The settings couldn’t have been more different. A couple years ago in rural Malawi I sat down with a team of two clinicians who provided care to 30,000 people with just a few medications, and even those weren’t always in stock. Yesterday I had a virtual meeting with a public health team providing care to over 2 million people in a high-income country. The situation was a bit similar: both times, I came in representing a hospital-based team of trainees who wanted to come alongside the existing community team and help create sustainable programs assisting the population. The ensuing discussions mirrored each other closely enough to trigger dejavu. Each time, I introduced the situation. We valued their roles, we wanted to assist them in the good work they were already doing. We had some ideas for program plans, but ultimately we wanted to help them set and reach their own goals for their target population. We planned to come alongside them for years to come. We wanted to help created sustainable programs that they could lead indefinitely in their own context. Then, after each introduction, I stopped talking and asked the teams for their thoughts, comments, and questions.
Both teams, separated as they were by time, location, and context, replied in a similar way. They were already overworked, understaffed and underfunded. Both groups said that they needed us to bring them resources if we hoped to help bring change in their context. Both times, the group was happy to work with us, and believed that new programs were important, but they wanted us to know their limitations and expectations. So each time, I acknowledged their words and affirmed that they were already doing so much with so little. I explained to them about some resources which we could bring to the table, resources which wouldn’t be exhausted like funds or materials. Our trainees could bring teachings to expand the impact of their providers. Our faculty could help develop protocols to extend the capacity of their care. We could help them develop specific programs and track those outcomes, and then we could help them look for funding opportunities that would be sustainable and specific to their context.
And both times, paradigms shifted. Instead of focusing on needs and scarcity of personnel, time and resources, both groups allowed us to imagine with them what self-fueled and self-sustaining interventions could look like. In Malawi, we walked alongside the team as they started their own hypertension and diabetes clinics. We helped them request medications form the government which were previously unavailable to them. Our trainees screened their population and helped them develop protocols for testing and treatment. Now when we follow up with them, the team no longer talks about what materials they needed, but they share about the progress they have achieved.
It was similar with the team in the high-income country. Our first meeting was only one hour, but by the end, the team was considering what type of teaching and facilitating resources would help them leverage their existing strengths. The communication helped them realize some funding they already had which could be better utilized to free up personnel resources. They began to see themselves readily filling a leadership role of initiatives and networking which they thought impossibly overwhelming an hour before. We started imagining together feasible plans for this first year, plans that could bring easy victories even while they were stretched thin. Then we dreamed of possibilities for following years when they could expand capacity based on pilots, and where the team could decide for themselves what direction to go next, after systems were established and problems were defined.
By the end of the meeting, I was bounding down the hallway and beaming at Greg. I never thought I would have the chance to influence a prestigious and influential group of peers towards paradigm-shifting mindset change, from thoughts of scarcity toward leveraging existing assets. The same models which I learned in missionary training and practiced in clinics, churches, or communities in Malawi now is making a difference within health systems in a high income country. Realizing the universality of assets-based development, seeing these kinds of mindset transformations first-hand is so incredibly life-giving, affirming, and energizing. I definitely feel like I am thriving, doing what God created me uniquely too do.