On Checkpoints and Toolboxes

By Adanna Chukwuma

“Look closely at the present you are constructing; it should look like the future you are dreaming.” — Alice Walker

Over 10 years ago, as a young physician, I joined the National Youth Service Corps and was assigned to work in Yobe, an underserved and conflict-affected state in Northeastern Nigeria.

It seems like it was yesterday when I was looking out at the children’s clinic overflowing with babies and weary mothers who had walked miles to receive care as I worked frantically to get to as many patients as possible. I mobilized other doctors and nurses in the city to run mobile clinics in rural areas and recall my feelings of frustration at how minuscule our efforts seemed considering the needs around us.

Because regardless of how hard we worked; it was never enough. Yobe did not have sufficient doctors, nurses, and clinics. Without an electronic health information system in the state specialist hospital, we could not even keep track of who we had treated; mobile clinics did provide temporary relief to some communities, but there were so many more people for whom skilled health care was out of reach.

It was a profoundly formative experience. I have the deepest respect for my colleagues who provide direct patient care, but after Yobe, I could not bring myself to keep working in a hospital.

My quest to understand how to ensure universal access to high quality health care has taken me to Oxford and Harvard. My commitment to apply the lessons I had learned led me to Global Health Corps, first, and now the World Bank Group where I lead and contribute to teams advising national policymakers on reforms to improve health care.

Throughout this journey, I have been expanding my metaphorical “toolbox” with skills and knowledge to make me more effective at solving the challenges I faced more than 10 years ago. How to raise domestic revenue to finance health care? Check. How to align health system spending decisions with access, quality, and efficiency? Check. What to do to improve service delivery organizations? Check. Learning to broker consensus across partners on reform design? Check. The grueling task of implementation? Again, Check.

It will thus come as no surprise that I applied for the Forbes Ignite Impact Fellowship primarily to add one more tool to my toolbox: Artificial Intelligence. I had followed, with fascination, discussions of how big data and powerful machine learning algorithms were enabling next generation solutions in health care, by personalizing treatment, improving diagnostic accuracy, and accelerating drug discoveries. I came in ready to brainstorm, prototype, and build a product we could scale.

Imagine my shock when, during Week 1, we were instead handed a book by Ayse Birsel: Design the Life You Love: A Step-by-Step Guide to Building a Meaningful Future. I wanted to build something concrete ASAP! To me, it was not immediately apparent what designing the life I loved had to do with improving health care access and quality. As it turned out — everything.

Over the next two weeks, I spent about 20 minutes each day, curled up under a blanket, book and pen in hand, and working through my life. First, I took it apart — and faced up to the things I was doing, and whom I had become. Predictably, a big chunk of my life was work — meaningful, but excessive, and always at an unnaturally hectic pace that I had become accustomed to. I slowly made my way through reimagining my life by reflecting on my heroes, the people I aspired to be like, and the life I wish I could have. By the very end of this two-week stretch, I was putting it all back together, deliberately weaving in things I had lost along the way and making hard choices about things I had to let go.

At the end of this process, I caught up with a dear friend I first met at Oxford many years ago, at the beginning of my journey to become a health systems expert. Like me, she had spent the last 10 years working at increasing her ability to contribute to fixing health care challenges; I marveled at the exceptional work she had done as we reflected on our journeys. What else did we need to learn? How else could we contribute? I had spent the past two weeks mulling over these questions; but I had answered another question in addition: Who was I becoming?

When I think about the life I would love to live, I imagine a tree with deep roots, a broad trunk, and branches stretching into the distance. I want a life rooted in faith, family, and friendship, aspects of my life which I have, at times sidelined while pursuing expertise and impact. In the sun and rain, I see the teachers, mentors, and sponsors who are fundamental to my growth as a leader, an expert, a sister, and a human. The shade and support of the trunk and branches represent a part of me that I hope never changes: my commitment to being part of the solution to seemingly intractable health care challenges.

I think of the past two weeks as a checkpoint, one I hope to intentionally return to from time to time, in the years ahead. For now, it’s back to the grind — toolbox out, gloves on, but with the life I love on my mind — off to fix broken health systems.