Brittney_VandeWater_authorphoto By Brittney van de Water PhD, RN, CPNP

Connect with on the Circle

Connect with on the Circle
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  • Global Impact

Relationships and trust: the glue to hold global health together

Short-term immersion trips, volunteer opportunities, medical missions, global clinical placements—if you can name it, I have done it. It is my life’s work. 

With an ignited passion for global health and curiosity about other cultures, I set out early in my life to learn about the world. After spending a month in Bolivia in high school, multiple trips to Honduras and other countries in Central America, and a semester abroad in South Africa while in university, I knew I wanted to make a career for myself in global health. In 2013, I spent a year in northern Malawi teaching pediatric nursing to undergraduate students at Mzuzu University through Seed Global Health’s and the US Peace Corp’s novel Global Health Service Partnership (GHSP) program. Seed Global Health is a non-governmental organization (NGO) that sends nurse, midwife, and physician educators to Malawi, Uganda, and Sierra Leone for one-year placements at partner academic sites to provide support to faculty and students through clinical mentorship and pedagogy, content expertise, and human resources. 

Being in Malawi for a year, I was able to immerse myself in the culture, and I learned a great deal about international development as a whole. The number of government, non-government, research, and faith-based organizations all operating within the health sector of Malawi astounded me. It was a sea of international alphabet soup—USAID, UNDP, BIPAI, WFP, WHO, CDC, GIZ, GAIA, PEPFAR, ICAP, I-TECH, and NEPI/MEPI - to name a few! 

My Malawian colleagues devoted significant time to managing partnerships within their university in addition to the time they spent teaching, attending faculty meetings, and overseeing student clinical rotations. Seeing the time it takes to manage volunteers and NGO partners really emphasized the importance of long-term commitments in order to alleviate the burden on the individuals and communities ‘we’ aim to support.

Here is where I had my moment of clarity: In the short-term ‘voluntourism’ opportunities I had participated in, I was gaining and learning more from my experience than I was actually giving. Yes, I had knowledge to share or skills to transfer, but the investment and opportunities others provided me was more impressive than the expertise I was able to provide. 

The longer-term projects combined local collaborators' backgrounds and mine, their knowledge and mine, to make incremental changes to better the health of the communities where we worked. It did not happen overnight—and it shouldn’t. However, it did happen because we knew the importance of developing a foundational relationship and trust first. We had time to develop mutual respect and understanding of one another’s background.

After returning to the US and after my year with GHSP, I decided to obtain my PhD in nursing and a doctoral certificate in global health. I wanted my research to be grounded in theory, practical in delivery, and rooted in what I have seen work best—synergy. 

I wear many more hats these days, and I continue to be energized and passionate about global health. In my part-time role with Seed Global Health as their Associate Director of Pediatric Nursing, I support our pediatric nurse educators and work with partner institutions to understand their needs and help recruit the best educators to provide specialized support. I am also a full-time faculty member at Harvard Medical School in their Department of Global Health and Social Medicine. In this capacity, I conduct research focused on improving models of care for tuberculosis in South Africa, an epicenter of HIV and TB. Over the past four years, I have spent 50% of my time living in South Africa, developing relationships with the hospitals where I work and collecting baseline information before embarking on a study intervention together. This time has provided valuable insights into the facilitators and barriers associated with making improvements in healthcare delivery. My colleagues at Harvard find my background in nursing incredibly valuable. I understand the clinical aspects of the work we do—and why we are doing it—in addition to the research skills I have gained as a nurse scientist. In my department, I am one of the only nurses with a PhD, yet much of the work the department conducts have nurses on the frontlines to deliver medications to patients, coordinate research studies, and assess the needs of patients. I credit my time in Malawi and South Africa, along with my prior short-term experiences, for equipping me with the knowledge and tools to develop relationships with collaborators over time. My long-term commitments to communities have given me a much more realistic understanding of the issues at play. In addition, I feel I am now able to contribute my skills and knowledge in a contextually and culturally appropriate way because of the strong relationships we have forged. I recognize that trust is not a guarantee, it is something earned; often over a cup of tea or through shared values and passions.


Brittney van de Water, PhD, RN, CPNP, is an Instructor of Global Health and Social Medicine at Harvard Medical School and the Associate Director of Pediatric Nursing at Seed Global Health, and she is a member of Sigma’s Beta Epsilon Chapter at Duke University School of Nursing in Durham, North Carolina, USA. 


  • volunteering
  • global health
  • Global Impact
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