WEBVTT

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I want to share with you
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,

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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

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in Monrovia, Liberia.

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

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and I had the privilege
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.

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But no condition is permanent.

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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.

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My school shut down,

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and when the rebel armies captured
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 --

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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.

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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.

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As I looked out the open hatch,

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I saw hundreds of Liberians
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

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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.

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I'd visit my father
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

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made it possible for me
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.

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My condition had changed.

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It had been 15 years
since I escaped that airfield,

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but the memory of those two lines
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.

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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.

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So if you got sick in the city
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,

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where you could be days
from the nearest clinic --

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

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all because they were
getting to me too late.

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Imagine you have a two-year-old
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

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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

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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,

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

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our innovations are not
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

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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.

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No condition should be permanent.

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And help in this case
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,

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Musu had been persistent.

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At the age of 18,
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

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for the diseases
they needed treatment for --

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deadly diseases, like malaria
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,

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and we got to thinking --

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

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Our health care system
is structured in such a way

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that the work of diagnosing disease
and prescribing medicines

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

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But nurses and doctors
are concentrated in cities,

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so rural communities like Musu's
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?

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What if we could have community
members like Musu

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

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What if Musu could help us bring
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,

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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,

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and my wife and I were
getting married that year.

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We asked our relatives to forgo
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.

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I promise you, I'm a lot
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

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and launched a nonprofit
called Last Mile Health.

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Our goal is to bring a health worker
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

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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

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the top 10 diseases afflicting
families in her village.

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A nurse supervisor visited her
every month to coach her.

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We equipped her with modern
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

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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.

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

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With the Liberian government,
we created a contract,

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paid her

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and gave her the chance
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,

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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.

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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

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reaches the places that most
family doctors could never go.

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One of my favorite things to do
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.

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He was in middle school,
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.

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And while he was making
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,

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

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

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

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A.B. noticed that Prince
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,

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got in a canoe

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and paddled for four hours
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.

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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.

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(Laughter)

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He's meeting his milestones,
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.

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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

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I'm having a chance
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

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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.

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I was so moved by how powerful
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.

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

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He lived in an area
where the roads were sparse

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and there had been massive
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.

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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,

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

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and eventually to other
parts of the world.

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Businesses shut down,
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,

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when we were told
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

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in the rainforest where
an outbreak had just happened.

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We were helping train and equip
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

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to keep them in the field.

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When Ebola threatened to bring
humanity to its knees,

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Liberia's community health workers
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.

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Community members across Liberia
learned the symptoms of Ebola,

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teamed up with nurses and doctors
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

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and helped break
the chain of transmission.

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Some ten thousand community
health workers risked their own lives

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

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(Applause)

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Today, Ebola has come
under control in West Africa,

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and we've learned a few things.

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We've learned that blind spots
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

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is actually an everyday system,

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and that system has to reach
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

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that we as people are not defined
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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to transform everyday citizens
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,

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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,

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but they're making it possible

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to bring health care within reach
of everyone everywhere.

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So now what?

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

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from preventable causes

00:13:11.373 --> 00:13:13.248
in rural communities around the world.

00:13:13.272 --> 00:13:17.113
And we know that the great majority
of these deaths are happening

00:13:17.137 --> 00:13:19.460
in these 75 blue-shaded countries.

00:13:19.849 --> 00:13:21.000
What we also know

00:13:21.024 --> 00:13:24.467
is that if we trained an army
of community health workers

00:13:24.491 --> 00:13:27.824
to learn even just 30 lifesaving skills,

00:13:28.508 --> 00:13:32.624
we could save the lives of nearly
30 million people by 2030.

00:13:33.652 --> 00:13:38.297
Thirty services could save
30 million lives by 2030.

00:13:38.321 --> 00:13:40.064
That's not just a blueprint --

00:13:40.088 --> 00:13:41.883
we're proving this can be done.

NOTE Paragraph

00:13:41.907 --> 00:13:43.067
In Liberia,

00:13:43.091 --> 00:13:47.356
the Liberian government is training
thousands of workers like A.B. and Musu

00:13:47.380 --> 00:13:48.538
after Ebola,

00:13:48.562 --> 00:13:52.039
to bring health care to every
child and family in the country.

00:13:52.063 --> 00:13:54.094
And we've been honored to work with them,

00:13:54.118 --> 00:13:56.626
and are now teaming up
with a number of organizations

00:13:56.650 --> 00:13:58.872
that are working across other countries

00:13:58.896 --> 00:14:00.919
to try to help them do the same thing.

00:14:02.005 --> 00:14:04.695
If we could help these countries scale,

00:14:05.550 --> 00:14:07.182
we could save millions of lives,

00:14:07.206 --> 00:14:08.562
and at the same time,

00:14:08.586 --> 00:14:10.367
we could create millions of jobs.

NOTE Paragraph

00:14:11.875 --> 00:14:14.797
We simply can't do that, though,
without technology.

00:14:15.286 --> 00:14:18.374
People are worried that technology
is going to steal our jobs,

00:14:18.398 --> 00:14:20.597
but when it comes
to community health workers,

00:14:20.621 --> 00:14:23.877
technology has actually
been vital for creating jobs.

00:14:23.901 --> 00:14:26.317
Without technology --
without this smartphone,

00:14:26.341 --> 00:14:29.063
without this rapid test --

00:14:29.960 --> 00:14:34.493
it would have been impossible for us
to be able to employ A.B. and Musu.

00:14:35.464 --> 00:14:38.146
And I think it's time
for technology to help us train,

00:14:38.170 --> 00:14:41.710
to help us train people faster
and better than ever before.

NOTE Paragraph

00:14:42.578 --> 00:14:43.728
As a doctor,

00:14:43.752 --> 00:14:47.243
I use technology to stay up-to-date
and keep certified.

00:14:47.267 --> 00:14:49.962
I use smartphones, I use apps,
I use online courses.

00:14:49.986 --> 00:14:52.198
But when A.B. wants to learn,

00:14:52.222 --> 00:14:54.317
he's got to jump back in that canoe

00:14:55.152 --> 00:14:56.792
and get to the training center.

00:14:56.816 --> 00:14:59.008
And when Musu shows up for training,

00:14:59.710 --> 00:15:03.315
her instructors are stuck using
flip charts and markers.

00:15:04.147 --> 00:15:08.680
Why shouldn't they have the same
access to learn as I do?

00:15:10.384 --> 00:15:14.012
If we truly want community health workers
to master those lifesaving skills

00:15:14.036 --> 00:15:15.288
and even more,

00:15:16.098 --> 00:15:19.352
we've got to change this old-school
model of education.

00:15:20.282 --> 00:15:22.180
Tech can truly be a game changer here.

00:15:22.204 --> 00:15:25.749
I've been in awe of the digital
education revolution

00:15:25.773 --> 00:15:28.933
that the likes of Khan Academy
and edX have been leading.

00:15:30.041 --> 00:15:32.534
And I've been thinking that it's time;

00:15:32.558 --> 00:15:33.949
it's time for a collision

00:15:33.973 --> 00:15:36.284
between the digital education revolution

00:15:36.308 --> 00:15:38.458
and the community health revolution.

NOTE Paragraph

00:15:39.483 --> 00:15:42.703
And so, this brings me
to my TED Prize wish.

00:15:43.759 --> 00:15:45.560
I wish --

00:15:45.584 --> 00:15:47.790
I wish that you would help us recruit

00:15:47.814 --> 00:15:51.742
the largest army of community health
workers the world has ever known

00:15:52.068 --> 00:15:54.893
by creating the Community Health Academy,

00:15:54.917 --> 00:15:58.122
a global platform to train,
connect and empower.

NOTE Paragraph

00:15:58.797 --> 00:15:59.963
(Applause)

NOTE Paragraph

00:15:59.988 --> 00:16:01.150
Thank you.

NOTE Paragraph

00:16:01.175 --> 00:16:04.777
(Applause)

NOTE Paragraph

00:16:04.801 --> 00:16:05.959
Thank you.

NOTE Paragraph

00:16:07.816 --> 00:16:09.360
Here's the idea:

00:16:09.384 --> 00:16:11.454
we'll create and curate

00:16:12.066 --> 00:16:15.941
the best in digital education resources.

00:16:16.802 --> 00:16:21.437
We will bring those to community
health workers around the world,

00:16:21.461 --> 00:16:22.714
including A.B. and Musu.

00:16:22.738 --> 00:16:25.540
They'll get video lessons
on giving kids vaccines

00:16:25.564 --> 00:16:28.777
and have online courses
on spotting the next outbreak,

00:16:28.801 --> 00:16:30.684
so they're not stuck using flip charts.

00:16:30.708 --> 00:16:34.544
We'll help these countries
accredit these workers,

00:16:34.568 --> 00:16:39.275
so that they're not stuck remaining
an under-recognized, undervalued group,

00:16:39.299 --> 00:16:42.036
but become a renowned,
empowered profession,

00:16:42.060 --> 00:16:43.821
just like nurses and doctors.

NOTE Paragraph

00:16:45.406 --> 00:16:48.729
And we'll create a network
of companies and entrepreneurs

00:16:48.753 --> 00:16:51.029
who've created innovations
that can save lives

00:16:51.053 --> 00:16:53.433
and help them connect
to workers like Musu,

00:16:53.457 --> 00:16:56.032
so she can help better
serve her community.

00:16:56.959 --> 00:17:00.165
And we'll work tirelessly
to persuade governments

00:17:00.189 --> 00:17:04.171
to make community health workers
a cornerstone of their health care plans.

00:17:05.734 --> 00:17:09.523
We plan to test and prototype
the academy in Liberia

00:17:09.547 --> 00:17:11.419
and a few other partner countries,

00:17:11.443 --> 00:17:13.230
and then we plan to take it global,

00:17:13.254 --> 00:17:15.477
including to rural North America.

00:17:16.103 --> 00:17:17.693
With the power of this platform,

00:17:17.717 --> 00:17:20.279
we believe countries can be more persuaded

00:17:20.303 --> 00:17:23.628
that a health care revolution
really is possible.

NOTE Paragraph

00:17:24.470 --> 00:17:28.558
My dream is that this academy
will contribute to the training

00:17:28.582 --> 00:17:30.794
of hundreds of thousands
of community members

00:17:30.818 --> 00:17:33.717
to help bring health care
to their neighbors --

00:17:33.741 --> 00:17:35.351
the hundreds of millions of them

00:17:35.375 --> 00:17:37.996
that live in the world's most
remote communities,

00:17:38.785 --> 00:17:40.866
from the forest communities
of West Africa,

00:17:40.890 --> 00:17:43.030
to the fishing villages of rural Alaska;

00:17:43.054 --> 00:17:47.116
from the hilltops of Appalachia,
to the mountains of Afghanistan.

00:17:47.140 --> 00:17:49.830
If this vision is aligned with yours,

00:17:49.854 --> 00:17:53.075
head to communityhealthacademy.org,

00:17:53.740 --> 00:17:55.420
and join this revolution.

00:17:56.536 --> 00:18:01.189
Let us know if you or your organization
or someone you know could help us

00:18:01.213 --> 00:18:04.444
as we try to build this academy
over the next year.

NOTE Paragraph

00:18:05.574 --> 00:18:07.530
Now, as I look out into this room,

00:18:08.310 --> 00:18:11.016
I realize that our journeys
are not self-made;

00:18:11.040 --> 00:18:12.549
they're shaped by others.

00:18:12.573 --> 00:18:16.416
And there have been so many here
that have been part of this cause.

00:18:16.440 --> 00:18:19.650
We're so honored to be part
of this community,

00:18:19.674 --> 00:18:22.357
and a community that's willing
to take on a cause

00:18:22.381 --> 00:18:23.749
as audacious as this one,

00:18:23.773 --> 00:18:25.848
so I wanted to offer, as I end,

00:18:25.872 --> 00:18:27.094
a reflection.

NOTE Paragraph

00:18:27.986 --> 00:18:30.973
I think a lot more about
what my father taught me.

00:18:31.726 --> 00:18:33.927
These days, I too have become a dad.

00:18:33.951 --> 00:18:35.967
I have two sons,

00:18:35.991 --> 00:18:39.979
and my wife and I just learned
that she's pregnant with our third child.

NOTE Paragraph

00:18:40.003 --> 00:18:41.011
(Applause)

NOTE Paragraph

00:18:41.035 --> 00:18:42.102
Thank you.

NOTE Paragraph

00:18:42.126 --> 00:18:43.677
(Applause)

NOTE Paragraph

00:18:44.056 --> 00:18:46.884
I was recently caring
for a woman in Liberia

00:18:46.908 --> 00:18:49.633
who, like my wife,
was in her third pregnancy.

00:18:50.371 --> 00:18:52.080
But unlike my wife,

00:18:52.958 --> 00:18:55.957
had had no prenatal care
with her first two babies.

00:18:57.549 --> 00:19:01.941
She lived in an isolated community
in the forest that had gone for 100 years

00:19:01.965 --> 00:19:03.354
without any health care

00:19:04.513 --> 00:19:06.141
until ...

00:19:06.165 --> 00:19:09.548
until last year when a nurse
trained her neighbors

00:19:09.572 --> 00:19:11.283
to become community health workers.

NOTE Paragraph

00:19:11.307 --> 00:19:12.599
So here I was,

00:19:12.623 --> 00:19:16.863
seeing this patient
who was in her second trimester,

00:19:16.887 --> 00:19:20.159
and I pulled out the ultrasound
to check on the baby,

00:19:20.183 --> 00:19:23.722
and she started telling us stories
about her first two kids,

00:19:23.746 --> 00:19:26.944
and I had the ultrasound
probe on her belly,

00:19:26.968 --> 00:19:29.236
and she just stopped mid-sentence.

00:19:31.221 --> 00:19:32.762
She turned to me and she said,

00:19:32.786 --> 00:19:35.080
"Doc, what's that sound?"

00:19:37.371 --> 00:19:40.549
It was the first time she'd ever heard
her baby's heartbeat.

00:19:42.111 --> 00:19:47.171
And her eyes lit up in the same way
my wife's eyes and my own eyes lit up

00:19:47.195 --> 00:19:49.330
when we heard our baby's heartbeat.

NOTE Paragraph

00:19:51.544 --> 00:19:53.697
For all of human history,

00:19:53.721 --> 00:19:58.253
illness has been universal
and access to care has not.

00:19:58.277 --> 00:20:00.163
But as a wise man once told me:

00:20:01.690 --> 00:20:04.178
no condition is permanent.

00:20:05.491 --> 00:20:06.719
It's time.

00:20:06.743 --> 00:20:09.066
It's time for us to go as far as it takes

00:20:09.090 --> 00:20:11.182
to change this condition together.

NOTE Paragraph

00:20:11.694 --> 00:20:12.848
Thank you.

NOTE Paragraph

00:20:12.872 --> 00:20:17.339
(Applause)