Robin: 00:27 I first came to know Emily Ausubel in 2008 when she was an applicant and then a student in our very first Global Gap Year program of Thinking Beyond Borders. In the years since, she's completed an undergraduate degree in Government & Legal Studies at Bowdoin College and has been working in the field of international development with a particular focus in public health. Emily Ausubel, welcome to the podcast.
Emily: 00:51 Thanks for having me.
Robin: 00:55 So why public health? What are the origins of of that for you?
Emily: 00:59 Yes so I kind of tell this as my like clichéd beginning to being interested in public health. I read Tracy Kidder's book Mountains Beyond Mountains about Paul Farmer and his organization Partners in Health. And I actually read it the summer before my senior year in high school, and I had just spent the previous two months volunteering in a rural town in the Dominican Republic with the Amigo's program, Amigo's de las Americas. And the work that I was doing didn't really directly have to do with public health, but I had this experience living in rural Dominican Republic, and then I read Paul Farmer's book and that really sparked an interest in public health that I kind of had just resting in my mind as I was finishing up high school and looking at colleges. Then when I found out about TBB and I ended up on the Thinking Beyond Borders Global Gap Year, we also had a unit on public health and that was my favorite unit. I loved the work that we did with health workers, going around visiting patients, really getting to talk to people and provide them with exactly what they needed, and bring the services to them. I thought that was a really important aspect of public health work, and all of these exposures were just kind of initial exposures into this into this interest area. And actually in college I didn't really focus as much on public health. I took one global health course, but when I was looking for jobs after graduating I kind of came back to health, and I think part of that interest, I think there's something to me that's very much universal about the desire to have to lead a healthy life. And I felt pretty confident in pursuing a career that I could feel proud of and happy in by pursuing that, in pursuing a career in public health.
Robin: 02:53 Tell me more about that. What are some of the factors that go into that in terms of being happy and fulfilled?
Emily: 03:00 Yeah and I think I actually, you know where I am and my thoughts about this right now are actually a little bit more nuanced than when I started my career in public health, and I actually have not been working in public health for the past year. Not necessarily as a specific decision to get out of it, just kind of by how everything aligned. I think healthiness and leading a healthy life are really foundational to being successful in a lot of other ways. I mean you think about issues of poverty you know and disempowerment that many people around the world experience every day. Health is a huge factor in that, and especially having worked in public health and really seeing what this looks like in practice, the amount of time and the amount of money that people have to spend seeking services for their health issues that most of the time are completely preventable. It's a huge burden. And I was excited to be part of work that was addressing that and helping people be able to be healthy and not have to worry about those issues and be able to focus on other parts of their life that that can bring them fulfillment. So that as a kind of pursuit I've found that to be really important.
Robin: 04:18 Tell me a little bit about your work in international development over the last few years. What have you been doing and what has your day to day been like in some of those different positions?
Emily: 04:29 Sure. So when I graduated from college in 2013 I first started working pretty soon after graduating at an organization called Management Sciences for Health, which is a pretty large international health organization that works on a whole array of different health issues: family planning, maternal and child, health HIV and AIDS, and all of the above. In addition to a lot more kind of the public health sphere called "health system strengthening work" in terms of actually supporting governments around the world and improving their health systems. So that could be about leadership in the government. It could be about pharmaceutical management and ordering drugs, et cetera. So I started in the business element department as a business development coordinator.
Robin: 05:25 So this was really this was a desk job.
Emily: 05:28 Yeah a lot of it was really a desk job. It's actually kind of interesting like this department actually doesn't really or that department didn't really have entry level jobs, but this was the most entry level job that they had. But actually, I got a lot more responsibility that was more kind of meaty in terms of doing some of the actual writing of portions of the grant proposals, writing up performance reports on our previous projects to show the donor what we had done in the past, and helping with organizing and running the technical strategy meetings with the technical staff from organizations. So, you're right, at the beginning it was it was a little bit more of a job and it became technically I was at a desk all day every day. So it was a desk job but in terms of...
Robin: 06:15 In Cambridge, Massachusetts, right? I mean you're not out in the field, this is this is really a U.S. based job.
Emily: 06:21 That's right. Yes.
Robin: 06:23 And after your time there went what happened next? What were the next opportunities that you took advantage of?
Emily: 06:29 I ended up finding out about an organization, an opportunity called Global Health Corps. And Global Health Corps funds one year fellowships for about 150 young professionals under the age of 30, who are both from the United States and from other countries around the world to work in public health organizations in several countries in Africa and then in the United States. So I applied, and I was awarded a fellowship to work at a pediatric HIV and AIDS organization in Kampala, Uganda for a year as a health care fellow. And I ended up actually having a pretty similar role as to what I had at MSH. I was doing grant writing and fund raising for the organization there.
Robin: 07:10 A desk job but on the other side of the world.
Emily: 07:15 That's right. Yeah. I think in some ways I was a little bit naive. I was like "oh I'm going to go over, and I'm going to live in Uganda, and I'm really going to be exposed to what public health work looks like on the ground." And I got there, and I definitely had more opportunities to interact with the people who were actually directly providing the services, and being part of it in the same office as them, and talk to them about the grants that I was writing and the programs I was helping design. But you're right, I was still in an office in the capital. I still absolutely believe in public health work. I just think I have some anxieties about the way that international health as kind of an industry functions today. And we might talk about that more in detail in a little bit. But I'll just give that as an initial explanation.
Robin: 08:01 I mean let's dive in now. Just listening to the way you told us your story so far, it sounds as though you feel like there is a disconnect between the international industry of public health and actually meeting the real on the ground needs of individuals and families and communities. Is that, is that part of it? And what does that disconnect look like and feel like?
Emily: 08:22 There there is a disconnect in a lot of different ways. I think one way is in terms of these large organizations like MSH where I worked, which by the way I didn't even know organizations like that existed until I started working at MSH. I kind of thought that all development work happened by grassroots organizations. I didn't understand how, just how large USAID's impact was and the US government's impact was in terms of funding international development and health projects, specifically abroad. And I think in many ways.
Robin: 08:22 And that that funding goes primarily to large...
Emily: 09:01 Yeah, large providers that are located, headquartered in the United States. And I won't get into all the nitty gritty about funding, but you know having worked in the development and seen how budgets are prepared, it is a lot about just the cost of sending a consultant to come from an organization like MSH and provide two weeks of technical support in Uganda or wherever it is. It's astronomical. And when I was in Uganda working for an Ugandan organization they had those technical people there already. And that's not to say that the staff in the US don't have really important expertise to offer. But there are a lot of ways in which I think the whole system has kind of been structured for so many years that it's not necessarily questioned anymore why you would spend so much money sending a technical expert across half way across the world when you could probably find one of those experts in that country. That's just one example. But I think what ends up happening is the big issue that I've seen is also this tension between large scale work and grassroots on the ground kind of community driven work. And organizations like MSH in a lot of ways are really talking about changing systems. And so the work that they do, like I was talking earlier, are more about empowering and training government leaders, or ministries of health, or health workers who work in public hospitals or public health institutions to improve the way that they do their work, whether that's actually providing the medical services according to WHO -- World Health Organization -- guidelines, or managing their finances better. There's a whole range of the way that that work happens. And when you're looking really big scale like that, you may or may not end up really being attuned to the needs of individual people in any given community, in any given country.
Robin: 10:56 Can you give an example? I mean are there things that you saw during your time in either in South Africa with Thinking Beyond Borders or in Uganda that you can think of an example of one that might have been the case?
Emily: 11:08 That's a really good question. I'll give one example that I think fits this kind of well. So when I was at Baylor Uganda, the way that Global Health Corps works just to give a tiny background. Each organization has a fellow from the country that that organization works in and then they have a foreign fellow. So I was working at Baylor Uganda, and there was also a Ugandan man also as a fellow at Baylor Uganda. And his role was in gender mainstreaming, which is actually a specific interest of mine, but I couldn't apply for that job because it was for the Ugandan nationals, which is I think actually a really good thing. But I had a lot of conversations with my co-fellow AB about gender and the role that gender plays in health and specifically in Uganda and related to the HIV AIDS program in that Baylor Uganda was providing in Uganda. And one of the things that he told me about that really kind of surprised me was that so many U.S. government funded, foreign funded health programs focus so much on women and children and talk about the need to cater services to women and children to address the disparate ways that women and children experience health, and the ways in which health issues disproportionately affect women, which is real. But interestingly, in Uganda a lot of men, AB told me, ended up feeling like their interests weren't being taken into account in any way and that with all of these services being so targeted at women there wasn't any room for them to seek services themselves. And that actually can be really dangerous because half of the population in the country is male. And when you're thinking about a health issue like HIV and AIDS, if those men aren't feeling like they can access services and there are services being provided specifically for them for HIV and AIDS prevention, that's a huge amount of people that you are not reaching with your services. As important as it is to focus on women and have those services accessible to them. So that's just one example of ways in which I think the international community, or even just anybody working in an organization thinking "how can we reach the women? Like these are the people who need to be getting these services. These are primary care providers for children. They are the ones who can transmit HIV to their through to their babies." But you can sometimes end up completely overlooking another need. That's really important as well.
Robin: 13:40 How are we defining development? Is it about hitting key indicators, economic indicators around maternal health or infant mortality or childhood literacy or the number of girls that are going to school, as compared to you know are there indicators we should be looking at about whether there's equity within families? And what does it mean to pursue equity within families? Does it mean to support women and girls who historically and even currently often are forgotten by this system? Or does it mean to approach the entire family differently?
Emily: 14:20 Absolutely. And I think, gosh this is so hard because I think about how the Millennium Development Goals. How many were there eight? Turned into the Sustainable Development Goals, which are 17 which each have like eight components to them. And actually, I don't know the exact number, but I know that gender is a part of the Sustainable Development Goals and there is more about exactly what we're talking about in terms of looking at equity within a family. And I think I think a lot of times people look at the word gender and they think women, right? And that's important, but it's also not the whole picture. And I think your whole point about how we define development -- on the one hand I don't think any Ugandan would say you know "we don't want improved health services. We don't want improved education for our children". But I do think there is a top down, in some ways, imposition of development goals from the international community, whoever that is or whoever sits on the committee is designing the priorities for international cooperation and achieving these goals. And it all ends up becoming very kind of formulaic. And then like you were saying about hitting the indicators. And that's important for measuring success. And I understand that, and I and I think it's valid and important, but I also do wonder sometimes how much we get caught up in these big sweeping ideas that may or may not actually reflect what any individual person decides they need for their own personal development as a as a person, as opposed to their country's development and statistics.
Robin: 15:58 So, you're someone who has been steeped in studying policy. You've got an undergraduate in Government & Legal Studies at Bowdoin, this fall you're starting at the Kennedy School at Harvard a Master's in Public Policy. How do you keep the human aspect of your work balanced with this expertise in policy, and the economic indicators, and all of the other framework for thinking about development?
Emily: 16:26 Yeah I mean I think, this is again kind of the tension that I was talking about earlier in terms of large scale versus small scale, working in an organization like MSH was really exciting because we were -- when our programs were successful -- we were impacting millions of people. And actually, Baylor Uganda has not the same quite the same scope and scale of impact, but also was a large organization in Uganda and affected many people. And knowing that you can be part of kind of systemic change, I think is exciting and I think it's important. And sometimes I look at smaller organizations, and I wonder even if the quality of their work is really is really high. How how can you kind of bring that to the masses? And of course that's the whole idea of scaling up your intervention. And what the exact problem is with that is oftentimes the human component ends up taken out. And I realize I'm not giving an actual solution because I think in some ways I don't really have the right answer. I think for me the thing that I've realized being involved especially in the proposal writing process, which is directly linked to the program design process, really intentionally including the perspectives and the director voices of the people who are going to be benefiting from the programs, I think is crucial. And as much as I've talked about MSH as being the like large U.S. based organization, they do do that. And they have staff in-country, and they interview health workers. They interview patients. They interview ministers of health and figure out what would this actually look like to implement. And I think that's at least the beginning. That's at least where you have to start being really intentional about bringing those voices into the conversation. Because I would never have thought of the gender mainstreaming ideas that my co-fellow AB brought into our work on my own. And part of that was because I'm a woman, and he was also talking about men's perspectives. And a big part of that is because I'm American. And he was talking about the Ugandan perspective and really making sure that that's there is really important and not getting too caught up in all of the indicators and the guidelines. And I think one of the big challenges is balancing balancing all of those different demands.
Robin: 18:56 You know listening to that I find it particularly interesting because when we talked recently you shared that in your undergraduate, stepping into women and women's issues in particular was an important experience for you. So you know, thinking about -- I just think about you as someone who is out trying to make a difference in the world, and that you, like all of us, you have an agenda for what that looks like, but that you were confronted with a challenge to that agenda by somebody else you respected in Uganda who was also trying to make the world better.
Emily: 19:35 Absolutely. I'm challenged every day, and I really welcome that challenge. I actually had -- I was challenged today in my work. I work at an organization that mostly works with Vietnamese immigrants and refugees in Boston, but broadly serves low income communities, which are primarily communities of color in this neighborhood. And I'm White. And I won't go into details about exactly what happened, but basically one of my colleagues came up to me today and told me that she was a little bit frustrated in the way that I had handled the situation with one of my other White colleagues. And she gave her perspective, and a big part of it was about the fact that we hadn't gone to our other colleagues for input. It was uncomfortable, but also like so important to have that feedback and something that I think about a lot, and am really -- I don't know if self-conscious is the right word, but I guess I'm partly self-conscious of it and also just try to be conscientious of my race, and my privilege, and how that plays into the work that I do, and the ways that it affects the decisions that I make in ways that I don't even understand until somebody points them out to me. So that was a really important experience that I had in America, but also among a community that I don't directly represent.
Robin: 20:55 So that, I mean that consciousness of privilege, or the pursuit of consciousness of our privilege, is really important in our work. Right? For people who want the world to be more equitable and just. But, I also hear you talking about the process of receiving feedback that can be hard. One of the things that strikes me is that your generation, that Millennial generation, is often critiqued for not being able to receive feedback effectively. What do you try to do in your process when you hear critical feedback like that, particularly around things that are so sensitive like around issues of privilege?
Emily: 21:31 I think it's hard. I think the automatic response is to defend yourself. And I think it's important sometimes to explain where you came from in your thought process. That can be an important part of reaching common ground with somebody. But I think trying hard not to just jump to the defense is really important, because then it feels like a serious confrontation. And like the conversation that I had today was tense, but at the end was like really amicable. And I don't know if I handled it perfectly. But, I think it could have ended a lot worse. And I think being, showing that you're open to receiving that, and I actually also I say OK I want to set up a meeting right now, and I wrote an e-mail to other people and we set up the meeting to further this conversation. And I think demonstrating a willingness to listen, and be respectful, and not just defend yourself and your actions is at least the first step in managing those kinds of situations well.
Robin: 22:37 I think that's a really important set of skills to develop and to continue to hone. I mean one of the things that we talk about at Thinking Beyond Borders as a team is, and as the leader of our team I always make clear to folks when they when they join our team, is that their primary responsibility every day, beyond you know the health and safety of each other and the students, is to learn. Is to you know is to be humble, and to be inquisitive, and to learn. And that that learning process is really hard. Particularly when we're taking on these tough issues that aren't just tough in society, but they're tough within our hearts and you know within our passions.
Emily: 23:16 Yeah and I think part of what happened in this situation at work recently was something had to get done. And we didn't have a set process for how it needed to get done. And so I just did it. And there was this sense of urgency that kind of overrode the need to reflect. And I think that is something that can also be like a real source of conflict in terms of just like getting your job done. And if you just looked at that, like I got what it needed to get done done, efficiently and quickly. But I didn't do it in the way that it needed to happen in terms of like bringing other people's feedback into the process. And it's really hard if you don't have the time, or you think you don't have the time, or you haven't created space or time to bring that process in. Then you end up in that situation over and over again, just rushing into decisions because you need to. And not specifically putting in a lot of time for reflection and it can make things feel inefficient if you spend three weeks talking about it before you do it. But it can end up being really valuable at the end of the day to have to have that process.
Robin: 24:38 This feels really related to what you were saying earlier about the tension between scope and scale when we're talking about development work. Do we need do we go for the expeditious we're going to we're going to change the whole system and touch millions of millions of lives, and we may lose some of those key humanizing factors of that approach to development? Or do we go the slow, localized,, very focused on people and their lived experience, and recognize that we may not touch millions of lives? We may touch lives in the hundreds or thousands.
Emily: 25:13 Right. And I also think like a big issue related to this is what I think a lot of people call, what we call in development like monitoring and evaluation of your programs. Right? And do you take the time to step back and reflect on whether or not you've actually been having the impact that you need to be having, or whether that's even impact you should be having? I think in some ways I actually think the development sector does this better. So I currently work at a small or medium sized nonprofit that does local community development work in the U.S., and most of our grant funding is from foundations, and we get one year grants. And that means that we have one year to just use their money the way that we said we we're going to, but there's no built in process for a long term growth or learning. And we have to do that internally with piecemeal grants that we may or may not get from people to continue the work that we do. And the international development sector, I think, has done a better job with some of this, where actually most of the programs are four or five years, and there's actually more time for learning in that process. And the big question is just whether it actually happens. There's time for it and but it's also maybe easier said than done. It's easier to just continue doing things the way you've been doing them, instead of really stopping and saying "hold on a second. This isn't working. We might need to completely rewrite our entire conceptual framework." It might not even be as simple as we should just work in those community use or with this age group instead. It could be really a completely different design of what you're doing, and I think you have to really be willing to be really reflective and actually make those changes that need to happen. And I do think that even though a lot of donors are interested in learning, and growth, and reflection, it realistically just doesn't happen with the restrictions that you have on on how you do this work and how you move forward with it year to year. So, also change usually doesn't even happen in four years or five years. It happens in generations, and I think that's the other big thing is like how do you even know how long to do something until you kind of give up on it as not working or you call it successful? There can sometimes be immediate, what looks like immediate, success and then it tapers off. And and that's a huge challenge in all of this work.
Robin: 27:34 Are there places that you find hope?
Emily: 27:43 Yeah I mean definitely. I think, I mean honestly like being part of a group like Global Health Corps has been has been really cool because the community is so international. Half of the fellows in the African countries are African, they're from those countries. And half of the fellows that serve in America are from other countries all over the world. And so being a bit more exposed to initiatives that are actually driven by people from other countries has also I think it has given me a lot of hope. It also gives me a little anxiety because that's not me. And that's in a lot of ways, I think that the way it should be, but it also leaves me questioning kind of you know where do I end up? I wrote a whole blog post for Global Health Corps about this. Where do I fit in? But yeah, I mean I think like I recently was asked by a couple of Ugandan friends from Global Health Corps to join them in starting an organization in Uganda. But the whole thing was really masterminded by this group of three young Ugandan health professionals who wanted to address an issue in their country and their communities. And they got the seed funding to start this organization, and that kind of work is really exciting for me, I think, and shows how this kind of work being international development and health work is being formed in a lot of new ways in recent years in terms of being driven by people from the countries that you know historically American organizations go in and work in. And now it's really being driven a lot of ways by Ugandans or whoever it is. And that's that's cool for me to see.
Robin: 29:19 So do you think there's a role for Americans to work internationally in international development? Or should we be working domestically?
Emily: 29:27 No know I mean I I think both. I really do actually. I think it's a constant challenge for all the reasons we've talked about, in terms of recognizing cultures that you're not a part of, or recognizing the systems that Americans have in our place here that may or may not be applicable to other countries. But I actually do think that there still is a role for Americans working in other countries, just as there is a role for other people from outside of the United States to come and work here. And again that's something that I thought Global Health Corps did really well, because we didn't -- it wasn't just like let's send Americans to other countries. It was also let's bring other people into the United States, and have them work full time at health organizations here, and give their perspective. And I think people as individuals have things to offer, expertise and insight and ideas regardless of where they're from or where they're working. And I think the challenge is just making sure that that is happening in a responsible way, and in a respectful way, and in a way that still allows for the voices and actual like physical leadership of people from other countries as well.
Robin: 30:42 You've been talking a lot about about process and about consciousness, you know trying to be critically conscious as you move forward in your work. Are there thinkers out there or there are resources that you try to tap into on a regular basis that really continue to support you and challenge you in that critical reflection?
Emily: 31:04 I mean, I think the conversation from from work today is a good example in terms of working in diverse environments, and I'm excited to be joining a diverse graduate program. And I think surrounding myself with peers who will challenge me has been a big part of that. When I was in Uganda, they were having a presidential election almost exactly a year before our presidential election, our most recent presidential election. But in Uganda the same man has been in power now for 31 or 32 years. And I was talking with my peers at work, all Ugandan, about the election and whether they were going to vote, and they were kind of what seemed like a little bit apathetic about it. Many of them, not all of them, many of them though say "why would I vote? It's rigged anyway. There's no point." And actually the the challenger for the sitting president was pretty popular, and a lot of people thought he actually could win the election. And I was kind of frustrated with my with my peers who didn't feel empowered to go out and vote, and didn't feel like they had a voice, and were kind of not in my -- from what I was reading -- like weren't taking any agency in the political reality of their country. And my co-fellow AB, who I have so much appreciation for, he was like "Emily, you never lived through a civil war. Like, you don't know what it's like to be here." And like the background of that is like Museveni is often praised for bringing peace to the country. Museveni is the current president of Uganda. And I think just like being corrected in this kind of self-righteous perspective that I was bringing to the conversation, and having like kind of having my privilege be thrown in my face, and being reminded that I am not from there, and I can't speak on behalf of people and talk about why they're making the decisions that they're making. That was a really impactful moment for me in terms of feeling like I can be responsible with the voice that I have, and the work that I do, and like the passion that I have for all of this. I believe in democracy and participating in civic duties. But I think you know having that conversation made me think about what it means to speak on behalf of other people, and more broadly what it what it means to do the work that I do responsibly and not kind of make assumptions about the people that I work with or on behalf of.
Robin: 33:40 So at the end of every episode we ask the folks that were were interviewing the same question. What's the most important question you're asking right now?
Emily: 33:49 Yeah. I mean I think, I'm kind of having two levels of questions. Maybe I'm cheating.
Robin: 33:49 You can cheat. It's OK.
Emily: 34:01 Because I think, you know as I'm about to start graduate school in a little less than six weeks, and so I think my like my personal question is is kind of "where do I want to go next, and how do I want to spend the next two years building my knowledge and expertise and challenging myself to think about what that next step is for me?" And that's kind of my big question. And what that is really kind of hinging on for me is "where do I think that I can have a positive impact?" And I haven't talked too much about it. But one of my big passions is women's rights and women's empowerment, and that is pretty broad still. And I'm trying to think about in what ways can I have an impact in that sphere. And how can I kind of find my place in that effort. And I think that relates to the bigger question, which is what we were just talking about, which is "How do we even know what the ultimate goals are and whether -- you know specifically in the field of international development that I that I was working in for a while, and do you think I'd like to continue working in -- but my big question is like "is this sector really going in the right direction? And do I want to be a part of it?" That might be like five questions. I have all the questions.
Robin: 35:25 In that last one it sounds like, I hate to do this, but it sounds like you're asking a question of "What is development?"
Emily: 35:31 I am absolutely asking the question "What is development?" I think you guys sent out an alumni survey recently and asked it to us again, and I got so stumped. I'm not sure I submitted the survey. I'm still I'm still figuring it out. I'm still figuring it out. And I asked myself that most days probably.
Robin: 35:53 All of the all of the alumni who are listening know what that question means, but for the folks in our audience who aren't as familiar with our programs, that question what is development is fundamental to our curriculum, and it's the first question we ask in the beginning of the program, it's the last one we asked in the last seminar, and it's not surprising maybe to hear if you're still grappling with it, even at this stage of your education and career. Emily thank you so much for joining us today on the podcast.
Emily: 36:20 Thank you so much.