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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

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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,

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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

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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,

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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 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,

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and my parent's persistence,

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and that community of supporters

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made it possible for me to go through
college 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 air field,

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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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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

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from conditions that 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 that she
could have malaria,

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and you know that 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,

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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,

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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 that 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 they 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
heatlh 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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real equipment,

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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 startup money
to launch a non-profit.

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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 dollars,

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teamed up with some
Liberians and Americans,

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and launched a non-profit
called Last Mile Health,

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and our goal is to bring
a health worker

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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,

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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 insure

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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

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is to care for patients
with community health workers,

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so last year I was visiting A.B.,

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and like Musu,

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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,

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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 with diagnosed 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,

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and he's a chubby little guy.

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(Laughter)

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He's meeting his milestones,

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he's pulled himself up to a stand,

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and 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. he said,

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"Doc, since I dropped out of school,

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this is the first time 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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And 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,

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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,

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airlines started cancelling 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

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to put on the masks,
the gloves and the gowns

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that they needed 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,

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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.

255
00:11:34,675 --> 00:11:38,165
They tracked thousands of people
who had been exposed to the virus,

256
00:11:38,165 --> 00:11:40,266
and helped break
the chain of transmission.

257
00:11:40,520 --> 00:11:43,923
Some ten thousand community
health workers risked their own lives

258
00:11:43,923 --> 00:11:47,084
to help hunt down this virus
and stop it in its tracks.

259
00:11:47,527 --> 00:11:50,202
(Applause)

260
00:11:54,784 --> 00:11:58,372
Today, Ebola has come
under control in West Africa,

261
00:11:58,372 --> 00:12:00,110
and we've learned a few things.

262
00:12:00,436 --> 00:12:03,057
We've learned that blindspots
in rural health care

263
00:12:03,057 --> 00:12:04,878
can lead to hot spots of disease,

264
00:12:04,878 --> 00:12:07,599
and that places all of us at greater risk.

265
00:12:07,885 --> 00:12:10,600
We've learned that the most efficient
emergency system

266
00:12:10,600 --> 00:12:12,737
is actually an everyday system,

267
00:12:12,737 --> 00:12:15,331
and that system has to reach
all communities,

268
00:12:15,331 --> 00:12:17,851
including rural communities like Emile's.

269
00:12:18,604 --> 00:12:19,659
And most of all,

270
00:12:19,659 --> 00:12:23,039
we've learned from the courage
of Liberia's community health workers

271
00:12:23,039 --> 00:12:27,160
that we as people are not defined
by the conditions we face,

272
00:12:27,160 --> 00:12:29,632
no matter how hopeless they seem.

273
00:12:30,140 --> 00:12:33,074
We're defined by how we respond to them.

274
00:12:34,387 --> 00:12:37,448
For the past 15 years,

275
00:12:37,448 --> 00:12:39,474
I've seen the power of this idea

276
00:12:39,474 --> 00:12:43,594
to transform everyday citizens
into community health workers --

277
00:12:43,594 --> 00:12:45,457
into everyday heroes.

278
00:12:46,175 --> 00:12:47,950
And I've seen it play out everywhere,

279
00:12:47,950 --> 00:12:49,993
from the forest communities
of West Africa,

280
00:12:49,993 --> 00:12:52,486
to the rural fishing villages of Alaska.

281
00:12:53,147 --> 00:12:54,153
It's true,

282
00:12:54,153 --> 00:12:57,326
these community health workers
aren't doing neurosurgery,

283
00:12:57,326 --> 00:12:58,777
but they're making it possible

284
00:12:58,777 --> 00:13:02,499
to bring health care within reach
of everyone everywhere.

285
00:13:03,765 --> 00:13:05,477
So now what?

286
00:13:05,931 --> 00:13:09,718
Well, we know that there are still
millions of people dying

287
00:13:09,718 --> 00:13:11,613
from preventable causes

288
00:13:11,613 --> 00:13:13,439
in rural communities around the world.

289
00:13:13,439 --> 00:13:17,311
And we know that the great
majority of these deaths are happening

290
00:13:17,311 --> 00:13:19,702
in these 75 blue shaded countries.

291
00:13:20,045 --> 00:13:21,071
What we also know

292
00:13:21,071 --> 00:13:24,537
is that if we trained an army
of community health workers

293
00:13:24,537 --> 00:13:28,760
to learn even just 30 life-saving skills,

294
00:13:28,760 --> 00:13:33,289
we could save the lives of nearly
30 million people by 2030.

295
00:13:33,685 --> 00:13:38,321
30 services could save
30 million lives by 2030.

296
00:13:38,321 --> 00:13:40,341
That's not just a blueprint.

297
00:13:40,341 --> 00:13:42,048
We're proven this can be done.

298
00:13:42,048 --> 00:13:43,051
In Liberia,

299
00:13:43,051 --> 00:13:47,448
the Libernian government is training
thousands of workers like A.B. and Musu

300
00:13:47,448 --> 00:13:48,448
after Ebola,

301
00:13:48,448 --> 00:13:51,624
to bring health care to every
child and family in the country.

302
00:13:52,095 --> 00:13:54,118
And we've been honored to work with them,

303
00:13:54,118 --> 00:13:56,722
and are now teaming up
with a number of organizations

304
00:13:56,722 --> 00:13:58,967
that are working across other countries

305
00:13:58,967 --> 00:14:01,365
to try to help them do the same thing.

306
00:14:02,180 --> 00:14:05,748
If we could help these countries scale,

307
00:14:05,748 --> 00:14:07,366
we could save millions of lives

308
00:14:07,366 --> 00:14:08,586
and at the same time,

309
00:14:08,586 --> 00:14:11,419
we could create millions of jobs.

310
00:14:11,971 --> 00:14:15,039
We simply can't do that though
without technology.

311
00:14:15,445 --> 00:14:18,556
People are worried that technology
is going to steal our jobs,

312
00:14:18,556 --> 00:14:20,741
but when it comes to
community health workers,

313
00:14:20,741 --> 00:14:23,712
technology's actually been vital
for creating jobs.

314
00:14:24,021 --> 00:14:25,139
Without technology --

315
00:14:25,139 --> 00:14:26,522
without this smartphone,

316
00:14:26,522 --> 00:14:30,143
without this rapid test --

317
00:14:30,143 --> 00:14:35,120
it would have been impossible for us
to be able to employ A.B. and Musu.

318
00:14:35,607 --> 00:14:38,312
And I think it's time
for technology to help us train --

319
00:14:38,312 --> 00:14:41,852
to help us train people faster
and better than ever before.

320
00:14:42,596 --> 00:14:43,752
As a doctor,

321
00:14:43,752 --> 00:14:47,267
I use technology to stay up-to-date
and keep certified.

322
00:14:47,267 --> 00:14:49,986
I use smartphones, I use apps,
I use online courses,

323
00:14:49,986 --> 00:14:52,507
but when A.B. wants to learn,

324
00:14:52,507 --> 00:14:56,799
he's got to jump back in that canoe
and get to the training center.

325
00:14:57,027 --> 00:15:00,044
And when Musu shows up for training,

326
00:15:00,044 --> 00:15:03,649
her instructors are stuck using
flip charts and markers.

327
00:15:04,298 --> 00:15:09,422
Why shouldn't they have the same
access to learn as I do?

328
00:15:10,446 --> 00:15:14,036
If we truly want community health
workers to master those life-saving skills

329
00:15:14,036 --> 00:15:16,296
and even more,

330
00:15:16,296 --> 00:15:20,011
we've got to change this old-school
model of education.

331
00:15:20,465 --> 00:15:22,386
Tech can truly be a game-changer here.

332
00:15:22,386 --> 00:15:25,899
I've been in awe of the digital
education revolution

333
00:15:25,899 --> 00:15:28,921
that the likes of Khan Academy
and edX have been leading.

334
00:15:30,121 --> 00:15:32,742
And I've been thinking that it's time.

335
00:15:32,742 --> 00:15:36,558
It's time for a collision between
the digital education revolution

336
00:15:36,558 --> 00:15:39,268
and the community health revoultion.

337
00:15:39,642 --> 00:15:42,862
And so this brings me
to my TED Prize wish.

338
00:15:43,823 --> 00:15:45,647
I wish --

339
00:15:45,647 --> 00:15:48,231
I wish that you would help us recruit

340
00:15:48,231 --> 00:15:53,023
the largest army of community health
workers the world has ever known

341
00:15:53,023 --> 00:15:55,871
by creating the community health academy,

342
00:15:55,871 --> 00:15:59,371
a global platform to train,
connect and empower.

343
00:15:59,717 --> 00:16:00,718
(Applause)

344
00:16:00,718 --> 00:16:01,721
Thank you.

345
00:16:01,721 --> 00:16:04,721
(Applause)

346
00:16:08,564 --> 00:16:10,131
Here's the idea.

347
00:16:10,131 --> 00:16:12,989
So we'll create and curate

348
00:16:12,989 --> 00:16:17,039
the best in digital education resources.

349
00:16:17,629 --> 00:16:22,145
We will bring those to community
health workers around the world,

350
00:16:22,145 --> 00:16:23,645
including A.B. and Musu.

351
00:16:23,645 --> 00:16:26,470
So they'll get video lessons
on giving kids vaccines,

352
00:16:26,470 --> 00:16:29,706
and have online courses
on spotting the next outbreak,

353
00:16:29,706 --> 00:16:31,600
so they're not stuck using flip charts.

354
00:16:31,600 --> 00:16:35,574
We'll help these countries
accredit these workers,

355
00:16:35,574 --> 00:16:40,112
so that they're not stuck remaining
an under-recognized, undervalued group,

356
00:16:40,112 --> 00:16:45,054
but become a renowned, empowered
profession just like nurses and doctors.

357
00:16:46,281 --> 00:16:49,627
And we'll create a network
of companies and entrepreneurs

358
00:16:49,627 --> 00:16:51,864
who've created innovations
that can save lives

359
00:16:51,864 --> 00:16:54,267
and help them connect
to workers like Musu

360
00:16:54,267 --> 00:16:57,052
so she can help better
serve her community.

361
00:16:57,897 --> 00:17:00,914
And we'll work tirelessly
to persuade governments

362
00:17:00,914 --> 00:17:05,070
to make community health workers
a cornerstone of their health care plans.

363
00:17:06,450 --> 00:17:10,332
We plan to test and prototype
the academy in Liberia

364
00:17:10,332 --> 00:17:12,426
and a few other partner countries,

365
00:17:12,426 --> 00:17:14,160
and then we plan to take it global,

366
00:17:14,160 --> 00:17:16,383
including the rural North America.

367
00:17:16,856 --> 00:17:18,401
With the power of this platform,

368
00:17:18,401 --> 00:17:20,987
we believe countries can be more persuaded

369
00:17:20,987 --> 00:17:24,604
that a health care revolution
really is possible.

370
00:17:25,250 --> 00:17:28,522
My dream is that this academy
will contribute

371
00:17:28,522 --> 00:17:31,663
to the training of hundreds
of thousands community members

372
00:17:31,663 --> 00:17:34,726
to help bring health care
to their neighbors --

373
00:17:34,726 --> 00:17:36,273
the hundreds of millions of them

374
00:17:36,273 --> 00:17:38,924
that live in the world's most
remote communities.

375
00:17:39,620 --> 00:17:41,721
From the forest communities
of West Africa,

376
00:17:41,724 --> 00:17:43,887
to the fishing villages of rural Alaska;

377
00:17:43,887 --> 00:17:47,477
from the hilltops of Appalachia
to the mountains of Afghanistan.

378
00:17:47,646 --> 00:17:50,730
And if this vision is aligned with yours,

379
00:17:50,730 --> 00:17:54,742
head to Communityhealthacademy.org,

380
00:17:54,742 --> 00:17:56,732
and join this revolution.

381
00:17:57,435 --> 00:18:01,402
Let us know if you or your organization
or someone you know

382
00:18:01,402 --> 00:18:05,914
could help us as we try to build
this academy over the next year.

383
00:18:06,345 --> 00:18:09,209
Now, as I look out into this room,

384
00:18:09,209 --> 00:18:11,872
I realize that our journeys
are not self-made,

385
00:18:11,872 --> 00:18:13,404
they're shaped by others.

386
00:18:13,404 --> 00:18:16,799
And there have been so many here
that have been part of this cause.

387
00:18:17,227 --> 00:18:20,533
We're so honored to be
part of this community,

388
00:18:20,533 --> 00:18:21,992
and a community that's willing

389
00:18:21,992 --> 00:18:24,457
to take on a cause
as audacious as this one.

390
00:18:24,457 --> 00:18:26,708
So I wanted to offer as I end,

391
00:18:26,708 --> 00:18:27,930
a reflection.

392
00:18:28,893 --> 00:18:31,880
I think a lot more about
what my father taught me.

393
00:18:32,514 --> 00:18:34,738
These days, I too have become a dad.

394
00:18:34,738 --> 00:18:36,777
I have two sons,

395
00:18:36,777 --> 00:18:40,964
and my wife and I just learned that she's
pregnant with our third child.

396
00:18:41,396 --> 00:18:43,079
(Applause)

397
00:18:44,875 --> 00:18:47,799
I was recently caring
for a woman in Liberia

398
00:18:47,799 --> 00:18:51,325
who like my wife was
in her third pregnancy,

399
00:18:51,325 --> 00:18:53,785
but unlike my wife,

400
00:18:53,785 --> 00:18:56,784
had had no prenatal care
with her first two babies.

401
00:18:58,384 --> 00:19:02,799
She lived in an isolated community
in the forest that had gone for 100 years

402
00:19:02,799 --> 00:19:05,277
without any health care ...

403
00:19:05,277 --> 00:19:06,972
until --

404
00:19:06,972 --> 00:19:10,378
until last year when a nurse
trained her neighbors

405
00:19:10,378 --> 00:19:12,112
to become community health workers.

406
00:19:12,112 --> 00:19:13,393
So here I was,

407
00:19:13,393 --> 00:19:17,656
seeing this patient who was in
her second trimester,

408
00:19:17,656 --> 00:19:20,867
and I pulled out the ultrasound
to check on the baby,

409
00:19:20,867 --> 00:19:24,430
and she started telling us stories
about her first two kids,

410
00:19:24,430 --> 00:19:27,550
and I had the ultrasound
probe on her belly,

411
00:19:27,550 --> 00:19:30,550
and she just stopped mid-sentence.

412
00:19:32,041 --> 00:19:33,605
She turned to be and she said,

413
00:19:33,605 --> 00:19:36,888
"Doc, what's that sound?"

414
00:19:38,055 --> 00:19:42,219
It was the first time she'd
ever heard her baby's heartbeat.

415
00:19:43,057 --> 00:19:48,093
And her eyes lit up in the same way
my wife's eyes and my own eyes lit up

416
00:19:48,093 --> 00:19:51,337
when we heard our baby's heartbeat.

417
00:19:52,340 --> 00:19:54,658
For all of human history,

418
00:19:54,658 --> 00:19:59,213
illness has been universal
and access to care has not,

419
00:19:59,213 --> 00:20:02,668
but as a wise man once told me,

420
00:20:02,668 --> 00:20:05,771
no condition is permanent.

421
00:20:06,255 --> 00:20:07,562
It's time.

422
00:20:07,562 --> 00:20:09,908
It's time for us to go as far as it takes

423
00:20:09,908 --> 00:20:12,600
to change this condition together.

424
00:20:12,600 --> 00:20:13,999
Thank you.

425
00:20:13,999 --> 00:20:16,020
(Applause)