The following is a conversation between Kathy Spahn, the President and CEO of Helen Keller International, and Denver Frederick, Host of The Business of Giving on AM 970 The Answer in New York City.

kathyatopblackfacemountaincoloradoaDenver: It is hard to imagine a more inspirational figure over the course of the last 125 years than Helen Keller, who said, “Optimism is a faith that leads to achievement. Nothing can be done without hope and confidence.” And the organization that bears her name absolutely proceeds with hope and confidence as it strives each and every day to live up to the very high bar that Helen Keller set. It is my pleasure to welcome to The Business of Giving the President and CEO of Helen Keller International, Kathy Spahn. Good evening, Kathy, and thanks for being with us tonight!

Kathy: Thanks very much for the opportunity to talk about our work.

Denver: Before we get to your work, tell us about Helen Keller. I didn’t really fully appreciate the extent of all the things that she was involved in and what a champion she was for so many different causes.

Kathy: She was a remarkable woman. And it’s true that people think of her as someone who was blind and deaf and define her by that.  But let me back up. She was born in 1880, and when she was born, she could hear and she could see. At about 18 months of age, she got very ill, and no one really knows what it was. It could’ve been scarlet fever; it could’ve been meningitis.  But as a result of the illness, she lost her sight, and she lost her hearing.

I think the world probably knows the story of her working with Annie Sullivan, a remarkable teacher and friend to her, who taught her how to speak, how to say “water” the first time she put her hand under a water pump. But I think what most people don’t know is that Annie Sullivan herself went blind. She went blind from a disease called “trachoma” that we’ll probably talk about later. It was a disease that existed in this country back in the 1950s and that we’ve conquered, but it still exists in other parts of the world. So Annie Sullivan herself lost her sight.

Helen Keller was a champion for anyone who is disadvantaged. She felt that nobody should be denied opportunity: because of a disability, because of religion, because of where they were born, who their parents were. So she was a big fighter for social justice, and there are many more dimensions to her than most people realize.

Denver: Helen Keller was also a real champion for social justice, beyond those who were blind and who were deaf.

Kathy: Helen Keller was a champion for anyone who is disadvantaged. She felt that nobody should be denied opportunity: because of a disability, because of religion, because of where they were born, who their parents were. So, she was a big fighter for social justice, and there are many more dimensions to her than most people realize.

Denver: Absolutely ahead of her time. Well, you celebrated your centennial anniversary last year– 2015.  The predecessor organization, that is Helen Keller International today, began in a most interesting way. Tell us how this whole thing got started.

Kathy: We got started because of the sinking of the Lusitania. There was an American wine merchant and philanthropist named George Kessler, who was also known as the “champagne king.” He was known for throwing very extravagant parties where he would take over hotels and redo them to look like what a Las Vegas hotel looks like now.. He was on the Lusitania when it sank. As he was in the freezing cold water, holding onto a plank of wood, he made a pact with his God that if he survived, he was going to help his fellow man. He did survive. He woke up in a hospital in Paris and he said, “Okay. I want to help soldiers from World War I.” He knew a lot of soldiers had been blinded from mustard gas, so he said that’s where he wanted to start. So he reached out to Helen Keller to join him in setting up this organization. We were actually founded in Paris, and we were called the “Permanent Blind War Relief Fund for Soldiers of the Allies.”

Denver: Now that’s a mouthful.

Kathy: Not a name that rolls off the tongue.

Denver: And then a couple of years later, he passed away, and William Cromwell, who was a founder of Sullivan & Cromwell, stepped in.

Kathy: Yes, he did. And because of that, we always have at least one, if not two, partners from Sullivan & Cromwell who serve on our board of trustees. So they continue to be very good partners and friends to Helen Keller International.

Denver: And Kathy, when did the organization adopt that name, Helen Keller International?

Kathy: We started using the name in the late 1970s. We had gone through many different names. Right before that, we were the American Foundation for the Overseas Blind. But when Helen Keller died in 1968, it got the organization thinking about what was the best way to honor the memory of  our co-founder.

There are 285 million people who are blind or have really low vision, and 39 million of those people are actually blind. That to me is just a number. What to me is the compelling fact is that 80 percent of people who are blind don’t need to be blind. That means that 8 out of 10 people who have lost their vision lost it for something that could’ve been prevented or could’ve been treated.

Denver: It would probably be helpful if you grounded us as to the magnitude and scope of vision loss and blindness around the world, and how much of it is preventable.

Kathy: I would love to talk about that because that’s what got me hooked and so excited about having the opportunity to lead Helen Keller International. I think numbers can be numbing. There are 285 million people who are blind or have really low vision, and 39 million of those people are actually blind. That to me is just a number.  What to me is the compelling fact is that 80 percent of people who are blind don’t need to be blind. That means that 8 out of 10 people who have lost their vision lost it over something that could’ve been prevented or could’ve been treated. That the science, the know-how, exists!  It’s just not getting to all the people who need it, and that’s what really motivated me!  It was thinking, “Eight out of 10 people have lost their sight that didn’t need to? That’s crazy!”

Denver: A lot of the work that you do, and I don’t think a lot of people would think about it immediately, is around malnutrition. Why is that the case?

Kathy: I want to talk a little bit first about our evolution because we started working with soldiers who had been blinded in the war. But around the 1950s, the organization decided that it was far more cost-effective and impactful to prevent blindness rather than treat those who are already blind. There were a number of organizations providing services to the blind, and we found there was a role for us to play in prevention of blindness. So in the 1950s, we started switching our mission and stirring the ship in a little different direction.

As we looked at the causes of blindness that are preventable and treatable, we knew that the largest preventable cause of blindness in children is a deficiency in vitamin A. When children are vitamin A-deficient, they’ll first lose their night vision; so they’ll get night blindness. And then later on, for different reasons, it progresses and affects the rods and receptors in the eye and can lead to permanent blindness. Now, why is a child deficient in vitamin A? Because they have a diet low in nutrients. They may eat a lot of rice; they may eat a lot of white potatoes, but what they need are things that are orange — carrots, mangoes, papayas– and dark, leafy greens — which we all should be eating a lot of. So in many parts of the world where the diets are deficient in that, children are deficient in vitamin A, as are many mothers.   

We started supplementing  vitamin A because you can give a high-dosage vitamin A supplement to a child six months apart, and it’s stored in the liver. It will actually keep providing…for about four of those six months… a source of vitamin A.

So in the late 1970s, we hooked up with a brilliant man, Dr. Alfred Sommer who was then at Johns Hopkins and went on to become the Dean of the Bloomberg School of Public Health. I’m sure Al Sommer had a lot to do with why Mike Bloomberg made it the Bloomberg School of Public Health.

Al was looking at our programs – and we had big programs in Bangladesh and Indonesia with vitamin A supplementation – and he wanted to see if vitamin A supplementation would stop these kids who are vitamin A-deficient and already had night blindness – so the first indicator that there was an issue – to stop them from going fully blind.

So, when they went back to see how are these kids were doing a year later, something like 70% of the kids had died. He was a researcher and a scientist, as well as an ophthalmologist, and he thought, “There has to be some causality here. Why are these children dying?” And sure enough, what became to me I think the most important public health discovery of the century– was he realized that vitamin A was necessary for your immune system to work. So you don’t die from vitamin A-deficiency, but you can die from a host of diseases that shouldn’t be fatal if you’ve got a functioning immune system. These kids might get measles or a cold that became an acute respiratory infection, or diarrhea, and their systems couldn’t fight it off. They ended up dying.

It was established that supplementing kids with vitamin A could improve their chances of living by as much as 24%. So, that was a big “lightbulb moment,” not only for Al Sommer, but also for Helen Keller International.

Right now, there are about six million children a year who die in the world before they reach the age of five, and 45% of those deaths are linked to malnutrition.

Denver: For everybody. Absolutely huge! How many kids under the age of five die from malnutrition?

Kathy: Right now, there are about six million children a year who die in the world before they reach the age of five, and 45% of those deaths are linked to malnutrition. Again, those children– had they not been malnourished– wouldn’t have died.  The causes could’ve been prevented or fought off. But I do want to note: that figure of six million who die every year before they reach their fifth birthday is much, much better than it was back in 1990. When I started at HKI in the early 2000s, that number was 12 million children. So we’ve halved the number of kids who die.

Denver: Also with a much larger population of children! So, it’s even more dramatic than that.

Kathy: Yes. That’s a good point. There are still about 250 million children who are vitamin A-deficient.  Among those, somewhere between 250,000 and 500,000 will go blind. So, it means the vitamin A deficiency is severe enough that they’ll go blind. And of those, half of them will die within a year of going blind. Now, they’re not dying from going blind; the blindness was an indicator of how severely malnourished they were!

I think malnutrition is so central to health, to development, to economic productivity … If a child doesn’t get proper nutrition, they will never fully develop. Their brains won’t fully develop, so they won’t be as smart as they could’ve been. Their bodies won’t fully develop. The damage is irreversible… so it really is a smart investment to invest in appropriate nutrition.

Denver: And you’ve been at the forefront of trying to change the lens of how we look at malnutrition… away from the costs, and to the benefits. Speak to that a little, if you would.

Kathy: I think malnutrition is so central to health, to development, to economic productivity. We focus on something called “the first 1000 days,” which is from when a child is conceived to their second birthday, because that is a critical window for nutrition… both in utero, through what the mom is eating, and in the first two years of life. If a child doesn’t get proper nutrition, they will never fully develop. Their brains won’t fully develop, so they won’t be as smart as they could’ve been. Their bodies won’t fully develop. The damage is irreversible.

So it’s really important to get good nutrition at that point. Otherwise, you’re going to have children who grow up stunted, meaning they’re too short. In fact, there are 156 million kids in the world today who are stunted. That means one in four children who are under five are stunted. And it’s not that there’s something wrong with being short. It’s that stunting is an indicator of malnutrition. It’s an indicator that their brains haven’t fully developed, and their bodies haven’t fully developed. So they’re not going to be able to contribute to society in the way they could have. They’re not going to be able to be physically productive in the way they could have. It has huge impact on the economy. So, it really is a smart investment to invest in appropriate nutrition.

Denver: Absolutely! In addition to distributing these vitamin A supplements, you have an effort where you’re trying to make mothers more self-sufficient in providing nutrients for their family and children– in something called the “Homestead Food Production Program.” How does that work?

Kathy: We started thinking about what we could do beyond the programs that were vitamin A supplementation because those are dependent on vitamin A supplements. We partner with Unicef on this being available for those children. We wanted something more sustainable, that became part of the fabric of daily life.

So we started a home gardening program where we worked with mothers who had backyards– that could have a backyard plot– to grow leafy, green vegetables and fruits that were healthy for their children. But we’re a very scientific organization. All of our work is based on evidence. So we went back to evaluate the women and the health of the families, and their levels of anemia, and how things were going. We realized we were not having the impact we thought we would. What we realized is without an animal source of vitamin A, and also animal sources of protein, we couldn’t have the impact we wanted. So, the program grew to include small-scale animal husbandry. Poultry farming is a main part of it, but now it’s grown to include fish farming. We do some work with goats.

And even then, we realized that looking at nutrition and food in a silo wasn’t going to have the impact we wanted. Because if you’re growing good food, and you’re feeding that food to your children, but they’re playing in the dirt, and animals are defecating in the dirt, the children are going to get sick.  They’re going to get diarrhea, and they’re going to lose all the food they’re eating.

So, we’ve now added a word to Homestead Food Production– which is Enhanced Homestead Food Production. It means it has a wrap-around of something called the “essential nutrition actions” that brings in care and health. That’s kind of the three-legged stool: food, care and health; and you need all three of those. With that, we promote the importance of exclusive breastfeeding for the first six months of life because that is the best nutrition the baby can get. We promote all kinds of sanitation and hygiene; we promote latrines; we promote face washing and hand washing– all kinds of things to ensure that the child is going to thrive.

Denver: A very holistic outlook. Another area that you’re involved in are neglected tropical diseases–which are often referred to as diseases of poverty.  The one you mentioned earlier is trachoma. What is trachoma?  And what work do you do in that area trying to find a solution?

Kathy: As I said, trachoma used to exist in this country. As I just mentioned about face washing and hand washing, that’s one of the ways to prevent it. But it is an infectious disease, and it is transmitted by flies. I think everyone has seen pictures of Africa with kids with flies all over their face, and the flies are looking for moisture. So, they go from the mouth to the eyes to the nose.. and back and forth. They go from mother to child, so a huge transmission vector there. What happens is the eye gets inflamed, and the eyelids swell up.  As a result of that infection and swelling in the eye, your eyelid turns inwards. So imagine having something like a big grain of sand under your upper eyelid, and that inverts your eyelashes. Every time you blink, your eyelashes scrape your eye. It is excruciatingly painful. I don’t know this from personal experience, but I’ve heard. And each time you blink, not only is it excruciating, but you’re scarring your cornea.

Denver: You blink yourself blind.

Kathy: And you blink yourself blind. In fact, you will see many women in African countries that have high rates of trachoma wear around their neck a pair of tweezers so that they can yank out their eyelashes to stop this from happening. So our program — I like that you used the word “holistic” — because our program is also holistic. It’s something called the “SAFE Strategy.” “S” is for surgery because we can do eyelid surgery or train people to do the surgery that reverts the eyelid back to its normal direction; “A” is for antibiotics because azithromycin prevents trachoma and can treat it; “F” is for face washing so that the flies don’t keep going back and forth and transmit more and more of the disease; and “E” is for the environment… meaning getting sources of water, and other good hygiene measures. So we do all of that in as comprehensive a way as possible to not only treat the disease when it’s gotten to that painful point, but also to prevent it from recurring.

Denver: Just as a footnote to that, I was involved in the restoration of the Statue of Liberty, Ellis Island, and the number one reason that immigrants were turned back from Ellis Island, and sent back to Europe, was because of trachoma.

Kathy: Which is amazing to think that recently, this was that big an issue in this country.

Denver: That’s right. Along those lines, river blindness–and that’s transmitted by a black fly bite. What is river blindness, and what do you do in that area?

Kathy: River blindness is one of those diseases that has a name people don’t like to pronounce. Its medical name is onchocerciasis. Again, just like azithromycin for trachoma, there is a drug, ivermectin known as Mectizan as well, produced by Merck, that can prevent and treat river blindness. So, again, there is a holistic approach in that there is administration of the drug… which I will come back to…but there have also been campaigns to spray the areas, to kill the flies, and other efforts. Our focus has been getting the drug out to the people who need it.

Something that I think is astonishing happened in 1987, when Roy Vagelos was at the helm of the pharmaceutical company Merck. When they realized that their drug ivermectin, a form of which I use as a heartworm pill for my little puppy, could prevent this disease, could kill the worms inside people because it is what we call a filarial disease — there are worms inside the body – they made a commitment to donate that drug…as much as was needed… for as long as was needed. I have to tell you, we get more than $100 million a year worth of free Mectizan from Merck that we distribute to people in Africa.

Denver: That’s incredible.

Kathy: So we’re reaching anywhere from 60, 70, 80, 90 million people a year, thanks to the generosity continuing to this day of Merck, for what has now become known as the Mectizan Donation Program.

There’s a huge amount of generosity in the pharmaceutical sector.

Denver: And I think that Dr. Vagelos really believes that that program has done so much to lift up Merck.  It has allowed them to attract the very best people, not just the scientists but throughout the organization, because people have such pride in what that program has meant to so many people. It’s the kind of place you want to work.

Kathy: Though I have to say, they also had the wisdom to spin off the Mectizan donation program. It is not part of Merck. They obviously are very involved with it, but it is a free-standing, free-governing entity. And I would be remiss not to say at this point: in the fight against trachoma that Pfizer donates Zithromax–  they are another generous pharmaceutical company. I think in the world of public health and nonprofits, people tend to damn the part of some pharmaceutical companies. They are donating drugs, drugs that stop kids from getting worms, drugs that treat these diseases. There’s a huge amount of generosity in the pharmaceutical sector.

…it is predicted that by 2030, if not much sooner, one in 10 people in the world will have diabetes.

Denver: I am so glad you pointed that out. I noted that the World Health Organization came out with what I think may be the first comprehensive report they have ever done– on diabetes. The numbers were staggering. There were about 100 million people in the world with diabetes in 1980, and now it’s over 400 million people. As you know, the projections going forward are not pretty. Tell us about the connection between diabetes and vision loss and some of the work you’re doing, especially in those countries that you mentioned before… like Bangladesh and Indonesia.

Kathy: I want to build on your stat first because it is predicted that by 2030, if not much sooner, one in 10 people in the world will have diabetes. That’s staggering! And one of the things about diabetes is you’re asymptomatic in the beginning unless you’re getting tested. But now, compound that with the fact that you know you have diabetes, and diabetes doctors monitor your feet – we’ve all heard about that – but they don’t always know to check your eyes. And what happens in the eyes of a diabetic person is the blood vessels in the retina proliferate, and you get something called “proliferative retinopathy.” Basically, what it means is the back of your eyeball is unhealthy, and you can go blind from that. And it’s detectable by taking a photo of the back of the eye… taking a retinal picture which can be done digitally.  But you need to have a diabetes doctor who knows to tell you to get your eye photographed. You need to have a retinal camera, and right now, those are still $40,000. You need someone who can look at the image and know what they’re looking at. Because if you see on that image that this proliferation of blood vessels is starting, there’s a pretty straightforward laser treatment that can stop it from continuing and stop you from losing your vision.

So what we have been doing in both Bangladesh and Indonesia: piloting a three-pronged approach because everything we do is holistic. So we work with the diabetes doctors, and we’ve actually provided diabetes clinics with that retinal camera so that the images can be taken. We’ve set up a grading center, and it doesn’t matter where that’s located because it’s all sent over the internet where people are trained to grade the photos of the eye and then can send the message back… so that the patient knows either that they’re fine; they need to get their eyes checked in a year; or they need to go to an ophthalmologist right now.

Then, we train the ophthalmologist on how to do laser surgery in those cases where the surgery is necessary. And then we do patient education. Where there are primary health clinics where people are going just for their regular care days, we make sure there’s information that says if you have diabetes, you need to be careful about your eyes as well. And my fear has been that – with these escalating rates of diabetes and the rates of obesity, we have only to look around ourselves anywhere in our own country to see how many people are obese.  Not everyone with diabetes is going to go blind. It could be 10% of them, 15%– there are no rock-hard statistics on this. But even if 10% out of those 1 out of 10 people go blind, I think the world is going to look around 20 years from now and say:  What was anybody thinking back in 2015, 2016 when we knew this was coming? So we’re trying to get ahead of that curve.

Denver: How about cataracts? Is that a big problem in the developing world?

Kathy: Cataract is a huge problem. It’s the cause of more than half of all blindness in the world. If you look at 39 million people who are blind, and about 18 million of those are blind from cataract. And if you try to put yourself in the frame of mind of a developing country, cut off from the latest advances in science and technology: You’re a 60-year-old woman in Myanmar or in Vietnam, and I’ve met these women.  They have no idea that their cause of blindness can be treated. “Well, I’m 60. Of course, I’m losing my eyesight. That’s what happens!”

Denver: Part of aging, happens to everybody. Yeah.

Kathy: And so the very first step is patient education. It’s saying, “No. You have something that is treatable and is easily treatable.” So we work on that end of it, and we work to improve the skills of surgeons because cataract surgery can be done in 20 minutes. It’s fairly straightforward. We’ve done some interesting work using digital technology.  When we’ve trained the surgeon, when they go back to their hospital to do surgery, we have a camera attached to the operating microscope. That camera will film the surgery so that their teacher back at the main hospital can check in every once in awhile and see how their student, “Denver,” is doing on his cataract surgery.  See if they need to call you back in for a little retraining or not!

Denver: I’m sure they would!  It’s so good to see you use technology that way. It’s great! The cataract surgery is not that expensive. It’s like $35 an eye.

Kathy: It depends where.

Denver: Yeah, on average, though.

Kathy: Yeah. In this country, it’s much more. There’s been some great work done by nonprofits in India. Aravind Eye Care System… LV Prasad, where they’ve worked out a way to do very high quality, but high volume surgery, so that they can have staggered fees and recoup enough money from those who can afford to pay to subsidize the surgery for the poor… and even provide free surgery.

Denver: Right. We had Larry Brilliant on the show. He founded the Seva Foundation, so he really went into a great explanation on all that. Talking about this country, let’s get back to the United States and children living in poverty.  They can experience vision problems, which can be quite difficult for them or their families to address, and you have a program called “ChildSight.”

Kathy: We do!  ChildSight is a program that targets mainly middle-school kids because that’s the age when your eyes may start to go, and you may start to need glasses. Certainly, when I was 12, I was a straight-A student. All of a sudden, I was squinting at the blackboard and had to sit in the front row. My grade started to dip, but I grew up in Westchester County in an upper-middle class family.

Denver: So you have empathy for this?

Kathy: Yeah. Absolutely! I was never picked for sports teams because I had trouble seeing the ball. And what we’re finding is that kids across the country are in this situation. They don’t know that they have a vision problem because they have nothing to compare it to. I remember when I got my first pair of glasses, I always thought that when you saw a tree in the distance, it was a solid round, green circle. And when I got my glasses, I realized that from far away, you could see individual leaves.

You don’t know what you don’t know. The kids don’t know that they have a vision problem. The teachers think the children are slow learners. The kids might start acting out because they can’t follow what’s going on on the blackboard. They may not be able to do their homework. So they get put in special education. They’re stigmatized because they’re not picked for their sports teams. In many cases, all they need is a pair of glasses. And unfortunately, this is not trending in the right direction. Ten years ago, we found when we worked in inner city areas and in underserved rural areas, one out of five kids we screened needed glasses and didn’t have them. Now, we’re finding one out of four of the kids we screen need glasses. In places like Newark, New Jersey, those rates are much higher. As the CEO of my organization, of course, I’m responsible for fundraising, and one of the challenges when I try to get people to support this program is they say, “Well, the Affordable Care Act should cover this.” If you’re a mom who’s living in poverty, and you are trying to figure out how to navigate that system, that’s one thing. It’s a very daunting system to access the benefits. And number two, you get a list of providers, and none of them are near where you live.

Let’s say you’re a single mom in the South Bronx in New York City, and the only provider who takes ObamaCare is a 90-minute drive away. You’re a day laborer. You’re going to take a day off from work and lose your wages to take your kid to the doctor and back? The beauty of our program is we go into the school; we screen several hundred kids at once.  We have an optometrist there for the kids who fail the exam and therefore need what’s called a “full refraction” to determine what their prescription is. And then we go back to the school a week or two later, give them the glasses, and test them to make sure their prescription is, in fact, the right prescription.

Denver: And with cool frames, I suspect?

Kathy: With cool frames… because when you’re dealing with kids who are 10, 11, 12, at the onset of puberty, they’re not going to wear dorky-looking frames. In fact, in the beginning of this program, we had a huge donation of Harry Potter frames, and they went like hotcakes until those were no longer popular. So we’ve learned what’s really key is to have an assortment of as many as 30 to 40 different frames – wire frame glasses, rimless glasses, glasses that are purple on the outside and green on the inside.  It won’t surprise you to know that once the cool kid picks one particular frame, everybody else in the class wants that.

Denver: Oh, yeah. What happened with braces! I know that when cool kids got braces, everybody wanted braces. They would go to their parents to get them. So I guess the other lesson here is: Don’t get too big an inventory because what’s hot today may not be hot tomorrow…

Kathy, tell us about your funding model. I know you mentioned you received an enormous amount of in-kind contributions, but significant financial ones as well. Tell us about where you get your revenues from.

Kathy: Our revenues are all what are known in the nonprofit lingo as “restricted grants.” So they are grants for programs.  A lot of them come from governments. Both the United States government and the Canadian government have been incredibly supportive of our programs. We’ve also gotten funding from the Irish government, British government, some Japanese funding. And that’s a large piece of our support.

We also get funding from some large foundations. It won’t surprise you that the Gates Foundation is on the list; the Hilton Foundation is on that list; the Starr Foundation is on that list. And then on the corporate side, our largest cash donor is Standard Chartered Bank who has a program that’s tied into an employee-giving program called “Seeing is Believing,” and they’re a huge source of support for our blindness prevention programs.

So, 95% of our budget comes from these grants–restricted grants for specific projects, which makes us a very complex organization.  Because at any given time, we have 150 different projects with different start and end dates… with different definitions of what’s a management cost and what’s a program cost…with a different format to report back to the donor about how we’re spending the money and achieving results. It makes for a very complex organization.

Denver: Yeah, and sometimes – and I can say it more easily than you – a lot of wasted effort sometimes as well. I think if people believe in an organization and trust an organization, they, the donors, would be well-served to give them a little bit more latitude. Sometimes there are undiscovered conditions that you can’t predict,  but you’re kind of locked into a grant contract. And I know there is a movement afoot, even in the foundation world, to lessen the restrictions a little bit and give organizations a bit more latitude.

Kathy: And I applaud Darren Walker and the Ford Foundation for being so forward-thinking about this. It’s that pesky word called “overhead.”  I’m sure our listeners feel that’s a bad thing, and that you want your money to support the program. But you can’t do a good program and know you’ve done it well unless you’ve got an office, and unless you’ve got management staff making sure it’s happening.

What’s particularly infuriating is every single organization that has been on this program, I’m sure, calculates what their management costs differently. Am I management?  I’m 100% management on my budget. In my last job, I was 50% management and 50% program because I spent a lot of time managing programs. So, if everybody is calling something… something different, how can a donor evaluate who’s more cost-effective by this artificial number of overheads? So it’s been a huge frustration for me.  It’s why now we are ramping up our staff to be able to raise more funds from individuals that are unrestricted funds that do just what you say. They believe in the work of Helen Keller International, and they want to support it. They trust us to use their dollars most wisely. In fact, one of my favorite things that was ever said about Helen Keller International was when Nick Kristof of the New York Times said we get the biggest bang for the buck that he knows of.

Denver: That’s fantastic. You’re absolutely right. We all make up the admin cost. Everybody has a different formula for it, and as Darren said when he was on the show: This whole attempt to keep it artificially low leads to an inauthentic conversation between the organizations and the funders. Because we all know it’s actually higher than we present, but we have to play that game if we’re going to be able to get that money. So, hopefully some honest dialogue is about to come.

Kathy: I can’t resist saying that we don’t play that game, and it has hurt us. So we say our overhead rate is 18% to 19%. It varies from year to year, and some people  say, “Well, then, we can’t fund you because that’s too expensive.” So we paid the price, but we believe in being transparent about what our costs are. It results in something that was written about a number of years ago called the “starvation cycle” where all of us brag about how low our overhead is, and we’re starving ourselves.

Three years ago, if you looked at Helen Keller International… and we are in 22 countries around the world, including the United States… we had six different accounting systems. We are now investing in something called an “ERP,” an enterprise resource planning system, to unify not only our accounting systems, but to align grant reporting systems with payroll systems, with budgeting and with accounting. It’s a $3 million investment– which is why our overhead rate right now is 18% or 19%, but it would be foolish for us not to invest in something like this.

Denver: That’s for sure.

You were on a panel during the United Nations General Assembly back in September called “The Power of Partnership.” I know you worked very closely with many, many partners on the ground. Tell us, Kathy, what do you look for in a partner and specifically, how do you go about building trust?

Partnerships are the DNA of Helen Keller International.

Kathy: I would start by saying we pretty much exclusively work through partnerships. Partnerships are the DNA of Helen Keller International. We’re about strengthening the capacity of people on the ground to deliver the services themselves. So you take that overused quote of:  “Give a man or a woman a fish, and he or she will eat for a day; teach them to fish, they’ll eat for a lifetime.” We go much farther than that and teach them how to clean the fish, how to cook the fish, how to store the fish. That teaching, that provision of assistance is through local partners on the ground. We’ve got a lot of experience in partnership. We probably have some battle scars from some of those experiences.

I would say there are a couple of fundamentals. One is cultural fit. You have to have the same organizational philosophy. Our world view is that people on the ground know what’s best. We partnered with an organization, also based in this country, that thought headquarters knew what was best.  It was a painful partnership because there was such a cultural divide. So number one is:  Is the organization a cultural fit? Do you share the same values?

Number two is:  spending a lot of time up front to mutually determine: What are the goals you’re trying to achieve?  And how are you going to get there?  You have to take painstaking time in the beginning to clarify what the expectations are, what each partner is expected to do, and make sure that everyone is then singing from the same songbook.

And then, as the relationship goes on: transparency. Don’t try to cover up mistakes. If there’s a screw up, sit down with the partner and talk about it. Create an open environment.

Denver: Let me pick up on cultural fit because we talk a lot about organizational culture on this show.  I think that’s one of the things that nonprofits are very guilty of overlooking. They really believe that the mission and cause that they have are enough to energize and motivate staff. As you’ve alluded to, you know it’s much, much more than that. What kind of organizational culture have you gone about trying to set out at Helen Keller International?

Kathy: I think the very first thing I set out to do was to open up communication and be more transparent. The management team at the time would meet on a monthly basis, and nobody knew what they talked about.  So, the first thing I did was distribute the minutes of the management team to all staff. If there was ever a discussion about a particular individual, we would remove that from the text. But if we were discussing scary things about needing to tighten the budget?  People are adults; we wanted to trust everybody with that information. And I had a few staff say, “I fell over dead when I saw your email and that you were sending these out.” So, transparency.

We are not a flat organization, but we’re not a particularly hierarchical one. And that’s also, I think, been part of my leadership style and the culture.

And then, thirdly, and what’s very important to me, and I try to convey throughout the organization is:  a culture where people are open to criticize. What I say to any new hire is, “I can’t get better unless I know what I’m doing wrong.” There used to be an old adage, “You can come and complain about something if you have three solutions.” I say: “I don’t care if you have solutions; not everything has solutions. I still need to know what the problem is.”  And I’d say another piece of our organizational culture is humility. We are not an arrogant organization.  In fact, every time someone on our fundraising team drafts a letter for me that starts out with, “I am proud to share with you…” I always change the word “proud.”

Denver: Well, let’s move on a little bit from the organization to you. You’ve had a very interesting personal journey in your professional life– having started out in the arts and now being the CEO of Helen Keller International — not your typical route. How did this trip unfold?

Kathy: I started out as a dancer. I think from that early age, if you’ve been dancing as a teenager, that physical health was very important to me because of that. And I worked in the dance world, in the performing arts for a number of years.  But this was in the 1980s. And what started to happen was my friends started dying. I would go on a trip to look for a new dance company to bring back to New York for the New York International Festival of the Arts. When I came back, someone else had been diagnosed with something called GRID, gay-related immune disease which, of course, became AIDS. And I reached a point where I felt:  it’s wonderful travelling around the world and going on dance and theater festivals and bringing high quality arts to New York audiences.  But that’s not who I am, and that’s not what I was put on this earth to do. So, I started looking about to switch.  It’s hard when you’ve got an artsy-fartsy dance-y resume. And an organization called God’s Love We Deliver was open-minded enough to hire me as Director of Operations. And six months after I got there, the founder, a remarkable woman named Ganga Stone, decided to step down or change her role.  She was going to become the President to lead the capital campaign for the organization. So the board began the recruitment for a new Executive Director.  I have big thanks to my husband, who the morning of the board meeting, as I was going to the subway said, “You’ve got to throw your hat in the ring.”

Denver: Throw your hat in the ring. Right. It’s right under your nose.

Kathy: “You are the one to do this. If not now, when?” So, six months later, I became the Executive Director at God’s Love We Deliver.  And it is a gem of an organization. The mission has since expanded. The initial mission was to feed people who were homebound with AIDS– too ill to be able to cook for themselves– and to provide nutrition counselling. It has since expanded to people with other debilitating illnesses as well.

And after five or six years there, I felt like I’d done what I’d gone there to do. It was time for a bigger challenge.  I had helped to start  a roundtable for women who are executive directors of social service organizations.  On that roundtable was a woman named Pina Taormina who ran an organization called ORBIS.  It had a flying eye hospital–knowing that there are so many microsurgery techniques that save sight in this country, and that it’s just a question of skills training– would fly the plane around the world to train surgeons in developing countries how to do eye surgery. So I went there as the Director of Operations pretty much, but I was Executive Vice President, Chief Operating Officer. And the same thing happened there that happened to God’s Love We Deliver. About six months to a year in, Pina said, “You know, I really hired you because I’m planning to step down.”

Denver: Right place, right time.

Kathy: So, she had gotten married, had moved to St. Louis. So I ended up becoming the CEO of ORBIS and was there for five years. Again, felt like it was a good long run and time for some different challenges. And when the opportunity at Helen Keller International came up, it was so exciting to me because I obviously had the whole background in blindness prevention work from my time with ORBIS… but the fact that there was this big and growing nutrition set of programs that then spoke back to my experience of working with people living with HIV and AIDS and nutrition—

Denver: Brought it all together.

Kathy: Brought it all together, and it was irresistible.

Denver: Last thing, you mentioned a moment ago about Mount Kilimanjaro. Now, tell us what that was all about.

Kathy: Our board chair, Henry Barkhorn, and another board member, Randy Belcher and I and some close friends joined in a fundraising climb of Mount Kilimanjaro to support an organization called The END Fund – end of neglected diseases, so those diseases of poverty we were talking about earlier that affect about 1.6 billion people in the world. So it was a fundraising climb, and for all of my professional years of fundraising for my organization, I’d never reached out to friends and family and said, “I want you to sponsor me.”

Denver: Sponsor my climb.

Kathy: And I had friends who advised me… a brilliant fundraiser named Kathy DeShaw, who gave me lots of advice about how to do it, and do it again, and do it again. Our team of five raised $90,000.

Denver: That’s fantastic.

Kathy: And I have to say, it was the most amazing experience of my entire life – to spend seven days cut off from the world, living above the clouds literally, feeling like you could reach your hands up and grab the Milky Way.  All you thought about was the next day’s climb.  And were you going to make it to that summit at 19,341 feet?  You didn’t worry about budgets; you didn’t worry about how your mom was doing; you didn’t worry about your friends; you didn’t worry about your dog. It was all about the climb and the group of people you were with.

Denver: No room for extraneous thoughts, just survival and getting to the next level. Well, Kathy Spahn, the President and CEO of Helen Keller International, thanks so much for being with us this evening. For those who want to learn more about the work of HKI, and also if they would like to financially support the organization, what would you have them do?

Kathy: I would have them go right to our website, which is and hopefully, we’ve made it pretty easy for you to learn about our programs and to hit that Donate Now button.

Denver: Great. It was a real pleasure, Kathy, to have you on the program.

Kathy: It’s been a pleasure chatting with you. Thank you!


The Business of Giving can be heard every Sunday evening between 6 and 7 PM Eastern on AM 970 The Answer in New York and on I Heart Radio. You can follow us at bizofgive on twitter and at

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