Working in Tanzania, Ghana, and Rwanda changed the way I think about healthcare.

When I first got involved in global health, I carried a lot of assumptions with me that I didn’t fully recognize at the time.

I believed healthcare systems could mostly be improved by expanding access, building infrastructure, creating programs, and implementing evidence-based models.

Those things do matter.

But over time, I started realizing something deeper.

Many of the biggest problems I saw were not because communities lacked knowledge, resilience, or ways of caring for each other.

In fact, many communities already had incredibly strong support systems.

Families.
Neighbors.
Community leaders.
Traditional healers.
Religious communities.
Informal networks of care and communication.

People often knew exactly who was trusted, who people turned to in crisis, and how information actually moved through the community.

What I saw more often was a mismatch between formal healthcare systems and the realities of people’s lives.

Programs are designed externally without enough understanding of the local context.
Guidelines that assumed resources existed when they didn’t.
Healthcare models that expect people to adapt to the system instead of adapting the system to the community.

And sometimes, despite good intentions, those approaches created even more distrust.

One thing that stayed with me was seeing how traditional healers were treated in some settings.

Instead of partnering with them, many healthcare institutions viewed them as competition or as part of the problem.

Patients were sometimes shamed for seeking care from traditional healers. Some became reluctant to admit they had seen one at all.

But the reality was that traditional healers were often deeply trusted members of the community.

People went to them because they understood their culture.
Because they trusted them. 

Because they were accessible.
Because relationships already existed there.

And instead of building bridges with those trusted relationships, healthcare systems often create division.

Healthcare works better when it becomes part of community life instead of trying to operate above it.

That shift in perspective changed a lot for me.

I stopped seeing communities primarily through the lens of what they lacked and started paying more attention to what was already strong within them.

The problem often wasn’t an absence of care.

It was that formal healthcare systems were failing to recognize, support, and integrate the trusted networks already surrounding people.

I saw this especially in Rwanda.

What stood out to me there wasn’t one specific medical intervention or project; it was how relational and integrated care felt.

People checked on each other.
Information moved through trusted relationships.
Community health workers were integrated into daily life.
Care extended beyond the walls of clinics and hospitals.

It made me realize that trust itself is part of the healthcare infrastructure.

Once I saw that, I started noticing the same disconnects back home in the United States.

Healthcare systems that feel fragmented.
Communities that don’t feel meaningfully included in care design.
People are struggling to navigate systems that were built around institutions more than relationships.

Global health didn’t make me lose faith in healthcare.

But it did make me question some of the assumptions I was trained to believe about where expertise lives and how sustainable healthcare systems are actually built.

It made me realize that communities are not empty vessels waiting to be fixed by institutions.

They already hold knowledge, relationships, culture, resilience, and systems of support.

The question is whether healthcare systems are willing to build with communities instead of simply building around them.