Cultivating women leaders

They listened as the medical school deans on stage discussed the future of medicine in Africa. When one man said that their countries would lead the world in progressive medical education, Barry shot a glance at El-Sadr.

“What is wrong with this picture?” Barry asked El-Sadr. Accustomed to seeing only white men speaking on similar panels in the United States, the two women had traveled around the world to find a panel composed of all black men in leadership and Francis Collins, MD, a white man who directs the U.S. National Institutes of Health.

Barry raised her hand to speak. “If you want to be the most progressive continent, look at who’s on your podium,” she said. “You don’t have a single woman. It behooves you to think about that.”

A few dozen women were scattered among the crowd of several hundred men. As Barry sat down, they stood and applauded. They understood that Barry’s comments were a call to action that went beyond this panel. That realization — in that moment — became the catalyst for what has become an international movement to ensure that the decision-makers in global health look more like the population whose lives and well-being depend on their decisions.

In the United States and Canada, women lead just 1 in 6 medical schools, according to a 2018 survey by the Association of American Medical Colleges. And worldwide, women lead fewer than a third of health organizations, according to research by Global Health 50/50, an independent initiative housed within the University College London Centre for Gender and Global Health. For now, the people making critical decisions about how doctors are trained and how health care resources are allocated around the world are disproportionately male.

Barry, the incoming chair of the Consortium of Universities for Global Health’s board of directors and past president of the American Society of Tropical Medicine, wondered if the imbalances at the highest levels of leadership contributed to the imbalances in health outcomes.

“There is no shortage of smart, educated and talented women working in global health,” she said. “These women bring a different perspective than men, and their perspective is critical if we are going to improve health outcomes around the world.”

For much of her career, Barry has focused on expanding access to health care. At Yale University, she created a mobile health van to connect medical professionals with victims of domestic violence who were unlikely to seek care in hospitals.

She launched the first clinic devoted to refugee health in the Northeast. And she started one of the first overseas residency programs to introduce U.S. physicians-in-training to different cultural approaches to health care and strengthen medical settings globally. At Stanford, she created a residency track to prepare physicians to work in places with few resources.

To Barry, director of the Stanford Center for Innovation in Global Health, the inequalities in health around the world demand attention and action. Why should people in one country suffer from a disease that is preventable, curable or at least manageable in another country?

After the conference in Nairobi, Barry began organizing the first women’s leadership conference, in part with help from Collins, who provided a grant from the National Institutes of Health to get started.

Barry wanted people working for gender diversity in health care to share best practices, identify ways to collaborate, and inspire each other and the next generation of advocates. The Women Leaders in Global Health Conference was held for the first time at Stanford Oct. 12, 2017.

Building the network

Physicians, professors and representatives from government and non-governmental organizations arrived on campus from 68 countries for the 2017 conference. Barry opened her Rolodex and leaned on her female colleagues to help her raise money and shape the conference’s content.

Women from 10 American universities and several foundations funded scholarships so women from low- and middle-income countries could attend. A group of women lawyers helped women from majority Muslim countries acquire visas so they could also make the trip, despite the travel ban President Donald Trump instituted earlier that year. Representatives from international organizations such as the World Health Organization, Women in Global Health and the United Nations Foundation helped structure the conference agenda.

The Bill and Melinda Gates Foundation awarded a grant to help fund the conference and sent a video greeting so Melinda Gates could speak to the more than 400 attendees. “This conference is about unraveling the complex, sometimes invisible systems that undervalue women,” Gates said. “It’s about building new platforms from which women can lead.”

Women with experience leading teams at foundations, universities and the NIH spoke at the conference about why gender matters in the health workforce, how to become change agents and enlisting men in the effort to elevate women. Former U.S. Secretary of Health and Human Services Donna Shalala encouraged the crowd to reach higher.

And Gary Darmstadt, MD, professor of pediatrics and associate dean for maternal and child heath at Stanford, reminded the mostly female crowd that they weren’t the only ones who would benefit from more diverse leadership. “Where you have greater gender equity, men’s longevity improves, as does women’s longevity,” he said. “We have a lot to gain.”

Rose Clarke Nanyonga, PhD, came from Uganda, where she is the vice chancellor of Clarke International University (formerly International Health Sciences University). Born in Uganda, she enrolled in college in the United States and stayed for graduate school.

After earning her doctorate in nursing from Yale University, Nanyonga considered staying in the United States, where she’d have more career opportunities. Instead, she returned home and ultimately took a position that was 20 percent academic and 80 percent administrative.

She wondered sometimes if she had chosen career suicide because she had no time to pursue research, write grant applications or collaborate with other people.

“I was in leadership, but I was so isolated,” she said. “I didn’t have the connections that I wanted to have. Or the encouragement that I desperately needed. The conference at Stanford felt like an intervention because it suddenly plugged me back into a network of like-minded people.”

Others were similarly inspired. At the final plenary session, women leaders from England, Rwanda and Peru stood one after another to offer up their home countries to host future conferences. Heidi Larson, PhD, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, called dibs on the 2018 conference. She spent a year organizing, planning and fundraising so she could expand the event, which took place over two days in November in London and included panels on political leadership, big data in global health and social entrepreneurship.

It also offered more formal mentorship opportunities, including a breakfast where early career women could seek advice from groundbreakers like Joanne Liu, MD, international president of Doctors Without Borders, and Patty Garcia, MD, the former minister of health in Peru.

“I had the most wonderful mentor,” Garcia said, remembering her early training in the United States with King Holmes, MD, PhD, former director of the Department of Global Health at the University of Washington. “I learned so many things from him that I would never have thought about otherwise. Unfortunately, in countries like mine, and most low- and middle-income countries, we don’t have that experience of mentorship.”

More than 900 people attended the London conference, and thousands more watched online. The gathering offered small-group discussions that sparked immediate collaborations. In one session, an attendee from Somalia said she wanted to offer more training for nurses and midwives but found it difficult to hire outside instructors because of the continuing armed conflict in her country.

“Those nurses and midwives could be trained in the neighboring stable countries — Rwanda or Uganda or Kenya,” thought Nanyonga, who was sitting a few rows back. She offered her own campus as a possible training location. “I never would have known what was going on there, or that there was a solution that we can effectively implement, if not for this conference.” Now back home, they are discussing logistics to make it happen.

Building the future

The first two conferences gave Barry, Larson and other organizers a sharper picture of what aspiring women leaders wanted and needed. At Stanford, Barry offered a pre-conference leadership skills-building workshop with Graduate School of Business faculty. The one-day course was open to 60 participants. More than 300 applied. In London, the mentoring breakfast was similarly oversubscribed.

Some conference attendees were inspired to action. After the Stanford conference, Aoife Kirk, MD, decided to enroll in a master’s program in public health so she could improve people’s health on a larger scale than she could as a physician. After the London conference, she co-founded Irish Doctors for the Environment and volunteered to write the group’s newsletter. “In London, the idea of a leader being and believing in something ‘greater than yourself’ came up several times,” she said. “Leaders also pass the microphone and allow others to obtain their voice.”

Barry wanted women around the world to find their voices. She wanted them to have all that the conferences provided — leadership training, a sense of community and inspiration — on a grander scale than was possible at a two-day event.

Barry wanted something permanent and available on demand. As she contemplated this bigger initiative, she tapped Amie Batson, whose 25-year career included prominent roles at the World Bank, the World Health Organization and PATH, an international nonprofit dedicated to entrepreneurship and innovation in global health. Along her career pathway, Batson saw the same imbalances among leaders in global health that concerned Barry.

“Women are a dramatically undervalued talent pool,” Batson said. “Too often, women with skills and talent reach the middle levels of leadership and find their careers stall there. Global health leadership urgently needs more diversity to achieve better health impact.”

Batson joined Barry as a volunteer, helping to shape the conferences and discussions about the future, and eventually signed on as the initiative’s senior adviser.

The two women assembled an international team to devise a strategy. Over time, they settled on a plan that calls for five hubs on five continents, physical locations where women can go for a few weeks of coaching and connection while each designs a project for her home community.

Then, over the next 18 months, as each woman implemented her project, she would network with her cohort, mentors and coaches. The whole group would then reconvene at the training hub to share what they learned and what could be replicated in other communities. Barry, Batson and their team received a planning grant from the Gates Foundation to fund the initial stages of the initiative, and will apply for future grants to complete it.

The team also envisions a virtual gathering place where women from around the world can share stories, seek assistance and generally inspire one another and others to change the world. Between the training hubs and online organization, the plan calls for helping 5,000 women accelerate their leadership journeys. And for each one of them to push, pull or motivate other leaders on their journeys.

“When Wafaa and I were sitting at that conference looking at the all-male panel, I knew the picture had to change,” Barry said. “The challenges in global health are too big and too complex to leave half the talent sitting on the sidelines.”

Barry still receives weekly emails from women who attended the conference at Stanford. They write to say thanks and to let her know they’re ready to stand up, connect across boundaries and help solve those challenges.