The Question That Caught Me Off Guard
“After all these years in international development, what do you actually know for certain?”
Dr. Makubalo asked me this during our coordination meeting in Pretoria. I’d just finished presenting HIV prevention data from the SADC region. We had seen a 23% drop in new infections over three years. Good numbers. But her question cut right through the PowerPoint slides.
We were in her office overlooking Pretoria. I should have been thinking about program indicators. Instead, I found myself remembering my uncle Antoine’s hands. He navigated from our home on Mahe, Seychelles, to the outer islands by starlight, demonstrating his unwavering confidence. He taught me to read the ocean before we went fishing, demonstrating his unwavering stability.
I spent over fifteen years working across Africa and Geneva. I worked through health crises and development programs. I realized my deepest certainties didn’t come from conference rooms. They came from ocean tides, program failures, and just paying attention to what actually works.
What I Know for Sure
1. The Ocean Always Wins
Growing up in Seychelles, you learn this fast. You can build seawalls and study weather patterns, but the ocean does what it wants. That’s not pessimism—it’s respect.
I’ve seen this in every health system I’ve worked with. In Brazzaville, we designed what should have been a perfect malaria program. On paper, it would cut transmission by 40%. The community had other ideas. We got 12%—still good, but the local context had the final word.
Work with natural forces, not against them. Ocean currents, community behavior, organizational change—same principle.
2. Being Present Changes Everything
Yoga taught me this, but HIV work in South Africa proved it. When you’re really there with someone—not thinking about your next meeting or mentally writing reports—the conversation shifts.
I remember sitting with Grace, a grandmother caring for six AIDS orphans in Mamalodi. My visit was supposed to last 30 minutes for an evaluation. I stayed two hours. Her story required my presence, not merely the gathering of data.
3. Small Islands Think Long-Term
When your whole country is 455 square kilometers, you can’t think short-term. Every decision affects everyone. There’s nowhere for consequences to hide.
This helped during pandemic planning in Geneva. While bigger countries debated quarterly budgets, I kept asking: “What will this look like in twenty years?” Small island perspective in a big world.
Our WHO AFRO strategy focused on health system resilience instead of just immediate response. Five years later, countries that took this approach handled the next health crisis better.
4. Your Body Remembers Everything
Kyokushin Karate taught me that your body keeps score of everything. It remembers every training session. It records every moment of fear. It notes every time you pushed through discomfort. This changed how I looked at burnout in development work.
In Johannesburg, our most experienced field officers were making weird mistakes. Not because they didn’t know better, but because their bodies were holding months of stress from working in trauma environments.
We added mindfulness breaks and movement to our monthly meetings. Sick leave dropped 30%. Program quality improved across the board.
5. Numbers Need Context
Data doesn’t lie, but it doesn’t tell the whole story either. Madagascar’s TB statistics looked great until I spent time in the communities. The numbers showed better reporting, not better health.
I strolled through Toamasina’s marketplaces, engaged in conversations with traditional healers, and spent time with families. These experiences revealed to me that our program, which we considered “successful,” was actually creating competing health systems. These systems confused people.
We revamped the entire strategy, bridging the gap between conventional and contemporary medical care. Real health outcomes improved, and the numbers finally matched reality.
6. Hard Conversations Are Worth It
My grandmother used to say, “The fish that’s hardest to catch feeds the family longest.” Professional version: The conversations you want to avoid usually create the most value.
In Pretoria, I had to deliver difficult news to a provincial health director. His pet project was a mobile clinic program. He’d championed it for three years. It wasn’t working. The data was clear. The conversation was going to suck.
I didn’t present failure. Instead, I asked him to help me understand what the program was actually achieving. Our metrics had missed these achievements. It turns out, it wasn’t treating diseases effectively. However, it was building trust in government health services for the first time in decades.
We redesigned around trust-building instead of service delivery. Both trust and health outcomes improved.
7. Consistency Beats Drama
Island life runs on routines—not because islanders lack imagination, but because consistency creates reliability when everything else is unpredictable. This changed how I approached programs.
In Harare, instead of launching new initiatives every quarter, we focused on doing basic things consistently well. Daily clinic check-ins. Weekly community meetings. Monthly data reviews. Nothing exciting, but nothing optional.
Over eighteen months, this boring consistency produced extraordinary results. Patient retention went from 45% to 82%. Community health worker turnover almost disappeared.
8. Everyone’s Fighting Some Battle
This Buddhist idea became professionally essential when coordinating between different national health systems. A health minister who seemed uncooperative was actually managing a cholera outbreak with no resources. A colleague who missed three meetings was dealing with her father’s terminal illness.
Understanding these facts didn’t excuse poor performance, but it changed how I solved problems. Instead of addressing symptoms (missed meetings, late reports), I started asking, “What support do you need to succeed?”
Program delivery improved, but more importantly, teams got stronger across all country offices.
9. Systems Break at the Weakest Point
Growing up on an island, you learn that chains break at the weakest link because your survival often depends on that chain. In Geneva, I watched sophisticated global health strategies fail because they ignored weak components.
During the Covid-19 response, there were excellent labs in capital cities, but they couldn’t get samples from remote areas. The entire response was only as good as our worst transport link.
Now I map entire systems, find the weakest parts, and strengthen those first.
10. Love Is the Only Thing That Lasts
This might sound unprofessional, but my years of development work convinced me that love—for communities, for justice, for human potential—is the only motivation that survives bureaucratic frustration and systemic setbacks.
Technical skills get you hired. Love keeps you going when your third program fails, when funding gets cut, when political priorities shift overnight.
I’ve seen brilliant people burn out because they ran on anger or ambition. I’ve seen average professionals sustain extraordinary impact because they genuinely loved the communities they served.
Living with Uncertainty
Sitting in my Geneva office, looking out at Lake Leman and thinking about Dr. Makubalo’s question, I realize these ten certainties aren’t about eliminating uncertainty—they’re about handling it better.
Like my uncle Antoine reading the ocean before fishing, these certainties don’t guarantee smooth sailing. They just increase the odds of reaching your destination and bringing something valuable back.
The most certain thing I know? Tomorrow will bring new challenges that will test these certainties and probably add more to the list. And that’s exactly right.
L J Padayachy 
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