Mary Cunningham

Tara Loyd, MPH is the co- Chief Executive Officer of PIVOTPIVOT’s mission, based on a fundamental belief in the worth of all people and a moral responsibility to address the needs of the destitute, is to create a model system of universal access to quality health care for Madagascar via comprehensive health system strengthening in a region near Ranomafana National Park.

Can you give us a brief overview of your background and what led you to a career in global health?

I started right out of college as a Peace Corps volunteer in Lesotho, in Southern Africa. I studied special education at the University of Virginia and went to Lesotho with the intention to be a special education teacher. However, I ended up there right in the middle of an AIDS pandemic. There was so much loss and death in the first couple of months alone. 

Other teachers passed away, and so did my Peace Corps assigned mentor. The orphan crisis was also mounting. It was a very impactful thing to see as a 21-year-old. I stayed for two years and ended up working with the Red Cross. I taught special ed, but I also became the first HIV peace corps volunteer in Lesotho. At that time, there was no formal category of health care volunteer; the Peace Corps was not sending people to help with the pandemic. I got to be part of the beginning stages for training volunteers in Lesotho. 

During the next few years, I struggled with what I had seen, and I contemplated how I could go about leading a normal life and use my special needs training to do what I had originally intended. I ended up back in Lesotho for a total of five years during my twenties. I helped a friend start a safe house for children who had been orphaned by HIV. I spent a lot of my twenties coming back and forth between Lesotho as a volunteer. 

I found Partners in Health (PIH) along my journey in Lesotho 10 years ago. It was remarkable because I had read Mountains Beyond Mountains like everybody else and thought, ‘wouldn’t it be remarkable if Paul Farmer and Jim Kim showed up here in Lesotho: this tiny, little, decimated place?’ 

PIH did show up one day, and I met Paul Farmer. I finished my time and went back to get my Master’s degree in Public Health at Johns Hopkins, and have been associated with Partners in Health ever since. I spent time in Malawi for a few years with my husband. While we were living in Malawi, we had our son and eventually moved to Boston, where I was the first employee of PIVOT, a non-profit healthcare organization that does work in Madagascar.  PIVOT is a partner to PIH. I am now the Co-Director of PIVOT. I just recently moved to Lexington, Kentucky, where I work remotely. 

Tell us about your work at PIVOT and what it's like to work at an organization that was created in the last few years.

PIVOT started in collaboration with PIH as a mission partner doing a health system strengthening project in Ranomafana, Madagascar. I was their first employee as Project Manager and am now their Co-Director. In the beginning stages of the organization, we had a lot of ideas about what we could do in Madagascar. For me, it was all about thinking how we could make other people’s jobs as simple as possible--having a clear, well-run, professional organization that met people's’ needs where they were. We also had to figure out how to hire people from the local community in a diplomatic way that did not show favoritism. That kind of stuff is what I was mindful of coming in. I wanted to approach my career at PIVOT with intention. 

Currently, I am the Co-CEO alongside Matt Bonds. We divide our work along the lines of internal vs. external facing work. Matt does more development, fundraising, researching, and institutional collaboration work. I do more day-to-day managing of the organization, overseeing what happens at our sites in Madagascar. I spend a lot of time on Skype. I call our Medical Director, Director of Operations and Country Director once a week. I stay involved in what their government relations look like, their progress at the hospital, patient stories, and any practical needs they might have. 

Our U.S. office only has five people, but there’s something to keeping a small group of people connected to work on the other side of the world; I need to help them to do their jobs well and keep them motivated even though they are so far away from the work. Visits to Madagascar are important to me as well. We are trying to figure out how to get every U.S. employee to Madagascar, but that’s no small feat in terms of time and expense for a small organization.  In the first 2 years of PIVOT being on the ground, I visited Madagascar 10 times; 2 of those times were month-long visits with my family. We could get into the groove of life there, which helped me understand the project better. 

Is there a specific moment from your career that you go back to as a source of motivation/inspiration? 

It’s not one specific story for me at this point -- it’s more a lifetime of exposure and trying to figure out what my role is in this work. I feel privileged to have spent so many years living in Sub-Saharan Africa. I noticed that when I go a long time in between trips and finally get to visit, I have a renewed sense of energy that I bring back to the U.S. that helps me take on my long to-do lists. 

In addition, now that I am a mother, I can connect on a deep level to the stories of childhood malnutrition or of a mother with trouble accessing a hospital because it is a three-day walk and the number of doctors is limited. I’m not going to pretend to understand that in all its complexity, but from mother to mother, for a moment I put myself in their shoes and feel the devastating lack of choices they have. That keeps me motivated and hopeful that someday families everywhere will have the same access to healthcare for their children that I do for mine. It doesn’t seem like too much to ask. It is rewarding to work in a place like Madagascar where the need is so cut and dry and where you can do something about the problem, and the people are so incredibly grateful. 

Do you have any advice for students interested in a career in international development?

My general advice would be to get as close as you possibly can to beneficiaries of your work early on. It doesn’t have to be Peace Corps; it could be any service that allows you to ‘walk the walk.' In doing this, you can develop a sort of empathy with the people you are serving which helps keep you motivated in the long term. There is a lot of justifying this work to people who are curious as to why you’re doing it, especially if you are going to do work overseas. They wonder why to bother to fly across the world to address social problems that exist everywhere. But if you are speaking from personal experience and you are doing this work because you, yourself, have been moved by something, then I think your answer for why you are doing this work comes naturally, and it becomes something you don’t question as much over the years. The opportunity to participate in Peace Corps or something like it is what in my opinion fuels a commitment to a lifetime of this kind of work. 

Do you have any book recommendations?

Paul Farmer’s books were important to me early in my career. I also really appreciated Jeffrey Sachs’ work, The End of Poverty. I liked the premise of the book that it is possible to end extreme poverty and that it’s not some hopeless, ridiculous, complicated problem that no one can understand. It should do with things like a country’s access to a waterway port, or fertile soil, or where people live in relation to equatorial disease burdens. 

I connect to the idea that I too might be living in extreme poverty if I had been born in an area where malaria was prevalent for example. Poverty is not a mystery and solving it is not impossible, but it does require a large amount of sustained commitment. I draw most of my ongoing motivation from going to places like Madagascar and drawing from the perspective the people we are serving.


Interview Conducted by Mary Cunningham

College of the Holy Cross, Class of 2017