The mission of Gary Darmstadt, MD ’89, to “fill in the gaps” as a global health and equality leader has taken him around the world and into an ever-broadening realm of effecting social change. From improving maternal and newborn care as a physician to being an advocate for family planning and gender equality, Darmstadt has led ambitious projects for the Bill and Melinda Gates Foundation and The Johns Hopkins Bloomberg School of Public Health, as well as a variety of humanitarian initiatives at Stanford University, where he is associate dean for maternal and child health and a professor of neonatal and developmental medicine in the Department of Pediatrics in the School of Medicine.
You’ve had quite a circuitous path to global health—could you talk a little bit about that? For instance, as an undergrad I learned that you studied crop science?
My past hasn’t been your traditional academic, straight-arrow path. It’s a little bit different. But I wouldn’t trade any of it. All along the way I’ve learned things that I’m able to apply to what I’m doing and I think it’s given me some unique perspectives.
With regards to my start in crop science, I went into that field for a couple reasons. One was I really liked the science of it. Also, I liked being outdoors, and I saw doing international agriculture as a way to be involved in trying to solve food issues around the world. I earned my bachelor’s degree in crop science at Cal Poly in San Luis Obispo, and then I went to the University of Wisconsin and got more involved in research in agriculture; in particular, I was looking at how herbicides can be used effectively to increase crop yields.
So I went through my master’s, and was about to enter a PhD program at UC Davis, when I decided to take six months and go down to Belize in Central America and work for a small NGO that was set up to give poor kids who flunked out of school the opportunity to get some vocational training and develop some skills and to get a job. I went down there to start their agriculture program, but when I arrived I learned you’ve really got to be flexible, you never quite know what’s going to happen. I actually ended up spending a lot of time building thatch huts to construct the school (which didn’t exist when I arrived) with a Mayan man who was just a brilliant guy. We would go out into the jungle and collect all the materials, bring them in, and create these buildings that he had in his mind, with no written plans. But it also gave me was a chance to go out and see what doctors were doing. I got to go out into villages, see them run clinics, and the more time I spent there, the more I felt like “Man, that’s me. That’s what I really want to do.” And that’s actually what ended up bringing me to UCSD.
That’s a really profound moment. What was it about seeing those doctors out in fields that appealed to you?
Absolutely. I saw them and thought, “You know, that ability to interact with people, to meet them where they’re at, to figure out how you can use what you know to help them,” I think something that’s characterized my career ever since is really thinking about these things: how do you bring science into real life situations? How do you bring it into different cultures when you’re working with a patient? How do you bring it into that patient’s life? And how do you translate that science in a way that engages the person and meets them where they’re at, and as best as you can, discern what brings value to them and that they leave the interaction boosted in some way? You know, I felt like in that interaction, you can dignify that person, you can convey a sense of worth and value to that person.
How did you end up choosing UC San Diego for your training?
There was the strong focus on science. I wanted to be in a place that’s really at the cutting edge of science and where you can think about things in new ways and where there’s a lot of room for discovery, a lot of room for challenging convention—conventional thought, conventional systems—that’s something that’s characterized my career. I wanted to learn to ask questions like, “Is this really as good as we can do? I think if we completely rethought this we might be able to do something different and better.” I felt like UCSD was a place that cultivated that sense of inquiry that was really up and coming, and I just felt like, “This is going to be an exciting place to be.”
And your career trajectory thereafter—you’ve been involved in so many things; can you lead us through your path?
After I left UC San Diego, I went to Johns Hopkins for pediatric residency, and I ended up going into pediatrics. It came down to a pretty simple decision that I just plain liked kids and wanted to help kids, and was drawn to that. And so pediatrics became a very natural choice for me. At Johns Hopkins, a number of my mentors were also doing global health work, and that’s really where I began to get exposed to public health and global health, and was really drawn to it. So I started reading and studying and thinking about these issues, and started to get involved in some research. I started to work in Bangladesh on a study. And as I was going through my pediatrics residency, one thing that I noticed is that pediatricians in general—and physicians in general—were not very good at understanding skin disease. It was a really neglected area, but if you’re going to be working and addressing issues in low resource settings, often what you’re going to have available is maybe your physical examination and actually what you see on your patient.
So I then went to Stanford and did a dermatology residency and I was able to combine it with a pediatric and infectious disease fellowship, which took me to the University of Washington. There, I really began to study the molecular genetics of how bacteria attacked and invaded the skin, and how they caused serious invasive infection. I was studying that, developing my laboratory career, while also continuing my connections with mentors at Johns Hopkins and was getting more involved in doing trials in low resource settings in Bangladesh and India.
And as I began attending meetings and getting opportunities to speak about these issues, “Save the Children,” a major NGO, came to me because I had been speaking around newborn health in these remote areas. I had realized that newborns were nowhere to be seen—they just weren’t coming in to health facilities. I can remember getting in with some colleagues driving around in this truck all over Bangladesh visiting health facilities and just trying to understand what the situation was, who’s coming in, who’s not coming in, and seeing that there’s really no newborns coming in, and then realizing that they were being born at home. They were being sequestered at home, as a means of trying to protect the babies. The doctors weren’t comfortable caring for them and I think the people kind of knew that, so they stayed home. So newborns weren’t getting medical care at all, and I began to think about this and began to do a lot of research on what are the issues and what’s the burden like and began to speak about this.
So “Save the Children” approached me and said, “We would like you to help us figure out this area and what we can do to address this.” They work in about 145 countries, so they were thinking pretty big. And I worked with them for a few months, helping them really dissect the issues. Turns out, they were writing a grant to the Gates Foundation for $50 million called “Saving Newborn Lives.” It was really the first major grant that anyone had received to do major work in low resource, low middle-income countries in addressing issues around newborns in the first month of life. They got the grant, and they came to me and they said, “We want you to run our research program.”
And so then I was confronted with: “Okay, so how do I do this now?” I’m in this great career, things are going well in the lab, I really like the science, but there was something missing for me. And there was a part of me that was always being tugged out to Bangladesh and these other places and cultures to work on those kinds of problems. I was energized by them. What seemed like massive problems, to me, looked like massive opportunities to try to do something, and to try to make a difference, and to innovate and try to come up with new solutions that could be applied in the cultural context.
So I thought about it for a little while, and I decided this is what I’m passionate about. I made the decision to go work for this NGO, and that’s where things really took off in my research career—really framing what is newborn health, what do we do about it, and doing a lot of studies to define new interventions, new ways of identifying illness in low resource settings.
Then my mentors at Johns Hopkins came back to me and said, “We want you to come to Hopkins, and establish a new international center for advancing newborn health.” There wasn’t anything like it in the world. So after two years with “Save the Children,” I went to Johns Hopkins and established that center and ran it for six years, and continued to do a lot of research, and it was really a great time in this field. We began to get a lot more funding and so it was really a great period of time to do a lot of research and change the field and even change the way the World Health Organization was thinking about it—getting global guidelines and recommendations for newborn health.
So I was at John Hopkins doing all this and loving it when the Gates Foundation asked me to consult with them about their maternal newborn child health and reproductive health strategy. Then they asked me to join them, which was another sort of crossroads. Here’s the most influential funder in this whole field of global health, doing a lot of really creative things. I looked at the opportunity and I thought, “I just can’t pass this up!”
I was there for seven years; an amazing experience. I went from initially focusing on developing the newborn health program to leading the strategy and program on maternal, newborn and child health, and then the nutrition and family planning programs came in. I eventually ended up transitioning into looking at issues of gender equality and how they impact health, because as I went through my career, I increasingly felt like so much of what we were seeing in the way of barriers to advancements in health and development had to do with disparities in power and disparities in opportunity, by gender. I began to think about how we address those issues.
It seems like one issue led to another and another?
I would say that my career has tended to go the opposite direction of most researchers—most people tend to go deeper and deeper and deeper into a subject. But what I realized, as I went through my career, is that when you’re working with families, with communities in these settings, that these issues are all interrelated. So, for example, when I walk into a village, I look around and I notice all the agriculture going on. Most of these societies are agrarian, and agriculture is kind of the center of their lives. Most people in public health will hardly give it a thought—unless you’re in agriculture development—but to me, I know that’s the centerpiece of community life, so I would always pay a lot of attention to that. And that was because of my training in agriculture.
I’ve done a lot with regard to skin, as a completely neglected aspect of health, and have used it as a vehicle for providing a number of beneficial interventions. But as I went along I did see these broader disparities. In some ways, I was seeing different manifestations of a more fundamental problem. At the Gates Foundation I was doing a lot of work around family planning. We were working to really revitalize attention to family planning around the world, which is a major means for also improving maternal health and child health and well-being and economic development. Even in the work I was doing with nutrition, so much of what’s really beneath these issues is just disparity: in some cases its social status; in some cases it’s economic; in many cases it was gender discrimination and limitations in opportunity. So that was the last thing I did with the Gates Foundation, was focus on that area.
And now at Stanford, I get to do whatever I can fund, basically. So I’m working on some aspects of newborn health, I’m working on some aspects of child development, I’m working a lot on gender equality, and I’m beginning some new things in looking at health care in situations of conflict. If you look around the world now, and look for where we’re making the least progress in health for mothers and children, it’s increasingly in situations of conflict. So how do you think about bringing care into those kinds of situations in ways that are more strategic, thinking about political and governence systems and health systems—how do you bring those together in a smarter way? My approach to a lot of my work has been “let’s understand the issues; let’s create a strategy around how you make a difference,” and “let’s devise new approaches and better ways of achieving better outcomes and addressing these disparities.”
What would you like people to know about why you do the work you do?
I’m a person of pretty deep faith, and I think it’s out of that that I think a lot of my values and my principles come. I just try to apply those values everyday through my work and the way I interact with people. The opportunity to dignify people, to empower people, to help people live through to their full potential for why they are here on this Earth, I feel like that’s kind of why I am here. That’s fundamentally why I do what I do, and it’s such a privilege that it ceases to be work, you know? It’s just how I think I’ve been wired.
It relates to something I talk to my students all the time about—how sometimes they will wrestle with, “Well, should I go to Namibia? Should I go to East Palo Alto? Where should I go and what should I do?” and I always tell them, “Just find what you love.” You know? Find what ceases to be work. Find the thing that you think about and where you can apply your skills in a way that brings you joy and happiness and energizes you and that helps other people. There’s nothing better than that. And that can be anything, you know? That can be working in Namibia; it can be working in a lab on the most basic scientific endeavor. You find what you’re equipped and made up to do—that’s your space, then just thrive in that space. Take advantage of every opportunity that comes your way. Don’t be afraid to take risks. Don’t be afraid to fail. Learn from those failures, and keep moving on.