WEBVTT - Cervical Cancer is Solvable 0:00:15.076 --> 0:00:22.716 Pushkin. I'm Mave Higgins, and this is Solvable Interviews with 0:00:22.796 --> 0:00:26.556 the world's most innovative thinkers working to solve the world's 0:00:26.556 --> 0:00:31.796 biggest problems. My solvable is tackling cervical cancer in low 0:00:31.836 --> 0:00:34.716 and middle income countries, where ninety percent of cervical cancer 0:00:34.756 --> 0:00:37.476 deaths happen wherever there's a pap smere available. That's what 0:00:37.556 --> 0:00:39.596 most women in the US and Europe know that. And 0:00:39.676 --> 0:00:41.996 cervical cancer is something that we don't even think about. 0:00:42.476 --> 0:00:47.036 And so with very low resources, very little resources, without doctors, 0:00:47.116 --> 0:00:50.636 without even clinics, we can go and screen women out 0:00:50.756 --> 0:00:55.836 in provinces, in schoolhouses and workplaces, and we can defeat 0:00:55.836 --> 0:00:58.836 cervical cancer. And really what we're talking about doing is 0:00:58.956 --> 0:01:03.276 preventing cervical cancer. That is doctor Vince Gennaro. He's an 0:01:03.276 --> 0:01:07.956 internal medicine doctor, a global health specialist, and a social 0:01:08.076 --> 0:01:12.596 justice advocate. It now here unsolvable. We do not shy 0:01:12.716 --> 0:01:17.036 away from the biggest problems, and this one certainly qualifies. 0:01:17.956 --> 0:01:22.156 Cervical cancer is a disease that's fueled by social, economic, 0:01:22.236 --> 0:01:26.916 and political inequities. The World Help Organization puts the situation 0:01:26.956 --> 0:01:30.636 in pretty blunt terms. Nine out of ten women who 0:01:30.836 --> 0:01:35.636 die from cervical cancer are in poor countries. Cervical cancer 0:01:35.836 --> 0:01:41.316 is both preventable by vaccines and education, and it's treatable. 0:01:41.836 --> 0:01:44.796 But when prevention and treatment are missing, it means that 0:01:44.876 --> 0:01:47.476 some of the most vulnerable women in the world are 0:01:47.596 --> 0:01:52.116 dying unnecessarily. It probably goes arout saying that this is 0:01:52.156 --> 0:01:56.356 not fair. In Sub Saharan Africa, cervical cancer is the 0:01:56.476 --> 0:02:01.316 number one cancer killer of women. It's so sad because 0:02:01.316 --> 0:02:04.716 we've seen these amazing health gains for women made in 0:02:04.916 --> 0:02:09.556 maternal health and HIV care around the world, so it's 0:02:09.596 --> 0:02:12.716 kind of a disaster to see that rising cervical cancer 0:02:12.796 --> 0:02:17.716 debts undermine those gains. The International Agency for Research on 0:02:17.796 --> 0:02:22.036 Cancer made some really scary sounding projections that show that 0:02:22.156 --> 0:02:28.036 unless preventative measures are implemented asap, by twenty forty, there'll 0:02:28.076 --> 0:02:31.716 be almost half a million deaths from cervical cancer per year. 0:02:32.996 --> 0:02:36.236 Here in the US. Sadly, more than four thousand women 0:02:36.356 --> 0:02:39.596 die from it each year. That is too many, but 0:02:39.756 --> 0:02:42.236 it's nowhere close to the scale that it is in 0:02:42.316 --> 0:02:46.676 low and middle income countries. Any woman listening that's here 0:02:46.716 --> 0:02:49.516 in a wealthier country will know about vaccines or are 0:02:49.556 --> 0:02:52.916 going for a smear test. Not fun, but just something 0:02:52.956 --> 0:02:56.436 that we do and it works. We just have to 0:02:56.476 --> 0:03:01.156 share it. Preventing and treating women's cancer in low income 0:03:01.196 --> 0:03:04.956 countries is doctor Vince Gennaro's life's work. He is so 0:03:04.996 --> 0:03:08.396 smart and passionate that he makes this challenge, which we 0:03:08.476 --> 0:03:13.076 know is seius and deadly, seem manageable. He's worked in 0:03:13.116 --> 0:03:16.036 seven countries. He speaks five languages, all of which you'll 0:03:16.076 --> 0:03:18.396 hear in this interview. No you won't, he is just 0:03:18.476 --> 0:03:21.556 being English. In this interview, he talks to an apple 0:03:21.596 --> 0:03:25.356 bound about cancer research here in the US, about how 0:03:25.636 --> 0:03:30.076 politics and education intersect with help, and how the nonprofit 0:03:30.116 --> 0:03:34.916 that he founded, Innovating Health International, does this huge work 0:03:34.996 --> 0:03:38.396 in countries like Haiti and Rwanda to look after women 0:03:38.516 --> 0:03:42.076 and to teach us to look after ourselves. Okay, take 0:03:42.116 --> 0:03:45.396 a listen. What's the problem? In a nutshell? Can you 0:03:45.436 --> 0:03:48.996 describe it in a couple of sentences? Globally, over half 0:03:48.996 --> 0:03:51.996 a million women are dying of cervical cancer every single year. 0:03:52.356 --> 0:03:56.116 It is a leading killer of women in low income countries, 0:03:56.396 --> 0:03:58.636 even though it's not even in the top ten cancer 0:03:58.716 --> 0:04:02.276 killers in US and Europe. So there's a huge disparity 0:04:02.356 --> 0:04:04.476 between what we know we can do and what we 0:04:04.516 --> 0:04:07.356 are actually doing. And when we're talking about a half 0:04:07.356 --> 0:04:10.996 a million desk globally women, these are women who are 0:04:11.076 --> 0:04:14.836 in their economically most productive years, in their forties and fifties. 0:04:14.836 --> 0:04:19.516 They are young mothers still, they're raising children, and when 0:04:19.556 --> 0:04:22.676 cervical cancer affects their life, it affects society at large. 0:04:23.516 --> 0:04:26.196 And what is it about this problem that makes you 0:04:26.236 --> 0:04:30.156 want to tackle it. I think in every society women 0:04:30.156 --> 0:04:33.076 are the backbone of it. The huge disparity, I think 0:04:33.156 --> 0:04:36.516 is what makes it so such a problem that it's like, well, Okay, 0:04:36.596 --> 0:04:38.636 we know we can fix this. You know, when HIV 0:04:39.036 --> 0:04:42.396 was an issue in the early two thousands in we 0:04:42.396 --> 0:04:44.676 were treating it just fine in US and Europe. We 0:04:44.756 --> 0:04:48.676 talked about expensive medications and difficult regimens and testing that 0:04:48.756 --> 0:04:53.356 was difficult. And so we're real technological challenges to rolling 0:04:53.356 --> 0:04:57.996 out widespread HIV treatment in lower income countries. With cervical cancer, 0:04:58.676 --> 0:05:01.676 we can screen with tests that cost two dollars, that 0:05:01.796 --> 0:05:06.756 has plastic speculum, and regular store bought vinegar and a light. 0:05:07.036 --> 0:05:08.636 Those are the three things that we really need to 0:05:08.676 --> 0:05:11.636 screen a for cervical cancer. So it really is something 0:05:11.676 --> 0:05:14.796 that can be done literally anywhere a woman can lay 0:05:14.796 --> 0:05:17.916 flat in privacy. It's a question then, of how to 0:05:17.996 --> 0:05:20.516 reach those women, How do we engage them in the 0:05:20.556 --> 0:05:23.916 health system, to the point that they understand the issue, 0:05:23.956 --> 0:05:27.996 that they realize the value of it, that they understand 0:05:28.076 --> 0:05:31.076 the longer term consequences of it, even in the immediacy 0:05:31.156 --> 0:05:33.836 of the life that they're living, which may often be 0:05:33.876 --> 0:05:37.636 in poverty or difficulty feeding and educating their own children. 0:05:38.036 --> 0:05:40.516 To get women to come in and engage with the 0:05:40.516 --> 0:05:43.116 health system is more the problem. To get the health 0:05:43.116 --> 0:05:45.156 system to reach out to these women and offer these 0:05:45.156 --> 0:05:48.356 simple services is more the issue than anything to do 0:05:48.436 --> 0:05:51.916 with having enough doctors or having enough clinics. So when 0:05:51.916 --> 0:05:53.916 you're faced with a problem like this one where you 0:05:53.996 --> 0:05:58.036 have the perspective of many millions of women in Haiti, 0:05:58.116 --> 0:06:01.716 for example, who don't know about cervical cancer, don't know 0:06:01.756 --> 0:06:04.916 about testing, often don't realize they have cancer until it's 0:06:04.916 --> 0:06:08.276 too late to treat, how do you begin thinking about it? 0:06:08.316 --> 0:06:10.196 What are the first depths you take? How do you 0:06:10.236 --> 0:06:12.796 break down the problem? You know? I think initially in 0:06:12.796 --> 0:06:16.596 twenty sixteen, Innovating Health International and our partners, we carried 0:06:16.596 --> 0:06:20.236 out a survey across the country of Haitio, interviewing five 0:06:20.316 --> 0:06:23.276 hundred women and men to talk about what their attitudes 0:06:23.316 --> 0:06:26.236 were towards cervical cancer and breast cancer. You know, we 0:06:26.276 --> 0:06:28.276 have to understand is that what it is that they know, 0:06:28.356 --> 0:06:30.476 what it is that they believe, what it is that 0:06:30.836 --> 0:06:32.836 they have access to for in order for us to 0:06:32.876 --> 0:06:35.276 be able to formulate a plan to attack it. And 0:06:35.316 --> 0:06:38.756 so we found some pretty stunning things. Between twenty and 0:06:38.796 --> 0:06:42.316 thirty percent of women don't know didn't had never heard 0:06:42.356 --> 0:06:44.676 of cervical cancer, They didn't know what the symptoms were, 0:06:45.116 --> 0:06:48.596 they didn't know what the tests involved. Most stunningly, seventy 0:06:48.596 --> 0:06:52.116 five percent of Haitian women couldn't identify where their cervix is. 0:06:52.836 --> 0:06:54.756 So if I'm trying to convince you to take a 0:06:54.796 --> 0:06:57.556 test that for every thousand women screen we're going to 0:06:57.596 --> 0:07:00.556 save ten lives. But if you don't know where the 0:07:00.556 --> 0:07:04.876 cervix is, what cancer of the cervix causes, where around 0:07:04.876 --> 0:07:07.636 you to get the test? Why would you get the test? 0:07:08.036 --> 0:07:10.436 You have immediate concern you have to You're worrying about 0:07:10.476 --> 0:07:13.116 feeding and educating your children, taking care of your family, 0:07:13.596 --> 0:07:17.276 So we start there. Obviously, that's a pretty big uphill task. 0:07:17.356 --> 0:07:19.636 If we're looking at those kinds of numbers of seventy 0:07:19.676 --> 0:07:21.836 five percent of women don't know where their service is, 0:07:22.156 --> 0:07:23.876 how are we going to convince you to take this test? 0:07:23.876 --> 0:07:26.236 And the importance of it. So looking at it like 0:07:26.276 --> 0:07:27.796 that and then we say, okay, then it has to 0:07:27.836 --> 0:07:30.476 start with education, it has to start with awareness, and 0:07:30.556 --> 0:07:32.956 most importantly, it's got to start with what we call 0:07:33.036 --> 0:07:36.316 engagement with the health system. That it's not just Okay, 0:07:36.316 --> 0:07:38.476 we're going to give you a little lecture, it's more 0:07:38.516 --> 0:07:40.356 than that. Part of it is them knowing where the 0:07:40.396 --> 0:07:43.436 nearest health center is, knowing the times it's open, knowing 0:07:43.436 --> 0:07:46.396 its services they offer, Knowing the prices that they may 0:07:46.396 --> 0:07:48.876 have to pay if there are user fees. These are 0:07:48.876 --> 0:07:51.556 the things that, again, a woman who is struggling to 0:07:51.556 --> 0:07:54.436 work and raise a family at the same time may 0:07:54.436 --> 0:07:56.756 not have access to that information. So we want to 0:07:57.436 --> 0:07:59.956 reach out to them with the health system as well 0:07:59.996 --> 0:08:02.516 as teaching them where to go. The other problem is 0:08:02.556 --> 0:08:05.476 that we're talking about preventative health, and when we're talking 0:08:05.476 --> 0:08:09.676 about preventative health, that's a more difficult thing for places 0:08:10.156 --> 0:08:12.356 for people who will again are focused on the here 0:08:12.356 --> 0:08:15.836 and now and surviving through today. We know that when 0:08:15.996 --> 0:08:19.596 care is free, when we have had free cervical cancer screenings, 0:08:19.596 --> 0:08:22.116 that major hospitals around the country of Haiti, that the 0:08:22.356 --> 0:08:25.236 screening numbers are very low because the most common bearers 0:08:25.236 --> 0:08:27.876 are actually not economic, even in a poor place like Haiti, 0:08:28.196 --> 0:08:30.676 they're structural. So that's what we talk about when we 0:08:30.676 --> 0:08:32.716 talk about engagement with the health system, and that really 0:08:32.756 --> 0:08:35.916 for us was the starting point. What about prejudice? Are 0:08:35.956 --> 0:08:38.476 people disturbed by the idea of that kind of exam 0:08:38.676 --> 0:08:41.196 Is it a cultural problem as well? It certainly is 0:08:41.236 --> 0:08:44.876 in many cultures in Haiti, not particularly, but in Malawi 0:08:44.956 --> 0:08:46.876 with another place that I work it can be. And 0:08:46.916 --> 0:08:49.516 then certainly in other culture is in Asia that's an issue. 0:08:50.236 --> 0:08:52.276 I think that's why one of the things that we're 0:08:52.276 --> 0:08:55.476 doing is self vaginal swabs, meaning that the woman doesn't 0:08:55.476 --> 0:08:58.036 have to be examined at all, meaning that she inserts 0:08:58.036 --> 0:09:00.876 a Q tip into her vagina and that is enough 0:09:01.156 --> 0:09:03.196 sensitive enough the test for us to be able to 0:09:03.196 --> 0:09:06.356 determine if they are at risk for cervical cancer or not. 0:09:06.476 --> 0:09:09.476 So you adjust the test depending on where you are. Yeah, 0:09:09.636 --> 0:09:12.636 those kinds of technologies. Cool thing about this is, you know, 0:09:12.676 --> 0:09:15.356 I said we can do this with simple no technology, 0:09:15.396 --> 0:09:17.596 and that's certainly true. But a technology like that that 0:09:17.796 --> 0:09:21.556 HPV test with a self swab opens up a whole 0:09:21.596 --> 0:09:24.076 new level of possibilities. It means that we don't need 0:09:24.396 --> 0:09:28.156 a doctor because the doctor is generally necessary to do 0:09:28.196 --> 0:09:30.436 a cervical exam on a lot of patients, or even 0:09:30.436 --> 0:09:33.236 a highly trained midwife. We can have someone with a 0:09:33.316 --> 0:09:36.676 high school education do the education for the patients and 0:09:36.796 --> 0:09:39.236 teach them how to do the swab. So and it's 0:09:39.236 --> 0:09:42.516 not subjective at all, it's scientific, is very sensitive and 0:09:42.916 --> 0:09:44.796 just about as much as a PAP smere that we 0:09:44.796 --> 0:09:47.796 would get in the US. So those kinds of technologies 0:09:47.796 --> 0:09:50.476 are helping us leap frog, and they also helping us 0:09:50.476 --> 0:09:53.556 overcome barriers that maybe they're culturally. I think one of 0:09:53.556 --> 0:09:58.676 the barriers is certainly sexism, gender based violence, gender stigma. 0:09:58.916 --> 0:10:01.916 Those are the things that really cut across culture. Is 0:10:01.916 --> 0:10:04.596 even in the US and Europe, those are true barriers. 0:10:04.916 --> 0:10:08.116 In a place like Haiti, where the male partner is 0:10:08.156 --> 0:10:10.636 paying for testing, then they certainly have a say in 0:10:10.956 --> 0:10:13.836 what tests that the women undergo. In our study, that 0:10:13.916 --> 0:10:16.876 we had forty percent of our breast and cervical cancer 0:10:16.876 --> 0:10:19.956 patients had been victims of gender based violence, whether it 0:10:19.996 --> 0:10:23.516 was physical, sexual, economic, and that was compared with twenty 0:10:23.556 --> 0:10:26.916 eight percent in the general population. So we know for 0:10:26.996 --> 0:10:30.196 a fact that globally that gender based violence increases the 0:10:30.316 --> 0:10:32.636 risk of cervical cancer because it increases the risk of 0:10:32.636 --> 0:10:35.596 transmission of HPV. And now we know in Haiti at 0:10:35.676 --> 0:10:38.396 least that the women who have cancer are more likely 0:10:38.476 --> 0:10:41.156 to be victims of gender based violence. So these kinds 0:10:41.156 --> 0:10:43.996 of things matter. And even when we did to our survey, 0:10:44.116 --> 0:10:48.196 the most common cited cause for breast or cervical cancer 0:10:48.236 --> 0:10:52.196 in Haiti was were sexual violence, so rough play with 0:10:52.276 --> 0:10:55.876 breast during sex, certain sexual positions they thought would lead 0:10:55.876 --> 0:10:59.076 to cervical cancer. So there is an association in the 0:10:59.076 --> 0:11:03.356 women's mind at least between some form of sexual violence, 0:11:03.356 --> 0:11:07.436 whether it's consensual or not, as being linked to these problems. 0:11:07.796 --> 0:11:10.876 But is that true. Certainly not. The rough sex and 0:11:10.916 --> 0:11:13.676 those kinds of things don't increase the chances of HPV, 0:11:13.876 --> 0:11:16.476 but more partners does, And so I don't know about 0:11:16.516 --> 0:11:18.916 the association between the people who have more partners and 0:11:19.156 --> 0:11:21.476 gender based fines. But When a woman generally can't choose 0:11:21.476 --> 0:11:23.836 your partners, when she can't negotiate condom use and those 0:11:23.916 --> 0:11:27.076 kinds of things, then she is at a higher risk 0:11:27.196 --> 0:11:31.916 of getting HPV. How did we persuade women in the 0:11:32.036 --> 0:11:34.436 United States to take these tests? Is there a history 0:11:34.476 --> 0:11:36.956 to this story? Yeah, I mean, the papsmer has been 0:11:36.996 --> 0:11:39.196 around for eighty years, and so that's part of it. 0:11:39.236 --> 0:11:42.716 We all grew up knowing about the PAPS mirror since 0:11:42.756 --> 0:11:45.196 we hit puberty and had the birds and the bees talk. 0:11:45.316 --> 0:11:48.316 So it's something that's been ingrained in us from day one. 0:11:48.356 --> 0:11:50.756 It was ingrained in our mothers as well, and our 0:11:50.796 --> 0:11:52.876 grandmothers would probably be the ones who could tell us 0:11:52.916 --> 0:11:55.636 what they remembered when they first heard about the PAPS mirror. 0:11:55.836 --> 0:11:58.796 But so we're talking about that kind of level where 0:11:59.276 --> 0:12:02.396 twenty percent know what several cancer causes. So if we're 0:12:02.396 --> 0:12:04.236 at that level, what do we do In the US. 0:12:04.716 --> 0:12:06.756 We've had access to the care for a long time. 0:12:07.116 --> 0:12:10.476 Right now, we have NFL football players wearing pink bracelets 0:12:10.596 --> 0:12:13.836 and pink cleats for breast cancer. So those kinds of 0:12:13.876 --> 0:12:17.916 things where the awareness is everywhere, right, it's it's almost 0:12:17.996 --> 0:12:20.956 unavoidable to talk about going to get your mamogram because 0:12:20.996 --> 0:12:23.436 of breast cancer. Obviously, in the US we've now we're 0:12:23.476 --> 0:12:26.756 past cervical cancer, so we don't even talk about it anymore. Man. 0:12:26.796 --> 0:12:29.196 That may be one of the issues with HPV vaccination 0:12:29.196 --> 0:12:32.076 in the US is that people don't really remember cervical 0:12:32.116 --> 0:12:34.636 cancer because they don't know anybody who's had it. Whereas 0:12:34.636 --> 0:12:38.196 in Haiti, these women they're dying in their forties and fifties. 0:12:38.516 --> 0:12:41.316 It's a really terrible death, it's it's it's quite the downer. 0:12:41.396 --> 0:12:43.356 But at the same time, I think we've forgotten that 0:12:43.476 --> 0:12:46.636 somewhat in the US and Europe, and that's possibly why 0:12:46.636 --> 0:12:49.436 that there's still a half million women dying globally. I 0:12:49.476 --> 0:12:52.556 think we're we're there a bit with cervical cancer where 0:12:52.596 --> 0:12:55.396 we are complacent, where we can actually have a discussion 0:12:55.436 --> 0:12:57.476 about whether it's worth it or not to have an 0:12:57.596 --> 0:13:00.796 HPV vaccine. Of course it is, and of course it's needed, 0:13:00.836 --> 0:13:02.396 and of course it's gonna you know, we know it's 0:13:02.396 --> 0:13:05.756 having huge impacts on HPV prevalence in the United States 0:13:05.796 --> 0:13:08.156 and Europe. So not only how do we get there 0:13:08.196 --> 0:13:11.156 in Haiti, but how do we reawaken that consciousness in 0:13:11.196 --> 0:13:14.276 the US and Europe that we're thinking about why we 0:13:14.316 --> 0:13:17.516 need the HPAVY vaccine, and we're thinking about how do 0:13:17.596 --> 0:13:20.676 we push our governments and our companies to be more 0:13:20.716 --> 0:13:24.316 aware of these problems in low income countries to expand 0:13:24.356 --> 0:13:26.876 the services that are available. I was very struck by 0:13:26.876 --> 0:13:29.676 I watched a video clip you made about some of 0:13:29.716 --> 0:13:31.716 the work you've done in Haiti in the past, and 0:13:32.276 --> 0:13:36.116 you spoke about giving treatment to some women who had 0:13:36.196 --> 0:13:38.476 just been identified as having cancer, some who had late 0:13:38.516 --> 0:13:41.396 stage cancer, giving them an extra two or three years 0:13:41.436 --> 0:13:43.716 of their lives that they might not have had otherwise. 0:13:44.156 --> 0:13:46.996 And you kept repeating that you wanted to give them 0:13:47.036 --> 0:13:50.076 care just like in the United States, as the kind 0:13:50.116 --> 0:13:52.276 of treatment they would have if they were in a 0:13:52.316 --> 0:13:55.156 different country. This is a more personal question, but that 0:13:55.396 --> 0:13:58.716 struck me. It's clear that you have a sense of 0:13:58.756 --> 0:14:02.916 injustice that people in Haiti in other countries that you've 0:14:02.916 --> 0:14:06.116 worked in aren't getting the same level of healthcare that 0:14:06.196 --> 0:14:09.716 Americans get, or that people in the developed world get. 0:14:09.996 --> 0:14:13.036 Where does that sense of justice come from? Certainly for 0:14:13.116 --> 0:14:15.756 my parents, lots of love and gratitude to them. I 0:14:15.796 --> 0:14:18.116 think also I was raised Catholic, but I think that 0:14:18.276 --> 0:14:21.076 the Catholics tradition of service to the poor is one 0:14:21.076 --> 0:14:22.756 of the reasons I am where I am, and I 0:14:22.796 --> 0:14:25.476 think that, you know, whatsoever you do onto the least 0:14:25.476 --> 0:14:27.756 of my brothers, you do onto me. And that's something 0:14:27.796 --> 0:14:29.916 again we've forgotten in the United States, but I think 0:14:29.916 --> 0:14:32.636 it's important. And I think that's something that drives me 0:14:32.996 --> 0:14:37.436 more importantly than that is. Once you're there, you're experiencing 0:14:37.556 --> 0:14:40.116 and living with these people. Cancer patients they come in. 0:14:40.236 --> 0:14:44.276 We run a chemotherapy center as well, and Atentivating Health International, 0:14:44.276 --> 0:14:46.876 and we do breast cancer and cervical cancer, and the 0:14:46.956 --> 0:14:49.716 women come in and they're getting chemotherapy and surgery for months, 0:14:49.756 --> 0:14:51.876 and so you really get to know them. You know, 0:14:51.876 --> 0:14:55.036 the Haitians are very emotive, expressive people, and it's hard 0:14:55.116 --> 0:14:57.756 not to fall in love with them so quickly. So 0:14:58.196 --> 0:15:01.956 I've watched a lot of women that I love and 0:15:02.036 --> 0:15:06.356 respect die, and that is it has to have an 0:15:06.356 --> 0:15:09.236 impact on you. Some points it was too much, and 0:15:09.116 --> 0:15:11.836 and I withdrew. And now I've gotten to a place 0:15:11.836 --> 0:15:14.876 where I can be present and experience the sadness and 0:15:14.996 --> 0:15:17.916 grieve with the family, and then use that sense of 0:15:17.956 --> 0:15:21.276 injustice to drive us to do more. It really was 0:15:21.316 --> 0:15:23.556 heartening to know that we can make that difference because 0:15:24.076 --> 0:15:26.676 I cried a lot of nights in twenty thirteen, fourteen, 0:15:26.676 --> 0:15:29.836 and fifteen about those women. And to see those numbers 0:15:29.996 --> 0:15:33.996 is you know, we're making an impact. Give me an 0:15:34.036 --> 0:15:37.756 example of one of your patients. How does how can 0:15:37.876 --> 0:15:41.836 chemotherapy change a family's life or change the way, you know, 0:15:41.956 --> 0:15:44.516 change the way a child grows up. Even when a 0:15:44.556 --> 0:15:46.916 woman comes in with stage four, we can still treat 0:15:46.956 --> 0:15:50.836 them both breast and cervical, and so the chemotherapy for 0:15:50.836 --> 0:15:53.956 breast or ovarian cancer, we can extend their life for 0:15:54.076 --> 0:15:57.396 two three four years. You know, our median survival is 0:15:57.396 --> 0:15:59.876 about eighteen months, which is pretty close to what it 0:15:59.956 --> 0:16:03.116 is in certain middle income in high income countries. Okay, well, 0:16:03.156 --> 0:16:04.996 so the woman's only going to live in another eighteen months, 0:16:05.076 --> 0:16:07.436 what's the point. Well to her ten year old son, 0:16:07.996 --> 0:16:10.836 who then becomes a less even before she passes, that matters. 0:16:10.916 --> 0:16:12.716 That's two more years of schooling he gets to go 0:16:12.796 --> 0:16:15.796 to with her working because she's not in bed, she's 0:16:15.836 --> 0:16:18.836 back at work. She's caring for him. For a husband, 0:16:18.876 --> 0:16:21.076 if he's there, that matters in terms of having help 0:16:21.156 --> 0:16:24.276 raising the kids, and for the woman, of course, it 0:16:24.276 --> 0:16:26.396 matters to have two more years of life. And like 0:16:26.396 --> 0:16:29.916 we said that that is something that they deserve as 0:16:29.996 --> 0:16:32.796 human beings. Healthcare as a human right no matter where 0:16:32.796 --> 0:16:35.396 in the world you live. And you know, when we 0:16:35.396 --> 0:16:38.356 get them at earlier stages, we can cure them. And 0:16:38.516 --> 0:16:40.636 you know, my mentor, Paul Farmer, would always say, it's 0:16:40.636 --> 0:16:43.276 almost as if they had a treatable disease, because it 0:16:43.316 --> 0:16:45.276 is treatable. It's just a question of getting to them 0:16:45.316 --> 0:16:49.756 with these simple treatments. We can treat a woman chemotherapy 0:16:49.796 --> 0:16:52.556 and surgery and all that for about twelve hundred bucks 0:16:52.556 --> 0:16:55.636 per woman, which sounds like a lot, but we spend 0:16:55.716 --> 0:16:58.436 fifty thousand or a hundred thousand per case of breast 0:16:58.436 --> 0:17:01.316 cancer in the United States, so it really is not 0:17:01.436 --> 0:17:04.636 much in terms of the global resources, and those prices 0:17:04.636 --> 0:17:07.636 will come down as chemo prices come down and volume 0:17:07.756 --> 0:17:10.876 goes up. You scale this because you know you're one 0:17:10.956 --> 0:17:13.356 doctor and you can only be in so many places. 0:17:13.556 --> 0:17:16.436 How do you spread these tactics to others? Yeah, it's 0:17:16.436 --> 0:17:20.076 all about education and training. There are six doctors at 0:17:20.116 --> 0:17:23.076 the Innovating Health International Cancer Center in Haiti right now, 0:17:23.116 --> 0:17:25.156 and they are seeing the patients on a daily basis. 0:17:25.676 --> 0:17:29.436 We trained them to give chemo. And you know, I'm 0:17:29.476 --> 0:17:31.996 not an oncologist, I'm an internal medicine doctor. There are 0:17:32.036 --> 0:17:36.276 no fellowship trained oncologists in Haiti, and realistically we don't 0:17:36.276 --> 0:17:38.796 really need them yet in any low income country. What 0:17:38.836 --> 0:17:41.796 we need is access to basic care. So we're kind 0:17:41.796 --> 0:17:45.076 of again back to where HIV was in two thousand 0:17:45.116 --> 0:17:47.756 and three, two thousand and four, where we have the tools, 0:17:47.916 --> 0:17:50.956 but there's no specialists in it. Globally, HIV is treated 0:17:50.996 --> 0:17:54.036 by generalists. In the United States, it is generally treated 0:17:54.076 --> 0:17:57.276 by infectious disease doctors. So in the United States, cancers 0:17:57.276 --> 0:18:00.036 treat you by oncologists, and globally we need to have 0:18:00.116 --> 0:18:03.556 generalists or internists treating cancer. So we need to be 0:18:03.596 --> 0:18:07.516 training lots and lots more internal medicine doctors to give chemo, 0:18:07.956 --> 0:18:10.716 to give it safely, to give it properly into the 0:18:10.756 --> 0:18:13.076 patients who need it, and how and went. But it 0:18:13.196 --> 0:18:15.716 is not that complex. You know, in the United States 0:18:15.756 --> 0:18:17.556 and Europe, it's gotten a whole lot more complex with 0:18:17.636 --> 0:18:20.356 genetic testing and higher order things. But if we're talking 0:18:20.396 --> 0:18:24.396 about ensuring first line care and ensuring a basic standard 0:18:24.436 --> 0:18:27.676 of care. Then it's not that difficult, it's not that expensive, 0:18:27.716 --> 0:18:30.436 And we can train a doctor who's an internal medicine 0:18:30.476 --> 0:18:33.036 doctor in a week to give chemo, and we've given 0:18:33.116 --> 0:18:36.116 chemo at four different public hospitals in Haiti. We are 0:18:36.236 --> 0:18:38.996 launching a permanent program now in the North and Capation 0:18:39.596 --> 0:18:41.756 and train doctors and nurses to do it, and they 0:18:41.756 --> 0:18:44.196 come watch us for a week, We give lectures, we 0:18:44.236 --> 0:18:46.676 have discussions about it, and then after that we're in 0:18:46.716 --> 0:18:49.676 touch by phone and email and to talk about all 0:18:49.716 --> 0:18:52.396 right this particular case, is it fall within the algorithm 0:18:52.476 --> 0:18:56.156 or not? As we expand treatment, That's the way it's 0:18:56.156 --> 0:18:58.236 gonna That's the way we're gonna do it by training 0:18:58.236 --> 0:19:01.876 other doctors and nurses and not waiting for oncologists to 0:19:01.876 --> 0:19:04.836 come down and train. So in Haiti, we have probably 0:19:04.876 --> 0:19:07.796 ten different doctors given chemo through our program over the 0:19:07.876 --> 0:19:10.796 last five years, and I've trained them all, watch them, 0:19:10.796 --> 0:19:13.116 we accompany them. You know. That's the way things are 0:19:13.116 --> 0:19:16.916 going to move forward, and not through donations of medicines 0:19:16.956 --> 0:19:19.836 and foreign doctors coming in and treating patients. It's going 0:19:19.836 --> 0:19:22.716 to be through training and a local workforce to do 0:19:22.756 --> 0:19:25.836 this exactly like we did at HIV, and that's as 0:19:25.836 --> 0:19:30.116 a result of rolling out services with algorithms and in simple, 0:19:30.916 --> 0:19:34.676 low cost ways, and cancer care is there. We're there, 0:19:34.756 --> 0:19:37.716 it's just a question of doing it. In order to 0:19:37.756 --> 0:19:40.196 do this, obviously, you need to speak the language of 0:19:40.396 --> 0:19:43.756 local people, so you speak Creole. UM. Maybe you could 0:19:43.796 --> 0:19:46.636 say a few words about how you learned it, and 0:19:46.676 --> 0:19:50.556 then you had to design a campaign in Creole, you know, 0:19:50.596 --> 0:19:52.476 to reach very poor people. Can you talk a little 0:19:52.516 --> 0:19:55.516 bit about how the um you know, how you thought 0:19:55.556 --> 0:19:59.716 about preparing the education campaign. Yeah. I've been blessed to 0:19:59.756 --> 0:20:02.276 speak a couple of languages. I speak about five languages, 0:20:02.316 --> 0:20:05.316 and so I learned Creole in South Florida growing up. 0:20:07.036 --> 0:20:10.436 And you know, I think anything that we do. You know, 0:20:10.436 --> 0:20:12.996 I'm an American and when I go to Haiti or 0:20:13.076 --> 0:20:15.596 go to Malawi, I try to stand on the side 0:20:16.556 --> 0:20:18.836 because this is not my place, it's not my country, 0:20:19.796 --> 0:20:21.756 it's not my culture and not my people. And so 0:20:22.116 --> 0:20:24.876 I want to be there to support the local staff 0:20:25.116 --> 0:20:27.796 to be able to roll out those things. So when 0:20:27.836 --> 0:20:30.516 we talk about the survey that we did, we had 0:20:30.756 --> 0:20:33.996 five different Haitian organizations. There was ten people in the room, 0:20:34.076 --> 0:20:36.916 two of whom were foreigners, and eight who were Haitian. 0:20:37.476 --> 0:20:39.596 The survey was written in Creole. It was never written 0:20:39.596 --> 0:20:42.036 in English and then translated. It was carried out in Creole. 0:20:42.076 --> 0:20:44.796 The results were entered into a Creole spreadsheet. We had 0:20:44.836 --> 0:20:49.396 to teach an artificial intelligence program to interpret the data 0:20:49.476 --> 0:20:51.876 in Creole because we didn't want to translate it into 0:20:51.876 --> 0:20:55.676 and lose that authenticity with it. So same thing with 0:20:55.716 --> 0:20:59.996 our awareness materials. The pictures in it, and we're all 0:21:00.116 --> 0:21:02.556 drawn by a graphic designer who's the son of a 0:21:02.596 --> 0:21:06.116 patient of ours. The videos we have on our website, 0:21:06.476 --> 0:21:09.876 concert Point Coom, it's an all Creole website, have all 0:21:10.676 --> 0:21:14.076 breast cancer and cervical cancer survivors as the actors and actresses, 0:21:15.836 --> 0:21:17.876 and they're the ones who wrote it actually, So I, 0:21:17.996 --> 0:21:20.116 you know, I've had very little to do with it 0:21:20.836 --> 0:21:26.036 other than you know, to facilitate um, you know, help people, 0:21:26.116 --> 0:21:28.836