Starting a career in global health can be intimidating. It’s a diverse field that evolves quickly and demands collaboration across disciplines, from finance to supply chain and logistics, to computer programming.
Each month we ask a seasoned colleague to share advice for those interested in forging a career in global health. This month we asked Economic Evaluation Analyst Jean Claude Mugunga to discuss his path to PIH.
“I am not going to have another child. This is it,” she said to me as we spoke in the Sovu Health Center, a small clinic in southern Rwanda. She was a 29-year-old woman who had come for a prenatal consultation for her sixth pregnancy. I was a 22-year-old first-year medical student working with a student group called Rwanda Village Concept Project.
The woman went on to tell me that she had never consulted a clinic for a pregnancy before, and that she had delivered all her previous children at home—including her most recent baby boy, who died before he reached 6 months old. She said she came to the clinic this time because one of her neighbors, a newly elected volunteer community health worker (CHW), advised her to seek care. Her husband had passed about two years back from unknown illness; one of the convincing arguments made by the CHW was that HIV may have been responsible for her husband’s death and that by going to a clinic and getting tested, she could possibly protect her unborn baby from infection.
Although my main task of that day was to speak to her about family planning and contraceptive methods, she started asking me question after question—most of which a first-year medical student was not able to answer— about what it meant to her and her baby if she tested positive. She had started to feel comfortable with me. It was obvious how scared she was about the HIV test results.
Having grown up in Rwanda after the genocide—where almost everything had collapsed and families experienced death every day; where diseases like AIDS and malaria were taking lives every day, including my own relatives; where alarming rates of infant and maternal mortality had become an acceptable fate; where everyday life was a harsh struggle—this was obviously not the first time I had engaged with a patient on a personal level in a clinical setting.
It was, however, the first time I had to think hard about how complex and intertwined most health problems are, and what my role in the reconstruction of Rwanda (and my own family) would be. I pondered the role of cultural beliefs in health, and how social and economic hardships perpetuate poor outcomes in any community. Although the picture was not completely clear, I realized that the availability of high-quality, community-based services could lead more people to seek care and improve outcomes.
During my years at the school of medicine, I had opportunities to travel to China, Finland, Sudan, Vietnam, the U.S., and most east African countries to broaden my perspective and education. I would always return home with a captious eye for global health disparities. Before I graduated from medical school, I found out about Partners In Health (PIH) and chose to do my final public health rotation at Rwinkwavu Hospital, where PIH has worked in partnership with the Rwanda Ministry of Health since 2005. I was taking baby steps and opening my eyes and extending my feet into the field of global health.
You have power and you have hands; extend them to the world in need, starting in your community.
To broaden my skills, I moved to Boston to pursue a graduate program in international health policy and management, where I focused on health economics. It felt like forever until I got an opportunity to rejoin PIH in my current role as an economic evaluation analyst within the Monitoring, Evaluation and Quality Improvement team (MEQ).
In a nutshell, the MEQ team helps various PIH programs design practical data collection systems, develop key performance indicators, and assess whether said programs are making a measureable difference. To me, there is no substitute to working with a team that supports the country sites in doing systematic and routine collection and analysis of information from our intervention.
As PIH strives to become more of a learning organization, generating evidence for informed decisions on improvement and on the scale-up of interventions, it is critical to support data use, learn from experiences, and to build the capacity of our partner teams across the sites. More importantly for my role on the team, I am contented by our work in generating evidence on resource utilization and the results obtained.
My exposure to health systems—from HIV and cancer services in Rwanda to high-quality surgical services in rural Haiti, to the cost of care in the U.S.—has enhanced my perspective of global health and my desire to keep pursuing it. I often thought that breaking into the field of global health meant that you have to be coming from somewhere in the “global north” with an Ivy League education to help the “global south.” However, those groundless assumptions did not stop me from stepping into my dream.
Anyone can become a global health champion, regardless of age and regardless of one’s previous career path.
To those who want to contribute to this satisfying work, don’t think of the word “global” as necessarily meaning countries other than your own, or a geographic concept. Rather, think about how illness and poor health have no borders. You have power and you have hands; extend them to the world in need, starting in your community.
Just like me, you will not be satisfied by simply identifying problems, so be driven to pioneer and create effective and sustainable solutions. You will be a more effective agent in the ongoing movement of tackling health inequity and transforming the world.