My co-fellows and I are somehow entering the final quarter of work in our placement sites. Our predecessors all warned us that the year would fly by, and sure enough, it’s nearly vanished before our eyes. Having completed seven months of the fellowship, we now have a unique view of our past, present, and future. We can see where we’ve come from, we can browse through folders of completed projects, and we remember achievements we’ve made, mistakes we’ve learned from, challenges we’ve overcome. We look around us and see friends, trusted colleagues, significant relationships we’ve built and a community in which we’ve become rooted. Many of us have adapted to new professional roles, organizations, even cultures, and have explored a new corner of the world and found in it a home.
At this point, we also look ahead to our next steps. Geographically, professionally, where will we be in the last months of 2014? What are our long-term goals and what immediate moves should we make to propel us toward them? Despite the satisfaction we may find in what we’ve accomplished so far, or the nervous excitement around making our next moves, we still focus on staying present. At our recent Quarter 3 retreat in Munyonyo, just outside Kampala, we talked about Brene Brown’s book Daring Greatly and the concept of “minding the gap.” No, we weren’t talking about disembarking British subway trains, but about recognizing “the space between where we’re actually standing and where we want to be.” The concept can apply to pursuing goals or progressing in a career, but Brown introduces it in regards to our personal value systems. We each have practiced values (where we’re standing) and aspirational values (where we want to be), and unfortunately the two categories often lie further apart than we want to admit. For example, inefficient systems or unexpected power outages can provoke me to complaints rather than patience, and unchecked envy can overshadow my capacity for gratefulness. Likewise, most organizations claim a set of values that guide their work. So as I began minding the gaps between my everyday actions and personal values, I also paid more attention to the alignment of my work projects with my organization’s core values.
At Reach Out Mbuya HIV/AIDS Initiative in Kampala, I’m heading up the Quality Assurance section, where most of my efforts center on improving the clinical and social services our clients receive. Among Reach Out’s core values are teamwork, maintaining a client focus, enhancing human capacity, and organizational learning. Of course we’re all responsible for some more menial tasks that don’t feel value-laden (think data cleaning or report editing), but I do find that my most meaningful assignments are those which further these values—for example, a research initiative I’m leading. My team and I are aiming to understand new client inflow, progression through the cascade of HIV care, and retention over the course of a year. By looking at the cohort of individuals who registered for voluntary counseling and testing (VCT) in 2013 we can understand the program’s reach over the year. Within that group we are focusing on positive-testers, and specifically those who enrolled for ongoing care and treatment in our clinics. We’re evaluating these new clients’ timely progression through important milestones of HIV care using outcome indicators and appointment dates (i.e., enrollment, baseline CD4 testing and result delivery, initiating ARV drugs, and WHO staging). Altogether, this analysis is highlighting the most common points in care where attrition or delays in service delivery occur, and signaling areas in need of quality improvement interventions. It’s allowing our organization to live out its values of teamwork, of focusing on our clients’ experiences and outcomes in treatment, ultimately enhancing their human capacity to live healthy, productive lives. Finally, the project poses a challenge: will we mind the gaps we find between actual outcomes and the highest possible quality of care? Will we demonstrate our value of organizational learning by making the necessary changes that are highlighted from this and other analyses of our services?
In striving to mind and fill our individual value gaps, Brown assures us that “we don’t have to be perfect, just engaged and committed to aligning values with action.” Surely it’s the same at the organizational level. No organization or employee is perfect, but we all have a responsibility to hold our organization’s progress up to the light of its goals with an honest and critical eye. By minding the gaps we discover, we can ensure that goals are reached and impact is made in the movement for global health equity.