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  • Nairobi Terrorism and the Hierarchy of Trauma

    3:32 pm on September 30, 2013 | 0 comments Permalink | Reply
    Tags: Africa, , Conflict, , Kenya, , ,

    Talk­ing about evil is hard. It involves at least two para­doxes. Here’s the first. On the one hand, to denounce evil is an eth­i­cal act. It is to affirm our deep­est val­ues and to com­mit our­selves to pre­vent­ing acts that dehu­man­ize oth­ers. On the other hand, to denounce evil can be an uneth­i­cal act. It is a way of demo­niz­ing; it is, pre­cisely, to dehu­man­ize another. Here’s the sec­ond para­dox: On the one hand, we need to the con­cept of evil to philo­soph­i­cally and eth­i­cally dis­tin­guish acts that shock our con­sciences, acts that are not ade­quately encom­passed by words like bad, wicked, or wrong. The con­cept of evil clar­i­fies. On the other hand, the con­cept of evil con­fuses, pre­vents think­ing. We imag­ine evil is other than human, beyond under­stand­ing, almost mys­ti­cal. This lets us off the hook, lets us deny our own capac­ity for evil, and stops us from ana­lyz­ing the very human, very com­mon causes of it.

    - James Dawes: The Guts of Atrocity

    I have never quite known what to react in the wake of tragedy. Say­ing too much almost feels too opin­ion­ated, and say­ing too lit­tle almost feels to insin­cere. I remem­ber my first encounter five years ago with a per­sonal tragedy and death was uncon­trol­lable laugh­ter. Appar­ently my ‘cop­ing’ mech­a­nism then, was to try to see the humor­ous side of the story. Highly inap­pro­pri­ate. But now, over the past week, I am find­ing no humor that can help me cope as I watch Kenya bal­ance a grow­ing sad­ness of a nation, the anger of their cit­i­zens and the anguish of loved ones as ter­ror­ists stormed an upscale mall in Nairobi claim­ing over 60 lives.

    As emails, phone calls, texts and social media updates came pour­ing in, the irony is not lost on me on how tragedies hap­pen every­day around the world and yet, why is it that this one just seems so much more real. As my emo­tions slide between the con­tin­uum of “why” and “shock”, a strange ver­sion of this Hier­ar­chy of Trauma began to emerge. As I scroll through the news for updates on Nairobi on that day, and through­out the week, it dawned on me that hun­dreds of peo­ple die and are affected by con­flicts around the world. In Pak­istan, 81 peo­ple per­ished in a church sui­cide bomb­ing. In Nige­ria, over 500 per­ished in ter­ror­ist related vio­lence in the north of the coun­try, and the on-going Syria cri­sis has claimed tens of thou­sands of lives. Coun­tries and com­mu­ni­ties that I can’t even com­pre­hend who and where — are suf­fer­ing. Yet, why my heart aches the most for my Nairobi home and only for a fleet­ing moment of empa­thy for the news in Pakistan.

    And sud­denly it struck me, trauma and grief isn’t a com­pe­ti­tion or a hier­ar­chy. We each grieve for dif­fer­ent losses, in our own way and in time. There is no trauma that is supe­rior to, lesser, greater, less shock­ing, bet­ter cov­ered, or any other com­par­a­tive phrase, than the suf­fer­ing of any indi­vid­ual or com­mu­nity. All we can do, is know that even if your expe­ri­ence does not have a chap­ter in other sto­ries of con­flict and trauma, it still a part of our story as human­ity as a whole.

    Think­ing of you.

    ***

    Selected pieces that pro­vide dif­fer­ent per­spec­tives on the Nairobi incident:

    1) Gen­eros­ity of cit­i­zens in dona­tions for the victims

    2) NY Times on the Value of Suffering 

    3) A Trib­ute to a Friend: Ravi

    4) Aung San Suu Kyi: the Free­dom from Fear

    5) A beau­ti­ful piece in The Nation on forgiveness

    6) Nan­jala Nyabola in Al-Jazeera on Keep­ing the Nairobi inci­dent in perspective 

    7) An inter­view with author, James Dawes on his new book: Evil Men - a col­lec­tion of dia­logues with war crim­i­nals from the Sec­ond Sino-Japanese War (1937–1945)

     
  • Leading Change in Emerging Health Markets

    7:53 am on May 8, 2013 | 0 comments Permalink | Reply
    Tags: Africa, , , , health, ifc,

    About a month and a half ago, I was in Istan­bul attend­ing a global pri­vate health con­fer­ence hosted by the Inter­na­tional Finance Cor­po­ra­tion (IFC) and John Hop­kins Med­i­cine Inter­na­tional. The event brought together global lead­ers in the pri­vate health indus­try to have share ideas, knowl­edge and lessons in the indus­try. Par­tic­i­pants were mainly senior management/CEOs across the health value chain from health ser­vice providers to phar­ma­ceu­ti­cal & med­ical tech­nol­ogy man­u­fac­tur­ers to investors in emerg­ing mar­kets. On top of the con­fer­ence, my team orga­nized a sep­a­rate panel ses­sion for health providers in sub-Saharan Africa.

    ifc banner

    I just wanted to share some of my notes and key take­aways from the con­fer­ence as I was really struck by the dis­cus­sions of the world’s lead­ing health providers and how it feeds into my work as an investor in emerg­ing mar­kets. Essen­tially, how I should be look­ing at the over­all mar­ket and types of deals I should be focus­ing on. There were two pre­sen­ta­tions in par­tic­u­lar that I would highly rec­om­mend going through, which is Credit Suisse’s Cap­i­tal Mar­kets Per­spec­tive on the health­care ser­vices sec­tor and IFC’s lessons from invest­ing in hospitals.

    • Health is a major dri­ver of GDP growth in OECD coun­tries aver­ag­ing approx­i­mately 7.3% as a per­cent­age of total GDP.
    • There is an upward trend of life sci­ence tools and med­ical equip­ment providers in terms of performance
    • When com­par­ing trad­ing val­u­a­tions (EV/EBITDA), EMEA and RoW com­pa­nies sig­nif­i­cantly out­per­form Amer­i­can com­pa­nies in terms of rev­enue growth, par­tic­u­larly in Acute Care provision
    • Banks are shrink­ing their lend­ing port­fo­lios par­tic­u­larly in SSA
    • M&A activ­ity will con­tinue to increase in a frag­mented mar­ket with pri­vate equity play­ing an impor­tant role in sec­tor consolidation
    • Health­care ser­vices are trend­ing from inpa­tient to out­pa­tient, inva­sive to non-invasive, and from treat­ment to prevention
    • The global finan­cial cri­sis slowed growth rates of com­pa­nies in IFC’s port­fo­lio, but none expe­ri­enced a drop in sales — indi­cat­ing that hos­pi­tal busi­nesses are resilient but not immune to the global finan­cial crisis
    • IFC’s rev­enue pro­jec­tions were rea­son­ably close to actual, on aver­age erring 5% lower than actual (which is impressive!)
    • The health mar­ket in SSA is an SME mar­ket, hence a need for smaller deal sizes, or a con­sol­i­da­tion of deals for increased access to financing

    Over­all, the con­fer­ence left me feel­ing uplifted, but also a great sense of urgency in terms of the work that I am try­ing to do. The con­fer­ence was IFC’s 5th annual health­care con­fer­ence and am already look­ing for­ward to the next one.

     
  • Responsibilities of an (Impact) Investor

    3:02 pm on December 6, 2012 | 0 comments Permalink | Reply
    Tags: Africa, , , , investing, , venture capital

    For the past few months, I have been reflect­ing a lot on my role as an investor. Busi­ness plans and pro­pos­als come across my desk and as I shift through them, it really struck me on how large a respon­si­bil­ity investors play in accel­er­at­ing trends, shap­ing a com­mu­nity or even country’s econ­omy, but yet how lit­tle this respon­si­bil­ity is spo­ken about in the invest­ing cir­cles. We place so much empha­sis on find­ing the right busi­ness, the right man­age­ment team, the right social impact, that some­times we get lost in our own capac­ity to rec­og­nize what really is inno­v­a­tive and what truly deserves to be funded. So, from my expe­ri­ences, here’s what I think an investor’s respon­si­bil­i­ties are on top of the typ­i­cal invest­ment work:

    1) Investors need to live in the future. 

    This is a point I feel very strongly about. If you’re an investor: VC/PE and par­tic­u­larly if you play in the startup and impact invest­ing work, (as Fred Wil­son pointed today in his blog post and what Paul Gra­ham said):  you should live in the future and see what is miss­ing. So well said. I’m cur­rently in an envi­ron­ment (yes, I rec­og­nize that I am in Africa — so feel free to shower stereo­types), where I know investors who are still using yahoo mail, inter­net explorer and Win­dows 2003 (true story!). Not to say that there are any­thing wrong with the prod­ucts, but more so — I think it’s so impor­tant to be keep­ing up with the trends in the world, tech­nol­ogy being one of them. How can you expect to iden­tify an invest­ment that is ‘ground-breaking’ if you’re not even fol­low­ing the newest trends in your sec­tor? Tak­ing this a step fur­ther, if you are fol­low­ing these global trends vs. local trends, it is then our respon­si­bil­ity to seek out entre­pre­neurs who can close this gap and fur­ther ele­vate the devel­op­ing world, or the devel­op­ing world would for­ever be play­ing ‘catch up’.

    2) Don’t be a sheep. 

    This respon­si­bil­ity is par­tic­u­larly impor­tant in the impact invest­ing space. Given that we’re play­ing in a field that is largely uncharted, risk is high and typ­i­cally, most investors are unable to size up a new mar­ket and end up rely­ing on the opin­ions of other investors. aka. I’ll invest if some­one else will too aka. a sheep. Impact investors say that they are risk tol­er­ant, but few trans­late this tol­er­ance into sign­ing along the dot­ted line. A very chicken and egg sit­u­a­tion. Hence, I have to con­stantly push myself to under­stand what is the right bal­ance of being a mar­ket leader but also not be a reck­less investor. Bal­ance is key.

    3) The need to close and dis­burse faster

    There are a lot of delays that occur in [impact] invest­ing. The court­ing of investors and [social] entre­pre­neurs, the dance between find­ing the right termsheet, the issue of mak­ing sure that the social impact actu­ally has an impact, and [insert your tra­di­tional delays in invest­ing here]. This is the norm. This is my chal­lenge to investors: rec­og­nize that the longer the delay, the big­ger the strain on the business/organization. From an entre­pre­neur per­spec­tive, you’re con­stantly watch­ing your ‘run­way’ aka. how much money do I have before I run out, and a delayed clos­ing round and dis­burse­ment is to the [social] entrepreneur’s dis­ad­van­tage as well as to their cus­tomers. If we’re really stand­ing with the poor, then deals need to close quicker with clear and sim­ple terms, as the longer the delay, the more peo­ple are miss­ing out on poten­tially expe­ri­enc­ing the product/service.

    This is by no means sup­posed to be an exhaus­tive list of respon­si­bil­i­ties, but instead ones that I feel are most impor­tant given my expe­ri­ence. As investors, we are in a priv­i­leged posi­tion to start/continue or end trends. I think it’s time that we started think­ing a lit­tle harder about where our respon­si­bil­i­ties lie.

     
  • My Week's Discoveries: Healthcare & Design

    10:47 am on November 20, 2012 | 0 comments Permalink | Reply
    Tags: Africa, , ,

    I’ve been spend­ing a lot of time in the health­care world for obvi­ous rea­sons, and have been immers­ing myself with knowl­edge from all angles. One of the more fas­ci­nat­ing angles is the cross sec­tion of health­care and design. Here’s a cou­ple of my favourite findings:

    1) Cut­ting for Stone by Abra­ham Verghese

    It’s been a while since I’ve read a work of fic­tion and I was highly rec­om­mended this book by my Acu­men Fund col­leagues. I fin­ished this book over the week­end and was so cap­tured by the story, out­raged on behalf of the pro­tag­o­nist, delighted by the inten­sity, and over­all over­whelmed at how beau­ti­fully writ­ten this book was. It’s a story that takes place from Ethiopia to New York, about love, med­i­cine and the inter­twin­ing of fate.

    We are all fix­ing what is bro­ken. It is the task of a life­time. We’ll leave much unfin­ished for the next generation

    - Cut­ting for Stone, A. Verghese

    2) Butaro Hos­pi­tal in Rwanda 

    When you look at East Africa’s health­care land­scape, Rwanda stands out as a med­ical suc­cess. Health indi­ca­tors have improved on all counts since the geno­cide, all pri­mar­ily due to the suc­cess of a uni­ver­sal health insur­ance, where the poor­est 25% of Rwan­dans get free med­ical care. One of my favourite things about the Rwan­dan health­care land­scape is a hos­pi­tal, Butaro hos­pi­tal that was designed by MASS Design Group The hos­pi­tal has no hall­ways, so patients can’t gather in close spaces, and the air in the wards are changed more than 12 times per hour to pre­vent patients from being infected by other patients — par­tic­u­larly, with multi-drug-resistant TB.

    Image taken from: Arch­Daily by Iwan Baan

    3) Future of health­care is Social - Fast Company 

    I recently was in Tan­za­nia attend­ing and speak­ing at a mobile health con­fer­ence orga­nized by USAID and the MIn­istry of Health of Tan­za­nia. The theme at hand was the increas­ing tech­nol­ogy and mobile pen­e­tra­tion that is chang­ing the health land­scape in Africa. There are over 500 mhealth projects deployed around the world with the major­ity of projects (over 30%) being in Africa. I really enjoyed this arti­cle by Fast Com­pany on the increas­ing social nature that comes along with the increased tech­nol­ogy pres­ence in health­care. Also worth read­ing is another arti­cle by Fast Com­pany, on 5 steps to design­ing a bet­ter health­care sys­tem.

    4)  Design for trust - UX Magazine 

    Good design isn’t beau­ti­ful. Good design builds trust. As an investor, when I eval­u­ate health­care inter­ven­tions, I look to see how the ser­vice accounts for fac­tors that mat­ter to a person’s dig­nity: they way they are being treated, train­ing of health­care staff and acces­si­bil­ity of infor­ma­tion. This is espe­cially impor­tant when deal­ing with the poor, who are used to being mar­gin­al­ized, and not receiv­ing proper ser­vice. The arti­cle is more web-based trust, but rel­e­vant nev­er­the­less, when think­ing about how you inter­act with a patient. At the end of the day, when receiv­ing med­ical news, every­one wants infor­ma­tion that is “cor­rect, com­plete and unbiased.”

    7) Design­ing Hand­wash­ing — Core77

    An older arti­cle, but a goodie in address­ing one the most fun­da­men­tal issues in health­care: Hand­wash­ing. A great read in explor­ing: Move­ment Design, Mus­cle mem­ory, move­ment scripts and fluidity.

     
  • Dambisa Moyo: Why aid is not working and how there is a better way for Africa

    9:27 pm on October 18, 2010 | 4 comments Permalink | Reply
    Tags: Africa, , , , , , ,

    I am so so unbe­liev­ably stockedex­cit­ed­hap­py­breath­lessi­nan­tic­i­pa­tion for this event. Seriously.

    I read her book, Dead Aid, when it first came out and it opened my eyes to a very dif­fer­ent per­spec­tive of aid, devel­op­ment and the finan­cial world. Her views are a chal­lenge and a strong vision on how to address the global poverty issue. Spread the word (and read the book!)

     
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