I wrote the following email last August to our Country Director, Gregory Karelas, and Executive Director, Mark Arnoldy, who had both recently taken the helm of Nyaya Health. It was at a challenging moment of transition, and one that brought much frustration and self-doubt. I asked Greg and Mark that I could share them now, since the themes I touched upon continue to be of relevance to our work and team dynamics. As we go about trying to do the impossible, as “impossibilists” (thanks to Adam Braun of Pencils of Promise for that word), we confront frequent failure, our own weaknesses and vulnerabilities, and many uncertainties. In these journeys together, we as leaders must accompany each other to translate failure into reflective evolution, and to accompany each other again to do the same when faced with the next failure. Yes, I will admit that the “act as if” reference does indeed come from Ben Affleck’s classic lecture in the movie “Boiler Room.” The letter below is unedited, including my grammatical mistakes and misspelling of the word “promissory” (that reference, of course, is from Dr. Martin Luther King, Jr).
“So as you transition in your first few weeks on the job, I wanted to ask you to reflect on acting as if. I’m sending this along to you because I’ve seen in talking with both of you how Nyaya has already forced upon a sense of skepticism, a feeling of being part of a losing battle. I think that is wrong, and I’m asking you, as the new leaders, to correct that. I’m not asking you to overnight change your deep-routed skepticism of this work, or to hide your fears and insecurities. But as leaders of Nyaya, as those to whom we look for guidance and ingenuity and boldness, I am asking you to act as if. Act as if Achham is a world of possibilities rather than one of death, nihilism, and incompetence. Act as if the citizens of Achham can control their own destinies. Act as if you are facilitators towards achieving these possibilities. Act as if optimism is not a dirty word, but rather it is one grounded in the realities and hopes of individuals who are sick and their families. For skepticism in what is possible quickly becomes defeatism, and defeatism, while an option perhaps for us, is not a viable option for those we serve. Act as if our work addresses some of the fundamental challenges of our generation. Act as if we can recruit the smartest people to meet these challenges, and that the most well-financed and hard-nosed donors will be inspired by our work. As leaders, you will need to believe that Nyaya has immense possibilities. Rather than having all this “cultural baggage” or “broken structures”, Nyaya has a remarkable substrate upon which to build a dynamic organization. We have the talent, the connections, the vision, the values—now we need you as our leaders to help us realize our potential. What do I see two years from now? I see a Nyaya that looks fundamentally different from where we stand today, though one that emerges from this period of growth sharing the same values as we always have:
- clean, tiled, structurally sound buildings at Bayalpata
- surgeries and blood transfusions taking place
- more dignified medical management of pain
- ongoing QI initiatives
- monthly data streams and effective research infrastructure
- Operationalize our support of health posts through staff trainings, referral systems, and the CHW program
- CHW network to cover entirety of Achham
- start of work in Bajura, via support of a new government hospital there
- $1 million per year in funding sources
- a professionalized board
- an effective volunteer network
- online collaborative resources and publications that advance global health delivery
Act as if all of these things (or more importantly, whatever it is that you are looking to accomplish) are not only possible but are our obligation. Ever since we started spending time in Achham, we’ve been writing promisory notes and its high time for the citizens of the Far West to cash in. Sometimes we get too caught up in being right. It’s a defense mechanism really. In Achham, if you choose skepticism and defeatism, you will always prove yourself right. Nyaya has become very good at saying amongst ourselves what cannot be done. Achham has gotten us down. But we wouldn’t have opened a hospital if we had that mentality from the beginning. Our only chance at survival as an organization is optimism. Optimism is not a dirty word, whatever Nyaya may sometimes lead us to believe. That optimism needs to be grounded in the realities our patients face and the realities of working in Achham, and it needs to be coupled with hard-nosed management strategies, with ongoing evaluations driven by data, and with a determination to never give up. You two did not join Nyaya to fight the good fight but lose. You’re in it for victory, and not just small victories, but big ones.”
Duncan Maru, MD, PhD is a co-founder of Nyaya Health. He is currently a resident in the Internal Medicine – Pediatrics program and fellow in Global Health Equity at Brigham and Women’s Hospital and Children’s Hospital of Boston.