Keeping up with Helene Gayle, MD, the CEO and president of CARE, as she makes a whirlwind visit to Africa requires the stamina and fleetness of Kenya’s international marathon champions. Today she is on the outskirts of Nairobi in an area called Kibera, reportedly the continent’s largest slum. For its estimated one million residents, the living conditions are deplorable. Thick mud sucks at our every step, but Gayle takes off at a near sprint down the fetid narrow alleyways, heavily rutted from tons of trash buried underfoot over the years. In this location, speed is a real feat. Slip, and you’re likely to slide into the open sewers that edge the labyrinth of lanes. Fall the other way, and you risk gashing your head on the rusting, twisted corrugated iron from the makeshift hovels that line these byways.
Since leaving America, we have been traveling for two days and are extremely short on sleep. But jet lag appears not to be a term in Gayle’s vocabulary. Her days are as scheduled as the average U.S. president’s, except that no head of state would accept itineraries starting at 4 am and continuing until 10 pm. There are no bathroom or coffee breaks factored in, although caffeine is desperately needed. Picnic meals are eaten out of cardboard boxes so as not to waste a minute as we drive from one location to another. Yet for all her Energizer Bunny animation, Gayle, 54, remains as fresh as she was when she left Atlanta, where CARE is headquartered, and as articulate and amiable as if she’d just had a nice nap in her own bed.
We are in Kenya ostensibly to check out maternal-health issues. Every year some 343,000 women and girls around the world die from complications of pregnancy and childbirth. But as the paramount multitasker—Gayle’s BlackBerry seems attached to her hand like a sixth digit—she is simultaneously co-leading, with a retired four-star admiral, what CARE dubs a “learning tour” for a group of American policy makers. These dignitaries make recommendations on government investments in global health, and Gayle hopes the tour will give them information they need but don’t normally get. The subtext is that such tours also raise CARE’s visibility in Washington and help in the fight for government money.
“The death of a woman in childbirth is one of the most inexcusable deaths on earth,” Gayle says. “Yet too often, when governments are asked for funding for women’s health care, people’s eyes glaze over.” When this happens, Gayle’s keen intelligence, encyclopedic knowledge of public health and natural authority, combined with her warmth, get their attention. She is passionate about every part of her mission. “Women need access to microfinance and savings programs so they can start businesses, so they can become more valued, so their girls can be educated,” she says. “It’s an overarching philosophy.”
Which neatly sums up how CARE, one of the largest private humanitarian organizations in the world, now operates. The agency has come a long way since it was founded in 1945 and started sending CARE packages to near-starving Europe. Today CARE has about 800 poverty-fighting projects in 72 countries, addressing issues in agriculture, education, economic development, health and nutrition, water systems and emergency relief. (For more about CARE’s programs, visit care.org/careswork.) With an annual budget of nearly $750 million, the agency earns a four-star “exceptional” rating for its effectiveness.
Gayle took the helm at CARE in 2006, the first woman and the first African American to lead the organization. “She may be the most trusted public health official in the world. People don’t necessarily trust the U.S., but they do trust Helene Gayle,” says David Satcher, MD, former director of the Centers for Disease Control and Prevention and former U.S. surgeon general. He was also her boss at the CDC—“to the extent that Helene Gayle ever had a boss, which I don’t think she did,” he jokes.
CARE’s beneficiaries trust Gayle, too, and she easily establishes a rapport with even the most destitute. In the Kibera slum we’re touring, women with multiple kids often make their homes in shacks that are barely six by eight feet. The men are usually absent, either away looking for work—unemployment in the area is thought to be higher than 70 percent—or dead from AIDS, or killed in the savage ethnic violence that followed Kenya’s election two years ago and is still bubbling under the surface.
Cynthia Aluoch, 39, invites Gayle into her one-room home. The only furnishings for a family of seven are a single bed, which functions as a sofa during the day, and a low table covered with a neatly hand-embroidered cloth. Aluoch talks, clearly drained, about how her husband, a day laborer, is off seeking employment but rarely finds it, how she is lucky if her family gets two meals a day.
As Aluoch speaks, Gayle gently reaches for her hand—a gesture of reassurance and support. It’s a brief moment in Gayle’s frenetic schedule but symbolic of her role as the head of CARE. For the policy makers on the learning tours, exposure to people whose poverty few Americans can imagine brings the issues up close and personal, in a way that’s very different from reading grant proposals. “We in Washington need to know what people in the field are up against,” says Democratic Congressman Keith Ellison of Minnesota, who was traveling with us in Kibera that day. “This is why such a tour is so valuable. We need accountability in funding but also flexibility if we want programs to work. How can we make these determinations shut in a hearing room in D.C.?”
What Gayle gets across to her guests is that there are many survival costs here that most Westerners never have to consider. Condoms are rarely affordable, so family size is hard if not impossible to control. In Kibera, the Aluoch family shares a latrine with dozens of shacks, and even that is a luxury. With barely enough money for the bucket of charcoal needed daily for cooking fuel, many families do not have the two Kenyan shillings (a quarter of a U.S. cent) that it costs to use the bathroom. And the facilities are locked nightly from 9 pm to 6 am anyway, because of the severe crime rate. Out of desperation, slum dwellers resort to what are known as “flying toilets”—human waste in plastic bags that are tossed as far from their homes as possible. In such unsanitary conditions, it is not surprising that diarrhea is a leading cause of death for children under five. For many who can’t afford $10 for a protective net, malaria, too, is a common problem. Aluoch is still feverish from an attack that felled her the previous week.
Gayle has devoted herself to addressing these issues. “I took on this type of work because as long as I can remember, I wanted to dedicate my life to helping bring about positive social change,” she says. “Philosophically and emotionally, I’m committed to this.” She was heavily influenced by what she saw around her as a child of the 1960s in America as the civil rights, women’s and antiapartheid movements were taking hold. But she also admits, “I feel better when I know that I make someone else feel better. This sort of work has a deep, emotionally satisfying aspect to it. It gives my life meaning.”
One of five children, Gayle grew up in Buffalo, New York. Her mother, described as brilliant by those who knew her, was one of the first black women to graduate from Columbia University’s School of Social Work; before that, she was homecoming queen at Fisk University in Nashville. Gayle’s mother also had chronic mental illness (at one point, doctors thought she was bipolar), which became worse as she got older. Eventually Gayle’s parents divorced, and Gayle and her siblings were shuttled between their parents (their father ran a beauty supply company) and other relatives.
At 11, Gayle was hit by a car while bike riding and was put in traction for three months and in a body cast for three more. The accident left her with one shortened leg and a slight limp, although neither is apparent. Nonetheless, she completed high school in three years and went on to major in psychology at Barnard. In medical school, Gayle developed an interest in pediatrics, until at the commencement of one of her brothers she heard a speech by Donald Henderson, MD, who in the 1960s headed the international effort to eradicate smallpox. “It was one of those defining moments,” Gayle says. “Here was somebody who had done what you knew you wanted to do: eradicate a disease off the face of the earth.”
“After that speech, Helene did something so grueling, few people would attempt it,” says Leslie Clapp, MD, a high school classmate of Gayle’s and her best friend for more than 40 years. “She simultaneously earned her MD at the University of Pennsylvania and a master’s in public health at Johns Hopkins.” It probably helped that Gayle appears to have an eidetic memory, enabling her to process and retain information with remarkable efficiency. Clapp remembers her being able to recite the telephone numbers of everyone in their community.
After a residency in pediatrics, in 1984 Gayle entered the epidemiology training program at the CDC, where she chose to focus on HIV/AIDS in the very early days of the disease. “Many people warned me to stay away from HIV,” she says. “They said it was an incredibly charged issue, more about politics than true public health. None of us knew how big an issue this would become.” At the CDC, where she would spend two decades, she rose through the ranks to head the center that focused on HIV/AIDS, tuberculosis and sexually transmitted diseases.
In 2001, Gayle joined the Bill & Melinda Gates Foundation as director of the HIV, TB and reproductive-health division at the Global Health Program, helping to choose which grants to underwrite and monitoring them afterward. Five years later, she was recruited to lead CARE. She made the move, she says, because she was ready to work on a broader set of issues than she had at Gates or the CDC. “There is no typical day running CARE, which has 13,000 employees,” she says. “I often sit down with our board members, I build partnerships with corporations, NGOs and other stakeholders, and I visit our country offices. I also spend a lot of time raising resources for our work.” The Chronicle of Philanthropy states that Gayle earns $375,000 a year, a sum that is not overly generous when you factor in 15-hour days, seven-day workweeks and extensive travel.
Such an intense workload has left her precious little time for a personal life. She is extremely close to her siblings and vacations with them every year. (It turns out that some of the compulsive texting she does is in response to the jokes her sister Karalenne is always sending her.) Gayle has never married, although she has had long-term relationships and is currently dating a businessman in Atlanta. When asked about the peridot ring on her engagement finger, she laughs. “I bought it myself,” she says. “It’s my birthstone.” She finds that her schedule makes it hard for her to commit—and hard for men to fit into her lifestyle. “Some things become a self-fulfilling prophecy,” she says. “You start on one journey, and it becomes harder to make a relationship the central focus. And the longer you don’t . . . I guess if that was the highest priority for me, I would have married.”
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.”
At the end of our Kenya visit, CARE holds a press conference about our trip for local media. Though earlier that morning we’d spent hours sitting on a hot plane on a runway and then gotten stuck in a traffic jam, Gayle showed up for the event looking fabulous in a vivid orange linen two-piece with a wide cinch belt. “I packed it so I could meet all the mucky-mucks,” she said, referring to the local officials—including Kenyan government ministers—who were on the press conference panel with her.
In the under-air-conditioned, standing-room-only conference hall, as other panelists droned on, many people were tuning out, some even nodding off. Then Gayle took the microphone, and a frisson of energy ran through the room. She was inclusive, eloquent and gracious as she tiptoed through diplomatic minefields. Her message was clear: We came to learn, not to lambaste.
Much of what Gayle does is like shuttle diplomacy, with its concomitant demands and exhaustion. But Gayle seems to worry not about what the job is doing to her but about whether she is doing her job well. Later she remarks that the movie Schindler’s List meant a lot to her. “What was so touching to me was that here was somebody who did so much but still worried about that person he didn’t save,” she says. “I hope I always cling to that, that I never say ‘This was good enough’ because I did something that helped some, when there are still others in need.”
She wishes there were unlimited resources, unlimited political will—“if the world were a little bit different, and we didn’t have constraints on what we do,” she says. “It’s easy to accept the status quo. You need a sense of righteous indignation. I’ve been able to keep mine. To be a force for social change and social justice.” She smiles. “Of course, eradicating world poverty would be good, too.”
Originally published in the July/August 2010 issue of More.