Raj Panjabi: How Can We Bring Healthcare To The Most Remote Places In The World? More than one billion people live in areas with no access to health workers. Physician Raj Panjabi started his group Last Mile Health to help bring care to the hardest to reach places.

Raj Panjabi: How Can We Bring Healthcare To The Most Remote Places In The World?

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It's the TED Radio Hour from NPR. I'm Guy Raz. And today, we're going to start in Liberia 30 years ago.

RAJ PANJABI: And I remember being in the fourth grade - it was in February of that year - and being pulled out of school and - abruptly.

RAZ: This is Raj Panjabi. And Raj grew up in Monrovia.

PANJABI: There were hundreds of people coming into the city from the rural countryside, fleeing war, some of them battered, others with gunshot wounds seeking care.

RAZ: Of course, at the time, Raj didn't exactly know what was going on. He was just 9 years old.

PANJABI: And three days later, they - the rebels captured the only international airport. And so at that point, there was a panic. My father, then being Indian citizens, had been helping the Indian Embassy to evacuate people. And that's what ended up happening - is that we - my father and my mother made a plan one night that we would try to get evacuated. And she said, pack the things you need for a month. And I packed a bunch of action figures (laughter).

And we were put into a white van and then rushed to the center of town, where an airfield had been commandeered. And it was a cargo - 1960s sort of Russian military cargo plane that had been brought in to evacuate people. I just remember sitting there sweating and - it was hot - and looking out the hatch and seeing right in front of us, there were hundreds of others, people that looked like my classmates, you know, in fourth grade who held Liberian passports that were restrained from jumping into that - onto that plane with us. And ultimately, we left those people behind. And we took off and ended up here in the United States. We ended up in North Carolina.

RAZ: Raj's dad opened a clothing store, and Raj would eventually graduate from college and then go on to medical school. But in Liberia, two back-to-back civil wars left the country brutalized.


PANJABI: It had been 15 years since I escaped that airfield, but it did not escape 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'd left behind.

RAZ: Raj tells his story on the TED stage.


PANJABI: And when I got back, what I found was utter destruction. The war had left us with just 51 doctors to serve a country of 4 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 2-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 days 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.

RAZ: Accessing better health is, in most parts of the world, a privilege, rather than a right. Where you live and what your circumstances are can mean the difference between clean and dirty air or even the ability to see a doctor. So today on the show, we're going to hear from TED speakers with ideas on how to increase access to a healthier way of life.

And for Raj Panjabi, he realized that typical medical system of patients visiting doctors and nurses just wasn't accessible for lots of people in Liberia. So to bring health care to rural communities, he needed help.


PANJABI: 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, like 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. So we started asking some questions. What if we could reorganize 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 health care from clinics and 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, equip her with real medicines, have her have a real job?

Well, in 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 nonprofit. I promise you I'm a lot more romantic than that.


PANJABI: We ended up raising $6,000, teamed up with some Liberians and Americans and launched a nonprofit 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.


RAZ: And that concept of community health workers is not new, right? I mean, this has been around for a long time.

PANJABI: That's right. That's right. You know, I had a chance to go to Alaska, where they've had a program for 50 years and have trained village-based community health aides to do everything from diabetes care to care for patients with potential heart attacks - screening them. So I had seen the power of that - when you combine focus on what we call radical task sharing - you know, the sharing of medical tasks with others other than doctors. And we wanted to apply that in Liberia, and so that's what, you know, gave rise to Last Mile Health.

RAZ: And how do you train people to do this?

PANJABI: So I was recently with a community health worker named Ruth, and Ruth - as an adult, she couldn't find work up until about three years ago in 2016, when our team hired her as a community health worker. So what does that mean? So over a few weeks, a nurse trained Ruth, equipped her with medicines and supplies, taking advantage of this revolution in biotechnology. We gave her a $1 handheld test for malaria - which is the biggest killer of children in Liberia - antibiotics to treat pneumonia, injectable contraceptives to provide to women in the community who were wanting long-term contraceptions. And she was also equipped with a smartphone with video lessons on topics like assessing a child for malnutrition.

And Ruth now is able to serve the daily health needs of her neighbors door to door, and she can do over 30 different medical skills. And, of course, they don't do neurosurgery. They also don't just pretend like they can care for a complex medical condition. They are connected to a network of nurses - outreach nurses who come and visit them and coach them every month. And those outreach nurses connect the patients who need higher levels of care to a network of clinics and hospitals.


PANJABI: 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 diarrhea. 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 canceling 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. 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 10,000 community health workers risked their own lives to help hunt down this virus and stop it in its tracks.


RAZ: So, I mean, are you - I don't know. I mean, are you encouraged? Does it - solution - I'm sort of reluctant to use that word because it's a problematic word, but based on what you have seen so far with community workers and the Last Mile challenge - yeah, I mean, what do you think? What - are the signs encouraging?

PANJABI: I'm glad you're critical of the word solution, as I am. And I think it's a part of the solution. I mean, let's make no mistake, you know? There needs to be more hospitals. There need to be more advances in cancer therapy, in personalized gene therapy. But, you know, Liberia has now launched a national program to get a worker like Ruth in every last community in rural areas, and they have a program of about 3,500 community health workers and nurses that then support them. And they've done extraordinary things - I mean, 2.5 million visits. Nine hundred thousand kids have been treated for malaria or tested for malnutrition. They've improved the vaccination coverage. They've improved the skilled birth attendants. Medical care is up by 50% for children.

And it turns out this makes economic sense, as well, right? For every dollar - there was a study done. For every dollar invested in professionalizing a community health worker - in other words, supervising them, paying them, training them as a paraprofessional, as real part of the health care team - there's $10 of return to the society because jobs get created where there's - where unemployment is high; health care leads to healthier, productive life years; and then sometimes, in the case of Ebola, as we found in Liberia, you can avert catastrophic epidemics.

Now, if every country, especially in low- and middle-income countries - rural, poor parts - and equip those workers and train them with even just 30 medical skills - I think there should be a lot more - but even the ones we know work, it turns out the world could save an additional 3 million lives every single year. And that's with stuff we already have in our formulary - you know, we - the medicines we already have, the testing kits we already have. So yes, I think the potential's huge. It's a big part of the solution, and it's a neglected part.

RAZ: That's Raj Panjabi. He's a physician and CEO of the nonprofit Last Mile Health. You can find his talk at ted.com. On the show today - ideas about Accessing Better Health. Stay with us. I'm Guy Raz, and you're listening to the TED Radio Hour from NPR.

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