Early in 2002, Karen M. Schmidt, M.P.H. ’00, described for readers of Yale Medicine her HIV prevention work in Kenya—and how it helped her avoid a traffic ticket (See “Moving Beyond Fear,” Winter 2002). Later that year she returned to the United States to begin working as a consultant. Her subsequent assignments took her to the Philippines and Ethiopia. She also worked on adolescent reproductive health manuals for programs in Botswana, Tanzania, Ghana and Uganda.

In December, a year after her departure from Nairobi, she returned to East Africa to work for the Center for Global Health and Economic Development, a joint project of the Earth Institute at Columbia University and Columbia’s Mailman School of Public Health. She plans to spend about a year as a technical advisor to the Ministry of Health in Kigali, the capital of Rwanda, the site of massacres a decade ago that killed between 800,000 and 1 million people. The country is calm, Schmidt says, but people refer to “the events of 1994” and signs of the genocide remain. “The Parliament building and a few others still have bullet holes.”

Known as the pays des mille collines (land of a thousand hills) in French, one of three languages spoken there along with English and Kinyarwanda, Rwanda is a tiny, densely populated country just south of the equator.

“My job is to get people talking and to encourage the government to keep moving towards better health care financing mechanisms,” says Schmidt. “I work for a project called MacroHealth, which is helping countries implement the findings of the World Health Organization’s Commission on Macroeconomics and Health, and I will be working a bit on the Access Project, which helps countries that are applying for or have received money from the Global Fund To Fight AIDS, Tuberculosis and Malaria.”

As often as not, she spends her days overcoming what elsewhere might seem like minor obstacles. “Massive amounts of money are flowing into health,” she says, “but it’s all earmarked for projects, so if the ministry runs out of paper or fuel or can’t pay its phone bill, you have to cope.”