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One year in and still learning every day. Grateful for the people, partners, and communities who make this work matter—and for the reminder that impact is built step by step, together. (Photo by Ingrid Bostrom)
A year ago today, I stepped into Direct Relief, bringing with me a career shaped by work in business, law, finance, and technology. At Salesforce and elsewhere, I learned how strongly organizations depend on discipline: clear priorities, transparent reporting, accountable teams, careful use of resources, technology that improves execution, and operating models that can scale. Those lessons still matter—but in humanitarian work, the measure of success is different.
At Direct Relief, the question is not whether a market responds or a product gains adoption. It is whether requested medicine reaches the right place, and people. Whether a clinic can continue operating after the power goes out. Whether a patient can stay on treatment during a disaster or conflict, despite poverty or displacement.
That difference adds weight to every decision.
It is a powerful motivator, and it reinforces something I believe more strongly now than when I arrived: business discipline and humanitarian purpose are not separate languages.
Purpose defines the obligation. Discipline helps determine whether it can be met.
Trust is earned through execution. Speed matters only when guided by judgment. Accountability depends on clear information. Resources must be used carefully because every choice carries a cost. And systems have to be reliable enough to work when conditions are uncertain.
A conversation I’ll always value. Grateful for the guidance, trust, and perspective that Dr. Byron Scott brought during this transition, and for the kind of leadership that lifts others along the way. (Lara Cooper/Direct Relief)
The Discipline Behind Purpose
Nonprofit work should never be seen as less rigorous than business. If anything, humanitarian work demands rigor because the margin for failure is measured in human life.
A vague operating model fails anywhere. In business, it can waste time, capital, and talent. In humanitarian work, it can delay medicine, misdirect supplies, break the cold chain, or leave a local health provider without support when patients are waiting.
At Direct Relief, a shipment is never only a shipment.
It begins as a note from a clinician who has run out of options. It carries the hope of a patient trying to stay on treatment when cost, distance, or disruption makes that feel impossible. It’s also an exercise in restraint—and in getting it right.
That restraint matters.
Humanitarian work is not simply about moving more. It is about moving what is needed, when it is needed, to partners positioned to use it well, to meet very specific needs.
That requires listening first.
Looking back on this past year, one of the most important lessons has been the power of listening. During our visit to Waiʻanae Coast Comprehensive Health Center – James & Abigail Campbell Clinic, we were reminded that the best solutions start by hearing directly from the people and communities leading the work every day. (Direct Relief photo)
Learning from Those Closest to the Need
This year, I have learned from people who are close enough to the need to see it clearly.
In Ghana, Elizabeth Esi Denyo and the Ghana Diabetes Association made clear that diabetes care requires more than medicine. It requires education, supplies, reliable access, and trusted relationships with families.
Dr. Beatrice Wiafe Addai’s work in breast cancer care showed the leadership required to keep pressing for earlier detection and treatment in places where late diagnosis is too common.
In Hawaiʻi, Sunny Chen and Healthy Mothers Healthy Babies Coalition of Hawaiʻi brought into focus how distance, power outages, transportation, and trust shape care long before a disaster makes those challenges visible to others.
In Ukraine, partners supporting rehabilitation, including UNBROKEN, showed what care means after catastrophic injury: prosthetics, counseling, clinical training, peer support, and the long work of rebuilding lives with dignity.
Through the International Confederation of Midwives, Anna af Ugglas and midwives around the world have reinforced how maternal care depends on trusted professionals who are often first to respond and last to leave when climate, conflict, or fragile systems disrupt care.
And in communities across the United States, free and charitable clinics, community health centers, charitable pharmacies, firefighters, and search-and-rescue volunteers have shown that preparedness is work done before the emergency, so help is ready when the call comes.
Each of these people and organizations has shaped my understanding of leadership.
Looking back on this year, one lesson stands out: listening to those closest to the challenge is where real progress begins. Hearing from Dr. Beatrice Wiafe Addai reinforced the persistence it takes to push for earlier detection and better treatment—especially in places where late diagnosis is still far too common. (Photo by David Uttley for Direct Relief)
Listening Must Lead to Action
Leadership begins with listening, but it cannot end there.
Listening must become clearer priorities, stronger partnerships, faster decisions, and better systems. It must become the discipline to say no to what is not needed and yes to what is.
That lesson applies across sectors, and it is one reason business and nonprofits need each other at their best.
At our best, each side brings something essential:
Companies bring medicine and medical products; technical expertise; manufacturing capacity; logistics capability; scale
Nonprofit and community partners bring proximity, trust, clinical judgment, and understanding of real need
Direct Relief’s role is to connect private resources with humanitarian need and trusted local delivery.
That is not charity as sentiment. It is a disciplined operational partnership.
The Systems People Rarely See
Cold chain is a good example.
Many modern medicines only work if they remain within the required temperature ranges from origin to destination. That means refrigeration, monitoring, validated shipping, trained staff, and backup power.
None of that is especially poetic.
But to a patient waiting for insulin, cancer medicine, or another temperature-sensitive therapy, it matters enormously.
The same is true of resilient power. A battery system or solar installation may not attract much attention. But if it keeps a clinic open, preserves vaccines, or allows refrigerated medicine to remain usable during an outage, it becomes vital.
This is the kind of work I have come to see differently.
The most important systems are often the least visible.
Listening in action. Standing alongside healthcare providers as we opened a Direct Relief midwifery kit, it was a reminder that the most effective solutions come from those doing the work every day—and our role is to listen, learn, and support what they know their communities need most. (Photo by David Uttley for Direct Relief)
Looking Ahead
Looking ahead, I see the need only growing. Health systems are under strain. Disasters are becoming more frequent and complex. Conflict continues to disrupt care. Extreme weather is testing power, cold chain, transportation, and continuity of care. Doctors, nurses, and midwives are being asked to do more with less.
The answer is not more sentiment.
It is more partnership, more preparedness, more transparency, more speed, and more disciplined connection between resources and real need.
The work ahead is not to choose between business discipline and humanitarian purpose. It is to bring the best of both to the places where the need is greatest.
-Amy
PS. Today is International Day of the Midwife, a fitting reminder that strong health systems often depend on people whose work is essential but too rarely visible. Direct Relief will have more to share soon about expanding efforts to support midwives and the communities they serve.
