We Lead Episode Six with Wuleta Betemariam

Haley Dowdie: This is We Lead, presented by Voices of Public Health, the JSI podcast. The women who lead JSI’s global health programs come from all walks of life. Their stories are as diverse as the countries where they work and the people they serve. In this series, we’ll hear from women in leadership at JSI to learn more about their personal and professional journeys and what they’ve discovered along the way.

Sita Strother: Hi, I’m Sita Strother, a program coordinator for JSI’s international division. Thanks for tuning in. Today on We Lead, we’re talking with Wuleta Betemariam. Wuleta is the new director of JSI’s Center for Healthy Women, Children, and Communities, and has more than 20 years of experience leading public health programs. In her previous role, Wuleta was JSI’s country representative in Ethiopia and project director for the Last 10 Kilometers Project. Before joining JSI, Wuleta was the deputy director of EngenderHealth’s program division in New York, where she provided strategic direction and oversight of country and global programs. She established EngenderHealth’s presence in Ethiopia, a program in Sudan, and was the country director for two countries. Wuleta has also been a technical advisor for USAID’s Population, Health, and Nutrition office, where she focused on reproductive health. Wuleta holds a master of public health and public policy from the University of Michigan. She is now in her final year of a doctoral program in public health leadership at the University of Illinois. Wuleta joins us today from Addis Ababa. Hi Wuleta! Thank you for joining us.

Wuleta Betemariam: Thank you so much, Sita. And thank you for the generous introduction.

Sita: So I know you’ve just stepped into the role of director for the Center for Healthy Women, Children, and Communities at JSI, and the center is definitely lucky to have you. What are you most excited about in this new role?

Wuleta: I feel very lucky to land such an important position at JSI. As you just said, my engagement with JSI for the past 14 years has been at the country level, specifically in Ethiopia, where I served as a project director for the Last 10 Kilometers Project, in addition to being the country rep over the last four years for JSI in Ethiopia. So I’ve worked very closely with the Ministry of Health through the projects, especially to strengthen the link between families, communities, and the primary healthcare system for improved reproductive maternal and newborn and child health outcomes. And leading L10K has been one of the most fulfilling journeys of my life. It’s allowed me and my team to contribute to the transformation of the health sector through bringing learnings and lessons from the ground. And it has enabled us to be at the seat, at the decision making seat, to inform and influence national strategies, programs, and policies, and really ultimately improve the lives of our fellow Ethiopians throughout the country. And what excites me about this new position is the platform it provides to be part of the global health discourse and help shape the global health programs, strategies, and policies through sharing our thought leadership at the global level, as well as evidences and lessons from the ground in the area of reproductive, maternal, newborn, and child health. And this new position, I believe will be a great platform to amplify the voices from the ground for the global good.

Sita: And it sounds like this position is now at more of a global level. Is there anything that you’ll miss about working more closely with countries?

Wuleta: Absolutely! I know that I’m going to be missing working at the ground level where you see the change happening right in front of your eyes. You’re part of the change. And when you’re a little bit removed working at the home office level, I would think that I would miss feeling part of what’s happening with the team that I’ve had, as I said, working very close with health workers, with communities more directly than I would be able to with the new position. But what the new position provides me with is a perspective of many, many countries, rather than focusing on one country. So the learnings, the evidence, and the lessons that I hope I’ll be able to bring up to the global level will enable us to influence global policies and programs.

Sita: So let’s talk a bit more about how you got to this point. I know you started out by studying and working in international development more broadly, but what drew you to focus on public health and reproductive health in particular?

Wuleta: So actually, my work throughout my career over the last 20 plus years has been in public health. As an undergrad, I studied international relations, African studies, and French, though my French skills are barely existent now. And then I joined University of Michigan’s Institute for Public Policy, which is now the Ford School of Public Policy, for my master’s [degree]. My intent at that stage was definitely to work in public service, in the international arena. And my interests spanned from being a diplomat to engaging in human rights, immigration policy, and those types of public service areas. And public health, honestly, or reproductive health was not really in my thoughts until I took a course, I think…it was the second semester of my first year in graduate school. And I remember the course was on population policy taught by two highly regarded professors at the school of public health, at again University of Michigan, professor[s] Jason Finkle and Alison McIntosh. And this was in the spring of 1992, if I remember correctly, when there was a hot and intense debate in the international arena on population and development between those who believed in demographic targets, which is arguing slowing population growth through birth control; family planning as a means to achieve sort of government numerical targets, and those [who were] geared for reproductive health as [an] individual right and [for] women[’s] empowerment. And I know you were pretty young and you might not remember, or you might have heard about it, but this was in preparation for the 1994 Cairo Conference for Population on Development. And it was really a watershed moment for reproductive health and rights. So then as a young woman, and especially as a young African woman, I was absolutely drawn into this debate, it was like, who decides on whose body, why would the government have to say anything about my reproductive choice? Why am I seen as a target and not as a woman has the right to choose? And from that point on, reproductive health and reproductive rights for women became my cause, my passion. And I suppose I can say that it was a watershed moment for me, as well as for women’s productive health and rights.

Sita: That sounds like a really powerful moment to be a part of, and you mentioned also being a young African woman in that space. Did you see many other people who looked like you and had similar backgrounds in your class?

Wuleta: Honestly speaking, there were not that many people that looked like me or that came from the same background at the University of Michigan. As diverse as the undergraduate population was, it was not that diverse. But relatively from the previous school that I came from where I did my undergrad, University of Michigan was a bit more diverse. But definitely I was, especially in public policy, one of the odd ones out. I think public health had more global students, especially because I focused on international health and then what was called population planning departments.

Sita: Did you feel like that affected the way that you engaged in that space at all?

Wuleta: No, I was pretty conscious of where I came from and where other people came from, but I don’t think it affected the way that I engaged with people or I engaged with my professors or engaged with the school community. I was definitely aware that I was different, but the difference in terms of engagement was pretty minimal. I would say my undergrad was totally different. Because during my undergrad years, I felt like a sore thumb.

Sita: Really.

Wuleta: I stuck out. I was in an honors program in what they called James Madison College at Michigan State University, where I think probably I was one of probably two or three black students out of 1,000, and people always assumed the worst. People would question if you really belonged in that honors school as a black woman, as an African woman, as a woman, and especially one that came from Ethiopia.

Sita: That does sound challenging, but also it sounds like you had a lot of perseverance to, despite that, still thrive in that environment, and go on to do your graduate degree in international development public health.

Wuleta: I had a good community, not at the undergrad level, but at the graduate level. There were a lot of Africans, Ethiopians, people from different parts of the continent that were there for their graduate school. So I bonded with them, and I think it made me grow perhaps a lot quicker than a usual undergrad life, and I see it as a positive.

Sita: So now, flash forward to returning back to Ethiopia after having moved to the U.S., and going back as a Michigan fellow with USAID, what was it like for you to return home after so many years in the States?

Wuleta: The time in the 1970s, in Ethiopia… I don’t know if you’re familiar with Ethiopia’s history and politics, but somewhere in between the ’70s and ’90s, a large number of Ethiopians that had the opportunity to leave the country, left Ethiopia during the Derg’s military regime. Many families sent their children abroad because of the fear of what could happen, and my sister and I were both sent to the U.S., both for education and also to escape, honestly, the dark situation that was happening in the country. And most of us did not know if and when we would ever be back to our homeland. We all yearned to go back home. So for me to be able to have gone back home in 1993, which was pretty much immediately after the overthrow of the military regime, was really a God-sent opportunity. And I came back home as a Michigan fellow as you said, and was posted [in]…USAID/Ethiopia’s health, population, and nutrition section. And USAID at that time was re-establishing its presence in Ethiopia after almost 20 years, and that really enabled me to be part of shaping and managing USAID’s strategic investment and engagement in the reproductive health sector.

I just want to mention someone that I feel like gave me this huge platform that basically kicked off my career, and that is Victor Barbiero, who was the Chief [of Health, Population, and Nutrition] at USAID/Ethiopia. He is actually the one who gave me this amazing opportunity that was key for my professional life. He might not be listening to the podcast, but hopefully, if someone that knows him is listening to the podcast, please let him know that Wuleta Betemariam gave him a shout out for giving me a huge opportunity many, many moons ago. The circumstances of how I met Victor is a bit funny, so this was immediately after my graduate school, I had moved to [Washington] DC, and I was working as a consultant at the Futures Group on a project called the Options Project, which actually brought my interest in public policy and reproductive health together. I was hired by this amazing woman, Janet Smith, and the job was to basically do research and write the policy paper on integrated versus vertical family planning programs, and it’s funny that it’s still an issue that we still contend with almost 30 years later. So, doing that during the day. In the evenings, I waitressed at a place called Cafe la Ruche, in Georgetown, to make ends meet and wait for my placement as a Michigan fellow. It normally takes up to six months, so about a year, once you’re accepted as a fellow, to be placed. So, one evening in July, I was waiting on a large table of mostly men and a few women, and I was going back and forth getting them drinks, their food, and refilling their water again and again and again, and I did a little overhearing and figured they are high level USAID personnel. So somehow, I mustered some courage and struck a conversation with them, that I had just graduated with a master’s in public health and public policy and that I’ve been accepted as a Michigan fellow and I’m dying to get a placement in Africa. And believe it or not, a year later that conversation at Cafe la Ruche landed me a fellowship at USAID/Ethiopia. Victor Barbiero was part of that group. And he really was instrumental in creating the fellowship position and offering me the position if I was interested.

Sita: Wow, that’s an amazing story. It just goes to show you, you never know who’s…

Wuleta: Yeah.

Sita: Sitting right next to you. It takes me back to my own waitressing days.

Wuleta: There’s a saying in Ethiopia. And I’ll say it in Amharic and translate it. And it’s a saying that I really believe in. It goes like this:

[foreign language]

Wuleta: Which literally translates to, “Without asking, you will not be a general.” So it’s a huge lesson in life. I mean, when you get that opportunity, yes, definitely, I had to go in and go for it. And I’m so glad I did. And basically, all this to say that returning back home was a huge opportunity. And I was actually one of the first returnees from my peers. And even though I didn’t do it purposefully, I hope that I’ve inspired others to brave it out and come back to Ethiopia, to contribute to the growth and development of the country.

Sita: It sounds like working with people and communities is so important to you, and building those personal relationships, whether they be mentorships, or in collaboration with communities has really guided your career. Is there any other person or experience that has really inspired you or motivated you, or even made you think differently about a problem?

Wuleta: There are many people that I’ve met in my life, that have inspired me, that have motivated me, and helped me look at things differently. Who I’m always in awe of are the community health extension workers that I’ve been able to meet and develop strong relationships with over the past decade of my life. So the health extension workers in Ethiopia are frontline health workers, and they provide preventive, promotive, and some curative care throughout the country, and mostly in remote places. I think at this point, there are about 40,000 health extension workers, most of whom, if not all, are women. And they work tirelessly to provide service to their communities. You know, the terrain in Ethiopia is no joke. It’s very, very difficult. And these health extension workers walk for three hours, four hours on rugged terrain, to immunize children, to provide contraception to women who want to plan their family, to provide prenatal care for pregnant women or postnatal care for newborns to diagnose and treat illness such as malaria, diarrhea, and pneumonia. They do this every day; day in and day out, day in and day out, they show up. Rain or shine, good day or bad day, they show up, and they show up to serve their communities. And they’ve made such a huge difference in the lives of women and children throughout the country. And for me, what more could be inspiring and motivating than having the privilege to work alongside these amazing, amazing women.

Sita: And I can imagine, too, with this pandemic, it’s really taken a toll on so many of us but especially the frontline health workers. Was there ever a time in this recent period that you’ve felt hopeless or felt like giving up and how did you work through that?

Wuleta: I’m not the kind of person who feels hopeless, I would say perhaps growing up in a country like Ethiopia makes us or most people to always be hopeful, resilient, that brighter days are there. So honestly, I can’t pinpoint a time that I felt completely hopeless, either through the pandemic, or the current unfortunate events that are happening in Ethiopia. I’m the kind of person that basically says, let’s move forward, let’s find solutions. And I try to align myself with people that look at the glass half full, and look for solutions and learn from the experience. I think if I can share one big lesson from my life in terms of challenges, failures, or mistakes, it is that you should take it as an opportunity for learning.

Sita: So taking a step back from your public health career, it would be great to get to know you a bit more as a person outside of your job. How do you think your friends and family would describe you?

Wuleta: I think my kids would say that I am very persistent, but [a] loving and giving mother. And they might even say that I’m low-key annoying, and perhaps that I’m too busy… I was too busy, especially as they were growing up to take part in some of their extracurricular activities. The reason I say this is because it’s an ongoing debate between myself and especially my son who had many, many, many extracurricular activities after school and me being busy with work, I know that I missed quite a bit. So they would say that I was extremely busy, but what I know for sure is that my kids are really grateful that they had the opportunity to grow up in Ethiopia, rooted in their culture, which gives them a great grounding and belongingness. We were actually about to move to another country in 2007, 2008 which would’ve made their lives totally different. So I’m really grateful and super blessed to have been given the opportunity to raise them in Ethiopia. And a super blessing is also having had the opportunity to be close to my parents, especially as they grew older. Being close to them, being by their side was a blessing that I know a lot of their peers didn’t have because as I said earlier, most children were out of the country. For me to have been there, I think was a huge opportunity, though I’m sure they would say that they wish they saw me more. And with my friends I think it’s a mixed bag, but I think a common description would be that I’m sort of a connector, an anchor for my friends. I think they’d say that I am empathetic. I’m a decent listener with a decent sense of humor, but a very, very bad voice, though I love to sing out loud when we hang out together at home.

Sita: Do you do karaoke ever?

Wuleta: There’s not been an opportunity for us to do karaoke in Ethiopia, but I wish I did. Actually, I did karaoke once for a JSI event with our [program officer] at that time, Heather McPherson. I think I did Gloria Gaynor’s “I Will Survive” in front of [former JSI president] Joel Lamstein and a whole bunch of JSI folks. My voice is really bad, but it’s my passion and I love to sing, especially along with old Ethiopian music or ’80s music. So they always have to bear with me. I even laugh when I hear my voice.

Sita: Oh, I bet you’re underselling it.

Wuleta: Oh no, no, no, no, no, no, no. [chuckle] I’m not. I’m sure they’ll crack up when they hear this.

Sita: So there’s no way I can convince you to sing a little bit on this podcast.

Wuleta: Oh my God, are you kidding me? People will be like, “Turn it off, turn it off!”

Sita: Do you have a favorite Ethiopian artist or singer?

Wuleta: I have a few, Muluken Melesse, Mahmoud Ahmed, Tilahun Gessesse. Oh, these are all men, but Gigi, okay a lot of women, the older ones I like, the Katamaa, those are the ones I usually listen to, and the ones that I like.

Sita: Do your children share your love of music and singing?

Wuleta: Unfortunately not. We don’t listen to the same music, but actually, I mean, there’s some that we do share, Burna Boy. There you go, now I’m hip. [laughter]

Sita: They’re lucky to have a mom as cool as you. So what is your greatest hope for your children?

Wuleta: My greatest hope for my children is that they live a purposeful and meaningful life, whatever they end up doing. I’m really blessed to have kids that have done pretty okay for their age in terms of schooling as well as starting their career. At the end of the day, what I want them to have is a really happy, happy life, surrounded with love. And then I hope that the world that they inherit and the world that their children live in will be much more peaceful and inclusive, which seems to be like a tall order these days with what’s going on in the world.

Sita: And going back to public health for a moment, what is your biggest concern for the future of reproductive maternal, newborn, and child health?

Wuleta: So if we keep 2030 in perspective, most countries in Africa and some in South Asia are tremendously off track to achieving the sustainable development goals, including universal coverage for reproductive maternal, newborn, and child health indicators, which is one of the goals stated by the [UN Sustainable Development Goals]. I know we’ve made significant progress over the past decade in improving access to sexual health services. And that has ultimately contributed to reducing maternal and child mortality globally. But despite the progress, hundreds of millions of women, children, and newborns have been and still are left behind. I would like to quote the late Dr. [Paul] Farmer because this for me is one of the most incredible truths. And I quote, “The idea that some lives matter less is the root of all that’s wrong with this world.” We need to work towards ensuring that quality healthcare is universal and accessible to women and children and newborns. And it should not matter where they live or what their economic status is. And we need to make sure that this goes beyond the rhetoric and we need to make it actionable.

Sita: I couldn’t agree more. And I think there’s more attention now to health equity, but still have so far to go.

Wuleta: Yes, a lot more to go. It’s very interesting that COVID showed us how somewhat fragile the health systems in the U.S. are, especially in some areas. I think that was a rude awakening for people that are working in public health in the U.S.

Sita: And having experienced both health systems, what are some of the ways that the U.S. could learn from a country like Ethiopia?

Wuleta: I think there are many things that one can learn from each other, but I would say the focus on community health and trying to make healthcare as equitable as possible, and being able to provide services closest to where people live, especially for the vulnerable population, I think it’s the most critical lesson that one can learn. That’s what Ethiopia has done, and not fully knowing how the country’s health system is within the U.S., I would think that one of the things that would address inequity could be by ensuring that the health system actually goes to folks that are not going to the health system for care.

Sita: Well, to end on a hopeful note, what is one thing that has inspired you in this past year?

Wuleta: So what inspired me most this past year, perhaps, is how communities come together to support each other during difficult times, and I think we’ve been able to see this somewhat globally with COVID. So for me, 2021 was probably one of the toughest years that I’ve had, I lost a few loved ones, I had a horrible COVID illness myself and the aftermath was even more disastrous. However, despite how low my spirit was, the unwavering support that I got from my community, and my community includes my family and my close friends, my L10K colleagues, who I call my L10K family, even JSI friends in Boston and DC were all inspiration. And this community is what undoubtedly gave me and helped me to push forward and to some extent, even thrive. Look at me now, at 50 something, I’m starting a brand new journey, and the support and inspiration from the people that I have within my community has helped me get to where I am.

Sita: This has been a wonderful conversation. Thank you for sharing.

Wuleta: Thank you so much Sita, this was a pleasure.

[music]

Haley: Thanks for listening to this episode of We Lead, presented by Voices of Public Health, the JSI podcast. We’d love to know what you thought of today’s conversation. Connect with us at JSI Health on Twitter, Facebook and Instagram, and share the episode if you like what you heard. To learn more about JSI’s work to improve health outcomes for all, visit our website at jsi.com.