise this well. So a good example was that when I was looking to engage one of the nursing teams in the project that we were delivering and I felt some early resistance and I wasn’t sure why. So I spoke to a local partner who highlighted that they didn’t know me as a person yet. I spent some time with my colleague exploring what was important locally – I baked and took food in to share, as food was an important part of that community trust building experience. I wore a long skirt rather than trousers to reflect the preferred local community dress sense and I spent time sitting with the nurses and allowing them to ask me questions about me and my life. It really helped.”

In terms of impact of the experience, Emily released that the global health placement helped to identify further knowledge she might need to seek out, and she subsequently did a Masters in Global Health, and is now a PhD candidate in Conflict and Health studies. She has also maintained positive friendships with her placement colleagues. Whilst global health and health systems, were the next step in her career pathway, she maintains a UK role as a clinical specialist. She has had several global health roles and responsibilities, including being part of the UK Emergency Medical Team (UKEMT) leadership, looking at the UK’s emergency response capability and capacity, running the All Party Parliamentary Group  (APPG) on Global Health in central government, based in the House of Lords, working as a Parliamentary Researcher, acting as a Global Health Consultant all over the world and more recently working for the HEE as a Senior Global Programme Manager in the Department of Global Health Partnerships. She is now based in the Middle East for five months, in the next season of her career. Her aim is to continue working between the UK’s NHS and international community.

She highly recommends the global experience programme to colleagues who express interest, and places great emphasis on understanding world views and how this shapes interactions with health services and partners.

Quote / Testimonial:

“I would say that it’s it was very positive experience for me and I would encourage people if they’re confident and happy that this is something that they want to pursue, I’d say go for it. I think the key thing for me would be recommending that they do it for the right reasons. I think the important thing to recognize is what a global opportunity is and what a global opportunity isn’t through this pathway. So I’m mostly recommending colleagues who are looking for an opportunity to enhance their understanding of health systems of cultural awareness of diversity and to make their practice more inclusive.”

Mutual learning and reciprocity is also of value in her opinion in terms of colleagues from overseas coming to learn in the UK.

Quote / Testimonial:

“I think it’s always interesting to see a different health system and to understand and learn a different culture as way of delivering health services and best practice. In the UK we focus on a principle of Universal Health Coverage (UHC) and therefore the NHS is an interesting model for those from other types of health service provider.”