The Changing Face of Global Health: Q&A with Chris Skopec

For more than 60 years, Project HOPE’s lifesaving work has been an indispensable force in global health, building a unique legacy and training successive generations of doctors, nurses and other frontline healthcare workers around the world.

Today, however, the face of global health is changing: as widespread conflict and displacement threaten strained health systems, as natural disasters reveal critical gaps in community health, and as noncommunicable diseases like heart disease and diabetes spread worldwide.

Chris Skopec joined Project HOPE in 2016 as executive vice president for global health, responsible for overseeing all of HOPE’s global health programs. Read on for an interview with Skopec on the greatest threats to global health and how, after 60 years, HOPE still has the power to meet them.

Q: How has Project HOPE evolved from its early history to become a global health and relief organization that reaches communities around the world?

A: Project HOPE was a pioneer in global health as early as the 1950s and really recognized early on the need for sharing our health expertise. And yet our approach has really evolved since that time.

What we were doing in the ’50s and ’60s was deploying volunteers on a floating field hospital to help alleviate the burden of care for countries around the world. Today, the whole industry of global health and development has recognized the need for sustainable training programs to really create long-lasting change, and HOPE’s programs have evolved as such. We’ve been able to leverage our tremendous volunteer network and our relationships with governments and the private sector to increase our impact into communities around the world and ensure the long-term sustainability of what we’re doing.

I think the timing is great for Project HOPE. We don’t live in our past, but we look to it and we appreciate it. And we’ve learned a lot from it. But we’ve evolved with the industry — we see ourselves as not just a founding member in this industry, but a leader in it. As global health and development have evolved from our starting point, we are reasserting ourselves and have all the tools in place: our partnerships with corporations, our relationship with the U.S. government, our global presence, and the technical capacities of our teams in the field. So we have a lot to build on.

Read more about Project HOPE’s History

Q: What are the most urgent unmet global health needs, and what is the human cost of not meeting them?

A: There are so many unmet needs. We live in a more densely populated and interconnected world than ever before. We’ve already seen what the threat of infectious disease can be — and that threat continues to grow.

If you look at the Ebola outbreak in D.R. Congo right now, we have so much more at our disposal today than we did even five years ago, yet we’re struggling to win that battle right now, and the potential for airborne illness and flu is greater than ever. The solutions can be very simple, but implementing them is where it gets challenging. So I think one of the major threats to global health around the world today is reducing the spread of infectious disease through strengthening of health systems, improving surveillance, and responding quickly and effectively to outbreaks wherever they may be.

If you look at the biggest killer in the world today, however, it’s noncommunicable disease. And that’s because with these population growths we also see the standard of living rising. You can see the clear correlation — as the standard of living in a country goes up, the morbidity shifts from infectious disease to noncommunicable disease.

That’s not going to show up on the front page of a newspaper, yet it is the biggest killer in the world today. One of the things I’ve always been attracted to about Project HOPE is that we really go where the need exists. There’s a huge need in noncommunicable diseases, and there aren’t enough actors stepping up to address it.

Q: With needs so widespread, how do you measure the impact of Project HOPE’s work?

A: If we’re talking about short-term responses to an acute emergency, then the way we measure impact is through the number of lives we save and the number of people we treat. But if we’re looking at a development program where we’re trying to create sustainable change to a health-care system, then we have to look more broadly at impact indicators like child mortality rates and maternal mortality rates. Those are hard to do, because you don’t measure those in an enclosed community. You don’t measure those in one or two primary health care centers — you measure those at a national level.

Are we seeing the prevalence of HIV go down? How are we reducing the rates of TB transmission in a given country? It doesn’t matter if you reduce them in one community when you’re talking about infectious disease, because if the next community over hasn’t changed, then you know a year after you leave it’ll be as if you were never there at all. What we want to see is national level — or sometimes international level — long-term impact and change.

Read “Saving the Newborn in the Dominican Republic”

Q: What excites you about how HOPE is evolving to meet the most pressing global health needs?

A: One of the first things that comes to mind is we are really changing how we go about disaster response. We envision ourselves as becoming a premier disaster response organization. We have so many of the right pieces in place: our history, our partnerships, our deep pool of dedicated volunteers, and our capacity to mobilize humanitarian supplies and pharmaceuticals quickly.

As important as anything else, though, we have a team with a first-responder mindset, which you can’t teach. You’ve got to have people who keep that backpack handy and are ready to mobilize on a moment’s notice, regardless of the inconveniences it places on their life. That’s the difference between saving lives or not. I’ve been very encouraged that HOPE has all those tools in place and has a team that is willing and ready to jump on a plane at a moment’s notice to go into an environment where you really don’t know what the situation is on the ground.

The other thing I touched on is training, but training is so critical. Emergency response, like every other field in international development, is evolving quickly, and we are holding ourselves accountable to a much more robust set of standards and guidelines and principles in our work. That’s a good thing: it increases our accountability. It ensures that we do no harm, which is our overriding principle of everything we do. It ensures that we’re accountable to the populations we serve and we’re accountable to the donors who support us.

Read “Honoring Brave, Dedicated Humanitarian Women”

Q: HOPE has responded to every major disaster since the 2004 Indian Ocean tsunami. How has the way you think about emergency response changed since then?

A: When there’s an emergency, we make three considerations. First, is there a need? Second, do we have the resources to respond? And third, can we make an impact? There are some emergencies where it’s not a health crisis — what people need is shelter, for instance. That’s not our specialty. So one of the major considerations is, what is our added value in a situation?

I think about when Hurricane Maria hit Puerto Rico — we immediately assessed that there was a need, that we could get there, and that we had the resources to help. But then once we were there, we recognized that there was an additional need beyond hurricane relief to address a more systemic problem with diabetes care, one that was badly exacerbated with the disaster.

I had a conversation recently where someone was questioning why Project HOPE has stayed in Puerto Rico so long after the hurricane. This is an island with universal health care and access to free health services. And I said, well, we identified very clear and obvious weaknesses specifically in diabetes care that we have expertise in, and we have programs that have been successful at addressing many of these weaknesses.

Read “Project HOPE and the University of Puerto Rico Protect Emergency Medicine Supply”

After Hurricane Maria, one of the biggest public health concerns in Puerto Rico that we encountered was that diabetic patients didn’t have access to their care, and more broadly the majority of people applying for care were suffering from noncommunicable diseases and had been cut off from access to their treatment regimes. It wasn’t the high number of trauma wounds that you see in an earthquake; it wasn’t an infectious disease outbreak resulting from flooding. This was a different profile of health patient and required a different type of response.

This is a new challenge in emergency response. So many of internationally adopted protocols for emergency response are focused around trauma. And here we were looking at a real public health crisis that focused on diabetics being able to access their insulin and patients on dialysis needing electricity to maintain it. We saw a very specific gap that we have a lot of expertise in, which is community-based care for diabetes. I think our work there speaks to the needs of the population.

Q: Why is it important for an organization like HOPE to leverage existing health systems and local knowledge in our work around the world?

A: We’re seeing more displacement today due to conflict and manmade disasters than at any point in history since World War II. So the needs are tremendous. One of the things that’s important to recognize as an NGO in development is that we are not the ones who are going to deliver change in the communities we work in. We need the buy-in of the governments. When we pitch these programs, we’re not just leveraging our own resources; we’re working within the framework of a responsible growth strategy for local health systems.

One of the things that was new to me coming to Project HOPE was just how insistent HOPE is that everything we do falls in line with the support of the ministries of health and communities with whom we work. We’re almost always working in support of their strategies for their own health systems, whether it’s in primary care, maternal and child health, disaster preparedness or infectious disease.

We believe that local team members who are actually on the ground have the best understanding of what the needs are within their communities — whether that’s at the village level, the district level, or the national level. So we design our programs around the needs as they are seen from that perspective. If we’re sitting here designing our programs from Virginia, then from the U.S. perspective we know it’s easy to default into a mindset that says, “Where’s the money going? Well, that must be where the biggest need is.” But in reality that’s often not the case.

I think our challenge, then, is to advocate for that and help people who care about global health understand that when they give to Project HOPE, they’re giving to an organization that understands what the best use of the funds is, how we’re going to save the most people’s lives, and how we’re going to have the greatest impact in the communities we work with.

Q: You’ve visited HOPE’s programs around the world. Have you experienced a recent story in the field that really stuck with you?

A: Every time I visit the field, I come away with stories that are really impactful. Recently, I was in Nigeria where I was visiting one of our programs that helps children who have been orphaned by HIV/AIDS. This young boy, about 8 years old, came in and he looked like any other 8-year-old boy. He had a big smile on his face and he came up and gave our doctor, Dr. Usman, a big hug. As Dr. Usman tried to remember who this boy was, one of the partners in the room explained that it was a boy he had treated two years earlier, when the boy was 6.

Both of his parents had died from HIV. He was staying with his grandmother, who was HIV positive, and he himself was HIV positive. At the time he came into the program, he was severely malnourished and extremely sick. He was not in school and he was essentially living on the street because his grandmother was too sick to take care of him. To hear it from Dr. Usman, the boy was probably a month or two away from death.

Now, he was properly nourished. He was enrolled in school. He and his grandmother were both put on treatment regimes and had their viral control in check. It was just a remarkable turnaround. And to see Dr. Usman’s eyes light up as he recognized that it was the same child who was almost lost to the world, that was really special.

Project HOPE had provided routine health care, medications, and home visits, but we had also enrolled him in school and provided him with school fees, books, and a monthly stipend to make sure he and his grandmother had enough food. He was involved in playgroups with children of his age and had access to counselors to help him cope with having lost both his parents. So the end result after just two years was a boy who was healthy mentally and physically — he talked proudly about how well his grandmother was adhering to the regime, because he actually manages her medications.

Stories like this affect me. I have two boys this age — I have a boy who’s 6 and a boy who’s 8, and, you know, I think of how much time and energy we put into every little sniffle and cold. By any measure of comparison my kids have a tremendous network of support around them. It was powerful to see the same expressions on this child’s face, when all he wants to do is kick the soccer ball around with his friends. You see the humanity in it. You see your own family in these children.

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