My name is MaryGrace Apostoli, and I currently work as a Senior Analyst for a health care consulting firm. My job is to uncover and disseminate industry best practices to support nursing executives around the world in addressing strategic and operational management challenges. Outside of my paid work, I volunteer serving as a Board Member with the Richmond Global Health Alliance, a group with which I have been involved since my early undergraduate days at University of Richmond. As a member of this group, I look to expand my knowledge of the field through every learning opportunity I can get my hands on.
This past weekend, I had the privilege of attending Unite for Sight’s Global Health and Innovation Conference, at which 2,200 professionals and students from all 50 states and more than 55 countries convened to exchange ideas related to global health equity and social entrepreneurship.
As a recent graduate (I am allowed to say that until I’m like, 30, right?) and an ‘o
utsider’ from a publicly-traded company, I admittedly felt intimidated to be in the company of incredibly influential people in the field, such as Al Sommer and Jeffrey Sachs. I was equally intimidated by the young Masters in Public Health candidates, who were frantically waving their hands in the front row of a lecture, eager to stump the presenters with complex questions and spout theoretical knowledge of program models and systems integration and all of those lofty terms we so often use to complicate relatively simple concepts.
I’ve never been one to frantically wave my hand in the front of any lecture, and as a non-MPH, many of the theoretical concepts sailed right over my head. But I did want to do my part in facilitating knowledge exchange by sharing some lessons that I took away from this weekend with all of you.
So here it is – my first ever blog post.
Food for Thought from the Unite for Sight Global Health and Innovation Conference
The majority of speakers spent a lot of time rallying around a few critical themes that are relatively well-known and well-demonstrated in the field of global public health. It was very interesting to discuss how you convert theory into action in a lot of these areas (promoting self-actualization over providing handouts, empowering the community you work with to drive forward your priorities, focusing on prevention and health promotion over curative medicine, etc.) – but in general, these are relatively well-accepted truths for those who study, dabble in or have made a living out of this kind of work.
My most valued ‘takeaways,’ however, were in the areas where there was some friction; where thoughts and perspectives were a bit less harmonious.
In a session on social businesses, we heard from a spirited Chief Executive Officer of an international fair trade coffee company who challenged the intense focus on ‘scalability’ in the global health and social entrepreneurship community. He told several stories to demonstrate his point, including one about how his organization paid for the education of a young daughter of a farmer in the coffee cooperative he worked with in order to save her from being sold into sex slavery in Saudi Arabia. Perhaps from a dollars and cents standpoint, that was not the most sound or most scalable investment he could have made. But because he cannot do that for every young woman at risk for being sold into domestic servitude, did that mean he shouldn’t do it for the one?
A similar story is told about Dr. Paul Farmer in Tracy Kidder’s famous book, Mountains Beyond Mountains. Kidder tells the story of how Dr. Farmer’s non-profit organization, Partners in Health, spent a large sum of money to fly a young boy with an advanced tumor from Haiti up to Chicago to get very expensive surgery that was ultimately unsuccessful. The young boy died, and many criticized Dr. Farmer for spending so many resources on just one person when it could have done so much good for so many people.
So the question raised by both of these stories, and the one the speaker at the conference challenged us with is: How do you weigh breadth of impact with depth of impact?
Breadth vs. Depth of Impact: Where do you draw the line?
Throughout the conference, nearly every non-profit or NGO representative, every researcher or clinician, and the majority of social entrepreneurs, would get up in front of the group and discuss the model for their projects or their business, the outcomes they’ve achieved and how they have already (or how they plan to) take that model “to scale.” This is both to accommodate growth and maximize return on future investment.
Resources are scarce, and “rationing” is a reality that we all have to live with. That is undoubtedly true across the board –the health care systems and hospitals of even our most economically developed countries face these kinds of ethical decisions every day. Showing maximum impact for minimum investment is prized in a world where resources are limited and there is a lot of work to be done.
Perhaps most importantly of all, having tangible data to “show for” your efforts is critical to proving responsible use of previously invested resources, as well as to attracting additional resources. As a person who spends her time studying and advising on operational efficiency, this way of thinking makes perfect sense to me. I like numbers, and I like evidence, and in their absence, I tend to be a bit of a skeptic.
So having a concrete vision for maximizing impact and appropriately scaling efforts are simply basic principles of good financial stewardship. How could these values ever be seen as anything but utterly responsible and entirely positive?
Can the pendulum swing too far?
Ordinarily, I’d argue that they can’t be seen as anything but positive. And for the most part, these are important principles to adhere to. The discourse initiated at the conference, however, made me question whether or not we are all at risk for taking this commitment to a bit too far. There is a fine balance to be struck, and we need to be wary of letting good financial stewardship impede justice.
Dr. Farmer has a quote that I particularly like: “The idea that some lives matter less is at the root of all that is wrong with the world.” If you really stop and think about it, he is exactly right. We let injustices and great disparities persist because – whether explicitly or implicitly – we believe that some lives are more valuable than others.
To return to the stories referenced earlier, if, for example (and God forbid), it were my sister who was being sold into sex slavery or my brother who was suffering from a tumor, I would walk through fire to get them the help they needed with no thought of financial stewardship. In fact, I can only imagine the choice words I’d have reserved for anyone who dared to raise those issues with me in a time of crisis. But that’s because, to me, the ‘return’ on an investment in the life of my sister or brother would be something I could never quantify or run a cost effectiveness analysis on. Their value is priceless.
Dr. Farmer sent that Haitian boy up to Chicago because, quite simply, it’s what he would have done for his own son. Resources were available to get this child what he needed to have a shot at survival, and Dr. Farmer gave them to him because it was the right thing to do for the patient – for the person – in front of him.
I don’t think we all naturally think that way – most of us, whether we’d like to admit it or not, don’t believe that all lives are equally valuable. But perhaps we should.
So thinking about it now, that question of - “is this investment worth it for one person? Or 10 people, or 15?” – while in general is totally economically rational thinking, is making me a little uneasy. I cannot help but think, what if all the people who helped me along the way had thought that way? My parents who raised me, often times each working multiple jobs to ensure I had every opportunity and privilege in the world at my fingertips. The countless donors to the University of Richmond who funded my college education. The coaches, teachers and friends who encouraged and supported me along the way, always pushing me to be the best I could be. What if they had all decided to evaluate the return on their investments in me, and they had decided they weren’t worth it? Where would I be today?
They say, “it takes a village to raise a child.” This was certainly true for me.
We, as the Richmond Global Health Alliance, in close partnership with Pan Peru, are privileged to be just a small part of the village helping to raise Pampas’s children. And while our sphere of influence, at present, may be geographically small, our impact deepens with every passing year as more resources – human, financial and otherwise – are added to our efforts and our relationship with the people of Pampas grows stronger.
To conclude, I will just offer a sincere and welcome invitation to each of you reading to join us by sharing your time, talent or treasure with the Richmond Global Health Alliance. If you’d like more information on our organization or are interested in donating, please email us at email@example.com or feel free to email me personally at firstname.lastname@example.org.