Melinda Gates is co-chair of the Bill & Melinda Gates Foundation. (KK Ottesen/For The Washington Post)

Melinda Gates, 54, is co-chair of the Bill & Melinda Gates Foundation, the largest private foundation in the world. She is the author of the recently released "The Moment of Lift: How Empowering Women Changes the World." In 2016, she and her husband, Bill Gates, were awarded the Presidential Medal of Freedom.

Coming to partnerships with more of the resources and power, how do you keep the dynamic healthy so you know you are really getting the best ideas, not just something driven from above?

One of the earliest lessons I learned was from former president Carter. He was already working in trachoma and Guinea worm and had been for many years all over Africa. I asked him, "What should we know now that you had to learn that maybe we wouldn't have to relearn?" And he said, "Melinda, you need to know that any Western idea you bring in, if the people in the local community don't want that tool or thing or idea, or they don't see it as their own, the minute you leave, everything's going to revert back to where it was." So if you really want lasting change, you have to spend the time to do the local cultural work and make sure that they get comfortable and see it as their own. I've seen this all over the world with partners working on the ground; it makes an enormous difference. And ultimately, what we've learned is that their government has to supply those vaccines and pay for a good part of them from the get-go. Then you get lasting, sustainable change.

What about ideas coming up from the field, as opposed to ones [from] within the foundation?

You absolutely have to figure out ways to bring people's voices into the conversation. I'll give you a great example. I do site visits all the time in many, many low-income countries. And I would be in different countries in Africa or in Southeast Asia, and out to talk to women and families about the difference that vaccines have made in their lives and their children's lives. And if I would stay long enough and provide enough time for them to ask questions of me, which I learned to do, they would say, "Okay, we're glad we talked about vaccines. Super important. But what about contraceptives? Why is it not available in this health clinic where I can go and get my vaccines for my kids but not get what I need?"

Quite frankly, the conversation just kept, kept, kept coming up. And I was pretty blown away by what women knew about them and how much they had used them — but then how little access they had now. So that's what got me on this path of realizing we needed to make sure that we were providing women the tools that they're asking us for, as a world, to plan and space the births of their children. The women would say to me, "This is a life-and-death situation for me and my children. I can't have more children right now." And it had fallen off the global health agenda because of political controversy, particularly in the United States.

There are many stories in the book of your going out, connecting with people, sitting and talking with them at a real level of intimacy. Do people usually know who you are? And does that create a barrier?

I very much try to create that intimacy and authenticity. So for the most part, when I’m talking to people in townships or in their homes or in a village, they do not know who I am. I go in as a Western woman in a pair of khaki pants and a T-shirt. They just know I’m there to listen and to hear their stories. Every now and then, they find out, and they’re pretty sweet about it. It’s more that they know who Bill is. Because they know about computers or cellphones, etc. Like Sister Sudha and her girls’ school [in India]. The girls did end up finding out who I was, and they were all, “Oh my gosh, your husband is Bill Gates.” Then one of them said to me, “Do you have any money for us?” which was actually very funny. And I literally shook my pockets out, and they could see: I had no money on me.

You know who taught me to go in as a Western woman in a pair of khaki pants was Warren Buffett’s wife, Susie. She told me early on, “Melinda, you will learn the most if you can fly under the radar.” She said, “If you can go in as not your name, you will learn so much talking to the women.” And so when I go to these countries, I definitely take big government meetings where it’s well known who I am. I might speak at a conference. But I try to go out and do my home and site visits before I start doing my official business and before it shows up in the newspaper.

Some of the stories that you share are really difficult ones, like meeting child brides, 10-, 11-year-old girls, or victims of abuse or female genital mutilation. Do you have moments where you are overwhelmed or just say, “I can’t do this”?

For the most part I’ve been able to keep it together in the site visits. But I’ll tell you, the second I get back to my hotel room, I often just completely lose it. And the same would be true of my husband. I mean, he’ll call home and say, you know, he just saw something devastating. And we will talk that through. Or I will reach out to my closest girlfriends and write them a long email. And it helps me process my feelings. But I have to let my heart break. Because it’s what ends up fueling the work. When I come back to Seattle, boy, I know what I want to do!

You clearly channel that anger and frustration. Where do you go for strength?

I go to certain stories or leaders that I have seen or studied. I was incredibly lucky to meet Nelson Mandela several times. And to know the quiet strength of what it took to channel his anger and to not come out of Robben Island angry, but to be able to take the pain that he endured and use it on behalf of society. Wow. And Mother Teresa, you know, struggled with doubt — huge doubt — for long periods of her life. Yet she went on to do the work that she did. That is, again, a kind of a strength of leadership.

I think sometimes we make the mistake of thinking leaders are born. No. Leaders are created. They’re created by the actions that they take based on what they have seen or experienced in the world. And then they have to go into their dark, hard places, their moments of vulnerability, to find the strength and the bravery to carry on the work.

This interview has been edited and condensed. Follow KK Ottesen on Twitter:  @kkOttesen.