Ophelia Dahl on her Radcliffe Prize and lessons learned from Paul Farmer and his youth

“I don’t think in terms of years,” laughs Ophelia Dahl. “I think in terms of decades.”

It’s two days before she will receive Harvard’s prestigious Radcliffe Medal, which has been awarded to such luminaries as Madeleine Albright, Toni Morrison and Ruth Bader Ginsburg, and the health care and social justice advocate takes time to sit in her Boston home and reflect on what she hopes will soon change in global health – and her realistic assessment of how long it will take for major improvements.

It’s been 36 years since Dahl co-founded Partners in Health (PIH) – an international public health nonprofit known for its community-based approach and redefining healthcare possibilities in some of the most challenging situations – with Paul Farmer, Jim Yong Kim, Todd McCormack and Tom White in Haiti’s rural central plateau. Since then, their team has grown to 14,000 people worldwide, providing lifesaving care and training in some of the world’s most needy countries, including Sierra Leone and Rwanda.

Dahl — a member of the director of the MIT Media Lab and a trustee of Wellesley College who also helps run the Roald Dahl Literary Estate, which manages her late father’s works — was executive director of PIH for 16 years and now chairs its board of directors. administration. When it was announced that she would receive the Radcliffe Medal, which annually recognizes “a person who has had a transformative impact on society”, Radcliffe Institute Dean Tomiko Brown-Nagin said it was her “unwavering optimism, clarity of vision, and unparalleled ability to do the job that makes her such a worthy Radcliffe Medalist.” Dahl spoke to NPR’s Goats and Soda about the importance of partnerships in global health, working closer to home during the COVID pandemic, and the loss and legacy of Farmer, who died early in last year at age 62. This interview has been edited for length and clarity.

How is Partners in Health moving forward with the work started by Paul Farmer?

Literally moving forward. I remember Paul once telling me something about how we stay in this job when things get really, really, really tough. I think it was after the earthquake in Haiti. Someone had said, “How do you stay in there?” And he said, “You’re not going.”

I think the way we continue is to continue to do this work and to continue to be ambitious, to raise the bar around the standards and not to settle for something that feels more comfortable to us, to continue to really really push the limits of what is possible.

Paul and others, all of us, have really tried to build a strong scaffolding around global health, supporting the public sector and creating an array of partners, donors and collaborations. Huge communities of people, from students to multilateral and bilateral donors, were brought together to build systems and create a much more equitable healthcare system in places that were either clinical deserts, as he had the usually say, lean health systems. . I think the way we continue is to continue to do this work and to continue to be ambitious, to raise the bar around the standards and not to settle for something that feels more comfortable to us, to continue to push the limits of what is possible.

You talked about collaborations and working with communities. How do you work with governments? How is this relationship?

Governments are often seen as monoliths and they really are not. These are individuals and officials who got involved because they really want to change things.

We tried to create links at the local level. It may be a district health commissioner in a rural area, and then it is communicating with presidents and ministers of health.

There is a lot of criticism of Western-led organizations that go to countries in the South to do this kind of work. What are you doing to make sure you don’t fall into the “savior” stereotype?

It’s hard to say we’re doing everything right, because I’m sure we’re not. But I think it’s fair to say that 99% of the people working at all of our locations are locals. It’s recognizing that it’s really about collaboration, that learning goes both ways. We listen to what local communities and governments need rather than what we think they should need.

Is that where the word “partner” comes from in the Partners in Health name?

It is. Paul would be so happy for you to point it out. There was almost no setting we were in where someone wasn’t saying something like “How do you do this job?” And he said, “In partnership. That’s why we call ourselves Partners in Health. And that’s true. We really knew from the beginning that we needed partners, we needed community, and I think that’s something we’ve tried to do in the 40 years that I’ve known Paul Farmer and my other co-founders, Tom [White]Todd [McCormack] and Jim [Yong] Kim. In this work, I would say that reaching out and finding partners in universities, other NGOs, partnerships with the public sector, public-private partnerships, this is something that we feel is really necessary.

What is a moment in your career that has marked you?

When I went to Sierra Leone during the Ebola outbreak in 2014, then returned a few years later – before the pandemic – and saw the plans underway in the east of the country to really consolidate the health system, to stimulate district hospitals there, to focus on very specific diseases and areas of vulnerability. It has been transformed, with a massive foundation poured and ready for a center of maternal excellence in the country with the highest maternal mortality rate in the world.

Our plan was to set up the kind of center that would not only provide help to the women there, but also serve as a model of how this can be done. I just came back from there a few weeks ago and it was an uplifting trip, to see all that had been done. And how many young women were employed on the site, having been trained in everything from welding to managing quotes to safety. Young women in their 19s or 20s who used to sell peanuts or corn on the street corner are now earning a living and sending their siblings to school.

What kind of changes did you have to make at PIH during the worst times of the COVID pandemic?

One of the things we did was get involved in Massachusetts. We realized we had a community-based model that trains and employs large numbers of community health workers to provide care and connect to clinics and tertiary hospitals to support them. We have this in every country we work in and places we work in, including Navajo Nation and a few other places since COVID.

So we formed a partnership with the government of Massachusetts and were able, along with other great partners, to train a wide range of contact tracers. They connected with the 351 different public health departments in Massachusetts and reached out to people and built connections for them, not only giving them contact tracing updates, but also making sure they had what was needed to be able to quarantine or shelter in place, if possible.

It’s interesting, because we generally think that PIH will work in other countries. Being able to help so close to home must have been rewarding.

It was and I think we learned a lot. I think it wasn’t perfect by far, but we learned a lot and stayed in touch with a few communities that we got involved with in New Bedford MA and also a few communities that have refugees or farm workers .

What do you think will be the biggest global health challenge in the near future?

I think there are a lot of challenges. I would say that we need to change the policy on debt cancellation, provide universal health care and try to prevent suffering and a huge number of unnecessary and indecent deaths.

If you look at Paul Farmer’s memorial resolution [a bill reintroduced in Congress in March and calling for a U.S. global health strategy], it’s a really solid document that shows what is needed. And the fact that these incredible congressmen have signed up to sponsor him is a great tribute to Paul and his decades of work.

I am just thinking of the countries of the North which, in our opinion, should support the South more. Really thinking about how to employ things like debt cancellation [forgiving debt owed by individuals or countries or slowing or stopping its growth] and decolonize certain institutions around global governance. I think those seem like very important things to put in place for the future.

There’s a lot going on around the world and in the United States, so there’s plenty to be distracted about. I think we need to try to keep our eyes on that as we continue to build our own programs in various countries and ensure that these beacons of healthcare equity, like the University of Equity in global health [in Rwanda]like the maternal center of excellence, are supported and allowed to thrive so we can really see what happens when you don’t go an inch deep and a mile wide but you really invest in areas and try to perform the full range of necessary services.

You lost your older sister Olivia to measles when she was a child. How did this influence your decision to get into global health and the way you approach your work?

I think there are probably a lot of things that influence the decision to act, but they’re probably subliminal. My older sister Olivia died before I was born, so I was truly born into the echo of that loss, sadness, and grief in my family. It certainly gave me a healthy respect for vaccines. There was a vaccine available at the time, but it was new and hard to get, and as we’ve seen with all sorts of other vaccine-preventable diseases, there was a lot of resistance.

I think there was a lot of heartbreak and sadness in the family I grew up in, but there was also a lot of strength, determination, creativity and inventiveness. Even though it was a bit bohemian, it was also a huge privilege to be so socialized for success and to feel that there are a lot of potential solutions for a lot of things, that those conditions can be solved. There are a lot of things that seem unsolvable and unsolvable, and they really aren’t. These are issues we can address, they’re just going to take a lot of attention, a lot of time, and a lot of resources.

Jill Langlois is a freelance journalist based in São Paulo, Brazil. She’s been a freelancer from the largest city in the western hemisphere since 2010, writing and reporting for publications like National Geographic, The New York Times, The Guardian And Time. Her work focuses on human rights, the environment and the impact of socio-economic issues on people’s lives.

Copyright 2023 NPR. To learn more, visit https://www.npr.org.

Ophelia Dahl on her Radcliffe Prize and lessons learned from Paul Farmer and his youth

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