Reflection as Action: What Nearly 25 Years of Philanthropy Have Taught Me
Elizabeth supporting the C2C team at the opening of our first clinic in Northern Haiti, 2017
At a time when global health and development funding is under immense pressure amid the dismantling of USAID programs and a steep decline in official development assistance across the Global South, philanthropists are being called to act faster and do more. The criticism is often fair: too many donors hesitate, or rely on short-term fixes, while communities shoulder the risks of delay.
But I have learned that effective philanthropy requires more than speed. It demands persistence, humility, and the discipline to pause. Rarely do philanthropists take stock of their giving, their approach, and the deeper “why” behind their choices. Over the past year, I made space for that reflection, not as an excuse for inaction, but as a way to recommit to the values that have guided me for nearly two decades: long-term, flexible, community-based support grounded in evidence and trust.
I became a donor in my mid-40s, when our family business began to generate dividends. The amounts were modest, just enough to supplement my income as a Physicians’ Assistant and public health consultant. At the same time, my father asked me to establish a family foundation with proceeds from the company. My first lessons were humbling and instructive: go directly to the community, ask what is needed, and design with the long view in mind.
We intended to be long term funders and partners in the community where the company had done business for several decades but with great needs, we need to narrow the focus to improving access to early childhood education and quality after school programming and conserving land along watershed corridors in Massachusetts. Our lesson was about the approach: to be community-centered, long-term, flexible, and grounded in trust.
Over time, my giving became intertwined with my professional career in emergency medicine and international public health. As a Physicians’ Assistant, it felt natural to focus on primary care, especially women’s health. I saw how healthy women create the foundation for healthier families and stronger communities. Yet I often grew frustrated at the gap between lofty rhetoric and lived reality. Health systems in low-resource settings were too often fragmented and disease-specific, when what people needed was simple, integrated care.
That frustration sparked creativity. I began sketching clinics in shipping containers—compact but complete, with a pharmacy, lab, and dignified space for care. A prototype was ready when the earthquake struck Haiti in 2010, and soon it became the foundation for my nonprofit, Care2Communities.
The most rewarding moments were never the easy ones. What made my philanthropy effective wasn’t simply writing checks. For more than a decade I devoted over 40 hours a week, learning alongside my partners. I led with evidence and data, but I also trusted my instincts and knew when to pivot. Those instincts were sharpened not by ego, but by questions and humility.
The work was deeply meaningful, but the years were also heavy. I raised two children as a single parent. I managed chronic illness. I cared for aging parents. I navigated high school and college with my kids during COVID. Through it all, I kept giving, kept learning, kept joining donor networks and boards, convinced that I was following best practices—yet rarely pausing to connect the dots.
What stayed steady was my commitment: to women’s health equity, to primary care, to women’s leadership. But eventually, I realized I needed to create space for reflection, not just action. So I invited two trusted partners— a philanthropic advisor, Nicole Ippoliti, who knows the landscape I fund, and my co-founder at C2C, Allison Howard Berry—to sit with me for a few days.
Their reflections were clarifying. They reminded me that I had already been practicing long-term, unrestricted giving; that I had been listening deeply; that I had been both leading and learning. Most importantly, they gave me a mirror. They helped me see that my philanthropic focus on women’s health and climate resilience was not just emerging but had been there all along, shaped by my own lived experiences and professional path.
That conversation shifted something in me. It helped me celebrate what I had built and recommit with fresh clarity. It reminded me that sometimes the most transformative investment we can make as donors is not in a new project or initiative, but in ourselves—in creating the quiet space to reflect, realign, and rediscover the through-line of our work.
If I could offer lessons to other philanthropists, they would be simple but hard-earned:
Short-term, one-off grants rarely create lasting change. Long-term, flexible, community-based funding does.
Partners can’t plan with uncertainty. Philanthropy should reduce risk, not add to it.
Stay in your lane and fund what you know.
Think like an investor: build a portfolio where different programs need different types and stages of capital.
Be engaged: learn constantly, join boards, speak on panels, show up for your partners.
Above all, fund equitable systems change.
