A mother held a lifeless infant in her arms, an infant who minutes before had been healthy and active. Her shocked and bewildered cry hit me like a tsunami, threatening to drown me in the grief one only associates with an unexpected, devastating loss. Instinctively, I reached out to touch her arm—to comfort her—but I suddenly recoiled at the sight of my pale hand, a startling reminder of my foreignness. I resigned myself to watch from the periphery as my Ghanaian colleagues gathered, encircling the wailing woman. She sat alone in a pool of cruel sunlight, rocking back and forth to the rhythm of sorrow, still clutching her dead child to her breast. I waited expectantly, in painful silence, for someone else—someone less foreign—to provide the solace that I could not.

Finally, a senior nurse stepped forward from the crowd. My heart leaped in anticipation of a show of empathy. But no—the nurse suddenly started a soliloquy, vigorously and repeatedly reenacting how the mother had wrapped her baby too tightly, ultimately suffocating it. With each rendition, the mother’s wails escalated in intensity as she endured the public shaming. In truth, she had not been responsible for her baby’s death, yet she bore the brand of guilt from the nurse. I again felt the urge to go to the woman’s side—this time to shield her from the nurse’s accusations—but I held back. I stared down at my white hands, taking in the irony that I held so much power but felt so powerless. I was a privileged outsider, a guest in an alien culture. My skin color and Western upbringing afforded me an uncomfortable level of influence and constant scrutiny. Any action on my part, while perhaps temporarily quelling my own desire to provide comfort to a suffering human being, could potentially be construed as intrusive and condescending. I was terribly fearful of the consequences that could come from my interference and thus remained silent.

I spent nearly a year in Ghana, taking in more circumstances that left my moral compass spinning: Physicians wittingly turned their backs on their patients and their profession during repeated, prolonged strikes; providers made countless verbal and even physical assaults on patients in my presence. I stood by, reticent and passive, adopting a mask of unconcerned amiability. All the while, my inaction made me feel like an accomplice to social injustice. I tried to tell myself that it was right to stay out of it; passing judgment on such situations using a foreign ethical framework was inappropriate and unfair.

Yet I felt hatred brewing within me. I hated the providers who behaved in ways that I believed were fundamentally at odds with our professional obligation as healers. I hated the culture that condoned such dispassionate behavior toward those who, by no personal fault, had been born into a destitute and disempowered life. And, oh, how I hated myself. I hated my hesitancy to serve as an advocate. I hated my skin color and all of its social implications that kept me from connecting with others. Above all else, I hated my own capacity for intolerance and judgment. I sought desperately to counter my disenchantment with Ghana and humanity, looking for inspiration among the devoted doctors crossing picket lines and the compassionate providers treating patients with kindness. I even tried rationalizing the ethically dubious behaviors I witnessed. Perhaps those providers aspired to treat patients with a tender hand, but in the face of so many environmental stressors and resource constraints, they couldn’t. Perhaps they went home at night and felt remorse and self-hatred as I did.

Yet, despite these rationalizations, I was consumed by an overwhelming sense of apathy toward my colleagues and work environment. I condemned their behavior as inhumane and immoral. I, myself, witnessed injustice and failed to rise to the occasion again and again. I was simultaneously a self-righteous, moral bigot and a hypocrite. There is no worse sensation than holding yourself to a certain moral standard but finding that your actions are discordant with it. It leaves you feeling deeply depraved, empty, and false.

When I returned to the States, the emotional vacuum remained. I resented the lauds I received for my work in Ghana, feeling unworthy of such praises. I met individuals who had spent time abroad and envied their elation and sense of purpose as they recounted the inspirational circumstances and people they had encountered. I wanted desperately to feel the same way but didn’t. Behind my mask, I struggled to hide the intense disorientation that threatened the lens through which I saw medicine and humanity. Most of all, I felt deeply unsettled and ashamed by what my experiences had taught me about myself. I was prone to hatred, prejudice, and cowardice.

I desired intensely to tell someone how I felt and remove my self-constructed mask. Perhaps, in the act of telling, I could repent for my hatefulness and complacency. And so, four months after returning from Ghana, I found myself sitting in a meeting with my mentors, struggling to find the words to set myself free. Surprisingly, I didn’t need to say much. My mentors saw right through my guise with the practiced wisdom of those who have borne and cast off masks of their own. They offered simple yet pivotal advice: “Just accept. Accept the good, bad, and ugly, both within you and around you.”

Every day since then, I have endeavored to accept and also to forgive. I have found it easier to forgive those who made me question the fundamental good within humanity and myself. Self-forgiveness has proven more difficult. I constantly question the appropriateness of my silence in Ghana and remain haunted by the notion that I could have done more to give a voice to victims of social injustice. At least, in speaking out now, I have found solidarity. I am comforted knowing that I am not alone—that others are fighting their own internal battles, questioning the silence.