For many years, I had a fulfilling career working as a physical therapist treating individuals who had suffered from a brain injury. I can still vividly remember many of the people who I was able to help sit up again, or walk again, and the joy on their family’s faces. I also had a pretty good gig going on: I would work and save money for about eight months of the year, and then take off to travel the world and volunteer my services for the rest of the year. I wanted to pass on the neurological rehabilitation skills that I had acquired to providers and patients in resource-poor areas of the world. For a time, I was working in a local rehabilitation clinic, providing physical therapy services, in rural Bihar, India. There I met and treated a young woman who had suffered from a stroke. She could not move one side of her body. This encounter would change the course of my life.
Supria had been beaten and abandoned by her husband. So she stayed with us, in one of the few beds that we had at the rehab facility. I was living in the facility too, and so I often spent evenings treating her, or just sitting with her.
Over time, I came to realize that the health system into which she was thrown was severely broken. Without strengthening that system, Supria had little hope of recovery, no matter how hard we worked. Further, I realized that while I was making a small difference in Supria’s life, I could have a greater impact on health care in the world if I worked to strengthen systems, and local organizations, and the governments within which those systems were imbedded. Supria introduced me to my new career. I attended graduate studies in public health in Boston, met Joel Lamstein, founder and president of JSI, learned about JSI’s work to sustainably improve health systems around the world, and finally arrived at a job at JSI.
Over the years at JSI, and as a founding member of JSI’s Capacity Development Center, I have worked with local teams throughout Africa on making national and community health systems stronger. From maternal health services in Ethiopia, to developing a basic health system in the young country of South Sudan, to community care for vulnerable populations in Tanzania, I have had the privilege of working on some amazing projects that have improved the chances of people like Supria to get the services that they need. After about five years, however, these projects end, and while I believe that we leave behind people and systems that are stronger and more capable than when we started, the sustainability of these efforts remains a burning question in my mind.
Recently, I had the chance to take this notion of sustainability to a new level. On behalf of JSI’s Capacity Development Center, I traveled to Guyana, a country in the process of transitioning away from external support such as USAID, to funding its own health systems and programs. I had the privilege of working with nine local NGOs under JSI’s USAID-funded Advancing Partners and Communities project. I facilitated a workshop on sustainability: working with leaders from these local organizations to help them develop practical strategies, plans and resources to make them become more sustainable – financially, technically, geographically, and environmentally. Taking a human-centered design approach, we explored each NGO’s individual market niche, looked at positioning and target audiences, and began to develop individualized resource mobilization and communication plans. In preparation for USAID pulling out of Guyana, I hope that in some small way, I have been able to assist these organizations to become more self-sufficient, and better equipped to continue to support health and development in their beautiful country.
From my early days of directly treating patients, to working with JSI in-country teams to improve health systems in resource-poor environments, to empowering local NGOs to become local leaders in health and development, I feel that I am steadily moving toward this notion of sustainability in global health and development. I think that we, the development community, have a lot to learn still, but I believe that we are at least on the right track to helping nations make the most sustainable use of resources to give people like Supria a chance to survive and even to thrive.