Small Projects Can Still Make a Big Impact on Global Health

Sydney Chen graduated from Duke in May 2025, completing majors in Global Health and International Comparative Studies with a regional focus on Africa. She participated in DGHI’s Student Research Training program in Kisumu, Kenya, under the mentorship of Megan Huchko, M.D., associate professor of global health, obstetrics and gynecology

We went straight from the airport to paint the childcare center. Fellow Duke graduates Melat Woldetensae, Anne Charles and I were delirious after 24 hours of international travel and a cold night spent sleeping hunched over on a table in the Nairobi airport. But as soon as we walked into the hospital in Kisumu, Kenya, and got paintbrushes in our hands, our energy came rushing back. 

Part of my energy came from being in a community I loved. For the past year, we’d been working to establish childcare centers in two local hospitals to provide free childcare to mothers while they attended medical appointments. One center launched as a pilot project in June 2024, and this past summer, we returned to open a second location, as well as to expand and improve the original childcare space. 

But I was also excited to be doing global health work despite the enormous budget cuts and freezes that had hit large aid organizations such as USAID and PEPFAR. Leading up to our trip, I had felt a sense of defeat from hearing the consequences of the freeze on foreign aid. Tuberculosis is resurging in Kenya. HIV infections are expected to increase. Globally, 14 million more people are predicted to die by 2030. It is easy to feel hopeless, like there’s no way to make progress in our upended field.

Painting a mushroom house and smiling fruit on the walls of a Kisumu hospital is certainly not going to offset these devastating wider impacts. But once we arrived in Kisumu and met our community partners face-to-face, I felt a growing sense of optimism about the difference these small actions can make. 

Local projects like ours belong to a broader category called DIY (Do It Yourself) Development. These initiatives are started by a few people who partner with local communities to work on a problem with personal or third-party funding. These projects are all over Kenya and other low- and middle-income  countries. Megan Mukuria started ZanaAfrica to help teen girls access period products and health education, an effort that now reaches 50,000 young women across Africa. One of my professors at Duke, Dr. Charlie Piot, and his students have set up several development projects in Togo which include cybercafés, health insurance, and a micro-lending initiative.

In Kisumu, we’ve seen the positive impact of DIY Development firsthand over the course of two years. Melat and I started our childcare program in the summer of 2023 when we went to Kisumu to work on a cervical cancer research project with Dr. Megan Huchko. During a visit to a hospital, Florence Mawere, a research technician on Dr. Huchko’s team, shared that mothers often had no one to take care of their children when they needed to attend medical appointments, forcing them to either bring their kids with them or skip the appointment.

Around the crowded waiting room, we saw exhausted mothers trying to keep their children occupied, and we started thinking of ways we could help. With the unwavering support of our community partners – hospital administration, community health promoters (CHPs), and our long-time friends – we returned in the summer of 2024 to set up a pilot run of a free, on-site childcare center which we called Jali Watoto (“care for children” in Swahili).

During its first year, Jali Watoto served more than 5,000 mothers and children. Enthusiastic responses to exit surveys told us that the moms loved it. “The children are looked after with much care,” one mother responded. ”Having them play with the available toys has eased my appointment at the hospital since the kids are having a nice time.” Although our primary goal was to increase appointment attendance, it seemed as though the more lasting impact was simply that a mom did not have to choose between her own health and that of her child. 

Motivated by the success of the pilot, we returned with the support of the Davis Peace Foundation to permanently establish Jali Watoto at the first hospital and build a new center at a second local hospital. We focused on making the space more child-friendly. We worked with a local artist to paint the walls, we solicited donations of toys for the kids, and we covered the floor with colorful mats and artificial grass.

The kids were thrilled to have such a colorful space to play. Moms could enjoy a moment of peace while watching their children have fun. The hospital administrators were satisfied with our work and have remained close partners and friends of ours. 

This is where I found hope. Even as USAID, PEPFAR, the WHO, NGOs, and other formal methods of aid were gutted, we successfully collaborated with international partners to improve access to healthcare for a community.

DIY development will not be the saving grace of global health. But I have hope that these kinds of projects offer a path forward in all the present chaos. From what I understand, global health and international development have always been about believing that the whole is greater than the sum of its parts: providing period products improves menstrual hygiene, yes, but it also helps teenage girls pursue their education like their male peers. Microloans of $100 or less have lifted people out of extreme poverty: more than that, some of those people have started their own businesses which give back to their community and stimulate the local economy.

At the same time, small-scale global health and international development projects can have benefits that go beyond the communities they serve. They promote foreign service and the right to health for all. And they signal to the world that Americans still care about helping others despite the actions of our government.

Certainly, it’s not necessarily true that in global health less is more. But right now, with formal institutions of aid in shambles, we have to hope that less is – and will be – enough.

Note: Thank you to our community partners at Lumumba and Migosi Hospitals for their kind welcome and amazing partnership, and to the many people who donated money and toys to help the childcare centers. Lastly, we want to express our sincerest gratitude to Dr. Megan Huchko for believing in us to make this project a reality.