1 00:00:15,076 --> 00:00:22,716 Speaker 1: Pushkin. I'm Mave Higgins, and this is Solvable Interviews with 2 00:00:22,796 --> 00:00:26,556 Speaker 1: the world's most innovative thinkers working to solve the world's 3 00:00:26,556 --> 00:00:31,796 Speaker 1: biggest problems. My solvable is tackling cervical cancer in low 4 00:00:31,836 --> 00:00:34,716 Speaker 1: and middle income countries, where ninety percent of cervical cancer 5 00:00:34,756 --> 00:00:37,476 Speaker 1: deaths happen wherever there's a pap smere available. That's what 6 00:00:37,556 --> 00:00:39,596 Speaker 1: most women in the US and Europe know that. And 7 00:00:39,676 --> 00:00:41,996 Speaker 1: cervical cancer is something that we don't even think about. 8 00:00:42,476 --> 00:00:47,036 Speaker 1: And so with very low resources, very little resources, without doctors, 9 00:00:47,116 --> 00:00:50,636 Speaker 1: without even clinics, we can go and screen women out 10 00:00:50,756 --> 00:00:55,836 Speaker 1: in provinces, in schoolhouses and workplaces, and we can defeat 11 00:00:55,836 --> 00:00:58,836 Speaker 1: cervical cancer. And really what we're talking about doing is 12 00:00:58,956 --> 00:01:03,276 Speaker 1: preventing cervical cancer. That is doctor Vince Gennaro. He's an 13 00:01:03,276 --> 00:01:07,956 Speaker 1: internal medicine doctor, a global health specialist, and a social 14 00:01:08,076 --> 00:01:12,596 Speaker 1: justice advocate. It now here unsolvable. We do not shy 15 00:01:12,716 --> 00:01:17,036 Speaker 1: away from the biggest problems, and this one certainly qualifies. 16 00:01:17,956 --> 00:01:22,156 Speaker 1: Cervical cancer is a disease that's fueled by social, economic, 17 00:01:22,236 --> 00:01:26,916 Speaker 1: and political inequities. The World Help Organization puts the situation 18 00:01:26,956 --> 00:01:30,636 Speaker 1: in pretty blunt terms. Nine out of ten women who 19 00:01:30,836 --> 00:01:35,636 Speaker 1: die from cervical cancer are in poor countries. Cervical cancer 20 00:01:35,836 --> 00:01:41,316 Speaker 1: is both preventable by vaccines and education, and it's treatable. 21 00:01:41,836 --> 00:01:44,796 Speaker 1: But when prevention and treatment are missing, it means that 22 00:01:44,876 --> 00:01:47,476 Speaker 1: some of the most vulnerable women in the world are 23 00:01:47,596 --> 00:01:52,116 Speaker 1: dying unnecessarily. It probably goes arout saying that this is 24 00:01:52,156 --> 00:01:56,356 Speaker 1: not fair. In Sub Saharan Africa, cervical cancer is the 25 00:01:56,476 --> 00:02:01,316 Speaker 1: number one cancer killer of women. It's so sad because 26 00:02:01,316 --> 00:02:04,716 Speaker 1: we've seen these amazing health gains for women made in 27 00:02:04,916 --> 00:02:09,556 Speaker 1: maternal health and HIV care around the world, so it's 28 00:02:09,596 --> 00:02:12,716 Speaker 1: kind of a disaster to see that rising cervical cancer 29 00:02:12,796 --> 00:02:17,716 Speaker 1: debts undermine those gains. The International Agency for Research on 30 00:02:17,796 --> 00:02:22,036 Speaker 1: Cancer made some really scary sounding projections that show that 31 00:02:22,156 --> 00:02:28,036 Speaker 1: unless preventative measures are implemented asap, by twenty forty, there'll 32 00:02:28,076 --> 00:02:31,716 Speaker 1: be almost half a million deaths from cervical cancer per year. 33 00:02:32,996 --> 00:02:36,236 Speaker 1: Here in the US. Sadly, more than four thousand women 34 00:02:36,356 --> 00:02:39,596 Speaker 1: die from it each year. That is too many, but 35 00:02:39,756 --> 00:02:42,236 Speaker 1: it's nowhere close to the scale that it is in 36 00:02:42,316 --> 00:02:46,676 Speaker 1: low and middle income countries. Any woman listening that's here 37 00:02:46,716 --> 00:02:49,516 Speaker 1: in a wealthier country will know about vaccines or are 38 00:02:49,556 --> 00:02:52,916 Speaker 1: going for a smear test. Not fun, but just something 39 00:02:52,956 --> 00:02:56,436 Speaker 1: that we do and it works. We just have to 40 00:02:56,476 --> 00:03:01,156 Speaker 1: share it. Preventing and treating women's cancer in low income 41 00:03:01,196 --> 00:03:04,956 Speaker 1: countries is doctor Vince Gennaro's life's work. He is so 42 00:03:04,996 --> 00:03:08,396 Speaker 1: smart and passionate that he makes this challenge, which we 43 00:03:08,476 --> 00:03:13,076 Speaker 1: know is seius and deadly, seem manageable. He's worked in 44 00:03:13,116 --> 00:03:16,036 Speaker 1: seven countries. He speaks five languages, all of which you'll 45 00:03:16,076 --> 00:03:18,396 Speaker 1: hear in this interview. No you won't, he is just 46 00:03:18,476 --> 00:03:21,556 Speaker 1: being English. In this interview, he talks to an apple 47 00:03:21,596 --> 00:03:25,356 Speaker 1: bound about cancer research here in the US, about how 48 00:03:25,636 --> 00:03:30,076 Speaker 1: politics and education intersect with help, and how the nonprofit 49 00:03:30,116 --> 00:03:34,916 Speaker 1: that he founded, Innovating Health International, does this huge work 50 00:03:34,996 --> 00:03:38,396 Speaker 1: in countries like Haiti and Rwanda to look after women 51 00:03:38,516 --> 00:03:42,076 Speaker 1: and to teach us to look after ourselves. Okay, take 52 00:03:42,116 --> 00:03:45,396 Speaker 1: a listen. What's the problem? In a nutshell? Can you 53 00:03:45,436 --> 00:03:48,996 Speaker 1: describe it in a couple of sentences? Globally, over half 54 00:03:48,996 --> 00:03:51,996 Speaker 1: a million women are dying of cervical cancer every single year. 55 00:03:52,356 --> 00:03:56,116 Speaker 1: It is a leading killer of women in low income countries, 56 00:03:56,396 --> 00:03:58,636 Speaker 1: even though it's not even in the top ten cancer 57 00:03:58,716 --> 00:04:02,276 Speaker 1: killers in US and Europe. So there's a huge disparity 58 00:04:02,356 --> 00:04:04,476 Speaker 1: between what we know we can do and what we 59 00:04:04,516 --> 00:04:07,356 Speaker 1: are actually doing. And when we're talking about a half 60 00:04:07,356 --> 00:04:10,996 Speaker 1: a million desk globally women, these are women who are 61 00:04:11,076 --> 00:04:14,836 Speaker 1: in their economically most productive years, in their forties and fifties. 62 00:04:14,836 --> 00:04:19,516 Speaker 1: They are young mothers still, they're raising children, and when 63 00:04:19,556 --> 00:04:22,676 Speaker 1: cervical cancer affects their life, it affects society at large. 64 00:04:23,516 --> 00:04:26,196 Speaker 1: And what is it about this problem that makes you 65 00:04:26,236 --> 00:04:30,156 Speaker 1: want to tackle it. I think in every society women 66 00:04:30,156 --> 00:04:33,076 Speaker 1: are the backbone of it. The huge disparity, I think 67 00:04:33,156 --> 00:04:36,516 Speaker 1: is what makes it so such a problem that it's like, well, Okay, 68 00:04:36,596 --> 00:04:38,636 Speaker 1: we know we can fix this. You know, when HIV 69 00:04:39,036 --> 00:04:42,396 Speaker 1: was an issue in the early two thousands in we 70 00:04:42,396 --> 00:04:44,676 Speaker 1: were treating it just fine in US and Europe. We 71 00:04:44,756 --> 00:04:48,676 Speaker 1: talked about expensive medications and difficult regimens and testing that 72 00:04:48,756 --> 00:04:53,356 Speaker 1: was difficult. And so we're real technological challenges to rolling 73 00:04:53,356 --> 00:04:57,996 Speaker 1: out widespread HIV treatment in lower income countries. With cervical cancer, 74 00:04:58,676 --> 00:05:01,676 Speaker 1: we can screen with tests that cost two dollars, that 75 00:05:01,796 --> 00:05:06,756 Speaker 1: has plastic speculum, and regular store bought vinegar and a light. 76 00:05:07,036 --> 00:05:08,636 Speaker 1: Those are the three things that we really need to 77 00:05:08,676 --> 00:05:11,636 Speaker 1: screen a for cervical cancer. So it really is something 78 00:05:11,676 --> 00:05:14,796 Speaker 1: that can be done literally anywhere a woman can lay 79 00:05:14,796 --> 00:05:17,916 Speaker 1: flat in privacy. It's a question then, of how to 80 00:05:17,996 --> 00:05:20,516 Speaker 1: reach those women, How do we engage them in the 81 00:05:20,556 --> 00:05:23,916 Speaker 1: health system, to the point that they understand the issue, 82 00:05:23,956 --> 00:05:27,996 Speaker 1: that they realize the value of it, that they understand 83 00:05:28,076 --> 00:05:31,076 Speaker 1: the longer term consequences of it, even in the immediacy 84 00:05:31,156 --> 00:05:33,836 Speaker 1: of the life that they're living, which may often be 85 00:05:33,876 --> 00:05:37,636 Speaker 1: in poverty or difficulty feeding and educating their own children. 86 00:05:38,036 --> 00:05:40,516 Speaker 1: To get women to come in and engage with the 87 00:05:40,516 --> 00:05:43,116 Speaker 1: health system is more the problem. To get the health 88 00:05:43,116 --> 00:05:45,156 Speaker 1: system to reach out to these women and offer these 89 00:05:45,156 --> 00:05:48,356 Speaker 1: simple services is more the issue than anything to do 90 00:05:48,436 --> 00:05:51,916 Speaker 1: with having enough doctors or having enough clinics. So when 91 00:05:51,916 --> 00:05:53,916 Speaker 1: you're faced with a problem like this one where you 92 00:05:53,996 --> 00:05:58,036 Speaker 1: have the perspective of many millions of women in Haiti, 93 00:05:58,116 --> 00:06:01,716 Speaker 1: for example, who don't know about cervical cancer, don't know 94 00:06:01,756 --> 00:06:04,916 Speaker 1: about testing, often don't realize they have cancer until it's 95 00:06:04,916 --> 00:06:08,276 Speaker 1: too late to treat, how do you begin thinking about it? 96 00:06:08,316 --> 00:06:10,196 Speaker 1: What are the first depths you take? How do you 97 00:06:10,236 --> 00:06:12,796 Speaker 1: break down the problem? You know? I think initially in 98 00:06:12,796 --> 00:06:16,596 Speaker 1: twenty sixteen, Innovating Health International and our partners, we carried 99 00:06:16,596 --> 00:06:20,236 Speaker 1: out a survey across the country of Haitio, interviewing five 100 00:06:20,316 --> 00:06:23,276 Speaker 1: hundred women and men to talk about what their attitudes 101 00:06:23,316 --> 00:06:26,236 Speaker 1: were towards cervical cancer and breast cancer. You know, we 102 00:06:26,276 --> 00:06:28,276 Speaker 1: have to understand is that what it is that they know, 103 00:06:28,356 --> 00:06:30,476 Speaker 1: what it is that they believe, what it is that 104 00:06:30,836 --> 00:06:32,836 Speaker 1: they have access to for in order for us to 105 00:06:32,876 --> 00:06:35,276 Speaker 1: be able to formulate a plan to attack it. And 106 00:06:35,316 --> 00:06:38,756 Speaker 1: so we found some pretty stunning things. Between twenty and 107 00:06:38,796 --> 00:06:42,316 Speaker 1: thirty percent of women don't know didn't had never heard 108 00:06:42,356 --> 00:06:44,676 Speaker 1: of cervical cancer, They didn't know what the symptoms were, 109 00:06:45,116 --> 00:06:48,596 Speaker 1: they didn't know what the tests involved. Most stunningly, seventy 110 00:06:48,596 --> 00:06:52,116 Speaker 1: five percent of Haitian women couldn't identify where their cervix is. 111 00:06:52,836 --> 00:06:54,756 Speaker 1: So if I'm trying to convince you to take a 112 00:06:54,796 --> 00:06:57,556 Speaker 1: test that for every thousand women screen we're going to 113 00:06:57,596 --> 00:07:00,556 Speaker 1: save ten lives. But if you don't know where the 114 00:07:00,556 --> 00:07:04,876 Speaker 1: cervix is, what cancer of the cervix causes, where around 115 00:07:04,876 --> 00:07:07,636 Speaker 1: you to get the test? Why would you get the test? 116 00:07:08,036 --> 00:07:10,436 Speaker 1: You have immediate concern you have to You're worrying about 117 00:07:10,476 --> 00:07:13,116 Speaker 1: feeding and educating your children, taking care of your family, 118 00:07:13,596 --> 00:07:17,276 Speaker 1: So we start there. Obviously, that's a pretty big uphill task. 119 00:07:17,356 --> 00:07:19,636 Speaker 1: If we're looking at those kinds of numbers of seventy 120 00:07:19,676 --> 00:07:21,836 Speaker 1: five percent of women don't know where their service is, 121 00:07:22,156 --> 00:07:23,876 Speaker 1: how are we going to convince you to take this test? 122 00:07:23,876 --> 00:07:26,236 Speaker 1: And the importance of it. So looking at it like 123 00:07:26,276 --> 00:07:27,796 Speaker 1: that and then we say, okay, then it has to 124 00:07:27,836 --> 00:07:30,476 Speaker 1: start with education, it has to start with awareness, and 125 00:07:30,556 --> 00:07:32,956 Speaker 1: most importantly, it's got to start with what we call 126 00:07:33,036 --> 00:07:36,316 Speaker 1: engagement with the health system. That it's not just Okay, 127 00:07:36,316 --> 00:07:38,476 Speaker 1: we're going to give you a little lecture, it's more 128 00:07:38,516 --> 00:07:40,356 Speaker 1: than that. Part of it is them knowing where the 129 00:07:40,396 --> 00:07:43,436 Speaker 1: nearest health center is, knowing the times it's open, knowing 130 00:07:43,436 --> 00:07:46,396 Speaker 1: its services they offer, Knowing the prices that they may 131 00:07:46,396 --> 00:07:48,876 Speaker 1: have to pay if there are user fees. These are 132 00:07:48,876 --> 00:07:51,556 Speaker 1: the things that, again, a woman who is struggling to 133 00:07:51,556 --> 00:07:54,436 Speaker 1: work and raise a family at the same time may 134 00:07:54,436 --> 00:07:56,756 Speaker 1: not have access to that information. So we want to 135 00:07:57,436 --> 00:07:59,956 Speaker 1: reach out to them with the health system as well 136 00:07:59,996 --> 00:08:02,516 Speaker 1: as teaching them where to go. The other problem is 137 00:08:02,556 --> 00:08:05,476 Speaker 1: that we're talking about preventative health, and when we're talking 138 00:08:05,476 --> 00:08:09,676 Speaker 1: about preventative health, that's a more difficult thing for places 139 00:08:10,156 --> 00:08:12,356 Speaker 1: for people who will again are focused on the here 140 00:08:12,356 --> 00:08:15,836 Speaker 1: and now and surviving through today. We know that when 141 00:08:15,996 --> 00:08:19,596 Speaker 1: care is free, when we have had free cervical cancer screenings, 142 00:08:19,596 --> 00:08:22,116 Speaker 1: that major hospitals around the country of Haiti, that the 143 00:08:22,356 --> 00:08:25,236 Speaker 1: screening numbers are very low because the most common bearers 144 00:08:25,236 --> 00:08:27,876 Speaker 1: are actually not economic, even in a poor place like Haiti, 145 00:08:28,196 --> 00:08:30,676 Speaker 1: they're structural. So that's what we talk about when we 146 00:08:30,676 --> 00:08:32,716 Speaker 1: talk about engagement with the health system, and that really 147 00:08:32,756 --> 00:08:35,916 Speaker 1: for us was the starting point. What about prejudice? Are 148 00:08:35,956 --> 00:08:38,476 Speaker 1: people disturbed by the idea of that kind of exam 149 00:08:38,676 --> 00:08:41,196 Speaker 1: Is it a cultural problem as well? It certainly is 150 00:08:41,236 --> 00:08:44,876 Speaker 1: in many cultures in Haiti, not particularly, but in Malawi 151 00:08:44,956 --> 00:08:46,876 Speaker 1: with another place that I work it can be. And 152 00:08:46,916 --> 00:08:49,516 Speaker 1: then certainly in other culture is in Asia that's an issue. 153 00:08:50,236 --> 00:08:52,276 Speaker 1: I think that's why one of the things that we're 154 00:08:52,276 --> 00:08:55,476 Speaker 1: doing is self vaginal swabs, meaning that the woman doesn't 155 00:08:55,476 --> 00:08:58,036 Speaker 1: have to be examined at all, meaning that she inserts 156 00:08:58,036 --> 00:09:00,876 Speaker 1: a Q tip into her vagina and that is enough 157 00:09:01,156 --> 00:09:03,196 Speaker 1: sensitive enough the test for us to be able to 158 00:09:03,196 --> 00:09:06,356 Speaker 1: determine if they are at risk for cervical cancer or not. 159 00:09:06,476 --> 00:09:09,476 Speaker 1: So you adjust the test depending on where you are. Yeah, 160 00:09:09,636 --> 00:09:12,636 Speaker 1: those kinds of technologies. Cool thing about this is, you know, 161 00:09:12,676 --> 00:09:15,356 Speaker 1: I said we can do this with simple no technology, 162 00:09:15,396 --> 00:09:17,596 Speaker 1: and that's certainly true. But a technology like that that 163 00:09:17,796 --> 00:09:21,556 Speaker 1: HPV test with a self swab opens up a whole 164 00:09:21,596 --> 00:09:24,076 Speaker 1: new level of possibilities. It means that we don't need 165 00:09:24,396 --> 00:09:28,156 Speaker 1: a doctor because the doctor is generally necessary to do 166 00:09:28,196 --> 00:09:30,436 Speaker 1: a cervical exam on a lot of patients, or even 167 00:09:30,436 --> 00:09:33,236 Speaker 1: a highly trained midwife. We can have someone with a 168 00:09:33,316 --> 00:09:36,676 Speaker 1: high school education do the education for the patients and 169 00:09:36,796 --> 00:09:39,236 Speaker 1: teach them how to do the swab. So and it's 170 00:09:39,236 --> 00:09:42,516 Speaker 1: not subjective at all, it's scientific, is very sensitive and 171 00:09:42,916 --> 00:09:44,796 Speaker 1: just about as much as a PAP smere that we 172 00:09:44,796 --> 00:09:47,796 Speaker 1: would get in the US. So those kinds of technologies 173 00:09:47,796 --> 00:09:50,476 Speaker 1: are helping us leap frog, and they also helping us 174 00:09:50,476 --> 00:09:53,556 Speaker 1: overcome barriers that maybe they're culturally. I think one of 175 00:09:53,556 --> 00:09:58,676 Speaker 1: the barriers is certainly sexism, gender based violence, gender stigma. 176 00:09:58,916 --> 00:10:01,916 Speaker 1: Those are the things that really cut across culture. Is 177 00:10:01,916 --> 00:10:04,596 Speaker 1: even in the US and Europe, those are true barriers. 178 00:10:04,916 --> 00:10:08,116 Speaker 1: In a place like Haiti, where the male partner is 179 00:10:08,156 --> 00:10:10,636 Speaker 1: paying for testing, then they certainly have a say in 180 00:10:10,956 --> 00:10:13,836 Speaker 1: what tests that the women undergo. In our study, that 181 00:10:13,916 --> 00:10:16,876 Speaker 1: we had forty percent of our breast and cervical cancer 182 00:10:16,876 --> 00:10:19,956 Speaker 1: patients had been victims of gender based violence, whether it 183 00:10:19,996 --> 00:10:23,516 Speaker 1: was physical, sexual, economic, and that was compared with twenty 184 00:10:23,556 --> 00:10:26,916 Speaker 1: eight percent in the general population. So we know for 185 00:10:26,996 --> 00:10:30,196 Speaker 1: a fact that globally that gender based violence increases the 186 00:10:30,316 --> 00:10:32,636 Speaker 1: risk of cervical cancer because it increases the risk of 187 00:10:32,636 --> 00:10:35,596 Speaker 1: transmission of HPV. And now we know in Haiti at 188 00:10:35,676 --> 00:10:38,396 Speaker 1: least that the women who have cancer are more likely 189 00:10:38,476 --> 00:10:41,156 Speaker 1: to be victims of gender based violence. So these kinds 190 00:10:41,156 --> 00:10:43,996 Speaker 1: of things matter. And even when we did to our survey, 191 00:10:44,116 --> 00:10:48,196 Speaker 1: the most common cited cause for breast or cervical cancer 192 00:10:48,236 --> 00:10:52,196 Speaker 1: in Haiti was were sexual violence, so rough play with 193 00:10:52,276 --> 00:10:55,876 Speaker 1: breast during sex, certain sexual positions they thought would lead 194 00:10:55,876 --> 00:10:59,076 Speaker 1: to cervical cancer. So there is an association in the 195 00:10:59,076 --> 00:11:03,356 Speaker 1: women's mind at least between some form of sexual violence, 196 00:11:03,356 --> 00:11:07,436 Speaker 1: whether it's consensual or not, as being linked to these problems. 197 00:11:07,796 --> 00:11:10,876 Speaker 1: But is that true. Certainly not. The rough sex and 198 00:11:10,916 --> 00:11:13,676 Speaker 1: those kinds of things don't increase the chances of HPV, 199 00:11:13,876 --> 00:11:16,476 Speaker 1: but more partners does, And so I don't know about 200 00:11:16,516 --> 00:11:18,916 Speaker 1: the association between the people who have more partners and 201 00:11:19,156 --> 00:11:21,476 Speaker 1: gender based fines. But When a woman generally can't choose 202 00:11:21,476 --> 00:11:23,836 Speaker 1: your partners, when she can't negotiate condom use and those 203 00:11:23,916 --> 00:11:27,076 Speaker 1: kinds of things, then she is at a higher risk 204 00:11:27,196 --> 00:11:31,916 Speaker 1: of getting HPV. How did we persuade women in the 205 00:11:32,036 --> 00:11:34,436 Speaker 1: United States to take these tests? Is there a history 206 00:11:34,476 --> 00:11:36,956 Speaker 1: to this story? Yeah, I mean, the papsmer has been 207 00:11:36,996 --> 00:11:39,196 Speaker 1: around for eighty years, and so that's part of it. 208 00:11:39,236 --> 00:11:42,716 Speaker 1: We all grew up knowing about the PAPS mirror since 209 00:11:42,756 --> 00:11:45,196 Speaker 1: we hit puberty and had the birds and the bees talk. 210 00:11:45,316 --> 00:11:48,316 Speaker 1: So it's something that's been ingrained in us from day one. 211 00:11:48,356 --> 00:11:50,756 Speaker 1: It was ingrained in our mothers as well, and our 212 00:11:50,796 --> 00:11:52,876 Speaker 1: grandmothers would probably be the ones who could tell us 213 00:11:52,916 --> 00:11:55,636 Speaker 1: what they remembered when they first heard about the PAPS mirror. 214 00:11:55,836 --> 00:11:58,796 Speaker 1: But so we're talking about that kind of level where 215 00:11:59,276 --> 00:12:02,396 Speaker 1: twenty percent know what several cancer causes. So if we're 216 00:12:02,396 --> 00:12:04,236 Speaker 1: at that level, what do we do In the US. 217 00:12:04,716 --> 00:12:06,756 Speaker 1: We've had access to the care for a long time. 218 00:12:07,116 --> 00:12:10,476 Speaker 1: Right now, we have NFL football players wearing pink bracelets 219 00:12:10,596 --> 00:12:13,836 Speaker 1: and pink cleats for breast cancer. So those kinds of 220 00:12:13,876 --> 00:12:17,916 Speaker 1: things where the awareness is everywhere, right, it's it's almost 221 00:12:17,996 --> 00:12:20,956 Speaker 1: unavoidable to talk about going to get your mamogram because 222 00:12:20,996 --> 00:12:23,436 Speaker 1: of breast cancer. Obviously, in the US we've now we're 223 00:12:23,476 --> 00:12:26,756 Speaker 1: past cervical cancer, so we don't even talk about it anymore. Man. 224 00:12:26,796 --> 00:12:29,196 Speaker 1: That may be one of the issues with HPV vaccination 225 00:12:29,196 --> 00:12:32,076 Speaker 1: in the US is that people don't really remember cervical 226 00:12:32,116 --> 00:12:34,636 Speaker 1: cancer because they don't know anybody who's had it. Whereas 227 00:12:34,636 --> 00:12:38,196 Speaker 1: in Haiti, these women they're dying in their forties and fifties. 228 00:12:38,516 --> 00:12:41,316 Speaker 1: It's a really terrible death, it's it's it's quite the downer. 229 00:12:41,396 --> 00:12:43,356 Speaker 1: But at the same time, I think we've forgotten that 230 00:12:43,476 --> 00:12:46,636 Speaker 1: somewhat in the US and Europe, and that's possibly why 231 00:12:46,636 --> 00:12:49,436 Speaker 1: that there's still a half million women dying globally. I 232 00:12:49,476 --> 00:12:52,556 Speaker 1: think we're we're there a bit with cervical cancer where 233 00:12:52,596 --> 00:12:55,396 Speaker 1: we are complacent, where we can actually have a discussion 234 00:12:55,436 --> 00:12:57,476 Speaker 1: about whether it's worth it or not to have an 235 00:12:57,596 --> 00:13:00,796 Speaker 1: HPV vaccine. Of course it is, and of course it's needed, 236 00:13:00,836 --> 00:13:02,396 Speaker 1: and of course it's gonna you know, we know it's 237 00:13:02,396 --> 00:13:05,756 Speaker 1: having huge impacts on HPV prevalence in the United States 238 00:13:05,796 --> 00:13:08,156 Speaker 1: and Europe. So not only how do we get there 239 00:13:08,196 --> 00:13:11,156 Speaker 1: in Haiti, but how do we reawaken that consciousness in 240 00:13:11,196 --> 00:13:14,276 Speaker 1: the US and Europe that we're thinking about why we 241 00:13:14,316 --> 00:13:17,516 Speaker 1: need the HPAVY vaccine, and we're thinking about how do 242 00:13:17,596 --> 00:13:20,676 Speaker 1: we push our governments and our companies to be more 243 00:13:20,716 --> 00:13:24,316 Speaker 1: aware of these problems in low income countries to expand 244 00:13:24,356 --> 00:13:26,876 Speaker 1: the services that are available. I was very struck by 245 00:13:26,876 --> 00:13:29,676 Speaker 1: I watched a video clip you made about some of 246 00:13:29,716 --> 00:13:31,716 Speaker 1: the work you've done in Haiti in the past, and 247 00:13:32,276 --> 00:13:36,116 Speaker 1: you spoke about giving treatment to some women who had 248 00:13:36,196 --> 00:13:38,476 Speaker 1: just been identified as having cancer, some who had late 249 00:13:38,516 --> 00:13:41,396 Speaker 1: stage cancer, giving them an extra two or three years 250 00:13:41,436 --> 00:13:43,716 Speaker 1: of their lives that they might not have had otherwise. 251 00:13:44,156 --> 00:13:46,996 Speaker 1: And you kept repeating that you wanted to give them 252 00:13:47,036 --> 00:13:50,076 Speaker 1: care just like in the United States, as the kind 253 00:13:50,116 --> 00:13:52,276 Speaker 1: of treatment they would have if they were in a 254 00:13:52,316 --> 00:13:55,156 Speaker 1: different country. This is a more personal question, but that 255 00:13:55,396 --> 00:13:58,716 Speaker 1: struck me. It's clear that you have a sense of 256 00:13:58,756 --> 00:14:02,916 Speaker 1: injustice that people in Haiti in other countries that you've 257 00:14:02,916 --> 00:14:06,116 Speaker 1: worked in aren't getting the same level of healthcare that 258 00:14:06,196 --> 00:14:09,716 Speaker 1: Americans get, or that people in the developed world get. 259 00:14:09,996 --> 00:14:13,036 Speaker 1: Where does that sense of justice come from? Certainly for 260 00:14:13,116 --> 00:14:15,756 Speaker 1: my parents, lots of love and gratitude to them. I 261 00:14:15,796 --> 00:14:18,116 Speaker 1: think also I was raised Catholic, but I think that 262 00:14:18,276 --> 00:14:21,076 Speaker 1: the Catholics tradition of service to the poor is one 263 00:14:21,076 --> 00:14:22,756 Speaker 1: of the reasons I am where I am, and I 264 00:14:22,796 --> 00:14:25,476 Speaker 1: think that, you know, whatsoever you do onto the least 265 00:14:25,476 --> 00:14:27,756 Speaker 1: of my brothers, you do onto me. And that's something 266 00:14:27,796 --> 00:14:29,916 Speaker 1: again we've forgotten in the United States, but I think 267 00:14:29,916 --> 00:14:32,636 Speaker 1: it's important. And I think that's something that drives me 268 00:14:32,996 --> 00:14:37,436 Speaker 1: more importantly than that is. Once you're there, you're experiencing 269 00:14:37,556 --> 00:14:40,116 Speaker 1: and living with these people. Cancer patients they come in. 270 00:14:40,236 --> 00:14:44,276 Speaker 1: We run a chemotherapy center as well, and Atentivating Health International, 271 00:14:44,276 --> 00:14:46,876 Speaker 1: and we do breast cancer and cervical cancer, and the 272 00:14:46,956 --> 00:14:49,716 Speaker 1: women come in and they're getting chemotherapy and surgery for months, 273 00:14:49,756 --> 00:14:51,876 Speaker 1: and so you really get to know them. You know, 274 00:14:51,876 --> 00:14:55,036 Speaker 1: the Haitians are very emotive, expressive people, and it's hard 275 00:14:55,116 --> 00:14:57,756 Speaker 1: not to fall in love with them so quickly. So 276 00:14:58,196 --> 00:15:01,956 Speaker 1: I've watched a lot of women that I love and 277 00:15:02,036 --> 00:15:06,356 Speaker 1: respect die, and that is it has to have an 278 00:15:06,356 --> 00:15:09,236 Speaker 1: impact on you. Some points it was too much, and 279 00:15:09,116 --> 00:15:11,836 Speaker 1: and I withdrew. And now I've gotten to a place 280 00:15:11,836 --> 00:15:14,876 Speaker 1: where I can be present and experience the sadness and 281 00:15:14,996 --> 00:15:17,916 Speaker 1: grieve with the family, and then use that sense of 282 00:15:17,956 --> 00:15:21,276 Speaker 1: injustice to drive us to do more. It really was 283 00:15:21,316 --> 00:15:23,556 Speaker 1: heartening to know that we can make that difference because 284 00:15:24,076 --> 00:15:26,676 Speaker 1: I cried a lot of nights in twenty thirteen, fourteen, 285 00:15:26,676 --> 00:15:29,836 Speaker 1: and fifteen about those women. And to see those numbers 286 00:15:29,996 --> 00:15:33,996 Speaker 1: is you know, we're making an impact. Give me an 287 00:15:34,036 --> 00:15:37,756 Speaker 1: example of one of your patients. How does how can 288 00:15:37,876 --> 00:15:41,836 Speaker 1: chemotherapy change a family's life or change the way, you know, 289 00:15:41,956 --> 00:15:44,516 Speaker 1: change the way a child grows up. Even when a 290 00:15:44,556 --> 00:15:46,916 Speaker 1: woman comes in with stage four, we can still treat 291 00:15:46,956 --> 00:15:50,836 Speaker 1: them both breast and cervical, and so the chemotherapy for 292 00:15:50,836 --> 00:15:53,956 Speaker 1: breast or ovarian cancer, we can extend their life for 293 00:15:54,076 --> 00:15:57,396 Speaker 1: two three four years. You know, our median survival is 294 00:15:57,396 --> 00:15:59,876 Speaker 1: about eighteen months, which is pretty close to what it 295 00:15:59,956 --> 00:16:03,116 Speaker 1: is in certain middle income in high income countries. Okay, well, 296 00:16:03,156 --> 00:16:04,996 Speaker 1: so the woman's only going to live in another eighteen months, 297 00:16:05,076 --> 00:16:07,436 Speaker 1: what's the point. Well to her ten year old son, 298 00:16:07,996 --> 00:16:10,836 Speaker 1: who then becomes a less even before she passes, that matters. 299 00:16:10,916 --> 00:16:12,716 Speaker 1: That's two more years of schooling he gets to go 300 00:16:12,796 --> 00:16:15,796 Speaker 1: to with her working because she's not in bed, she's 301 00:16:15,836 --> 00:16:18,836 Speaker 1: back at work. She's caring for him. For a husband, 302 00:16:18,876 --> 00:16:21,076 Speaker 1: if he's there, that matters in terms of having help 303 00:16:21,156 --> 00:16:24,276 Speaker 1: raising the kids, and for the woman, of course, it 304 00:16:24,276 --> 00:16:26,396 Speaker 1: matters to have two more years of life. And like 305 00:16:26,396 --> 00:16:29,916 Speaker 1: we said that that is something that they deserve as 306 00:16:29,996 --> 00:16:32,796 Speaker 1: human beings. Healthcare as a human right no matter where 307 00:16:32,796 --> 00:16:35,396 Speaker 1: in the world you live. And you know, when we 308 00:16:35,396 --> 00:16:38,356 Speaker 1: get them at earlier stages, we can cure them. And 309 00:16:38,516 --> 00:16:40,636 Speaker 1: you know, my mentor, Paul Farmer, would always say, it's 310 00:16:40,636 --> 00:16:43,276 Speaker 1: almost as if they had a treatable disease, because it 311 00:16:43,316 --> 00:16:45,276 Speaker 1: is treatable. It's just a question of getting to them 312 00:16:45,316 --> 00:16:49,756 Speaker 1: with these simple treatments. We can treat a woman chemotherapy 313 00:16:49,796 --> 00:16:52,556 Speaker 1: and surgery and all that for about twelve hundred bucks 314 00:16:52,556 --> 00:16:55,636 Speaker 1: per woman, which sounds like a lot, but we spend 315 00:16:55,716 --> 00:16:58,436 Speaker 1: fifty thousand or a hundred thousand per case of breast 316 00:16:58,436 --> 00:17:01,316 Speaker 1: cancer in the United States, so it really is not 317 00:17:01,436 --> 00:17:04,636 Speaker 1: much in terms of the global resources, and those prices 318 00:17:04,636 --> 00:17:07,636 Speaker 1: will come down as chemo prices come down and volume 319 00:17:07,756 --> 00:17:10,876 Speaker 1: goes up. You scale this because you know you're one 320 00:17:10,956 --> 00:17:13,356 Speaker 1: doctor and you can only be in so many places. 321 00:17:13,556 --> 00:17:16,436 Speaker 1: How do you spread these tactics to others? Yeah, it's 322 00:17:16,436 --> 00:17:20,076 Speaker 1: all about education and training. There are six doctors at 323 00:17:20,116 --> 00:17:23,076 Speaker 1: the Innovating Health International Cancer Center in Haiti right now, 324 00:17:23,116 --> 00:17:25,156 Speaker 1: and they are seeing the patients on a daily basis. 325 00:17:25,676 --> 00:17:29,436 Speaker 1: We trained them to give chemo. And you know, I'm 326 00:17:29,476 --> 00:17:31,996 Speaker 1: not an oncologist, I'm an internal medicine doctor. There are 327 00:17:32,036 --> 00:17:36,276 Speaker 1: no fellowship trained oncologists in Haiti, and realistically we don't 328 00:17:36,276 --> 00:17:38,796 Speaker 1: really need them yet in any low income country. What 329 00:17:38,836 --> 00:17:41,796 Speaker 1: we need is access to basic care. So we're kind 330 00:17:41,796 --> 00:17:45,076 Speaker 1: of again back to where HIV was in two thousand 331 00:17:45,116 --> 00:17:47,756 Speaker 1: and three, two thousand and four, where we have the tools, 332 00:17:47,916 --> 00:17:50,956 Speaker 1: but there's no specialists in it. Globally, HIV is treated 333 00:17:50,996 --> 00:17:54,036 Speaker 1: by generalists. In the United States, it is generally treated 334 00:17:54,076 --> 00:17:57,276 Speaker 1: by infectious disease doctors. So in the United States, cancers 335 00:17:57,276 --> 00:18:00,036 Speaker 1: treat you by oncologists, and globally we need to have 336 00:18:00,116 --> 00:18:03,556 Speaker 1: generalists or internists treating cancer. So we need to be 337 00:18:03,596 --> 00:18:07,516 Speaker 1: training lots and lots more internal medicine doctors to give chemo, 338 00:18:07,956 --> 00:18:10,716 Speaker 1: to give it safely, to give it properly into the 339 00:18:10,756 --> 00:18:13,076 Speaker 1: patients who need it, and how and went. But it 340 00:18:13,196 --> 00:18:15,716 Speaker 1: is not that complex. You know, in the United States 341 00:18:15,756 --> 00:18:17,556 Speaker 1: and Europe, it's gotten a whole lot more complex with 342 00:18:17,636 --> 00:18:20,356 Speaker 1: genetic testing and higher order things. But if we're talking 343 00:18:20,396 --> 00:18:24,396 Speaker 1: about ensuring first line care and ensuring a basic standard 344 00:18:24,436 --> 00:18:27,676 Speaker 1: of care. Then it's not that difficult, it's not that expensive, 345 00:18:27,716 --> 00:18:30,436 Speaker 1: And we can train a doctor who's an internal medicine 346 00:18:30,476 --> 00:18:33,036 Speaker 1: doctor in a week to give chemo, and we've given 347 00:18:33,116 --> 00:18:36,116 Speaker 1: chemo at four different public hospitals in Haiti. We are 348 00:18:36,236 --> 00:18:38,996 Speaker 1: launching a permanent program now in the North and Capation 349 00:18:39,596 --> 00:18:41,756 Speaker 1: and train doctors and nurses to do it, and they 350 00:18:41,756 --> 00:18:44,196 Speaker 1: come watch us for a week, We give lectures, we 351 00:18:44,236 --> 00:18:46,676 Speaker 1: have discussions about it, and then after that we're in 352 00:18:46,716 --> 00:18:49,676 Speaker 1: touch by phone and email and to talk about all 353 00:18:49,716 --> 00:18:52,396 Speaker 1: right this particular case, is it fall within the algorithm 354 00:18:52,476 --> 00:18:56,156 Speaker 1: or not? As we expand treatment, That's the way it's 355 00:18:56,156 --> 00:18:58,236 Speaker 1: gonna That's the way we're gonna do it by training 356 00:18:58,236 --> 00:19:01,876 Speaker 1: other doctors and nurses and not waiting for oncologists to 357 00:19:01,876 --> 00:19:04,836 Speaker 1: come down and train. So in Haiti, we have probably 358 00:19:04,876 --> 00:19:07,796 Speaker 1: ten different doctors given chemo through our program over the 359 00:19:07,876 --> 00:19:10,796 Speaker 1: last five years, and I've trained them all, watch them, 360 00:19:10,796 --> 00:19:13,116 Speaker 1: we accompany them. You know. That's the way things are 361 00:19:13,116 --> 00:19:16,916 Speaker 1: going to move forward, and not through donations of medicines 362 00:19:16,956 --> 00:19:19,836 Speaker 1: and foreign doctors coming in and treating patients. It's going 363 00:19:19,836 --> 00:19:22,716 Speaker 1: to be through training and a local workforce to do 364 00:19:22,756 --> 00:19:25,836 Speaker 1: this exactly like we did at HIV, and that's as 365 00:19:25,836 --> 00:19:30,116 Speaker 1: a result of rolling out services with algorithms and in simple, 366 00:19:30,916 --> 00:19:34,676 Speaker 1: low cost ways, and cancer care is there. We're there, 367 00:19:34,756 --> 00:19:37,716 Speaker 1: it's just a question of doing it. In order to 368 00:19:37,756 --> 00:19:40,196 Speaker 1: do this, obviously, you need to speak the language of 369 00:19:40,396 --> 00:19:43,756 Speaker 1: local people, so you speak Creole. UM. Maybe you could 370 00:19:43,796 --> 00:19:46,636 Speaker 1: say a few words about how you learned it, and 371 00:19:46,676 --> 00:19:50,556 Speaker 1: then you had to design a campaign in Creole, you know, 372 00:19:50,596 --> 00:19:52,476 Speaker 1: to reach very poor people. Can you talk a little 373 00:19:52,516 --> 00:19:55,516 Speaker 1: bit about how the um you know, how you thought 374 00:19:55,556 --> 00:19:59,716 Speaker 1: about preparing the education campaign. Yeah. I've been blessed to 375 00:19:59,756 --> 00:20:02,276 Speaker 1: speak a couple of languages. I speak about five languages, 376 00:20:02,316 --> 00:20:05,316 Speaker 1: and so I learned Creole in South Florida growing up. 377 00:20:07,036 --> 00:20:10,436 Speaker 1: And you know, I think anything that we do. You know, 378 00:20:10,436 --> 00:20:12,996 Speaker 1: I'm an American and when I go to Haiti or 379 00:20:13,076 --> 00:20:15,596 Speaker 1: go to Malawi, I try to stand on the side 380 00:20:16,556 --> 00:20:18,836 Speaker 1: because this is not my place, it's not my country, 381 00:20:19,796 --> 00:20:21,756 Speaker 1: it's not my culture and not my people. And so 382 00:20:22,116 --> 00:20:24,876 Speaker 1: I want to be there to support the local staff 383 00:20:25,116 --> 00:20:27,796 Speaker 1: to be able to roll out those things. So when 384 00:20:27,836 --> 00:20:30,516 Speaker 1: we talk about the survey that we did, we had 385 00:20:30,756 --> 00:20:33,996 Speaker 1: five different Haitian organizations. There was ten people in the room, 386 00:20:34,076 --> 00:20:36,916 Speaker 1: two of whom were foreigners, and eight who were Haitian. 387 00:20:37,476 --> 00:20:39,596 Speaker 1: The survey was written in Creole. It was never written 388 00:20:39,596 --> 00:20:42,036 Speaker 1: in English and then translated. It was carried out in Creole. 389 00:20:42,076 --> 00:20:44,796 Speaker 1: The results were entered into a Creole spreadsheet. We had 390 00:20:44,836 --> 00:20:49,396 Speaker 1: to teach an artificial intelligence program to interpret the data 391 00:20:49,476 --> 00:20:51,876 Speaker 1: in Creole because we didn't want to translate it into 392 00:20:51,876 --> 00:20:55,676 Speaker 1: and lose that authenticity with it. So same thing with 393 00:20:55,716 --> 00:20:59,996 Speaker 1: our awareness materials. The pictures in it, and we're all 394 00:21:00,116 --> 00:21:02,556 Speaker 1: drawn by a graphic designer who's the son of a 395 00:21:02,596 --> 00:21:06,116 Speaker 1: patient of ours. The videos we have on our website, 396 00:21:06,476 --> 00:21:09,876 Speaker 1: concert Point Coom, it's an all Creole website, have all 397 00:21:10,676 --> 00:21:14,076 Speaker 1: breast cancer and cervical cancer survivors as the actors and actresses, 398 00:21:15,836 --> 00:21:17,876 Speaker 1: and they're the ones who wrote it actually, So I, 399 00:21:17,996 --> 00:21:20,116 Speaker 1: you know, I've had very little to do with it 400 00:21:20,836 --> 00:21:26,036 Speaker 1: other than you know, to facilitate um, you know, help people, 401 00:21:26,116 --> 00:21:28,836 Speaker 1: give them the resources. The Haitians are in particular super 402 00:21:28,876 --> 00:21:32,236 Speaker 1: creative and so they're they're really good at at at 403 00:21:32,276 --> 00:21:34,236 Speaker 1: those kinds of things. And the videos are you know, 404 00:21:34,276 --> 00:21:37,076 Speaker 1: they're not just someone talking to the camera. It's a conversation. 405 00:21:37,116 --> 00:21:39,956 Speaker 1: It's a little bit of a soap opera and people 406 00:21:39,996 --> 00:21:42,196 Speaker 1: get involved in them even though they're only three minutes long. 407 00:21:42,276 --> 00:21:48,636 Speaker 1: So it's more about accompaniment and helping our colleagues in 408 00:21:48,716 --> 00:21:52,596 Speaker 1: low income countries to express themselves. And you know what 409 00:21:52,636 --> 00:21:55,596 Speaker 1: they need is they need some time space money to 410 00:21:55,676 --> 00:21:58,236 Speaker 1: be able to accomplish those things. And it's not really 411 00:21:58,276 --> 00:22:02,116 Speaker 1: about um us doing it. It's about us standing standing 412 00:22:02,156 --> 00:22:04,476 Speaker 1: aside and letting them do their thing like we would 413 00:22:04,556 --> 00:22:09,356 Speaker 1: do here. But we just have a whole lot more resources. 414 00:22:09,516 --> 00:22:12,196 Speaker 1: Give me some examples of success. So how do you 415 00:22:12,316 --> 00:22:15,436 Speaker 1: know you're succeeding? This is a vast problem. You're tackling 416 00:22:15,436 --> 00:22:18,516 Speaker 1: it from different angles. You're doing prevention, you're doing new 417 00:22:18,596 --> 00:22:21,916 Speaker 1: kinds of treatment, you're training doctors. What makes you think 418 00:22:21,996 --> 00:22:24,476 Speaker 1: you can can solve this problem? You know, we talked 419 00:22:24,476 --> 00:22:27,516 Speaker 1: about the personal aspect. Now I'm by sitting in office 420 00:22:27,516 --> 00:22:29,836 Speaker 1: and talk and write grants and think of ideas and 421 00:22:30,436 --> 00:22:32,716 Speaker 1: look at numbers and so those numbers are really what 422 00:22:32,716 --> 00:22:35,436 Speaker 1: we're talking about, and it's it's impersonal. But at the 423 00:22:35,436 --> 00:22:37,676 Speaker 1: same time, if I say we screened four thousand women 424 00:22:37,716 --> 00:22:40,716 Speaker 1: at a factory for cervical cancer, then we know we 425 00:22:40,996 --> 00:22:43,676 Speaker 1: saved at least ten lives. We know that that was 426 00:22:43,716 --> 00:22:45,916 Speaker 1: a successful program because we did what we set out 427 00:22:45,956 --> 00:22:47,956 Speaker 1: to do it with the budget we had. We know 428 00:22:48,036 --> 00:22:50,596 Speaker 1: that we've handed out sixty thousand booklets for breast and 429 00:22:50,596 --> 00:22:53,036 Speaker 1: cervical cancer awareness. We know, like I said, we've trained 430 00:22:53,476 --> 00:22:57,596 Speaker 1: fifty doctors and ninety nurses and cancer treatment over the 431 00:22:57,636 --> 00:23:00,236 Speaker 1: last three years. That I said, the statum most proud 432 00:23:00,276 --> 00:23:02,356 Speaker 1: of is the fact that we've decreased the number of 433 00:23:02,396 --> 00:23:05,036 Speaker 1: women coming in in stage four breast cancer from forty 434 00:23:05,076 --> 00:23:07,836 Speaker 1: percent to twenty two percent in five years. Because I 435 00:23:07,876 --> 00:23:11,196 Speaker 1: know that is huge numbers, A live saved. Our populations 436 00:23:11,196 --> 00:23:14,116 Speaker 1: also getting younger, there's more women under forty coming in. 437 00:23:14,556 --> 00:23:16,636 Speaker 1: We're going to treat close to three hundred women with 438 00:23:16,676 --> 00:23:19,636 Speaker 1: breast cancer this year alone. We've already we've treated over 439 00:23:19,676 --> 00:23:22,956 Speaker 1: a thousand in the last couple of years. So the numbers, 440 00:23:23,116 --> 00:23:26,756 Speaker 1: while impersonal, are certainly telling. And then you know, you 441 00:23:26,796 --> 00:23:29,756 Speaker 1: look at like on our website, there's Nadine who's twenty six. 442 00:23:29,796 --> 00:23:31,876 Speaker 1: When she came in with breast cancer. She had the 443 00:23:31,916 --> 00:23:34,916 Speaker 1: support of loving husband, so she not only found the mass, 444 00:23:35,076 --> 00:23:38,676 Speaker 1: but sought out care and got to us quickly, and 445 00:23:38,996 --> 00:23:41,556 Speaker 1: you know she's cured she's now thirty years old, she's 446 00:23:41,596 --> 00:23:44,676 Speaker 1: got two kids. Every time I see Nadine, you know, 447 00:23:44,796 --> 00:23:47,876 Speaker 1: it makes me smile. It's those two sides. It's the numbers, 448 00:23:48,556 --> 00:23:50,916 Speaker 1: number of doctors trained, the number of people that were 449 00:23:50,956 --> 00:23:53,956 Speaker 1: treating and screening, and the lives touched. We know we 450 00:23:53,996 --> 00:23:57,036 Speaker 1: have the tools, we know we have we're making progress. 451 00:23:57,236 --> 00:23:59,396 Speaker 1: The fact that I'm sitting here speaking with you tells 452 00:23:59,476 --> 00:24:02,156 Speaker 1: me that we're onto something, that this is an issue 453 00:24:02,156 --> 00:24:04,236 Speaker 1: that people care about and want to hear about, and 454 00:24:04,356 --> 00:24:06,596 Speaker 1: this is an issue that's moving forward. You know, we 455 00:24:06,676 --> 00:24:08,676 Speaker 1: just gotta we gotta get over that hump to the 456 00:24:08,676 --> 00:24:10,796 Speaker 1: point where we are now rolling these programs out. We're 457 00:24:10,796 --> 00:24:13,516 Speaker 1: not talking about pilot programs or small scale that. We're 458 00:24:13,516 --> 00:24:18,036 Speaker 1: talking about national, international, global, and really decreasing that number 459 00:24:18,036 --> 00:24:20,916 Speaker 1: of half a million women dying every year from cervical cancer, 460 00:24:21,076 --> 00:24:23,756 Speaker 1: and it's totally solvable. What kind of decrease are we 461 00:24:23,796 --> 00:24:26,276 Speaker 1: talking about and by when? What would be your guests? 462 00:24:26,276 --> 00:24:28,236 Speaker 1: So even if we were to test every woman in 463 00:24:28,316 --> 00:24:31,156 Speaker 1: low end, middle income countries for cervical cancer even once 464 00:24:31,196 --> 00:24:35,076 Speaker 1: in their lifetime, one papsmere, one HPV test, one test 465 00:24:35,116 --> 00:24:37,916 Speaker 1: with vinegar, we'd reduce cervical cancer mortality by eighty or 466 00:24:37,996 --> 00:24:40,836 Speaker 1: ninety percent, So we really don't have to set up 467 00:24:40,876 --> 00:24:43,596 Speaker 1: an infrastructure where they're getting paps members every three years. 468 00:24:44,356 --> 00:24:46,156 Speaker 1: That would to get to one hundred percent, we would, 469 00:24:46,196 --> 00:24:48,716 Speaker 1: but to get eighty percent, which then we're talking about 470 00:24:48,716 --> 00:24:51,156 Speaker 1: four hundred thousand lives saved, we just have to screen 471 00:24:51,196 --> 00:24:54,076 Speaker 1: them once. That's why we're talking about mobile screening. We're 472 00:24:54,116 --> 00:24:56,756 Speaker 1: going to go out into a clinic in the middle 473 00:24:56,756 --> 00:24:59,196 Speaker 1: of nowhere with a community healthcare worker with a backpack 474 00:24:59,276 --> 00:25:02,196 Speaker 1: full of HPV swabs. She talks to the women, gives 475 00:25:02,196 --> 00:25:05,796 Speaker 1: them a lecture on not only cervical and breast cancer, 476 00:25:05,796 --> 00:25:09,276 Speaker 1: but also sexual reproductive health. They do breast exam, she 477 00:25:09,316 --> 00:25:11,636 Speaker 1: teaches them how to do a self breast exam, and 478 00:25:11,676 --> 00:25:15,236 Speaker 1: then the women do insert the HPV self swab. We 479 00:25:15,676 --> 00:25:18,276 Speaker 1: come back to that same town two weeks later with 480 00:25:18,316 --> 00:25:21,316 Speaker 1: a midwife and for all those women who are HPV 481 00:25:21,436 --> 00:25:24,436 Speaker 1: positive it's around twenty five percent. We treat them right 482 00:25:24,476 --> 00:25:27,436 Speaker 1: then and there with a battery operated piece of equipment 483 00:25:27,476 --> 00:25:31,476 Speaker 1: that basically uses heat to remove the pre cervical cancer 484 00:25:31,556 --> 00:25:35,036 Speaker 1: from the cervix. It's battery operated, it's portable, it's about 485 00:25:35,076 --> 00:25:37,156 Speaker 1: the size of a large cell phone or a tablet, 486 00:25:37,476 --> 00:25:40,196 Speaker 1: and it can be done anywhere a woman can lay flat, 487 00:25:40,276 --> 00:25:42,076 Speaker 1: we can do it in a church on a church pew, 488 00:25:42,156 --> 00:25:45,156 Speaker 1: behind a curtain. You know. Those kinds of things are 489 00:25:46,556 --> 00:25:50,476 Speaker 1: or I think what makes this feasible. There's other technology 490 00:25:50,676 --> 00:25:53,636 Speaker 1: from Mobile ODT. It's the Eva Culpa scope and it's 491 00:25:53,636 --> 00:25:56,356 Speaker 1: a it's a connected to a smartphone and it's got 492 00:25:56,356 --> 00:25:58,396 Speaker 1: a little camera and magnifying glass to look at the 493 00:25:58,396 --> 00:26:01,916 Speaker 1: cervix and we can take pictures and stream video and 494 00:26:02,596 --> 00:26:06,036 Speaker 1: quality control with it. But the machine is actually going 495 00:26:06,076 --> 00:26:08,396 Speaker 1: to be able to tell a normal servix versus an 496 00:26:08,396 --> 00:26:11,876 Speaker 1: abnormal service come this fall. That's interesting. So you're talking 497 00:26:11,916 --> 00:26:15,276 Speaker 1: about actually a combination of low tech and very high 498 00:26:15,276 --> 00:26:17,876 Speaker 1: tech potentially. So then so part of the way to 499 00:26:17,916 --> 00:26:20,316 Speaker 1: solve it is to combine them together. Well, so we're 500 00:26:20,316 --> 00:26:24,276 Speaker 1: talking about doing tomorrow's test for cervical cancer today, HAITI 501 00:26:24,356 --> 00:26:27,756 Speaker 1: is leapfrogging in the United States. By using these HPV tests, 502 00:26:27,756 --> 00:26:31,116 Speaker 1: our daughters will not be getting pap smears, and so 503 00:26:31,516 --> 00:26:34,876 Speaker 1: HAITI is moving past that and leapfrogging, and that's that's important. 504 00:26:34,916 --> 00:26:38,876 Speaker 1: We're pairing it with education and engagement we're coming to them, 505 00:26:39,156 --> 00:26:41,636 Speaker 1: We're going to their workplace, We're going to their their 506 00:26:41,756 --> 00:26:45,156 Speaker 1: church on a Sunday and screening fifty women. And everything's 507 00:26:45,156 --> 00:26:48,036 Speaker 1: battery operated. Everything can be you know, use internet or 508 00:26:48,076 --> 00:26:50,156 Speaker 1: not Internet if there's no service out where they are. 509 00:26:50,436 --> 00:26:53,596 Speaker 1: It is beautiful, simple technology, which means you don't have 510 00:26:53,636 --> 00:26:56,396 Speaker 1: to train the people as much. The cost of the 511 00:26:56,516 --> 00:26:58,796 Speaker 1: you know, equipment is two three thousand bucks, which spread 512 00:26:58,796 --> 00:27:02,076 Speaker 1: out over you know, is nothing comparatively speaking, and you know, 513 00:27:02,116 --> 00:27:04,676 Speaker 1: because you're paying a community healthcare worker instead of a doctor, 514 00:27:05,036 --> 00:27:08,316 Speaker 1: the costs have dropped significantly for the human resources side. 515 00:27:08,636 --> 00:27:11,956 Speaker 1: So using technology, going out there with a backpack full 516 00:27:11,956 --> 00:27:15,716 Speaker 1: of supplies and engaging on a human level, convincing them 517 00:27:15,756 --> 00:27:17,796 Speaker 1: to take the test, telling them how important it is, 518 00:27:18,156 --> 00:27:20,876 Speaker 1: and then treating them right then and there in this 519 00:27:20,956 --> 00:27:23,636 Speaker 1: one room schoolhouse in this church. That's what makes this 520 00:27:23,716 --> 00:27:26,836 Speaker 1: a solvable problem, is is getting out into the community 521 00:27:27,476 --> 00:27:31,916 Speaker 1: to community based education, screening and treatment. So people listening 522 00:27:31,956 --> 00:27:35,356 Speaker 1: to this program, what can they do to help solve 523 00:27:35,396 --> 00:27:39,276 Speaker 1: the problem of high rates of cervical cancer in the 524 00:27:39,356 --> 00:27:41,756 Speaker 1: developing world? I mean, I think the first thing we 525 00:27:41,756 --> 00:27:43,756 Speaker 1: can do is make sure you're getting screened and make 526 00:27:43,796 --> 00:27:46,796 Speaker 1: sure we're getting vaccinated at home. I think that's got 527 00:27:46,796 --> 00:27:49,236 Speaker 1: to be baseline, and we have to have real conversations 528 00:27:49,236 --> 00:27:52,876 Speaker 1: about the effectiveness of these interventions so that we understand 529 00:27:52,876 --> 00:27:56,636 Speaker 1: how effective they are in other places. If there's any 530 00:27:56,676 --> 00:27:59,116 Speaker 1: doubt of how effective HPV vaccine is here in the 531 00:27:59,196 --> 00:28:01,116 Speaker 1: United States, it's going to be hard to convince people 532 00:28:01,516 --> 00:28:04,716 Speaker 1: of the solvability of this problem. I think advocating for 533 00:28:04,756 --> 00:28:07,676 Speaker 1: cancer research is always helpful for us. You know, the 534 00:28:07,716 --> 00:28:10,116 Speaker 1: cancer moonshot in the United States. Those are the things 535 00:28:10,156 --> 00:28:14,596 Speaker 1: that produce technologies that help places like Haiti Leapfrog. I think, 536 00:28:14,756 --> 00:28:17,116 Speaker 1: you know, it doesn't make sense to have this discussion 537 00:28:17,116 --> 00:28:19,996 Speaker 1: without talking about voting. Um you need you need to 538 00:28:20,076 --> 00:28:24,636 Speaker 1: vote your conscience and vote where to make things better 539 00:28:24,676 --> 00:28:27,516 Speaker 1: where people live. If we're talking about mass immigration and 540 00:28:27,596 --> 00:28:31,316 Speaker 1: Europe and Central America, that that's partially because there's services 541 00:28:31,356 --> 00:28:33,516 Speaker 1: don't exist where they live and they are coming for 542 00:28:33,516 --> 00:28:36,916 Speaker 1: a better life. And then vote your conscience through your 543 00:28:36,916 --> 00:28:40,476 Speaker 1: wallet by purchasing from companies like Gap and Levis and 544 00:28:40,516 --> 00:28:44,116 Speaker 1: other companies that are using fair trade practices and providing 545 00:28:44,156 --> 00:28:47,196 Speaker 1: healthcare to the people who in the supply chain. And 546 00:28:47,236 --> 00:28:50,436 Speaker 1: then finally be open with your with your heart, and 547 00:28:50,476 --> 00:28:52,916 Speaker 1: with your wallet. I think it's important. America is the 548 00:28:52,916 --> 00:28:55,556 Speaker 1: most generous country in the world. Two percent of all 549 00:28:55,556 --> 00:28:59,036 Speaker 1: of our income goes to donations, and that's by far 550 00:28:59,076 --> 00:29:00,796 Speaker 1: and away more than any other country in the world, 551 00:29:00,836 --> 00:29:03,316 Speaker 1: and so I want to encourage people to get out 552 00:29:03,316 --> 00:29:07,476 Speaker 1: there and give. The money does end up helping people? 553 00:29:07,796 --> 00:29:10,196 Speaker 1: You know, do your research, do your due diligence, but 554 00:29:10,716 --> 00:29:14,356 Speaker 1: donate your time, don'tate your money. It matters. Such a 555 00:29:14,356 --> 00:29:18,236 Speaker 1: great conversation now, cervical cancer, it's still a threat in 556 00:29:18,276 --> 00:29:21,276 Speaker 1: the global north. But isn't it crazy how those of 557 00:29:21,316 --> 00:29:24,116 Speaker 1: us lucky enough to live in some of the eighty 558 00:29:24,116 --> 00:29:28,196 Speaker 1: four countries around the world with this HPV vaccine program. 559 00:29:28,596 --> 00:29:31,756 Speaker 1: It's like we've almost forgotten about the diseases it's protecting 560 00:29:31,836 --> 00:29:35,156 Speaker 1: us from. And an interesting side note is that more 561 00:29:35,156 --> 00:29:37,796 Speaker 1: than twenty of those countries now give the vaccine to 562 00:29:37,956 --> 00:29:41,436 Speaker 1: boys and girls. I'm sure it struck you as it 563 00:29:41,476 --> 00:29:45,396 Speaker 1: did me. How practical minded doctor de Gennio is at 564 00:29:45,396 --> 00:29:49,036 Speaker 1: the same time as being really compassionate. He mentioned this 565 00:29:49,036 --> 00:29:52,196 Speaker 1: book called Scarcity, The New Science of Having Less and 566 00:29:52,316 --> 00:29:55,316 Speaker 1: how it defines our lives, which weirdly I happen to 567 00:29:55,396 --> 00:29:57,756 Speaker 1: be reading at the moment, so I want to add 568 00:29:57,756 --> 00:30:00,796 Speaker 1: my endorsement for what that's worth. Now that is your 569 00:30:00,796 --> 00:30:04,116 Speaker 1: homework before next week's episode. No, it's not. I'm just kidding, 570 00:30:04,436 --> 00:30:09,876 Speaker 1: Thanks for listening. Solvable is a collaboration between Put Industries 571 00:30:09,876 --> 00:30:14,356 Speaker 1: and the Rockefeller Foundation, with production by Laura Hyde, Hester Kant, 572 00:30:14,476 --> 00:30:18,196 Speaker 1: Laura Sheeter, and Ruth Barnes from Chalk and Blade. Pushkin's 573 00:30:18,236 --> 00:30:23,196 Speaker 1: executive producer is Neia LaBelle, Research by Sheer, Vincent, engineering 574 00:30:23,236 --> 00:30:26,956 Speaker 1: by Jason Gambrel and the great folks at GSI Studios. 575 00:30:27,436 --> 00:30:31,116 Speaker 1: Original music composed by Pascal Wise and special thanks to 576 00:30:31,316 --> 00:30:36,396 Speaker 1: Maggie Taylor, Heather Fine, Julia Barton, Carli Mgliori, Jacob Weisberg, 577 00:30:36,476 --> 00:30:40,036 Speaker 1: and Malcolm Gladwell. You can learn more about solving Today's 578 00:30:40,076 --> 00:30:45,716 Speaker 1: biggest problems at Rockefeller Foundation dot org slash solvable. I'm 579 00:30:45,756 --> 00:30:47,636 Speaker 1: Mave Higgins. Now goost solve it.