"I don't think in terms of years," says Ophelia Dahl with a laugh. "I think in terms of decades."
It's two days before she is to receive Harvard's prestigious Radcliffe Medal, which has gone to such luminaries as Madeleine Albright, Toni Morrison and Ruth Bader Ginsburg, and the health-care and social justice advocate is taking the 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 has been 36 years since Dahl cofounded Partners in Health (PIH) — an international public health nonprofit known for its community-based approach and redefining health-care possibilities in some of the most difficult 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 most in-need countries in the world, including Sierra Leone and Rwanda.
Dahl — a director's fellow at the MIT Media Lab and trustee of Wellesley College who also helps lead the Roald Dahl Literary Estate, which manages her late father's works — was PIH's executive director for 16 years and now chairs its board of directors. When it was announced she would receive the Radcliffe Medal, which every year goes to "an individual who has had a transformative impact on society," Radcliffe Institute dean Tomiko Brown-Nagin said it was her "unfailing optimism, clarity of vision and unsurpassed ability to get the work done that make 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 passed away early last year at age 62. This interview has been edited for length and clarity.
How does Partners in Health move forward with the work Paul Farmer started?
Literally by going forward. I remember Paul saying to me once something about how we stay in this work when things get really, really, really difficult. I think this was after the earthquake in Haiti. Someone had said to him, "How do you stay in this?" And he said, "You don't leave."
I think the way we go on is to continue doing that work and to continue to be aspirational, to raise the bar around standards and not settle for something that feels more comfortable to us, to continue to really really push the limits of what's possible.
Paul and others, all of us, really tried to build a sturdy scaffolding around global health, supporting the public sector and building an array of partners, donors and collaborations. Huge communities of people, from students all the way through to multilateral and bilateral funders, were pulled together to build systems and create a much more equitable health system in places that were either clinical deserts, as he used to say, or had meager health systems. I think the way we go on is to continue doing that work and to continue to be aspirational, to raise the bar around standards and not settle for something that feels more comfortable to us, to continue to push the limits of what's possible.
You mentioned collaborations and working with communities. How do you work with the governments? What's that relationship like?
Governments are often seen as monoliths and they're really not. They are individuals and civil servants who have gotten involved because they really do want to affect change.
We have tried to make connections on the local level. That can be a district health commissioner in a rural area, and then it's all the way up to connecting to presidents and ministers of health.
There's a lot of criticism of organizations run by Westerners that go to the Global South to do this kind of work. What do you do to make sure you don't fall into the "savior" stereotype?
It's hard to say that we do everything right, because I'm sure that we don't. But I would think it's reasonable to say that 99% of the people working at all of our sites are local people. It's recognizing that this is really a collaboration, that the learning is going both ways. We are listening to what local communities and governments need rather than what we think they should need.
Is that where "partner" in the name Partners in Health comes from?
It is. Paul would be so pleased that you pointed that out. There was almost no setting we were in where someone didn't say something like, "How do you do this work?" And he would say, "In partnership. That's why we're called Partners in Health." And it's true. We really, from the very beginning, knew we needed partners, we needed community, and I think that's something we've tried to do across the 40 years I've known Paul Farmer and my other cofounders, Tom [White], Todd [McCormack] and Jim [Yong] Kim. In this work I would say that reaching out and finding partners across universities, other NGOs, public sector partnerships, private-public partnerships, that's something we really feel is necessary.
What is one moment during your career that stands out?
When I went to Sierra Leone in the Ebola epidemic in 2014, and then I went back a few years later — before the pandemic — and saw the plans being made in the eastern part of the country to really shore up the health system, to boost district hospitals there, to focus on very specific illnesses and areas of vulnerability. It was transformed, with a massive foundation poured and ready for a Maternal Center of Excellence in the country with the highest maternal mortality rate in the world.
It was our plan to put in the kind of center that would provide not only help for the women there but also act as a model for how it can be done. I just came back from there again a couple weeks ago and that was an uplifting trip, to see how much had been done. And how many young women were employed on the construction site, having been trained in everything from welding, to cite management, to safety. Young women, 19 or 20 years old, who were selling 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 parts of the COVID pandemic?
One of the things we did was get involved in Massachusetts. We realized we have a community-based model that trains and employs a large number of community health workers to deliver care and to connect to clinics and tertiary hospitals to assist them. We have that in all the countries in which we work and places in which we work, including Navajo Nation and a couple other places since COVID.
So we formed a partnership with the government of Massachusetts and were able to, with other big partners, train a large cadre of contact tracers. They connected with the 351 different public health departments in Massachusetts and contacted people and made connections for them, not just giving them updates from contact tracing but also making sure they had what was necessary to be able to quarantine or shelter-in-place, if possible.
That's interesting, because we usually think about PIH going to 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 a longshot, but we learned a great deal and we've stayed connected to a couple of communities that we got involved with in New Bedford in Massachusetts and also a couple of communities that have refugees or farm workers.
What do you see as the biggest challenge in global health in the near future?
I think there are a lot of challenges. I would say we need to change policy around debt forgiveness, confer universal health care and try to prevent suffering and an enormous number of unnecessary and indecent deaths.
If you look at the Paul Farmer Memorial Resolution [a bill reintroduced in Congress in March and calling for a U.S. global health strategy], it is a really strong document showing what is necessary. And the fact that these amazing congresspeople signed up to sponsor it is a great tribute to Paul and his decades of work.
I'm just thinking about the countries in the Global North that, we think, should be supporting the Global 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 decolonizing certain institutions around global governance. I think that those feel like very important pieces to put in place for the future.
There's a lot going on in the world and the United States, so there's a lot to be distracted by. I think we need to try to keep our eyes on that while continuing to build our own programs in various countries, and making sure that these beacons of health-care equity, like the University of Global Health Equity [in Rwanda], like the Maternal Center of Excellence, are supported and allowed to thrive so that 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 do the entire gamut of necessary services.
You lost your older sister Olivia to measles when she was a child. How did that influence your decision to go into global health and the way you approach your work?
I think there are probably a lot of things that influence one's decision to do things, but they're probably subliminal. My older sister Olivia died before I was born, so I was really born into the echo of that loss and that sadness and that grief in my family. It certainly gave me a healthy respect for vaccines. There was a vaccine available at that time, but it was new and hard to get, and like we've seen with all kinds of other illnesses prevented by vaccines there was a lot of resistance.
I think there was a lot of grief and sadness in the family I grew up in, but there was also a lot of strength and resolve and creativity and inventiveness. Even though it was slightly bohemian, it was also an enormous privilege to be in that way socialized for success and feeling as though there are a lot of potential solutions for many things, that these conditions are solvable. There are a lot of things that feel intractable and insoluble, and they're really not. They're issues we can take on, they're just going to take a lot of attention, a lot of time and a lot of resources.
Jill Langlois is an independent journalist based in São Paulo, Brazil. She has been freelancing 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 socioeconomic issues on people's lives.