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Beyond his daytime duties of strategy and corporate development, Nakagawa helped colleague Blaise Judja-Sato with his vision of bringing essential health services to the poor in Africa and beyond. In 2000, Judja-Sato founded VillageReach in Seattle, Washington. In 2001, Nakagawa left his investment banking career for what he saw as a higher calling — to use his financial expertise and business acumen to provide a better life for the world's poor as a social entrepreneur.

He was appointed chief operating officer of VillageReach. In this role, Nakagawa was responsible for organizational development and strategy and for assessing ventures for potential partnerships. In 2004, the Bill & Melinda Gates Foundation endorsed VillageReach by providing $3.3 million in critical funding to increase immunization rates, efficacy, and safety for five million people. Nakagawa has done what Nelson Mandela (a VillageReach honorary Board Member) expresses so eloquently: "We must not become immobilized by what we think of as the 'hugeness' of our problems. Let us consider what can be done, and start finding practical ways of doing things."

By 2007, Nakagawa became acting president and expanded VillageReach from a two-person venture in Seattle to an organization of 40 employees with six offices in two countries.