Not bad you old horse, reckon you should add a paragraph about HO years and how logistically you ended up getting the first role in Gulu. That's what most med students I've talked to about you end up asking me. An exaggeration, but there's a bit of insecurity that you need to be a 15 year post graduation Infectious Disease consultant before you can make the jump
Second this- as a PGY3 the path from here to there is not super clear! And lots of questions about at what point we become useful to anyone.
Thanks @Gavin Bishop 🔹 and @Joseph Pusey those are really tricky questions that's for sure, no easy answer but here are a few reflections.
First I'll say that once you've worked somewhere in a low/middle income country for at least a 3 month stint, future opportunities can often pop-up. But pathways to get there initially are tricky yes!
When am I useful?
I would say you are likely "useful" working anywhere in the world from the moment you qualify as a doctor even more so in lower income countries where there are less trained medical professionals. From there on its a sliding scale of usefulness, so if we ask the different question "when might be a good time to consider volunteering or work long term in a low income setting" I would say after 2-4 years experience working, and Ideally having done a Tropical medicine diploma or at least a short course before. By this stage you have likely moved from being a bit useful to having the clinical experience to manage most things without needing constant supervision. Obviously the more experienced you are the better, but if you wait too long you might never do it..... In saying that we had a 65 year old GP volunteer at our medical center for a couple of 6 months stints, and the guy was incredible, many levels better than I'll ever be as a doctor.
Pathways to working in Global Health/Medicine
In the past, there were more options and ways to get into global health pathways, whether its research, entrepreneurship or clinical. I came out here funded by the Anglican Church in New Zealand, to work initially as a regular medical officer at a Catholic Hospital (go figure). Here are a few options. I think once you visit somewhere for the first time.
1. University or Hospital partnerships can be a great onramp - for example Manchester University has a partnership with Gulu here. America have loads of these bilateral partnerships, often research-based.
2. Self-fund. Sadly more and more people are self-funding their first foray. This is easy but has obvious downsides - not only financial but also people worry how it looks on their CV
3. Government schemes. We've had doctors here in Uganda from the USA, England and Estonia supported with small pots of government money. New Zealand and Australia have few options, but I know a couple of people who were funded by the government to work in Pacific islands
4. PHDs. A number of friends have used funded PHDs as an onramp to spend 4-5 years living and working in low-income countries. I could never manage a PHD lol, but a good option for some.
Often the barrier is money. Me getting a small salary makes it much easier for me. There aren't too many pathways to earn High income salaries in Low income settings.
Again when you actually start living and working in low-income settings, fresh opportunities and ideas often present themselves. My advice is generally to block out 3 months to a year and just go and work somewhere where you are needed more, and which is more interesting - even if you're self-funding. Even if you decide Global Health isn't your jam, I doubt you'll regret it.
What an inspiring story, Nick - especially as a fellow New Zealander and someone who also started in medicine. I really resonate with the idea that a medical background can be used for impact far beyond hospital walls (I ended up moving into epidemiology for similar reasons). Like you, I’ve found EA really helpful in thinking more clearly about how to use that background for good. Thanks for sharing this.
TLDR: My story from Childhood, to Medicine, to Effective Altruism, to managing our Non-Profit OneDay Health
I don’t think I can add much to the incredible career advice from this week, so, I thought it might be interesting to tell the story of how my "career"[1] ended up shaped by Effective Altruism, even when I only read “the book” at age 30. Maybe some of you will resonate with some of it.
Not AI - my actual roof
I sometimes wake up as the morning peeks into our hut and stare at the most beautiful roof we will call our own - and pinch myself. Like Denkenberger said “As you reflect on your blessings, consider your job among them. And perhaps let that gratitude inspire….”
My youth was middle-class suburbia at its mostly best. Incredible parents who gave me more opportunities than they ever had. Violin, football, and extra math. Pushed a little too hard towards high expectations and anxiety. Wetting your bed age 13 goes poorly at an all boys school camp….
I barely encountered poverty, let alone understood the significance. As a seven year old I was friends with a kid on our street who’s mum lived on welfare - but my parents soon managed to “upgrade” and leave that neighbourhood. I first remember considering people less fortunate than me at church aged 16, when I heard whispers of “If you have two shirts, share with the one that has none”. I was slow to wake up to reality.
In my first year at pre-med I had tutorials every day. Except Tuesday. And through fate or providence on Tuesday a brilliant woman Jo ran a “justice” group at church. I didn’t know what “justice” meant (I was a bit oblivious), but on the first Tuesday in February 2003, her first question gave me my first dose of EA-style thinking.
“I just gave my cool friend 2 packs of cigarettes to bribe him to raise money for World Vision, do you guys reckon that’s OK?”
By second year med school I was already convinced that other countries needed me more than my wonderful home of New Zealand. I was a below average med student and never destined for excellence, but poorer countries could do with more average doctors right? My first year as a doctor only strengthened my resolve - I spent my days as a paper-clerk following 3 other doctors around who spent 1 hour discussing each patient.[2] New Zealand would hardly notice if I was gone.
After 4 years doctoring and managing rural health centers in Northern Uganda, I became disillusioned with the BINGOS[3]. Just 5 years after a 30 year civil war ended, the BINGOs were everywhere, doing everything and nothing all at once. Save the children, Feed the Children, Feed the Future, Save the….. My neighbours attended agriculture trainings and “resilience” workshops. They gave glowing testimonies for the cameras, while nothing in their lives changed for the better and they complained privately about these useless projects. They would ask "Why doesn't someone just us money directly?" World Vision especially ired me[4] with their vaunted “holistic approach”, which had no evidence behind it. Then a friend recommended a book “Doing Good Better” - it had me from page 1. The assessment of an inefficient and unscientific charity world matched what I saw first hand- nice sounding nebulous projects which achieved close to nothing. I determined not to make the same mistakes with my development future.
And then at age 30, I completely forgot about this whole “effective altruism” business for a year.
Until I followed my brilliant wife for 10 months to Cambridge[5], where her PHD was funded by the richest man around (cheers Bill). I’ll never forget first meeting the EA community co-ordinator at a wee cafe - might have been more nervous than me but I appreciated her warmth and conviction. I was blown away by this small group of exceptional people 10 years younger than me who had big aspirations - and boy did they back that up. It didn’t surprise me when Clare Donaldson ended up directing LEEP and Neel Nanda did cool AI stuff[6].
I realised my life wasn’t a choo-choo train, I had real choices to make, clear tradeoffs even at age 31 within the confines of public health work in Northern Uganda. Not long before Cambridge my Ugandan friend Emma and I started launching some small one-nurse Health Centers in remote places because well, we saw a need and and it seemed like a good idea. I used my Cambridge masters thesis to do a cost-effectiveness analysis of different healthcare delivery methods, and realised that tiny health centers could probably do more good than both larger facilities or my own doctoring work.
So I decided to make OneDay Health the next “season” of my life
For the last 7 years, I’ve co-led OneDay Health, which launches health centers in remote parts of Uganda. We’ve grown from 4 remote health centers to 60, and treated 350,000 patients in healthcare “black holes” where people had no good healthcare options. I’ve gradually grown with the organisation - both in ability and confidence. I don’t think you need to have it all together or be exceptional to run an org. Old horses can learn new tricks. I’ve muddled along and learned how to lead a team, manage conflict, write applications, pitch to funders. EA and the Public Health world can sometimes feel elitist, like you can only start things or lead organisations if you are from an Ivy league university and won the school debate contest or something. I don’t think we need to be that good, at least not at first. Most of us can find a place, people and a vocation where we can do a decent amount of good. Not always the most good possible, but good enough. If I have any “competitive advantage”, it comes from a wonderful slow journey living in a Northern Ugandan community for 12 years, while observing the development landscape.
Perhaps an obvious reflection is that when we are happy and believe in our work, we might just learn to do a decent job - this has been my experience anyway. I would be more than content as a doctor, seeing patients every day for the rest of my working life. But by fate or providence, I’ve found something moregood. At least for now.
1) Be part of an inspiring real life community. Live with good people, meet weekly with good people, marry someone who inspires you. Too many people surround themselves with people who have settled for less-good. Humans are not islands and who we encounter every day matters.
2) For many, committing to 3-5 year “seasons of life” can be a sweet spot. Every 3 years my wife and I assess our work in Uganda, and decide whether we want to commit for another season. Often shorter (1 year) or longer (10 year) commitments can be counterproductive.
3) On that note “Most people overestimate what they can do in one year and underestimate what they can do in ten years.” (Bill again)” Don’t anchor yourself on Will Mckaskill and LEEP's rapid success, most good things take time. Yes building career capital quickly can be important, but if you find yourself in a strong position making a difference, sticking with it for a while might be better than the-next-cool-thing. I worry sometimes that younger EAs feel that if they haven't done something amazing in 5 years they are kind of a failure
4) If you have some decent career options, lean towards gratitude and away from paralysis. Gratefulness can be a wind behind our backs as much as social capital or money.
Keen to hear any thoughts or reflections!
I don't resonate with the concept of "career", for me my work is more of a vocation.
The Quality of medical care in New Zealand is amazing, and long discussions between colleagues contribute to that. I'm not deriding New Zealand's wonderful medical system at all
Big International Non Governmental Organisations
Beautifully written, and thanks for your work!
Thanks @Laura Duffy and am a big fan of you and RP's work as well thank you!