In September 2014, as the largest Ebola outbreak in history was devastating West Africa, Alusine Mark Dumbuya was struggling with an additional, very personal concern in a rural region of Sierra Leone. 

Slowing the spread of multidrug-resistant tuberculosis (MDR-TB) in Lesotho means going to many more places than hospitals and clinics.

It means going to taxi associations. Mining companies. High schools. Primary schools. Prisons and police facilities.

As she spoke to nurse managers from Rwanda, Liberia and Haiti, Dr. Lynda Tyer-Viola—a longtime nurse manager in Texas—cited a daily situation that’s true for medical professionals anywhere. 

“The everyday minutiae sucks all the air out of the room,” she said, referring to the flood of unexpected, urgent tasks that arise in busy hospital environments. Such tasks often detract from larger projects or duties, Tyer-Viola said, and can change whatever plans managers thought they had for their day.

Orderly lines of homes and shelters stretch far down crowded, uniform roads at Mahama Refugee Camp in southeastern Rwanda, where more than 55,000 people have arrived since 2015 after fleeing political unrest and violence in Burundi.