The Question That Stopped Me Cold
“After everything you’ve seen in international development — what do you actually know for certain?”
Dr. Makubalo asked me this in her Pretoria office after I’d finished presenting HIV prevention data from the SADC region. New infections down 23% over three years. Solid numbers. But her question cut straight through the slides.
I should have been thinking about program indicators. Instead, I was remembering my uncle Antoine’s hands — how he navigated from our home on Mahé, Seychelles, to the outer islands using nothing but starlight. He taught me to read the ocean before we ever left shore. Confidence built on watching, not guessing.
Fifteen years working across Africa and in Geneva will do something to your certainties. Health crises, program failures, budget cuts, political pivots. I kept waiting to feel like I had it figured out. Instead, I found something more useful: a handful of things I know to be reliably true, regardless of the context.
Here they are.
What I Know for Sure
1. The Ocean Always Wins
Growing up in Seychelles, this is the first thing you learn. You can study the weather patterns, build the seawalls, run the models — and the ocean will still do what it wants. That’s not defeatism. That’s respect for systems bigger than yourself.
I carried this into every health program I designed. In Brazzaville, we built what looked on paper like a near-perfect malaria intervention — projected to cut transmission by 40%. The community had different priorities, different rhythms, different trust levels with the health system. We got 12%. Still meaningful. But the local context had the final word, as it always does.
Work with the current, not against it. This applies to oceans, communities, and organizational change equally.
2. Being Present Changes Everything
Yoga taught me what HIV work in South Africa confirmed: when you’re genuinely in a room with someone — not composing your follow-up email in your head, not watching the clock — the conversation shifts into something real.
I once visited Grace, a grandmother in Mamalodi raising six AIDS orphans. My evaluation slot was 30 minutes. I stayed two hours. Her story didn’t fit a data collection form, and it didn’t need to. What it needed was someone actually listening.
In an era of remote meetings and AI-generated summaries, physical and emotional presence has become rarer — and more valuable — than ever.
3. Small Islands Think Long-Term
When your entire country is 455 square kilometres, short-termism isn’t a luxury you can afford. Every decision ripples out to everyone. There’s nowhere to hide consequences.
This framing proved useful in Geneva, where I was often in rooms with people debating quarterly budget lines. I kept asking the same question: “What does this look like in twenty years?” Not because I had the answer, but because the question itself changes the conversation.
The WHO AFRO strategies that focused on health system resilience — rather than emergency response alone — consistently outperformed the reactive ones when the next crisis arrived. Small-island thinking scales.
4. Your Body Remembers Everything
Years of Kyokushin Karate taught me that the body keeps a running record — every training session, every moment of fear, every time you pushed through when you wanted to stop. I didn’t fully understand the implications until I started noticing burnout patterns in development workers.
In Johannesburg, our most experienced field officers were making uncharacteristic mistakes. Not from lack of knowledge. From accumulated stress carried in the body from months of trauma-adjacent work.
We introduced mindfulness breaks and physical movement into our monthly team meetings. Sick leave dropped 30%. Program quality improved across every office. The evidence now backs this up broadly: psychological safety and nervous system regulation aren’t soft extras. They’re operational infrastructure.
5. Numbers Need Context
Data doesn’t lie, but it often flatters. Madagascar’s TB statistics looked strong until I spent time in the communities those statistics were supposed to represent. The numbers were reflecting better reporting, not better health outcomes.
Time in Toamasina’s markets — talking with traditional healers, sitting with families — revealed that our “successful” program had quietly created two competing health systems. People were confused about who to trust and where to go.
We rebuilt the strategy around integration rather than replacement, linking traditional and biomedical care. Real health outcomes improved. The numbers finally meant something.
6. Hard Conversations Are Worth It
My grandmother put it plainly: the fish that’s hardest to catch feeds the family longest. The professional version: the conversation you most want to avoid usually creates the most value.
In Pretoria, I had to tell a provincial health director that the mobile clinic program he had championed for three years wasn’t working. The data was unambiguous. I wasn’t looking forward to it.
I didn’t walk in with a failure report. I asked him to help me understand what the program was actually achieving — things our metrics had missed. It turned out it wasn’t treating disease effectively, but it was building trust in government health services for the first time in a generation.
We redesigned around that finding. Trust improved. Then health outcomes followed.
7. Consistency Beats Drama
Island life runs on routines — not because islanders lack imagination, but because when the sea is unpredictable, reliability becomes a survival strategy.
In Harare, instead of launching new initiatives every quarter to satisfy donor reporting cycles, we focused on doing a small number of things consistently and without exception. Daily clinic check-ins. Weekly community meetings. Monthly data reviews. Nothing exciting. Nothing optional.
Eighteen months of that produced results that surprised everyone but us. Patient retention climbed from 45% to 82%. Community health worker turnover nearly disappeared. Boring works.
8. Everyone Is Managing Something You Can’t See
This idea — borrowed loosely from Buddhist philosophy and confirmed by two decades of coordinating across health ministries — became essential to how I managed relationships.
A health minister who seemed obstructive was managing a cholera outbreak with almost no resources. A colleague who missed three consecutive meetings was watching her father die. Understanding this didn’t excuse poor performance. It changed how I framed the problem and what support I offered.
Teams strengthened. Programs improved. Not because I lowered standards, but because I started asking “what do you need to succeed?” before “why didn’t this get done?”
9. Systems Break at the Weakest Point
When your childhood depends on the reliability of a fishing line, a boat hull, a weather read, you develop an instinct for where things fail. It’s never where you reinforced. It’s always where you assumed.
During the COVID-19 response, I watched sophisticated global health strategies collapse not because capital-city labs weren’t excellent, but because samples couldn’t move reliably from remote areas to those labs. The entire system was only as good as its worst transport link.
Now, whenever I assess a program, I map the full chain and look for the weakest component first. Strengthen that, before anything else.
10. Love Is the Only Motivation That Lasts
This is the one that sounds least professional and matters most.
Technical competence gets you hired. Love — for communities, for justice, for what human beings are capable of — is the only thing that keeps you going when your third program fails, funding disappears, or political winds shift overnight.
I’ve watched brilliant people burn out because they were running on ambition or anger. I’ve watched people with average credentials sustain extraordinary impact for decades because they genuinely cared about the people they were serving.
That’s not sentiment. In a sector defined by complexity and deferred outcomes, love is the only fuel that doesn’t run out.
Living with Uncertainty
What Certainty Actually Means
Back in Geneva, looking out at Lac Léman, Dr. Makubalo’s question still sits with me. These ten things aren’t a formula for eliminating uncertainty. They’re a better relationship with it.
Like my uncle reading the ocean at 4 AM before we went out — you don’t get guarantees. You get a more honest reckoning with what you’re dealing with. And you come back with something worth bringing home.
The most certain thing I know is that tomorrow will challenge every item on this list. That’s not a problem. That’s the job.
What certainties has your field work given you? I’d be interested to hear them — particularly from those working in health systems, climate adaptation, or community development in 2026 and beyond.
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