Effective Altruism Applied Case Study: My life

Life throws a lot of surprises at me - from opportunities I'd never dreamed of to sorrows that close in on hope. You never know what you'll get and all I have to stabilize myself to the surprises life constantly throws at me are some reflections on the past, ambitions for the future and some of the frameworks I've mentioned in this series. So here we go.

Childhood Biases

We all have biases, they’re products of our environment. Instead of working to eliminate them I find it helpful to recognize them and use them when helpful. Here we’ll talk about childhood biases that influence(d) me.

I grew up in South Carolina as a brown person whose family has/had a less than perfect immigration status. When I was 10 my parents started sending me to Ecuador alone to visit my family over there. The divides between the two realities, marked me and pushed me to try to do something for this world – and so I decided I wanted to be a doctor. Original. From this snapshot we can see some nice career focus points:

Immigration system reform in the USA and/ or Latinx rights/ general POC status in the USA
Latin America and/or Developing world in general

Now let’s analyze both of these areas.

Immigration is something that tormented me constantly growing up, I was very aware of our vulnerability and the fact that anyone in my 30-person family could be deported at a second’s notice. As children, my cousins and I used to play a game that involved hiding from any white van because that’s what the immigration vans looked like. Fun stuff.

And so, while the inequalities in Ecuador were upsetting but they seemed further away, less tangible, less “important” to my personal life. Further, when I was in high school I tried to start a fund to give medicine to a small Ecuadorian village and it was actually pretty unfulfilling since it felt like a drop in the bucket. Moreover, the year after my donation the entire health center was shut down and there was no way for the village to receive health. was coupled with the local health center closing down –delivering the final blow to their ability to get quality healthcare.

However, out of that lukewarm global health effort came a desire to do better. The failure bothered me and the potential to help seemed there. $500 had given medicine for a year and it had only taken me 3 months to raise vs 16 years of strife for a green card to appear. Tractability and potential for impact seemed higher in global health, I just had to figure out how to do it.

College & Refresh Bolivia

College came. 18 years old and excited, I signed up for 10 different clubs looking for something that would “call to me” that would “be my passion.”

POC Clubs: Lots of anger against white people and white privilege, anger I didn’t understand the point of. Yes, the world is unfair, but to me Harvard was the fairest and most diverse place I had ever been so I didn’t understand why they were so angry. It was a privilege for me to even get an education, much less be at Harvard. I get it now, and the anger is justified for sure but I still don’t think it’s the way to change. I left these clubs struggling with the question of: How can you convince people that anger isn’t the way, when they have a right to be angry? I wasn’t sure there was an external or quick solution to this – rather it seemed like a personal matter. The tractability seemed low and I didn’t think I could make much of a difference.

Global Health Clubs: The global reach inspired me here, but it seemed like we were just talking the talk and that in order to make impact you had to pick a place and get working. All the theories started sounding the same after 6 months and implementation seemed like the key and so I quit junior year.

Refresh Bolivia: 18 years old, I took over – never having been to Bolivia before and with the responsibility of having to lead a volunteer trip at the end of August. I loved it. Getting the chance to use the information I learned in those wood paneled Harvard rooms on the ground was an awesome privilege. Learning by doing was definitely more my style and still is today. It pushed me to travel, doing global health work/research in 7 different countries, to change my major to focus on global health, to write my papers on Bolivia. Why? Well…

Neglect
Attention: Peru, Nicaragua, Brazil, Honduras, Ecuador, South Africa, India and Bolivia. All countries I’ve done global health work in/ about. Bolivia isn’t the lowest on the socioeconomic ladder or in quality of life, but in my mind everyone always talked about India and Africa as needing help, but what about South America? Literally connected the great USA it didn’t seem like much attention at all was being given to this continent that many of my SC school classmates thought was an extension of Mexico.
On campus presence: There were no organizations like this on campus (RB isn’t affiliated with Harvard at all in any way shape or form) so a college club couldn’t fulfill my desire to do real work, time to make a non profit.
Tractability
Flashing my USA passport and having cash for the projects, I could do whatever I wanted in Bolivia. No one questioned my judgment nearly as much as they should have. Sure, I did my best to apply all my knowledge at all times but it wasn’t enough at first and I made a serious amount of mistakes. Like not signing contracts with anyone we did work with until year 4 of running RB. That should have stopped me from doing work – but it didn’t. Nothing did.
So it seemed doable to me, making impact seemed easily tractable.
Personal Fit
Unsatisfied with the answer “this is your time to learn and then you can give back later” Refresh Bolivia gave me the motivation to learn more, do more, be better and take advantage of college to directly serve others.
Native Spanish speaker, Ecuadorian and culturally similar to Bolivians I thought I could do a solid job. Given my lack of expertise on most technical things, diirecting an NGO anywhere that wasn’t South America seemed unfathomable given my lack of ability to connect with the people. Connecting with people was something I had decided was the most important thing in doing helping them. Not so much anymore. Now, I think it’s pretty easy to see that people who don’t have food probably want it. However, where cultural knowledge comes in is in the actual innovation of the solution – but not everyone has to have this cultural knowledge. Rather its better to have different perspectives. If you actually have skills/knowledge to contribute then I don’t think you should limit yourself to a national boundary.
Scale/ Impact
A population of over 100,000 with little/no access to sanitation and health vs tutoring someone in a super competitive college run program – if I didn’t get to tutor her some other Harvard kid would have. Seemed like an easy decision to me. Doesn’t mean I had all the skillsets the people I was serving deserved to help, but in my mind if we did small enough projects to minimize negative consequences then it was better than doing nothing. If we didn’t help no one else would.
Beyond making impact in the community I believe/hope that our trips and our college student boards create impact in the lives of students. I recently read an article written by one of our leaders in Cambridge, MA that said “you place your own limitations.” That was awesome, empowering the world’s brightest young minds and showing them that they can easily employ their knowledge to help is awesome. We’ll see the real impact of this in the next 20 years, but already a former volunteer has returned to his home country to dedicate his life to reforming environmental policy.

And so, I focused a lot of my energy on Refresh Bolivia freshman and sophomore year. Junior and Senior year I split it between volunteering at Harvard Law’s immigration clinic. Family matters had pushed it back onto the stage and I began to re-evaluate my ability to make impact in that field and seriously considered an MD/JD and went through some similar thought processes:

Neglect:
It made sense to me to work at Harvard Law’s clinic because there was no one else who was willing to spend a lot of hours there who spoke Spanish to a high level. Even pre-Trump they were always in need of interpreters and helpers and I loved helping. However, I realized that this was a publicity problem (rather than a lack of interest problem) and tried to spread the world to interested people.
Tractability
Didn’t seem that tractable from the lawyers’ end – the system was more the problem. After Trump become president the tractability for a fair immigration system plummeted in my eyes. While, I do think now is the time to fight for fair immigration processes more than ever, it’s definitely not the easiest time to do it. So this is a good example of when low tractability might not mean it’s not worth doing. Once again, it depends on your goal. If you want to spend your life to move a valuable cause 1cm in the right direction vs saving a ton of lives in the developing world. Go for it. It’s your balance and they’re both worthy.
Lawyers literally told me to become a doctor instead. Many seemed frustrated with the system, so I decided against the MD/JD figuring that the MD would give me enough of the face to face interaction needed to get to know the intricacies of the problems and I probably needed to find another degree/or way to change the large system.
Personal Fit
Spanish skills, an interest in immigration law and an ability to do background research made me good for the job.
Scale/ Impact
A brilliant team of Harvard lawyers could help a couple of people a year get immigration status and ultimately get better lives, fantastic. But these were remarkably intelligent people, people capable of doing more than going through state-set procedures and playing a game they couldn’t change the rules of. They were doing more than just being lawyers they were advocates, teachers, writers and speakers. This increased their impact significantly but it just didn’t seem like it was enough for me. Policy seemed like the answer and jumping through legal hoops to get through it didn’t appeal to me.

However, I needed these activities as much or more than they needed me. Maybe no one would have taken on those roles if I hadn’t but without them I definitely wouldn’t have made it through Harvard with my ideals and values in tact. I sought them out to maintain a balance of receiving a privileged education/opportunities and giving them back to the community out of frustration (maybe even guilt) that everyone didn’t have them. It let me keep my daily reality one step closer to my ideals and morals, it helped in eliminating the dissonance that often comes when your reality is different from what you want to your ideal to be.

Pic around the time I decided to commit full time to RB - right decision for sure, doesn't mean I wasn't terrified. Climbing into the deepest cave in South America didn't help either. Summer 2014.

Ideal Balance and Future (?)

Here we go, let’s see if theory can actually be applied.

NOTE: Whenever the word need is used here, it’s not used lightly. It’s actually something I feel like I must do in order to maintain my balance.

Area of Work

Global health and making an impact in terms of number of lives saved now and in the future. No measurements for this. Some sort of mix between helping right now and mending systematic flaws. Not clear on how it’s going to happen so we’ve got 4 years of medical school and maybe business school or some sort of business related job coming up to find out.

In terms of South America, it’ll always be in my heart and maybe I’ll realize that cultural connection really does matter more than skillsets. But with more knowledge and skills I’d like to give doing a work around the world another try. I think medicine, an understanding of business and a background in non-profits will make me versatile enough to be able to help anywhere. Which is what I want. A place on the international stage, but we’ll see on this one since I’m still not sure how influential international organizations are and what their real impact is.

Finances

Money matters. Surprise surprise huh? Well it was to me. Naively perhaps, I thought it would be noble to eek out an existence as a poor doctor in a rural part of Bolivia for the rest of my life. I still think it is. But in terms of impact, I guess money and power would help increase the number/amount of people helped. It is a drop in the bucket in the end, but drops fill the bucket right?

When RB’s bank account jumped from $2,000 to $40,000 our potential impact increased by 500%. This is a pretty common realization and argument to make, and the risk is losing yourself in the pursuit and living a daily reality that’s in dissonance with your ideals/goals. But since I’ll be a doctor I hope that my at least weekly contact with the very vulnerable populations I wish to aid will be enough to keep my head on straight. In the end there’s risk in everything, I could die tomorrow or in the middle of a consulting stint where I’m pulling in $100k a year but at least I was trying right? Donating 10% of your salary and volunteering also help if you don’t want to hedge all your bets on the future.

Career Independence

Being a healer of the human body is applicable and useful across all cultures. I think that it can show you some of the most private moments of humankind. Having the ability to guide people through their lowest moments is such an incredible skill and privilege to have. In terms of impact sure there are bigger things, but in terms of beauty and understanding the human character – I can think of little else. Further, you can do this anywhere. All around the world. Doctors will find a job. Romanticized view for sure, so check in next year to see if med school has cured me of this naivety or if it’s actually the world.

Further, while it might be harder than if I was a consultant being a doctor does give me enough flexibility to be able to transition into administration, policy and higher level leadership roles as long as I stick to the realm of health. Which is all good with me since I think health is the backbone to change – after all you can’t have a better life if you’re dead.

Personal Fit

One of my favorite quotes is “what’s the difference between a doctor and a scientist? People.” I love working with people. I need some level of face to face impact to feel like I’m actually doing something, to motivate me, to keep me going. So yeah, I like it.

In terms of qualifications, I’m actually better at reading, writing and speaking than hard science. Which is why I’d like to have a role in management, policy or business as well as be a doctor. If I was brilliant in science, I would probably be more inclined to devote my time/ energy to doing research. Thankfully, I am not/ have no inclination to be the next Marie Currie so I can ignore bench science guilt-free.

Impact

Having a high impact does matter to me, a lot. In terms of balancing immediate impact and long term impact I definitely don’t have the answer on this one. I need immediate impact to keep motivation up for sure but I’m not sure how much yet. For example, can I commit to a life in policy as long as I practice medicine 2-3 times a week? My guess right now is no, I’m more of a immediate impact kind of person at the moment. But that annoying truth that the past will keep repeating itself unless structural change happens has been replaying itself to a higher frequency than it did when I was 19, so perhaps that’ll increase. Perhaps there’s a way to do both. I’m trying to do both with Refresh Bolivia right now by developing programs that meet needs right now but also documenting them well enough so they can be scaled-up by the government. More opportunities and time are needed to answer this one.

Tentative solution here is being a doctor but eventually transitioning to practicing 2-3 times a week while balancing other responsibilities like policymaker or CEO of a health-related company. Something like the Global Fund, Partners in Health or Medicines Sans Frontiers call out to me right now since it seems like they balance research, direct impact and changing broader healthcare policy systems effectively/ all at once but we shall see.

Pic from UP in India, health clinics are low resource there. This is literally a light bulb keeping a baby alive. Power outages are common, effects are fatal. Spring 2015.

Community / Relationships

Family

When I came home junior year and my 3-year-old sister didn’t know I was her sister I realized that it was time to make a change. I couldn’t swallow the words of my well-intentioned friends “you’re doing more for them by providing a role model” anymore and senior spring I flew back 3 times to visit my family in South Carolina. It gave me my childhood friends back. The people I grew up with and laughed with, who had known me since day one. I didn’t realize how much I valued it or how much of a difference it made. But it does, every day. Medical school has limited breaks so I’ll probably fly home on the weeks every other month to see my sisters grow up or to visit my mom or to see my crazy Ecuadorian family of 37 people.

Friends

People tell you this sort of stuff all the time, but quality over quantity for sure.

Work Colleagues

Who I work with really matters but since I’ve only worked in global health fields and research –aka both fields where you are working towards the betterment of humanity –I’ve really had the privilege of working with great people. Motivation for the job and belief in the mission is so important. More than teammates, I love to get to know them as people and try to be friends. In fact, only one of my very close friends has saved herself from doing work with me in South America (just kidding everyone help RB it’s great).

Pic of some of the great people and teammates I've had. Fun fact for my graduation they gave me a larger than life tapestry of this. Jan 2017.

Next Steps

Go to med school and become a doctor
Fly home every other month to see your friends & family
Keep being involved with RB
Look for a new activity in NYC where you learn about business in health/ in general
Get involved in something else that will help me learn more about my preferences regarding short term immediate, hands-on impact vs long term impact.
Try out being a donor, consultant etc.
Try out working on larger problems where you’re only a small piece of the puzzle à like research, which I didn’t like before but let’s give it another shot.
Think more and figure out a career path.

So that’s me. Definitely don’t have all the answers. I recognize that while I want to make the biggest impact possible in order to do that I need to engage in “lower impact” activities – like helping individuals first hand in my local community or seeing my family. And even though I often wish I were a workaholic robot, being human has been cool so far, so the balance to maintain it is worthwhile. However, in order to stay true to my goals I do think thought and structure are important which I why I laid out my life above.

At 23 this is the best I’ve got – so give this activity a shot if you so desire. You might be surprised to see what you find –maybe you’ll have more answers than you thought or maybe you’ll have less. If you have less then think about things you want to learn, pieces of the puzzle that are missing and focus on learning those first. It’s all good if your conclusion is “I need to spend more time thinking about what I want to do with my life” because, if you have time to think about it then you should take it.

Good luck & as usual message me with any questions/concerns. Thanks for the read and good luck finding/following your own path. The world's got so much to offer and so do you :)