Go To The People: Celebrating 50 Years at MSH

Help us celebrate MSH's 50th birthday! We were incorporated in Massachusetts, USA, on May 21, 1971 and have since then worked in over 150 countries. To celebrate our 50th, we invite you to follow our Go To The People series, sharing stories and reflections from current and former MSHers, partners, and local health leaders worldwide, as they reflect on the impact we’ve made together on the lives of individuals, communities, and in global health. Working together, let's shape the next 50 years for greater health impact.


Dr. Ann Phoya, Deputy Chief of Party for the USAID ONSE Health Activity, Malawi:

It was my first job after returning home to Malawi, having just completed my PhD in the U.S. It was 1994 and Malawi was designing its first Safe Motherhood program, specifically addressing issues around maternal mortality. As the Safe Motherhood coordinator starting from zero, I knew the first thing that we needed in place was political commitment, so I managed to secure an appointment with the First Lady. I asked her to become an advocate for safe motherhood in the country because I thought she—as a woman married to the head of state—could carry our information to the top levels of government, without me having to write a memo that may get lost in the bureaucracy. The First Lady agreed to assist us, and soon after that we saw the head of the state begin making statements as he went out to meetings—statements such as ‘let's take care of our women, let's put a bit more resources here, let's be more respectful of women in our country.’ At that time, Malawi's fertility rate was very high, around 7.6, which meant women gave birth to about 7 children throughout her life. At a public meeting, the head of state at that time specifically told the men to ‘put on the brakes’ to help reduce this fertility rate. He meant—of course—using family planning, so at that time I felt very motivated and saw that I had spoken up and convinced people that we really needed to put resources towards improving the health of women and children.

Over my career, I've learned to speak my mind and to speak the truth. My father was someone who spoke his mind when he felt that people needed to know something, and I think it was because of his passion for education that he encouraged me to go to school and become a nurse midwife. When I was promoted to be Director of the Health Sector “SWAP”—also known as the Sector Wide Approach—one of my responsibilities was to coordinate utilization of a health fund, which pooled resources from government and development partners to make sure that we deliver a package of essential health assistance for the people of Malawi. My Minister of Finance at that time felt that the health sector had been funded adequately to do this, but I had to go back to his office and tell him that we don't have enough money. I emphasized that our health workers—especially nurse midwives—were resigning probably one every two hours to go work in the UK where they could make a fair, livable wage, so one of the things we did at that time was to negotiate an increase in salary for health workers, and to make sure that we were training them in an appropriate environment. I advocated for the resources needed to increase the training space in our universities, improve our laboratories, and expand classroom space in the College of Nursing. We also negotiated that as soon as these graduates leave the school, they are immediately employed. We needed somebody to make a bold decision, and go there and make noise in the appropriate ears, so that people would listen. This is one of the things that I'm passionate about, and everything I pushed for happened.


Jude Antenor, Senior Associate for Information Technology at MSH, USA: 

My passion for technology started when I was in high school, living in Haiti, where I’m from. A friend had introduced me to HTML, and soon I was spending a few hours a week at the cyber cafe in Cap-Haitien, my hometown. The cost per hour was 35 Gourdes (0.42 cents in today’s rate), which felt like a lot of money as a kid borrowing from his parents. I was amazed by how the Internet worked; how I could connect to friends outside of Haiti and all over the world. However, my interest quickly turned into desperation, as I did not even have a computer of my own. When I had the opportunity, I enrolled in computer science school. The journey wasn’t easy, but I was dedicated to achieving my goals. My senior year, I had an internship at one of the biggest tech companies in Haiti. I could see my future ahead of me. But in January 2010, the earthquake hit.

It was like the world had collapsed on my shoulders, and I could see my future and dreams under the rubble. Two months later, thanks to great leadership from my school’s staff, they reopened their doors. I continued with classes, although under extreme difficulties: no electricity or Internet. On top of that, I was sleeping in a tent in my front yard, as we were scared to live in the house, and badly shaken by the earthquake. But I couldn’t allow these hardships to stop me, and I obtained my bachelor’s degree with honors in October that same year. I am conscious of all the effort that people from different fields make every day to make the world we live in better and safer. I also believe it can’t be achieved without technology. My colleagues at MSH have always encouraged me to keep pursuing my goals and in 2020, I started a masters degree program. Through technology, I want to play a part and make an impact. I know it requires a lot of sacrifices and dedication, but I am up for the challenge.


  

Alaine Umubyeyi Nyaruhirira, Principal Technical Advisor for Laboratory Services at MSH, South Africa: 

I was among the first few waves of young Rwandans who decided to return home after the 1994 genocide and the end of our civil war. I joined the National University as a lecturing medical biologist. I started to see people who were very sick: young people, returning members of the army, survivors of the genocide. My friend, who would become my husband, told me ‘it’s not just poverty and poor nutrition, these people have HIV, and many have TB.’ I knew about HIV, of course, but to put the name of that disease onto your people—people you know—was devastating. The health system was in tatters. Treatment was not in place, and my colleagues and I watched helplessly as many suffered, withered slowly, and died. I decided to start working with our community at the university to teach them about sexually transmitted diseases, including HIV, so I formed the first club of young people to talk about this issue. I was a young lecturer, 26 years old, and so those around me were quite shocked.

They didn’t expect to see a young woman teaching about sexual health, a topic that’s somewhat taboo in our culture, but I was confident in the skills that I had. I worked with a clinician to provide teaching materials for my discussions. In my microbiology courses, I started to teach about HIV transmission and how my students could protect themselves. My husband had just become the head of the University Teaching Hospital of Kigali, and we had to move to the capital. Looking at this crisis, he felt strongly that the solution would be to fund treatment, strengthen the health system, and have good diagnostics in place. Already having a background and interest in health technology, I committed myself to studying medical sciences and helping to build diagnostic capacity for HIV and TB in Rwanda.

It was not common at that time to see a woman go for a PhD, especially outside of the country, and there was pressure to take care of my responsibilities at home, but my husband—who had become the State Minister of Health—told me ‘you need to go to school because it’s you who will help our country and family later.’ I completed college at 17, the only woman in my graduating class that year. My father had been a medical doctor; growing up, I envisioned a similar career for myself. But, because my family had been living as refugees in the Democratic Republic of the Congo, I didn’t have access to the department of medicine, and so I studied biology instead. 

Access: that's my dream

When I look back to 1994, when we were starting to rebuild the health system, we would not have believed that testing and treatment for HIV would become so accessible. The first lab that I worked in had just three microscopes. From 2000 to 2012, I worked with Rwanda’s Ministry of Health to build our national reference laboratory’s, as well as East African regional level’s, capacities for diagnosis of TB, HIV, malaria, and other diseases. Today, ten years later, of course the same labs can do nearly any kind of test, from HIV and TB to diabetes to types of cancer, and many hospitals have the same diagnostic testing capacity and resources. The speed of diagnostic development is amazing, but my first wish is to see greater equity in diagnostic access. Even within a country, some populations do not have access to basic diagnostics. Access: that's my dream. 

However, the current pandemic shows us again and again that we have a broken and unsustainable global health system, with weak diagnostic capacity that no longer protects the world against future diseases and deadly epidemics. Together, with my colleagues, I am proud of the work we are doing to build laboratory capacity across the world. I am determined to be part of the fight against TB, HIV, malaria, other chronic diseases, and epidemics such as the current COVID-19 pandemic, with the hope to see their eventual elimination.

From South Africa to Afghanistan

2017 was the first time I went to work in Afghanistan. I went from South Africa where I now live, and I was a little afraid, and then I was so struck by how kind and resilient the people were, just like Rwandans. Afghanistan has a similar story to Rwanda after the genocide: so much insecurity, instability, and a health system that had been badly damaged years ago. I was the only woman in the office at the time, and I had to take care to cover myself with the appropriate clothing. I had to respect their religion and customs, and yet I have my own culture that I wanted to be recognized and respected.

I’m the eldest in my family—and most of my siblings are men—so at an early age I learned how to negotiate with men, but another issue in Afghanistan was my skin color. The first time I met members of the Ministry of Public Health, they were very curious and a little bit suspicious of me; it’s very uncommon to see black people there. At the first training on GeneXpert MTB/RIF—a new diagnostic tool to detect TB and Rifampicin resistance—there were 60 people in the room, all of them men, and my first observation was this gender imbalance. The first question I often received that first year there was about my PhD: How had I reached that level of education? Why was I doing this work? Yet, as I told my story, these colleagues and trainees would often ask to take a photo with me, so that they could show their wives and daughters that there are women like me who travel and teach. I took that as a huge compliment.

At the end of my first mission to Afghanistan, the Minister of Public Health and TB program director organized a reception and presented me with a gift of three beautiful necklaces. He thanked me and requested that I return and continue our work together. Even now, my Afghan colleagues ask me when I will be coming back to see them. We are very proud of the work we’ve achieved together under the USAID-funded Challenge TB projectto introduce faster, more accurate diagnostic tools in labs across the country to help fight TB. I want to add that four years later, since that first trip in 2017, there have been drastic changes with the new leadership in Afghanistan, which has started to promote access for women in all levels of the state and in education.

What’s next?

On the African continent in particular, I would like to see many more female graduates in universities—both in their home countries and abroad—return to take up leadership in all levels of the health system. I'm grateful for the opportunities I’ve been given during my career, opportunities from mentors in my PhD program to the different organizations I have worked in. To give back, I am a co-founder of Pan African Women in Health [PAWH], which advocates for and mentors young women in my field, and in sciences in particular. PAWH brings together leaders who are passionate about a common goal: increasing networking and improving women’s opportunities to be the next generation of female African leaders, who need to be included, heard, and valued.