In a jungle hut on the Thailand-Myanmar border, a rice cooker hissed in the corner – not to make rice, but to sterilize surgical instruments.
There was no electricity or medical equipment. Only the hum of a generator, the sharp scent of iodine, and the quiet defiance of a Burmese doctor who refused to let her people be forgotten. That rice cooker symbolized more than ingenuity; it was a quiet claim to agency in a system that too often leaves those on the frontlines waiting for solutions designed far away.
In 1988, after fleeing Myanmar’s military crackdown, Dr Cynthia Maung began treating patients with nothing but her medical training, a few health workers and improvised tools like that rice cooker. What began as an act of necessity has saved hundreds of thousands of lives. Mae Tao Clinic was not founded with a strategic document or theory of change, but with a crisis, a community and a commitment to care.
Mae Tao Clinic is not alone. In Indonesia, refugee women supported by Same Skies are building mental health networks on peer trust and lived experience. In Atlanta, BLKHLTH, a Black-led public health initiative, reshapes health equity by centring cultural knowledge, lived history and trusted messengers.
Like that rice cooker, these efforts take what is at hand and turn the ordinary into something extraordinary – because the alternative is nothing at all.
Transformative solutions take root when those closest to the problem lead, shaping tools to fit their realities and steering their own future. In a better world, funders and consultants would back them to grow and last. Too often, though, they are overlooked or pulled onto a funding conveyor belt driven by funder priorities.
Without changes to how global health is funded and governed – top-down, short-term and wedded to logical frameworks and linear change models – the next Mae Tao Clinic might not grow beyond a grassroots improvisation.
We have heard this narrative before. So why now? Because the funding landscape is shifting. With major US foreign aid cuts and many bilateral donors pulling back, more funders are rethinking their roles, calling for trust in local leadership and multi-year, flexible grants.
We have seen promising initiatives like Singapore’s ImpactCollab – backed by the Monetary Authority of Singapore and the Gates Foundation – set ambitious goals to move capital into vetted organisations across Asia.
These efforts matter. But if they stop short of reaching the small, unpolished clinics and networks we have walked alongside, they risk leaving the most urgent innovations invisible. Even well-intentioned “collective impact” models can end up concentrating power in a small circle of philanthropists, guided by boardroom visions that risk becoming prescriptive.
Real, lasting change rarely follows the boardroom script. It is slow, relational and deeply rooted – built on trust earned over years, not lost when a grant cycle ends. Too often, those visions arrive with conditions: metrics and data that risk missing the heart of the work.
When every interaction is framed in deliverables and data points, partners start performing for the metric rather than engaging for the mission. As such, the space for honesty, nuance and risk-taking shrinks. Communities translate their realities into funder-friendly language, sometimes at the expense of telling the full truth.
This is where trusted networks matter – not to abandon oversight, but to design accountability that reflects what is happening on the ground. Like a well, impact can be measured in liters drawn, but also in the trust it inspires in those who depend on it. As one health worker told me, “Sometimes, the best treatment is not a pill. It is being heard.”
Dr Cynthia knows this. Over tea, her hands wrapped around a warm cup, she spoke of pressure from some board members amid shrinking resources to prioritize high-profile partnerships to keep Mae Tao Clinic afloat.
She gently pushed back: “It is the smaller ones who need us,” she said, thinking of the makeshift clinics deep in the hills, run by young people with grit and community ties. Her conviction was clear: trust is built on the ground, not in boardrooms.
Walking with those at “ground zero” rarely comes with fanfare. It is easier to raise funds for an established name like Mae Tao Clinic than for an emerging clinic still proving itself. The question is not whether they already have a track record, but whether they have the vision, commitment and community trust to grow.
Many such solutions will never appear in a grant portal. Their leaders are busy doing the work, not packaging it for funders. They rarely fail for lack of relevance, but for lack of scaffolding – the technical, financial and network support needed.
We have seen this “messy middle” in a pharmacy that doubled as a schoolroom, and in a frontline clinic led by displaced health workers that kept going with no salaries for months – spaces that exist because people refused to wait for perfect conditions. Finding them takes proximity and translation so a funder in Singapore does not get to decide which part is “effective,” “transformative” or “fundable.”
That rice cooker was never just a workaround. It was a refusal to wait for permission – a defiance of the idea that care must come from somewhere else. It is the essence of “messy middle”: improvisational spaces led by those closest to the issue, supported by people with networks and resources who choose to use their privilege to open doors.
As Nils Daulaire, former US assistant secretary for global affairs, once said, global health must move from “missionary benevolence” to a “shared public good” – not we help them, but we face this together. The next Mae Tao Clinic is out there right now. The question is whether we will find them – and stand with them.
Tiah Ling (MBBS, MPH) is co-founder and executive director of Arq by Allyvate, a boutique consultancy based in Singapore focused on global health, migration and social equity. With over 20 years of experience as an emergency medicine specialist and more than a decade in development work, she is currently supporting the establishment of an Emergency Care Unit at Mae Tao Clinic.
Sharon Low (MPH, MS) is co-founder and operations director of Arq by Allyvate. She is currently a public health doctorate candidate at the Harvard T.H. Chan School of Public Health, a senior fellow with AsiaGlobal at the University of Hong Kong and Equity Initiative, and a committee member of the Health Systems Global Thematic Working Group on Fragile & Conflict-Affected Settings.
✌️🌏✌️Nice…. Keep out USAID & NED‼️✌️✌️✌️