International Center for Health Leadership Development (ICHLD)

Leadership Stories

Working Across Nations: Reflections of a Collaborative Leader
Joseph M. Harrington, BA

Chicago native Joseph M. Harrington earned a Bachelor of Arts degree in education from Chicago State University. He serves as a project director in the Department of Preventive Medicine at Rush University Medical Center, a position he has held since 1996. Currently, he administers two projects funded by the National Institute of Health, the Selenium and Vitamin E Cancer Prevention Trial (SELECT) and the Women's Health Initiative (WHI). He also provides oversight and support for regulatory affairs of the department's Clinical Research Center and coordinates the department's weekly educational conference. In 1998, Mr. Harrington joined the ICHLD Health Partners Fellowship.

Mr. Harrington came to ICHLD with an extensive track record of community involvement. He has years of experience serving on nonprofit boards and advisory committees and has participated in several innovative projects. He is one of the founders of the Chicago Network of Black Professional Organizations, an entity that includes representatives from over 18 health and social service associations. He also co-founded and is vice-chairperson of the African American Health Care Council, an organization that seeks to eliminate health disparities with a particular emphasis on African Americans. "Our focus is policy and advocacy. We want to heighten awareness concerning health disparities at the community and professional levels so that real change will occur. We understand that this problem did not happen overnight and it won't be resolved overnight either," Mr. Harrington explains.

While his professional and community involvement is extensive and diverse, Mr. Harrington hesitates to cite a list of accomplishments. "I don't think of myself as a leader but as a catalyst for change and a facilitator of that change. . . It was Bishop Desmond Tutu who said, 'I am a leader by default, only because nature does not allow a vacuum.' In the same way, I often, I find myself in a leadership role because a void has been created and someone has to step forward," Mr. Harrington explains.

While Mr. Harrington is not a self-conscious leader, he is quite passionate about the issue of social justice. "The unequal distribution of health and health care services are social justice issues. I am interested in efforts that improve and promote equitable access to health care. I don't see health disparities lessening without removing the barriers that cause them - barriers such as access to care are often driven by forces outside the purview of those of us in health care," he points out.

In this leadership story, Mr. Harrington briefly describes his diverse body of work, especially the Community-based Infrastructure Development Project (CBIDP), and comments on his initial encounters with his future CBIDP partners and the role that he played in shepherding the development and submission of its grant application. He concludes with thoughts and reflections regarding leadership and his belief in the power of a greater good.

The Community-Based Infrastructure Development Project

These interests, plus his talent at networking and interacting collaboratively, provided the springboard from which Mr. Harrington launched the Community-Based Infrastructure Development Project (CBIDP), an international project that spans two continents and engages four academic centers. CBIDP utilizes a multi-disciplinary, inter-institutional approach that builds upon existing, local relationships and fosters community engagement. Through creating a collaborative and nurturing environment, these relationships are expected to evolve and grow stronger over time.

CBIDP partners include the University of Transkei and Frere College of Nursing, both located in South Africa; the University of Illinois at Chicago School of Public Health; and Rush University Medical Center (RUMC), also in Chicago. CBIDP leadership is provided by Dr. Khaya Mfenyana, chair of the Department of Family Medicine at the University of Transkei; Ms. Felicia Mazwi, chair of the Department of Nursing, Frere Nursing College and an ICHLD international fellow; Dr. Shaffdeen Amuwo, associate dean for community and government affairs at the UIC School of Public Health; and Mr. Harrington from RUMC who serves as project coordinator. Two advisory councils have been formed, one located in South Africa, the other in the United States.

An understanding of Transkei is necessary for understanding the context of CBIDP. Transkei was an independent South African state from 1976 to 1994; it is now part of the Eastern Cape province. Eastern Cape province has a population of over three million persons. It is one of the poorest of the nine South African provinces with barren land and few natural resources. Access to safe, clean potable water is limited. There are virtually no toilet facilities in the rural areas and the bucket system is used in most towns, including Umtata. Most men earn their living by working as migrant laborers in urban areas. The infant mortality rate in the Eastern Cape is 54/1000 compared to the national average of 42. Additionally, the population has been hit hard by HIV/AIDS largely due to high rates of migration of young people (mainly men) to urban areas.

BIDP efforts have been guided by the work of John L. McKnight, who developed the concept of community asset mapping. Through this approach of directing resources where they are most needed and facilitating service coordination, CBIDP intends to enhance the existing public health infrastructure. Specific efforts will be directed towards strategies to address environmental issues (such as clean water, a safe food supply and sanitation) and to establish prevention and treatment services focused on behavioral change and education of women, children and other vulnerable groups. "CBIDP does not plan on evaluating specific development projects with the thought to make them 'CBIDP projects,' but rather to pool resources and talent in support of projects that other organizations will take on as their own," Mr. Harrington explains. In addition, as required by their funders, the partners will take part in a worldwide research/development endeavor which calls upon universities to utilize their capacity, talent pools and resources to create productive partnerships with other forces in society.

CBIDP identified five strategies for accomplishing its goals:

  • Mobilize concerned industry, community scholars and students;
  • Assess collaboration arrangements;
  • Develop unified strategies, including funding mechanisms;
  • Develop proposals for large scale funding of programs; and
  • Ensure sustainability and foster institutional change.

How did CBIDP Become a Reality?

Mr. Harrington started the ball rolling to create CBIDP by sharing his interest in and commitment to collaborating with South African clinicians and activists. "When I returned from my first trip, I started looking for opportunities to collaborate. I knew that whatever we were going to do would need funding. The discussions about what we were going to do became more concrete as we sorted through the funding issues." Mr. Harrington remembers this time as a dynamic learning situation. "We had to balance the ideas that felt comfortable to us with the needs of the South African communities and the interests of the funders. Each of the partners brought something different to the table. Khaya and Felicia understood the context very well, I had access to funding information, and others in my network knew the logistics of working on international projects. The body of work emerged through this process," he continues.

How Did This All Begin?

When asked, "How did this all begin?" Mr. Harrington says, "If I think about that question from a personal perspective, I would say that it all started even before I was born. I think it has to do with what happened to my ancestors - how the vast majority of Africans arrived in this country in the first place. It's important for us all to remember that most African Americans are no more than four or five generations removed from slavery. Much of my involvement in this project is spurred by something inside me that says that, given the opportunity, I need to do something with and for the people of Africa . . . to somehow be involved in Africa . . . to work to improve the unconscionable conditions that have taken root and are allowed to exist there." He is well aware that his knowledge and understanding of history are coupled with his real life experiences, with the way he was raised and nurtured. "The values instilled in me as a child by my parents and grandmother have been very influential. My mother instilled in me a love of people and the value of doing good works. My father, a small businessman, taught me fairness and - above all else - he taught me to be true to myself and others. From him, I learned that one of the few things that a man has is his word - this is something I have never forgotten. He was always fair and honest in his business dealings," Harrington continues.

Developing an African Network

Mr. Harrington traveled to South Africa for the first time in 1997 - his first trip outside the U. S. and Canada. "This was real life, not a book full of words and pictures or a computer-generated view of life. This trip allowed me to see the situation first hand - to see people and programs in action and the tragic consequences of inaction," he remembers.

The trip provided him with invaluable insights and affected him profoundly. He had the opportunity to interact with people of different cultures - people on another continent in the context of their country and their individual circumstances. Furthermore, he gained a greater appreciation for the humanity of people everywhere, observing, "Fundamentally, there is really no difference in people no matter where they live. The issues that make people laugh, smile, cry, and feel sad right here in the U. S. are the same issues that cause these reactions in South Africa. Nonetheless, I was struck by the degrees of difference among the various segments of the population. He was particularly conscious of the real socio-economic gap between the 'haves and the have-nots.' "

Mr. Harrington traveled to South Africa for the express purpose of meeting people and making contacts. He visited Cape Town, Johannesburg and Pretoria - all large urban areas. This allowed him to develop many new relationships and exchange insights with individuals involved in health initiatives at a variety of administrative, faculty and governmental levels. Over the years, he has maintained contact with many of these professionals, including representatives of the Ministry of Health, Ministry of Trade, the director of the Center for Bioethics at the University of Cape Town and colleagues from the Chris Hani Baragwanah Hospital in Soweto. At the same time, Mr. Harrington was one of the organizers of the Midwest Regional Summit on Africa, held in Chicago in September 1998. The Summit brought together Africa- and U. S.- based activists to discuss diplomatic and economic relations. Participants also engaged in policy discussions on health, education, peace and human rights. "Participating in the summit broadened my network in Africa and in Chicago," Mr. Harrington remembers.

Second Visit Expands Connections

Mr. Harrington's second trip to South Africa occurred during his ICHLD Fellowship. In 2000, ICHLD international fellow Felicia Sheilla Mazwi, a senior lecturer and head of the Nursing Science Department at the Frere Nursing College, organized a visit to South Africa. As part of this trip, the fellows presented a conference, Building Partnerships in South Africa. This event served as the culminating project of their fellowship. Over 100 participants gathered to engage in a week-long session of lectures, small group discussions and skill-building exercises. During their visit, Ms. Mazwi arranged to have the ICHLD fellows tour Transkei, one of the poorest provinces in the country. Mr. Harrington says, "This was a profound life-changing experience. There's nothing like standing in a mud hut in a rural South African settlement to open your eyes to the harsh realities of this world. It offered me a very realistic, concrete exposure to a side of human experience I had never before seen. I was struck by the obvious, blatant poverty, but more importantly, this experience brought home the fact that poverty - the absence of wealth - should not be confused with lack of assets. I came away feeling that the individuals that I saw were a strong, caring, happy people in spite of their lot in life. They are extremely rich in those things in life that really matter. They are true to themselves and have a closeness to the land on which they live that many of us in the U. S. cannot begin to imagine. The lives they live may be perceived to be a struggle, but their lives are real and very full and rich in many, many ways." Ms. Mazwi also arranged for the ICHLD fellows to meet Dr. Mfenyana, head of Family Medicine at the University of Transkei and director of several primary care clinics in the area. Members of the group observed first hand the delivery of quality care within the context and limitations of the rural poor. The ICHLD fellows met clinic staff and patients as well as members of the community advisory board. Consistent with his style, philosophy and approach to networking, Mr. Harrington maintained contact with Dr. Mfenyana who is now the South African project director for CBIDP.

Impact of ICHLD Curriculum and Training

The ICHLD fellowship curriculum emphasizes leadership, multiculturalism, community capacity building, university/community partnerships, collaborative relationships, conflict resolution and public policy. During the two years, fellows have the opportunity for self-assessment and reflection, as well as sharing leadership stories and participating in site visits, presentations, lectures and group exercises. For Mr. Harrington, participation in the Health Partners Fellows program validated the skills and talents that had worked well for him over the years. He also came to understand that these were not simply personal attributes, but recognized and valued strategies for improving health and addressing community needs.

"I find the concepts outlined by Arthur T. Himmelman to be particularly useful for my work," Mr. Harrington explains. Himmelman defines collaborative leadership as, "facilitating mutual enhancement among those working together for a common cause." Himmelman also identifies various levels of working together, beginning at the first stage of networking and moving through to the most formal, intense and trust filled relationships as exemplified in a collaboration. Himmelman states that the individual has "a commitment to improve circumstances based on values, believes and a vision for change that is communicated both by talking it and walking it."

"If at First You Don't Succeed..."

It was in this spirit that Mr. Harrington approached his work when he returned from South Africa. "I returned from South Africa determined to maintain relationships, share resources, and seek opportunities for participation on projects of mutual benefit," Mr. Harrington remembers. "I was committed to improve the circumstances of the people that I had met. And I was determined to do it in a collaborative way, using the principles and skills from the fellowship program." Mr. Harrington discussed his trip and related interests with friends and colleagues. One day, to his surprise, he received an email from a colleague announcing the availability of funds to support such activities. The Fogarty International Center, a large internationally-focused branch of the National Institutes of Health, was soliciting proposals for research exploring the relationship between economics and the health of a country. Investigators from the U. S. could not apply independently, but had to partner with and collaborate with a second or third tier country.

After some preliminary research, Mr. Harrington convened a meeting of key individuals to explore possibilities. He contacted his friends in South Africa (one network connection) as well as his colleagues in the School of Public Health in Chicago whom he felt would be personally interested (another network connection). Over the period of a month or more, there was a flurry of individual telephone conversations, conference calls, faxes and emails. Subsequently, all parties decided that they would aggressively pursue this opportunity. They then outlined a plan for developing a response to the Fogarty International Request for Proposals. In addition, an economist from the School of Public Health was added to the team to ensure an appropriate response, thereby increasing the likelihood of success.

At this juncture, Mr. Harringtons's role changed. His networking efforts had been successful and a team had been pulled together. He began to serve as a facilitator and provide technical assistance. To move the process along, he generated and circulated a pre-approved list of questions and solicited feedback from all partners. Partners provided answers that Mr. Harrington summarized and redistributed to the group for critique and comment. In this manner, Mr. Harrington was able to draw out information and ideas, contributing to effective problem solving and avoiding ineffective restatements of problems.

The Fogarty International deadline loomed large and overshadowed the process. The time crunch was particularly acute because communication had to occur across time zones. Also, the computer capabilities and timeliness of mail delivery varied. At this point, Mr. Harrington decided to speed up the process and pay a personal visit to his collaborators. Ms. Mazwi and Dr. Mfenyana had been invited to speak at a meeting of the National Medical Association which was being held in Washington, D. C. This was made possible through one of Mr. Harrington's network connections, Dr. Javette Orgain, a member of the Health Partners Fellows Class of 2000. Through a previously established relationship - another networking connection - Mr. Harrington was able to contact a representative at the South African Embassy and arrange for a meeting to be held at the Embassy. He saw this as an added bonus, an opportunity to solicit support and encourage buy-in from representatives of the South African government. While the discussions and the meeting went well, the deadline and time pressures forced the partners to accept that the application would not be ready as planned. They were disappointed but not discouraged. Their relationships remained intact and the partners agreed that they wanted to continue to collaborate and look for appropriate opportunities. The necessary groundwork had already been laid and the partners were now ready for the next opportunity.

"...Try, try again."

The group did not have to wait too long. Soon after this, Mr. Harrington received an email about funding possibilities from UNI-SOL (Universities in Solidarity for the Health of the Disadvantaged). UNI-SOL is supported by WHO and UNESCO. "I became aware of the UNISOL Request for Proposals through ICHLD Director Virginia Martinez and the ICHLD listserv. Even though the fellowship was over, my network connections had come through again!" he says. Mr. Harrington quickly checked the web site and reviewed UNI-SOL's requirements. This convinced him that the partners could develop a proposal that would build upon the work they had started. "A UNI-SOL project would be smaller in scope than our original plan. However, the program was compatible with our ideas and would give us a start. It would provide the partners with a solid foundation for securing major funding support," he continues. He then set out to convince the other partners. "At this point, I had to rely on the trust developed during the Fogarty International process. The partners knew I supported them and that I am always willing go the extra mile to make sure that things happen."

Mr. Harrington was able to rally the partners and get the grant writing process underway. The team agreed upon the focus of the application, designed an action plan and thereafter clarified roles and assigned responsibilities. Mr. Harrington continued his facilitating and supportive role. Along with Dr. Amuwo at the School of Public Health, Mr. Harrington drafted the proposal and maintained links between the partners and UNI-SOL. At this time, UNI-SOL was based at WHO in Geneva, Switzerland and coordinated out of the University of Arizona. Ms. Mazwi and Dr. Mfenyana held a series of meetings and discussions with groups in the targeted rural communities to determine their priority areas; information was then fed back to the team for incorporation into the plan. Mr. Harrington mused, "At times, it seemed as if we were playing musical chairs with different individuals taking the lead and driving the process depending upon what needed to be accomplished."

The application was submitted within the deadline. Mr. Harrington was encouraged by the fact that the final project represented a collaboration that would support and strengthen existing partnerships, while at the same time expanding network connections. More importantly, the UNI-SOL application required the establishment of sub-contractual relationships, thereby creating formal partnerships between institutions of higher learning in South Africa and the U. S.

Lessons Learned

"I learned so much during this period of time that it's difficult for me to pick out the most important lessons learned, but several stand out," Mr. Harrington begins. ?? Establish an environment of mutual respect and trust. If a climate of trust doesn't exist when the partnership is formed, it has to be created. In all cases, it must be maintained. This can be enhanced if the partners establish a plan of action that includes clear levels of responsibility among team members. A clear plan helps to decrease the number of assumptions individuals make, while at the same time it defines the framework and establishes the motivation for being involved in the project.

  • There has to be a shared sense of purpose. Everyone has to have the feeling, "We're all in this together." A shared sense of purpose will serve as a guide for making decisions and hard choices.
  • Collaboration across countries and cultures can take place. Some issues transcend national and ethnic boundaries. The need for social justice crosses national and cultural boundaries. Just as in our domestic communities, each partner brings different strengths and needs to the project. And, just as in our domestic work, the success of the collaboration depends largely on how everyone's strengths and needs are articulated.
  • Maintain consistent, purposeful communication and networking across borders. Collaborative leaders maintain a variety of networks at the same time - We don't expect all of our contacts to work on every project together. This is even more important when working internationally. It will greatly enhance receptivity to more committed relationships and formal partnerships.
  • Communication across countries will consume an inordinate amount of time. While anyone who engages in networking and collaboration knows that time has to be allowed for communication, we tend to forget how easy we've got it here in the U. S. It can take more time than one can imagine. This become even more important when you consider the fact that international collaborative projects work across time zones and have to meet the political, economic, social and cultural realities of each country.
  • Strong individuals with compatible personalities and professional goals can effectively work together. When leadership is not ego-driven - when leaders are motivated by the common good and stay focused on the success of the project - a group of people, each of whom is a leader in his/her own milieu, can work together successfully. This is illustrated in the accompanying figure designed to help groups identify, understand and work toward an acceptable balance between personal gain and public good.

In summarizing his contribution, Mr. Harrington reflects, "I believe what I really brought to the project and process was the acumen to see the potential of our collaboration and the desire to make it happen. The key to our work can perhaps be best summed up as follows: If not now, when? If not us, who? If not here, where?"

 
UIC - University of Illinois at Chicago