“Some people are quite skeptical about the transferability of skills you gain in medical school. But I think the fact that you’ve had to deal with situations of real significance for people’s lives and advocate for them means you’re building a unique skill of engaging with difficult issues and finding a way forward.”
Bal Dhital currently works as a program manager for the Lead Exposure Elimination Project, a charity that aims to eliminate lead-based paint and products in countries around the world. But over the years, he’s worn many hats: doctor, clothing company founder, and briefly, aspiring space physician. How he got to his current role is a fascinating journey—attesting to the need for openness and exploration in figuring out what you want to do. This conversation has been edited for clarity and brevity.
Let’s start when you’re in med school. You’re on a track to become a doctor. How did your career ambitions change over time?
I was working on my medical degree when I took a year off to do research. My career plan at the time was to pursue space medicine—thinking that aviation physicians could go on to become astronauts. I thought there would be nothing cooler than being an astronaut. So I took this research year under the guise of doing a project that was kind of associated with space. The project itself did not go very well. I managed to break the machine that I was meant to be using for the year. It was a real mess. But what I got out of the year was being able to spend a lot of time thinking about space and how I might be able to posture a career to end up on a rocket ship to Mars.
I nerded out, went to a couple of space camps and space events, met a few astronauts, and generally tried to immerse myself as much as I could in this totally different world, a world in which a medical background is fairly rare. People were often very surprised as to why I was turning up at these events. But for me, the whole thing that’s exciting about space is the sort of things you see watching Interstellar. It’s humans going out and exploring somewhere new. It was very humbling going through the space events and realizing space exploration is the tiniest fraction of what the field was about. Everyone else was involved in space for every other reason—for satellites, propulsion, and all these other things that I hadn’t even the faintest clue about!
I managed to insert myself in a few workshops related to health in space. I thought, well if I can just be the tiniest bolt in the machine of a human achievement that takes someone to land on Mars, that would be a pretty cool thing to have done before I die.
But then I experienced a big shift. I remember very distinctly being in a workshop about the applications of space to global health. I had been thinking of it the other way around (applying health to space). The workshop used this one example of how they were using very high-frequency satellites to map out parts of Uganda. There had been this global health program that was trying to immunize kids against polio in Uganda. The program had a challenge where the local maps, state maps, and government maps all looked different. They were trying to vaccinate a proportion of the population, but they couldn’t actually identify where people were. The way they got around that was by using this high frequency Earth observation data from the satellites so they can actually see where the houses were.
This was a real turning point for me. I remember thinking, “If I’m honest with myself, I’m not going to advance the field of medicine in space. I’m not a great burgeoning scientist. That’s not where my skill set lies. Also, astronauts tend to be very very healthy to begin with. Do I really want to dedicate my life to not advancing how much we know about health in space for an incredibly healthy group of people?”
I spent a whole year dedicated to doing this one thing, but then that one lecture brought me back to thinking about global health. This was really the reason I’d gone into medicine in the first place. I’d been a bit sidetracked with a childhood dream, but then I was quite literally splashed back to Earth.
How did the return journey look? What was it like getting back to med school with more of a health focus?
Before going into medicine, I’d done a year of a law degree. What sat at the heart of these three very different career aspirations—law, medicine, and the crazy one of being an astronaut—was the human element. I wanted to contribute something to humanity. It’s a bit pithy and cliche to say, but I realized that was my real driving interest.
After the research year, I wanted to go back to clinical medicine and find something at the juncture of medicine and global and public health. I graduated, then worked as a clinical physician for just shy of two years. In Australia, you get a two-year contract, and you work as a general doctor in the hospital. You do some medical rotations, some surgical rotations, some in the emergency department. Normally, at the end of that two year period, people have a sense of what they’d like to do. They may spend another year or two in an undifferentiated role, or they start working directly towards surgical applications or becoming a consultant in a particular specialty. So naturally, the 2 year mark is a convenient jumping off point. I left a bit early because I was offered my current position at LEEP.
Before we get into your current role, what factors made you want to leave clinical work or try out something else?
I’d always been interested in global health. In university I’d been really involved with activities and societies related to global health. But it’s easy to look at the suffering in lower-income countries and say you want to do something about it. Actually doing something about it can feel quite nebulous.
When I went into clinical work, it was kind of like the opposite of the universe expanding. You get to a hospital and it’s like the big bang in reverse. You had all these aspirations of doing something on a large scale in global health. You think about all the 1000’s of people who die from these treatable diseases that have been eradicated elsewhere, and you want to solve it. But all of a sudden, in clinical work, your sole point of focus is the patient in the bed in front of you. There’s not a lot of time or space to be thinking about what’s happening outside of the hospital.
What jogged me to think more about public health was feeling a little bit powerless, especially as a junior doctor. You see a barrage of patients coming in. And the reason they’re in the hospital is often because of the socio-economic determinants of health. They come in, we effectively patch them up, and we send them home. When you have such high throughput and staff shortages (which, in high-income countries, are already better staffed than low-income countries), there’s rarely the opportunity to get to the heart of the issue.
During my surgical rotation, for example, we started seeing a lot of patients with inflammation of the gallbladder. But these patients were much, much younger than what we’d been taught to look for in med school. I felt like I was seeing an epidemiological shift happening right before my eyes. They would come in and the surgeons would remove their gallbladder. I would write up their pain medications in the hospital and ensure they had a discharge plan ready. We’d provide a little bit of input around nutrition and diet—some of the key factors that lead to gallbladder disease. But then we’d often send people back to the kind of environment that was conducive to their pathology in the first place.
Having had an interest in public health beforehand, and then seeing this kind of shift at the bedside, I thought it would be crazy to not try to do something in public health. I at least wanted to test it out for a couple of years before committing to a career in clinical medicine. This opened the door for me to find out what I wanted to do next.
Once you came to this realization, how did you pivot to a non-clinical role?
Hi-Med [a nonprofit that helps doctors maximize their positive impact] had just started at that point. They had a fantastic reading course. I learned about the Charity Entrepreneurship’s incubation program and thought that running a charity would be a fantastic way to jump into public health work. So I applied for the incubation program and I didn’t make it all the way through, but I found the process to be really useful. It made me realize I had all the subconscious feelings about what was important about a career. It became clear that I wanted to work somewhere in the intersection of development, health, and economics. I already had a sense of this deep down, but putting it all down on paper was clarifying for me in knowing where my next career step should lie.
Then I spent time searching job boards and came across an open position at LEEP (Lead Exposure Elimination Project). I was really lucky to be offered the position pretty early on in my search, and I accepted as soon as it was offered to me.
In your specific role as a program manager, what does the day-to-day actually look like?
At LEEP, the overall aim is to stop a new kind of lead-based paint being sold. The sooner we can stop lead-based paint being sold on the shelf, the better. One arm of our intervention is the regulatory arm—working with governments to support the introduction of laws or regulations or standards that stop lead paint being sold and punish manufacturers for making lead paint. And then the other side is working with manufacturers and encouraging them to shift towards lead-free paint.
A lot of my work is stakeholder management—communicating with the contacts we have in governments or various manufacturers and trying to nudge them towards the goal we agreed on (in the least annoying way possible). A lot of the governments we work with are strapped for time. They’re not looking for new projects. The stakeholder management in this context is trying to remind them of the importance of preventing lead exposure. We try to smooth the path, keep them on track, and work towards specific goals.
Then, with industry and manufacturers, it gets more complex. Economics is a major driving force, so it’s hard to advocate for something that could make their product more expensive. A lot of my work is having to pick up the phone, speaking to people, and trying to remind them of the importance of the issue. Then, it’s trying to make their life easier so they can implement the changes we’re suggesting.
The importance of this work for us at LEEP is the counterfactual impact. We know lead-based paint will be eliminated at some point in the future. So the sooner we can make that happen the better—compared to what would have happened otherwise.
As far as my day-to-day goes, I do a bit of stakeholder management. I think we have 20+ programs across the world—from South America to Indonesia and Vietnam to several countries in Africa, where the bulk of the work is. I have a call or two on average. Then, a fair amount of time goes to drafting emails, briefs, and documents for relevant stakeholders. A lot of time goes into planning trips. I’m currently heading off to Nigeria in two weeks, and a lot of time goes into making sure the time we spend there is the most effective. We find that being there in person is one of the best ways to accelerate our work. We really try to build relationships with stakeholders in a way that facilitates progress and makes it that much easier to call someone up on WhatsApp in a couple of weeks.
In this role, I travel between one to four months of the year. I’ve been on trips to Rwanda, Zimbabwe, and Ethiopia. This year, I spent a month in Uzbekistan, and then some time in Pakistan and India as well. The main purpose behind most of the trips is doing a paint study. We go to paint shops and ask about what the most popular paint brands are, getting a sample, and sending it off. I guess a lot of it is waiting for paint to dry, actually.
What kinds of things do you think helped you get this job?
It seems like a lot of random stuff, but the two key ones were working as a doctor and having a crack at running a startup. The backstory of the startup is that I went to a university called University of Newcastle outside of Sydney. It’s a super lovely town, but it’s surrounded by swampland and full of mosquitoes. The university decided to shift the problem-solving to the students and created a competition called “The Grand Challenge” to create a business idea or organization with an intervention. And the intervention or product should tackle two problems—the first problem being the nuisance of mosquito bites on the campus, but more broadly, it would be great if it could contribute in some way to the burden caused by mosquitoes around the world.
I had one of those butterfly effect moments where I just happened to be at the library one day studying for an exam. The screensaver on the computer that I was sitting on advertised “The Grand Challenge”. I was interested because I had tried small entrepreneurial projects when I was young and had a sense that I wanted to have a crack at something a bit more serious. My friends and I decided to make mosquito-repellent clothing and then donate some of the profits to charities working on malaria intervention. So we pitched “Borne Clothing,” won the pitch competition, and got some funding. Today we’re figuring out future plans but we’re still selling t-shirts. It was such a useful learning experience. I know for a fact that this experience was very useful in getting my job at LEEP. They noted that something that stood out on my application was that I had tried doing something that requires a lot of agency. No one else was responsible for the outcome except us.
How does your previous work as a doctor apply to your current non-clinical work?
I was actually talking about this with a friend of mine who recently left clinical medicine. The question came up: would you study it again? I think that perhaps I would have studied something like economics instead, but I certainly don’t regret doing medicine. And the reason for that is the unique experience it provides early on in your career.
Very early on, you have a privilege of being involved in people’s lives in vulnerable moments when very important decisions are made. You’re exposed to conversations that are sensitive and have to be able to simultaneously communicate with different groups of people. You’re communicating with the people more senior on your medical team—with the expectation of using more complex medical language. You’re also communicating with Board staff and the ward staff. And you’re communicating with the patient and the patient’s family. You’re also advocating for the patient to the other hospital staff.
One of the key experiences from my time in the hospital was being forced to try to convince some poor CT registrar that my patient deserves a scan. There’s a limited number of scans a day and I need to justify why my patient deserves one. I had to really learn to advocate, which I now have to do when I manage stakeholders with different priorities.
It’s a lot about the soft skills you gain along the way. Some people are quite skeptical about the transferability of skills you gain in medical school. But I think the fact that you’ve had to deal with situations of real significance for people’s lives and advocate for them is a very unique opportunity.
What do you think makes for an especially good program manager—at least at LEEP?
There are about 10-12 program managers on the team. Three of us have a medical background, two with a legal background, and the rest are a real variety. Several worked in consulting. Some worked with UN agencies or the Peace Corps. Or there’s people who have entrepreneurship experience.
I think the thing that ties these backgrounds together is how comfortable people are speaking with new people. The key skills come down to communication and stakeholder management. You need to be someone who is willing to pick up the phone, call a paint manufacturer on the other side of the world, and try to convince them why they should stay on the phone and take what I have to say seriously. You need to be comfortable working with and explaining things to different groups of people—whether members in government or the Minister of Environment or an NGO or a multinational manufacturer, a tiny paint manufacturer. It’s a huge diversity of people, so the work involves trying to get them together. It’s trying to establish a common language and guiding people towards a common understanding of an issue. If that’s something you enjoy or are comfortable with, it could be a good fit.
What’s especially fulfilling about your work?
In the hospital, if a procedure goes well for a patient and you successfully discharge them or treat the issue, there’s an immediate satisfaction with that. In my work now, it’s different. You don’t get to see change on a day-to-day basis. There are moments that are really satisfying—when we hear from a paint manufacturer that they have swapped or they’re decided to swap to lead free paint. Or when we hear from the government that regulation has been drafted or it’s been sent to the Minister to be signed. Those are real achievements.
I think overall, though, it’s more about the slow progress and the feeling that things are generally moving in the right direction. Or the sense that lead exposure is becoming more of an issue in the minds of the stakeholders we work with. Looking back at the end of the week, it’s always exciting to realize how much the team has achieved. And to know that there are 10 other people working in the same role as you and they’re just getting a whole bunch done.
We’re working towards this seemingly impossible goal. Lead exposure is a massive problem. But it’s totally solvable. And I can see week-to-week just how much progress we’re making towards that goal. It’s very fulfilling.
Do you have any advice you’d give to other med students or even to your younger self?
I preface what I’m about to say recognizing that, unfortunately, there are just staff shortages everywhere. And even in high-income countries, well-resourced hospitals have staff shortages. But I think when you’re in a health-based degree program, especially in medicine and for the competitive specialities, it’s very easy to just jump onto the treadmill as soon as you leave medical school—meaning, you’re constantly chasing a very competitive end goal.
So in opposition to the advice that you should never leave med school, I think that it’s important to recognize that you kind of have the best of both worlds. You have this incredible safety net of a job that is well-paying. You’re never going to be in need of a job because there are staff shortages everywhere. If you have the opportunity to go and explore something, it’s not really going to make a difference to your career—unless you want to be the pioneering neurosurgeon at a high far-flung hospital.
Taking a year or two away from the hospital to try something functionally shouldn’t make a big difference in your career. It may just give you the opportunity to do something that you end up enjoying far more—and something that will really benefit from the application of your skills. So for people who are considering leaving for a year or two to do something else but are afraid of what it might mean, I would just emphasize the value of the safety net you’ve built for yourself. It provides an opportunity to try something else. It’s an incredibly lucky position to be in.
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