Susan Casey-Leininger on Village Life and the Meaning of Global Citizenship

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Susan Casey-Leininger has done it all – from working with Americorps to fundraising for the African Leaders Malaria Alliance to living and working in East Africa. Today, as the executive director of Village Life, Susan personifies the word “adventurous.” As shown in her work, Susan is passionate about cultural immersion and the benefits – as a community, society, and world – of learning about each others’ differences. Her various travels and work experiences have given her a unique and valuable perspective on fostering change both inside and outside of Cincinnati. 

Interview by Courtney Reynolds. Compiled by Emerin Boomer. Photography by Angie Lipscomb.

Tell us a little about yourself. Are you from Cincinnati?

I am from Cincinnati. My dad was a retired U.C. professor and my mom is a retired pediatric nurse from Children's. We're like a deep Cincinnati family [laughs]. 

How did you come to work in Africa?

So, I finished my undergrad degree in political science and comparative politics and really wanted to do an Americorps year. I applied to a bunch of different programs and got a really great position at Peaslee Neighborhood Center, with the Intercommunity Justice and Peace Center.

About halfway through my Americorps year, I was in D.C. for a conference, and one of the women who runs our national program of the Americorps branch that I did, she was like, "I hear you really want to travel. Do you want to move to Kenya for a year and work in a children's clinic?" 

I literally never thought about moving to East Africa and I was like, “Yeah, that kinda sounds like fun.” So I moved to Kenya in the beginning of 2009 – the first time I'd actually ever left the country other than going to, like, Canada. I moved halfway around the world to a really rural community in western Kenya, near the border of Uganda, and worked as a grant writer at a clinic that worked with kids with disabilities. I loved my job there; I had a great time. There's nothing like being 24 years old and living halfway around the world in a completely new environment. 

I went in like a lot of young white women who think that they can change the world one African baby at a time, and that year taught me a lot about my own insignificance, which was really important and transformative to my personal career. I was thinking while I was there, “There are organizations and people around the world who are changing poverty; how do I get involved with that?” And I thought the first step would be to get a grad degree in international relations. So I decided when I was in Kenya that I was gonna get my master's degree. I took my G.R.E. in Nairobi in a hot, sweaty, un-air-conditioned building, and did all of my grad applications from a little dialup internet cafe in this tiny little town in Kenya. And I actually got accepted to Seton Hall's [School of Diplomacy and International Relations] Whitehead School, which is in northern New Jersey right outside of New York.

Tell me more about Village Life.

Sure! So Village Life was founded in 2004 by a family medicine physician here in Cincinnati; his name is Dr. Chris Lewis. He recently transitioned: He still does family medicine care, but he's now also in the provost office at U.C. So it's fun and hugely beneficial to our organization to have that rooted connection with U.C. Basically, Chris was doing his family medicine residency at U.C. and he had the opportunity to do some work at a hospital in Shirati in northern Tanzania. I think that he and I have a lot of parallels in our stories: He went in as a young hotshot doctor; thought that he was there to save one baby at a time, and I think that experience taught him some about his own insignificance, even as a physician.

We create better doctors by working together across cultures.

His first patient was a young woman who was hemorrhaging and in labor and had about an 8-hour walk from her home to the hospital and died in transit – which is very sad to think about, but a pretty common occurrence. So he came home and he was just compelled that he was gonna do something to address this healthcare access issue. So as he was building his practice here in Cincinnati, he was also building the Village Life outreach project and took a team of physicians back to Tanzania the following year to do mobile healthcare clinics to help reach some of those people who weren't able to get into the hospital to see a doctor. 

We have a really strong partner organization in Tanzania called Shirati Health and Education Development Foundation (SHED). And they essentially do our day-to-day operations in Tanzania and one of their directors, Dr. Esther Kawira, and Chris got this whole thing launched together. And we went to SHED and said, “We want to find a partner community that needs our help, but also is willing to be a collaborator, a partner.” Because if a community is just looking for Americans to come in and just give things away, we're not in a position to do that and don't have any interest in doing that; we're interested in a collaboration. SHED came back and brought us these three communities – Roche, Nyambogo, and Burere. He went to the communities and said, “We wanna make sure you can see a doctor when you need to; we're gonna bring American physicians,” and they said, “Chris, that's great, but what are we gonna do if we have access to a doctor but the water still makes us sick?” Or, “We have access to a doctor but my child is still sick because my child is going to school hungry.” Chris realized that to have an impact in these communities, it was more about funding programming that impacted the social determinants of health, rather than just saying, “Here's a doctor; here's a nurse; here's a medication.” So that's really where the three pillars of our programming – water work, health, and education – came out of. 

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When we were creating the signature projects in each community, Chris and the team went in and said, “What is the biggest challenge for you here? What do you see keeping your family in poverty?” In Roche, they said, “Our children, our mothers – they're dying. We need a doctor here.” And so Roche Health Center came out of that. In Nyambogo – they're very far from the lake; they're high up on a hill – they said, “We don't have any water; when it doesn't rain, it's not even about finding a pond that we share with livestock. There's nothing, and our children are dying because they don't have any water.” So we said, “Okay.” The well system and the water distribution was built first in Nyambogo and we've used that model in the other two communities. Burere said, “We just want a safe place for our children to go to school,” and so we worked on the school building there.

How does collaboration work from halfway across the world?

Basically what we do here in the U.S. office is get information and program ideas from our committees in each community who are living these poverty challenges every day. And our responsibility here is to say, “Great, let's use experts to fine-tune that idea and make it as good as it can be, and then we're gonna find the people and the money to resource that solution.” 

The face of foreign aid and what international nonprofit work looks like is really changing. It used to be much more: people going in; “This is the best practice; we're gonna do this and it's gonna work and then we're gonna leave.” And a lot of people found that that really wasn't working and that listening to the people who are actually living the poverty challenges was the only way that you were gonna make sustainable change.

How do you decide who's on the committees?

So everything there is really autonomous; we try to take our hands out of those decision-making processes. We really rely on our partner, SHED, to manage that process for us. They make sure the right people are on the committees, working with local village leadership to make sure that they feel represented and that the families that are really invested in having an impact on the community are placed to help us on those committees.

Is there any challenge putting women on those committees?

So we actually had to step in and set a quota, basically. We were finding that they were really male-dominated and that the women who were on the committees weren't having a lot of chances to speak up. While we are highly invested in keeping their work autonomous, we did wanna make sure we were having voices from all aspects of the community, so we talked to SHED and we said, "We need to talk about it being half women and half men to make sure that all voices are represented.” Like so many other places in the world, in East Africa women are often the ones doing the heavy lifting, so having their voices on our committees was incredibly important. I think the women on our committees are amazing. I go there twice a year and I oversee meetings with the committees, so watching women stand up more and more for themselves, and asserting themselves into the conversation… Even more in the meetings I go to now, I see women stepping forward. The people who've been running the meetings before me have been men, so I really hope that my presence as a leader for Village Life has helped them step forward.

I know in a lot of places women are responsible for the water. One of your pillars is talking about water access; how has that changed the dynamic for women as well?

Women definitely are responsible for the water for their families. And we were finding that in the communities we work in, we're talking about several hours, in some cases, to walk to a water source, and then you get to that water source: It's sort of what you think of as a muddy pond that's being shared with livestock; it's not water that you can just drink. It has to come home and it has to be filtered; it has to be boiled to make it safe, and if you don't take all of those precautions, then you're ingesting dirty water. We've had a lot of different approaches to water, but they've all been, essentially, “How can we make access to water for women and children easier so that they can spend their days doing different things?” And we’ve been really encouraged because we see that as the tap stands are extended, not only are you living closer to clean water, but this is water that doesn't need to be filtered; it doesn't need to be boiled; it's not a whole process, and so women are taking these hours and making sure their kids are going to school and investing in other parts of their family life, putting more into their farming, putting in small businesses. It's been amazing to see what women can do with their time when you take this tremendous chore away from their daily lives. 

Speaking of education, you said you’re setting up schools? How does that work?

Education is a really interesting area to work in, especially in sub-Saharan Africa, because you want to make sure that you're following the guidelines of the government that the kids are living within. But you also want to make sure that kids are going to school, and when they're in school, they're learning, which is why we really focus on this idea of overcoming the obstacles that keep kids out of school. In Burere, our signature project was a new school building. There's one primary school in this community – hundreds of kids go to school there – and the school building was literally crumbling. The back wall fell down and class was outside under the trees. It’s something that American kids ask, "Oh, can we have class outside?" And Tanzanian kids ask, "Can we please not have class outside?" [Laughs.] So we worked with Engineers Without Borders here at U.C. and worked with DAAP students on the construction and design and built a seismic-resistant school structure at the Burere primary school. So, in some cases we have built school buildings but we're not actually building new schools, per se. It's more about improving the space that exists already. 

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Another big thing we saw was kids were coming to school, but Tanzanian kids don't pack a lunch the way American kids do, and so at lunchtime maybe they were going home to eat something, but if they went all the way home they weren't coming back to school. Or if it wasn't possible for their parents to feed them in the middle of the day, they were staying at school, and basically, their big meal for the day was at the end of the day. Think about how distracted you get during a meeting when you're hungry, let alone trying to sit there and learn at school with an empty stomach. So we started a nutrition project, a feeding program that basically feeds about 2,500 kids in six different primary schools a porridge called uji – made of cornflour and sugar and water – every day. And now we would love for it to be a more nutritious project; we would love to be able to expand it, but right now it’s important for us to be putting something in their stomachs. It keeps them at school; it keeps them focused, and we've seen attendance go through the roof. We're working on transitioning from it being a fully donor-funded project to asking the communities to invest in their children's health and well-being and moving to more of a matching grant process where maybe we're helping fund the corn being grown at the school rather than buying the corn from local vendors, and doing a 1:1 match with parents on some of the inputs for the project so we can build some community ownership. It was initially sort of like an emergency response – like, we have to get these kids fed – and now we want to build that community component to it.

So that brings us to healthcare. How large is your influence with healthcare and what are some of the things you're doing?

Roche Health Center is certainly the biggest piece. It’s essentially the first freestanding outpatient healthcare facility of its kind in a region of about 25,000 people. Right now we have an outpatient clinic care building done [and staff housing]. 

We have a clinical officer there, and a clinical officer is kind of at the same level as a nurse practitioner. But because in Tanzania you're looking at about one physician for every 250,000 people, people like clinical officers end up having a lot more impact in small facilities like this. So Eric, who is our clinical officer, essentially is our main doc and our manager of this outpatient healthcare facility, and he is 24. He's a superstar; we love him. He is amazing at what he does; he manages his staff very well. He's a Tanzanian. Everyone who staffs Roche Health Center is Tanzanian. We don't have any Americans who work there. 

All of this started because Chris started taking doctors to do mobile outreach clinics. We’re working on a residency rotation project with U.C. in the various departments, and we would like to establish a program where we have U.C. residents who rotate for a month. They live at Roche Health Center; they work with Eric, but that's less about providing American care and more about this idea that we create better doctors by working together across cultures. So it's just as beneficial for the resident who goes and rotates for a month as it is for the community that they're working in. And it's not a free clinic; we can't afford to do that. It is still highly donor-sustained. But people do pay for care there. You pay to deliver your babies there. I mean, nothing like what we think of in the United States. There are no $2,000 E.R. visits – it's, like, $7 to deliver your baby. The research has found over and over and over again that programs that are free and just given to communities, they don't last. They don't have a sustainable impact. But when you ask someone to pay for something, in the end it's much more valuable. And they're much more likely to take care of it because they've invested some of themselves into it. So our water projects are fee-based; all of the water distribution systems have a very, very nominal fee for a 5-gallon bucket, and then Roche Health Center, as well, is a fee-based facility.

Is funding and finding donors your main job? How difficult is that?

The biggest challenge is telling people in Cincinnati why it's important that we're here. And why it's important to donate to an organization that feels like it does all of its work halfway around the world. It seems like, on the surface, everything we do is in Tanzania, but a huge component of our work is bringing global citizenship to students and professionals here in Cincinnati. So while a lot of what I do is fundraising and making sure that we have enough money to operate, like any executive director or small N.G.O. team, a lot of what we do, too, is community outreach and organizing experiences for students to travel there. We go to students and do presentations at high schools and elementary schools; we have tons of programming around this idea of building global citizenship in Cincinnati while offering lots of international experiential learning for students at the college and professional level. So mostly when I'm talking to funders and they're saying, “Why should I give you money for an organization that doesn't help Cincinnati?” I say, “It does, because building global citizenship anywhere makes an impact in a community.”

This is not an opportunity to pick up a paintbrush and paint a school; you're not gonna dig a garden. This is about cultural immersion and peer-to-peer connections between Cincinnati girls and Tanzanian girls. 

What local high schools have you partnered with?

I was working with Rachel Kemper, who is the director of service-learning at St. Ursula Academy, and we talked about, “What would it be like to bring high school students to Tanzania?” And initially I was a little concerned because I'm used to working with college kids and med students, so the idea of bringing 16-year-olds halfway around the world was a little intimidating, but I will say as a young woman, being in East Africa completely transformed my life. And one of my favorite things about this job is introducing this totally transformative place, my second home, to other young people – especially young women. So while I was initially skeptical about this idea, Rachel convinced me that it was a really good idea, and we launched the first of our international cultural immersion trips. This is not an opportunity to pick up a paintbrush and paint a school; you're not gonna dig a garden. This is about cultural immersion and peer-to-peer connections between Cincinnati girls and Tanzanian girls. 

Our pilot project was this past June, and it was amazing. It was so fun to see. The teachers learned a lot; we learned a lot. We were getting off the plane in Cincinnati after two weeks in Tanzania and one of the girls pulled me aside and she just started crying, and I was like, "Are you so happy to be home?" 

And she was like, "No, I don't want to be home! I just want to go back!" We're doing it again with St. Ursula this summer, and I would eventually like to take it to other schools, build it up for boys and girls, and also eventually include groups of students who traditionally might not have the funding to travel halfway around the world. 

Why do you think it’s so important for young women to go and experience these things?

Perhaps I'm projecting my own experience on young women, but I don't wanna focus on the narrative of, like, "We bring you to Tanzania because we want you to see the poor Africans and we want you to appreciate everything you have." That's not the narrative that we go in with. I think one of the most powerful lessons that the girls we work with learn is the power of love and community that in so many cases – especially in Tanzania – is fostered by the women in their communities. There's so much about the value that a person brings to their community in Tanzania that isn’t necessarily about wealth or things, but rather what they've done to make their village a better place. 

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One of the things that we did with our St. Ursula girls was make sure we had peer-to-peer activities in each of the communities. So we had a music teacher and an art teacher from St. Ursula who came with us, and they each ran an activity with our girls from St. Ursula and a group of Tanzanian women who were about the same age. So the curriculums were great: Our music teacher taught all the girls a song in a made-up language and they talked about what it was like to be pushed outside of your comfort zone in a language you don't understand – but it's not English and it's not Swahili – and let's talk about how that made us feel as a group. The art teacher did this really wonderful painting project where all the girls stood on a canvas and painted around each other, and it was this visual representation of them coming together, and while those programs were really great, the most exciting things that I saw were the girls just sitting on the lawn together, maybe with a translator, and just sharing what their high school experiences were like, and the American girls realizing life in Tanzania for a 16-year-old, it's not that different than being a 16-year-old in Cincinnati. Sure, what surrounds you, what you have is different, but the challenges of being a teenager are the challenges of being a teenager no matter where you live. 

So, what do you see being next for Village Life?

You know what, I think that the future of Village Life is really about building community ownership and sustainability and starting to look at a very long-term future when the communities don't need us anymore. So much of our programming in the first 14 years has been immediate-need response. Our work over the last couple years has been significantly more strategic. We've backed off from building new programming, and worked more with the communities on strategic visioning around, “What do you need to end poverty for your family?” And we're not talking about, “Well, I need food in my belly; I need water.” No, like, what do you need to make those things happen for your family? And what was interesting, what came out of it was, while all of the initial things that we had talked about were still important, most of the adults we were talking to were saying, "We want adult education. We want training on X, Y, and Z," and basically new programming to put in place to allow people to do all of these things for themselves. So rather than coming in and building a building, more about training people on how to use a brick press, and some small business training about how you open a shop with that brick press, and then you sell those bricks to people to build homes, and then you've created a business for someone where they can take care of their own family while using this technology that we've introduced in the community that makes buildings safer. And that's really what I see as the future of Village Life, is building programming that allows people to take charge of their own lives and really get to a point where they can say, "Okay, we're good; you can go." 

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I'm gonna finish up because I could keep talking to you forever, and I know you have to go back to work [laughs]. Tell us about an influential woman in your life.

Well, I saw this on your website so I was like, hmm, I've been thinking about it [laughs]. I'm gonna break it down into two sects of influential women in my life. I know this is cheesy and everybody says it, but my mom is, like, this amazing woman. She worked in Cincinnati nonprofit as this superstar fundraiser for years and years and years: She worked for SUMA; she worked for Cincinnati New Bethel as the person who was getting all the money that moms and babies in this town needed. But she spent most of her life regretting that she had never gone to nursing school. All she ever really wanted to do with her life was be a pediatric nurse. When she was 46 years old, she decided that she was gonna do that. She finished nursing school when she was 50 years old, and she left the Cincinnati nonprofit world and went and was a floor nurse at Children's for several years before they saw how extraordinarily talented she was and she ended her career as a nurse educator at Children's basically preparing nurses of the future to move into quality pediatric care. She's so amazing and she is a true testament to that if you are ever not 100% satisfied with where you are in your life, that you make the change to make your life what you want. She had twins at 37 years old, and she has owned a knitting shop; she's lived around the country; she's had 100 different jobs, always because she makes creating happiness in her life a priority. 

The other piece of this is I went to Kenya with an organization called Notre Dame Mission Volunteers. I'm never a particularly religious person myself; I actually grew up in the Unitarian Church across the street. And the Notre Dame Mission Volunteers are run by Catholic nuns. The nuns I've worked with are literally women who have picked up their lives, wherever they were, and decided they were going to devote their life to another community and spend their life there. I remember working with a woman named Sister Judy who was an American nun who had moved to Kenya in her 20s, and she was 75 when I was living there, and she has essentially changed the way people thought about kids with disabilities in their community. I worked with a Haitian nun when I lived in Haiti who was essentially transforming educational opportunities for people in her community. And she was like this powerhouse at 70 years old, and so just seeing the passion and the drive that Catholic nuns have without having to attach religious meaning to it… They do it because it’s their calling from God, but they are totally willing to accept little heathen Unitarians who wanna do important things and say, "It doesn't matter what religion you come from; you're here to do good in the world and we're here to support you."

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