We are touring the Pumwani Maternity Hospital in Nairobi, one of the busiest maternity hospitals in Africa. Pumwani is run on a shoestring, and staff is limited, since many Kenyan physicians and nurses, who can barely make a living wage in Africa, have joined the brain drain to Western hospitals. When I stop to talk to 39-year-old Beatrice Kageha, who gave birth four days earlier, she bursts into tears as I ask why she is still in the hospital. “I don’t have the KES 6,800 [$86] for the delivery, so they won’t let me leave,” she says. “My husband died, and my six other kids are at home alone. Who will feed them?” Holding mothers and their infants hostage until the bill is paid is widespread in African hospitals, although the economics seem illogical. When I bring up the situation with Gayle, she says, “Just as the U.S. is struggling to provide equitable health care, countries with far fewer resources than we have do not always have patient rights. It shows us the work we have to do.”
As we pass a room filled with cribs of underweight newborns, their palms the size of postage stamps, Gayle stops to go inside. These infants are abandoned on the streets because their mothers can’t afford to feed them. Known as “police babies,” they are the lucky ones who are found by the authorities and taken to the hospital before they starve to death. As Gayle bends over to stroke a tiny face, her voice gets a little wobbly and her eyes watery. “I want to scoop up these kids and take them with me. I always do,” she says softly. “Then practical reality takes over. But one day I might consider adopting a child . . .
“There is never a time that I go out into the field that I don’t have something, someone tug at my heart. I can be reduced to tears daily. Abandoned kids gaze up at you with their big eyes. They’re not loved or held. They will never be able to regain that sense of attachment. It always tugs at your heart, whether I show it or not.”
One of Gayle’s strengths as a leader is how well she has been able to translate the intimacy, urgency and passion of such a moment into the language spoken in the halls of power, where checks are written. When Gayle started at CARE, she began a sophisticated form of advocacy aimed directly at policy makers and the administration. “No other NGOs do this,” says Kevin Layton, CARE’s director of strategic initiatives. “It’s very different, very 21st century, part of her vision. She connects the dots and what works and what doesn’t with the policy makers. It’s brilliant.”
As Gayle started dealing directly with politicians, she encountered resistance from some CARE staffers in the field, one of them later told me. “They felt there are a lot of land mines when you start talking to policy makers. People said we have finite financial resources, and they were used to doing things a certain way—CARE was all about programs. What did they know about lobbying? They were very old-school.”
Satcher says he wouldn’t be surprised if Gayle ended up surgeon general or secretary of Health and Human Services. Sylvia Matthews Burwell, a colleague of Gayle’s at the Gates Foundation who is now president of its Global Development Program, believes Gayle could be tapped for the top spot at UNICEF or a senior position at USAID. But Gayle’s success in introducing CARE to politicians should not suggest that she imagines a political career. “I think in many ways I’ve already had one,” she says. “I’ve thought about running for office, like Congress. But I don’t have an undying desire to do it. My life is committed to service. With the skills that I’ve been able to gain over the years, I want to contribute them where they can make the highest impact.”