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Dr. Susan Desmond-Hellmann had heard the stories about her prospective new bosses at the Bill & Melinda Gates Foundation.

The Microsoft co-founder, in particular, has a reputation for being demanding and caustic.

So during her interviews for the CEO job, Desmond-Hellmann brought up criticisms of the foundation and other thorny topics, to see how philanthropy’s power couple would respond.

“I felt like I tested what it would be like to have a conversation about a difficult issue,” Desmond-Hellmann said. And she liked what she heard.

Working around smart people with high standards is nothing new for her, Desmond-Hellmann pointed out. As chancellor of the University of California, San Francisco, she managed more than 20,000 faculty and staff members and a major medical center.

Before that, as head of drug development at Genentech, she and her teams brought several blockbuster cancer treatments to market.

But despite her qualifications, Desmond-Hellmann’s hiring marks a departure for the Gates Foundation, whose previous CEOs were all former Microsoft executives and close friends of Bill and Melinda Gates. Desmond-Hellmann is also the first physician and research scientist to hold the top job at the world’s richest philanthropy.

That outside perspective is already proving valuable, she said in an interview last week in her modest office at the foundation’s headquarters.

“What I hope I bring to the foundation … is coming at things from a fresh angle,” she said. “I find myself asking a lot of questions, and I think that’s an asset.”

Desmond-Hellmann’s arrival also marks a pivotal time for the foundation.

Under the leadership of former CEO Jeff Raikes, the philanthropy nearly doubled in size to 1,200 employees and ramped up its annual giving to $3.4 billion. Raikes orchestrated a major reorganization and refocused on core priorities, like the eradication of polio and malaria, improving women’s access to birth control and helping subsistence farmers in the world’s poorest countries.

Focusing on impact

Desmond-Hellmann, 56, takes the helm of a mature organization with an endowment of nearly $40 billion — and doesn’t plan any major course changes.

“The strategies we have are awesome,” she said. “We’re working on some of the most important problems in the world.”

But so far, much of that work is still in the research phase, is limited to pilot projects or faces logistical and political hurdles to implementation. Eradicating polio, for example, has proved much tougher than expected due to conflict and chaos in countries like Pakistan, Afghanistan and Nigeria.

Desmond-Hellmann said her top priority is to ensure that the foundation’s investments have a broad impact.

“If you make a medicine and no one gets it, it’s not really worth celebrating,” she said.

Recognizing the difficulty of delivering vaccines or improving child survival in remote villages with no clinics or even refrigerators for drug storage, the Gates Foundation has increased its emphasis on economic development and boosting health systems, while also pursuing technological fixes.

“The best public health now starts to think about civil society: Water, sanitation, city planning, climate, the economy, mobility,” Desmond-Hellmann said. “The foundation has evolved as the field has evolved, and it’s exciting to see.”

Desmond-Hellmann, whose tenure at Genentech left her independently wealthy, will earn $1 million a year at the Gates Foundation — more than double her salary at UCSF.

Her first official visits abroad since her May 1 start date were to the foundation’s offices in India and China, where she met with local employees who work closely with government and community groups to overcome barriers to improved health and well-being.

Desmond-Hellmann will travel to several African countries later this year. She and her husband, Dr. Nick Hellmann, spent two years conducting AIDS research in Uganda early in their careers.

But next up on her schedule is a trip to Nashville, Tenn., where Desmond-Hellmann will learn more about the foundation’s education programs — an area where she acknowledged she faces a steep learning curve, and which includes some of the foundation’s more controversial initiatives.

On Thursday, one day after the foundation hosted community leaders at a reception to welcome Desmond-Hellmann, 150 teachers marched in protest of the foundation’s emphasis on student test scores as a way to rank teachers and its push for Common Core educational standards.

The fact that a private foundation wields so much influence on education in the United States as well as global health and development has led some critics to call for more accountability and transparency.

Desmond-Hellmann said she brings a “predisposition to being forthright” to the foundation, which has already opened up more to its grantees and now regularly seeks their feedback.

“I think we have that muscle and I do think we’re starting to exercise that muscle for transparency and communication even more than when I started paying attention to the foundation,” she said.

And on the topic of muscles — Desmond-Hellmann described herself as a sports lover who likes to talk trash. A fan of the San Francisco 49ers, she arrived at her new office to find it plastered with Seahawks placards.

She took most of those down but keeps a Richard Sherman jersey on the wall and a plastic football with a personal inscription from Seahawks coach Pete Carroll on her bookshelf. The latter was given to her at a going-away party in San Francisco by former 49ers CEO Carmen Policy, a friend of Carroll’s.

“Everyone’s waiting to see if I’m going to switch gears,” she said, with a laugh.

Sandi Doughton: 206-464-2491 or