"We need to get to the root causes."
Josephine Among Muhairwe (43), a native Ugandan and trained medical doctor, had been the country director in Lesotho since the beginning of 2016. Before she left SolidarMed at the end of October, Pierina Maibach took the opportunity to talk to her about the work in Lesotho.
Josephine Among Muhairwe is a Uganda-trained physician with a Master's degree in Public Health from the London School of Hygiene and Tropical Medicine in England. She is currently pursuing a PhD in Global Health at the University of Geneva. Prior to joining SolidarMed in 2016 as the first African Country Coordinator, she held various positions in foundations, organizations and health institutions in Uganda, Sierra Leone, the UK and the US. Her interests and experience include maternal and child health, HIV/AIDS, malaria prevention, and health systems strengthening. Josephine is married with two children. In 2019, she and SolidarMed colleague Isaac K. Ringera won the prestigious Pfizer Award for Infectious Diseases.
"The mobile clinic, which reaches extremely disadvantaged people, is very close to my heart."
You have lived and worked in many countries. How important are these experiences?
I would say the most important aspect is my origin - Uganda. That's where I was born, where I got my medical training and my first work experience. But because I have also traveled to many other African countries, I have a clear understanding of the culture, although of course there are differences between countries. Working in Sierra Leone during the Ebola outbreak made me very resilient. And finally, I learned to understand the Western world in the UK and in the US. I think that's a very good and important mix to be successful in international cooperation.
Tell me more about your time in Sierra Leone.
The mission there was to launch a malaria prevention campaign focusing on pregnant women, lactating mothers and children under five. But then Ebola came along and malaria dropped out of the picture. When people are dying from another disease - as they have been in recent months because of Covid-19 - other diseases take a back seat. We were doing Ebola prevention programs, talking directly to people. But it also included clinical and humanitarian work. It was hard to see so many people - and even colleagues - die.
The position of country coordinator involves many different areas. What attracted you to it?
My father was an orthopedic surgeon and my mother was a nurse practitioner. So I come from a medical family. I chose medicine out of passion and because at SolidarMed the clinical was combined with the other areas in one position, it appealed to me. So I could still see patient:inside, which kept me close to reality and helped me understand the context. You can only design and lead effective, high-quality programs if you know the problems from the root. This aspect of the work gave me an extra dose of motivation. Academic research additionally means providing evidence that in turn makes a difference for individuals and public health. It is important that these areas are closely linked. For my personal life, I could have given up one of these areas to find a better work-life balance [laughs].
What are your greatest successes?
Of course, I can't take credit for the successes of the last few years alone. But I am already proud that we have succeeded in positioning SolidarMed as a strong partner at the Ministry of Health. The work and support of our organization is highly appreciated and has a direct impact on medical guidelines and strategic projects - we are important for healthcare. In addition, I was able to meaningfully expand the team and thematic focus. SolidarMed now runs a much wider range of impactful projects in Lesotho than when I started. With the mobile clinic (see article p.4), we are reaching the most vulnerable people in society with basic medical care. This is a project that is very close to my heart.
What was the biggest challenge?
SolidarMed's goal is to close the gaps in health systems. Duplicating existing programs or interventions that overlap are not effective. Closing gaps, however, means building a good partnership with the Ministry of Health and district-level leaders. Other organizations' projects and ours must complement each other. Building this collaboration was not always easy in the beginning.
What distinguishes SolidarMed from other organizations?
The long-term strategic planning together with partners and the acquisition of knowledge for new projects. Mainly it is the combination of research with project design and management together with the proximity to patients. SolidarMed works very context-based: e.g. in a country with a humanitarian crisis like Mozambique, you have to provide humanitarian aid for the time being and not design large research projects like we have the possibility to do here. The programs are developed together with local partners, such as the ministries of health, so that they are sustainable.
How do you achieve universal health coverage in Lesotho?
Universal health coverage has a lot to do with quality and access to care - that has to be the focus of every project. If you continue to focus on mothers and children, you reach whole families and a large proportion of those in need. We are also tackling non-communicable diseases with a new project. These have become a major challenge in recent years in addition to infectious diseases. Strengthening the health system as a whole must remain a central aspect of SolidarMed's work.