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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,

250
00:12:12,470 --> 00:12:15,196
and that system has to reach
all communities,

251
00:12:15,220 --> 00:12:17,495
including rural communities like Emile's.

252
00:12:18,540 --> 00:12:19,691
And most of all,

253
00:12:19,715 --> 00:12:23,176
we've learned from the courage
of Liberia's community health workers

254
00:12:23,200 --> 00:12:26,921
that we as people are not defined
by the conditions we face,

255
00:12:26,945 --> 00:12:29,009
no matter how hopeless they seem.

256
00:12:30,140 --> 00:12:32,272
We're defined by how we respond to them.

257
00:12:34,300 --> 00:12:36,351
For the past 15 years,

258
00:12:37,249 --> 00:12:39,252
I've seen the power of this idea

259
00:12:39,276 --> 00:12:43,373
to transform everyday citizens
into community health workers --

260
00:12:43,397 --> 00:12:45,260
into everyday heroes.

261
00:12:46,124 --> 00:12:47,926
And I've seen it play out everywhere,

262
00:12:47,950 --> 00:12:50,008
from the forest communities
of West Africa,

263
00:12:50,032 --> 00:12:52,277
to the rural fishing villages of Alaska.

264
00:12:52,979 --> 00:12:54,129
It's true,

265
00:12:54,153 --> 00:12:57,202
these community health workers
aren't doing neurosurgery,

266
00:12:57,226 --> 00:12:58,718
but they're making it possible

267
00:12:58,742 --> 00:13:01,814
to bring health care within reach
of everyone everywhere.

268
00:13:03,645 --> 00:13:04,862
So now what?

269
00:13:05,812 --> 00:13:09,576
Well, we know that there are still
millions of people dying

270
00:13:09,600 --> 00:13:11,349
from preventable causes

271
00:13:11,373 --> 00:13:13,248
in rural communities around the world.

272
00:13:13,272 --> 00:13:17,113
And we know that the great majority
of these deaths are happening

273
00:13:17,137 --> 00:13:19,460
in these 75 blue-shaded countries.

274
00:13:19,849 --> 00:13:21,000
What we also know

275
00:13:21,024 --> 00:13:24,467
is that if we trained an army
of community health workers

276
00:13:24,491 --> 00:13:27,824
to learn even just 30 lifesaving skills,

277
00:13:28,508 --> 00:13:32,624
we could save the lives of nearly
30 million people by 2030.

278
00:13:33,652 --> 00:13:38,297
Thirty services could save
30 million lives by 2030.

279
00:13:38,321 --> 00:13:40,064
That's not just a blueprint --

280
00:13:40,088 --> 00:13:41,883
we're proving this can be done.

281
00:13:41,907 --> 00:13:43,067
In Liberia,

282
00:13:43,091 --> 00:13:47,356
the Liberian government is training
thousands of workers like A.B. and Musu

283
00:13:47,380 --> 00:13:48,538
after Ebola,

284
00:13:48,562 --> 00:13:52,039
to bring health care to every
child and family in the country.

285
00:13:52,063 --> 00:13:54,094
And we've been honored to work with them,

286
00:13:54,118 --> 00:13:56,626
and are now teaming up
with a number of organizations

287
00:13:56,650 --> 00:13:58,872
that are working across other countries

288
00:13:58,896 --> 00:14:00,919
to try to help them do the same thing.

289
00:14:02,005 --> 00:14:04,695
If we could help these countries scale,

290
00:14:05,550 --> 00:14:07,182
we could save millions of lives,

291
00:14:07,206 --> 00:14:08,562
and at the same time,

292
00:14:08,586 --> 00:14:10,367
we could create millions of jobs.

293
00:14:11,875 --> 00:14:14,797
We simply can't do that, though,
without technology.

294
00:14:15,286 --> 00:14:18,374
People are worried that technology
is going to steal our jobs,

295
00:14:18,398 --> 00:14:20,597
but when it comes
to community health workers,

296
00:14:20,621 --> 00:14:23,877
technology has actually
been vital for creating jobs.

297
00:14:23,901 --> 00:14:26,317
Without technology --
without this smartphone,

298
00:14:26,341 --> 00:14:29,063
without this rapid test --

299
00:14:29,960 --> 00:14:34,493
it would have been impossible for us
to be able to employ A.B. and Musu.

300
00:14:35,464 --> 00:14:38,146
And I think it's time
for technology to help us train,

301
00:14:38,170 --> 00:14:41,710
to help us train people faster
and better than ever before.

302
00:14:42,578 --> 00:14:43,728
As a doctor,

303
00:14:43,752 --> 00:14:47,243
I use technology to stay up-to-date
and keep certified.

304
00:14:47,267 --> 00:14:49,962
I use smartphones, I use apps,
I use online courses.

305
00:14:49,986 --> 00:14:52,198
But when A.B. wants to learn,

306
00:14:52,222 --> 00:14:54,317
he's got to jump back in that canoe

307
00:14:55,152 --> 00:14:56,792
and get to the training center.

308
00:14:56,816 --> 00:14:59,008
And when Musu shows up for training,

309
00:14:59,710 --> 00:15:03,315
her instructors are stuck using
flip charts and markers.

310
00:15:04,147 --> 00:15:08,680
Why shouldn't they have the same
access to learn as I do?

311
00:15:10,384 --> 00:15:14,012
If we truly want community health workers
to master those lifesaving skills

312
00:15:14,036 --> 00:15:15,288
and even more,

313
00:15:16,098 --> 00:15:19,352
we've got to change this old-school
model of education.

314
00:15:20,282 --> 00:15:22,180
Tech can truly be a game changer here.

315
00:15:22,204 --> 00:15:25,749
I've been in awe of the digital
education revolution

316
00:15:25,773 --> 00:15:28,933
that the likes of Khan Academy
and edX have been leading.

317
00:15:30,041 --> 00:15:32,534
And I've been thinking that it's time;

318
00:15:32,558 --> 00:15:33,949
it's time for a collision

319
00:15:33,973 --> 00:15:36,284
between the digital education revolution

320
00:15:36,308 --> 00:15:38,458
and the community health revolution.

321
00:15:39,483 --> 00:15:42,703
And so, this brings me
to my TED Prize wish.

322
00:15:43,759 --> 00:15:45,560
I wish --

323
00:15:45,584 --> 00:15:47,790
I wish that you would help us recruit

324
00:15:47,814 --> 00:15:52,728
the largest army of community health
workers the world has ever known

325
00:15:52,752 --> 00:15:55,577
by creating the Community Health Academy,

326
00:15:55,601 --> 00:15:58,806
a global platform to train,
connect and empower.

327
00:15:59,553 --> 00:16:00,660
(Applause)

328
00:16:00,684 --> 00:16:01,835
Thank you.

329
00:16:01,859 --> 00:16:05,461
(Applause)

330
00:16:05,485 --> 00:16:06,643
Thank you.

331
00:16:08,500 --> 00:16:10,044
Here's the idea:

332
00:16:10,068 --> 00:16:12,138
we'll create and curate

333
00:16:12,750 --> 00:16:16,625
the best in digital education resources.

334
00:16:17,486 --> 00:16:22,121
We will bring those to community
health workers around the world,

335
00:16:22,145 --> 00:16:23,398
including A.B. and Musu.

336
00:16:23,422 --> 00:16:26,224
They'll get video lessons
on giving kids vaccines

337
00:16:26,248 --> 00:16:29,461
and have online courses
on spotting the next outbreak,

338
00:16:29,485 --> 00:16:31,368
so they're not stuck using flip charts.

339
00:16:31,392 --> 00:16:35,228
We'll help these countries
accredit these workers,

340
00:16:35,252 --> 00:16:39,959
so that they're not stuck remaining
an under-recognized, undervalued group,

341
00:16:39,983 --> 00:16:42,720
but become a renowned,
empowered profession,

342
00:16:42,744 --> 00:16:44,505
just like nurses and doctors.

343
00:16:46,090 --> 00:16:49,413
And we'll create a network
of companies and entrepreneurs

344
00:16:49,437 --> 00:16:51,713
who've created innovations
that can save lives

345
00:16:51,737 --> 00:16:54,117
and help them connect
to workers like Musu,

346
00:16:54,141 --> 00:16:56,716
so she can help better
serve her community.

347
00:16:57,643 --> 00:17:00,849
And we'll work tirelessly
to persuade governments

348
00:17:00,873 --> 00:17:04,855
to make community health workers
a cornerstone of their health care plans.

349
00:17:06,418 --> 00:17:10,207
We plan to test and prototype
the academy in Liberia

350
00:17:10,231 --> 00:17:12,103
and a few other partner countries,

351
00:17:12,127 --> 00:17:13,914
and then we plan to take it global,

352
00:17:13,938 --> 00:17:16,161
including to rural North America.

353
00:17:16,787 --> 00:17:18,377
With the power of this platform,

354
00:17:18,401 --> 00:17:20,963
we believe countries can be more persuaded

355
00:17:20,987 --> 00:17:24,312
that a health care revolution
really is possible.

356
00:17:25,154 --> 00:17:29,242
My dream is that this academy
will contribute to the training

357
00:17:29,266 --> 00:17:31,478
of hundreds of thousands
of community members

358
00:17:31,502 --> 00:17:34,401
to help bring health care
to their neighbors --

359
00:17:34,425 --> 00:17:36,035
the hundreds of millions of them

360
00:17:36,059 --> 00:17:38,680
that live in the world's most
remote communities,

361
00:17:39,469 --> 00:17:41,550
from the forest communities
of West Africa,

362
00:17:41,574 --> 00:17:43,714
to the fishing villages of rural Alaska;

363
00:17:43,738 --> 00:17:47,800
from the hilltops of Appalachia,
to the mountains of Afghanistan.

364
00:17:47,824 --> 00:17:50,514
If this vision is aligned with yours,

365
00:17:50,538 --> 00:17:53,759
head to communityhealthacademy.org,

366
00:17:54,424 --> 00:17:56,104
and join this revolution.

367
00:17:57,220 --> 00:18:01,873
Let us know if you or your organization
or someone you know could help us

368
00:18:01,897 --> 00:18:05,128
as we try to build this academy
over the next year.

369
00:18:06,258 --> 00:18:08,214
Now, as I look out into this room,

370
00:18:08,994 --> 00:18:11,700
I realize that our journeys
are not self-made;

371
00:18:11,724 --> 00:18:13,233
they're shaped by others.

372
00:18:13,257 --> 00:18:17,100
And there have been so many here
that have been part of this cause.

373
00:18:17,124 --> 00:18:20,334
We're so honored to be part
of this community,

374
00:18:20,358 --> 00:18:23,041
and a community that's willing
to take on a cause

375
00:18:23,065 --> 00:18:24,433
as audacious as this one,

376
00:18:24,457 --> 00:18:26,532
so I wanted to offer, as I end,

377
00:18:26,556 --> 00:18:27,778
a reflection.

378
00:18:28,670 --> 00:18:31,657
I think a lot more about
what my father taught me.

379
00:18:32,410 --> 00:18:34,611
These days, I too have become a dad.

380
00:18:34,635 --> 00:18:36,651
I have two sons,

381
00:18:36,675 --> 00:18:40,663
and my wife and I just learned
that she's pregnant with our third child.

382
00:18:40,687 --> 00:18:41,695
(Applause)

383
00:18:41,719 --> 00:18:42,786
Thank you.

384
00:18:42,810 --> 00:18:44,361
(Applause)

385
00:18:44,740 --> 00:18:47,568
I was recently caring
for a woman in Liberia

386
00:18:47,592 --> 00:18:50,317
who, like my wife,
was in her third pregnancy.

387
00:18:51,055 --> 00:18:52,764
But unlike my wife,

388
00:18:53,642 --> 00:18:56,641
had had no prenatal care
with her first two babies.

389
00:18:58,233 --> 00:19:02,625
She lived in an isolated community
in the forest that had gone for 100 years

390
00:19:02,649 --> 00:19:04,038
without any health care

391
00:19:05,197 --> 00:19:06,825
until ...

392
00:19:06,849 --> 00:19:10,232
until last year when a nurse
trained her neighbors

393
00:19:10,256 --> 00:19:11,967
to become community health workers.

394
00:19:11,991 --> 00:19:13,283
So here I was,

395
00:19:13,307 --> 00:19:17,547
seeing this patient
who was in her second trimester,

396
00:19:17,571 --> 00:19:20,843
and I pulled out the ultrasound
to check on the baby,

397
00:19:20,867 --> 00:19:24,406
and she started telling us stories
about her first two kids,

398
00:19:24,430 --> 00:19:27,628
and I had the ultrasound
probe on her belly,

399
00:19:27,652 --> 00:19:29,920
and she just stopped mid-sentence.

400
00:19:31,905 --> 00:19:33,446
She turned to me and she said,

401
00:19:33,470 --> 00:19:35,764
"Doc, what's that sound?"

402
00:19:38,055 --> 00:19:41,233
It was the first time she'd ever heard
her baby's heartbeat.

403
00:19:42,795 --> 00:19:47,855
And her eyes lit up in the same way
my wife's eyes and my own eyes lit up

404
00:19:47,879 --> 00:19:50,014
when we heard our baby's heartbeat.

405
00:19:52,228 --> 00:19:54,381
For all of human history,

406
00:19:54,405 --> 00:19:58,937
illness has been universal
and access to care has not.

407
00:19:58,961 --> 00:20:00,847
But as a wise man once told me:

408
00:20:02,374 --> 00:20:04,862
no condition is permanent.

409
00:20:06,175 --> 00:20:07,403
It's time.

410
00:20:07,427 --> 00:20:09,750
It's time for us to go as far as it takes

411
00:20:09,774 --> 00:20:11,866
to change this condition together.

412
00:20:12,378 --> 00:20:13,532
Thank you.

413
00:20:13,556 --> 00:20:18,023
(Applause)