Health Partners Fellowship Program

Leading Leaders: Marshalling & Maintaining Resources to Improve International Health
An interview with Javette Orgain, MD

For the past ten years, Javette Orgain, MD, a board certified family physician has been an Assistant Professor of Clinical Family Medicine at the University of Illinois at Chicago College of Medicine. Since graduation from medical school in 1981, the numerous local and international roles that she has assumed and the recognition that she has received, attest to her skills and leadership abilities. She is the 100^th President of the National Medical Association (NMA) and has received Commendable Service and Meritorious Awards from the NMA Family Practice Section and Service Award from the Council on Concerns of Women Physicians. In July of this Year, She was listed in Black Enterprise Magazine as among America's 101 Leading Black Physicians, and one of five within the category of Primary Care Physicians.

Dr. Orgain joined the International Center for Health Leadership Development (ICHLD) Health Partners Fellowship in August 1998, becoming one of the first twelve members to be selected for the two-year training program. Dr. Orgain cites her dedication to global health issues as a key influence on her decision to compete for this award. In this leadership story, she talks about her ties to the National Medical Association (NMA) and her work and activities in Africa. She references past projects and current initiatives, highlighting lessons learned and reflections from her Health Partners Fellowship experience.

The National Medical Association (NMA)

The National Medical Association (NMA) is the oldest and largest organization representing African American physicians and health professionals in the United States, Puerto Rico and the Virgin Islands. Established in 1895, it is the collective voice of more than 25,000 African American physicians and the patients they serve.

The NMA is a 501 c (3), national, professional and scientific organization whose commitment includes, (but is not limited to) i): preventing the diseases, disabilities and adverse health conditions that disproportionally or differentially impact African American and underserved populations; ii) supporting efforts that improve the quality and availability of health care to the poor and underserved populations and promote the betterment of the public health; and iii) increasing the representation and contribution of persons of African descent in medicine.

Adopted a credo at its inception, which remains in effect today.

It should be stressed that throughout its history, the NMA has acted to influence society and its institutions on health issues through principles, goals, initiatives and a philosophy that encompasses primarily the medically underserved, yet includes All sectors of society. With 35 state and 61 local medical society affiliates located in six geographic regions, the NMA has an extensive national, regional and local infrastructure for the promotion of its programmatic and research initiatives.

The National Medical Association provided one vehicle through which Dr Orgain obtained leadership experience and gained opportunities to work collaboratively on health initiatives with national and international partners.

Her involvement in projects in Africa and related training through the International Center for Health Leadership Development program are explored below.

Collaborating for Health in Africa: Past and Current Programs

In 1993, as an officer in the association, Dr. Orgain, other physician members of NMA and members of the Auxiliary to the NMA spearheaded the Water for Children Africa Project. This project had as its mission to develop linkages and assist poor communities in rural areas of Africa, obtain clean water. Many of the diseases in Africa are waterborne and serious illnesses arise due to a lack of a clean and ample water supply. Indeed, millions of children die each year from contaminated water. Over the years, members have raised funds and mobilized resources in the U.S. Partnering U.S. cities with African countries proved an effective way to repair wells and pumps in several locations in Africa. The changes made remain in place today and Dr. Orgain has maintained her involvement.

The success of this initial venture created a climate that fostered further collaborative efforts. Members were subsequently recruited and invited to participate in a larger- scale more ambitious initiative.

Partnership with the International Medical Exchange (IME) - Part I

Dr. Orgain became involved in the International Medical Exchange, once again as a member of the NMA Board of Trustees and prior to joining the ICHLD Fellows Class of 2000. The IME is based here in the United States; it operates under the direction of a Nigerian who resides in the USA (Maryland) and a co-chairman who lives in Zambia, South Africa. A multi-cultural organization had been created in 1995 that had leadership across waters and across borders. Furthermore, the presence and prominence of a national medical association (the only organization of its kind in the USA) provided an excellent basis for a strong and viable linkage between the IME and the African nationals in East, West, and Southern Africa.

The primary purpose of this collaborative was to develop an exchange of officials, resources and efforts that would lead to a focus for healthcare development that was based on the needs of African communities. It was envisioned that the African representatives would define these needs as the partnership progressed.

Members of the IME came together on several occasions to develop a health agenda and to plan for an exchange program in 1997. Dr. Orgain was the program co-chair for these meetings. These efforts culminated in a successful event in Sun City, South Africa at the end of that year. The conference, which had as its theme "Empowerment through Health," attracted a diverse group of more than 500 participants. Ministers of Health and other representatives from more than ten African countries, members of the National Medical Association and other individuals from USA, including pharmaceutical company personnel, were in attendance. The major outcome was the determination by the group to continue with discussions of collaboration and to forge the agenda for the exchange of knowledge and resources between the two continents. The ultimate goal was to improve the quality and delivery of health care to the underserved, poor and uninsured populations in these areas. Thus the next chapter in the program planning partnership began.

IME Conference Program

Partnership with the International Medical Exchange- Part II Dr. Orgain continued as the program co-chairperson to support and promote the collaborative efforts of the planning initiative. A second conference for the Year 2000 was agreed upon and the organizing efforts resumed. However, the initial success experienced by the group, fanned perhaps by member enthusiasm and optimism, was threatened. She and her fellow committee members were faced with a number of setbacks many of which seriously challenged the very core of the IME operations and its ultimate sustainability. Examples of some of the major issues encountered are highlighted below. These challenges while specific to the IME circumstance are not uncommon, nor are they all-inclusive. However, they do serve to illustrate the scope and diversity of problems leaders can encounter during the initiation and maintenance of collaborative efforts.

1.) The key players changed, with resulting loss of critical resources.

The original team that traveled to Sun City, South Africa, included the mayor and elected officials of an urban eastern city within the U.S.A. While there, these individuals agreed to host the second Exchange conference. However, on retuning home, a significant change in city government occurred. Some officials were replaced; others resigned, left politics or moved to other government positions. In the end, the agreement to host the conference was not honored by the new leadership. Thus new relationships had to be forged. This factor was critical because IME no longer had access to needed financial support as well as other resources and services.

2.) The available support was inadequate to accomplish the proposed plans.

The African nationals preferred (and it was voted upon at the first meeting in Sun City), that the next IME event would be held in the United States. However, some members felt that it would be better to meet again in Africa particularly because of the exchange rate of the dollar and the prohibitive expense of bringing a large number of African nationals from the continent of Africa to the United States. Furthermore, the focus was on Africa and on bringing information and other healthcare resources to those countries that were in need. However, the continental Africans were not convinced.

3) The expectations of certain partners were not always realistic.

The significant financial constraints under which the IME labored were compounded by the overzealous expectations of some of the members. Many believed that the USA and its constituents had (or could have access to) unlimited resources to finance the necessary travel, accommodations and meals for a one -week period of exchange. Thus while the initial funding sources had vanished, the expectation of a visit to the USA remained. Partners were disappointed (and understandably) when IME was not able to raise sufficient funds to fulfill their dreams.

4.) New Partners came to the table with incompatible agenda and objectives.

IME had established collaborative relationships with Ministers of health and lead governmental officials in Africa. Thus to facilitate the process it would also be important to have the same caliber of partners here in the United States. However, the stakes were higher and the vision and the concept of partners and partnerships varied with the new US collaborators. After several of the key USA partners withdrew, the leadership of IME tried to develop different relationships to achieve the objectives (publicity, funding exposure and access to resources). However the new partners had multiple agenda and were not completely forthright and transparent in their approach to the relationship

5.) The partnership was expansive and over-ambitious.

IME was engaged in an enormous project form the perspective of collaborations and resources, if one considers Africa as a continent and recognizes that the team was interfacing with many countries. This situation may have been different if the leadership focused on one country and a defined project such as Water for Children Africa. However, in this case, each country has its own culture and its own needs. Furthermore, Dr. Orgain and the team were interacting with ministries of health and health organizations that experienced changes in leadership in several countries during the course of the project. So while the leadership in the USA remained stable, the dynamics continued to shift with many of the key players in Africa with whom IME-US leadership was working. Partners were from several African cities and countries, including Gaborone, Botswana; Gambia; Ghana; Nairobi, Kenya; Windhoek, Namibia; Lagos, Nigeria; Senegal; East London, Johannesburg, and Pretoria, South Africia; and, Swaziland.

6.) There were inherent threats to effective decision making/timely communications

Communication was very difficult, based on the technology and the technological divide between the U.S. and Africa. E-mail was difficult and letters took a longer time to reach their destination. When Dr. Orgain and the team needed to plan or make changes quickly, they were not able to do so because of the number of persons they had to reach in Africa. In the U.S.A. there is often little difficulty meeting in person or via teleconference. In comparison, it can take ten times that effort when working internationally. Thus reaching consensus quickly around any key issue became a formidable problem.

As a result of these issues, IME was not able to host the constituents from Africa, the planning conference was cancelled and the development of the exchange agenda was interrupted. However, most importantly, IME, did not fold, the Continental African partners did not abandon ship. Dr Orgain remains in a leadership role and is a project consultant.

When asked what she believed contributed to the viability of IME, Dr. Orgain mentioned several contributing factors, but highlighted two key areas.

Impact of ICHLD Health Partners Fellowship

As Dr. Orgain reflected back on her experience, she pinpointed numerous lessons that she had learned. She nonetheless gives emphasis to the following points:

Key Leadership Lessons Learned

• There is a long path from establishment of a vision and mission to the desired outcomes, even when these do not initially appear difficult to achieve.
• Laying of the initial groundwork is critical to long-term success.
• Activity can often be generated as a reaction to a perceived crisis, however mechanisms need to be in place to set priorities and deal with the long view.
• IME is reorganizing and the partners need to be selected carefully.

In multi-cultural, multi-country collaborations, a leader must be particularly vigilant and attuned to the interaction among the players. Dr. Orgain, as a person of African descent, born and raised in America, interacting in another country, and as the meeting coordinator, gained heightened sensitivity to these interactions, particularly the dynamics between men and women.

Dr. Orgain contends that as she learned throughout the fellowship she became more grounded and focused. In addition, the ICHLD experience provided her a considerable amount of direction regarding how to proceed with IME and other collaborations.

The IME project has been refined and focused. Furthermore, reflecting on her continued role she states:

Closing Remarks