TED2017
Raj Panjabi: No one should die because they live too far from a doctor
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Illness is universal -- but access to care is not. Physician Raj Panjabi has a bold vision to bring health care to everyone, everywhere. With the 2017 TED Prize, Panjabi is building the Community Health Academy, a global platform that aims to modernize how community health workers learn vital skills, creating jobs along the way.
Raj Panjabi - Physician
A billion people around the world lack access to health care because they live too far from a clinic. 2017 TED Prize winner Raj Panjabi aims to extend health services to the last mile. Full bio
A billion people around the world lack access to health care because they live too far from a clinic. 2017 TED Prize winner Raj Panjabi aims to extend health services to the last mile. Full bio
Double-click the English transcript below to play the video.
00:12
I want to share with you
something my father taught me:
something my father taught me:
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no condition is permanent.
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It's a lesson he shared with me
again and again,
again and again,
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and I learned it to be true the hard way.
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Here I am in my fourth-grade class.
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This is my yearbook picture
taken in my class in school
taken in my class in school
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in Monrovia, Liberia.
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My parents migrated from India
to West Africa in the 1970s,
to West Africa in the 1970s,
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and I had the privilege
of growing up there.
of growing up there.
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I was nine years old,
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I loved kicking around a soccer ball,
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and I was a total math and science geek.
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I was living the kind of life
that, really, any child would dream of.
that, really, any child would dream of.
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But no condition is permanent.
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01:00
On Christmas Eve in 1989,
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civil war erupted in Liberia.
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The war started in the rural countryside,
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and within months, rebel armies
had marched towards our hometown.
had marched towards our hometown.
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My school shut down,
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and when the rebel armies captured
the only international airport,
the only international airport,
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people started panicking and fleeing.
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My mom came knocking one morning
and said, "Raj, pack your things --
and said, "Raj, pack your things --
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we have to go."
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We were rushed to the center of town,
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and there on a tarmac,
we were split into two lines.
we were split into two lines.
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I stood with my family in one line,
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and we were stuffed into the cargo hatch
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of a rescue plane.
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And there on a bench,
I was sitting with my heart racing.
I was sitting with my heart racing.
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As I looked out the open hatch,
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I saw hundreds of Liberians
in another line,
in another line,
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children strapped to their backs.
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When they tried to jump in with us,
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I watched soldiers restrain them.
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They were not allowed to flee.
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We were the lucky ones.
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We lost what we had,
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but we resettled in America,
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and as immigrants, we benefitted
from the community of supporters
from the community of supporters
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that rallied around us.
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They took my family into their home,
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they mentored me.
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And they helped my dad
start a clothing shop.
start a clothing shop.
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I'd visit my father
on weekends as a teenager
on weekends as a teenager
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to help him sell sneakers and jeans.
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And every time business would get bad,
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he'd remind me of that mantra:
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no condition is permanent.
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That mantra and my parents' persistence
and that community of supporters
and that community of supporters
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made it possible for me
to go through college
to go through college
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and eventually to medical school.
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I'd once had my hopes crushed in a war,
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but because of them,
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I had a chance to pursue my dream
to become a doctor.
to become a doctor.
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My condition had changed.
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It had been 15 years
since I escaped that airfield,
since I escaped that airfield,
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but the memory of those two lines
had not escaped my mind.
had not escaped my mind.
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I was a medical student in my mid-20s,
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and I wanted to go back
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to see if I could serve
the people we'd left behind.
the people we'd left behind.
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But when I got back,
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what I found was utter destruction.
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The war had left us with just 51 doctors
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to serve a country of four million people.
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It would be like the city of San Francisco
having just 10 doctors.
having just 10 doctors.
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So if you got sick in the city
where those few doctors remain,
where those few doctors remain,
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you might stand a chance.
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But if you got sick in the remote,
rural rainforest communities,
rural rainforest communities,
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where you could be days
from the nearest clinic --
from the nearest clinic --
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I was seeing my patients die
from conditions no one should die from,
from conditions no one should die from,
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all because they were
getting to me too late.
getting to me too late.
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Imagine you have a two-year-old
who wakes up one morning with a fever,
who wakes up one morning with a fever,
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and you realize she could have malaria,
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and you know the only way to get her
the medicine she needs
the medicine she needs
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would be to take her to the riverbed,
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get in a canoe, paddle to the other side
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and then walk for up to two days
through the forest
through the forest
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just to reach the nearest clinic.
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One billion people live
in the world's most remote communities,
in the world's most remote communities,
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and despite the advances we've made
in modern medicine and technology,
in modern medicine and technology,
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our innovations are not
reaching the last mile.
reaching the last mile.
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These communities have been left behind,
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because they've been thought
too hard to reach
too hard to reach
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and too difficult to serve.
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Illness is universal;
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access to care is not.
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And realizing this lit a fire in my soul.
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No one should die because they live
too far from a doctor or clinic.
too far from a doctor or clinic.
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No condition should be permanent.
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And help in this case
didn't come from the outside,
didn't come from the outside,
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it actually came from within.
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It came from the communities themselves.
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Meet Musu.
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Way out in rural Liberia,
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where most girls have not had
a chance to finish primary school,
a chance to finish primary school,
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Musu had been persistent.
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At the age of 18,
she completed high school,
she completed high school,
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and she came back to her community.
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She saw that none of the children
were getting treatment
were getting treatment
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for the diseases
they needed treatment for --
they needed treatment for --
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deadly diseases, like malaria
and pneumonia.
and pneumonia.
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So she signed up to be a volunteer.
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There are millions of volunteers like Musu
in rural parts around our world,
in rural parts around our world,
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and we got to thinking --
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community members like Musu
could actually help us solve a puzzle.
could actually help us solve a puzzle.
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Our health care system
is structured in such a way
is structured in such a way
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that the work of diagnosing disease
and prescribing medicines
and prescribing medicines
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is limited to a team of nurses
and doctors like me.
and doctors like me.
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But nurses and doctors
are concentrated in cities,
are concentrated in cities,
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so rural communities like Musu's
have been left behind.
have been left behind.
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So we started asking some questions:
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What if we could reorganize
the medical care system?
the medical care system?
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What if we could have community
members like Musu
members like Musu
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be a part or even be the center
of our medical team?
of our medical team?
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What if Musu could help us bring
health care from clinics in cities
health care from clinics in cities
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to the doorsteps of her neighbors?
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Musu was 48 when I met her.
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And despite her amazing talent and grit,
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she hadn't had a paying job in 30 years.
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So what if technology could support her?
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What if we could invest in her
with real training,
with real training,
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equip her with real medicines,
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and have her have a real job?
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Well, in 2007, I was trying
to answer these questions,
to answer these questions,
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and my wife and I were
getting married that year.
getting married that year.
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We asked our relatives to forgo
the wedding registry gifts
the wedding registry gifts
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and instead donate some money
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so we could have some start-up money
to launch a nonprofit.
to launch a nonprofit.
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I promise you, I'm a lot
more romantic than that.
more romantic than that.
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(Laughter)
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We ended up raising $6,000,
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teamed up with some
Liberians and Americans
Liberians and Americans
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and launched a nonprofit
called Last Mile Health.
called Last Mile Health.
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Our goal is to bring a health worker
within reach of everyone, everywhere.
within reach of everyone, everywhere.
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We designed a three-step process --
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train, equip and pay --
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to invest more deeply
in volunteers like Musu
in volunteers like Musu
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to become paraprofessionals,
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to become community health workers.
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First we trained Musu to prevent,
diagnose and treat
diagnose and treat
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the top 10 diseases afflicting
families in her village.
families in her village.
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A nurse supervisor visited her
every month to coach her.
every month to coach her.
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We equipped her with modern
medical technology,
medical technology,
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like this $1 malaria rapid test,
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and put it in a backpack
full of medicines like this
full of medicines like this
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to treat infections like pneumonia,
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and crucially,
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a smartphone, to help her track
and report on epidemics.
and report on epidemics.
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Last, we recognized
the dignity in Musu's work.
the dignity in Musu's work.
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With the Liberian government,
we created a contract,
we created a contract,
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paid her
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and gave her the chance
to have a real job.
to have a real job.
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And she's amazing.
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Musu has learned over 30 medical skills,
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from screening children for malnutrition,
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to assessing the cause
of a child's cough with a smartphone,
of a child's cough with a smartphone,
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to supporting people with HIV
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and providing follow-up care
to patients who've lost their limbs.
to patients who've lost their limbs.
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Working as part of our team,
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working as paraprofessionals,
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community health workers can help ensure
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that a lot of what
your family doctor would do
your family doctor would do
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reaches the places that most
family doctors could never go.
family doctors could never go.
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One of my favorite things to do
is to care for patients
is to care for patients
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with community health workers.
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So last year I was visiting A.B.,
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and like Musu, A.B. had had
a chance to go to school.
a chance to go to school.
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He was in middle school,
in the eighth grade,
in the eighth grade,
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when his parents died.
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He became an orphan and had to drop out.
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Last year, we hired and trained
A.B. as a community health worker.
A.B. as a community health worker.
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And while he was making
door to door house calls,
door to door house calls,
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he met this young boy named Prince,
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whose mother had had trouble
breastfeeding him,
breastfeeding him,
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and by the age of six months,
Prince had started to waste away.
Prince had started to waste away.
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A.B. had just been taught how to use
this color-coded measuring tape
this color-coded measuring tape
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that wraps around the upper arm
of a child to diagnose malnutrition.
of a child to diagnose malnutrition.
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A.B. noticed that Prince
was in the red zone,
was in the red zone,
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which meant he had to be hospitalized.
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So A.B. took Prince
and his mother to the river,
and his mother to the river,
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got in a canoe
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and paddled for four hours
to get to the hospital.
to get to the hospital.
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Later, after Prince was discharged,
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A.B. taught mom how to feed baby
a food supplement.
a food supplement.
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A few months ago,
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A.B. took me to visit Prince,
and he's a chubby little guy.
and he's a chubby little guy.
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(Laughter)
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He's meeting his milestones,
he's pulled himself up to a stand,
he's pulled himself up to a stand,
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and is even starting to say a few words.
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I'm so inspired by these
community health workers.
community health workers.
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I often ask them why they do what they do,
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and when I asked A.B.,
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he said, "Doc, since I dropped out
of school, this is the first time
of school, this is the first time
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I'm having a chance
to hold a pen to write.
to hold a pen to write.
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My brain is getting fresh."
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The stories of A.B. and Musu
have taught me something fundamental
have taught me something fundamental
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about being human.
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Our will to serve others
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can actually help us
transform our own conditions.
transform our own conditions.
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I was so moved by how powerful
the will to serve our neighbors can be
the will to serve our neighbors can be
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a few years ago,
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when we faced a global catastrophe.
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In December 2013,
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something happened in the rainforests
across the border from us in Guinea.
across the border from us in Guinea.
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A toddler named Emile fell sick
with vomiting, fever and diarrhea.
with vomiting, fever and diarrhea.
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He lived in an area
where the roads were sparse
where the roads were sparse
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and there had been massive
shortages of health workers.
shortages of health workers.
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Emile died,
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and a few weeks later his sister died,
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and a few weeks later his mother died.
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And this disease would spread
from one community to another.
from one community to another.
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And it wasn't until three months later
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that the world recognized this as Ebola.
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When every minute counted,
we had already lost months,
we had already lost months,
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and by then the virus had spread
like wildfire all across West Africa,
like wildfire all across West Africa,
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and eventually to other
parts of the world.
parts of the world.
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Businesses shut down,
airlines started canceling routes.
airlines started canceling routes.
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At the height of the crisis,
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when we were told that 1.4 million
people could be infected,
people could be infected,
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when we were told
that most of them would die,
that most of them would die,
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when we had nearly lost all hope,
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I remember standing with a group
of health workers
of health workers
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in the rainforest where
an outbreak had just happened.
an outbreak had just happened.
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We were helping train and equip
them to put on the masks,
them to put on the masks,
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the gloves and the gowns that they needed
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to keep themselves safe from the virus
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while they were serving their patients.
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I remember the fear in their eyes.
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And I remember staying up at night,
terrified if I'd made the right call
terrified if I'd made the right call
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to keep them in the field.
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When Ebola threatened to bring
humanity to its knees,
humanity to its knees,
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Liberia's community health workers
didn't surrender to fear.
didn't surrender to fear.
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They did what they had always done:
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they answered the call
to serve their neighbors.
to serve their neighbors.
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Community members across Liberia
learned the symptoms of Ebola,
learned the symptoms of Ebola,
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teamed up with nurses and doctors
to go door-to-door to find the sick
to go door-to-door to find the sick
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and get them into care.
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They tracked thousands of people
who had been exposed to the virus
who had been exposed to the virus
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and helped break
the chain of transmission.
the chain of transmission.
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Some ten thousand community
health workers risked their own lives
health workers risked their own lives
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to help hunt down this virus
and stop it in its tracks.
and stop it in its tracks.
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(Applause)
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Today, Ebola has come
under control in West Africa,
under control in West Africa,
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and we've learned a few things.
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12:12
We've learned that blind spots
in rural health care
in rural health care
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can lead to hot spots of disease,
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and that places all of us at greater risk.
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We've learned that the most efficient
emergency system
emergency system
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is actually an everyday system,
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12:24
and that system has to reach
all communities,
all communities,
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including rural communities like Emile's.
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And most of all,
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we've learned from the courage
of Liberia's community health workers
of Liberia's community health workers
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that we as people are not defined
by the conditions we face,
by the conditions we face,
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no matter how hopeless they seem.
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We're defined by how we respond to them.
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For the past 15 years,
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I've seen the power of this idea
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12:51
to transform everyday citizens
into community health workers --
into community health workers --
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into everyday heroes.
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And I've seen it play out everywhere,
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from the forest communities
of West Africa,
of West Africa,
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to the rural fishing villages of Alaska.
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It's true,
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these community health workers
aren't doing neurosurgery,
aren't doing neurosurgery,
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but they're making it possible
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13:10
to bring health care within reach
of everyone everywhere.
of everyone everywhere.
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13:15
So now what?
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Well, we know that there are still
millions of people dying
millions of people dying
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from preventable causes
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in rural communities around the world.
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And we know that the great majority
of these deaths are happening
of these deaths are happening
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in these 75 blue-shaded countries.
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13:31
What we also know
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is that if we trained an army
of community health workers
of community health workers
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to learn even just 30 lifesaving skills,
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we could save the lives of nearly
30 million people by 2030.
30 million people by 2030.
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Thirty services could save
30 million lives by 2030.
30 million lives by 2030.
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That's not just a blueprint --
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we're proving this can be done.
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In Liberia,
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the Liberian government is training
thousands of workers like A.B. and Musu
thousands of workers like A.B. and Musu
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after Ebola,
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14:00
to bring health care to every
child and family in the country.
child and family in the country.
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14:04
And we've been honored to work with them,
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14:06
and are now teaming up
with a number of organizations
with a number of organizations
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that are working across other countries
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to try to help them do the same thing.
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14:14
If we could help these countries scale,
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we could save millions of lives,
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and at the same time,
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we could create millions of jobs.
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14:23
We simply can't do that, though,
without technology.
without technology.
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14:27
People are worried that technology
is going to steal our jobs,
is going to steal our jobs,
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14:30
but when it comes
to community health workers,
to community health workers,
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14:32
technology has actually
been vital for creating jobs.
been vital for creating jobs.
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14:35
Without technology --
without this smartphone,
without this smartphone,
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without this rapid test --
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14:41
it would have been impossible for us
to be able to employ A.B. and Musu.
to be able to employ A.B. and Musu.
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14:47
And I think it's time
for technology to help us train,
for technology to help us train,
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to help us train people faster
and better than ever before.
and better than ever before.
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14:54
As a doctor,
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I use technology to stay up-to-date
and keep certified.
and keep certified.
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I use smartphones, I use apps,
I use online courses.
I use online courses.
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15:01
But when A.B. wants to learn,
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15:04
he's got to jump back in that canoe
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15:07
and get to the training center.
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15:08
And when Musu shows up for training,
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15:11
her instructors are stuck using
flip charts and markers.
flip charts and markers.
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15:16
Why shouldn't they have the same
access to learn as I do?
access to learn as I do?
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15:22
If we truly want community health workers
to master those lifesaving skills
to master those lifesaving skills
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15:26
and even more,
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15:28
we've got to change this old-school
model of education.
model of education.
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15:32
Tech can truly be a game changer here.
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15:34
I've been in awe of the digital
education revolution
education revolution
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15:37
that the likes of Khan Academy
and edX have been leading.
and edX have been leading.
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15:42
And I've been thinking that it's time;
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15:44
it's time for a collision
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15:45
between the digital education revolution
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and the community health revolution.
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And so, this brings me
to my TED Prize wish.
to my TED Prize wish.
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I wish --
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I wish that you would help us recruit
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15:59
the largest army of community health
workers the world has ever known
workers the world has ever known
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16:04
by creating the Community Health Academy,
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16:06
a global platform to train,
connect and empower.
connect and empower.
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(Applause)
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Thank you.
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16:13
(Applause)
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Thank you.
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16:19
Here's the idea:
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16:21
we'll create and curate
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16:24
the best in digital education resources.
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16:28
We will bring those to community
health workers around the world,
health workers around the world,
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16:33
including A.B. and Musu.
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16:34
They'll get video lessons
on giving kids vaccines
on giving kids vaccines
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16:37
and have online courses
on spotting the next outbreak,
on spotting the next outbreak,
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16:40
so they're not stuck using flip charts.
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16:42
We'll help these countries
accredit these workers,
accredit these workers,
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16:46
so that they're not stuck remaining
an under-recognized, undervalued group,
an under-recognized, undervalued group,
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16:51
but become a renowned,
empowered profession,
empowered profession,
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16:54
just like nurses and doctors.
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16:57
And we'll create a network
of companies and entrepreneurs
of companies and entrepreneurs
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who've created innovations
that can save lives
that can save lives
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17:03
and help them connect
to workers like Musu,
to workers like Musu,
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17:05
so she can help better
serve her community.
serve her community.
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17:08
And we'll work tirelessly
to persuade governments
to persuade governments
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to make community health workers
a cornerstone of their health care plans.
a cornerstone of their health care plans.
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17:17
We plan to test and prototype
the academy in Liberia
the academy in Liberia
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17:21
and a few other partner countries,
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17:23
and then we plan to take it global,
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17:25
including to rural North America.
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17:28
With the power of this platform,
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17:29
we believe countries can be more persuaded
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17:32
that a health care revolution
really is possible.
really is possible.
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17:36
My dream is that this academy
will contribute to the training
will contribute to the training
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17:40
of hundreds of thousands
of community members
of community members
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2212
17:42
to help bring health care
to their neighbors --
to their neighbors --
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2899
17:45
the hundreds of millions of them
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1610
17:47
that live in the world's most
remote communities,
remote communities,
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17:50
from the forest communities
of West Africa,
of West Africa,
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2081
17:52
to the fishing villages of rural Alaska;
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2140
17:55
from the hilltops of Appalachia,
to the mountains of Afghanistan.
to the mountains of Afghanistan.
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4062
17:59
If this vision is aligned with yours,
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1067140
2690
18:01
head to communityhealthacademy.org,
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1069854
3221
18:05
and join this revolution.
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1680
18:08
Let us know if you or your organization
or someone you know could help us
or someone you know could help us
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4653
18:13
as we try to build this academy
over the next year.
over the next year.
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18:17
Now, as I look out into this room,
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1956
18:20
I realize that our journeys
are not self-made;
are not self-made;
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2706
18:23
they're shaped by others.
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1509
18:24
And there have been so many here
that have been part of this cause.
that have been part of this cause.
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3843
18:28
We're so honored to be part
of this community,
of this community,
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3210
18:31
and a community that's willing
to take on a cause
to take on a cause
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2683
18:34
as audacious as this one,
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1368
18:35
so I wanted to offer, as I end,
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a reflection.
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18:39
I think a lot more about
what my father taught me.
what my father taught me.
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2987
18:43
These days, I too have become a dad.
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2201
18:45
I have two sons,
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2016
18:47
and my wife and I just learned
that she's pregnant with our third child.
that she's pregnant with our third child.
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3988
18:52
(Applause)
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1008
18:53
Thank you.
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1067
18:54
(Applause)
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18:56
I was recently caring
for a woman in Liberia
for a woman in Liberia
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18:58
who, like my wife,
was in her third pregnancy.
was in her third pregnancy.
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2725
19:02
But unlike my wife,
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1709
19:04
had had no prenatal care
with her first two babies.
with her first two babies.
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2999
19:09
She lived in an isolated community
in the forest that had gone for 100 years
in the forest that had gone for 100 years
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4392
19:13
without any health care
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1389
19:16
until ...
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1628
19:18
until last year when a nurse
trained her neighbors
trained her neighbors
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3383
19:21
to become community health workers.
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1711
19:23
So here I was,
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1292
19:24
seeing this patient
who was in her second trimester,
who was in her second trimester,
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4240
19:28
and I pulled out the ultrasound
to check on the baby,
to check on the baby,
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3272
19:32
and she started telling us stories
about her first two kids,
about her first two kids,
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3539
19:35
and I had the ultrasound
probe on her belly,
probe on her belly,
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3198
19:38
and she just stopped mid-sentence.
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2268
19:43
She turned to me and she said,
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1541
19:44
"Doc, what's that sound?"
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2294
19:49
It was the first time she'd ever heard
her baby's heartbeat.
her baby's heartbeat.
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1177371
3178
19:54
And her eyes lit up in the same way
my wife's eyes and my own eyes lit up
my wife's eyes and my own eyes lit up
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5060
19:59
when we heard our baby's heartbeat.
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1187195
2135
20:03
For all of human history,
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2153
20:05
illness has been universal
and access to care has not.
and access to care has not.
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4532
20:10
But as a wise man once told me:
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1886
20:13
no condition is permanent.
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2488
20:17
It's time.
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1228
20:18
It's time for us to go as far as it takes
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20:21
to change this condition together.
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20:23
Thank you.
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1154
20:24
(Applause)
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4467
ABOUT THE SPEAKER
Raj Panjabi - PhysicianA billion people around the world lack access to health care because they live too far from a clinic. 2017 TED Prize winner Raj Panjabi aims to extend health services to the last mile.
Why you should listen
Raj Panjabi was nine when civil war broke out in his native country, Liberia. His family resettled in High Point, North Carolina, but he returned to Liberia as a medical student in 2005. He was shocked to find a health care system in total devastation. Only 50 doctors remained to treat a population of four million.
With a team of Liberian civil war survivors, American health workers and $6,000 he'd received as a wedding gift, Panjabi co-founded Last Mile Health. The organization saves lives in the world's most remote communities by partnering with governments to deploy, sustain and manage national networks of community health professionals. They currently support the Government of Liberia's deployment of more than 4,000 health workers to provide life-saving healthcare to 1.2 million people and protect against the next epidemic. Last Mile Health's network of community health workers can be leveraged in a crisis -- in the fight against Ebola, the organization aided government response by training health workers in southeastern Liberia.
Panjabi is a physician in the Division of Global Health Equity at Harvard Medical School, Brigham and Women's Hospital. He is a recipient of the Skoll Award for Social Entrepreneurship and was named to TIME's list of the "100 Most Influential People in the World" in 2016. As the winner of the 2017 TED Prize, Panjabi is creating the Community Health Academy, a global platform to train, connect and empower community health workers. The Academy aims to reinvent the education of community health workers -- and the leaders who support them -- for the digital age.
Raj Panjabi | Speaker | TED.com