“What impact have I really had?”

This is a question many people ask themselves. For our international volunteers, people who serve in remote and impoverished parts of the world for six months to a year, the question can become a bit of a burden. It can feel at times that very little is accomplished and very little has changed. 

This past July, during our volunteer orientation for incoming international volunteers, our SVP of Programs and Volunteers, Dick Day, addressed this nagging question. With his experience serving as Peace Corps Director for Africa, where he was responsible for more than 3,000 volunteers, his insights and stories were extremely powerful.

In this piece, Dick shares personal reflections about loss, love, and a life of service. He inspired everyone in the room and we were urged to share it with our larger CMMB family – including you. 

The impact that you have is rarely seen or felt in the moment.

This concept was really driven home to me by the people who recently shared stories and remembrances about my father during a memorial celebrating his life. My father lived and served in Malawi for the last 28 years. I want to share this because I think it’s absolutely critical that you – and anyone who chooses to serve – really comes to understand and believe that you are having an impact, even though it won’t necessarily feel like it sometimes. Even if you can’t see change on the scale you would like given the needs of the situation.

The real and lasting impact that you will have will be on a one-to-one basis. It will become evident over time.

During the memorial for my father, the stories I kept hearing were about something he had said or something he had done, or about the confidence that he helped to build that really impacted them. Each of you will have similar opportunities regardless of what you are doing – just through the care and the respect that you show in your daily interactions with host country colleagues, CMMB staff, patients, and others. You will leave a real impact – sadly, you just don’t get to see that, in the moment.

But, I encourage you to take heart – you ARE making a difference – and I encourage you to figure out how you will navigate those tough times when you don’t’ feel like you’re making a difference. One thing I might suggest you consider doing is something I learned from a Peace Corps volunteer who served in the very far north of Mali. He kept a big tomato can – about the size of a two pound coffee can in the U.S. At the end of a day, he would scratch a little note about something he had accomplished and slip it into that big red can. Then, on rough days, when he did not think he was having an impact, he’d reach into that tomato can, pull out one of those slips of papers, and read it – to remind himself of the moments when he had an impact, so that he could say “Oh, yes, I remember.” It’s just a way of keeping yourself connected to both the challenges and the opportunities that you have as volunteers working in foreign environment.

I know that our alumni volunteers – people like Dr. Mary Fleming, Dr. Harry Owens Jr., and Dr. Helene Calvet–  can speak to this connection very well. Just know you are having an impact.

Dick sending our volunteers off with a good luck message.

Dick Day and other members of the CMMB staff share words of thanks and encouragement with the newest cohort of international volunteers during our orinetation at the CMMB headquarters in NYC.

Dick with our newest volunte

A final farewell!

The other thing that strikes me – and this is really for medical professionals – is that you have great opportunities to make a difference, but you will also face very significant challenges – challenges that are endemic in a low-resource environment. There may be situations when you might not be able to save a life due to lack of medications or equipment or adequate personnel, lives that you would have been able to save in the U.S. This is something that my own family has reflected on with my father’s passing.

My father died on June 28 after a massive stroke. I share this story because it’s very real but actually kind of surreal. I hope it will help highlight some of the challenges you will face in patient care without adequate resources. My Dad had to be taken about an hour and half from where my parents lived to get proper medical care. The ambulance actually had to come from that hospital. The ambulance did not have any real treatment capacity or resuscitation equipment, and there was not a trained EMT on-board. While it did have an oxygen tank, it was not mounted in the car. So, Sydney, my parents’ driver, had to go in the ambulance to hold the cylinder so that my father would have oxygen during the long drive to the hospital.

It was many hours after his stroke that my father finally arrived at the hospital. For medical professionals, you know that time is of the essence when treating a stroke. Consequently, by the time my father arrived at the hospital, the doctors and nurses were working way behind the curve. But, they were able to get him to rest quietly. Several hours later, with no equipment beeping or nurses around, my Mom noticed my father wasn’t breathing – no vital signs.  Instead, Sydney, who had stayed with my mother in the hospital room, went off to tell the nurses that my father had passed away.

The nurses came running in and started doing CPR. Then, someone wheeled in a crash cart and pulled out a defibrillator. But, of course they couldn’t find all the equipment – the nurses were rummaging through drawers and mumbling that they couldn’t find the paddles. A nurse finally ran out to try and find them. Throughout all of this, there was no doctor around.

You know my mom was totally okay with all of it – all the confusion and disorganization. At that point and time, she was able to realize and accept that passing on was the natural progression of life for my father. In that very moment, she knew it was his time to go. However, for the healthcare practitioners who are committed to saving lives – that is not necessarily an acceptable outcome.

Dick's father and mother

Dick’s father and mother

At Peace Corps, I used to oversee a program called the Global Health Services Partnership, where we fielded doctors and nurses to serve as medical trainers in hospitals or nursing schools. We found that one of the greatest challenges for these accomplished professionals was feeling inadequate in the situation. They could not bring the level of care they thought was appropriate based on their skills, training, and expertise and without the resources that they were accustomed to in the U.S.

You will need to balance those standards and expectations with the medical environment and cultural values of your new situation. You will not be able to “fix” all the things that are lacking in your hospital and in that foreign culture where you will serve, just like my mom reflected, there is a different understanding about life and death. It is not about the value of life, but rather about the progression of life and its natural ending.

You will make a difference nonetheless. You will bring yourself and your lifesaving services. But you won’t be able to do it all. When you are not able to bring the level of care that you think is appropriate, my exhortation would be: please be kind to yourself.

The ABCs of Cultural Integration

The last thing I would like to talk about is the concept of “cultural integration.” Cultural integration is  defined as a form of cultural exchange where one group or individual assumes the beliefs, practices, and rituals of another group without sacrificing the characteristics of its own culture. In the Peace Corps, we emphasized the importance of integrating. We asked that volunteers work hard to learn the language, that they learn about the culture and respect it, and that they become integrated into their new environment. But I came to realize that this is an unrealistic expectation.

Please be kind to yourself.

My wife and I lived overseas for ten years with our family – and we struggled going between two cultures when we lived in Africa. My father, who was a wonderful thinker, helped us understand the dynamics with a simple illustration. He explained that when you leave home and participate in some kind of international service, you leave your “Culture A” – and you enter into “Culture B” with its different languages, customs, beliefs, weathers, challenges, etc. You enter into it, but you don’t become “Culture B.” However, as a consequence of your immersion in that other culture, you are  also no longer “Culture A”. Instead, you morph into “Culture C” – a kind of a mixture of the two different cultures. You never become a “B” but you are no longer the “A” you started as.

Perhaps one of the most interesting and for some quite challenging experiences is returning to “Culture A” after a period of time in “Culture B”. There is always a period of reintegration – some call it reverse culture shock – the psychological, emotional, and cultural experiences of coming home. Suddenly you experience home with new eyes.

A Different Kind of Goodbye

My father was buried in Malawi because that was his adopted home. As we went through the whole burial process, there were parts that we understood and embraced and others that we had to simply say, “You know, we are not Malawian and that’s okay.”  It can be uncomfortable being a “C” because there’s always this underlying recognition that, “I don’t understand everything that’s going on, and I don’t totally fit in.”

Given this, I encourage you to seek out someone that can be a kind of culture-bridger for you – someone who can help you understand the things that are not being said, the things that are going on behind the scenes.

The other challenging part of this process is when you come back home. You had this rich experience and, of course, you just want to share it. But, the people that you talk to – even family members – don’t really understand you because they didn’t experience “Culture B” like you did. You will come back into your culture and there will be parts of it that will feel very foreign to you – even repulsive – because you are no longer a “Culture A” member, but instead a “Culture C” – something very different from everyone around you.

Overtime, you can kind of assimilate back into your home culture and become a little bit more of an “A.” It took me 20 years after coming back from being overseas to be able to say, without hesitation, where I was from when people asked. For such a long time I could not bring myself to say where I was from, because I had this identity in the back of my head from having lived in and loved Africa.

So, it’s okay if you don’t understand everything that’s going on – you shouldn’t, you won’t, you can’t. Try to find somebody that can help you understand more of what’s going on, particularly the silent, unspoken parts of a culture.

A Word of Warning and Advice

Brace yourself for when you come home with stories to tell. A couple years after living overseas, I put together a Kodak carousel deck with 140 slides. I had such wonderful stories with gorgeous photos to share. Within 10 minutes of starting my show-and-tell people started to glaze over or fall asleep. I came to realize that it was simply “too foreign” – they became overwhelmed by how different it was from their experienced “world.”

But eventually we found a group of friends who could really connect with the stories. The key is to find a few friends who love you at a heart level, people who really want to walk through the journey you’ve been on, and who will try to understand you.

A Message for Our Amazing Volunteers

I want to end by saying that I so appreciate every one of you for your willingness to volunteer. Each of you are sacrificing a rich period of your life to serve others who have less. You are emulating the example of Jesus who had compassion for the poor and healed the sick.

When it gets hard and you feel like you aren’t making the difference that you’d like, be kind to yourself – you ARE making a difference, in ways that cannot be measured or imagined.

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