Working in Global Health: Shin Daimyo

It can be intimidating to start a career in global health. It’s a diverse field that evolves quickly and demands collaboration across disciplines, from finance to supply chain and logistics, to computer programming.

In this series, we ask a seasoned colleague to share professional experiences with those interested in forging a career in global health. For this edition we asked Shin Daimyo, clinical program officer and program manager for mental health.

As an undergraduate at the University of Southern California in 2005, I was fortunate enough to take a service trip to the Navajo Nation, a large tribal area in the Southwest. At a traditional ceremony one day, a Navajo leader introduced himself with the standard greeting Ya’at’eeh and spoke of some of the hardships that the Navajo faced. While we talked, he stressed how important it was to care for your own and to care for those who were the most vulnerable.

I’m the first generation of my family to grow up in the United States. My mother is from Vietnam and my father is from Japan, and I spent a good deal of time with the Vietnamese boat-person refugee community in Los Angeles, CA. Many of them fled political persecution during the Vietnam War and braved treacherous journeys across the Pacific Ocean in small boats. Growing up, I admired their strength and resolve to build better lives for their families, but was also struck by how difficult it was for them. They sacrificed so much to escape persecution, but found themselves suffering new hardships. Something about the Navajo leader’s call for empathy resonated with me that day. Actually, it did more. It set me off on the long, hard, and deeply rewarding career path I’ve been pursuing ever since.

Back at USC, I changed my major from business to psychology, and over the next couple of years, I researched depression and phobia treatments for Asian Americans and systems-based interventions for at-risk Latino populations. My time in Cyprus, learning about the long-running tensions between Turkish and Greek Cypriots, and the complex psychological consequences that accompany the Cyprus problem, shifted my passions globally.

I decided to pursue a master’s degree in public health at Boston University. While there, I won a fellowship through Duke University to work at the World Health Organization to develop global mental health policies. The work was incredible, but I still felt I was missing a key piece of the puzzle. Policies tended to be general and broad; it was unclear how to translate them into culturally sound and locally driven global health services.

Wanting to see how things actually happened on the ground, I took a job as a health systems and quality improvement advisor for four hospitals in the Kingdom of Lesotho. While it only paid a stipend and housing expenses (and I shouldered significant debt), I learned the invaluable lesson of how to integrate specialized health services (HIV, tuberculosis, and mental health) into the primary care system in a low-resource setting. It also revealed how supply chains, finance, management, monitoring and evaluation, and supervision are as critically important as high-quality clinical expertise. Overall, it helped me connect big-picture policy and systems thinking with practical strategies for how to get services to those who needed them most.

I felt like I was finally carving out my niche in global health, but after returning to the United States from Lesotho, finding a job in that niche proved hard. Despite emailing professors, applying for openings, and working connections for months, I couldn’t find a position in global health, let alone one in global mental health. Still strapped for cash and deep in debt, I almost gave up. But I was lucky enough to get a health-policy job that taught me about how to improve health care quality (and make it more equitable for all people, not just those who can afford it). Soon after, I got a job working in global mental health, managing programs for victims of torture and natural disasters.

I ended up at PIH because friends and colleagues vouched for my passion for the work and for my ability to make that passion a reality. If there has been anything I’ve learned in this work, it’s to surround yourself with people who challenge you and share your passion for social justice, and whom you genuinely like. Not only did that help me get my job at PIH, but it has made my journey a much more fulfilling and enjoyable one.

It has been an incredible three years at PIH. But as I write this, I am actually about to do something I never thought I would do: leave PIH. Supported by the community of the Paul and Daisy Soros Fellowship, I’m going to Yale School of Nursing to become a psychiatric nurse practitioner.

Why I’m doing this takes a bit of explaining. At PIH, I’ve had the privilege to work with colleagues to build sustainable, high-quality mental health systems for the poorest and most vulnerable people in the world. When I visit our most rural clinics, the majority have very few staff doing everything they can to serve those in need. But no matter what, there is always a nurse.

Our nurses, along with our community health workers, are often tasked with providing care to the most marginalized patients. I believe that integrating advanced levels of psychiatric and psychological care in general nurses (and raising the profession of advanced-practice nursing) will be key in ensuring that the mental health burden is addressed in a sustainable and impactful way.

What have I learned in my career so far? Do what you know is right, even if it is the hard thing to do. Do it even though all those around you doubt you. Do it even if all those around you berate you. The suffering of others should never be taken as the status quo, and you should refuse to ever believe anything else. The journey is long and hard, but I cannot think of a more deserving cause to devote your heart to than those who suffer without a voice.