Creating Space for New Leaders with Dr. Agnes Binagwaho
Many Complex Variables, One Simple Solution
The first time I met Dr. Agnes Binagwaho, Vice Chancellor of the University of Global Health Equity (UGHE) and former Minister of Health of Rwanda, I was at Yale University for Global Health Corps’ Training Institute. After myriad sessions on leadership development, diversity, the equity agenda, and more, I began to re-evaluate my career in communications; did these buzzwords hold any tangible value in my life?
Dr. Agnes Binagwaho’s words were the first to cut through the noise: “there are no complex solutions, only complex excuses.”
I made excuses for a long time about pursuing my goals. For a long time, I didn’t think I could move abroad for a job; what about my parents who are getting older? Or if my relationship falls apart? Or my savings account takes a nosedive? What if the time to take a risk was behind me?
Fortunately, it wasn’t, and speaking with Dr. Agnes reaffirmed that realization. While there were many complex variables in my way, there was one simple solution: take the job.
It wasn’t easy. I’d jolt out of my deep slumber with intrusive doubts about my work ethic and station in life. I frequently felt like I had nothing together, and often still do. I wondered if other women grappled with similar crossroads as they moved ahead in their careers and lives, particularly in the health sector, be it a glaring imbalance in work/life commitments or a raging case of imposter syndrome. According to a 2017 article in The Lancet, though women make up the majority of global health students worldwide, they are grossly underrepresented in its leadership at only 24% — a clear indication that the systems in which we work do not cater equitably to our needs, particularly for women of color.
In sitting down with Dr. Agnes, I wanted to further understand the challenges that women in the health sector face. From Vice Chancellor to Physician to Minister to Professor to Senior Advisor, Dr. Agnes has held various leadership positions and is well-known in the global health world for her work in strengthening health systems. Now, she’s chairing the International Conference Committee for the 2019 Women Leaders in Global Health conference to be hosted by UGHE in Kigali, Rwanda (November 9–10). After a year of working within her organization, I was curious about what advice she’d have for a young professional like myself.
We met at her home in Kigali.
Can you tell me why you decided to pursue medicine? What were some of the earliest memories that influenced your decision to become a doctor?
When I was about seven years old, I knew I wanted to be either a healer or an educator. Probably because my father was also a doctor. I watched him growing up, and the concept of healing and serving others was instilled in me from an early age.
Can you describe a meaningful moment in your education? Was there a teacher or class that made an impact on you?
This is an example of how a teacher can have a negative impact on you, but it taught me a very important lesson. In medical school, I had a teacher who was quite inflexible, and lacking in strategic thinking. He thought very highly of his sociology class, and made sure the students knew that. I remember joking around with my classmates once and him specifically singling me out. He made generalizations about my country (Rwanda) and specifically placed negative stereotypes on me as a black, African woman, and shared those with the whole class.
After that, I realized how someone with power has the ability to mislead young people. Young people can be stubborn, yes, but we must never paint one person with a broad stereotype simply because of where they are from. I vowed that if I ever become a teacher, I would never stereotype someone based on where they are from.
When you first started your career, were there any health inequities that you witnessed?
Oh yes. I’ve worked in many different contexts. In Belgium, the teaching hospital was near an area where many of the patients lacked housing and basic needs, so you would see many marginalized people when you walked around the hospital. In France, where I worked as a pediatrician, inequities were even more apparent especially because I was looking after children. I saw how quickly the system wanted to draw children away from parents, creating a cycle of poverty and inequity.
This is structural violence and we have a responsibility to fight against it. It exists in all systems, not just health. And we need to be vigilant in seeing it and helping those who are victims of it.
The Lancet cites that in some countries, women comprise 75% of the global health workforce, but are hardly represented at the top levels of decision-making, which is disappointing to say the least. Why do you believe that we need to see more women at the leadership level, particularly in the health sector?
Globally, women make up 52% of the world’s population, yet you would never know if you looked at a pie chart of industry leaders. We don’t see women in these positions because globally, we’re not educated at the same rate as boys, and are not given the same pay for the same job. When you think about it, this is a form of slavery. If you pay me 75% of what a man makes, you’re getting 25% free labor out of me. Additionally, women’s advancement is not the same. There are expectations for women to maintain relationships, families, and work, all at the same time. We start our education and careers with a handicap. We need to see more avenues for young women’s career growth within organizations.
What do you think needs to be done to get more young people like myself who are early on in their careers, to positions of leadership?
Of course to fight for that. And we need to train you to fight, not to just let it go.
The thing is, women have to prove more than men. Meaning that if you see a woman in a position of leadership, you can be assured that she is excellent because of the effort it took to get there. There is less forgiveness and tolerance for women’s mistakes. This is why no matter what role she has — be it a doctor, community health worker, or communications specialist — she must be trained as if her goal is to be the best no matter what.
Women of my generation need to give you the strategic thinking tools to navigate the world of men. In Rwanda, parliament is comprised of 67% women. This is progress. But at the grassroots level, how many women have the same say as men? We need to do more all over the world to amplify the voices of women and girls.
Something I think about a lot is mistakes. I’m very hard on myself when I make an error or have an oversight at my job, and I’ve made many mistakes so far in the three years I’ve worked since graduate school. I find they stick with me, and moving through a mistake is challenging as I overthink and wonder whether I’m actually fit for the job at hand. I’m curious what you think about this?
First of all, I’ve made early career mistakes, mid-career mistakes and late-career mistakes. So let’s just get that straight: we all make mistakes. When you’re innovating something it’s hard to be “perfect” or “right” and at UGHE we are constantly growing and innovating. Every time we shift our way of doing something we open ourselves up to the possibility of failing. But failure isn’t a bad thing. We learn from our failures and we grow from them. Look back at your own mistakes from years ago and see how much you’ve grown.
Global Health Corps and UGHE both place emphasis on training the next generation of global health leaders. I know my generation is on the cusp of inheriting the world and all its problems, but why do you think it’s so critical to see programs that invest in young professionals?
Oh because you are going to work after me and pay my retirement!
But on a more serious note, you are the ones who are going to lead the world, whether you’re aware of it, or ready for it. We’ve been passing this baton for millions of years from generation to generation and will continue to do so. We’re getting ready to pass it to your generation and if we want the world to be a good place, with the capacity for positive change, then we need to make sure we’re both educating young professionals and learning from them. We don’t have all the answers, no one ever does. We just need to have the willingness to learn and grow.
There is a lot of collective hatred and/or worry about the millennial generation. I’m not sure all of it is founded since we’ve inherited many inequitable systems (be it social, economic, cultural) that are outside of our control and leave many of us with legitimate anxiety. Given this, what do you see as the greatest challenges facing my generation?
Yes, people your age are in a tough position. I see employment as a challenge. Your generation is the best educated ever. However, in terms of true skills in entrepreneurship, strategic-thinking, solidarity, and systems-building, I’m not sure our educational systems are truly equipping young people with the right critical thinking skills. At UGHE, we’re working on giving professionals these skills, because we see a gap in how health professionals are addressing the inequities of the systems in which they work.
Your generation also faces a very difficult political period where it feels like the needle is moving in the wrong direction. There is a lot of frustration in the world, certainly with Western politics, but that’s not the only case. You face a world where capacity is greater than ever — money is not an issue, but the willingness to share is less than ever.
Members of my generation fought for many things — racial equality, gender equity, human rights — and now it’s as though we’re starting from square one; encountering versions of these same obstacles. It’s like we are at the bottom of the curve where these inequities still exist, but there is less willingness to address them. Perhaps this is due in part to the information overload caused by this new digital landscape which drowns out the real significance of these problems. It’s not good. There’s a lot of information, but much of it is misleading.
This is why what’s essential in today’s world is good global leaders. People who are able to connect across perspectives and backgrounds with honesty and integrity. For generations we’ve seen a lot of the same type of leadership, and thus a persistence of the same issues. This is why we’re fighting so hard for diversity in leadership, with the belief that there will be positive ripple effects across global social, economic, and political life.
At GHC training institute, which is a long time ago now — you said “There are no complex solutions, only complex excuses” — can you expand upon this statement?
The solutions to problems are simple, in the sense that you need to start with your work. And you need to start with the humility that you don’t know everything, and that what you do today will likely be obsolete tomorrow.
The fact that people are making excuses — “this challenge is too complex to tackle”, “let’s think on it,” “let’s have a workshop,” — can often be a waste. See, people make it complicated as an excuse not to act. We need to act. We need to deliver.
The word “influencer” has taken on a new definition in our current lexicon. In the digital age, it can often be someone with a massive following, who yields power over others’ choices. However, in speaking with Dr. Agnes, I realized that “influence” and “leadership” aren’t just qualities that someone in a high-level position can exercise.
Leadership is a constant. It starts in how I interact with my colleagues, how I handle the mistakes that I inevitably make with humility and willingness to grow, and how I rise to the challenge of a new opportunity.
Even in the small communications role I play at UGHE, I have the ability to show up and exhibit leadership in my day-to-day. Should I find myself in an “actual” leadership position one day — an executive or directorship role — I know I will be faced with many unknowns, and continue to make mistakes. But a good leader has the ability to admit that they don’t know everything. That regardless of where they stand, there are miles and miles to go. I look forward to going the distance.
Samia Kemal is a 2018–2019 fellow in Rwanda.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.