You’ve said you are obsessed with global health policy. Why do you say that?
I am employed full-time here in Dushanbe, Tajikistan, for a donor-funded international aid project that works on health policy in Central Asia. We focus specifically on tuberculosis and HIV. We’re looking for ways to improve the quality of health care provided for tuberculosis and HIV, which are both huge health issues for Central Asia.
I’m a co-founder of a group called SMART Aid. We’re working to educate donors and startup projects about international aid. We try to highlight the best ways to do it, and criticize efforts that aren’t working. We provide support and constructive criticism — identifying the things that are working, and flag things that aren’t.
So what things are working, and what things aren’t, in international aid?
Lately we’ve been very excited about new efforts in transparency and reducing corruption. The Global Fund to Fight AIDS, Tuberculosis and Malaria just established a new policy on fighting corruption and on transparency so that we can see what happens to their money. And USAID just developed new rules on evaluation on transparency. I feel like that’s a really good trend.
Another trend we’re glad to see is that some organizations have moved away from donating used stuff to the developing world. Donating used items is not an efficient way of giving. A lot of times it’s more about the donor feeling like they did something useful with their old things, than any benefit in the developing world.
In particular: After disasters, money is pretty much always the most efficient means of donating. People often have this concern that if they give money, then it will go astray. But honestly, if you don’t trust the group you’re donating to to actually use your money wisely, you shouldn’t give your stuff, either. Because, you know, they could just sell your stuff and take the money if they’re not trustworthy.
If you look at reporting on Haiti, they are already starting to get big piles of things they don’t need — out-of-season clothing, expired drugs — that have been shipped by the containerload to Haiti. It’s too hard to know what someone else needs, and it’s not that common for what someone else needs to be exactly what you want to get rid of. I worry that the same thing will now happen in Japan.
You describe your writing as “without diplomatic varnish.” Why did you decide to write so frankly?
In the beginning it was an accident: I didn’t realize how unusual it was to be saying what I was saying. Over time, it started getting more deliberate. I began to realize that it wasn’t dangerous to me; it hasn’t harmed me yet. A lot of people are legitimately extremely careful, because they have careers to preserve, and jobs and families to protect, and work to do. It would absolutely kill me if my blogging ever affected my day job. I am careful in what I say; I don’t share opinions I can’t back up, but I also don’t spend a lot of time worrying about the right bureaucratic language to use.
I love my writing and I feel that it’s a way that I have impact on the world, but I also really love the work that I do every day — the work that earns me my salary. And I would feel like I’d lost a limb if I were deprived of that.
There is a real appetite for genuine writing and criticism. And, like I said, I think it’s not as dangerous as it seems at first. I think sometimes what seems really brave and blunt is actually just using ordinary words instead of international development jargon. Hearing development work described in everyday vocabulary seems revolutionary, but the content of what I am saying doesn’t differ much from everyone else.
At one point on my blog, I said, “Honestly, I’m not saying anything very unusual or interesting. Most of my blog posts are just the stuff that everybody I know talks about over dinner or beer. I’m just codifying the knowledge that already exists in the system, and putting it out there so that new people can absorb it.”
Blood and Milk is a very striking name. Where did your blog’s name come from?
I started the blog in 2003, back when it was just a collection of links I found interesting (I now use Twitter for that). “Blood and Milk” struck me as a powerful name. It’s a Russian phrase, and it represents health and beauty. I guess in England they say a “peaches-and-cream complexion.” In Russia they say a “blood-and-milk complexion.” There are fairy tales about the heroines who are so beautiful, they have a face like blood and milk.
It also has a health resonance for me. Milk makes me think of breastfeeding, and all the things that make kids sick in the developing world: all the categories like diarrhea, respiratory infections, all those things. And then blood makes me think of all the diseases of the developed world: cardiovascular diseases, diabetes, and so on.
What change is most urgently needed in the world of global health?
It’s hard to prioritize just one. I think that there needs to be a recognition that global health is genuinely global. It doesn’t mean health in poor countries that you don’t have to worry about if you’re wealthy. Global health genuinely affects everyone on this planet, and we need to think of it that way. It’s not about sharing, it’s about mutual survival.
There are so many ways now that we’re interconnected. In little ways, like how infectious diseases spread much faster across the world than they used to, because of people traveling more. And in bigger ways: the ways our economies are interconnected. If there’s a country that’s stuck being poor because it has a health burden it can’t get out from under, that’s a drag on the whole global economy. That affects everybody.
Another example is that a country with a high rate of maternal mortality means a lot of motherless children. Research shows motherless children tend to grow up into violent adults. That leads to conflict. Conflict in one place hurts the whole world — politically, economically. There are so many linkages that it’s a matter of benefit to the developed world, not just the developing world, to focus on global health.
Which of your many projects are you most proud of?
One of the projects I’m proud of was during my time working on women’s health issues in Turkmenistan. We were looking at the health of pregnant women in particular, and it was a strange situation. Literacy rates are very high in Turkmenistan. Women are educated. They knew what they needed for a healthy pregnancy, but they still were not taking care of themselves. The problem was that they had trouble, based on their status in the family — as women — actually getting what they needed.
It wasn’t enough for them to know that they needed to be eating a variety of foods. And it wasn’t enough to know that they ought to be getting protein on a regular basis. Because if the man ate first because he had a job and she didn’t, it didn’t particularly matter what she knew she needed, she still couldn’t have it.
So we helped teach women how to talk about these issues with their husbands and their mothers-in-law. That way, they could actually explain why it mattered to the family, to the baby, and to their health, that they get a share of protein, that they avoid certain kinds of agricultural work that involves pesticides, things like that.
I liked the program because it took a little bit of extra research to figure out why women couldn’t put their knowledge in action. And helping them do that was inspiring. But we didn’t directly train pregnant women. We trained outreach nurses, and the outreach nurses went on to work with women in the population. We were investing that capacity in the government program so it could go on without us.
That’s one of the things I’m proud of: seven years later, the outreach nurses are still doing that.
You’ve said you like to talk about fan fiction, where fans re-create stories or elaborate on their favorite books, TV shows, films, etc. Do you write fan fiction?
I don’t write fan fiction, but I do read it. I think that it’s a way of reclaiming human creativity from corporate culture.
I primarily read fan fiction for television, where people write alternate episodes of shows. I think because television is written, in essence, by committee, and processed through so many corporate filters, that if you look at mainstream television, it’s very white, very heterosexual, and it’s very male. It’s disappointing.
As a woman of color — my father is Pakistani and my mother is Canadian — there aren’t a lot of people on TV that look like me. One of the joys of fan fiction is that people are reclaiming that and reshaping things to reflect the lives they actually live and the people they actually see.
There are many aspiring social entrepreneurs out there who are trying to take their passion and ideas to the next level. What is one piece of advice you would give to them based on your own experiences and successes?
I’m really not a social entrepreneur or entrepreneurial at all, but I do have a perspective on social entrepreneurship, since it’s a big force right now in new startups in international aid efforts.
There are two key elements. First of all: passion. You need to be able to put your heart into it and keep going, because international development is a really tough field to make a difference in. You don’t see change for 10, 15 years in this field. It doesn’t come quickly, and it doesn’t come easily.
Secondly, there’s a lot of value to actually doing your research first and making sure you’re not repeating something that already failed in 1973. There’s a real depth of knowledge about what works and what doesn’t, and scanning that first will save you a lot of wasted effort.
How has the TED Fellowship influenced you?
The ideas that I ran into at the TED Conference really changed the way I see the world, in directions I didn’t necessarily expect. Sometimes it would be the strangest TED talks that would give me some little nugget that suddenly shifted my perspective on things. In that sense, it was a broadening and shifting of angles in how I see everything I do.
Particularly impactful was Sunitha Krishnan’s TEDTalk about working with children and women who had been sexually trafficked in India. At TEDIndia, people were spontaneously standing up to give her money. Afterwards, I kept thinking, “What was it about her and her story that was so compelling, that made everybody want to stand up and be a part of that?”
I realized that in the stories she was telling us, she was telling us about these people as people. As people with agency, and an ability to act, and who care about other people. She wasn’t telling us about victims. She was telling us about strong individuals. It made me think about the way development projects work in communities. It made me think how we need to recognize that power, sense of hope, and sense of possibility in everybody we work with. Because that’s what’s powerful about what we do.
Learn more about how to become a great social entrepreneur from all of the TED Fellows on the Case Foundation