World Health Organization, Genève

(Cover photo credit goes to Megan Prasad, fellow intern)

If I had to name my perfect work environment, it would have to be something close to this–not the beautiful backdrop of a Parisian beach or an ornate Harvard library with hundreds of students furiously typing away–but rather the exact temperament of this particular afternoon, a rainy sky and a steaming cup of tea nearby. As I sit at my desk in the office of the Emergency and Essential Surgical Care (EESC) Programme at the WHO Headquarters in Geneva, I feel that optimal work “flow” as the rain falls lightly outside of my window and the sound of The Piano Guys comes through my earphones. This cubicle-filled environment is certainly a far cry from the rolling hills of Mexico, but I’ve realized that I can also feel comfortable here. Indeed, perhaps it is fitting that I should feel such a distinct feeling of peace as I sit in what has long been the seat of international health governance and diplomacy.

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I arrived in Geneva for the first time last week, and was immediately taken with that distinct air of European order coming at me with full force as soon as I exited the airport. The world around me was filled with all manner of languages and the signs were all perfectly assembled and arrayed so as to make the travel of the wayward passenger easier. There were far more people smoking on the neat cobblestone streets than I was used to seeing, and all manner of coffee shops crowded around me as trams glided gracefully past. Pedestrians waited expectantly at the requisite stops and then pressed a thousand green buttons all over the city before entering and taking their seats–all perfectly routine, ordered, and yes, peaceful. While a city like this certainly has it’s charm, I know that I’ll always miss that distinct vibrancy and flavor of Mexico. The same rambunctious noise just doesn’t exist on the streets here, and far more people are walking purposefully with their headphones in than they are stopping and conversing loudly with people that they may very well have just met. It’s certainly a different manner of being, but it reminds me of the stark difference between my rural healthcare delivery experience of the last three months and the far more formal and ordered one that I will be having in healthcare policymaking for the next three.

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Streets of  Genève

I am working on a project to improve patient safety in surgical care during my time here, an area of particular interest considering my long-time work for patient advocacy in healthcare-seeking behavior. Unlike the days I spent walking on the red dust-laden streets of the Sierra in my jeans and sneakers, here I arise early each morning to get on the tram and make my way to work with suit jacket, purse, and coffee cup in hand. Upon entering the large steel WHO HQ building each morning, I walk under a sea of brilliantly colored flags that sway from the ceiling and remind me of the impressive array of experiences represented by the people who walk across these marble floors each day.

 

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The annual World Health Assembly just took place last week–a grand event for which the world’s health ministers descend on Geneva each year in order to discuss the most pertinent health topics of the day and the actions that their respective countries will take in order to address them. As one might expect, this is not a place where efficiency rules the day, but rather dialogue. Director General Dr. Margaret Chan recently gave her debrief from the Assembly, during which she highlighted the growing role of climate change on the world stage and her belief that the WHO will have to factor environmental concerns more prominently in its health decisions in the post-2015 development agenda.


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WHO Director-General Dr. Margaret Chan addresses the room in a debrief on the 2014 World Health Assembly 

Here I quickly saw that there is also room for self-criticism and reflection on the bureaucratic processes that some believe are more of a hinderance to action than they are a mechanism for maintaining order. One WHO staff member piped up and asked Dr. Chan what she thought about the debate procedures that are used yearly to allow member states to discuss topics ranging from the recent ebola outbreak to the international response to antimicrobial resistance. The speaker said that he believed the process to be too cumbersome, allowing some member states to speak for hours with prepared remarks while others’ comments are not properly documented in the meeting record. I couldn’t help but think how similar these issues were to those I had experienced myself during “Model United Nations” committee meetings since middle school–I guess our mock version wasn’t a far cry from the real thing :) But as I sat there in the WHO Executive Board room and waited for Dr. Chan’s response, I was pleasantly surprised to see internal review taking such a prominent place in the discussion.

Perhaps what was most heartening to see, however, was the Director General’s commitment to honoring the needs of the Member States who are, after all, the heart of the WHO. A large screen projected the images of at least 10 different WHO country offices during the conversation, all arrayed into neat little boxes with the labels “WHO – Baghdad” or “WHO – India”at the bottom as conference rooms  from around the world were beamed into the room via videoconference. This allowed them to hear Dr. Chan’s comments in real time. “Power, lack of visibility, and money are the root causes of inefficiency,” she said, adding that the WHO’s presence may not be felt at all in some countries due to poor communication and lacking horizontal and vertical integration within the organization.

But none of this was new, Dr. Chan insisted. “I’ve made these comments before!” she said. “Where were all of you??” she asked the room pointedly. A brief pause, and then came a unified response: “We were working!”

Dr. Chan erupted into laughter as the room did the same. “Well….good!” she said with a smile.

And then, a note of finality and hope for continued progress.

Let’s prove to the member states that we can do better,” said the Director-General.

As I listened to her words, peppered with eruptions of her easygoing laugh and sharp jokes, Margaret Chan was far more informal than I had imagined, but far more viscerally honest, too. As we sat there in a cavernous hall filled with a thousand small microphones and plush blue armchairs, I had the distinct feeling that I was in a seat of power, and yet there I was witnessing the utmost respect being displayed for a job that is emblematic of public service.

Here’s to many more wonderful days in Genève!

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