Where are you from?

Sudan. I was born and raised in Khartoum, the capital city.

 

What inspired you to pursue a career in public health in humanitarian settings?

I actually didn’t intend to end up here. I studied medicine and decided I wanted to do Public Health. But then, the career opportunities that showed up tended to be in the humanitarian sector in Sudan, so that’s where I ended up just by default. I’m glad I did, though! That was a lovely accident.

 

Who inspires you and why?

I wouldn’t say it’s one person. It’s a kind of person that you bump into, in different forms and shapes and sizes, but same kind of character.

I would say that one person that really inspired me was the health programme manager in Sudan. I think he was so calm, even though humanitarians don’t tend to be, they tend to be stressed. He was an excellent team leader but also managed to maintain and build great relationships with the community members, with authorities and with the team, but also very professional ones. So, despite having been there for 7 years and not being from that community at all, the way he managed those relationships was quite inspiring. He could do it very calmly and for a very long period of time. He was very professional, but very kind at the same time.

I have met a few people like him since, who had the same kinds of qualities.

 

What did you work on before your current position at the LSHTM?

I studied medicine but even during medical school I knew that I didn’t enjoy clinical work very much. I was very drawn by the concept of public health, prevention, and also helping fix problems at a macro level, rather than at an individual level, particularly in Sudan where most deaths are preventable. That’s how I ended up in Public Health. I worked in the Sudan National Research Institute on TB and HIV, that’s where I started. For a while I was also working in sexual and reproductive health programming as well as a bit of research around female genital cutting.

I then moved to the UK and did clinical work for two years and got licensed as a doctor. After that, I started a distance learning masters in Epidemiology at the LSHTM, so I went back to Sudan and continued working with the research institute on respiratory illnesses. After I got my masters that’s when I joined the humanitarian sector in Sudan. I did a combination of paid jobs and freelance consultancies, but I would say the agency I enjoyed the most working with was Care International in Sudan. I worked with them in various capacities: supporting programme design and monitoring and evaluation, where I tried to put my epidemiology skills on setting up rigorous monitoring and evaluation systems for the health and nutrition programming.

I then moved to more technical advisory roles informing and writing technical assistance focused on epidemics, conflict… all sorts of problems. After that, I moved to the international humanitarian sector with Save The Children UK, where I was their regional health advisor for the middle east and north Africa. Most of my time was spent with the Syria response. That was between 2014 and 2017. I supported Palestine and the broader Syrian refugee crisis, in countries like Georgia, Iraq, Turkey, Palestine and Libya. Then I had programme policy and programme learning jobs still with Save The Children UK, that weren’t country-specific but more about general quality improvement of programming and response.

By then, I was quite tired of travelling, since my job meant never staying long enough in one place – whether that’s was home or another country. So, I went back to consulting freelance, generating and using public health information for responses. Finally, I applied for this job in July 2018.

 

What is your current role at the LSHTM and what does it involve and what projects are you currently working on?

As an assistant professor in humanitarian health practice, I do a combination of learning activities with students and research. The latter takes most of my time.

Since the start of the Covid-19 pandemic, I have taken part in the support of various humanitarian actors in preparing for the pandemic at the very early stages (March 2020). That role involved a lot of promotion of alternative prevention strategies, as opposed to massive quarantine or contact-tracing exercise, which we thought we were not really going to be able to do in those settings.

I’ve also supported modelling work for Middle East and North-Africa responses on Covid-19. The idea was to make available some information for policy-makers and a select handful of countries in the Middle East, so they can use it to make decisions about their covid responses.

Since then, I’m a Sudan member of the covid-19 research group. I’m very proud of that part of my job. We collaborate with young volunteers in Sudan to conduct research and come up with very practical solutions to promote prevention, which is really the only way out. We really help and support feasible and acceptable prevention strategies that people can actually do, as alternatives to severe lockdowns. The volunteers also do campaigns, interventions and awareness, and we do a lot of advocacy with the results.

I am also a part-time PhD student.

 

What does your role as a lead researcher for RECAP’s Work Stream 1 involve?

This project is approaching public health information from an accountability perspective. As humanitarian responders, we need to be better accountable in terms of the decisions that are usually not evidenced-informed. Also, nobody knows how those decisions are usually made.

Our suggested solution was to create an audit tool so humanitarian health responders would stop and check what they are doing in terms of their programme design. Most of the time, important questions are left to external evaluators who come quite at the end of the response. So now, the teams themselves can use this tool without having to rely on an external person. The way it works is that we give them a score (rather than a lot of text) to show how appropriate is their response in terms of design. Then beyond that, within your chosen design it’s also about how well you are actually doing your performance.

The idea was to develop that tool and test it in three or four different crises and get agencies to use that, with the idea that they would hopefully incorporate it into their own monitoring systems. Unfortunately, because of the pandemic, we haven’t had the opportunity to test it yet. I don’t think we will in the remaining time of the grant, but hopefully we will in the future. At the moment, we are focusing on trying to make it available on a public platform so whoever wants to, can use it without the need of external guidance.

 

What is/are your proudest career achievement(s) and why?

In this job, I’d have to say the Sudan covid-19 research group. It started off in March 2020 as just a group of young volunteers reaching out to me saying: ‘We are promoting hand washing, but nobody is really listening to us.’ They asked me to try to figure out if they were doing something wrong, but instead it evolved to a research question. I said: ‘Should we study it together and try to figure out why aren’t people adopting preventive measures?’ Then our collaboration attracted the attention of some donors and the group has evolved since then. I am particularly proud that we managed to do a lovely combination of research, interventions and a advocacy with the results. It’s been a very rewarding experience to be able to use research to address an emergency. It feels like a full circle, rather than isolated academic theoretical work.

But also, the word achievement gives me a feeling of personal success, but usually it’s not. It’s being part of an amazing story, like the Sudan covid-19 research group. I’m a founding member, but I’m not the only person.

I think that being part of vaccination campaigns in Syria was also very rewarding. It’s a lot of planning, but in seven days you’ve reached a quarter of a million children. I think that’s probably why I went into Public Health - you have this ability to mass scale reach a lot of people and protect them.

 

What would you say are the most relevant challenges in public health programming in humanitarian settings?

One of the biggest problems we have is the lack of information, which is also used as an excuse to make decisions and not be clear about how those decisions were taken. There isn’t a clear documentation either. It’s never quite clear how a specific programme was designed a certain way and who made those decisions. For instance, when choosing a vaccination campaign versus a clinic, nobody can answer that. And that bothers me - I think these choices should be clear primarily for the beneficiaries, because they need to understand why certain things are available and others are not.

There should be a more rigorous transparent approach to making those decisions and also documenting the process. So, if somebody comes along and asks these questions, they know why a decision was made.

The other problem linked to the lack of data is that funding is almost always for interventions and not for improving data availability. We all identify the lack of Public Health information as a problem in a crisis, but no donor wants to invest in improving data availability.

 

Why do you think this happens?

I think there’s no interest in improving evidence-based programming. Nobody wants to put the hard-work behind it and a lot of agencies don’t have the technical expertise to generate that data. So, the donors don’t have anyone to pay to do that and nobody is asking for money.

 

What lessons have you learned from your career journey so far?

I think that soft skills and transferrable skills, such as writing, time-management, team work, leadership and having a systematic approach to any task, are really important. Probably more than technical skills, because you can google anything these days. With transferable skills you can move between sectors, like I did from a local research institute to international NGOs and then to academia. It’s not easy to navigate for a black woman from a very poor country. I think I’ve been lucky to have great mentors and supporters along the way.

Coming to LSHTM having this unusual career path, it’s also hard to fit in because unless you have a typical academic career path, you don’t end up in a role like the one I have. I think this happens because there’s a lack of appreciation of soft skills and transferrable skills. Unless you have proof of the technical skills required for a position like this, it’s not acknowledged.

Another lesson, which I think is quite important for a black woman, is that the glass ceiling is extremely low. I think it’s good to tell people that when they’re very young so that they don’t have to find out the hard way. Just saying: ‘Look, it’s actually very hard to get far and trying to fit into the system is not going to get you far. It just means that you will work twice as hard as everyone else and actually not won’t get anywhere. So, you need to be advocate for yourself, you need to be vocal about your job needs and your space, and if you are happy or not.’

I don’t think many other people will be able to empathise with that experience, so unless you vocalise it and demand improvement for yourself and others, it’s not going to get fixed. Trying to fit into the system is a really bad strategy, not just in terms of making a better world, but for your own career progression. If you suffer in silence, it’s never going to get better. Working hard is not enough. We need to vocalise it and you’d be surprised of how many people there are out there, who do want to help. And then if the place you are working in is toxic, just leave because it’s not going to get better.

I think it’s just a fact of life and it’s better to be aware of it and know what to do about it, rather than trying to fit in. I tried that and it doesn’t get better. It only means that you become more miserable, because you can’t fix a whole inequitable system, there’s just no space for you.

Also, I think you really need to learn about work/life balance. I am still learning how to balance both. I am better now because I have a child that forces me to stop working. But before that, I wasn’t that great. I think it’s important to learn to not overwork and not make working out of hours okay, especially for young professionals, who feel like they need to proof themselves.

What does humanitarian public health / humanitarianism mean to you?

I think it’s putting into practice a person’s belief in the value of human life. Assisting those that aren’t able to help themselves, usually in the worst moments of their lives, so that means they’re very vulnerable. It is also doing so not just out of the goodness of your heart, but in a way being aware that it’s a huge game of chance which side of the equation you end up, and it’s in your benefit to create a system where there’s mutual empathy and assistance. If we all invest in a system that ensures that both sides aren’t completely separate and that there’s a way for communication and assistance, it’s in everyone’s benefit. One day you can be the target for whatever reason, so it’s probably in your interest to create a more tolerant and equal society, just in case you end up on the other side.

The assistance side of it is what appealed to me at the beginning but now I also see how it’s a smart way for humans to sustain humanity.

 

Where do you see yourself professionally in the future?

I hope I finish my PhD in four years, since I am doing it part-time. I am not sure if I want to continue in academia beyond that. I see my future as a combination of academia and response, or finding something that falls in between. For instance, having a more research-oriented role in the response part of the system, or having more opportunities to do programme policy work in an academic institution. I think it’s unlikely that I only do research or response, I will probably do a hybrid of both.

 

What advice would you give to a student or young professional who wants to start or is starting a career in your field?

For someone in academia in the humanitarian sector, I’d say ‘try to get some field experience in the humanitarian sector at some point’. It is very valuable to do that because it will probably make you a better researcher. You can still have a career in research, but take a short career gap if you can to do actual response and then come back to academia. I think the humanitarian world doesn’t resemble anything in life, so unless you have been part of a humanitarian response it is very hard to imagine, and therefore very hard to identify research questions and address them systematically while also having feasible research. I’d say the earlier you do that in your career the better, because you are more likely to end up in the frontline response. And that’s really what you want, to have the frontline experience to see how that big machine delivers aid at the other end.

For people starting in the humanitarian system, I’d say ‘I feel for you. It is very hard finding a job and it might take you a year or two to find it, but that’s normal. Try to be flexible with the thinking that you need to get your foot into the door. Don’t take on something you can’t deliver on.’ Some people would find it fairly easy to get a job that they might not be qualified for and that can lead to failure. In many situations they expect you to be a very independent worker, and you won’t get as much support as you think you would. On the other hand, I’d say: ‘Don’t despair if you can’t find a job quickly. It takes a long time and there’s a lot of passport privilege with jobs. Keep an eye out for consulting opportunities as well, because those aren’t restricted to senior experts as many people seem to think, there are a lot of entry-level opportunities. If you want to work in the humanitarian system, you have to be patient.’

 

What do you do in your spare time?

It used to be reading, and I started a fashion label a while ago as well. But now I barely have the time for either of them. If I did, I would actually learn how to make my own clothes. But more recently it’s spending time with my two-year old daughter.

Reading is usually my escape, as long as it’s fiction, I don’t mind. In the Keppel Street building there’s a staff room on the first floor and they have two shelves with books that people no longer want. I have read every book from these two shelves. I just love reading and I am a very fast reader as well. As long as it’s fiction and takes me away, I can finish most books even if they’re not well-written. I used to bring books everywhere I went, now it’s diapers and napkins!