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Currently I am working overseas for the U.S. Agency for International Development (USAID) in Malawi. You may be wondering what took a biology graduate from rural Oregon to sub-Saharan Africa, to work at the intersection of two important development sectors--health and education.

Well, I actually didn't plan a career in international development work. But, if there is one thing I have learned over the years, it is to be flexible and open-minded, especially when it comes to long-term plans. After receiving a B.Sc. in biology at the University of Oregon in 1986, I taught science for a year as a Peace Corps Volunteer in Kenya. The original idea was that this would be a break before I was going to undertake graduate work in genetics. Working in Africa was also a natural progression from my undergraduate time where I had been heavily involved in campus anti-apartheid activities. Teaching science in a rural Kenyan girls' secondary school was a way for me to see what Africa is really like and experience a different life.

"I learned much more than I taught"

But while I was living in a village in a small corrugated tin house, teaching a curriculum full of abstract theory, but with little practical information to girls who would soon marry, start families, and struggle to support their families off their small maize farms, my plans and priorities soon changed. I started integrating more relevant topics into my teaching materials, so we discussed family planning, HIV/AIDS, sustainable agriculture, gender equality. ... And, as is so often the case, I learned much more than I taught. I saw the human face of the vast potential that is irretrievably lost to deprivation and disease.

It was then clear to me that I wanted to work in the international development sector. My teaching experience convinced me that accessible and appropriate health and education services are absolutely necessary on the ground for the poor of the world to escape grinding poverty. And yet it is most often the case that these services are either unavailable, inaccessible, or of extremely poor quality in many developing countries, particularly for girls and women. There was (and still is) much to be done.

Upon returning to the U.S., I applied for the master's program in public health at the University of North Carolina. I completed the master's degree after 2 years, also working full-time in a hematology research lab. While this program gave me the background in biostatistics and epidemiology I desired, I quickly discovered that I needed more specific research and training in international development and the area I am most interested in--reproductive health planning and programming.

So in 1993, living now in Chicago, I began a doctorate in community health at the University of Illinois Chicago School of Public Health. I spent 6 months in Botswana, interviewing family planning clients at government clinics for my dissertation research in 1996. I continued to work on my research part-time and finished my dissertation, defending it in 1999.

One might think that with a raging HIV/AIDS pandemic, extremely high rates of infant and maternal mortality, and relentless poverty in sub-Saharan Africa, it would be easy to launch a career in development. However, I found this was not the case: "Breaking into" the development field with full-time, long-term work seemed to place one in that old Catch 22--one needs experience to get a job, but without a job one cannot get experience! There are limited opportunities and a dearth of funding for much-needed projects and personnel.

So when a friend, a physician with a master's in public health, told me about his experience as an AAAS fellow at USAID I immediately applied. These fellowships, which are 1 to 2 years in length, are designed to place scientists in the federal government so that they can use their science knowledge to help shape policy and programs. Most of the fellows have a strong background in "bench science" and learn about development work through an intensive 2-week orientation and the fellowship itself. I was fortunate to be accepted to the fellowship program with my social science background and find a position on the Washington, D.C.-based Africa Bureau education team as a HIV/AIDS and education advisor.

The USAID Africa Bureau education team leader was my mentor. The main purpose of the team is to provide technical support to African USAID education programs. My role was to assist in the incorporation of HIV/AIDS and school health and nutrition into education programs. Common issues across USAID programs included bridging between schools, local communities, and government ministries to ensure the acceptability and appropriateness of HIV/AIDS prevention, voluntary counseling, testing, and care for young people and support for education professionals that were involved in this process.

This involved traveling three or four times a year for about a month at a time to Uganda, Zambia, Namibia, South Africa, and Malawi. Through program development and monitoring I was able to build up experience and expertise in the development and implementation of HIV/AIDS education curricula.

After 2 years in Washington, D.C., this first fellowship came to an end and I wanted to be more directly involved in program work at the level of a single country. So I applied for an AAAS overseas fellowship position and am currently the HIV/AIDS advisor on the education team at USAID Malawi. The other three members of this team are Malawian education professionals. I manage HIV/AIDS activities within the education program. To do this, I work closely with the Malawi Ministry of Education and liase with the Ministry of Health, National AIDS Commission, Teachers Union of Malawi, and relevant nongovernment organizations to coordinate activities, mobilize resources, and improve the delivery of HIV/AIDS education.

While both the health and education sectors are filled with knowledgeable, experienced, and devoted people, they rarely communicate with each other, let alone share sector-specific scientific methodology and evidence to shape policy. This is true because people develop very specific skills and knowledge and are very busy in their own areas of expertise, whether this is curriculum development or provision of antiretroviral therapy, trying to make the best of infrastructures already overwhelmed by demand. Furthermore, funding tends to be stove-piped into either health or education. So, while government officials, development professionals, teachers, and health care workers may agree that cross-sectoral work is important, it often does not happen.

Bringing together professionals and officials in education and health

What this means on the ground is that education systems implement interventions with inadequate review of evidence from epidemiological studies on the effect of changes in behavior. In sub-Saharan Africa they will often send rather vague messages about avoiding "immoral behavior." Health systems, on the other hand, often rely almost exclusively on mass media and national-level social marketing of condoms to young people without actually reaching out to students, teachers, parents, and communities to assess what is acceptable in terms of HIV/AIDS prevention and sex education. Not surprisingly, the result is often disjointed and ineffective interventions. So a large part of my work involves bringing together professionals and officials in education and health to share their experiences and build on relevant firsthand knowledge to develop best practice.

Obviously this type of work requires the ability to interact with officials at all levels. On a more subtle level, it requires flexibility and patience, as every culture's bureaucracy is unique. In Malawi this means that any idea, proposal, project, or change in the way things are done must go through extensive consultations and formal channels. So things tend to move very slowly. It also requires humility, a recognition that there are people with perhaps less formal training and education who understand the local context and know what is realistic.

For scientists with an expertise in agriculture, the environment, or health and who are interested in applying their knowledge and skills closer to society, working on policy issues and programs can be professionally exciting and rewarding. Fellowships are a great way to do this, whether one is looking for a new career track or simply a change of pace for a couple of years. As the world gets smaller through communication and travel and people recognize their interdependence on each other, I expect this type of career will become more common.

Graduates who are interested in international development work should have a clear vision as to how they would like to apply their expertise and get as much international experience as possible. This could include short-term work overseas, research with potential applicability to developing countries, or collaboration with overseas partners.

For my husband and myself, Malawi has proven to be not only a tremendous learning experience, but a wonderful place to live with our three young daughters. Unfortunately, my fellowship is finished at the end of August. There is certainly the opportunity for a career track with the Foreign Service, but we would prefer to hold on to the flexibility we have now to look for work anywhere in the world. We will stay in Malawi for at least another year; I will do consultancy work on HIV/AIDS. And from here ... who knows where we will go!