The Last Report (in which I discuss the conference and finally get sad about the end of the Watson)

It’s September 1st, and the cold morning air seems to be celebrating the beginning of fall. I’ve ducked into a nearby café for a warm coffee, and it turns out to be Scandinavian-themed, with surprising authentic kanelbullar and phrases written in Dutch that look almost identical to their Swedish equivalents. This will be my first fall in the US not consumed by back-to-school sales and the idea of new classes; by this time a year ago, I had already been living in Sweden for over a month. I can’t help but feel a pang of nostalgia for that time, a fitting emotion to go along with the bite of cold weather.

All the 2016-17 Watson Fellows. I am honored to be standing here with such an honest, lovely, and inspiring group of people.

My last reflection for the Watson year is due today, so I am sharing it here (fair warning – it is a bit longer than the other quarterly reflections). This will be the end of this blog, so I want to thank everyone who followed me and supported me throughout the year. Knowing that so many people were reading the blog is what kept me writing, and I love you all for that. Thank you.

Watson Final Reflection (Quarter 4)

New York City is a lot kinder than I remembered. After years growing up in Manhattan, I expected to come back to a place that seemed harsher and more foreign than ever before. But I find the city friendly and kind – maybe because I’ve been on the receiving end of so many kindnesses this year that I am more aware of the potential of kindness in everyone. Or maybe it’s because my Watson year was difficult and full of the unknown, and the mere fact that New York is familiar, with signs in English, makes it seem easy. Maybe it’s because I was so worried I’d be disillusioned with New York and the US as a whole when I returned, and it turns out that I’m not. That even with all my strange new definitions of “home,” New York City is, indeed, my home.

In typical New Yorker fashion, I have been riding the subway nearly every day since returning to the city. When I’m on the trains (which look the same as they have my whole life, for better or worse), I often feel like time doesn’t exist; that “now” could be 5 years ago, or 5 years in the future. I wonder if the Watson hasn’t happened yet or if it’s already happened many years ago. This sense of warped time is partially due to the nature of being in transit, frequently traveling amongst strangers – a state I’ve gotten quite used to. Riding the New York City subway is familiar, as something I’ve done all my life (certainly “pre-Watson”), but it is also very similar to much of my movement on the Watson.

This is all to say that I am still processing the end of the Watson. I avoid saying “since I’ve come back home…,” because it implies some circular nature to the events of the past year. The Watson was far more than a simple trip for which I left home only to come back a year later. It was a step forward, a continuation of the life I have been living, and a year in which I had many homes. Though I am in the same physical city now as I was before the Watson, the world has carried on in the meantime, and I feel different, older. So I haven’t exactly gone back.

The Watson conference was a wonderful place to start processing these strange feelings. Meeting my cohort of Watson Fellows was an emotional experience that far exceeded my expectations. For some reason that I can’t understand now, I was worried that it would be too overwhelming, with too many strong personalities in too short a time. But as the Watson Foundation promised, the few days we spent together felt more like a warm family reunion than a conference. The other Fellows, with their eloquent and thoughtful presentations, were able to describe emotions that I have felt deeply throughout the year but have been unable to voice. As one Watson Fellow put it, the conference felt like an opportunity to meet forty versions of the same passionate individual; a chance to see who we could have been if we had pursued different projects or chosen to live in other countries. Talking with the other Fellows, and discussing the more complex feelings and challenges we encountered this year, helped validate my experience and cement the Watson as a very real year.

The conference was also the first time in a few months that I let myself feel emotions again. About a month or two before I left Botswana, my last project country, I realized that I had been stemming deeper emotions, or at least compartmentalizing more than before. I thought it would hit me at some point that the Watson was ending, and that I would become overwhelmed and sad – but even just a week before my flight to the US, I didn’t feel as much of a sense of loss or even as much excitement as I expected. I said goodbye to my best friends in Botswana with more of a “see ya later” attitude than a real goodbye. I didn’t feel the depth of it when packing, or on the plane, or on my surprise 16-hour layover in Doha, even though I had the chance to meet up with my close friends from Qatar much sooner than expected.

Even at home, I didn’t feel it – not until the conference. Early into the Watson year, I happily realized that I was making more friends and forming deeper relationships than I ever hoped to, considering how little time I had in each place. But with all these lovely friendships came far more goodbyes than I could have predicted either. Fully feeling every goodbye, every loss, and every ending got harder and harder, only a few months apart each time, so I suppose I subconsciously learned to protect myself from those emotions. For that reason, I am glad that the Watson year is over. The lifestyle would have been become unsustainable. It was already emotionally exhausting, and now that I have finally let myself appreciate the end of the Watson and what I’ve lost, but also everything that I’ve gained, I find my heart quite a bit heavy. I feel like I’ve lived six full lifetimes over the past year, and that’s a lot to carry around, even though what I’m holding includes lots and lots of wonderful things. Maybe that’s why I can’t easily say that I’ve “come back” – because I can’t ignore that, while my one suitcase stayed the same weight all year, I feel heavier in other ways.

I want to remember these wonderful things, so I will put some of them down here, in writing. I don’t want to forget the way my Japanese host parents kept waving as I went through airport security for as long as it took for me to disappear from view. I don’t want to forget singing along to Beyoncé with project collaborators in Botswana on the 4-hour drive back from the most remote village I’ve ever seen. I want to remember telling my parents over Skype about going to a Japanese hot spring with my host mom, sitting naked in the steam with her and speaking broken English, and not realizing how weird that sounded until I said it out loud. I don’t want to forget the names of anyone I’ve met, or the looks and smells of the 50 different rooms I stayed in over the course of the year. I like remembering the little moments – wandering around Osaka by myself on Easter Sunday, meeting a group of young entrepreneurs trying to cultivate start-up culture in Nagoya, and having so many difficult conversations about Trump, racism, and Christianity with cab drivers in Botswana.

Of course, I will also remember what I learned from all of my meetings. In the last quarter, my project focused more on grand themes than individual, illustrative products. Though there were many times in Japan when I thought I had heard all the possible answers to my questions, and that I wasn’t finding new insights, I was still struck by the patterns that developed. By the end of my time there, I had a clear sense of the importance of collective culture, which favors large established companies over innovative start-ups. Along with the high aversion to risk that I noticed in Japan – probably part of the reason why Japanese life expectancy is so high – it becomes evident why there is not a high acceptance or early adoption of new medical devices in Japan, especially those that are invasive or require extensive testing.

In Botswana, the key factors that influence reactions to medical technology turned out to be the population size, the influence of the government, and the importance of community. The small population, a sparse two million in Botswana’s landscape, means that very little comes from Botswana or is made there. The head of the Botswana chapter of the South African Federation for the Disabled told me that, since Botswana is relatively well-off, foreign donors overlook the country compared to others in the region – even though the Botswanan government is constantly seeking additional funds for health crises. The fairly centralized government is one of the country’s largest employers, so it is a big part of Batswanan life. Instead of fast-paced start-ups or private companies leading medical technology innovation, all ideas and projects must involve the government to have a wide reach, which means the development of healthcare products gets slowed down by layers of bureaucracy. Furthermore, since Botswana doesn’t have a history of invention or a critical mass of people working outside the government, there are very few success stories to inspire new innovators – and much of the older generation looks down on the quality of potential “made in Botswana” devices. Luckily that attitude appears to be changing with new generations.

With fewer distinct medical technology projects and products to pursue in Botswana than in other countries, I had to adapt my approach. I enjoyed this change, as I was able to delve further into the examples I did see rather than having many one-off hourlong meetings with different companies. I followed one mHealth start-up in particular – a company that started in Kenya and offers a smartphone app for easy eye examinations – and watched it evolve over the course of two months. I interviewed the project manager in Gaborone, attended a preliminary budget meeting with the government at the Ministry of Health, and went into the field to talk to community health workers in rural villages about the start-up’s pilot program in one of Botswana’s school districts. It was fascinating to see this mHealth project from different sides and add the dimension of time to my understanding of their work – especially how working with the government, while necessary in Botswana, can slow progress.

Thinking about all the countries I visited, human-centered (ergonomic) design is absolutely a key factor in creating positive reactions to medtech. Of course, each country and each community is unique, and I found different answers to my questions in every project country. User-focused development processes, however, naturally account for most of these differences since they involve working and designing with relevant local groups. I also found other, less anticipated factors that were important in most countries, such as the presence of an innovative environment; the importance of finding and working with the key opinion leaders of a community, whether patients or doctors or village leaders; and the need for a good business plan or supportive finances, as the discussion of ergonomic design is a privilege that comes after establishing the affordability of these medical technologies. I learned that the slightest difference between countries could manifest in completely different attitudes to medical technology – and that different attitudes to medical technology, such as in Sweden and Japan, could lead to very similar health standards. The only way to know the impact of those small changes is to really know a country – its healthcare and technology, and the interplay of its politics, culture, and society – and that’s a process I truly enjoyed.

I wish I could say that I am inextricable from my project, as many Fellows are. I would love to draw a beautiful connection between the findings of my project and my personal development on the Watson. While both surely evolved, I do think of them as two separate progressions.

It’s hard to say exactly what will become of my findings this year, or my blog. I am happy to do all of this to wrap things up – the conference, this last report, closing up the blog – but I also don’t want to say that this all ties up in a neat little bow. It wasn’t the easiest year, of course, and not all of my meetings were thrilling or elucidating. Some were contradictory. Some seemed really exciting at the moment but turned out to be outliers or one person’s exaggerated experience. It’s difficult to package this up and neatly put it away, and I’m not sure I want to; all of my Watson year experiences are now part of who I am today, and that will stay with me. I think having this project has helped me think even more broadly than my liberal arts education. Observing so many “sustainable” design projects has inspired me to not only consider these elements in my future engineering work, but also to ultimately move from engineering to design.

As far as my own personal developments, I’m sure they will be evident more and more as the years pass. But one clear change is the fact that I enjoy and seek out alone time more than I ever have before. It sounds like such a small thing, but it does matter to me. I never needed alone time in college, and though I didn’t realize it at the time, that desire to be around people all the time was somewhat indicative of my own insecurities. I’m really fond of this change because it means that I am more comfortable with myself – happier spending time with myself and generally more confident in who I am as a person. I feel less reliant on others to give me advice and suggest how to be happy, and I have less of a need to fill my time with other people and other things. I have a new (or re-discovered) sense of completeness in being alone. I don’t want to lose my new appreciation of alone time now that I have the opportunity to be surrounded by people all the time. I want to make a conscious effort to keep that.

Similarly, I now feel comfortable going into situations without too many plans or expectations because I trust myself to deal with whatever might come up. I’ve gained more from being patient and seeing what will happen, knowing that either way things will be different from what I could predict and that I will be able to handle it anyway.

Another change I wish to hold onto is the way that this year has pushed me to be better. The Watson Foundation’s immense trust and investment in each year’s Fellows forces us to rise to the occasion, and I found myself particularly motivated to add something positive to people’s lives in order to be a worthy recipient of the grant. It’s impossible to ignore the privilege of mobility and the pangs of imposter syndrome that can accompany such a grant, and I think the only way to mitigate those feelings is to try to make some sort of positive impact while on the Watson and pay it forward in the future.

On the other hand, I’m sure some of the changes I’ve adopted this year are temporary, like so much about the Watson. I won’t always feel super comfortable living out of a suitcase, or be so used to hellos and goodbyes, and that’s okay. One of my favorite parts of the Watson conference was when we discussed what we want to take with us from the year as well as what we want to leave behind. I’m tempted to live the Watson lifestyle forever, and it was a good reminder that it’s okay to leave certain things behind from the year, to lighten that load a bit. Of course, there are many things I want to keep forever, such as that newfound appreciation of alone time, the ability to maintain steady emotions in the face of the most unexpected events and setbacks, and how to say “Cheers” in a few different languages.

For now, I feel like it’s time to redirect my energy to the US, where I do understand the culture and can act in my own context – at least for a little while. I haven’t yet figured out exactly what that will look like, and I’ve been getting impatient, likely because I’m still on the Watson time pacing. I got used to living full lives in spans of a few months, so it’s strange to me to have far more time than that to figure things out. But then I look at my Watson conference list of things I want to bring with me from the year, and the only word I underlined – amid self-confidence and minimalism and paying kindnesses forward – is “patience.”

All in all, I am filled with love and gratitude and humility after the Watson year and the conference. Thank you.