How (not) to practice global health: A field guide for the distinguished global south expert

Sir,

A letter has just arrived in my postbox:

“Congratulations, dear colleague! You are a rising star in Global Health from the Global South. You studied abroad (twice), have a LinkedIn banner that says “decolonising health,” and now carry the sacred burden of saving your own continent from itself.

You are not just any professional—you are a southern saviour. Unlike your Northern counterparts, who must travel 10,000 miles to “serve,” you only need to cross the campus gate in your SUV. And this, dear reader, is your definitive guide on how (not) to practice Global Health in the Global South—while performing just enough to be invited to the next Geneva panel.”, it says.

May I give you a few tips?

Wear the cape of Decolonisation, but leave the mirror at home. Begin every keynote with a Frantz Fanon quote and end with one from Ngũgĩ wa Thiong’o. Bonus points if you insert the word “decoloniality” at least once within the first two minutes. But do not, under any circumstances, reflect on how you might be replicating colonial power structures. That is for others to do. You are from the Global South, ergo, you cannot be complicit. You are not part of the problem. You are the postcolonial solution.

Conduct workshops on communities, not with them. Host a high-profile “community engagement” meeting in a five-star hotel. Fly in a few community representatives—preferably ones who won’t challenge you too much—and provide them with enough hospitality to ensure their gratitude.

Present your findings in English using four-quadrant logic models and sustainability matrices. If community members look confused, take that as proof of their “limited capacity,” and offer to “build” it through another externally funded project.

Preserve the pyramid: You are the principal investigator, not the participant. When Northern collaborators send over a draft with your name in a gloriously middle-author position, do not push back. Take a screenshot for Twitter with a caption: “Humbled to be part of this amazing North-South collaboration!” Ignore your own junior colleagues who weren’t invited. After all, they’re still struggling with the “publish or perish” part. You’ve already moved on to the “collaborate or keynote” phase.

Preach equity, but practice elitism. Chant “health equity” by day; pull rank by night. At home, don’t mentor rural faculty or first-generation students—unless they’re useful for increasing your “grassroots quotient” in donor reports. In your editorial board, only include Global South members who also hold adjunct positions in the Global North. That way, your South will always be sufficiently North-adjacent.

Avoid clinical work. Appear on panels. Your work, naturally, is too strategic for messy fieldwork. Let interns or fellows handle the “monitoring and evaluation.” You, meanwhile, must attend global summits and host webinars on “community-centered innovation.” Field visits are best reserved for documentary footage or Facebook updates captioned “On the ground, where it matters most.”

Master the language of ‘Impact Factorism’. This is your academic duty: getting published. Always aim for the highest-impact journals, preferably those that have rejected you before, because nothing says “decolonised” like seeking validation from the colonial centre. Even if your own national journals are read by tens of thousands of your peers, they don’t have that “elite sheen.” Your manuscript will probably result in a warm rejection letter citing space constraints, assuring you that the decision isn’t about your quality. Reassured, you should resubmit to your national journal (which, incidentally, reaches thousands of doctors)—but only after you’ve exhausted all Western doors. This cycle, repeated endlessly, is your rite of passage.

Say ‘Decolonise’, but cite North! Despite advocating for “Southern knowledge,” cite mostly scholars from Global North. Why? Because the editor said your literature review must include “canonical texts.” Your local colleagues, who’ve published brilliant work in non-indexed or regional journals, should remain uncited. After all, what's the use of a publication no one important reads? And when a young researcher dares to ask why you don’t cite local scholarship, nod gravely and say, “It's a complex ecosystem.”

Authorship is Power. Use it wisely. Let's be honest: the politics of authorship is delicate. So don’t risk disrupting harmony by offering lead authorship to field-based collaborators who did most of the work. Instead, give them a warm line in the acknowledgments, calling them the “true heroes.” It costs you nothing and ensures they stay heroically silent in the next round too. Meanwhile, lobby to join the editorial board of a prestigious journal. That's where you can really decolonise: one special issue at a time.

Ignore the Article Processing Charge (APC) elephant in the room. This is now $3800 but it is not your concern. You're covered by institutional waivers and personal networks. But please don’t bring it up in public forums: it spoils the vibe. When junior colleagues from LMICs say they can’t afford APCs, tell them to “collaborate internationally”, code for attaching themselves as middle authors on someone else's paper, in someone else's voice.

Finally, avoid mentioning Global North supremacy! Whatever you do, avoid naming the real foundation of global health inequity, which is supremacy ideology from the North. Definitely, colonization was bad. But now that everyone's talking about “decolonisation,” let's keep it abstract. Don’t risk the discomfort of tracing colonialism back to its root, i.e., the belief in the innate superiority of Global North knowledge, systems, and people. That's a bit too… real. After all, acknowledging this would force us to question why curricula, research partnerships, and funding flows are still centred on elite institutions in high-income countries. It would mean recognizing that our own institutions have been trained to perpetuate this ideology, dressed up as “rigour.” It would even mean teaching our students to question these norms, and that might mean they question us! Better to keep things polite. It's safer to talk of “decolonisation” as if it's just a rebranding exercise.

Epilogue: a satirical selfie

This satire does not mock — it mirrors. In that spirit, we must admit that the call to decolonise isn’t just external; it's internal, uncomfortable, and urgent.

We, the Global South elite, often become gatekeepers in the very structures we claim to dismantle. ¹ We chase Western validation while neglecting the journals, researchers, and ideas at home. We cry “inclusion” in Geneva while excluding from Jabalpur, Jos, or Jakarta.

The epistemic Gordian knot lies in our colonial mindsets: we seek peer approval through trophy publications, only to face rejections that push us, grudgingly, back to our own journals, which we ourselves refuse to strengthen. ²

This is not merely about geography, but ideology. Global health's architecture rests on the historic scaffold of Global North supremacy; unless this is dismantled, no amount of “local ownership” or “capacity building” will free us. ³

We must shift the centre of gravity to reflect population, disease burden, and dignity. We must re-evaluate partnerships, elevate local knowledge, and build Global South institutions that are not hand-me-downs of their Northern counterparts, but their equals. ⁴

To paraphrase Desmond Tutu: we’re no longer satisfied with crumbs of compassion tossed from the global table: we want the full menu. And perhaps the kitchen too. Because the real revolution may not be peer-reviewed in an elite journal, but will be peer-affirmed in Lagos, Lahore, and Lima.