Fellows in the Field 2016 - 2017

NOVEMBER 7, 2016

The paradox of change

How can change happen so quickly and so slowly all at the same time?

I first set out to Myanmar to test this very question, even if I didn’t know it at the time. When I began my fellowship, I wrote that I wanted to understand globalization by immersing myself in it, rather than just intellectualizing it from the classroom. It was a sensible next step for a recent graduate like myself: my academic study focused on the relationship between politics and economics in a globalizing world; the era we live in is one of globalization everywhere in disrepute; the country I was coming to was one that was just consenting to the political changes that would inject a strong dosage of globalization (whatever that means). I was in a position to situate myself in globalization: its oddities, its beauties, its complications, its clashes, its goods and its bads.  For ten months, my intellectual interests (and what I imagine to be one of the most interesting sets of questions about today’s world) were to be driving every little detail of my life.

But, I had no clue what this would mean. What question would I really be confronting? How would my intellectual interests actually manifest in my daily life here?

Now, I think, the question that is driving my time here is coming into clarity, even if the answer seems to only be elusive: How can change happen so quickly and so slowly all at the same time?

By this, I mean life has a certain quality here. Uncertainty. Confusion. In constant flux. Even in the bureaucratic culture – one inherently resistant to rapid change – that I find myself interacting with most frequently. Certainly, the fluidity of life and work here is compounded by my own status as an outsider – as someone who will never quite grasp what is going on. I may be wrong, but I sense that I find myself in a time and place that is uniquely chaotic. A place where everything is possible. But nothing is certain. And everything is difficult.

The most intractable difficulty is in trying to understand what should come first in the immensity of being here: in my day, in my work agenda, in my policy institute’s strategy, in the country’s economic agenda, in the new government’s careful balance of different priorities ranging from building momentum for the peace process, to increasing trust in government institutions, to spurring economic development, to educating a generation of youth who can set out to answer all of these challenges and more in the future.

And, at times, the last few months have been frustrating. The slow change amidst all that is happening rapidly. There is so much to do that one can feel paralysis: Where to start? In retrospect, I have some semblance of an answer, or at least of where I have started: I have had to begin by absorbing. Absorbing the culture. Absorbing the work that is ongoing to begin economic reform. Absorbing the politics – only to realize how little I will ever understand. Absorbing the traffic patterns, so as to avoid the worst of the congestion. One needs to know something before they can do anything about it – but they will never be able to know everything before they get started.

And, I think, this is what the new government has been trying to do: to absorb what it means to govern (after many decades of protest); to absorb the expertise being offered to them from people all across the world (what is useful and what is useless); to absorb and understand what the people who elected them actually want from their government; to absorb what it means to build democratic institutions that can also function in today’s highly connected global economy.

Myanmar has come so far in so short a time. So, too, has my institute – in developing a strategy to assist in Myanmar’s economic reform, in absorbing new staff, in identifying new partners. And, I think, my fellowship has come quite far as well: in learning about the country, in listening to what is going on around me, in trying to identify and set an agenda that can be both helpful and manageable given my many limitations (of context, expertise and experience). And how quickly have I learned about things I knew little about before: tax reform and investment laws, avoiding that crippling traffic, teaching English to monks and colleagues, working with people from all over the world.

Yes, all of this is great. But sometimes it doesn’t feel like enough. Expectations are high. We want things to happen overnight. The country, long waiting for an opportunity to change, finally has it. And the window of opportunity might be small.

How can change happen so quickly and so slowly all at the same time? This seems the nature of any monumental change. And so, we try to respond; to speed up the good changes, to slow down the bad ones; to accept that most are beyond our control. We do this one step at a time. With just enough productive frustration. Always knowing there is much more to learn, but also knowing that we can do something with what we already have.

JULY 14, 2016

The space beyond "learning"

Intellectual humility is something that we are good at expressing, but it is much harder to find the right balance in practice. In the weeks leading up to my departure, I became very good at saying that my fellowship was about a “learning opportunity for me” rather than a service opportunity for the organization I was partnering with and designing research around. It became a sort of tape-recorded message I would deliver whenever asked about what I would be doing and I had to explain why a recent undergraduate whose “job experience” consists of a few internships and caddying was qualified to be working with a think-tank that is trying to craft economic policy for one of the poorest countries in the world. Luckily, nobody prodded too deeply at these insecurities about the position I would be in, the capabilities I have and the level of access I would be granted just because of my Western education, my American passport, and the connections in Myanmar – to the highest level of government and civil society – that my education and passport afforded before I had even visited the country.

But at this first meeting, I was reminded that I have to confront these insecurities because now I am here, and now I am in the middle of things in my own, small way. I have to – for lack of a better phrase – maximize the returns on investment that someone (Duke, Sanford, HLP, the Hart family etc.) made in me.  But, more importantly, I have to maximize the returns on investment that so many people in Burma are making me. Time is a precious commodity here in this country’s era of sweeping change and infinite possibility, and people are willing to spend some of theirs on me. So, I must make sure I can contribute something small to a very big process of change that is ongoing. I can’t only use my rhetoric about this as a “learning opportunity,” I must also begin to contribute in a small, but still meaningful way. I am still not sure how I will do this – I could barely make it to my office in one piece! It is an uneasy feeling, but it was at this meeting that I first realized I now had to confront something that had been purely rhetorical up until now. Now it is time to get going. My question is how.

NOVEMBER 7, 2016

"Goldilocks" doesn't exist

“Who will pay the man, standing outside the bars on Soi 21, until two a.m., imploring dancers and guests to come for an HIV test?” asked a tall man, profoundly French, his eyes shining through his glasses. He was a representative of the 5% Initiative, a program from the French government to complement the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

For nearly fifteen years, civil society organizations, as supported by the Global Fund, have led the effort to offer HIV prevention services to communities at highest risk. As someone aspiring to be a physician, I came to Thailand with little appreciation for the role that civil society could play as part of the health system. The people I’ve have met here have changed my mind. When a sex worker faces stigma in accessing sexual health services at the hospital, it is civil society that closes the gaps, offering HIV testing and STI screening at friendly community sites. When a transgender person is harassed by the police, it is civil society who is the first to reach out to provide counselling and support. When a migrant worker with HIV has challenges in accessing treatment, it is civil society who visits them at their home, provides a translator, and gives information on treatment referrals and health insurance packages. This lifesaving work has been overwhelmingly reliant on the support of the Global Fund. However, over the past year, we had been hearing reports that the Global Fund would be leaving Thailand after 2017. In anticipation of this planned departure, Thailand’s National Health Security Office (NHSO) recently established a six-million-dollar fund dedicated towards HIV prevention in high-risk populations. As part of a team at Raks Thai, I had been working to develop strategies to make this funding accessible for civil society organizations so they could sustain their work after the Global Fund departure.

Everything was turned upside down at the meeting. To our surprise, representatives from the Global Fund had confirmed that Thailand was still eligible for Global Fund support for at least ten more years. But the room smelled of skepticism. Many community members predicted that the funding would be refused by the Country Coordinating Mechanism (CCM), a committee of country stakeholders representing diverse sectors, including government and civil society, that made decisions on the Global Fund’s continued presence in Thailand. From the perspectives of the meeting participants, I pieced together a fearful narrative that went like this: the CCM, strong-armed by the government representation, would surely force out the Global Fund and neglect the voices of civil society organizations, leaving them to die. But, I think there were other pages in the story: the Thai government had made significant progress in its national AIDS program and was actively moving towards domestic independence, making investments in the right direction like the NHSO program. The continued presence of the Global Fund could stale the government’s hunger to rapidly institutionalize its own funding programs for civil society. Why bother?

If the Global Fund leaves Thailand, some civil society organizations will die. But if the Global Fund never leaves, Thailand will never be able to stand firmly on its own feet in its national HIV response. We all want the ‘Goldilocks Fund:’ staying long enough to make sure civil society organizations can continue their life-saving work, yet still giving enough space and time for the development of domestic institutions. But that doesn’t exist. I don’t know how the deck will be played: whether international donors will abandon ship too early or overstay their welcome. And, I don’t know whether or not the very real people that these programs serve will be in the room when the decision is made.