Sisters First

by Jenna Bush Hager

  In 2009, we opened applications for our first class of fellows—young people focused on using their minds and creativity to improve health-care delivery in underserved parts of the world. We weren’t sure if anyone would apply—we were “a community of young leaders,” but we were few in number—a brand-new organization with poor branding and no track record. Yet the opportunity to serve and use nontraditional skills to solve problems appealed to the almost one thousand young people who applied. We picked twenty-two inaugural fellows to build GHC with us. Being in this together made us braver than we ever imagined we could be. Looking back, I can hardly believe we grew from such a fledgling operation to where we are today. Our team is twenty times that size now, and our global community of fellows and alumni is nearly nine hundred strong—and while we still sleep in bunk beds on travels, no one sleeps under a table anymore. We recruit high-potential people, age twenty-one to thirty, from around the world to work on the front lines of health equity in Malawi, Rwanda, Uganda, the United States, and Zambia—and each year almost six thousand people apply for 140 positions. About one-third of our fellows work in major US cities—because if you believe that global health is a problem that only happens in other countries, you are mistaken. For many years, statistics have shown that one out of every twenty people living in Washington, DC, is HIV-positive.

  We try not to divide the world by what’s happening in each country. GHC consciously avoids using terms like “I,” and perhaps most importantly, “us” and “them.” The world is becoming only more global, and the only way problems will be solved is if all of us, and I mean the global “us,” are in it together. Our projects reflect our diversity and the many possible avenues to solve problems. Our fellows may work inside government ministries or develop mobile apps to improve data collection. Some are researching the impact of unintended pregnancy, some are working to increase access to midwives, and others are teaching about childhood nutrition. It is a roll-up-your-shirtsleeves-and-dive-in type of work.

  So what kind of people become GHC fellows? The ones who qualify share an impressive amount of grit. One of the grittiest was Ameet Salvi. I first met Ameet at GHC’s inaugural training program—he was twenty-six years old and had left a stable job to go to Zanzibar. He graduated from UC Berkeley with a degree in engineering and had been using his engineering brain as a supply-chain expert at the Gap, the large clothing retailer (supply chains are how products are produced and transported to reach consumers). He’d always been social justice–oriented, but he hadn’t found a way to apply his practical business skills to serving others. Once he joined GHC, Ameet’s task was to do for the one million people living on the island of Zanzibar exactly what he had done for Gap. But instead of working to get the season’s hottest jeans and T-shirts into stores, Ameet used his skills to get lifesaving medicines to health clinics—and into the hands of the patients who needed them most. (In Tanzania, like many places in the world, drug shortfalls are frequent. A mother might take her sick child to a health clinic and learn he has malaria, only to be told that the medication for malaria is not in stock at the local pharmacy. Suddenly, that preventable illness becomes a death sentence.) Ameet took a chance on GHC, and it took his life in a direction he couldn’t have predicted—that of a global health advocate. He stayed in East Africa after his fellowship, and when the Ebola crisis erupted, Ameet moved to Sierra Leone to be part of halting its spread. He now works as the director of operations for Partners In Health in Sierra Leone.

  A couple of years ago, someone described GHC to me as a crew of “rational dreamers”—people who believe the world can and should be made better and then go about connecting the dots, putting in the sweat every day to make that dream a reality. Each summer, as they wrap up their year of service, all the fellows gather alongside a body of water, the Indian Ocean in Tanzania or the Nile River in Uganda, and share their stories of impact and failure. A few years back, I sat on the breezy bank of the Nile River with Temie Giwa, one of our fellows from Nigeria, who is a passionate women’s health advocate and a great example of a rational dreamer. When I first met her, she seemed quiet, likely feeling the impostor syndrome that most of our fellows do on day one. Now I was listening to her share her personal story. When Temie gave birth, there were complications. She was in desperate need of blood, but there was no blood to be had because Nigeria did not have blood banks. Temie and her baby survived, and from there she made it her singular mission to start a system of blood banks in Nigeria so that other mothers and their babies might be saved. She had to change minds and overcome a culture that was rightfully fearful of donating and sharing blood because of the risks from AIDS. She could have easily walked away with a healthy baby; instead, she works every day so other mothers never have to face the obstacles or know the fear that she experienced.

  My initial impression of Temie was wrong—she is not quiet, she is fierce, singularly focused on solving a seemingly insurmountable problem. It brings me to tears of both inspiration and pride every time I read an article or receive an e-mail update from her. Temie’s story is just one of almost nine hundred—our interconnected family (#GHCfam) who have chosen to wake up and see opportunities to serve rather than be debilitated by problems. In my own bit of rational dreaming, I can’t help but wonder what the world will look like when there are thousands of Ameets and Temies working alongside one another in the unglamorous, but critical, middle ground of health systems.

  Ironically, for people who come from a family of homebodies, my sister and I have chosen careers where we travel often: she in front of the camera; me most often tucked away on another continent and hard to find. My work with Global Health Corps means I spend more time on a plane than at home, en route to East or Southern Africa, Europe, and crossing the United States. Some people think international development is all about glamorous treks through rural areas in Land Rovers and meeting with ambassadors. While that might be the experience of some, my own experience has differed, instead riding a bus with my partners on the bumpy roads of Butaro, Rwanda, to see the lifesaving work of our fellows at Partners In Health. Or sleeping on bunk beds with my colleagues in Kigali as we struggled to open our first African office, not knowing if anyone was going to apply to GHC, but hoping they would.

  As much as I travel, I still find magic with each trip, but a kind of magic that feels more like a blessing of tranquillity. Where I once was overwhelmed with the physical beauty of new places, now the breadth of that beauty includes the people I know from my travels and the closeness that we feel. When I land in Rwanda, I know which taxi drivers I’ll recognize at the airport; I know who is waiting for me in the city and the countryside—hundreds of people, as many as I know in New York. They are my community. Some of them have even become my second family. Our first Rwandan hire is “my brother,” and me his “sister”; in Uganda, there is another Barbara who works with GHC, whom we all call Mama B. They both come to my apartment in New York and know my cat, Eleanor. A year can go by without any of us being in the same room, but once we are together, it is as if no time has passed. We trust each other in every way. We are each other’s leap of faith.

  Along with the people, I have discovered another type of beauty: When I stand in parts of Tanzania or Zambia, I feel as if I am looking through a glass all the way back to Texas—where I can see the same expanses of yellow, dried grasses, red sands, and clusters of spruce trees. I now know that the places I have been have led me full circle, back to a renewed love of home.

  More Than Tongue Can Tell

  JENNA

  On his eighty-eighth birthday, I interviewed my grandfather for the Today Show. I did it outside at Walker’s Point in Maine. It is his favorite spot, the place where he has gone nearly every summer since he was born. Gampy calls this home his “anchor to windward.” I was sitting with my grandfather in a place that held his history, his heart, and mine.

  Gampy seldom talks about himself. He’s never been one to tell “war stories” or recount his accompl
ishments in government and politics. So I started off by asking him the obvious questions about his life and being a young man fighting in World War II. He had ignored his dad’s advice to go to college right out of high school and enlisted instead. He became the youngest naval aviator to date, at age eighteen. As we were talking, I forgot the lights or the cameras, or why I was even there. I looked over at him, really looked, and I saw his paper-thin, vein-lined skin, the wrinkles and spots marking a life well lived. The man who had stood at my wedding was now in a wheelchair. I felt compelled to ask my grandfather something I might otherwise have been afraid to—I veered from my carefully typed list of questions and I asked him if he had ever thought about death.

  He answered without any hesitation. “Yes, I think about it. I used to be afraid. I used to be scared of dying. I used to worry about death. But now in some ways I look forward to it.” And I started crying. I managed to choke out, “Well, why? What do you look forward to?” And he said, “Well, when I die, I’m going to be reunited with these people that I’ve lost.” And I asked who he hoped to see. He replied, “I hope I see Robin, and I hope I see my mom. I haven’t yet figured it out if it will be Robin as the three-year-old that she was, this kind of chubby, vivacious child, or if she’ll come as a middle-aged woman, an older woman.” And then he said, “I hope she’s the three-year-old.” Robin was the daughter this giant of a man lost years before to leukemia. The little girl he held tightly, who spoke the phrase I have heard Gampy repeat for my entire life, forever knitting Robin’s voice into the tightly woven fabric of our family: “I love you more than tongue can tell.”

  Six months later, we almost lost Gampy.

  It was Christmas Eve and I was in Richmond, Virginia, with my in-laws. We were just sitting down to dinner when my mom called. She didn’t waste any time. She told me that Gampy wasn’t doing well and that Henry and I had to come to Houston. We needed to go—now—to say good-bye. She had booked Henry and me on a flight early the next morning.

  I sat down to dinner, passing festive plates of holiday ham and wiping my eyes. My in-laws were comforting, but I alternated between feeling terrible about ruining the meal and excusing myself to go into the bathroom and cry. More than anything, I wished Barbara were there.

  The next morning, my parents and Barbara picked us up at the airport. It was a relief to see Barbara’s face, and I held her hand as we rode to the hospital. During the car ride we all spoke of our determination to make it a good day: “Okay, we aren’t going to cry.” My father, a notorious tear-shedder, was firm about all of us holding our emotions in check, saying it again and again, until I realized that what I was hearing was his own inner monologue. My dad had already written his father’s eulogy.

  I was almost five months pregnant with my first child, Mila, who was barely a round bump, and the first thing Gampy did as we walked to the bedside was reach out his shaking hand and touch my stomach. And then he said, “There’s death and there’s life and I can’t wait to meet this baby.” Barbara grabbed me to steady me, but I still started to cry, and so did Henry and my dad and my mom, because we all believed that there was no way our Gampy was going to meet my baby. My grandmother, sitting in a chair a few feet away, asked: “Why are you crying? What do you have to cry about? He can’t wait to meet the baby. He’s going to meet the baby.” Awash with hormones, I couldn’t stop sobbing, and I had to leave the room to regain composure. When I came back, Ganny was still saying how “Gampy can’t wait to meet the baby” and “Gampy can’t wait to be at the library opening” for the dedication of my dad’s presidential library. She was sitting there by his bedside, as she had done nonstop since he was first brought to the hospital. As she sat, her hands were in constant motion, needlepointing a Christmas stocking for my unborn child.

  We nodded our heads, and I thought, Poor Ganny. It was abundantly clear that everyone except her knew the truth. The only explanation was that my grandparents’ lives were so intertwined that she couldn’t face life without him.

  In retrospect, it was in fact a memorable day. But not in the way any of us had planned. We’ve always called my grandmother “the Enforcer,” and on this Christmas, she just wouldn’t give up. She kept stating over and over again all the things that Gampy had to look forward to. She gave him no choice but to live. And so he did.

  When our second daughter was born, three years after we thought we were saying good-bye to Gampy, we had already decided to name her Poppy. As a boy and then a young man, Poppy was Gampy’s nickname. I had never really heard people call him that, because he was Gampy to us, until one night when Henry and I watched a documentary about him.

  One of the people being interviewed was an older gentleman named Bruce Gelb who had gone to boarding school with Gampy. He looked into the camera and recalled how he was picked on, teased, and bullied when he arrived at Andover. Then suddenly he heard the voice of an older boy rise up above the others and say, “Leave him alone!” And it was the voice of “Poppy” Bush. As the man told this story, decades later, he started wiping away tears, saying that because my grandfather had the goodness to stand up for him, his life was changed. (My grandfather has too much humility to tell us this story; I’m not surprised anymore when I learn something new about him by reading a book or watching an interview.)

  I was newly pregnant, but far enough along that we knew it was a girl, and I looked over at Henry and said, “Maybe we should name the baby Poppy. That’s the type of girl we want, somebody who will stand up for others and for what’s right.” So we did. When she was born, we FaceTimed Gampy from the hospital to introduce him to his great-granddaughter, named for him. And as soon as he saw her little pink face, he teared up, which I didn’t expect because many people in our family, all of whom love him so much, have his name. Putting aside all the Georges—even among the girls there is a Georgia and Georgies—so we were by no means the first people to name our baby after him, although no one else has used his nickname. Once he started crying, we did too. Poppy’s newborn head was covered in tears.

  A couple of years ago in Maine, we were all sitting around the robin blue oval table that we’ve sat around for years having dinner—with Gampy at the head. The room was full of laughter. Everybody was talking, except for Gampy, and the conversation was ricocheting around the table. It started getting loud, and eventually he leaned over and in a hoarse voice, he whispered, “I miss this.”

  And I asked, “What, Gampy, what do you miss?”

  And he looked around and said, “I loved being in the game. Don’t forget to enjoy being part of the game.”

  Jenna and Gampy on the morning of his ninetieth birthday, before his big skydive.

  A New Season

  JENNA

  It was mid-April in New York, cool but with canopies of new leaves and flowering trees, signs that winter had finally departed for good. On days like this, Manhattanites are overeager to move on to the next season: They sit wrapped in parkas at sidewalk cafés or run alongside the Hudson River tightly zipped into fleece.

  I felt a bit of that same spring fever as I climbed out of bed in a room with barely enough space for our king frame and two tiny nightstands. But at eight months pregnant, I needed the strength of both arms to hoist myself up and over the side of the mattress. I was continually surprised by my size. I had reverse body dysmorphia; I couldn’t tell how massive I had become except for the enormous effort that it took to do simple tasks.

  In a cycling class that morning, a man who sat in front of me commented as I shimmied between the handle bars to get to my bike: “Girl, you are having that baby today…be careful or we will have to carry you out like a Trojan horse.” I laughed. “The baby isn’t coming for a few more weeks,” I assured him.

  Afterward, I squeezed into a bright-marigold-yellow dress, which, because of my protruding stomach, was short. Too short, really, for a grown pregnant woman. (During my next pregnancy, I wore that same dress on the Today Show and someone tweeted that I looked like Big Bird.) B
ut I was tired of dark winter colors and thick, insulated tights. I was going to wear the yellow dress. I didn’t even ask Henry for his opinion before we left the apartment. But on the sidewalk, I stood behind him, slightly embarrassed and afraid what might be revealed in the sunlight. As I hailed a cab, I kept tugging at the hem, wishing the dress would miraculously stretch and become a few inches longer. I was on my way to my baby shower, planned with meticulous detail by Barbara and many of my dearest friends.

  I arrived to a room decorated with baby bottles filled with tiny blue and pink M&M’s and cookies in the shapes of rattles. I usually love a good party, but as I entered, I didn’t want to be there. I felt uncomfortable and anxious and kept fiddling with my dress. I avoided the center of the room, preferring to cluster in a corner of the apartment. When Barbara walked over, I grabbed her arm. “Stay here with me,” I told her. “I can’t talk to anyone else.”

  Barbara laughed. She reminded me that I was among friends. “Come on,” she added, propelling me forward.

  I still lagged behind. I felt an almost primal urge to hide, and I clung to the one who knew me from before I was born.

  The caterer came by, but nothing looked appealing. I turned down a favorite food, a donut. When we got to the gift opening, the hostess clapped her hands and gathered us all together into a semicircle. I was ushered to the seat of honor in the center of the group, my temporary throne a lovely pink chair.