From a mobile clinic in Africa to hospitals in the West - How permission, power and care collide
From mobile clinics in Africa to hospitals in the West why the silencing of women’s health is not cultural, but systemic.
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“Please… can you help me? I need to be seen before my husband comes home.” That’s what she said.
She had stepped out of the long line outside a mobile health truck and tugged at the sleeve of one of the medical volunteers. The truck had just arrived in a rural town in Africa, and a crowd had already formed. But she couldn’t wait.
She wasn’t just in pain. She was afraid. She had walked over 10 kilometers - more than two hours on foot, because she couldn’t afford the tuktuk fare. And now, she needed to be helped quickly. To be seen discreetly. To get back home before her husband returned.
Because if he found out she had let another man examine her, especially her breast, there would be consequences. Even though it was swollen. Even though she could barely breathe. Even though she knew something was very wrong.
The team examined her. She had a massive tumor pressing on her lungs. She was rushed for immediate surgery. It was a miracle she was still alive.
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That story was shared with me recently. And it hasn’t left me. Not just because of the desperation in her voice but because it echoed something I had felt years earlier, when I was running a nonprofit in Nigeria.
Back then, I believed that giving rural women access to capital and skills would be enough. We taught trades. We offered microloans. But again and again, we hit the same invisible wall: permission. If a woman couldn’t say yes to the opportunity because of fear, or control, or social norms, then no amount of money or training could help.
I thought: This is the problem. And I thought: This is cultural. But I was wrong.
Because what happened in that mobile clinic wasn’t just a story from “over there.” It was a window into a system that exists everywhere.
Years later, living in the West, I see it again. Different context. Different mechanisms. Same outcome.
Women misdiagnosed for a decade because their symptoms don’t match the male template
Hormones vilified, even when clinically indicated
Clinical trials that still exclude female physiology
Founders told their innovation is “niche” because it addresses uteruses, breasts, hormones, or pain
Midlife women offered antidepressants instead of diagnostic workups
It’s a structural pattern, and a global one at that.
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In Sudan, a writer on Substack recalls: “We (women) worked the land, but we never owned it.”1 In Nigeria, I saw women labor for harvests they never got to sell. And here in the West? We generate the data. We publish the research. We raise the capital. And still, women’s health is underfunded, under-researched, under-cared for.
It's the same architecture of control. Cloaked in policy. Polished in systems. But the result is unchanged: your body can wait. Your care is negotiable.
I used to think the barriers I saw were tied to geography. Tradition. Marriage. Faith. But now I know: it’s not about where you live. It’s about how much your body is allowed to matter.
Because what is a woman begging to be seen before her husband gets home… If not the same as a woman here in the west begging her insurance to cover hormone therapy?
What is walking two hours for a private exam… If not the same as a woman hiding her symptoms in a corporate job because menopause is taboo?
What is fearing your husband’s punishment for seeking help… If not the same as fearing professional backlash for advocating for your health out loud?
It’s the same thing. It’s just wearing different clothes.
I don’t run that nonprofit anymore. But I carry its lessons. And one of the clearest is this:
Empowerment that ignores fear isn’t empowerment.
Access that doesn’t account for permission isn’t access.
And care that isn’t shaped by women’s lived realities won’t reach the women who need it most.
When we talk about health innovation, when we fund it, design it, scale it, we can’t just ask: “Will it work?” We have to ask:
“Will she be able to access it?”
“Will she be believed?”
“Will her context; economic, cultural, or clinical make it usable?”
Because even in the West, where women don’t need permission to seek care, they still face systems that delay, dismiss, or deny. They say yes and the system says “not yet.” Or worse: “not for you.”
And if we don’t address those gaps between availability and usability, intention and impact we will keep building solutions that never reach the women who need them most.
That woman, wherever she is now was not voiceless. She knew exactly what she needed. She found the courage to ask. She walked for hours in pain. She risked everything to be seen.
And if we zoom out far enough, we realize: we are all her.
Not because we all face the same danger. But because the same systems continue to shape what kind of care is available, permitted, and prioritized for all of us. So let’s stop calling it cultural. And start calling it what it is: systemic.
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This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.
I don’t recall the name of the Substack or the writer, would have loved to tag them. If you do, please let me know.