Rahima Dosani, MPH’17, combines business acumen and public health heart to fix impoverished health systems
The serious young man in the faded denim jacket casts a nervous glance at the community health worker. He’s braved the long wait at Bvumbwe Health Center—a sturdy, tin-roofed edifice on a red dirt road in rural Malawi—to have his blood tested for viral load of HIV. He offers his hand and watches as the worker pricks his finger with a needle and dabs the blood on an absorbent card. Soon, the man’s sample, along with others, will be whisked by motorbike to a nearby lab. Within a week, the results will be texted back. If the man’s viral load is high, he may need to move to stronger antiretroviral medication. But with luck, any change will have been caught before he develops drug resistance.
This is the kind of public health intervention that Rahima Dosani, MPH ’17, loves: cost-efficient, scalable, and adapted to fit into a country’s health care system in places where the need is greatest.
Just a few years ago, routine viral load testing was rare in Africa. Before finger-prick technology was introduced, the cost of drawing, storing, and safely transporting vials of blood for testing put testing out of reach in many rural areas. And the weeks-long wait for test results led to many patients’ dropping out of the system before their follow-up appointments.
When Dosani—who earned a degree this past spring in global health and population from the Harvard T.H. Chan School of Public Health—first arrived in Malawi in 2012 as an analyst with the Clinton Health Access Initiative (CHAI), just 7 percent of the country’s HIV patients had access to viral load testing, and even fewer actually received it. The new, simple rapid test changed the country’s public health landscape.
Dosani took the lead on CHAI’s HIV Diagnostics Team in 2013, and thanks in part to her work, the country became the second in Africa to introduce viral load testing using the finger-prick method. Within a year, 35 percent of HIV patients had access to the test. If all goes as planned, that number will double by the end of next year—an impressive achievement even in the most privileged milieus.
BUSINESS ACUMEN AND PUBLIC HEALTH HEART
A warm, attentive, and self-assured woman, Dosani earned an MBA at Harvard Business School last year before entering the Harvard Chan School. While working with and observing nonprofits during college and in the field, she saw that good ideas can fail for lack of effective management. That, she decided, was where she could make a difference.
“The thing that drives me is having an impact on patients—really improving their lives—through national-level change,” she says. “I love working with a country on a program that can affect thousands of people and being able to say that I helped scale it up and implement it more efficiently.”
With CHAI in Malawi, Dosani oversaw a 20 percent expansion of the number of babies receiving HIV testing. Infants who harbor the virus can rapidly die from lack of treatment. In Malawi, too few were being tested—and one reason why was tragic in its simplicity: To test a baby for HIV, a health worker must draw blood from the baby’s heel. Newborns kick and cry during the procedure, and Malawian health workers didn’t have the heart to inflict pain, and as a result, often didn’t draw blood. Dosani and her colleagues found that with better supervision and mentorship, workers could get over their discomfort and help HIV-infected babies receive the timely treatment they need.
In Malawi, Dosani says, building relationships in the Ministry of Health was key to success. Unlike other organizations working in the country, CHAI provided solid analytical evidence to help inform government decisions, rather than merely throwing money at a problem. At the time, some 80 to 85 percent of the country’s health budget was funded by donors. “It was like a traffic jam of donors,” Dosani says.
Such a glut of foreign aid can paradoxically cripple a country’s health leadership. “So many organizations doing the same thing in the same place means public health leaders in-country lose agency and ownership of the work,” Dosani says. “What they really need is help building their own capacity.”
After her time in Malawi, CHAI assigned Dosani to Myanmar, where she conducted market intelligence analyses that persuaded new suppliers to enter the tuberculosis testing market—another straightforward intervention that, in this case, increased competition and reduced the cost of new testing technologies.
Dosani’s drive to serve is rooted in her own biography. Born in Pakistan to a Kenyan father and an Indian mother, she spent most of her childhood in Atlanta, Georgia. Growing up, she was one of just a few people of color in her small, conservative school and the only Muslim.
“I’ve always been aware of how different I was from a very early age. It made me realize that everyone feels isolated at times, and it pushed me to want to bring people together,” she says. During an internship in Pakistan, her eyes were opened to the ways in which people’s environments profoundly shape their health.
Dosani also found that while she was viewed as an outsider in the United States, the people in her Pakistan homeland saw her as a Westerner. “It was the first time that I felt that I didn’t have any place where I fit in,” she says. A few years later, as an undergraduate at the University of Pennsylvania, she learned to embrace her identity as a South Asian American. “I’m a person who exists between worlds. But I’ve learned to navigate between them and find common ground”—a critical skill, she adds, for a public health professional.
FREEING HER VOICE
Even as she was succeeding in her vocation, a part of Dosani’s identity was holding her back from living what she calls “an authentic life”: her stutter.
“My stutter controlled everything. I thought about it every second of the day,” she says. “I tried to hide it, but I wasn’t fooling anyone.” Around the time she decided to go to the Business School, she resolved that she needed to address the problem head-on.
Dosani had taken speech therapy before, but the focus was always on fluency—how to control stuttering through breathing and avoiding triggering words. “The message was that deep down, it’s not OK to talk the way you talk,” she says. “I didn’t want to keep living like that.”
She attended a summer program at the American Institute for Stuttering, where the focus was on making peace with stuttering and breaking down any sense of shame. Part of the process was desensitization. For one exercise, Dosani walked onto a crowded New York City subway car and shouted, “Hey, my name is Rahima and I stutter!”
It worked. “When you care less about what people think about you, your speech won’t hold you back,” Dosani says. “That program was the best thing I’ve ever done. It changed me completely. I’m so much happier, and now I live in such a different way.” When a stutter does arise in conversation, as it inevitably does sometimes, she is neither apologetic nor awkward but picks up her train of thought in a seamless, confident way.
Soon after she completed the program, Dosani fulfilled a long-held dream of performing slam poetry. In a spoken-word competition at New York City’s iconic Bowery Poetry Club, she performed a poem titled “Did You Forget Your Name?” which directly addressed the misconceptions people have toward stutterers. The audience went wild. She won.
Living more authentically as a person who stutters has also helped Dosani achieve her public health aspirations. “Since I’ve been more open about my stutter, I don’t hold back anymore professionally. I can speak up for what matters to me whenever I need to, and I worry less what people think of me. Every time I fight through a stutter and free my voice, I know I’m not just speaking for myself but for people less fortunate than myself. It gives me courage.”
Dosani hopes to ultimately start her own global health consulting firm focused on helping governments, nonprofits, and companies boost the effectiveness of their infectious-disease programs. She applied to the Harvard Chan School to gain expertise in biostatistics, epidemiology, and monitoring and evaluating health interventions, and received funding from the Zuckerman Fellows Program, based at the Center for Public Leadership at Harvard Kennedy School. Attending both the Harvard Chan and Harvard Business Schools, Dosani also learned to recognize the types of environments where she is most effective.
“Since I’ve been more open about my stutter, I don’t hold back anymore professionally. Every time I fight through a stutter and free my voice,
I know I’m not just speaking for myself but for people less fortunate than myself. It gives me courage.”
—Rahima Dosani, MPH ’17
“I do my best work when I can connect with a person, sit down, and figure out what I can do for them,” she says. And she’s found that her stutter can actually help break down barriers.
“Stuttering forces you to continually put yourself out there and be vulnerable,” she says. It also creates a safe space for others to be vulnerable and state what’s really on their mind.
Dosani thinks back to her time in Malawi, where she had scaled up a program to place machines for same-day CD4 testing for HIV-positive patients at clinics where local communities would reap the most benefit. At the time, because of resource constraints, HIV patients had to wait until their CD4 count dropped below a certain level before they could start lifesaving antiretroviral treatment. During a site visit, she encountered a woman who, though visibly ill, had received a CD4 count result that was too high to start treatment. Dosani sensed that something was awry. She asked the health worker to rerun the test. This time, the woman’s test reflected the seriousness of her illness and she was able to start treatment for HIV.
“She turned to the health worker and, speaking in Chichewa, addressed me: ‘Because of you, I’m not going to die,’” Dosani recalls. “I don’t take the credit, but I do carry her with me.”
Amy Roeder is assistant editor of Harvard Public Health.