Pioneering Minority Woman to Head CARE

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Dr. Helene Gayle will soon become the first woman and the first person of color to head CARE, one of the world's top humanitarian agencies. She talks about the desire to help that drives her.

ED GORDON, host:

From NPR News, this is NEWS & NOTES. I'm Ed Gordon.

In the coming weeks, Dr. Helene Gayle will become the first woman and first person of color to head CARE, one of the world's top humanitarian agencies. She has spent her entire career in the public health sector working both locally and globally to help poor at-risk communities. She comes to CARE from the Gates Foundation and before that the Centers for Disease Control. At the CDC, she studied AIDS and its early progress long before the disease became either a pandemic or a household name. Dr. Gayle recently discussed her big move with NPR's Farai Chideya.

FARAI CHIDEYA reporting:

What was it in your childhood or maybe our young adulthood that made you look at the way people live and the diseases people suffer from and say, `You know,that's important. I can do something about that'?

Dr. HELENE GAYLE (CARE): Well, I began my interest in medicine because I wanted to have a skill that I felt could make a concrete contribution to society, but understanding that poor health does occur in an overall context. And so while I found a lot of satisfaction from treating individuals or people with diseases kind of on a one-by-one basis, it was when I stepped back and realized that so much of what we try to improve health really has to do with looking at populations and communities and it's why I went into public health. You know, when I heard people talk about things like eradicating diseases like smallpox off the face of the Earth, it made me realize that the power of having a long-term impact on health really comes from working with communities, and that many of the things that I saw as a clinician taking care of individuals--you know, people would continue to come in with the same sorts of conditions if we didn't look at the population level impact.

CHIDEYA: Natural and manmade disasters like the tsunami, Hurricane Katrina and the war in Iraq regularly make headlines, but a lot of the simple diseases are the ones that are really affecting developing nations--tuberculosis, malaria. How do you raise support and awareness of that fact?

Dr. GAYLE: CARE is an organization that has a mandate to respond to these emergencies and that will continue to occur and it will be important for CARE to continue to have the capacity to respond to them. But it is the thing--not only health conditions, but conditions of social injustice, gender inequity, poor access to education, poor access to clean water. All of these things together that may not hit the radar screen, may not hit the media on a daily basis, but are the kinds of things that CARE wants to have a long-term impact. And so those are the things that I think we have to make the population and the world more aware of so that the resources and the support will be there to have the kind of sustainable impact that CARE and others want to make.

CHIDEYA: You talked about issues like gender inequality. And certainly when you are talking about something like that, you're talking about attitudes, you're talking about access to birth control. It sometimes gets into some very tricky waters, especially around the role of the federal government. The CDC, of course, has been very active in other nations in trying to deal with some of women's health problems but it's also been criticized for now not pushing condoms as a way to prevent the spread of AIDS as heavily as it did in previous years. How does your new organization, CARE, navigate all of these different cultural perceptions, not just of the other nations that, you know--organizations in the federal government may be going into help but our own government itself.

Dr. GAYLE: Well, I think first of all there's a lot of common ground. You mentioned gender inequity. One of the greatest issues around gender inequity is just simple access to education, basic education, and particularly education for young girls and women. I think that there are many issues that there's a lot of common ground around, and I think by first starting out with the areas where there's common ground, one can then build consensus around some of the more difficult issues to tackle. I think if we agree that the goal of having women be equal partners in the economic development of countries, the social development of countries, if we feel that's an important goal, an important part of moving the whole world forward, then I think we look at what are the different components to that that are important and really work to develop consensus around that.

CHIDEYA: What similarities are there between the health crises in developing nations and in underdeveloped American neighborhoods? Gender inequality exists in America, as well; racial inequality. How similar or different are those situations that we have within our nation with some of the ones you deal with in developing countries?

Dr. GAYLE: Well, I think there are a lot of similarities and a lot of lessons to be learned. In our country, which is a rich nation, it is the relative differences between populations rich and poor, black and white and other demographic dividers that is so unacceptable. It's unacceptable that a child born in one community and in this nation might have a very different outcome because they don't have the same access to education and health services, etc., that a child in another community may have, so I think, you know, there are a lot--and the same sort of approaches, how do you empower communities, how do you make sure that people have access to the basic services that really can make a difference in their life outcomes? The difference is that, you know, the absolute levels of poverty, the absolute level of lack of services is so different even when you compare it to poor communities here in this nation. But I think some of the root causes are the same, but the chances of having a better life are still going to be greater for a child here in this country because we, relatively speaking, have much greater resources.

CHIDEYA: Let's pull out one specific disease, which is AIDS and HIV. What have you done in your career around AIDS? I know that early on at the CDC that was something you dealt with before it was the pandemic it is today. How are you going to deal with the issue of AIDS at your new position?

Dr. GAYLE: Many of the strategies would be the same as some of the strategies that we focus on here to make a difference, particularly in areas of prevention. It's important that communities, first and foremost, recognize that HIV is a problem for the community, that there's buy-in from the different structures, be it the religious and faith communities, civic organizations, fraternities, sororities or whatever, the different civil society organizations that there are as well as the government. Countries where we've seen rates go down have been countries where there have been high-level government and political leadership, adequate resources to fight the epidemic as well as community buy-in. And so I think those things are similar no matter where the epidemic strikes, that you need those kind of elements.

But it's also important to pay attention to issues of gender inequality, for instance, which we've discussed before. In this country now a third of new HIV infections are occurring among women. About a decade ago that was less than 10 percent. In sub-Saharan Africa, over 50 percent of new infections are occurring among women. And rates are starting to increase in countries in southern Asia as well, so we know that this issue is continuing to hit hard women, as well as all the other aspects of how do you get a community engaged in this fight against HIV and take it seriously and have the kind of high-level political leadership that's necessary.

CHIDEYA: Where were you and how old were you when you first saw someone die of AIDS?

Dr. GAYLE: I was probably in my mid-20s at the end of my residency training.

CHIDEYA: You've done so much around not just AIDS and HIV, of course, but so many diseases. But AIDS, specifically, again, you once said that a condom and a clean needle are not enough, education is not enough. So what is enough to bring you to the moment in your future where you envision the last person ever dying of AIDS?

Dr. GAYLE: It's going to be imperative that people who are already infected with HIV worldwide have greater access to treatment. In this country since the combination therapy was first prescribed and discovered, we've seen dramatic declines in death rates. We've seen hospital wards emptied out. But in the long run we won't be able to keep pace with needs of treatment if we don't continue to focus and put a high priority on preventing the number of new HIV infections.

We know already that if we put in place the things we know--education is important. It's a foundation. But it's not enough. People maintaining monogamy and monogamous relationships, access to condoms, treating other sexually transmitted diseases; making sure the people who are infected know they're infected. Ninety percent of the people in the world today who are infected with HIV don't even know it because they don't have access to testing. Making sure that women who are HIV-infected and pregnant get antiretroviral therapy so that they decrease the chances that they'll spread HIV to their unborn child. But in addition to that we need new tools; we need to find a vaccine. It's imperative that we continue our search for a safe and effective HIV vaccine and that we look for other tools like microbicides, chemicals that women can use. So I think we've got to continue on the research angle, find better tools, ultimately a vaccine, use what we know already works, and then make sure that we are providing treatment for people who are already infected. And I think if we use that three-prong type of strategy we could have a huge impact in the next 10 years on this HIV epidemic.

CHIDEYA: Finally, I've read about your daily schedule. You're absolutely relentless. So even if you don't live to see AIDS disappear from the face of the Earth or some of the other diseases, like malaria, that your agency, CARE, is going to fight, when will you be able to step back and relax and just say, `I've done enough?'

Dr. GAYLE: I'm not sure when I'll be able to step back and relax and say that I've done enough. There's a lot to do. I feel fortunate that I've been given opportunities through the CDC, the Gates Foundation and then with CARE to be able to make a contribution to the broader society and to the world. It's what I feel I can do and have some of the skills that can make a difference. I don't think poverty is going to be stamped out in my lifetime, but I think that there are ways in which we can find better and better ways to empower individuals, empower communities, give them the types of skills to reduce some of the gaps in economic prosperity and the economic growth that we see around the world.

You know, we see incredible economic growth in some parts of the developing world. We need to figure out how do we extend that, how do we get the kinds of policies that will allow good economic growth even in the poorest parts of the world. And what are the things that detract from that, like poor health, that we can also have an impact on that will ultimately also impact poverty? So these are the kinds of things that, you know, I think will keep me and others busy for the foreseeable future and, you know, I'm gonna keep at it as long as I've got the energy and the will, and given the kind of opportunities to be able to make those kinds of differences.

CHIDEYA: Dr. Helene Gayle was recently named president and CEO of CARE, one of the world's top humanitarian aid agencies. Thank you so much for joining us.

Dr. GAYLE: Thanks. My pleasure.

GORDON: That was NPR's Farai Chideya.

This is NPR News.

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