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

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

"No condition is permanent."

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

and I learned it to be true the hard way.

Here I am in my fourth grade class.

This is my yearbook picture taken
in my class in school

in Monrovia, Liberia.

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

and I had the privilege
of growing up there.

I was nine years old,

I loved kicking around a soccer ball,

and I was a total math and science geek.

I was living the kind of life

that really any child would dream of.

But no condition is permanent.

On Christmas Eve in 1989,

civil war erupted in Liberia.

The war started in the rural countryside,

and within months,

rebel armies had marched
towards our hometown.

My school shut down,

and when the rebel armies captured
the one international airport,

people started panicking and fleeing.

My mom came knocking one morning

and said, "Raj, pack your things.

We have to go."

We were rushed to the center of town,

and there on a tarmac,

we were split into two lines.

I stood with my family in one line,

and we were stuffed into the cargo
hatch of a rescue plane.

And there on a bench,

I was sitting with my heart racing
as I looked out the open hatch

I saw hundreds of Liberians
in another line,

children strapped to their backs.

When they tried to jump in with us,

I watched soldiers restrain them.

They were not allowed to flee.

We were the lucky ones.

We lost what we had,

but we resettled in America,

and as immigrants we benefitted
from the community of supporters

that rallied around us.

They took my family into their home,

they mentored me,

and they helped my dad
start a clothing shop.

I'd visit my father on weekends
as a teenager

to help him sell sneakers and jeans.

And every time business would get bad,

he'd remind me of that manta:

no condition is permanent.

That mantra,

and my parent's persistence,

and that community of supporters

made it possible for me to go through
college and eventually to medical school.

I'd once had my hopes crushed in war,

but because of them,

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

My condition had changed.

It had been 15 years
since I escaped that air field,

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

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

and I wanted to go back

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

When I got back,

what I found was utter destruction --

the war left us with just 51 doctors

to serve a country of four million people.

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

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

you might stand a chance.

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

where you could be days
from the nearest clinic,

I was seeing my patients die

from conditions that no one
should die from.

All because they were
getting to me too late.

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

and you realize that she
could have malaria,

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

would be to take her to the riverbed,

get in a canoe,

paddle to the other side

and then walk for up to two day
through the forest

just to reach the nearest clinic.

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

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

our innovations are not
reaching the last mile.

These communities have been left behind

because they've been thought

too hard to reach
and too difficult to serve.

Illness is universal;

access to care is not.

And realizing this lit a fire in my soul.

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

No condition should be permanent.

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

it actually came from within.

It came from the communities themselves.

Meet Musu.

Way out in rural Liberia

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

Musu had been persistent.

At the age of 18,

she completed high school,

and she came back to her community --

she saw that none of the children
were getting treatment

for the diseases that they
needed treatment for --

deadly diseases like malaria
and pneumonia.

So she signed up to be a volunteer.

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

and we got to thinking --

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

Our health care system
is structured in such a way

that they work of diagnosing disease
and prescribing medicines

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

But nurses and doctors
are concentrated in cities,

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

So we started asking some questions.

What if we could re-organize
the medical care system?

What if we could have community
members like Musu

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

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

to the doorsteps of her neighbors?

And Musu was 48 when I met her,

and despite her amazing talent and grit,

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

So what if technology could support her?

What if we could invest in her
with real training,

real equipment,

with real medicines?

And have her have a real job?

Well, 2007 I was trying
to answer these questions,

and my wife and I were
getting married that year.

We asked our relatives to forgo
the wedding registry gifts,

and instead donate some money

so we could have some startup money
to launch a non-profit.

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

(Laughter)

We ended up raising $6,000,

teamed up with some
Liberians and Americans,

and launched a non-profit
called Last Mile Health,

and our goal is to bring
a health worker

within reach of everyone everywhere.

We designed a three-step process:

train, equip and pay,

to invest more deeply
in volunteers like Musu

to become paraprofessionals,

to become community health workers.

First we trained Musu to prevent,
diagnose and treat

the top 10 diseases afflicting
families in her village.

A nurse supervisor visited her
every month to coach her.

We equipped her with modern
medical technology,

like this one dollar malaria rapid test,

and put it in a backpack
full of medicines like this

to treat infections like pneumonia.

And crucially,

a smartphone to help her track
and report on epidemics.

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

With the Liberian government,

we created a contract,

paid her,

and gave her the chance
to have a real job.

And she's amazing.

Musu has learned over 30 medical skills,

from screening children for malnutrition

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

to supporting people with HIV

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

Working as part of our team,

working as paraprofessionals,

community health workers can help insure

that a lot of what your
family doctor would do

reaches the places that most
family doctors could never go.

One of my favorite things to do

is to care for patients
with community health workers,

so last year I was visiting A.B.,

and like Musu,

A.B. had had a chance to go to school.

He was in middle school
in the eighth grade

when his parents died.

He became an orphan and had to drop out.

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

And while he was making
door-to-door house calls,

he met this young boy named Prince

whose mother had had trouble
breastfeeding him,

and by the age of six months,

Prince was starting to waste away.

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

that wraps around the upper arm
of a child with a diagnosed malnutrition.

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

which meant he had to be hospitalized.

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

got in a canoe

and paddled for four hours
to get to the hospital.

Later, after Prince was discharged,

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

A few months ago,

A.B. took me to visit Prince,

and he's a chubby little guy.

He's meeting his milestones,

he's pulled himself up to a stand,

and he's even starting to say a few words.

I'm so inspired by these
community health workers.

I often ask them why they do what they do,

and when I asked A.B. he said,

"Doc, since I dropped out of school,

this is the first time I'm having a chance
to hold a pen to write.

My brain is getting fresh."

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

about being human.

Our will to serve others can actually
help us transform our own conditions.

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

a few years ago,

when we faced a global catastrophe.

In December 2013,

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

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

He lived in an area
where the roads were sparse,

and there had been massive
shortages of health workers.

Emile died,

and a few weeks later his sister died,

and a few weeks later his mother died.

And this disease would spread
from one community to another.

And it wasn't until three months later

that the world recognized this as Ebola.

When every minute counted,

we had already lost months,

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

and eventually to other
parts of the world.

Businesses shut down,

airlines started cancelling routes.

At the height of the crisis

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

when we were told
that most of them would die,

when we had nearly lost all hope --

I remember standing with a group
of health workers

in the rainforest where
an outbreak had just happened.

We were helping train and equip them

to put on the masks,
the gloves and the gowns

that they needed to keep themselves
safe from the virus

while they were serving their patients.

I remember the fear in their eyes,

and I remember staying up at night,

terrified if I'd made the right call ...

to keep them in the field.

When Ebola threatened to bring
humanity to its knees,

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

They did what they had always done.

They answered the call
to serve their neighbors.

Community members across Liberia
learned the symptoms of Ebola,

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

and get them into care.

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

and helped break
the chain of transmission.

Some ten thousand community
health workers risked their own lives

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

(Applause)

Today, Ebola's come under
control in West Africa,

and we've learned a few things.

We've learned that blindspots
in rural health care

can lead to hot spots of disease,

and that places all of us at greater risk.

We've learned that the most efficient
emergency system

is actually an everyday system,

and that system has to reach
all communities,

including rural communities like Emile's.

And most of all,

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

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

no matter how hopeless they seem.

We're defined by how we respond to them.

For the past 15 years,

I've seen the power of this idea

to transform everyday citizens
into community health workers --

into everyday heroes.

And I seen it play out everywhere,

from the forest communities
of West Africa,

to the rural fishing villages of Alaska.

It's true,

these community health workers
aren't doing neurosurgery,

but they're making it possible

to bring health care within reach
of everyone everywhere.

So now what?

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

from preventable causes

in rural communities around the world.

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

in these 75 blue shaded countries.

What we also know

is that if we trained an army
of community health workers

to learn even just 30 life-saving skills,

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

30 services could save
30 million lives by 2030.

That's not just a blueprint.

We've proved this can be done.

In Liberia,

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

after Ebola,

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

And we've been honored to work with them,

and are now teaming up
with a number of organizations

that are working across other countries

to try to help them do the same thing.

If we could help these countries scale,

we could save millions of lives

and at the same time,

we could create millions of jobs.

We simply can't do that though
without technology.

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

but when it comes to
community health workers,

technology's actually been vital
for creating jobs.

Without technology --

without this smartphone,

without this rapid test --

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

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

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

As a doctor,

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

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

but when A.B. wants to learn,

he's got to jump back in that canoe
and get to the training center.

And when Musu shows up for training,

her instructors are stuck using
flip charts and markers.

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

If we truly want community health
workers to master those life-saving skills

and even more,

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

Tech can truly be a game-changer here.

I've been in awe of the digital
education revolution

that the likes of [Conn Academy]
and [EdX] have been leading.

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

It's time for a collision between
the digital education revolution

and the community health revoultion.

And so this brings me
to my TED Prize wish.

I wish --

I wish that you would help us recruit

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

by creating the community health academy,

a global platform to train,
connect and empower.

(Applause)

Thank you.

Here's the idea.

So we'll create an curate
the best in digital education resources.

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

including A.B. and Musu.

So they'll get video lessons
on giving kids vaccines,

and have online courses
on spotting the next outbreak,

so they're not stuck using flip charts.

We'll help these countries
accredit these workers,

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

but become a renowned, empowered
profession just like nurses and doctors.

And we'll create a network
of companies and entrepreneurs,

who've created innovations
that can save lives

and help them connect
to workers like Musu

so she can help better
serve her community.

And we'll work tirelessly
to persuade governments

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

We plan to test and prototype
the academy in Liberia

and a few other partner counties,

and then we plan to take it global,

including the rural North America.

With the power of this platform,

we believe countires can be more persuaded

that a health care revolution
really is possible.

My dream is that this academy
will contribute

to the training of hundreds
of thousands community members

to help bring health care
to their neighbors --

the hundreds of millions of them

that live in the world's most
remote communities.

From the forest communities
of West Africa,

to the fishing villages of rural Alaska;

from the hilltops of Appalachia
to the mountains of Afghanistan.

And if this vision is aligned with yours,

head to Communityhealthacademy.org,

and join this revolution.

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

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

Now, as a look out into this room,

I realize that our journeys
are not self-made,

they're shaped by others.

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

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

and a community that's willing

to take on a cause
as audacious as this one.

So I wanted to offer as I end,

a reflection.

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

These days, I too have become a dad.

I have two sons,

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

(Applause)

I was recently caring
for a woman in Liberia

who like my wife was
in her third pregnancy,

but unlike my wife,

had had no prenatal care
with her first two babies.

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

without any health care --

until ...

until last year when a nurse
trained her neighbors

to become community health workers.

So here I was,

seeing this patient who was in
her second trimester,

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

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

and I had the ultrasound
probe on her belly,

and she just stopped mid-sentence.

She turned to be and she said,

"Doc, what's that sound?"

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

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

when we heard our baby's heartbeat.

For all of human history,

illness has been universal
and access to care has not,

but as a wise man once told me,

no condition is permanent.

It's time.

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

to change this condition together.

Thank you.

(Applause)