WHOlights from Week #2

If my first week at the World Health Organization was mainly surreal and awe-inspiring, my second week could admittedly be described as more of a reality check. Not that it was in any way boring or un-challenging. What I mean is that, as I continued to dive further into the projects and processes of the GLC and the WHO at large, I began to understand the (in?)significance of my own particular tasks relative to all the objectives and challenges involved in managing MDR-TB around the world. Through conversations with Salmaan and other GLC staff, I've also begun to ascertain the many issues and imperfections in massive systems that deal with policies, politics, patients, and pills. Here are a few:

(1) Structure - How should groups and sub-groups be organized? Are they heirarchical? Cyclical? How do you manage conflicts of interest? How do you maintain impartiality?

(2) Incentives - Is there really a sense of urgency here? Are people really doing things as efficiently as they could be? How do you balance needing to take another coffee break with the fact that someone dies of TB every 20 seconds?

(3) Definitions - How ambiguously do you define your policies? When should guidelines be specific and when should they be left intentionally vague? What happens when your guidelines have to be the least common denominator among the desires of your constituent countries?

(4) Coordination and Cooperation - How do you get a hundred different countries to do what you want them to do when you have no authority over them and your job is to serve them? Is it possible for an organization like the WHO that is not an implementing body to have any teeth? How do you get everyone in between the policy and the patient to follow the guidelines?

(5) Dogma vs. Data - Does scientific evidence always inform policy, or is it entrenched in principles and weighed down by a hesitancy to offend others?

(6) Rhetoric vs. Reality - How much of what is said is actually being done? Who is doing the 'doing' anyway?

(7) Ownership of Data - The GLC doesn't own any of the data it receives. It belongs to the countries, and it is their decision whether and when they submit it.

(8) Changing the Status Quo - Couldn't you just use a comprehensive web-based tool for doctors and pharmacists to input their drug forecasts, treatment progress, and patient outcomes? Wouldn't the GLC have instant access to all of it? Wouldn't this eliminate all the needless spreadsheets and emails? Maybe, but what about the current systems in place? What about communities without internet? What about hospitals without electronic medical records? What about compatibility with those that do have electronic records? What about the implementation costs?

But let me not understate that work is still quite fun. One of the things I've had to do is create country profiles for all the approved GLC projects and send them to the national TB project managers to be amended and reviewed. This requires hunting through the labyrinth that is the GLC computer database. I liken it to getting lost in a museum: It would be daunting, except that around every corner is something else that's even more fascinating. If you started looking for a particular file, you might find yourself five minutes later looking at some totally unrelated PDF of a letter to the GLC from Cambodia's National Tuberculosis Project Manager formally requesting approval of their project, or maybe you'll accidentally stumble upon the resumes of Stop TB Department staff (do I sound like I'm speaking from experience?). Apart from the tasks for which I'm responsible, I've also really enjoyed any opportunity I get to chat with the GLC staff. During one conversation with Salmaan, I asked him to map out a visual diagram of how all the components of the GLC's programs relate, since it is unbelievably complex. I gained a better understanding of the whole system in ten minutes than I had in ten days. Here's a simplified version I made:

Besides these conversations, there have been several other highlights from my second week at the World Health Organization. Here are some of them:

(1) Sharing free cocktails with other Ivy League students, alumni, and UN interns at an event hosted by the Harvard Club of Switzerland on the shores of Lake Geneva. I've never been surrounded by so many Swiss bankers in my life.

(2) Attending a very informative and well-organized briefing for new MDR-TB interns (Amy, myself, and a couple others) given by Ernesto, who is the man, along with representatives from Eli Lilly (pharmaceutical company) and the World Medical Association. Again, one of those experiences where you walk out sincerely saying, "Wow, I just learned a lot."

(3) Joining the rest of the Tuberculosis, HIV, and Drug Resistance (THD) Department at the house of the THD coordinator himself, Dr. Paul Nunn. His house was a beautiful "chateau" in the hills of the French countrside north of Geneva, not far from Bois Chatton. More importantly, the food was delicious. And even more importantly, I really enjoyed the chance to see and interact with my superiors in a non-work context, and many of them brought along their spouses and kids as well.