My JOURNEY | Nahadsadrazodi

I am an immigrant-American with 25 years of frontline, managerial, and leadership experience in public health, development and emergencies. Over the years, I have learned to approach public health both through a systems thinking lens particularly in identifying problems and opportunities, as well as through community engagement and empowerment in determining priorities and sustainable solutions.

Below is a summary of my professional journey soon after I graduated with a Masters in International Health and Epidemiology.

In 1998 and 1999, I accepted volunteer opportunities in India (inter-faith health) and South Africa (microfinance) where I was immediately exposed to the complex systems and interactions in societies and communities that affect our individual and collective health and wellbeing. I learned early on that health is not only produced and impacted by the healthcare systems but also greatly by our homes, locations, race, employment, wealth, air, water, neighbors and friends, etc.

I spent the early 2000s working in the frontlines with non-government and local government agencies in various areas of public health, including HIV/AIDS and tuberculosis prevention, adolescent health education, psychosocial youth support, oral hygiene program in inter-city schools and refugee health. I discovered the art of collaboration and building relations with stakeholders ranging from high-level politicians and medical personnel to community leaders and women/youth groups.

By the mid-2000s, I had witnessed firsthand the complexity of human systems at the heart of public health and decided to pursue an advanced degree in change and knowledge management which explored the intersections of learning, performance and behavior change. I have since been greatly influenced and directed by the E+R=O system.

I joined the Centers for Disease Control and Prevention (CDC), Global Immunization Division, in 2008 and was seconded to the World Health Organization (WHO) Regional Office for the Eastern Mediterranean until 2012. It was an interesting time to live and work in the Middle East as in 2011 several countries, including Egypt where my family and I were based, made history in what later became known as the Arab Spring.

Over the last decade, though perhaps the seeds were planted during my undergraduate studies in microbiology, I have developed a passion for immunization, and have been fortunate to be part of several important initiatives. In 2010, in collaboration with national colleagues and global partners, I helped launch the first Eastern Mediterranean Regional Vaccination Week, which has since become an annual global communication and advocacy campaign promoting the value of immunization and ultimately influencing choices and behaviors.

During this period, I also contributed to improving evidence-based decision-making in the Eastern Mediterranean region. With strong regional leadership and commitment from national governments, I helped establish and strengthen governance structures for 21 National Immunization Technical Advisory Groups (NITAGs).

In 2012 and 2013, I returned to CDC and joined the newly-established Emergency Operations Center, where I helped manage global partnerships and provided technical, operational and communications support to the Polio Eradication Initiative in Afghanistan.

Late 2013, I was offered an opportunity to be part of UNICEF, whose former executive director, late Jim Grant, had a profound impact on the trajectory of my life and career. I worked in various specialist, managerial and leadership roles and capacities, serving in two very different regions, yet with notable familiar challenges of frequent political upheavals, remote and marginalized populations, and fragile health systems. As Maternal and Child Health Specialist in the Pacific, I helped integrate plans and programs not only within health (including newborn and measles) but also across other sectors, such as education, nutrition and water and sanitation.

Moreover, in 2016 as the Immunization Specialist for the UNICEF Middle East and North Africa region, I embraced the importance of generating reliable data to drive social and political demand. However, given the prolonged economic challenges and realities, I learned that governments have to make difficult choices in allocating their finite amount of resources for maximal societal gains.

In this regard, I benefited greatly from completing a graduate degree in health economics. The degree equipped me with relevant framework, tools and techniques to contribute to the regional efforts in ensuring sustainable, sufficient and efficient use of immunization financing given that several immunization programs in low and middle-income settings continue to face significant challenges with their fiscal space. For example, vaccine procurement is one of the areas with high potential quick wins and significant efficiency gains. Potential cost savings can be used to finance new vaccine introductions and to strengthen immunization system functions, especially in countries where donors’ assistance may be winding down.

Despite the regional role and responsibilities, I continue to return to my roots of appreciating that health happens at the local level by capturing the communities' voices through genuine engagement. As such, in the last few years, with great regional support and leadership, I collaborated with several country offices, partners and governments to build upon existing capacities and systems by mainstreaming under-utilized health strategies.

A few of these strategies relevant to the region included: intensifying efforts to identify, estimate and track displaced, mobile and neglected populations, such as urban slum dwellers, those displaced by conflict, migrants, and nomads; finding ways to identify and reduce missed opportunities for vaccination, including providing and integrating immunization services during the second year of life and beyond; and engaging effectively with the private/nongovernmental health providers in order to improve the coordination, quality, access to and reporting of immunization services.

In March 2020, I moved to Oregon (US) to assume the role and responsibilities of Director of Public Health for Deschutes County Health Services. The day (March 11, 2020) I landed in beautiful Bend, we had the first reported case of COVID-19 in the County, and the rest is history...

It was an honor to be the Public Health Director during an unprecedented crisis. I led a team of consummate and dedicated professionals who motivated me to be a better version of myself every day. In July 2022, I made one of the most difficult professional decisions in stepping down. It was time to reboot and recalibrate.

Part of my future will include doing my small part in advancing Diversity, Equity and Inclusion in our local communities. I have found my voice as a periodic guest columnist in our local paper.

Another part will be reflecting on the last two years and the lessons and observations which will guide my professional journey. These lessons will be added to an existing list that has held the test of time thus far, such as:

Public health should be approached both from an adaptive and complex system lens to 'see' the priorities, as well as through genuine engagement with national partners and communities to 'own' the solutions - which are often practical and commonsensical. In the complex world of public health, these simple solutions win because they expedite, execute and remove excuses.
Elite public health leaders are on a journey (rather than doing a job) and take people along with them through the relations and trust that they build and earn. Therefore, I believe that we all can have leadership qualities in us, as it's a role reflected in our daily choices and relations rather than by our title or level of authority.