No one should die because they live too far from a doctor | Raj Panjabi

Summary

The speaker recounts his journey from a war-torn childhood in Liberia to becoming a doctor in America, emphasizing the lesson 'no condition is permanent.' He founded Last Mile Health, a nonprofit that trains community health workers in remote areas, leveraging technology to bridge the gap in healthcare access. The speaker's TED Prize wish is to create the Community Health Academy, a global platform for training these workers, aiming to save millions of lives by 2030.

Takeaways

• 🌟 The speaker's father instilled in him the belief that 'no condition is permanent', a lesson that has profoundly influenced his life.
• 🏞️ Growing up in Monrovia, Liberia, the speaker had a privileged childhood until the outbreak of civil war in 1989 disrupted his life.
• 🚁 Forced to flee due to the war, the speaker and his family were among the fortunate ones to escape on a rescue plane, leaving many behind.
• 🏡 Resettling in America, the speaker's family received support from a community that helped them rebuild their lives.
• 🎓 The mantra 'no condition is permanent', along with community support, enabled the speaker to pursue higher education and become a doctor.
• 🏥 Returning to Liberia as a medical student, the speaker was shocked by the severe lack of healthcare, with only 51 doctors for a population of four million.
• 🌐 Recognizing the global issue of inaccessible healthcare in remote communities, the speaker was determined to address this disparity.
• 👩‍⚕️ The speaker introduced the concept of community health workers, like Musu, who could bridge the gap in healthcare access in rural areas.
• 🤝 The nonprofit organization Last Mile Health was founded to train, equip, and pay community health workers, thereby improving healthcare delivery.
• 📱 Technology, including smartphones and medical tests, was integrated to empower community health workers and enhance their capabilities.
• 🌟 The speaker's TED Prize wish is to create the Community Health Academy, a platform to train and connect community health workers worldwide.

Q & A

What is the central lesson the speaker learned from his father?

The central lesson the speaker learned from his father is that 'no condition is permanent,' which means that circumstances can change and one should not be defined by their current situation.

Why did the speaker's family have to flee from Liberia?

The speaker's family had to flee from Liberia due to the civil war that erupted in 1989, which led to the closure of schools and panic among the citizens as rebel armies approached their hometown.

How did the community in America support the speaker's family after their arrival?

The community in America supported the speaker's family by taking them into their homes, mentoring the speaker, and helping his father start a clothing shop.

What was the impact of the civil war on Liberia's healthcare system?

The civil war left Liberia with just 51 doctors to serve a population of four million people, highlighting a severe lack of healthcare professionals, especially in rural areas.

What is the 'Last Mile Health' initiative the speaker co-founded?

Last Mile Health is a nonprofit co-founded by the speaker, aimed at bringing a health worker within reach of every person, everywhere by training, equipping, and paying community health workers to serve their local communities.

How does the speaker propose to use technology to improve training for community health workers?

The speaker proposes to use technology to create a global platform, the Community Health Academy, which will provide digital education resources to train community health workers more effectively and efficiently.

What was the speaker's TED Prize wish?

The speaker's TED Prize wish was to recruit the largest army of community health workers the world has ever known by creating the Community Health Academy, a platform to train, connect, and empower them.

How did the Ebola outbreak in 2013 highlight the importance of community health workers?

The Ebola outbreak in 2013 highlighted the importance of community health workers as they played a crucial role in identifying symptoms, tracking the virus, and breaking the chain of transmission, demonstrating their value in emergency situations.

What is the potential impact of training community health workers in 75 countries as mentioned in the script?

Training community health workers in 75 countries could save the lives of nearly 30 million people by 2030 by providing essential healthcare services in remote and underserved areas.

How does the speaker's personal experience with his wife's pregnancy relate to the importance of community health workers?

The speaker's personal experience of hearing his baby's heartbeat during his wife's pregnancy parallels the joy and importance of prenatal care. He contrasts this with a woman in Liberia who had no access to such care until community health workers were trained, emphasizing the life-changing impact of their work.

Outlines

00:00

🌍 A Lesson on Impermanence

The speaker shares a life philosophy imparted by his father: 'no condition is permanent.' He recounts his idyllic childhood in Monrovia, Liberia, disrupted by the outbreak of civil war in 1989. Forced to flee with his family, they were among the fortunate few to escape on a rescue plane, leaving behind many who were not as lucky. Resettling in America, the speaker's family was embraced by a supportive community that helped them rebuild their lives. The mantra 'no condition is permanent' resonated with him through hardships and successes, including pursuing a medical career.

05:01

🩺 Healthcare Inequality and the Power of Community

Upon returning to Liberia as a medical student, the speaker was confronted with the reality of a country left with only 51 doctors for four million people post-war. This stark healthcare disparity, especially affecting remote communities, inspired him to consider innovative solutions. He introduces Musu, a woman from rural Liberia, who despite limited opportunities, became a community health volunteer. The speaker ponders on how to leverage such community members to bridge the gap in healthcare access, suggesting a reorganization of the medical care system to include trained volunteers like Musu.

10:02

🛠️ Building Last Mile Health

The speaker, along with his wife, founded Last Mile Health, a nonprofit aimed at ensuring healthcare access for all. They developed a three-step approach: training, equipping, and paying community health workers like Musu. Musu was trained to manage the top health issues in her village, equipped with medical tools including a smartphone for disease tracking, and provided with a formal job and income. The speaker emphasizes the transformative impact of this model on both the health workers and the communities they serve.

15:04

🌐 The Global Impact of Community Health Workers

The speaker discusses the broader implications of community health work, highlighting the critical role these workers played during the Ebola outbreak in West Africa. Their efforts in educating communities, tracking the disease, and supporting patients were pivotal in controlling the epidemic. The speaker advocates for technology to enhance training and empower these workers, suggesting a global platform for digital education and community health empowerment. He concludes with a TED Prize wish to create the Community Health Academy, a platform to train and connect health workers worldwide.

20:06

👨‍⚕️ The Vision for Universal Healthcare

In the final paragraph, the speaker shares his vision for a world where healthcare is accessible to all, regardless of geographical barriers. He reflects on the universal experience of hearing a baby's heartbeat for the first time, linking it to the broader goal of healthcare equity. The speaker calls for a collective effort to change the现状 of healthcare disparity, emphasizing the importance of community health workers in achieving this vision.

Keywords

💡Civil War

Civil war refers to a large-scale conflict that occurs within a country, involving two or more factions fighting against each other for control of the government or territory. In the video, the speaker recounts the outbreak of civil war in Liberia in 1989, which drastically changed the conditions of his life, forcing him and his family to flee their home.

💡Refugee

A refugee is a person who has been forced to leave their country in order to escape war, persecution, or natural disaster. The speaker's family became refugees when they were forced to flee Liberia due to the civil war, seeking safety and a new life in America.

💡Community Health Workers

Community health workers are individuals, often from the communities they serve, who are trained to provide basic health care and educate community members about health issues. In the video, the speaker highlights the pivotal role of community health workers like Musu and A.B. in bridging the gap in healthcare access in remote areas of Liberia.

💡Last Mile Health

Last Mile Health refers to the concept of extending healthcare services to the most remote and hard-to-reach communities. The speaker co-founded the nonprofit organization Last Mile Health with the mission to bring healthcare within reach of everyone, everywhere, emphasizing the importance of the 'last mile' in healthcare delivery.

💡Ebola Outbreak

An Ebola outbreak is a sudden and often widespread occurrence of the Ebola virus disease, which is highly contagious and can be fatal. The video discusses the devastating impact of the Ebola outbreak in West Africa and how community health workers played a crucial role in combating it, demonstrating their importance in emergency health situations.

💡Preventable Causes

Preventable causes refer to illnesses or conditions that can be avoided through proper healthcare, sanitation, or other preventive measures. The speaker points out that millions of people in rural communities die from preventable causes due to lack of access to healthcare, highlighting the need for improved healthcare systems.

💡Paraprofessionals

Paraprofessionals are individuals who perform tasks similar to professionals but have not completed the full professional qualification process. In the context of the video, the speaker mentions training volunteers like Musu to become paraprofessional community health workers, enabling them to provide essential healthcare services in their communities.

💡Healthcare Access

Healthcare access refers to the ease with which individuals can obtain healthcare services. The video emphasizes the inequity in healthcare access, particularly for those living in remote areas, and the speaker's mission to improve access through community health workers and technology.

💡Digital Education

Digital education involves the use of technology to deliver educational content. The speaker envisions a digital education platform, the Community Health Academy, to provide community health workers with the training and resources they need, leveraging technology to enhance their skills and effectiveness.

💡Community Empowerment

Community empowerment is the process of enabling communities to take greater control over their own affairs and improve their living conditions. The video discusses how training community members like Musu and A.B. as health workers not only improves healthcare in their communities but also empowers them personally and professionally.

💡Global Health Inequity

Global health inequity refers to the unfair and avoidable differences in health status seen within and between countries. The speaker addresses this issue by discussing the disparities in healthcare access and the potential for community health workers to help reduce these inequities, particularly in the most remote and underserved areas.

Highlights

The importance of the lesson 'no condition is permanent' and its impact on personal growth.

The author's childhood in Monrovia, Liberia, and the sudden outbreak of civil war.

The experience of being evacuated from Liberia and the stark divide between those who could flee and those who could not.

The resettlement in America and the support from the community that helped the author's family.

The mantra 'no condition is permanent' as a driving force in the author's life and education.

The author's return to Liberia as a medical student and the reality of the country's healthcare crisis.

The concept of 'last mile' healthcare and the challenge of reaching remote communities.

The story of Musu, a community member who became a volunteer to help bridge the healthcare gap.

The idea of reorganizing the medical care system to include community members as health workers.

The launch of Last Mile Health, a nonprofit aimed at bringing healthcare to remote areas.

The three-step process of training, equipping, and paying community health workers.

The impact of technology in empowering community health workers like Musu.

The story of A.B., a community health worker who helped save a child's life through early detection and intervention.

The Ebola crisis and the critical role of community health workers in containing its spread.

The potential of training community health workers to save millions of lives by 2030.

The TED Prize wish for creating the Community Health Academy, a global platform for training community health workers.

The vision of a healthcare revolution that brings care to the world's most remote communities.

The call to action for joining the Community Health Academy and contributing to the healthcare revolution.

Transcripts

I want to share with you something my father taught me:

no condition is permanent.

It's a lesson he shared with me again and again,

and I learned it to be true the hard way.

Here I am in my fourth-grade class.

This is my yearbook picture taken in my class in school

in Monrovia, Liberia.

My parents migrated from India to West Africa in the 1970s,

and I had the privilege of growing up there.

I was nine years old,

I loved kicking around a soccer ball,

and I was a total math and science geek.

I was living the kind of life that, really, any child would dream of.

But no condition is permanent.

On Christmas Eve in 1989,

civil war erupted in Liberia.

The war started in the rural countryside,

and within months, rebel armies had marched towards our hometown.

My school shut down,

and when the rebel armies captured the only international airport,

people started panicking and fleeing.

My mom came knocking one morning and said, "Raj, pack your things --

we have to go."

We were rushed to the center of town,

and there on a tarmac, we were split into two lines.

I stood with my family in one line,

and we were stuffed into the cargo hatch

of a rescue plane.

And there on a bench, I was sitting with my heart racing.

As I looked out the open hatch,

I saw hundreds of Liberians in another line,

children strapped to their backs.

When they tried to jump in with us,

I watched soldiers restrain them.

They were not allowed to flee.

We were the lucky ones.

We lost what we had,

but we resettled in America,

and as immigrants, we benefitted from the community of supporters

that rallied around us.

They took my family into their home,

they mentored me.

And they helped my dad start a clothing shop.

I'd visit my father on weekends as a teenager

to help him sell sneakers and jeans.

And every time business would get bad,

he'd remind me of that mantra:

no condition is permanent.

That mantra and my parents' persistence and that community of supporters

made it possible for me to go through college

and eventually to medical school.

I'd once had my hopes crushed in a war,

but because of them,

I had a chance to pursue my dream to become a doctor.

My condition had changed.

It had been 15 years since I escaped that airfield,

but the memory of those two lines had not escaped my mind.

I was a medical student in my mid-20s,

and I wanted to go back

to see if I could serve the people we'd left behind.

But when I got back,

what I found was utter destruction.

The war had left us with just 51 doctors

to serve a country of four million people.

It would be like the city of San Francisco having just 10 doctors.

So if you got sick in the city where those few doctors remain,

you might stand a chance.

But if you got sick in the remote, rural rainforest communities,

where you could be days from the nearest clinic --

I was seeing my patients die from conditions no one should die from,

all because they were getting to me too late.

Imagine you have a two-year-old who wakes up one morning with a fever,

and you realize she could have malaria,

and you know the only way to get her the medicine she needs

would be to take her to the riverbed,

get in a canoe, paddle to the other side

and then walk for up to two days through the forest

just to reach the nearest clinic.

One billion people live in the world's most remote communities,

and despite the advances we've made in modern medicine and technology,

our innovations are not reaching the last mile.

These communities have been left behind,

because they've been thought too hard to reach

and too difficult to serve.

Illness is universal;

access to care is not.

And realizing this lit a fire in my soul.

No one should die because they live too far from a doctor or clinic.

No condition should be permanent.

And help in this case didn't come from the outside,

it actually came from within.

It came from the communities themselves.

Meet Musu.

Way out in rural Liberia,

where most girls have not had a chance to finish primary school,

Musu had been persistent.

At the age of 18, she completed high school,

and she came back to her community.

She saw that none of the children were getting treatment

for the diseases they needed treatment for --

deadly diseases, like malaria and pneumonia.

So she signed up to be a volunteer.

There are millions of volunteers like Musu in rural parts around our world,

and we got to thinking --

community members like Musu could actually help us solve a puzzle.

Our health care system is structured in such a way

that the work of diagnosing disease and prescribing medicines

is limited to a team of nurses and doctors like me.

But nurses and doctors are concentrated in cities,

so rural communities like Musu's have been left behind.

So we started asking some questions:

What if we could reorganize the medical care system?

What if we could have community members like Musu

be a part or even be the center of our medical team?

What if Musu could help us bring health care from clinics in cities

to the doorsteps of her neighbors?

Musu was 48 when I met her.

And despite her amazing talent and grit,

she hadn't had a paying job in 30 years.

So what if technology could support her?

What if we could invest in her with real training,

equip her with real medicines,

and have her have a real job?

Well, in 2007, I was trying to answer these questions,

and my wife and I were getting married that year.

We asked our relatives to forgo the wedding registry gifts

and instead donate some money

so we could have some start-up money to launch a nonprofit.

I promise you, I'm a lot more romantic than that.

(Laughter)

We ended up raising $6,000,

teamed up with some Liberians and Americans

and launched a nonprofit called Last Mile Health.

Our goal is to bring a health worker within reach of everyone, everywhere.

We designed a three-step process --

train, equip and pay --

to invest more deeply in volunteers like Musu

to become paraprofessionals,

to become community health workers.

First we trained Musu to prevent, diagnose and treat

the top 10 diseases afflicting families in her village.

A nurse supervisor visited her every month to coach her.

We equipped her with modern medical technology,

like this $1 malaria rapid test,

and put it in a backpack full of medicines like this

to treat infections like pneumonia,

and crucially,

a smartphone, to help her track and report on epidemics.

Last, we recognized the dignity in Musu's work.

With the Liberian government, we created a contract,

paid her

and gave her the chance to have a real job.

And she's amazing.

Musu has learned over 30 medical skills,

from screening children for malnutrition,

to assessing the cause of a child's cough with a smartphone,

to supporting people with HIV

and providing follow-up care to patients who've lost their limbs.

Working as part of our team,

working as paraprofessionals,

community health workers can help ensure

that a lot of what your family doctor would do

reaches the places that most family doctors could never go.

One of my favorite things to do is to care for patients

with community health workers.

So last year I was visiting A.B.,

and like Musu, A.B. had had a chance to go to school.

He was in middle school, in the eighth grade,

when his parents died.

He became an orphan and had to drop out.

Last year, we hired and trained A.B. as a community health worker.

And while he was making door to door house calls,

he met this young boy named Prince,

whose mother had had trouble breastfeeding him,

and by the age of six months, Prince had started to waste away.

A.B. had just been taught how to use this color-coded measuring tape

that wraps around the upper arm of a child to diagnose malnutrition.

A.B. noticed that Prince was in the red zone,

which meant he had to be hospitalized.

So A.B. took Prince and his mother to the river,

got in a canoe

and paddled for four hours to get to the hospital.

Later, after Prince was discharged,

A.B. taught mom how to feed baby a food supplement.

A few months ago,

A.B. took me to visit Prince, and he's a chubby little guy.

(Laughter)

He's meeting his milestones, he's pulled himself up to a stand,

and is even starting to say a few words.

I'm so inspired by these community health workers.

I often ask them why they do what they do,

and when I asked A.B.,

he said, "Doc, since I dropped out of school, this is the first time

I'm having a chance to hold a pen to write.

My brain is getting fresh."

The stories of A.B. and Musu have taught me something fundamental

about being human.

Our will to serve others

can actually help us transform our own conditions.

I was so moved by how powerful the will to serve our neighbors can be

a few years ago,

when we faced a global catastrophe.

In December 2013,

something happened in the rainforests across the border from us in Guinea.

A toddler named Emile fell sick with vomiting, fever and diarrhea.

He lived in an area where the roads were sparse

and there had been massive shortages of health workers.

Emile died,

and a few weeks later his sister died,

and a few weeks later his mother died.

And this disease would spread from one community to another.

And it wasn't until three months later

that the world recognized this as Ebola.

When every minute counted, we had already lost months,

and by then the virus had spread like wildfire all across West Africa,

and eventually to other parts of the world.

Businesses shut down, airlines started canceling routes.

At the height of the crisis,

when we were told that 1.4 million people could be infected,

when we were told that most of them would die,

when we had nearly lost all hope,

I remember standing with a group of health workers

in the rainforest where an outbreak had just happened.

We were helping train and equip them to put on the masks,

the gloves and the gowns that they needed

to keep themselves safe from the virus

while they were serving their patients.

I remember the fear in their eyes.

And I remember staying up at night, terrified if I'd made the right call

to keep them in the field.

When Ebola threatened to bring humanity to its knees,

Liberia's community health workers didn't surrender to fear.

They did what they had always done:

they answered the call to serve their neighbors.

Community members across Liberia learned the symptoms of Ebola,

teamed up with nurses and doctors to go door-to-door to find the sick

and get them into care.

They tracked thousands of people who had been exposed to the virus

and helped break the chain of transmission.

Some ten thousand community health workers risked their own lives

to help hunt down this virus and stop it in its tracks.

(Applause)

Today, Ebola has come under control in West Africa,

and we've learned a few things.

We've learned that blind spots in rural health care

can lead to hot spots of disease,

and that places all of us at greater risk.

We've learned that the most efficient emergency system

is actually an everyday system,

and that system has to reach all communities,

including rural communities like Emile's.

And most of all,

we've learned from the courage of Liberia's community health workers

that we as people are not defined by the conditions we face,

no matter how hopeless they seem.

We're defined by how we respond to them.

For the past 15 years,

I've seen the power of this idea

to transform everyday citizens into community health workers --

into everyday heroes.

And I've seen it play out everywhere,

from the forest communities of West Africa,

to the rural fishing villages of Alaska.

It's true,

these community health workers aren't doing neurosurgery,

but they're making it possible

to bring health care within reach of everyone everywhere.

So now what?

Well, we know that there are still millions of people dying

from preventable causes

in rural communities around the world.

And we know that the great majority of these deaths are happening

in these 75 blue-shaded countries.

What we also know

is that if we trained an army of community health workers

to learn even just 30 lifesaving skills,

we could save the lives of nearly 30 million people by 2030.

Thirty services could save 30 million lives by 2030.

That's not just a blueprint --

we're proving this can be done.

In Liberia,

the Liberian government is training thousands of workers like A.B. and Musu

after Ebola,

to bring health care to every child and family in the country.

And we've been honored to work with them,

and are now teaming up with a number of organizations

that are working across other countries

to try to help them do the same thing.

If we could help these countries scale,

we could save millions of lives,

and at the same time,

we could create millions of jobs.

We simply can't do that, though, without technology.

People are worried that technology is going to steal our jobs,

but when it comes to community health workers,

technology has actually been vital for creating jobs.

Without technology -- without this smartphone,

without this rapid test --

it would have been impossible for us to be able to employ A.B. and Musu.

And I think it's time for technology to help us train,

to help us train people faster and better than ever before.

As a doctor,

I use technology to stay up-to-date and keep certified.

I use smartphones, I use apps, I use online courses.

But when A.B. wants to learn,

he's got to jump back in that canoe

and get to the training center.

And when Musu shows up for training,

her instructors are stuck using flip charts and markers.

Why shouldn't they have the same access to learn as I do?

If we truly want community health workers to master those lifesaving skills

and even more,

we've got to change this old-school model of education.

Tech can truly be a game changer here.

I've been in awe of the digital education revolution

that the likes of Khan Academy and edX have been leading.

And I've been thinking that it's time;

it's time for a collision

between the digital education revolution

and the community health revolution.

And so, this brings me to my TED Prize wish.

I wish --

I wish that you would help us recruit

the largest army of community health workers the world has ever known

by creating the Community Health Academy,

a global platform to train, connect and empower.

(Applause)

Thank you.

(Applause)

Thank you.

Here's the idea:

we'll create and curate

the best in digital education resources.

We will bring those to community health workers around the world,

including A.B. and Musu.

They'll get video lessons on giving kids vaccines

and have online courses on spotting the next outbreak,

so they're not stuck using flip charts.

We'll help these countries accredit these workers,

so that they're not stuck remaining an under-recognized, undervalued group,

but become a renowned, empowered profession,

just like nurses and doctors.

And we'll create a network of companies and entrepreneurs

who've created innovations that can save lives

and help them connect to workers like Musu,

so she can help better serve her community.

And we'll work tirelessly to persuade governments

to make community health workers a cornerstone of their health care plans.

We plan to test and prototype the academy in Liberia

and a few other partner countries,

and then we plan to take it global,

including to rural North America.

With the power of this platform,

we believe countries can be more persuaded

that a health care revolution really is possible.

My dream is that this academy will contribute to the training

of hundreds of thousands of community members

to help bring health care to their neighbors --

the hundreds of millions of them

that live in the world's most remote communities,

from the forest communities of West Africa,

to the fishing villages of rural Alaska;

from the hilltops of Appalachia, to the mountains of Afghanistan.

If this vision is aligned with yours,

head to communityhealthacademy.org,

and join this revolution.

Let us know if you or your organization or someone you know could help us

as we try to build this academy over the next year.

Now, as I look out into this room,

I realize that our journeys are not self-made;

they're shaped by others.

And there have been so many here that have been part of this cause.

We're so honored to be part of this community,

and a community that's willing to take on a cause

as audacious as this one,

so I wanted to offer, as I end,

a reflection.

I think a lot more about what my father taught me.

These days, I too have become a dad.

I have two sons,

and my wife and I just learned that she's pregnant with our third child.

(Applause)

Thank you.

(Applause)

I was recently caring for a woman in Liberia

who, like my wife, was in her third pregnancy.

But unlike my wife,

had had no prenatal care with her first two babies.

She lived in an isolated community in the forest that had gone for 100 years

without any health care

until ...

until last year when a nurse trained her neighbors

to become community health workers.

So here I was,

seeing this patient who was in her second trimester,

and I pulled out the ultrasound to check on the baby,

and she started telling us stories about her first two kids,

and I had the ultrasound probe on her belly,

and she just stopped mid-sentence.

She turned to me and she said,

"Doc, what's that sound?"

It was the first time she'd ever heard her baby's heartbeat.

And her eyes lit up in the same way my wife's eyes and my own eyes lit up

when we heard our baby's heartbeat.

For all of human history,

illness has been universal and access to care has not.

But as a wise man once told me:

no condition is permanent.

It's time.

It's time for us to go as far as it takes

to change this condition together.

Thank you.

(Applause)