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There are many places the Gateses could go together for an adventure. That they chose to come to India and Bangladesh to sit on concrete floors and talk about tuberculosis and diarrhea sets them apart from most globe-trotting billionaires. But their relationship with the developing world is even more complicated than that. As they tour hospitals and huts, they seem to delight in these escapades, not just because they are intellectually captivated by the scientific challenge of treating the diseases of the poor but also because they are convinced that they are living through a historic inflection point when medical breakthroughs could save the lives of millions. They see the Bill & Melinda Gates Foundation not as a solution but as a catalyst for this progress: pumping resources and rigor into the fight just when scientists are inventing new tools that could change everything. "This is a magic time in terms of the momentum we can get going," Bill says later from his hotel suite.
And beneath all those grand ambitions, there is another force at work: they get a kick out of sharing these pilgrimages as a couple--talking with transgendered sex workers in India or women who start businesses with micro loans in Bangladesh. In these situations, they prefer it if people don't know who they are. "We're just people from the moon, as far as they know," says Bill. Later, they spend hours talking about everything they've seen. Says Melinda: "That's a huge side benefit. We love doing this together."
In its six-year existence, the Gates Foundation has accomplished a fraction of what it aims to do. But already it has helped save at least 700,000 lives in poor countries through its investments in vaccinations. In the U.S., its library project has brought computers and Internet access to 11,000 libraries. And it has sponsored the biggest privately funded scholarship program in history, sending 9,048 high-achieving minority students to college. It is the largest foundation in the world, with an endowment of $29 billion. Each year it spends almost the same amount as the World Health Organization (WHO). In public health in particular, to which the foundation devotes 60% of its funds, "it's the most important organization in the world," says former President Jimmy Carter. The Carter Center, which has been working to eradicate guinea worm disease since 1986, received a pledge of $25 million from the foundation this year. "We've been intimately acquainted with their method of operation, the thorough investigation they do before they make a decision, their willingness to take a chance, their willingness to stick to something once it's begun and the extremely high competence of their top people," says Carter. "They know what they're doing."
But all that pales in comparison to what the foundation has done for the public imagination. For decades, the field of global health had languished, and there was a consensus that little could be done to change the fate of the poorest of the poor. Jim Kim, until recently director of WHO's department of HIV/AIDS, refers to that dark period as BGF (Before the Gates Foundation). Now, says Kim, "the Gates Foundation has made global health cool."