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Watsi, the crowd-funding healthcare site, proves that not every change-the-world Silicon Valley start-up is a scam.

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He recalls his work in Costa Rica as “successful” but says that at the same time he was already getting burned out by the slow pace at which things got accomplished. “I’m an impatient person by nature,” he says. “I wanted to do something bigger.”

Meanwhile, back home in Northern California it was 2010 and the tech economy was starting to boom again. “Stealing” Wi-Fi off a satellite provider dedicated by the Costa Rican government to the local indigenous population, Adam started getting restless at the news from Silicon Valley.

“I got really interested in technology and start-ups. I started reading Hacker News. I would read all of Paul Graham’s essays and dream of this other life that was the complete opposite of my life. A lot of cool powerful things were happening in Silicon Valley, and a lot of people were doing good, and a lot of people weren’t getting credit for how much good they were doing. I saw Silicon Valley as a space where young people were actually having a pretty massive impact, at least from my perspective as a person in the Peace Corps on the other side of the world working on a project that had no funding.”

Then came the epiphany. Near the end of his two-year Peace Corps tour, Adam was on a bus on his way back to Watsi, the town where he was working. He watched a woman get on the bus and start begging people to give her money for her son’s medical care. He didn’t understand why everyone was contributing — “I’m a skeptical person,” he says, “I don’t give money to people on the street” — until he realized she was showing the bus riders her son’s medical records. In essence, she had vetted her own solicitation.

“She got off the bus and I had the epiphany. There’s Kickstarter, there’s Donor’s Choice, there’s Kiva — it’s crazy that we don’t apply this model to healthcare.”

Back in San Francisco, while holding down a day job at Pacific Community Ventures, he hooked up with a group of geographically distributed volunteers and started putting together what became Watsi. Every Tuesday evening the globe-spanning group would hang out online for four or five hours hashing out Adams’ original idea. A software developer named Jesse Cooke agreed to build the site for free. By August 2012, for the trivial cost of $3,000 over the previous eight months, Watsi was live.

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In January 2013, Watsi became  the first nonprofit to be accepted into Paul Graham’s Y Combinator start-up accelerator. The  recently controversial investor declared that he had “never been so excited about anything we’ve funded.” By July, the nonprofit had secured an additional $1.2 million in seed round financing from Graham, Sun Micrososytems’ co-founder Vinod Khosla, Silicon Valley angel investor Ron Conway, and others. You would be hard put to round up a more likely group of suspects responsible for funding the nonstop Silicon Valley greed machine, but in this case, there isn’t going to be any profitable return on their investment. There will be no IPO, no cash-register “exit event.” Watsi is a nonprofit. The business goal is ultimately to be self-sustainable, not to “disrupt” incumbent healthcare players and steal their revenue streams.

But still. What about that neocolonialism? I’ve looked at the home page of Watsi, all packed with grinning brown faces. It feels weird to try to choose who gets medical treatment and who doesn’t based on whatever illusory “connection” I might feel to one person’s life story or appearance. In 2006, I wrote about how Kiva felt like a bizarre variant of  online dating.Adding life-or-death tension to that equation is troubling.