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Failure #1 – A Lack of Preparation and Strategy

by Helen Fosam

When I received the request from John (not his real name) seeking my help to create a telemedicine medical education program in Nigeria, I was excited that my experiences and skills would be put to good use. It was as if my plan to start giving back had found me. I did not have to create anything new or design any elaborate plan because the plan was already made in its full glory. I just had to fit into it.

As a freelance medical writer, I could decide when to work and how much I wanted to work. I could carve out one day a week to work on the telemedicine medical education program. I was super excited at the prospect of the initiative being an international collaboration. I was ready and happy to give my time freely to the initiative. John had already established connections in the United States. He had a relationship with a major hospital in India. And of course, he had excellent connections to physicians and medical educators in Nigeria. I was soon exchanging emails and ideas with my new collaborators. 

As ideas came up, I jumped on them. I wrote a letter to the then program coordinator at the United States Agency for International Development (USAID) to introduce our initiative and solicit funding. The email response included a list of useful links to lots of information and a reminder that USAID grants are a competitive process in response to requests for applications. No funds came through. I applied the skills gained from my decade-long experience in the continuing medical education industry writing grant applications. I pulled out my Rolodex of pharmaceutical and non-pharmaceutical companies. I searched for those operating in Africa, with “corporate giving” on their website. I tracked down the names and contacts of the relevant personnel at these companies and emailed them directly. The majority did not respond, and the few that did politely told me that they would review my request and get back to me. They did not. Undeterred, I soldiered on, I wrote grant proposals on behalf of my collaborators. They were all denied. Still undeterred, I responded to a request to write a Memorandum of Understanding (MOU) on behalf of the collaborators. The MOU was a formal agreement to work with the Federal Ministry on a telemedicine education program. But that also did not go anywhere. 

Almost two years had elapsed since that initial contact with John. The lack of progress, despite so much effort – at least on my part – was beginning to crack the foundation. A collaborator brought on to analyze the data we had planned to collect from our initiative politely bowed out, closely followed by academic institutions on standby to offer their expertise and exchange students. Money is a service driver – when the former is not on the table, the latter does not happen. Thinking about it now, I was so naïve. There was no other outcome but this. 

On reflection, my involvement in the telemedicine initiative reminds me of my leap of faith into freelance medical writing, except the stakes were now much higher. Then, jumping in feet first into something I knew little about was less of a risk. Nothing was at stake. I was on my own. To sink or swim. In contrast, a lot was now at stake, involving an international multidisciplinary collaboration of academics, healthcare professionals, potentially patients, and possibly $ with lots of zeros. 

In my excitement for an initiative that resonated with my ambitions, I had neglected to do my research and ask fundamental questions to establish the feasibility of success. Instead, I had dived into an idea that did not have a clearly defined mission, vision, or strategy. The elaborate spreadsheets of projected income, but mainly expenses, were created in silos. There was no business plan to anchor the spreadsheet and provide a roadmap to steer the initiative towards success. The successes of my previous grant applications were written for companies with a track record of successful project execution. I now wrote grants for an initiative with a track record of successful project execution of zero. Hard-earned cash, especially tax-payers cash, is not given up easily to an idea with nothing to demonstrate the potential for success. 

Two years after my initial excitement, the telemedicine medical education initiative died. I was disappointed at the failure, including my $ thrown down the bottomless pit. Although the lack of mission, vision, and strategy contributed to the collapse of the initiative, on reflection, I learned valuable lessons about turning an idea into a business. The failure forced me to admit my shortcomings and how ill-prepared I was to execute such an initiative. It also forced me to face my insecurities, which I had to address.

I vowed that this was the end of the road. After all, I had tried. But, unfortunately, it just did not work out. Time to move on. Time to focus on my clients and deadlines. But like a bad itch, the idea of CME in Africa just will not leave me alone. So after six months, long enough to get over my disappointment, I tried again, but this time from a different angle, taking along the lessons I learned.

Helen Fosam is the founder of the Missing Link to Improved Health Outcomes (MiLHO) Initiative. The initiative focuses on creating online continuing medical education courses for healthcare professionals in Africa. We are currently beta-testing our pilot course on type 2 diabetes. Click here to subscribe and to access the free diabetes course.

A medical writer focusing on continuing medical education, Helen has roots in pre-clinical research, in academia as a faculty member, and in the healthcare sector as an R&D adviser. She holds a Ph.D. in Physiology from Sheffield University, UK, MSc in Biochemistry from Sussex University, UK, and BSc in Biochemistry from Kent University, UK.

The MiLHO Initiative emerged from a combination of a personal medical emergency, the role CME played in that emergency, and the realization that healthcare professionals’ access to and participation in CME is critical to evidence-based patient care and their optimal health outcomes. The mission of the MiLHO Initiative is to support healthcare professionals in Africa to access relevant and affordable CME in their local settings. Join us. Together, we can make a difference. Click here to subscribe, and then forward the link to your contacts.