After spending two and a half years at FSG, I moved to Western Kenya to work with AMPATH, a leading health organization that is providing HIV/AIDS treatment to over 35,000 patients. I enjoyed my time at FSG tremendously and I saw the difference that we made at the strategy and evaluation level. But I was hungry for more on-the-ground operational experience and being closer to the people we were trying to help.
And I’m definitely getting all of that! I’m rapidly adjusting to daily life in Kenya, from the catcalls of “Mzungu-Chinese” as I walk down the dusty road to town, to navigating the crowded “mboga” market where I get fresh vegetables straight from the farm. I’m also coming face-to-face with many of the difficult questions of global health work. Is it more paternalistic to bring “Western” expectations for performance or to accept local standards as “culturally determined”? How do I make sure that my work is sustainable and will last after I’m gone? And I’m seeing the operational difficulties that lie beneath the high level achievements – all the challenges of managing and operating a complex organization that don’t make it into the headlines.
Living here also brings the stark disparities in healthcare more into focus than when I was a two-week visitor. This is the macabre reality: If something happened to me or my wife, we would go to a private clinic for medical care rather than the government hospital where we work. We’re succeeding dramatically at making improvements, but we’re also desperately failing to provide the minimum level of care we might accept for ourselves and our loved ones. Being here has been a lesson in accepting that conflicting emotions can all be justified – to be okay with feeling angry, despondent, inspired, hopeful, and proud, all at the same time.
A final reflection is how immensely valuable my time at FSG was in preparing me for being here. Wrestling with all the challenges that leading organizations in global health struggle with taught me how to think rigorously about what works and what doesn’t. I have seen the importance of continuous evaluation, experimentation, and developing buy-in from stakeholders, and am able to bring those perspectives to this organization. Moreover, the management skills have been perfectly transferrable: Leading decision-making without formal authority, selling new ideas and practices to leadership, facilitating discussions, and juggling many tasks at the same time.
Now if only I had learned more about how to keep my shoes clean while walking on all these dirt roads…