Dawit Bisrat, Country Director, Ethiopia
Dawit Bisrat grew up with his four sisters, one brother, parents and grandmother in Tigray, Ethiopia, the arid northernmost region of the country. They lived in a district named for the mountain chain that encircles it to the east, but Dawit equally appreciated the plain, flat horizon to the west, which led to stunning, uninterrupted, yellow sunsets.
While Dawit enjoyed playing soccer with friends and sneaking to swim in dangerous rivers during the rainy season, much of his childhood was overshadowed and hindered by war.
By the time Dawit was a teenager, he and his family had lived through two long wars. During the Ethiopian Civil War, which stretched from before Dawit’s birth until he was 6, he saw wounded and dead soldiers scattered out in the open, and he lost several family members, who were guerilla fighters. During the Eritrean-Ethiopian War, Dawit was in high school. He missed one year of school and lost several classmates who died in the fighting.
Dawit says that living through such volatile events made him a generally peaceful person, and one driven to live with urgency and purpose. Living through war also left Dawit fascinated with leadership, especially how leaders can prevent problems that are foreseeable.
“I remember that I used to say, ‘Why is this happening to us?’ We are kids, and we are supposed to go to school, supposed to be happy and play soccer, but during the war time, school was closed, and we couldn’t go out to play with our friends, and there was no TV, no electricity,” Dawit said. So, he read his father’s books—many of them translated politics books. “That helped me to understand that the war was man-made and could have been prevented. Then I started to say that if I were a leader, I could have avoided the war.”
In Ethiopia, students are placed in university and told what to study, based on the country’s needs. Dawit was interested in leadership or management, but he was placed in the University of Gondar, Ethiopia’s health science and medical school, to study nursing and laboratory science.
After graduating, he went to work in the university hospital, where he became one of the youngest department heads, president of the health care worker association and a member of the hospital management team.
“I saw many people dying from preventable disease because of poor management. That gave me emotional courage to pursue my dream of becoming a leader,” Dawit said. “A lot of people working there would say we have a bad system so we can’t do this or that, but there isn’t any system that says don’t be motivated or creative or be nice to coworkers. I would ask why the work is not up to standards and challenge the leadership when I saw poor management. I was outspoken. The hospital managers didn’t like me, but placed their trust and confidence in my commitment and ability to change things for the better.”
In 2009, after six years at the hospital, Dawit joined the Clinton Health Access Initiative, working on its Ethiopian Rural Initiative, building the country’s primary health care capacity and strengthening systems to better report on maternal and newborn health and services for tuberculosis, HIV and chronic conditions.
Through this work, he learned that just 15% of women in Ethiopia were delivering babies in a facility and that maternal deaths were high. In response, Dawit and his colleagues engaged community leaders and health extension workers to encourage pregnant women and their husbands to follow up antenatal care, while also improving the quality of service at health centers to build trust and improve the community referral system. Through listening, they learned that for women who wanted to deliver in facilities, the biggest challenge was transportation.
“We established a team called a ‘community ambulance’ where local youths carry pregnant women on makeshift stretchers to transport them to the health centers,” Dawit said. “Now the rural areas have better access to a motorbike ambulance system, and there is still much to be done.”
Yale University was the external evaluator of this project. After several interviews, and because the health facility Dawit oversaw was one of the best performing sites, he was asked to interview to join Yale in 2011 at the Global Health Leadership Institute. His primary goal was to develop communication between Ethiopia’s health facilities and the ministry of health for the first time, which would also allow the development of indicators. He was also charged with coordinating a master’s degree program in Hospital and Healthcare Administration, designed to nurture the leadership capacity of hospital and regional health managers.
While at Yale, Dawit earned his MPH and his master’s degree in business analytics in international business. In 2017, Yale sent him to Rwanda for two years to manage a master’s program there.
In 2018, Dawit sought a break, after intense years of work and schooling. He took a sabbatical year to spend time with family and friends and travel. Former colleagues repeatedly sent him vacant governmental positions to apply for, but he was not ready or interested. He saw an open position with Vital Strategies’ Resolve to Save Lives initiative, but he felt that it was more narrow, focused on hypertension, compared to the systems strengthening work he had previously been doing.
One day, a friend called to say that Jeannie Mantopoulos, Resolve to Save Lives’ Chief Operating Officer, was in Ethiopia and searching for people to interview. Dawit knew Jeannie because they had worked together at Yale for many years. The friend convinced him to apply for and take the position, which he quickly grew to love.
“Many programs have funded millions in Ethiopia on infectious diseases, but there was no funding for road safety, for data and for noncommunicable diseases,” Dawit said. “Hypertension is a very neglected disease. Many people think it is a problem of developed countries… Only 3% of those with high blood pressure seek health services. And then when we improve hypertension service, we are also improving services for others.”
In 2019, Dawit came to New York for meetings with the Resolve to Save Lives Cardiovascular Health team, and suggested that Vital Strategies register in Ethiopia and open an office. In the past year, the office has grown to 17 people and officially registered in July, with Dawit as the country lead. He is in the process of hiring six additional people.
The COVID-19 pandemic thrust Dawit into emergency response work. He was one of a few people who had permission to travel and work in the Federal Ministry of Health office. He became the liaison between the ministry’s task force on COVID-19 and Vital Strategies’ communication, surveillance and contact tracing teams in New York. He participated in full days of calls, while also urgently draft funding proposals and concept notes.
Through this, he has often had trouble sleeping, waking during the night wondering what would happen next, thinking about poor outcomes he could prevent, scribbling down potential solutions to problems and second guessing some of his decisions.
“Ethiopia wasn’t ready for anything, for any pandemic. We have a weak system for emergencies and in health facilities,” he said. “We moved the majority of the resources in health facilities for COVID-19 and forgot the essential services. Sometimes I feel that we were right, that we have to invest in COVID-19 because we don’t know anything about it. We saw what happened in Italy and New York, but we also shouldn’t stop essential services. About 173 people die every day from cardiac health issues. People are dying because they think facilities are closed because of COVID-19 or fear they will die from COVID-19.”
In addition to this work, Dawit supervises a growing team. Checking in with them regularly has made him feel less lonely during the pandemic.
“In Ethiopia, we respect when leaders are so strong, aggressive and autocratic. That’s how we grow up and understand leadership but that’s not important or effective now. You have to be nice to people. Leadership starts from there. And if you are nice to yourself, you will be nice to others and see positive things in others and help them grow.”
“When I see challenges, I always think how could this have been prevented, and I go back and see if that was preventable. I believe good leadership saves lives.”
Dawit feels inspired by the leadership of Elizabeth Bradley, now the president of Vassar College in New York, by Tom Frieden’s leadership and that of Dr. Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization.
“Betsy (Bradley) looks at details, small details that can bring significant change. You can start small, and use the resources you have, and if you find the one thing that is very important and solve that problem, you can solve most of the problems you have. From Tedros, I have learned from his charismatic personality and his ability to balance tasks and relationships. And Tom Frieden is amazing. He knows where to implement work and where the challenges are. And he’s flexible and quick to respond, like how he mobilized funding to support the fight against COVID-19. He thinks way far, like we can save 100 million people worldwide. That’s amazing vision. I’m so glad I’m a part of that vision.”
Dawit has always dreamed of being a public health leader in global health, to have the power to avert foreseeable problems.
“Because I lived through wars, I saw a lot of people dying, our economy went down and a lot of families were separated, not because we don’t have the resources, but because no one planned ahead of time,” he said. “When I see challenges, I always think how could this have been prevented, and I go back and see if that was preventable. I believe good leadership saves lives.”