Women in Public Health: Transforming Lives, Carving Paths, and Paying It Forward.

Published online: 4/4/2023

For any aspiring young professional, in any discipline, mentorship is key. Not many are lucky enough to have found themselves a mentor as I have when I made a career shift from clinical medicine to public health.

Having gone through a career pivot herself, Sesnie Zemichael, Smile Train’s Senior Program Manager for East Africa, has a story that is truly one for the books. 

Today, I have the honor of sitting down with her; a great mentor, a supportive colleague, a phenomenal woman, and a dear friend. I am Eleleta Surafel, and I am hosting Sesnie Zemichael today. 

Have a wonderful read!

ES: Thank you so much for your time, Sesnie.

SZ: Of course! Thank you for choosing my story.

ES: Let’s jump right in, shall we?
Let’s start off by a brief history of your professional background.

SZ: My training is in Marketing Management, but I have spent the majority of my career working in the humanitarian and development space with international organizations such as Department for International Development (DFID), Save the Children, World Bank, Irish Aid, Canadian International Development Agency (CIDA) and now Smile Train. I have also had the benefit of working in the private sector, including startup, and running my own business.

My scope of expertise spans across program management, finance, human resources, operational and managing strategic partnerships across Africa, where I have led large programs with multidisciplinary experts, across a wide geographic area.

ES: Oh wow! So health management is quite different from all the other programs that you’ve managed prior to this role. What made you decide to take up this role? What was the transition like?

SZ: Taking on the role of managing a health program was indeed a bold move for me, especially considering that I had no prior experience in the medical field.

However, when I joined Smile Train, I was excited to take on this challenge because I saw the opportunity to make a difference in the lives of people who were affected by cleft lip and palate.

Believe me, the transition was not easy, as I had to learn medical terminologies, understand the science, and familiarize myself with protocols and procedures from scratch. But I was determined to succeed, and I employed a lot of innovation and tact to maneuver. One of the things that helped me move through this new terrain was my capability of building meaningful relationships quickly with a range of professionals in the medical space. They were willing to hold my hands, and I was determined to learn fast.

I will forever be grateful to the surgeons, anesthetists, nurses, and other experts who helped me navigate, benefiting me and the program at large. The past 8 years of my career in this role have helped me build some of the most important relationships of my life. Even though cleft management was quite unique from all the other programs I had managed, it has been one of the most rewarding experiences that taught me the value of resilience, determination, and building strong professional relationships.

ES: That’s a beautiful way of putting it. How would you say your role at Smile Train relates to you as a person and as a professional?

SZ: My role at Smile Train goes far and beyond my professional development. This role has allowed me to grow emotionally and has given me a greater purpose in life. Working for an organization that is committed to transforming the lives of individuals with cleft lip and palate has been incredibly rewarding.

The “why” behind what I do every day is crystal clear. Our programs are designed in a way that is unique and sustainable. We empower local medical professionals to provide free and comprehensive cleft care to patients in their own communities. This commitment requires us to have a deeper understanding of the different environment & landscape we operate in, we identify areas for improvement in the health system, and invest in the necessary resources to ensure safe & quality care for our patients.

But beyond the technical aspects of our work, the true impact lies in the immediate transformation that we see in our patients’ smiles, as well as the ripple effect it has on their families’ lives. As a mother myself, I can empathize with the parents and guardians of children with cleft lip and palate. I understand the social, emotional, and economic burden that comes with having a child with a facial difference in a society where there is limited awareness, and support for people born with this condition. It brings me great joy to be able to play a role in alleviating some of that burden and make a significant difference in someone’s confidence and self-esteem.

Therefore, my role has not only allowed me to grow professionally, but it has also given me a sense of purpose and a deeper appreciation for quantifiable impact in development.

ES: Anyone who works in the healthcare sector has that one story that changes or influences the entire trajectory of their perception, career, and behavior. This could be the story of a patient, an attendant, a healthcare professional, or even the healthcare infrastructure or facility itself. Can you share a story that has been pivotal for you in that regard?

SZ: I have been fortunate enough to encounter many patients whose lives we have been able to transform. However, in 2015, there was one patient in particular whose story has stayed with me and influenced the trajectory of my career.

Akile Tosa, a 22-year-old young lady from the Oromia region in Ethiopia, had been labeled as “Broken Mouth” by some people in her community due to her cleft lip and palate. She grew up feeling isolated and rejected. She’s never been to school or had any friends.

But what brought tears to her eyes was the fact that she was never invited to participate in the daily customary coffee ritual in her village. As she shared her story with me, she tearfully recounted how she could hear the laughter and chatter of the young women in her neighborhood, but she was always left behind.

Hearing Akile’s story, I realized that a simple act of exclusion from a community ritual could have such a devastating impact on a young person’s life. It reinforced for me the importance of providing access to quality healthcare and supporting individuals who are marginalized by society.

Akile underwent successful cleft lip and palate surgery. The transformation in her appearance was incredible, but what struck me the most was the transformation in her demeanor. For the first time in her life, Akile felt seen. She had a newfound confidence and joy that was contagious.

Akile’s story, as well as many others that followed, have stayed with me for a long time. It has shown me the value of hearing our patients’ stories firsthand and understanding their pain. It has also highlighted to me the significance of a simple surgical procedure on someone’s life. 

ES: What a story!

SZ:  It really is!

ES: What are some of the projects that you are proud of? And how did you come to conceive and initiate these projects?

SZ: I am incredibly proud of the many projects that I, along with my team and partners have been able to implement in the regions under my docket. Amongst these, are some that stand out to me in terms of the impact they’ve had.

One of the projects that I am most proud of is kickstarting and expanding our programs in Somalia and South Sudan. These are regions that have historically been challenging to reach, due to security challenges, poor infrastructure, and trained manpower. However, through the hard work of a dedicated team, support from our management and donors, we have been able to provide access to free and comprehensive cleft care to people who previously had no access.

The other initiative that stands out to me is the establishment of the Africa Surgical Safety and Quality Reviewers Network. This network was born out of the need to standardize surgical care across our partner hospitals and to identify health systems that require strengthening not just for cleft patients but also for every patient that gets to access the facility. Through this network, we have been able to strengthen safety protocols and share best practices by learning from one another in the continent.

Again, another project that has been particularly instrumental in the efforts to grow speech therapy program in Ethiopia is the training and mentorship program we implemented through the years where we have been able to increase the number of cleft speech therapists from 1 to 17, practically empowering graduates of the Addis Ababa University speech therapy program, to continue their career with their craft, ultimately improving the care that we are able to provide to our patients.

Finally, I am extremely proud of the innovative and trailblazer psychosocial support project which is a brainchild of myself and my team, ‘The Moving Smile. This project is currently funded by Smile Train and implemented by SunEko, a local NGO in Ethiopia. This project employs artistic endeavors to help alleviate the psychological burden faced by cleft communities through providing them creative outlets of expression such as amateur sports, art therapy, social circus, music, and performance art as a tool to re-engineer the belief they have about themselves and give the public an opportunity to re-imagine people with cleft as able & productive beings. The project also works to uplift & inspire cleft communities through trauma healing sessions and counseling services bring about tremendous impact on the emotional wellbeing of our patients and their families.

These projects and many more were born out of deep conviction, commitment, collaboration, and innovation to improve the quality of people’s lives and have one way, or another improved the livelihood of families economically empowering them to positively contribute to society.

ES: All that in under a decade? That’s amazing!

SZ: Thank you! But we’d like to believe that we’re only getting started.

ES: And we look forward to seeing a lot more. So to lead a program as successful as yours, it requires good leadership and management qualities. When did you realize that you are a leader?

SZ: In my opinion, leadership is not a destination, rather a journey of continuous growth and development. Throughout my career, I have had the privilege of working with many outstanding leaders who have inspired me to pursue brilliance in all that I do and covered me when I felt extremely vulnerable.

I have been encouraged by my family and even pushed sometimes to take on leadership roles, despite my discomfort. Whether it was in school, working in teams, or community groups, I have found myself naturally gravitating towards positions of responsibility and influence. However, it wasn’t until I started my career in development and eventually in healthcare, that I truly began to understand the importance of effective leadership.

Working alongside many skilled and experienced leaders who have mentored, guided, and collaborated with me throughout the years, I have learned that leadership is not just about me being in charge but about serving others and creating an environment where everyone can thrive. I have met many beneficiaries taking on a leadership role in their communities advocating for their own cause.

Therefore, as a leader, I am deliberate about inspiring my partners and motivating my team, by setting clear goals and expectations, and empowering and supporting them to achieve their full potential.

I’m also mindful that leadership is not something that is bestowed upon me, but rather a quality that I must continually work to develop and refine. I am grateful to the many leaders who have gone before me and made it possible for me to succeed, and I am committed to using my leadership abilities to help others be more.

ES: Interesting. And of course, managing any program is a very challenging feat, much less on a regional scale where you must navigate through several challenges. What drives or inspires you to look for ways around these challenges?

SZ: Managing a program on a regional scale is undoubtedly a complex undertaking, and there are many challenges that must be navigated to achieve success. However, what inspires me to keep pushing forward and finding solutions to these challenges are the people that we serve and the hard-working medical professionals who make our programs possible.

Despite the cross-cultural terrain, the logistical and HR challenges that we face in countries like Somalia, Djibouti, South Sudan, Malawi, and others, I am continually inspired by the resilience and determination of our team on the ground. These individuals work tirelessly to provide free and comprehensive cleft care, often in the face of resistance from the community due to myths and beliefs surrounding the condition.

At times, it can be disheartening to see cleft lip and palate ranked low on the priority list of national health programs, resulting in inadequate attention by governments due to competing priorities. However, even in the face of these challenges, our team remains committed to our mission and dedicated to improving the lives of those we serve.

Therefore, what drives me to look for ways around these challenges is a deep sense of purpose and a desire to make a difference in these communities. I know that our work is important, and the impact we have on their lives is significant.

ES: That is quite inspirational. So we’ve talked about overcoming challenges and navigating hurdles. I would also be interested to know some of your projects that you would say have “failed”?

SZ: Yes, failure is inevitable when implementing any program, despite our best efforts. Over the course of my career, I have experienced my fair share of setbacks and failures, but it is often through these failures that I learn my most valuable lessons.

One such failure that stands out to me occurred when we brought in trained professionals from other African countries to train local professionals in one of our programs. We had hoped that by providing continuous training and mentorship, we could empower local professionals to own the programs and build sustainable healthcare systems in their communities. However, we discovered that the desire and the commitment to be trained was not there.

We have also faced setbacks due to external factors such as illness and pandemics, where the only surgeon helping a particular community dies, and our program hits a snag. In other instances, war, famine, and outbreaks have aborted our plans, leaving patients in dire situations for extended periods.

In some cases, we have had to withdraw our efforts, step back, and strategize. In other times, we have had to accept the failure and learn from it, so we improve our programs moving forward.

Failure is not always the end of the road, but rather an opportunity to learn and grow. Through our failures, we have been able to identify areas of improvement, refine our strategies, and ultimately achieve success.

ES: And what would you say are some aspects of the program that will need to be strengthened? Areas that need attention as much as your successful projects.

SZ: As with any program, continuous attention and improvement is required by all stakeholders and government agencies to maximize the impact of our programs. Nutrition is one of the critical components of any healthcare program, and it is vital for children with cleft, to have optimal nutritional status to ensure that they are fit for surgery. However, malnutrition remains a significant challenge in many African countries, and it is imperative to address this issue with priority.

Speech therapy is also a vital aspect of cleft care, as it significantly affects a patient’s communication ability, development, and overall confidence to grow and thrive in society. 

The next critical area for me is anesthesia care, which requires the utmost attention when talking about surgical safety. Governments, donors, and other stakeholders will need to put in a lot of time and effort to train and increase the capabilities of non-physician anesthetists alongside anesthesiologists. Continuous education and training are necessary to ensure that these professionals are well-equipped to provide safe and quality care.

Lastly, a comprehensive, cross-cutting approach to intervention and collaboration is essential across stakeholders and funding agencies. By working together and sharing resources and knowledge, we can develop effective strategies to address the complex challenges facing our cleft communities. In addition to the areas mentioned above, incorporating reliable data and information into program design and implementation is also critical. Establishing a birth defect registry is necessary to accurately track and monitor the incidence of cleft lip and palate, as well as other birth defects. This data can help us better understand the prevalence of these conditions and tailor our programs accordingly.

ES: And finally, what piece of advice do you have for young professionals like myself looking to make a mark in their communities, regions and the world at large through such programs?

SZ: My advice to young professionals such as you would be to remain open-minded and curious, trying new things, and engaging in volunteer work and initiatives that will allow you to explore your passion and refine your sense of purpose will broaden your horizon. Don’t limit yourself to what you have been told you’re good at or skills that you’ve already learned, but instead be flexible to embrace new challenges and opportunities.

Once you’ve found your sense of your purpose, it’s important to be patient, resilient, and determined in pursuing your goals. Don’t be afraid to ask questions and learn from others. Seek out mentors and experienced leaders who can guide and support you along the way.

In addition, building and maintaining meaningful relationships with people, colleagues, and collaborators is critical to succeeding in any field. Adapting to new and unfamiliar environments, however, is scary. Having a collaborative approach and working with others can help you achieve more than you could on your own, giving you valuable learning opportunities.

Ultimately, it’s important to recognize that the path to success is a journey of growth and development, and it requires a willingness to learn, adapt, and evolve over time. By embracing new experiences and seeking out guidance and support from others, young professionals such as yourself can pave the way for a fulfilling and meaningful career.

Author: Dr. Eleleta Surafel
Nutrition Advisor, Smile Train - East Africa.
email: - eleletasabay@gmail.com


F.Kifle assisted with the writing and editing of this article.

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