A version of this blog first appeared on my website in November 2013. It has had a little tweaking but is still as relevant today as it was six years ago…

© da-kuk / iStock
© da-kuk / iStock

I talk a lot about participation, stakeholder engagement, beneficiary engagement. Not only do I think it is essential to truly understanding impact and getting a good sense of the change you are working towards, but it is because a story a woman told me once in a hospital in Tel Aviv many years ago convinced me that everything I thought I knew about impact was wrong.

In one of my previous roles I was chief executive of a small fundraising grant-making charity in the UK, working in the HIV sector. One of the things I had to do at least once a year was to go and see the results of the grants that we had made to organisations in the UK and abroad. On one such visit my colleague and I went to Tel Aviv to review the results of a grant we had provided to a hospital there, to improve their HIV centre that worked with both Israelis and Palestinians (and other HIV positive people from across the Middle East). I don’t mind telling you that I had initially opposed the grant being made and didn’t see the point of this particular visit other than to satisfy the donor.

It was for the most part, a perfectly normal monitoring visit. Until the last day when a British-Israeli woman living in Tel Aviv who was also a patient of the HIV centre requested to meet with us. We will call her Rachel for the purposes of this blog.

Rachel told us how in 1986, she was newly divorced after 20 years of marriage and having her first post-marital relationship. She discovered as that relationship ended that her partner had infected her and she was HIV positive. In 1988 it was inconceivable that a divorced mother of three would be HIV positive. In Israel, to get a test you had to give your identity number and therefore could not remain anonymous. Rachel believed that this meant she was on a list of people diagnosed with HIV and would be discriminated against by the government.

Her response was to leave Israel and go to the US. She arrived in New York, had a breakdown and ended up on the streets before linking up with Act Up, where she was cared for. However Rachel had not yet reached rock bottom. She kept moving and ended up in Miami, where she attempted suicide. Attempting suicide in Miami was illegal at the time and Rachel found herself in a secure mental health facility. After a period of time she was able to convince the authorities that she posed no danger to the public and left the US to return to the UK, where her parents were living. Arriving at Heathrow, Rachel asked her taxi driver to take her to the nearest hospital, she knew she needed help. He drove her to St Mary’s Hospital, which at that time had the largest HIV clinic in the UK. The year was 1988.

Rachel decided she had to tell her parents that she was HIV positive. Her father disowned her, meaning that she had nowhere to live and was effectively on the street again. At this point the fundraising grant-making charity that I went on to work for stepped in to support Rachel through a hardship fund that it had established for people living with HIV in the UK. The charity funded Rachel’s housing and her rehabilitation. This support, small as it was, was just what Rachel needed to begin to sort her life out and return to Israel and repair relations with her children.

Rachel became an activist for HIV in Israel, eventually becoming the chair of the largest NGO in the country providing education and prevention services and support services for people living with HIV in Israel. Rachel went on to serve on the board of GNP+ (The Global Network of People Living with HIV/AIDS).

Now as a grandmother of six, Rachel still lectures and advocates for HIV. She has outlived her father, who had rejected her all those years before. 

Rachel believes that the small investment made by the charity that I worked for had made the difference in her life. If we hadn’t cared for her then, she would not have been able to care for others through the years and possibly may not have been alive to tell me her story all those years later.

The nature of a lot of your work will mean that you won’t get the chance to meet someone who had been your beneficiary 20 years ago. But hearing Rachel’s story and understanding the difficult road that she had to travel taught me that making those small changes in someone’s life today can lead to significant changes later on. Rachel’s work in Israel and internationally has improved the quality of life for many people living with HIV, which may never have been possible if one small charity in London had not stepped in to support her when she needed it most.

Hearing Rachel’s story taught me that we needed to change what we were measuring, we needed to listen more to our beneficiaries and stakeholders; so that we could continue to improve what we were doing to help our beneficiaries.

When did you first come face to face with impact? What did you learn from seeing impact for the very first time? What are the things that really matter to you when thinking about impact?


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