Deconstruct - Technology | Impact | Culture

International health work is built upon personal and professional dilemmas.

If you have a story that you think is important enough that you want it to reach your friends, coworkers, and someday the entire world, why on earth would you choose to start writing anonymously?

Because the world is unkind to truth-tellers! We live in a system that exists because it benefits the people in power. The more unstable the system becomes, the incentive to remain in power grows larger and larger.

Let's not get all philosophical just yet. What am I afraid of? I'm not a whistleblower. I'm not Reality Winner or Chelsea Manning. I'm not anywhere close to any classified intelligence or drone footage. I'm just a simple American who has traveled, studied, and lived internationally. I have seen the dysfunction of international NGO work and the chaos that we cause when we parachute into countries whose languages we can't speak and try to fix problems we can't possibly understand.

I first started writing when I was still working at an NGO. After three long years of cognitive dissonance, I was becoming confident that I was not the right person for this job. There was a widening gulf between the impact that I originally thought I would have in that role, and the impact that I was actually having.

I was traveling multiple times per year to a country where I did not speak either of the official languages!

I was working in the field of digital health but I never felt properly qualified. Even though I had a Masters degree in Public Health, I constantly felt inadequate because most of my knowledge and experience came from my on-the-job training!

I was working remotely for an NGO that raised money in the US and invested that money internationally. The mental, social, and physical distance between my day-to-day work and the daily reality of my colleagues was too much for me to bear. I often thought that it would be far more effective to just transfer my entire salary to my international colleagues directly. They would be able to hire more staff and do more with it than me!

When I was able to travel to visit my colleagues in person, to see the hospitals and clinics where our software was being used, I felt better for a moment. The distance between what I dreamed of achieving and what I had actually achieved was still there, but it felt like the gap might be slowly closing.

I wish I could tell the stories of the people I worked with, and maybe someday I will. But there was something more urgent that I needed to get off my chest. I had started to realize that the international nonprofit (international development) system was set up so that our international partners would be persistently deprived of power while “The Experts” in the US and Europe amassed more and more power.

It was everywhere I looked.

Academic partnerships – professors writing papers and doing advanced data analysis using data that was planned, collected, curated, cleansed, polished, and packaged up by unnamed research assistants and students so that The Experts could publish in prestigious journals and give prestigious speeches.

Financial partnerships – the foundations and US Government agencies that funded our work created or modified their “funding opportunities” every year but the processes never became more simplified. More hoops to jump through, more data required to prove that the “interventions” were successful, more paperwork to share monthly success stories. But no opportunity for the truth-tellers to speak their minds to those in power.

—– draft in progress —-

Two years ago I traveled to Washington DC for a conference for work. I arrived around lunchtime at the Reagan Airport, full of excitement and boundless enthusiasm. As far as I can tell, it was the 4th annual Global Digital Health Forum, a gathering of experts in my field.

What is my field exactly?

I have to start by telling you about a sector that has gone through many identity crises over the years. In the olden days, in some circles it was known as ICT4D [Information and Communication Technologies for Development]. This was the catch all phrase for people or organizations that dared to believe that the internet revolution would extend beyond the OECD countries and eventually touch every rural district in the world.

ICT4D spurred many programs and partnerships to support technical capacity building, open-source software development, and hardware procurement were pioneers in the early days of ICT4D, which is now generally known as “Digital Development”. After many examples of projects and technologies that failed spectacularly for completely predictable reasons, practitioners in the field started working together to affirm principles to guide responsible work at the intersection of technology, social impact, and innovation. Digital Principles

But that's not exactly my field.

In the health sector, there have also been a few waves of naming rights. First it was eHealth (electronic), then it was mHealth (mobile – as in mobile phones), then it was digital health (tablets, laptops, smart watches, and all the Bluetooth things).

I guess you could say I was a digital health expert, or I wanted to be one. But what does that even mean? I wasn't a software developer. I wasn't even working for a software company, I worked for an NGO. So why was I attending a conference in DC, funded by US Agency for International Development, World Bank, and Deloitte?

I wanted to learn from people who had made the same mistakes that I was currently making. I wanted to learn the secrets to successful implementation of digital health programs. I wanted to talk to visionary leaders who understood the funding landscape and might know how we could line up sustainable funding to do this work properly.


I'm walking a fine line here. I want to give enough context about myself and my work history to draw the contours of the personal and professional dilemmas that I keep tripping over. But for many reasons, I feel the need to do this anonymously.

Partly I'm afraid for myself – even though I don't work for an NGO anymore, I don't want to get called into HR by my current company for something nasty that I said online. And most days when I read the news, I really want to say some things that I might regret.

Partly I'm afraid for my former NGO employer – I really believed in their mission and their values, and I still do. I know that the ethical dilemmas that I experienced there were not unique to that organization, because the entire industry is tied in knots caused by the capriciousness of donors, whether they are “high net-worth individuals” themselves or their spawn: the family foundation.

Finally I'm afraid for my former NGO colleagues specifically – they are people who dedicate their lives to serving their home countries and sometimes serving neighboring countries as expats. They are the ones who walk that tightrope – forming tight partnerships with government officials to ensure that the day-to-day work is not impeded, and speaking out carefully when bureaucracy rears its ugly head.

If I were to speak up and say what I have seen, who would bear the brunt of this radical act? Surely not me, the white cisgender person who lives in the USA. It's never me, it's never people like me.

But if I never speak up publicly, then what? I continue down the path that I am on, becoming more jaded and more discouraged about the widening chasm between the impact I wanted to have and the impact that I am likely to have.


This, dear reader, is where you come in.

What if we pool our stories, our mistakes, and our regrets together? Can we tell the truth about our experiences without giving away too much?

Could we can shine the light on the problems, in a way that pushes for real changes in the systems?

We don't all need to be whistleblowers, but maybe we can encourage people who need to know that they are not alone in their struggle. Maybe our writing can give them the confidence to make tough changes on the inside of their organization (or government).


In the 1950s, there was a black and white TV show called Dragnet that began with a dramatic narrative voice-over:

“The story you are about to see is true. Names were changed to protect the innocent.”

If you have a story that you might want to share, please reach out. You can remain anonymous if you want, that's really up to you.

I can't promise that I will publish what you share, but I can promise to read and respond, and we can decide together what to do next.

Your story can be personal: How did it feel to be laboring for a cause that was near to your heart, and how did you admit to yourself that you were showing all the signs of burnout?

Your story can be professional: What did you do when you realized that your organization or your team had your priorities completely backwards? Did you ever have a boss who cared more about “Keeping USAID happy” than anything else?

If you have a story to share, or you just want to reach out to say hi, you can find me at hello@deconstruct.technology.

A year ago I had a brilliant idea. I acted with intention and excitement. I agonized over the perfect domain name. I researched how to self-host a blog on the cheap. I told a few trusted friends about my idea and they were supportive.

As soon as everything was in place and I was reach to launch my creativity into overdrive, the world changed.

I remember the last time I ate an entire meal inside a restaurant. I remember the last time I hugged someone who isn't a family member. I remember the last time I flew on an airplane. I refused the soda and peanuts, because I thought the virus was spread on surfaces. I remember coming home from that trip and washing every single clothing item that I brought with me. We didn't know. There was so much we didn't know.

My enthusiasm and creative energy waned, like a well that was drained and filled with anxiety and stress. My job at an international health nonprofit organization became even more intense than it was before. I would dream all night long about how my workload was unmanageable and then wake up with dread and a knot in my stomach. It wasn't because I hated my job. It was because I loved my job and I felt like I was failing at it.

There was so much to do and so little time. It was early in the pandemic and we had no way of knowing how fast the virus would spread from the international airports and bus terminals and ports of entry into the heartland of the countries where our beloved colleagues lived.

We watched in horror as the daily statistics climbed. Most days it felt like there was nothing we could do. But we had to try to do something. So we would work feverishly, each alone in our home offices, isolated from our routines, our stability, and each other.

We would meet regularly on video conference calls, but the face-to-video-face interaction only made us more exhausted. Our colleagues outside the US and Canada were abruptly instructed to start working from home. For many of them, it was the first time in their lives. This was a huge cultural shift that the technology infrastructure could not yet handle.

***

It has been nearly a year since everything fell apart. It is time for me to start writing again, not because things are stable now, but because they are still so unbelievably unstable. Not because we in the “international community” have learned our lessons, but because it appears that our leaders have not learned a damn thing.

There were a few things that almost drew me back to writing about deconstruction.

Early in the pandemic, I was experiencing so much anxiety and stress related to my job that I sought therapy from a mental health counselor. I had never met her before, but she accepted my insurance, she did telehealth visits via Skype, and she was willing to take me on. So we got into it. She encouraged me to ask myself if it was time to start looking for a new job, to apply for jobs like I was trying on new clothes. Just see how the job fits, and imagine yourself there. So I did just that.

By the time I met with my therapist 2 weeks later, I had reached out to a technology company, inquired about openings, and informed my manager that I was looking. A few weeks later I accepted the job offer and gave my three-week's notice. Choosing to change jobs and leave a steady job for a 12-month contract job during a pandemic is not something that normal people do. I thought about writing about that, but I couldn't find the “deconstructing” angle.

Later on in the pandemic, we had an all-staff meeting at work. A project that our company had invested millions of dollars and untold minutes, hours, and years of time was being killed. It wasn't being killed for lack of funding, as most international health projects typically die, but because of government in-fighting. We had done everything right, we had already begun the sustainability transition plan for the country officials to take ownership of the project and push it forward. Then one day, some one pulled strings and all our work was torpedoed. This was the largest project of its kind, anywhere in the world. Hundreds of thousands of users. Millions of “lives touched” by the software, and by the humans who used the software. A longitudinal dataset with years of history that researchers will never be able to replicate.

Torpedoed. Killed off. And for what?

Maybe because governments live and die by their accomplishments, and this accomplishment wasn't theirs. They wanted their own thing, not our thing.

Maybe because someone was blackmailing someone else.

Maybe because there was more money to be made elsewhere.

***

When you work for a non-profit organization, you can never be truly honest about what you need. You can never be honest about how you failed, and what you would do differently next time.

You must cater every public message and every report to carefully manage the expectations of your supporters and donors. Admitting mistakes might cause donors to think twice next time.

The same is true when you work for a technology company. If you criticize the failures of one government, even if they are truly self-inflicted mortal wounds, you will not gain the trust of the next government that you hope to work with.

It's a balancing act. Too much publicity and transparency sends chills through the system. Money will tighten up and be directed elsewhere, and this will risk the good progress that we are making. Not enough transparency promotes decay and corruption in the system. Money will tighten up and be directed elsewhere, and this will risk the good progress that we are making.

***

We have to tell the truth. There has to be a way for us to tell the truth about how things are not working, and who is to blame.

There is no reason that we should all be afraid of Bill and Melinda Gates ripping up the checks that they write if we say anything critical of the Foundation. When Bill Gates wrong, and he is often wrong, those of us who know the truth need to be able to say so.

There is no reason that one man, Bill Gates, should have veto power over the entire World Health Organization. There is no reason that one man, Chris Murray, should have veto power over the way that we calculate the “Global Burden of Disease”. There is no reason that the world has to be this way, except that we are all too scared of the consequences of speaking out.

So this is my brilliant idea. We need a way to safely speak the truth without risking retribution from these powerful people.

The consequences of their retribution are too severe for us to be cavalier about it. But the consequences of not speaking out are even greater.

If we do not deconstruct this self-serving system of international health, we will fail those who are harmed by it.

Deconstruct (n): To take apart or examine (something) ... exposing biases, flaws, and inconsistencies

What is Deconstruct.Technology?

The future is unwritten.

It could be a blog with musings about my work at an international nonprofit organization headquartered in the United States.

It could be aimed at decolonizing the “nonprofit industrial complex” that centers the needs of donors above the needs of impoverished people.

It could be a community where we mercilessly take apart the Sustainable Development Goal framework and talk about the changes that would be required in order for change to take root.

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