Nairobi Terrorism and the Hierarchy of Trauma

Talking about evil is hard. It involves at least two paradoxes. Here’s the first. On the one hand, to denounce evil is an ethical act. It is to affirm our deepest values and to commit ourselves to preventing acts that dehumanize others. On the other hand, to denounce evil can be an unethical act. It is a way of demonizing; it is, precisely, to dehumanize another. Here’s the second paradox: On the one hand, we need to the concept of evil to philosophically and ethically distinguish acts that shock our consciences, acts that are not adequately encompassed by words like bad, wicked, or wrong. The concept of evil clarifies. On the other hand, the concept of evil confuses, prevents thinking. We imagine evil is other than human, beyond understanding, almost mystical. This lets us off the hook, lets us deny our own capacity for evil, and stops us from analyzing the very human, very common causes of it.

James Dawes: The Guts of Atrocity

I have never quite known what to react in the wake of tragedy. Saying too much almost feels too opinionated, and saying too little almost feels to insincere. I remember my first encounter five years ago with a personal tragedy and death was uncontrollable laughter. Apparently my ‘coping’ mechanism then, was to try to see the humorous side of the story. Highly inappropriate. But now, over the past week, I am finding no humor that can help me cope as I watch Kenya balance a growing sadness of a nation, the anger of their citizens and the anguish of loved ones as terrorists stormed an upscale mall in Nairobi claiming over 60 lives.

As emails, phone calls, texts and social media updates came pouring in, the irony is not lost on me on how tragedies happen everyday around the world and yet, why is it that this one just seems so much more real. As my emotions slide between the continuum of “why” and “shock”, a strange version of this Hierarchy of Trauma began to emerge. As I scroll through the news for updates on Nairobi on that day, and throughout the week, it dawned on me that hundreds of people die and are affected by conflicts around the world. In Pakistan, 81 people perished in a church suicide bombing. In Nigeria, over 500 perished in terrorist related violence in the north of the country, and the on-going Syria crisis has claimed tens of thousands of lives. Countries and communities that I can’t even comprehend who and where – are suffering. Yet, why my heart aches the most for my Nairobi home and only for a fleeting moment of empathy for the news in Pakistan.

And suddenly it struck me, trauma and grief isn’t a competition or a hierarchy. We each grieve for different losses, in our own way and in time. There is no trauma that is superior to, lesser, greater, less shocking, better covered, or any other comparative phrase, than the suffering of any individual or community. All we can do, is know that even if your experience does not have a chapter in other stories of conflict and trauma, it still a part of our story as humanity as a whole.

Thinking of you.


Selected pieces that provide different perspectives on the Nairobi incident:

1) Generosity of citizens in donations for the victims

2) NY Times on the Value of Suffering 

3) A Tribute to a Friend: Ravi

4) Aung San Suu Kyi: the Freedom from Fear

5) A beautiful piece in The Nation on forgiveness

6) Nanjala Nyabola in Al-Jazeera on Keeping the Nairobi incident in perspective 

7) An interview with author, James Dawes on his new book: Evil Men – a collection of dialogues with war criminals from the Second Sino-Japanese War (1937-1945)

Leading Change in Emerging Health Markets

About a month and a half ago, I was in Istanbul attending a global private health conference hosted by the International Finance Corporation (IFC) and John Hopkins Medicine International. The event brought together global leaders in the private health industry to have share ideas, knowledge and lessons in the industry. Participants were mainly senior management/CEOs across the health value chain from health service providers to pharmaceutical & medical technology manufacturers to investors in emerging markets. On top of the conference, my team organized a separate panel session for health providers in sub-Saharan Africa.

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I just wanted to share some of my notes and key takeaways from the conference as I was really struck by the discussions of the world’s leading health providers and how it feeds into my work as an investor in emerging markets. Essentially, how I should be looking at the overall market and types of deals I should be focusing on. There were two presentations in particular that I would highly recommend going through, which is Credit Suisse’s Capital Markets Perspective on the healthcare services sector and IFC’s lessons from investing in hospitals.

  • Health is a major driver of GDP growth in OECD countries averaging approximately 7.3% as a percentage of total GDP.
  • There is an upward trend of life science tools and medical equipment providers in terms of performance
  • When comparing trading valuations (EV/EBITDA), EMEA and RoW companies significantly outperform American companies in terms of revenue growth, particularly in Acute Care provision
  • Banks are shrinking their lending portfolios particularly in SSA
  • M&A activity will continue to increase in a fragmented market with private equity playing an important role in sector consolidation
  • Healthcare services are trending from inpatient to outpatient, invasive to non-invasive, and from treatment to prevention
  • The global financial crisis slowed growth rates of companies in IFC’s portfolio, but none experienced a drop in sales – indicating that hospital businesses are resilient but not immune to the global financial crisis
  • IFC’s revenue projections were reasonably close to actual, on average erring 5% lower than actual (which is impressive!)
  • The health market in SSA is an SME market, hence a need for smaller deal sizes, or a consolidation of deals for increased access to financing

Overall, the conference left me feeling uplifted, but also a great sense of urgency in terms of the work that I am trying to do. The conference was IFC’s 5th annual healthcare conference and am already looking forward to the next one.

Responsibilities of an (Impact) Investor

For the past few months, I have been reflecting a lot on my role as an investor. Business plans and proposals come across my desk and as I shift through them, it really struck me on how large a responsibility investors play in accelerating trends, shaping a community or even country’s economy, but yet how little this responsibility is spoken about in the investing circles. We place so much emphasis on finding the right business, the right management team, the right social impact, that sometimes we get lost in our own capacity to recognize what really is innovative and what truly deserves to be funded. So, from my experiences, here’s what I think an investor’s responsibilities are on top of the typical investment work:

1) Investors need to live in the future. 

This is a point I feel very strongly about. If you’re an investor: VC/PE and particularly if you play in the startup and impact investing work, (as Fred Wilson pointed today in his blog post and what Paul Graham said):  you should live in the future and see what is missing. So well said. I’m currently in an environment (yes, I recognize that I am in Africa – so feel free to shower stereotypes), where I know investors who are still using yahoo mail, internet explorer and Windows 2003 (true story!). Not to say that there are anything wrong with the products, but more so – I think it’s so important to be keeping up with the trends in the world, technology being one of them. How can you expect to identify an investment that is ‘ground-breaking’ if you’re not even following the newest trends in your sector? Taking this a step further, if you are following these global trends vs. local trends, it is then our responsibility to seek out entrepreneurs who can close this gap and further elevate the developing world, or the developing world would forever be playing ‘catch up’.

2) Don’t be a sheep. 

This responsibility is particularly important in the impact investing space. Given that we’re playing in a field that is largely uncharted, risk is high and typically, most investors are unable to size up a new market and end up relying on the opinions of other investors. aka. I’ll invest if someone else will too aka. a sheep. Impact investors say that they are risk tolerant, but few translate this tolerance into signing along the dotted line. A very chicken and egg situation. Hence, I have to constantly push myself to understand what is the right balance of being a market leader but also not be a reckless investor. Balance is key.

3) The need to close and disburse faster

There are a lot of delays that occur in [impact] investing. The courting of investors and [social] entrepreneurs, the dance between finding the right termsheet, the issue of making sure that the social impact actually has an impact, and [insert your traditional delays in investing here]. This is the norm. This is my challenge to investors: recognize that the longer the delay, the bigger the strain on the business/organization. From an entrepreneur perspective, you’re constantly watching your ‘runway’ aka. how much money do I have before I run out, and a delayed closing round and disbursement is to the [social] entrepreneur’s disadvantage as well as to their customers. If we’re really standing with the poor, then deals need to close quicker with clear and simple terms, as the longer the delay, the more people are missing out on potentially experiencing the product/service.

This is by no means supposed to be an exhaustive list of responsibilities, but instead ones that I feel are most important given my experience. As investors, we are in a privileged position to start/continue or end trends. I think it’s time that we started thinking a little harder about where our responsibilities lie.

My Week’s Discoveries: Healthcare & Design

I’ve been spending a lot of time in the healthcare world for obvious reasons, and have been immersing myself with knowledge from all angles. One of the more fascinating angles is the cross section of healthcare and design. Here’s a couple of my favourite findings:

1) Cutting for Stone by Abraham Verghese

It’s been a while since I’ve read a work of fiction and I was highly recommended this book by my Acumen Fund colleagues. I finished this book over the weekend and was so captured by the story, outraged on behalf of the protagonist, delighted by the intensity, and overall overwhelmed at how beautifully written this book was. It’s a story that takes place from Ethiopia to New York, about love, medicine and the intertwining of fate.

We are all fixing what is broken. It is the task of a lifetime. We’ll leave much unfinished for the next generation

– Cutting for Stone, A. Verghese

2) Butaro Hospital in Rwanda 

When you look at East Africa’s healthcare landscape, Rwanda stands out as a medical success. Health indicators have improved on all counts since the genocide, all primarily due to the success of a universal health insurance, where the poorest 25% of Rwandans get free medical care. One of my favourite things about the Rwandan healthcare landscape is a hospital, Butaro hospital that was designed by MASS Design Group The hospital has no hallways, so patients can’t gather in close spaces, and the air in the wards are changed more than 12 times per hour to prevent patients from being infected by other patients – particularly, with multi-drug-resistant TB.

Image taken from: ArchDaily by Iwan Baan

3) Future of healthcare is Social – Fast Company 

I recently was in Tanzania attending and speaking at a mobile health conference organized by USAID and the MInistry of Health of Tanzania. The theme at hand was the increasing technology and mobile penetration that is changing the health landscape in Africa. There are over 500 mhealth projects deployed around the world with the majority of projects (over 30%) being in Africa. I really enjoyed this article by Fast Company on the increasing social nature that comes along with the increased technology presence in healthcare. Also worth reading is another article by Fast Company, on 5 steps to designing a better healthcare system.

4)  Design for trust – UX Magazine 

Good design isn’t beautiful. Good design builds trust. As an investor, when I evaluate healthcare interventions, I look to see how the service accounts for factors that matter to a person’s dignity: they way they are being treated, training of healthcare staff and accessibility of information. This is especially important when dealing with the poor, who are used to being marginalized, and not receiving proper service. The article is more web-based trust, but relevant nevertheless, when thinking about how you interact with a patient. At the end of the day, when receiving medical news, everyone wants information that is “correct, complete and unbiased.”

7) Designing Handwashing – Core77

An older article, but a goodie in addressing one the most fundamental issues in healthcare: Handwashing. A great read in exploring: Movement Design, Muscle memory, movement scripts and fluidity.

Dambisa Moyo: Why aid is not working and how there is a better way for Africa

I am so so unbelievably stockedexcitedhappybreathlessinanticipation for this event. Seriously.

I read her book, Dead Aid, when it first came out and it opened my eyes to a very different perspective of aid, development and the financial world. Her views are a challenge and a strong vision on how to address the global poverty issue. Spread the word (and read the book!)

Image from

Half the Sky: Turning Oppression into Opportunity for Women Worldwide

Women hold up half the sky – Chinese Proverb

Reality is hard. It is a startling revelation at times often because we choose to surround ourselves with our view and experience of the world. This Thanksgiving, I am reminded of reality when I sat down to read Half the Sky by Nicholas Kristof and Sheryl WuDunn. In Half the Sky, Kristof and WuDunn throw an interesting twist into the conventional view of plights of women around the world: by telling their stories. From Cambodia to South Africa. From sex slaves to maternal health. By putting a name, emotion and passion into the stories. This tentative foray into the realm of story-telling melds surprising well with what is, essentially, a passionate call to action against our generation’s most pervasive human rights violation: the oppression of women and girls worldwide.

The opening of the book follows the story of Srey Rath, a young Cambodian teenager, who was sold as a sex salve across the borders, ending up in Kuala Lumpur, Malaysia where she endured routine brutality and constant humiliation. It was a huge shock to my system, as Malaysia is someplace I call my home town…  to read in such vivid detail the human rights violation done to Srey Rath was stunning in every sense.

These stories of human perseverance, injustice and ultimately hope, just like Srey Rath, are woven into three main issues: sex trafficking and forced prostitution; gender-based violence e.g. honor killings and mass rape and maternal mortaility. Sub issues include education, microcredit and religion. The stories in the book are shocking, but ultimately this is the central truth of the book: Women aren’t the problem but the solution. The plight of girls is no more a tragedy than an opportunity.

“It appears that more girls have been killed in the last fifty years, precisely because they were girls, than men were killed in all battles of the twentieth century. More girls are killed in this routine “gendercide” in any one decade than people were slaughtered in all the genocides of the twentieth century.

In the nineteenth century, the central moral challenge was slavery. In the twentieth century, it was the battle against totalitarianism. We believe that in this century, the paramount moral challenge will be the struggle for gender equality around the world. “

Through stories, Kristof and WuDunn demonstrate how the key to economic progress lies in the fact that as a society, we need to stop ignoring women who hold up half the sky. Unleashing this incredible human potential is not only the right thing to do in terms of our own shared humanity, but also the best way to tackle poverty. They show how in vastly different circumstances, the endurance of the human spirit and how a little help can go a long way e.g. the simple act of iodizing salt to improve a baby’s IQ.

I won’t go into the details of the book because my summary will not do these incredible stories justice. However, on a personal level, this book’s message has imprinted itself deeply within my beliefs in international development. After all, how many books make such a  statement about a matter than concerns everyone because of our shared humanity? The stories of these women show me the resilience and amount of hope they have within themselves who have every reason to give up but continue on. It’s so moving and inspirational that I just want to shout it out loud and tell everyone about the issues Kristof and WuDunn have written about. If there is one thing that this book is about, it is the story of transformation.

Rating: 10/10

“If you think education is expensive, try ignorance.” – Derek Bok

Review: UBC iWeek Global Keynote Speaker- Paul Rusesabagina (Hotel Rwanda)

A couple weeks ago, I attended a very interesting event, one that provoked two thoughts:

1) There is always, always two sides of a story and

2) We need to use resources around us – beyond what we have at hand in order to learn

This event was in UBC as part of the International Week celebrations:

To provide some background: (Taken from event description)

Mr. Paul Rusesabagina was the manager of the Sabena Hôtel des Mille Collines, and sheltered hundreds of Tutsis and moderate Hutus people for a hundred days using all available resources to him.  His courageous efforts thwarted bands of genocidal militia while Rwanda descended into outright genocide and civil war, and was celebrated in the Hollywood movie production, “Hotel Rwanda”.

A recipient of numerous international awards, including the Wallenberg Medal and the Presidential Medal of Freedom, Mr. Rusesabagina is a powerful speaker with a story of heroism and humanity in inhumane conditions.  In addition to his experiences during and after the Rwandan genocide, Mr. Rusesabagina will share his insights into the nature of the conflict, the failure of the West to stop it, and the challenges of reconciliation.

The event started out with a quick introduction by Brian Sullivan and quickly proceeded to Paul Rusesabagina’s speech itself. I won’t go into details of the speech, which was an account of his experiences of the Rwandan genocide and what went down in Hotel Rwanda. It was incredible hearing his accounts first hand, but the real experience cam during the Q&A period. Prof. Michael Byers was the moderator for the session.

Three things occured during the Q&A that took me completely by surprise:

1) There was a substantial amount of people that are Rwandan genocide refugees that were present. I had no idea that event of this event managed to reach past the UBC community, which was impressive.

2) The questions regarding comparisons of South Africa and Rwanda’s economy was very much unexpected, considering the different political, cultural and economic conditions of both countries.

3) The response towards Paul Rusesabagina’s speech was centered around his accountability and actions of Hotel Rwanda.

Needless to say, due to time constraints, only 3-4 questions were answered and the session ended. However, several Rwandan community representatives spoke up on their version of Paul Rusesabagina’s actions, questioning his motives, financial accountability as well as alliances during the genocide. They had the Chan Centre riveted with accounts of their personal stories of their survival and encounters with the military.

I have been to numerous events at the Chan but this was the first one that I have ever experienced such a strong outcome and discussion after. Students were gathering outside the Chan around these Rwandan genocide survivors who were engaging in more personal conversation about their experiences and there was buzz in the atmosphere about newfound knowledge.

My Main Takeaway: Paul Rusesabagina has been potrayed by Hollywood as a hero and revered for his courageous efforts during the genocide. However, the discussion at the Chan center which questioned his alliances, financial accountability, and actual self-preservation efforts. This  has made me realise that there are always two sides to a story, no matter how well know one side is. It is our responsibility to always be aware of the other side.

I leave you with a phenomenal TED talk by Chimamanda Adiechi telling the danger of a single story. Because our lives and cultures are composed of many overlapping stories, if we hear only a single story about another person or country, we risk a critical misunderstanding.