We Lead Episode Two With Nabeela Ali

In our newest episode of We Lead, we meet with Nabeela Ali, JSI’s Country Representative for Pakistan and Chief of Party for our Integrated Health Systems Strengthening and Service Delivery Project. Nabeela is recognized globally for generating evidence for policy and design programs, ranging from chlorhexidine for newborn cord care to marginalized communities in Pakistan.

Amelia Karayianis: Hi, everyone. I’m Amelia Karayianis, a program officer in JSI’s International Division. Thanks for tuning in today. On today’s episode of We Lead, we’re talking with Dr. Nabeela Ali. Dr. Nabeela is JSI’s Country Representative for Pakistan and leads the USAID’s Supported Integrated Health System Strengthening and Service Delivery Project. She has helped design numerous national-level maternal newborn and child health policies and has managed large public health programs that have helped strengthen Pakistan’s health system. Dr. Nabeela is globally recognized for generating evidence to inform public health policies and programs, such as using the antiseptic chlorhexidine to improve newborn umbilical cord care, saving thousands of newborn lives. She is also a medical doctor by training. Dr. Nabeela joins us today from Islamabad. Hi, Dr. Nabeela, thank you for joining us today.

Dr. Nabeela: Thank you, Amelia. Thank you for your intro.

Amelia: Obviously, you’ve had an impressive professional career, but before we get too much into that, can you tell me a little bit about yourself? Who is Dr. Nabeela? How would your family and friends describe you?

Dr. Nabeela: Thank you, Amelia. Nabeela is a humble person who likes to work hard with dedication to the cause, and I like to celebrate achievements, even if they’re small. At the same time, I accept my mistakes and learn from them. I am a family person and enjoy the support and love of my husband and my children. Besides my family, I have very sincere friends and colleagues, who keep giving me very candid feedback so that I have my two feet on the ground.

Amelia: That’s great to hear. It sounds like you have some wonderful people supporting you in your life, both professionally and personally. I read from your bio that your father was passionate about girls’ education, especially for his daughters. Would you say that he was unique in that opinion at the time, and also how important to you was it that your father supported you in gaining an education?

Dr. Nabeela: Amelia, I was lucky to have parents who value daughters and sons equally. We are two brothers and two sisters, and when it came to my and my sister’s education, my father took keen interest in guiding us each step of the way to pick our career and provide resources and opportunities to get in the best medical college as he wanted to have both sisters to become doctors. In those days, girls were getting married at an early age of 17 and 18. My father supported us to complete our education, so that was really important to us.

Amelia: And whose idea was it to enter medicine? Was that your idea or your parents’ idea?

Dr. Nabeela: To be honest, my parents, they, you know, they didn’t force us. But at the same time, in those days, there were two professions, you know, which were seen and considered prestigious. One was teaching, and the other was to become a doctor. So it was, I guess, a joint decision to go into the medical field.
Amelia: So, you did begin your career as a medical practitioner and spent several years on that path. What was it that motivated you to move away from medical practice and towards public health programming?

Dr. Nabeela: Yes, that is correct. I was passionate about my work on the clinical side and wanted to build my career in surgery. I always wanted to be a surgeon and I really enjoyed that. In the late 80s, I was on a family way, and it was difficult for me to do justice with my duties in the anesthesia department and operation theater. So my friends, they suggested me to get a posting in a primary health care facility, which is in rural areas, where normally doctors go for a few hours and there are no emergency duties to perform. But in my case, it was the other way around. I started enjoying my work and felt the real need is in rural areas where access to health services is limited. Most woman medical offices they do not even opt for rural health centers. As a result, the utilization of health facilities remains sub-optimal. That is how my career started in public health in 1990, and I never looked back, although I feel that preventive and clinical services are equally important. But public health requires attention in all aspects, realistic planning, preparing strategies and policies, and allocation of budget so that women and children and men you know, they can get the services that’s their right, and I’m very happy to have contributed in implementation of successful initiatives in Pakistan. That led to policy formulation, like National Program on skilled birth attendants and chlorhexidine national scale up.

Amelia: Would you say that you have a strong preference for the work you do now, then? Could you ever see yourself practicing medicine again? Or, are you happy where you are?

Dr. Nabeela: Absolutely, I’m very very happy where I am, because I realized that this is where I belong. Because I’m a people’s person, I like to interact with people, I like to talk to people, you know, and see what I can do for them. And I think the chances of performing and providing services close to humanity and the community is where public health comes in, and I’m very happy that I am in this sector.

Amelia: Could you tell us a little bit more about your experience working in rural parts of Pakistan? Obviously, there were parts of that experience that motivated you to move towards public health programming. Do you have any stories or experiences that kind of show why that shift happened in your career?

Dr. Nabeela: Oh, Amelia, there are many stories that I can share with you. I think I saw the plight of women and children. It was heartbreaking to see a newborn die of birth asphyxia, as the nearest health facility were the health care providers who had skills to resuscitate the baby were three to four hours away. On top of that, the transport challenges and the time lost in making the decision by the traditional birth attendant, to take the baby to a tertiary care hospital. The baby was dead by that time. Likewise, in case of women who deliver at home in rural areas and end up with excessive bleeding, they die on the way to hospital, as she has just two hours between life and death. These are all needless deaths and can be saved. So when I looked at all of that, I realized that we need more doctors, we need more nurses and lady health workers in rural areas, so that we can cater to their sufferings and provide them quality services.

Amelia: I can’t imagine how heartbreaking some of those things were to see. It’s obvious to me that you are someone who possesses empathy based on your reaction to some of the experiences that you just described. How do you think that empathy plays into our careers as public health professionals? Is it an essential quality of medical professionals or public health workers?

Dr. Nabeela: Actually, it is part of the oath that all doctors and medical professionals, you know, they have to take at the time when they start their practice. But empathy, we look at it, is a characteristic of every human being, it is the capacity to understand or feel what another person is experiencing. It is essential for health professionals, as there is no medicine to cure emotions or hurt or neglect and deprivation. We cannot understand the sufferings of others unless we put ourselves in their shoes. This requires good listening skills and assurance to the patient or client that you understand their situation. And if you have done that, then half of their, you know, miseries they are gone. They feel that we can feel how they are, and in what condition they are, what are they going through. So in my experience, at times, when a pregnant woman would come to the health center with a mother-in-law, I used to meet them separately. The request of the daughter-in-law was always to explain to her mother-in-law that she needs rest during the day as it is her last trimester, or she has other kids to look after, or she has to cook food. Whereas the mother-in-law would complain that she does not help me with household chores, she would say when I was expecting, I never said no to my mother-in-law. So you understand how the situation was, but after counseling, both the daughter-in-law and the mother-in-law, they would both agree to look after each other. So it was not just the medicine that satisfied the patients and clients. It was listening to them and counseling as well.

Amelia: That’s kind of an amazing anecdote that you just provided because I think it has to do with kind of the behavior change aspect of public health as well, not only the medicine, I was originally going to ask if you had a lot of pushback from those mother-in-laws that you mentioned, but it seems that you were able to find some common ground between the two in order to lead to a more successful birth for both the mother and the baby.

Dr. Nabeela: So Amelia, I tried to find a common ground and I would always talk to the mother-in-law that see if your daughter-in-law, get some time to rest. It is in your favor because then your grandchildren, you know, they will be healthier, and you will be happy to see them running around rather than having low birth weight babies and all, and I would always give them an example that would turn out to be in their favor. So that worked well.

Amelia: That’s a really great strategy. Would you say that some of those attitudes have changed all these years later?

Dr. Nabeela: They have, because, you know, I’m talking of like 35-30 years back. But now the times have changed. Now, the mother-in-law is also educated, you know, and she has also worked during her, you know, young age, and she understands how it is difficult to take care of younger children. So I guess the mother-in-law and the daughters-in-laws, they are very friendly, and that is exactly the case of my two daughters-in-laws. We are like friends.

Amelia: That’s great to hear. So building off of that you mentioned something in your bio that I found very interesting. You said that public health is a science and an art. I think that many use science and art as opposing forces. Can you elaborate a little bit on what you meant by that?

Dr. Nabeela: Yes, I strongly believe that public health is science and an art, as it requires management of health problems, where we give medicines and perform surgery. At the same time, public health is also a lifestyle. So there is a strong preventive aspect to the overall management. For instance, look at the heart diseases or the diabetes or, you know, birth spacing, all of them, they require lifestyle change, it’s not just the medicines that will cure the patient. So this aspect of health is the art, as it requires behavior change to achieve holistic health. Even if we look at the definition of health, it is social, mental and physical well being.

I will share how in one of JSI’s Projects, Pakistan Initiative for Mothers and Newborns, we combined the science and the art. So USAID towards the very end of the project added family planning component to our scope of work, and my team and myself after careful thinking and deliberations on which interventions to introduce to have impact in shortest possible time. So we decided to make a commercial movie on issues like son preference, too close pregnancies, health of mother, and girl child education as one of the interventions. Because this is something which is very prevalent in Southeast Asia. So we thought that through the Enter Education, we can send the message across. It is a long story, but in the end, we were successful in convincing USAID to sponsor a commercial movie called Bol, which turned out to be a success, and was shown in several countries in academic institutions, and is also archived in libraries of public health institutions. I even saw it on Qatar Airways coming to the US, you know, so I believe healthcare is both science and an art.

Amelia: And I assume that you starred in that movie, right, Dr. Nabeela?

Dr. Nabeela: No, I was the director there in that movie, but yeah, provided all the technical background.

Amelia: That’s such an interesting way to be able to use your creativity when your original training was much more science based. I love that you get to use both of those things in your professional career now, and I’m sure that it’s had great impacts on the individuals that you work
with.

Dr. Nabeela: Absolutely. Absolutely.

Amelia: Can you share one or more of your favorite stories or experiences from your professional life?

Dr. Nabeela: Yes, there are many stories, you know, and because during my 36 years of service, I’ve come across many experiences. There’s one particular incident that I still remember. During the planning phase of one of the projects that I led, we went to interior Sindh to a project district called Dadu, that it’s a rural district. I was told there is an area within that district, where due to a law and order situation, the health services are non-existent, and women and children, they die as for almost four to five months in a year. That geographic area gets cut off from the main district due to floods, and the health center is being used as a stable. So that was really difficult for me to absorb. So I decided to go and see for myself the situation and design a program for that area to save mothers’ and newborns’ lives. But to my surprise, the health center had no doors and windows, and there were no health care providers. So we immediately called the community elders and listened to their demands. At the end of the day, it was a joint venture of community, district government, and USAID project led by JSI and we came up with an intervention so that that health center can become functional 24 hours, seven days a week. The government provided two skilled birth attendants who were then residing in the residential quarters and JSI through USAID funding provided an ambulance to build the capacity of the healthcare providers, and provided the relevant equipment. So the center started working. And the community took the responsibility for the safety and security of the staff there.

What touched my heart was the local community. They planted a tree in the compound of the health center and put a plaque with my name on it. I mean, when I went there, 10 years later, it has grown into a big tree now, and at that time, the first baby girl who was born in that facility was named Nabeela. So you see the community-owned the health center and guarded the health center with their life. And the ambulance that we gave them, when Benazir Bhutto, our prime minister was assassinated, there were riots all over Sindh, and people, you know, came with sticks in their hands, and they smashed even the government ambulances, but they spared the ambulance, which was given by JSI and USAID, because they said, no, we planned to make this facility operational and this is our ambulance, and we cannot, you know, damage that. So this was really nice, and I always remember the day that we went there, and then afterwards how the services started and were being provided to the community over there, and how satisfied and happy they were.

Amelia: That’s amazing to hear the impact that you have had on that community, and it’s beautiful to hear that there’s a tree planted in your name there. Have you been back recently to visit that community?

Dr. Nabeela: I’ll be honest, the last visit was like seven years ago, but that’s a very good idea. I think I should go and revisit and see in which condition that tenth facility is now.

Amelia: I’m sure that it did have such a big impact on so many people’s lives. So while that was such a lovely story, we do know that no journey is without challenges and obstacles. Can you tell us about one or more challenges that you faced as a woman leader in public health?

Dr. Nabeela: I have yet to see a journey in this case, you know, career without challenges. But if you are a woman leader, the challenges are compounded, especially in the developing countries. To have a male leader is considered the norm. If a woman becomes you know, or makes it to that position, people, your own peers, they consider it as a favor done. So that is not a very good feeling, you know, but I want to share with you. In 1998, I got selected after a rigorous open competition for a position as Chief Executive Officer for one of the 10 districts that got autonomous status in Punjab. There were three rounds of interviews, and the last one was by the Chief Minister of Punjab himself. I was the first one to get selected, the youngest candidate, and female, besides men who had served in many leadership positions. So on a lighter note, on the first day of our orientation, they all laughed at me and even asked me to go home and play, but later, we all became friends. And I used to teach them how to prepare PowerPoint presentations, and they were not, you know, computer friendly, so they welcomed my support. So that’s how I made my way and entry into the leadership position.

Amelia: That’s great to hear that even after the initial reaction, the men that you were working with ended up becoming friends of yours. Do you think that that experience that they had with you then kind of trickled down into their own families and their other interactions that they had with women in the professional setting?

Dr. Nabeela: I think I met their families and their daughters later on, and they were very thankful to me. They said that their attitudes have changed, you know, when they have started accepting us and they have, they’re encouraging us to go into professional careers. So, that was really good, you know, to see the change, behavior change in them.

Amelia: So that all being said, how important is it to encourage young girls and women to pursue education?

Dr. Nabeela: Well, Amelia girls’ education is extremely important, as they are the first teachers of their kids, and research has also shown that if a mother is educated, she will make sure that her children are educated. In Pakistan, women constitute 48% of the population. Educated women can join the workforce and they can contribute to the economy of the country. So the times have changed. You know, when I started my career in 1985, and when I look now, there are many opportunities available for young girls, both in public and private organizations, because they encourage women, you know, to apply, and the affirmative action that they take is to provide them with pick and drop service so that there are no excuses, you know, that the parents or family members can make that how they will go to the office and things like that. So times have changed, and it’s very heartening to see girls coming forward in different walks of life.

Amelia: And do you think it’s equally important to teach young boys the importance of girls education?

Dr. Nabeela: Absolutely, because you see, these young boys, they’re going to become the brothers and then the husbands, you know, of young girls. And it’s important for parents to teach their sons, you know, that women are equally important, and they should be encouraged, and they are equal members of the household.

Amelia: So what are some examples of things that you say to your own children to encourage this type of learning?

Dr. Nabeela: Well, my sons, they’re outliers, you know, they, they really respect their wives and their sister and their mother, anyone for that matter. I always feel so happy, you know, that they are so respectful towards women, and my daughter has a young, you know, daughter, like she’s about two years old. But I see my son-in-law, you know, pampering her, and I can tell that when they will grow, they will have all the opportunities in the world that boys can get. So it’s a very, very good feeling.

Amelia: Can you speak a little bit more about your own journey to leadership? Are there any lessons that you’ve learned to become an effective leader, and on the flip side, any mistakes that you, you would say that you’ve made?

Dr. Nabeela: If I look back, I was always supported by men in my life, and I want to thank all of them for that. Starting from my father, my brothers, my husband, and my sons, I found even my colleagues who supported me and my seniors who gave me confidence and courage, that I’m no less. So I feel that I was lucky to have them around me. In my country, Pakistan, we had the first woman prime minister, the first woman speaker of the National Assembly, and now we have the first Surgeon General in the army. These are unprecedented experiences, but times have changed. In my case, I’ve managed projects for the last 21 years in a leadership role. I found very respectful colleagues and subordinates who have always supported me, and I can’t thank them enough. I never hit the glass ceiling, I would say. I got opportunities and I found ways you know, and everybody supported me. But to become an effective leader, one should groom the subordinates and provide opportunities to them to be future leaders, and always listen to the advice of, you know, your peers and your team members, as we achieve more if we work as a team. I’ve also learned that to become an effective leader, we need to be assertive, and do not shy away to take tough decisions, because in leadership positions, you have to take tough decisions. There you cannot say, “Oh, I’m a female and you know, I can’t take such decisions if you have to. For example, fire someone. So these are areas where, you know, if you’re in a leadership role, you have to build your capacity in that. But at the same time, I’ve made several mistakes, I believed people for what they portrayed themselves to be. But at times I had to suffer because of that, and I’ve made many mistakes, as I said, but I always learned from my mistakes.

Amelia: The key element is to learn from those mistakes, right? Do you practice mentorship with any of your either subordinates or young people currently?

Dr. Nabeela: I do when I tell them, you know, guide them for the future and their career, and I still remember there was a leadership program that the Population Council used to have, and they would invite us as leaders, you know, to talk to young professionals how they can excel in their own respective fields, and I love that.

Amelia: So what do you think is next for you? Would you ever consider teaching or moving out of the profession that you’re in now?

Dr. Nabeela: Well, I think during my mid-career, I was teaching Masters Public Health at Health Services Academy, and I have lots and lots of students, you know, all over Pakistan and that was such a good feeling. And yeah, I love teaching, and I can continue with that. Even now I am an adjunct faculty for two institutions in Pakistan, and I enjoy teaching whenever they call me for a session. I never say no to that, because as I said, I enjoy doing that.

Amelia: It sounds like you’re a busy person, then do you ever have any free time?

Dr. Nabeela: Yes, I love socializing. And I like to enjoy my life. I take holidays, I spend time with my family. And, you know, I go to parties, it’s not just work. So I like to mix work and social life, but create a balance between that.

Amelia: Definitely, and if you enjoy your work and enjoy your life outside of work, I think that’s the key to a happy life.

Dr. Nabeela: Yes, that’s true.

Amelia: What is your biggest public health concern for the future, either in your technical area, in Pakistan, or countries you’ve worked in, or for humankind as a whole more generally.

Dr. Nabeela: Amelia, in my view, the biggest public health concern for the future is ever increasing population and climate change. In the near future, we will face food and water scarcity, and that really scares me, because then we are going to face the adverse effects of deforestation, environmental pollution, and all the ailments as a result of overpopulation.

Amelia: Are you hopeful, though? I know that there’s a lot of initiatives related to climate change, are you hopeful that we can see a change in our lifetime?

Dr. Nabeela: Well, I’m a very optimistic person, but I’ll be very honest, the pace at which the population is increasing, it will become very difficult, you know, because people if they do not get jobs, and if they, you know, if their social needs are not met, then they’re bound to do things, stuff like deforestation, as I said, which will lead to flooding and all and then that will lead to other suffering. So I hope we do more, because we are not doing as we should be doing in for our climate. And we need to work very hard, side by side, and even health programs should have a component of climate change, you know, within that built in.

Amelia: Absolutely. That’s our reality going forward. So to end on a little bit more of a positive note, what advice would you give to young people starting out in the public health field?

Dr. Nabeela: I’ll be very honest with them, and I’ll tell them that public health work requires dedication and passion. One has to leave the comfort zone and spend time in the field. Because unless you do that and get the first-hand experience, we can’t do justice. It requires an understanding family and their support because you have to travel. There is no shortcut to hard work and success, but one thing I can assure the young people is the satisfaction one gets in public health to serve the poor and marginalized. Whether you’re working at the grassroot level, or you are at the policymaking level, it is very, very satisfying.

Amelia: Thank you, Dr. Nabeela.

Dr. Nabeela: Thank you, Amelia.