Courtesy of Last Mile Health
Dr. Raj Panjabi has his blood pressure checked by a Liberian community health worker.
Courtesy of Last Mile Health
It started with a poster he made at Kinko's and displayed at his wedding in May 2007: Would guests donate to help start a new kind of health care program in Liberia?
He got $6,000.
Now he's won a million dollar prize for his efforts.
Dr. Raj Panjabi is a physician at Brigham and Women's Hospital in Boston and the founder of Last Mile Health, which trains people from the community to provide health care in isolated parts of Liberia — a country where doctors are in short supply and some 1.2 million people live in rural areas far from any health clinic. LMH now has 300 community health workers who serve 50,000 patients in Rivercess and Grand Gedeh counties.
On Thursday, Panjabi was named the recipient of the 2017 TED Prize. "Dr. Panjabi and his team of community health workers have proven it possible to deliver world-class care in some of the most remote areas of the planet," said TED Prize director Anna Verghese. The prize, funded by TED and the Sapling Foundation, a private nonprofit created by Chris Anderson, is to be used to fulfill "a wish."
We spoke to Panjabi, who was in Rome this week to speak to a conference of Fortune 500 CEOs, to learn more about his work.
How many people do not have access to health care?
Last year, the World Bank said 400 million for sure. A couple of years earlier a WHO report said 1 billion. The honest truth is, I don't think people know. The census is off because people don't get counted [in remote areas].
One way to bring health care to these people is with community health workers — that's what Last Mile Health does. Can you give us a quick definition of a "community health worker"?
In impoverished communities with doctor and nurse shortages, someone in the community is trained for several months, ideally on a range of conditions. These are folks that almost always are not college educated — they're usually middle-school and up to high school educated. In Liberia, the training would focus on everything from malaria treatment for children to mental health and disease surveillance for Ebola.
Does this just happen in poor countries like Liberia? Are there community health workers in the U.S.?
There are 48,000 community health workers according to the Bureau of Labor Statistics. In the Navajo nation they're called community health representatives. In Harlem, they're called health coaches and may focus on diabetes.
And they're paid a salary?
Most of these programs in developing countries do not pay these workers. They serve as volunteers. But there are those of us who believe that if we're to truly value these workers, we should treat them like formal workers, and that includes a living wage. In Liberia that now happens to be $70 a month [for Last Mile Health community health workers] — but they should have more. But a UNICEF study showed of 20 programs in East Africa, 60 percent [of community health workers] did not get cash payment.
These workers don't have a medical degree. Can they, say, administer injections?
In a program in Peru, they administer injections for people with multidrug-resistant tuberculosis. In Liberia, they assist in vaccinations. The best programs have a nurse supporting these community health workers, assessing them to see if they make the correct diagnosis, randomly selecting patients to see if the care given was safe and accurate.
Are patients reluctant to be treated by someone who's a community member with just a few months of training?
The community doesn't have trust until the workers start treating kids and parents see kids who were dying now live. Imagine having a 2-year-old who gets sick with a fever in a village in Liberia. You'd have to take the child to the river bed, get in a canoe, then walk for two days to get to a clinic. Once you see community health workers treat the children, parents start to see modern medicine work. The respect grows. Adults start saying, we want services, too.
You have a special connection to Liberia, where Last Mile Health does its work.
I was born there to parents of Indian origin. My dad migrated there looking for job opportunities and set up shop in retail goods. My mom came over as a teacher. My sister and I had the privilege of being born there. Then the civil war happened. In 1990 we were abruptly evacuated.
Yet you have fond memories.
I played soccer with my fourth grade classmates, I had yearbook pictures with them. My parents haven't yet come back, but when I was 17, 18, I started to have the notion, wouldn't it be great to go back? I had that chance at 24 as a medical student.
Do you have plans for the million dollar prize?
We'll work to develop a project that we'll launch at the 2017 TED conference in April. We want to expand our reach and make our impact even greater. There will be more details then.
It's hard for us in the West to imagine how dire conditions might be in remote areas. Can you give an example?
In Liberia, a mom brought a 7-day-old child into a clinic. The mom knew the child was sick, wasn't sucking well. She was eight hours away from the clinic. She finally makes it. We had the antibiotics but needed an oxygen tank. We had to go to another unit in the clinic, a C-section unit, and beg them to give us their only oxygen tank. They said, "You can take this but if a mom comes in who needs a C-section, we need it back." We started this little girl with the nostril tubing for the oxygen, she started to breathe better. Twelve hours later a mom came in in labor and needed a C-section and the oxygen tank was taken back. That mom delivered a little baby girl. Our baby girl died because she essentially suffocated. That was two years before I started Last Mile Health.
What are your memories of that death?
It's both a great sadness and tragedy but also a great anger. I asked an aid worker, "Can't you just supply oxygen tanks?" The answer was: "Our group should only provide what's expected in African health centers." And this was 2005, this wasn't the 18th century. The subtext: African babies don't deserve oxygen. I hope the one thing this prize does is to humanize the very people we're all trying to serve; people who live in remote areas are not any less deserving of the kinds of modern medical care you and I get for our kids.
How will you celebrate the prize?
On Sunday I'm heading to Liberia to be with our team. I'm speaking with some of the health workers to ask their thoughts. And there will probably be a cake involved. We like cake in Liberia!