My grandfather had been stricken with worry that his plan for his son’s better life in the United States had fallen through. 

My dad quickly explained that he had always planned to pay his father back—he was merely trying to save a few dollars on the exchange rates. My parents weren’t scraping by; they had more than enough to host my grandparents. My dada smiled with relief. The two proud men hugged and wept silently. As I played on the floor next to their packed suitcases, my  grandfather looked down with pride. He picked up his American grandson and walked out of the airport as my dad struggled with all their bags. 

Like that luggage, my grandparents’ bet was occasionally too big for me to handle. Every day, I felt the weight of making good on the opportunity my family had provided. If we forgot, our parents often reminded  Ami and me of our cultural inheritance at the dinner table. We weren’t alone: Nearly all my friends of Indian descent were expected to work  hard, play by the rules, bring home good grades, and become either a doctor or an engineer (the safest paths to success in our parents’ eyes). Those  expectations were one reason I decided to become a doctor, starting my  studies as an undergrad at the University of Michigan. 

But I felt the pull to take risks, too, to put everything on the line even when I had no retirement account to liquidate. My grandfather had bet  it all, my father and mother had abandoned everything they knew to find  the life that they wanted—what risks would I take? 

When I was seventeen, Nelson Mandela visited our hometown, Detroit, on a triumphant US tour. He had been released just a few months earlier from decades of imprisonment for fighting apartheid in South Africa. Sitting on the edge of the couch in my family’s living room, I watched every minute of Mandela’s speech on the field of Tiger Stadium, where my family and I went to games. I felt a thrill when he thanked  everyone in “Motor town,” as he endearingly called Detroit, for being a  part of the struggle for racial equality and human rights. 

My family and I had faced our share of America’s racism—the hateful glances, the slurs, and, when I was a kid, the occasional shoves and  punches—that came with being a skinny brown kid growing up in predominantly white communities. As such, I was mesmerized not just by Mandela’s demand for equity but his generosity of heart toward those  who had been indifferent or even opposed to his people’s plight. At the  end of his speech at the stadium, he said to those in Detroit, “I respect you. I admire you. And, above all, I love you.” 

Mandela’s visit made me want to do something meaningful with my life. I had no idea what that meant, let alone how to do it. I had no idea what my parents might think. But I thought there might be a way to make change on a bigger scale, as Mandela had through the force of his  conviction and personality. 

To change the world in big ways, you may think you have to be like  Mandela, a singular, saintly figure in human history. Or you might think you have to suffer as he did—to serve nearly three decades in a prison cell, breaking rocks as punishment. Or some of you might think you have to  go into the field, living beside those you aim to serve. That is what most saints do—they pay some price to change the world. 

But I soon discovered that for all my newfound conviction to sacrifice everything in the service of others, I wasn’t cut out to be a saint. 

In college, I worked hard on the pre-med track while also studying economics, an interest—along with politics—that fueled my growing passion for social change. I knew I had a lot to learn about the world, so I went to study abroad for a year at the London School of Economics (LSE) in England. There, I hoped to get the necessary grounding in geopolitical and economic forces to make change. I gained that education and more.

In London, I met my future wife, Shivam Mallick, a junior at Georgetown University who was also studying abroad for a year at LSE. With her stylish hats, oversized glasses, big smile, and loud laugh, Shivam was hard to miss and harder to connect with: She was always surrounded by an army of friends. Still, I saw enough of her in our econometrics class—she was confident and really cute—to like her right  away. 

Shivam became a great clarifying force in my life. Her parents had also expected her to go to medical school, but she found her own way (she always does), volunteering in a county prison during college. Studying government in London, she was super smart and had a sense of both  purpose and adventure—she was, and still is, a woman on a mission. She encouraged me to find my own mission, and act on it. Talking endlessly in pubs and coffee shops in London, we vowed to stop just talking about  doing something big and to get out there and try to do it. 

Soon after my return home, I thought I might have found my opportunity. At a fundraiser, my parents met a doctor named Hanumappa Sudarshan, a legendary humanitarian who lived and worked in one of  India’s poorest places. Dr. H, as he was known, was celebrated around the world for his singular dedication to the Soliga, a people who live  in the Biligiri Rangana Hills, or B. R. Hills. Over fifteen years of work  there, Dr. H shrank the incidence of leprosy nearly a hundredfold among  the seventy thousand people in the area, from 21.4 per 1,000 population  to 0.28 per 1,000, all but solving the problem, eliminating the disease in  that slice of India.

As I learned about his story in the university library, I grew convinced I was meant to be the next Dr. H. With Shivam’s encouragement and my  parents’ support, I applied to be an intern at his clinic in the summer of 1995, before the start of medical school. That is how I found myself going  hut to hut in the B. R. Hills with a sharpened plastic stick, like a toothpick, to probe for shedding skin, one sign of leprosy. It was oppressively hot and the work was difficult, made no easier by the fact that my very limited grasp of Gujarati, my parents’ tongue and one of India’s dominant  languages, was of no use with people who spoke a different dialect altogether. 

Leprosy was rare—such was the success of Dr. H’s work—so what we found most often were empty pantries and hungry children. Our most effective treatments were often sustenance, not medicine. At dinner, our patients and many hungry Soliga children sat along the floor of the large  dining hall with us. We were served flavorless ragi balls made of nutrient dense millet flour and a hot curry broth. Often those balls were the only thing that kept these kids from crossing the murky and often fatal line from hunger to starvation. 

I would return after dinner to my little hut with its thatch roof. Tossing and turning as I tried to sleep, I would whisper a confession to myself: This wasn’t for me. I respected Dr. H’s remarkable life of service and was honored to be a small part of it. But I also knew I couldn’t hope to equal it. 

Yes, some of it had to do with the difficulties of living in the B. R. Hills or anywhere like it. My hut stank from the mosquito coil whose smoke did little to end the ceaseless biting. And it was sweltering. I lost about ten pounds that summer. I missed modernity and its comforts. 

What’s more, deep down, it nagged at me that we were treating only symptoms while providing comfort to a tiny slice of humanity. Dr. H is as close to a living saint as I’ve ever met—he saved tens of thousands from the horrors of leprosy. Every day, he and his team improved the well-being of the Soliga where they could. But as I looked at it, in 1993, more than 700 million people, or 12 percent of the world’s population, were hungry— ten thousand times the number of people who lived in the region where Dr. H worked. Eleven million children under the age of five died that year,  almost all in poorer countries—56 percent of whom suffered from chronic malnutrition. We didn’t have enough Ragi balls to save them all. 

As I arrived home from that summer—landing at the same airport where I’d seen my grandparents for the first time—I was weary, eager for a night of sleep in my own bed and a big American-style meal. And I felt weighted down by a sense of futility: that the best we can do is incrementally alleviate human suffering around the edges of an unacceptable status quo. I kept asking myself: How does anyone—how could I—ever  hope to solve the world’s biggest problems like global poverty, hunger, or preventable disease? Was that even possible? 

You may have similar questions, looking for your own path to change the world, whether solving the big problems or even seeking to improve upon them. You don’t have to get it right, right away. The truth is, if you pursue  a call to serve, you’ll have missteps and false starts. I struggled for nearly  a decade after leaving the B. R. Hills to find my path. 

I didn’t find it at the University of Pennsylvania, where I pursued a medical degree and a doctoral degree in economics. Though I enjoyed seeing patients and even loved dissecting cadavers, I spent a lot of my time trying to do other things. I worked in poor neighborhoods of West Philadelphia to educate children about the dangers of HIV/AIDS. I volunteered for political campaigns and considered running for office. Shivam and I started a nonprofit organization to promote community service and political activism among young South Asian Americans like  ourselves. I started a small data-analytics company with a graduate student classmate and joined a think tank in Washington, DC. 

More and more, I thought the path to big change would be in politics. I applied twice—and got rejected twice—to work for Vice President Al Gore’s presidential campaign in 2000. But then I got a call from a friend working for the campaign who told me to apply again. The third  time was the charm. The offer of a grunt campaign job left me with a choice: either continue at Penn in my MD/PhD program and pursue a career as a physician, or risk losing my scholarship to go work for the candidate I believed would be the country’s next president. 

Excerpted from BIG BETS: How Large-Scale Change Really Happens by Rajiv Shah, published by Simon Element, a division of Simon & Schuster, Inc. Copyright © 2023 The Rockefeller Foundation.


  • Dr. Rajiv J. Shah serves as president of the Rockefeller Foundation, a global institution with a mission to promote the well-being of humanity around the world. With a century-long track record of leveraging science, technology, and innovation, The Foundation is pioneering new ways to enable individuals, families, and communities to flourish. Dr. Shah is a graduate of the University of Michigan, the University of Pennsylvania School of Medicine, and the Wharton School of Business. He has received several honorary degrees, the Secretary of State’s Distinguished Service Award, and the US Global Leadership Award. He is married to Shivam Mallick Shah, and they have three children.