Speaker 1: Pushkin. I'm Mave Higgins, and this is Solvable Interviews with
Speaker 1: the world's most innovative thinkers working to solve the world's
Speaker 1: biggest problems. My solvable is tackling cervical cancer in low
Speaker 1: and middle income countries, where ninety percent of cervical cancer
Speaker 1: deaths happen wherever there's a pap smere available. That's what
Speaker 1: most women in the US and Europe know that. And
Speaker 1: cervical cancer is something that we don't even think about.
Speaker 1: And so with very low resources, very little resources, without doctors,
Speaker 1: without even clinics, we can go and screen women out
Speaker 1: in provinces, in schoolhouses and workplaces, and we can defeat
Speaker 1: cervical cancer. And really what we're talking about doing is
Speaker 1: preventing cervical cancer. That is doctor Vince Gennaro. He's an
Speaker 1: internal medicine doctor, a global health specialist, and a social
Speaker 1: justice advocate. It now here unsolvable. We do not shy
Speaker 1: away from the biggest problems, and this one certainly qualifies.
Speaker 1: Cervical cancer is a disease that's fueled by social, economic,
Speaker 1: and political inequities. The World Help Organization puts the situation
Speaker 1: in pretty blunt terms. Nine out of ten women who
Speaker 1: die from cervical cancer are in poor countries. Cervical cancer
Speaker 1: is both preventable by vaccines and education, and it's treatable.
Speaker 1: But when prevention and treatment are missing, it means that
Speaker 1: some of the most vulnerable women in the world are
Speaker 1: dying unnecessarily. It probably goes arout saying that this is
Speaker 1: not fair. In Sub Saharan Africa, cervical cancer is the
Speaker 1: number one cancer killer of women. It's so sad because
Speaker 1: we've seen these amazing health gains for women made in
Speaker 1: maternal health and HIV care around the world, so it's
Speaker 1: kind of a disaster to see that rising cervical cancer
Speaker 1: debts undermine those gains. The International Agency for Research on
Speaker 1: Cancer made some really scary sounding projections that show that
Speaker 1: unless preventative measures are implemented asap, by twenty forty, there'll
Speaker 1: be almost half a million deaths from cervical cancer per year.
Speaker 1: Here in the US. Sadly, more than four thousand women
Speaker 1: die from it each year. That is too many, but
Speaker 1: it's nowhere close to the scale that it is in
Speaker 1: low and middle income countries. Any woman listening that's here
Speaker 1: in a wealthier country will know about vaccines or are
Speaker 1: going for a smear test. Not fun, but just something
Speaker 1: that we do and it works. We just have to
Speaker 1: share it. Preventing and treating women's cancer in low income
Speaker 1: countries is doctor Vince Gennaro's life's work. He is so
Speaker 1: smart and passionate that he makes this challenge, which we
Speaker 1: know is seius and deadly, seem manageable. He's worked in
Speaker 1: seven countries. He speaks five languages, all of which you'll
Speaker 1: hear in this interview. No you won't, he is just
Speaker 1: being English. In this interview, he talks to an apple
Speaker 1: bound about cancer research here in the US, about how
Speaker 1: politics and education intersect with help, and how the nonprofit
Speaker 1: that he founded, Innovating Health International, does this huge work
Speaker 1: in countries like Haiti and Rwanda to look after women
Speaker 1: and to teach us to look after ourselves. Okay, take
Speaker 1: a listen. What's the problem? In a nutshell? Can you
Speaker 1: describe it in a couple of sentences? Globally, over half
Speaker 1: a million women are dying of cervical cancer every single year.
Speaker 1: It is a leading killer of women in low income countries,
Speaker 1: even though it's not even in the top ten cancer
Speaker 1: killers in US and Europe. So there's a huge disparity
Speaker 1: between what we know we can do and what we
Speaker 1: are actually doing. And when we're talking about a half
Speaker 1: a million desk globally women, these are women who are
Speaker 1: in their economically most productive years, in their forties and fifties.
Speaker 1: They are young mothers still, they're raising children, and when
Speaker 1: cervical cancer affects their life, it affects society at large.
Speaker 1: And what is it about this problem that makes you
Speaker 1: want to tackle it. I think in every society women
Speaker 1: are the backbone of it. The huge disparity, I think
Speaker 1: is what makes it so such a problem that it's like, well, Okay,
Speaker 1: we know we can fix this. You know, when HIV
Speaker 1: was an issue in the early two thousands in we
Speaker 1: were treating it just fine in US and Europe. We
Speaker 1: talked about expensive medications and difficult regimens and testing that
Speaker 1: was difficult. And so we're real technological challenges to rolling
Speaker 1: out widespread HIV treatment in lower income countries. With cervical cancer,
Speaker 1: we can screen with tests that cost two dollars, that
Speaker 1: has plastic speculum, and regular store bought vinegar and a light.
Speaker 1: Those are the three things that we really need to
Speaker 1: screen a for cervical cancer. So it really is something
Speaker 1: that can be done literally anywhere a woman can lay
Speaker 1: flat in privacy. It's a question then, of how to
Speaker 1: reach those women, How do we engage them in the
Speaker 1: health system, to the point that they understand the issue,
Speaker 1: that they realize the value of it, that they understand
Speaker 1: the longer term consequences of it, even in the immediacy
Speaker 1: of the life that they're living, which may often be
Speaker 1: in poverty or difficulty feeding and educating their own children.
Speaker 1: To get women to come in and engage with the
Speaker 1: health system is more the problem. To get the health
Speaker 1: system to reach out to these women and offer these
Speaker 1: simple services is more the issue than anything to do
Speaker 1: with having enough doctors or having enough clinics. So when
Speaker 1: you're faced with a problem like this one where you
Speaker 1: have the perspective of many millions of women in Haiti,
Speaker 1: for example, who don't know about cervical cancer, don't know
Speaker 1: about testing, often don't realize they have cancer until it's
Speaker 1: too late to treat, how do you begin thinking about it?
Speaker 1: What are the first depths you take? How do you
Speaker 1: break down the problem? You know? I think initially in
Speaker 1: twenty sixteen, Innovating Health International and our partners, we carried
Speaker 1: out a survey across the country of Haitio, interviewing five
Speaker 1: hundred women and men to talk about what their attitudes
Speaker 1: were towards cervical cancer and breast cancer. You know, we
Speaker 1: have to understand is that what it is that they know,
Speaker 1: what it is that they believe, what it is that
Speaker 1: they have access to for in order for us to
Speaker 1: be able to formulate a plan to attack it. And
Speaker 1: so we found some pretty stunning things. Between twenty and
Speaker 1: thirty percent of women don't know didn't had never heard
Speaker 1: of cervical cancer, They didn't know what the symptoms were,
Speaker 1: they didn't know what the tests involved. Most stunningly, seventy
Speaker 1: five percent of Haitian women couldn't identify where their cervix is.
Speaker 1: So if I'm trying to convince you to take a
Speaker 1: test that for every thousand women screen we're going to
Speaker 1: save ten lives. But if you don't know where the
Speaker 1: cervix is, what cancer of the cervix causes, where around
Speaker 1: you to get the test? Why would you get the test?
Speaker 1: You have immediate concern you have to You're worrying about
Speaker 1: feeding and educating your children, taking care of your family,
Speaker 1: So we start there. Obviously, that's a pretty big uphill task.
Speaker 1: If we're looking at those kinds of numbers of seventy
Speaker 1: five percent of women don't know where their service is,
Speaker 1: how are we going to convince you to take this test?
Speaker 1: And the importance of it. So looking at it like
Speaker 1: that and then we say, okay, then it has to
Speaker 1: start with education, it has to start with awareness, and
Speaker 1: most importantly, it's got to start with what we call
Speaker 1: engagement with the health system. That it's not just Okay,
Speaker 1: we're going to give you a little lecture, it's more
Speaker 1: than that. Part of it is them knowing where the
Speaker 1: nearest health center is, knowing the times it's open, knowing
Speaker 1: its services they offer, Knowing the prices that they may
Speaker 1: have to pay if there are user fees. These are
Speaker 1: the things that, again, a woman who is struggling to
Speaker 1: work and raise a family at the same time may
Speaker 1: not have access to that information. So we want to
Speaker 1: reach out to them with the health system as well
Speaker 1: as teaching them where to go. The other problem is
Speaker 1: that we're talking about preventative health, and when we're talking
Speaker 1: about preventative health, that's a more difficult thing for places
Speaker 1: for people who will again are focused on the here
Speaker 1: and now and surviving through today. We know that when
Speaker 1: care is free, when we have had free cervical cancer screenings,
Speaker 1: that major hospitals around the country of Haiti, that the
Speaker 1: screening numbers are very low because the most common bearers
Speaker 1: are actually not economic, even in a poor place like Haiti,
Speaker 1: they're structural. So that's what we talk about when we
Speaker 1: talk about engagement with the health system, and that really
Speaker 1: for us was the starting point. What about prejudice? Are
Speaker 1: people disturbed by the idea of that kind of exam
Speaker 1: Is it a cultural problem as well? It certainly is
Speaker 1: in many cultures in Haiti, not particularly, but in Malawi
Speaker 1: with another place that I work it can be. And
Speaker 1: then certainly in other culture is in Asia that's an issue.
Speaker 1: I think that's why one of the things that we're
Speaker 1: doing is self vaginal swabs, meaning that the woman doesn't
Speaker 1: have to be examined at all, meaning that she inserts
Speaker 1: a Q tip into her vagina and that is enough
Speaker 1: sensitive enough the test for us to be able to
Speaker 1: determine if they are at risk for cervical cancer or not.
Speaker 1: So you adjust the test depending on where you are. Yeah,
Speaker 1: those kinds of technologies. Cool thing about this is, you know,
Speaker 1: I said we can do this with simple no technology,
Speaker 1: and that's certainly true. But a technology like that that
Speaker 1: HPV test with a self swab opens up a whole
Speaker 1: new level of possibilities. It means that we don't need
Speaker 1: a doctor because the doctor is generally necessary to do
Speaker 1: a cervical exam on a lot of patients, or even
Speaker 1: a highly trained midwife. We can have someone with a
Speaker 1: high school education do the education for the patients and
Speaker 1: teach them how to do the swab. So and it's
Speaker 1: not subjective at all, it's scientific, is very sensitive and
Speaker 1: just about as much as a PAP smere that we
Speaker 1: would get in the US. So those kinds of technologies
Speaker 1: are helping us leap frog, and they also helping us
Speaker 1: overcome barriers that maybe they're culturally. I think one of
Speaker 1: the barriers is certainly sexism, gender based violence, gender stigma.
Speaker 1: Those are the things that really cut across culture. Is
Speaker 1: even in the US and Europe, those are true barriers.
Speaker 1: In a place like Haiti, where the male partner is
Speaker 1: paying for testing, then they certainly have a say in
Speaker 1: what tests that the women undergo. In our study, that
Speaker 1: we had forty percent of our breast and cervical cancer
Speaker 1: patients had been victims of gender based violence, whether it
Speaker 1: was physical, sexual, economic, and that was compared with twenty
Speaker 1: eight percent in the general population. So we know for
Speaker 1: a fact that globally that gender based violence increases the
Speaker 1: risk of cervical cancer because it increases the risk of
Speaker 1: transmission of HPV. And now we know in Haiti at
Speaker 1: least that the women who have cancer are more likely
Speaker 1: to be victims of gender based violence. So these kinds
Speaker 1: of things matter. And even when we did to our survey,
Speaker 1: the most common cited cause for breast or cervical cancer
Speaker 1: in Haiti was were sexual violence, so rough play with
Speaker 1: breast during sex, certain sexual positions they thought would lead
Speaker 1: to cervical cancer. So there is an association in the
Speaker 1: women's mind at least between some form of sexual violence,
Speaker 1: whether it's consensual or not, as being linked to these problems.
Speaker 1: But is that true. Certainly not. The rough sex and
Speaker 1: those kinds of things don't increase the chances of HPV,
Speaker 1: but more partners does, And so I don't know about
Speaker 1: the association between the people who have more partners and
Speaker 1: gender based fines. But When a woman generally can't choose
Speaker 1: your partners, when she can't negotiate condom use and those
Speaker 1: kinds of things, then she is at a higher risk
Speaker 1: of getting HPV. How did we persuade women in the
Speaker 1: United States to take these tests? Is there a history
Speaker 1: to this story? Yeah, I mean, the papsmer has been
Speaker 1: around for eighty years, and so that's part of it.
Speaker 1: We all grew up knowing about the PAPS mirror since
Speaker 1: we hit puberty and had the birds and the bees talk.
Speaker 1: So it's something that's been ingrained in us from day one.
Speaker 1: It was ingrained in our mothers as well, and our
Speaker 1: grandmothers would probably be the ones who could tell us
Speaker 1: what they remembered when they first heard about the PAPS mirror.
Speaker 1: But so we're talking about that kind of level where
Speaker 1: twenty percent know what several cancer causes. So if we're
Speaker 1: at that level, what do we do In the US.
Speaker 1: We've had access to the care for a long time.
Speaker 1: Right now, we have NFL football players wearing pink bracelets
Speaker 1: and pink cleats for breast cancer. So those kinds of
Speaker 1: things where the awareness is everywhere, right, it's it's almost
Speaker 1: unavoidable to talk about going to get your mamogram because
Speaker 1: of breast cancer. Obviously, in the US we've now we're
Speaker 1: past cervical cancer, so we don't even talk about it anymore. Man.
Speaker 1: That may be one of the issues with HPV vaccination
Speaker 1: in the US is that people don't really remember cervical
Speaker 1: cancer because they don't know anybody who's had it. Whereas
Speaker 1: in Haiti, these women they're dying in their forties and fifties.
Speaker 1: It's a really terrible death, it's it's it's quite the downer.
Speaker 1: But at the same time, I think we've forgotten that
Speaker 1: somewhat in the US and Europe, and that's possibly why
Speaker 1: that there's still a half million women dying globally. I
Speaker 1: think we're we're there a bit with cervical cancer where
Speaker 1: we are complacent, where we can actually have a discussion
Speaker 1: about whether it's worth it or not to have an
Speaker 1: HPV vaccine. Of course it is, and of course it's needed,
Speaker 1: and of course it's gonna you know, we know it's
Speaker 1: having huge impacts on HPV prevalence in the United States
Speaker 1: and Europe. So not only how do we get there
Speaker 1: in Haiti, but how do we reawaken that consciousness in
Speaker 1: the US and Europe that we're thinking about why we
Speaker 1: need the HPAVY vaccine, and we're thinking about how do
Speaker 1: we push our governments and our companies to be more
Speaker 1: aware of these problems in low income countries to expand
Speaker 1: the services that are available. I was very struck by
Speaker 1: I watched a video clip you made about some of
Speaker 1: the work you've done in Haiti in the past, and
Speaker 1: you spoke about giving treatment to some women who had
Speaker 1: just been identified as having cancer, some who had late
Speaker 1: stage cancer, giving them an extra two or three years
Speaker 1: of their lives that they might not have had otherwise.
Speaker 1: And you kept repeating that you wanted to give them
Speaker 1: care just like in the United States, as the kind
Speaker 1: of treatment they would have if they were in a
Speaker 1: different country. This is a more personal question, but that
Speaker 1: struck me. It's clear that you have a sense of
Speaker 1: injustice that people in Haiti in other countries that you've
Speaker 1: worked in aren't getting the same level of healthcare that
Speaker 1: Americans get, or that people in the developed world get.
Speaker 1: Where does that sense of justice come from? Certainly for
Speaker 1: my parents, lots of love and gratitude to them. I
Speaker 1: think also I was raised Catholic, but I think that
Speaker 1: the Catholics tradition of service to the poor is one
Speaker 1: of the reasons I am where I am, and I
Speaker 1: think that, you know, whatsoever you do onto the least
Speaker 1: of my brothers, you do onto me. And that's something
Speaker 1: again we've forgotten in the United States, but I think
Speaker 1: it's important. And I think that's something that drives me
Speaker 1: more importantly than that is. Once you're there, you're experiencing
Speaker 1: and living with these people. Cancer patients they come in.
Speaker 1: We run a chemotherapy center as well, and Atentivating Health International,
Speaker 1: and we do breast cancer and cervical cancer, and the
Speaker 1: women come in and they're getting chemotherapy and surgery for months,
Speaker 1: and so you really get to know them. You know,
Speaker 1: the Haitians are very emotive, expressive people, and it's hard
Speaker 1: not to fall in love with them so quickly. So
Speaker 1: I've watched a lot of women that I love and
Speaker 1: respect die, and that is it has to have an
Speaker 1: impact on you. Some points it was too much, and
Speaker 1: and I withdrew. And now I've gotten to a place
Speaker 1: where I can be present and experience the sadness and
Speaker 1: grieve with the family, and then use that sense of
Speaker 1: injustice to drive us to do more. It really was
Speaker 1: heartening to know that we can make that difference because
Speaker 1: I cried a lot of nights in twenty thirteen, fourteen,
Speaker 1: and fifteen about those women. And to see those numbers
Speaker 1: is you know, we're making an impact. Give me an
Speaker 1: example of one of your patients. How does how can
Speaker 1: chemotherapy change a family's life or change the way, you know,
Speaker 1: change the way a child grows up. Even when a
Speaker 1: woman comes in with stage four, we can still treat
Speaker 1: them both breast and cervical, and so the chemotherapy for
Speaker 1: breast or ovarian cancer, we can extend their life for
Speaker 1: two three four years. You know, our median survival is
Speaker 1: about eighteen months, which is pretty close to what it
Speaker 1: is in certain middle income in high income countries. Okay, well,
Speaker 1: so the woman's only going to live in another eighteen months,
Speaker 1: what's the point. Well to her ten year old son,
Speaker 1: who then becomes a less even before she passes, that matters.
Speaker 1: That's two more years of schooling he gets to go
Speaker 1: to with her working because she's not in bed, she's
Speaker 1: back at work. She's caring for him. For a husband,
Speaker 1: if he's there, that matters in terms of having help
Speaker 1: raising the kids, and for the woman, of course, it
Speaker 1: matters to have two more years of life. And like
Speaker 1: we said that that is something that they deserve as
Speaker 1: human beings. Healthcare as a human right no matter where
Speaker 1: in the world you live. And you know, when we
Speaker 1: get them at earlier stages, we can cure them. And
Speaker 1: you know, my mentor, Paul Farmer, would always say, it's
Speaker 1: almost as if they had a treatable disease, because it
Speaker 1: is treatable. It's just a question of getting to them
Speaker 1: with these simple treatments. We can treat a woman chemotherapy
Speaker 1: and surgery and all that for about twelve hundred bucks
Speaker 1: per woman, which sounds like a lot, but we spend
Speaker 1: fifty thousand or a hundred thousand per case of breast
Speaker 1: cancer in the United States, so it really is not
Speaker 1: much in terms of the global resources, and those prices
Speaker 1: will come down as chemo prices come down and volume
Speaker 1: goes up. You scale this because you know you're one
Speaker 1: doctor and you can only be in so many places.
Speaker 1: How do you spread these tactics to others? Yeah, it's
Speaker 1: all about education and training. There are six doctors at
Speaker 1: the Innovating Health International Cancer Center in Haiti right now,
Speaker 1: and they are seeing the patients on a daily basis.
Speaker 1: We trained them to give chemo. And you know, I'm
Speaker 1: not an oncologist, I'm an internal medicine doctor. There are
Speaker 1: no fellowship trained oncologists in Haiti, and realistically we don't
Speaker 1: really need them yet in any low income country. What
Speaker 1: we need is access to basic care. So we're kind
Speaker 1: of again back to where HIV was in two thousand
Speaker 1: and three, two thousand and four, where we have the tools,
Speaker 1: but there's no specialists in it. Globally, HIV is treated
Speaker 1: by generalists. In the United States, it is generally treated
Speaker 1: by infectious disease doctors. So in the United States, cancers
Speaker 1: treat you by oncologists, and globally we need to have
Speaker 1: generalists or internists treating cancer. So we need to be
Speaker 1: training lots and lots more internal medicine doctors to give chemo,
Speaker 1: to give it safely, to give it properly into the
Speaker 1: patients who need it, and how and went. But it
Speaker 1: is not that complex. You know, in the United States
Speaker 1: and Europe, it's gotten a whole lot more complex with
Speaker 1: genetic testing and higher order things. But if we're talking
Speaker 1: about ensuring first line care and ensuring a basic standard
Speaker 1: of care. Then it's not that difficult, it's not that expensive,
Speaker 1: And we can train a doctor who's an internal medicine
Speaker 1: doctor in a week to give chemo, and we've given
Speaker 1: chemo at four different public hospitals in Haiti. We are
Speaker 1: launching a permanent program now in the North and Capation
Speaker 1: and train doctors and nurses to do it, and they
Speaker 1: come watch us for a week, We give lectures, we
Speaker 1: have discussions about it, and then after that we're in
Speaker 1: touch by phone and email and to talk about all
Speaker 1: right this particular case, is it fall within the algorithm
Speaker 1: or not? As we expand treatment, That's the way it's
Speaker 1: gonna That's the way we're gonna do it by training
Speaker 1: other doctors and nurses and not waiting for oncologists to
Speaker 1: come down and train. So in Haiti, we have probably
Speaker 1: ten different doctors given chemo through our program over the
Speaker 1: last five years, and I've trained them all, watch them,
Speaker 1: we accompany them. You know. That's the way things are
Speaker 1: going to move forward, and not through donations of medicines
Speaker 1: and foreign doctors coming in and treating patients. It's going
Speaker 1: to be through training and a local workforce to do
Speaker 1: this exactly like we did at HIV, and that's as
Speaker 1: a result of rolling out services with algorithms and in simple,
Speaker 1: low cost ways, and cancer care is there. We're there,
Speaker 1: it's just a question of doing it. In order to
Speaker 1: do this, obviously, you need to speak the language of
Speaker 1: local people, so you speak Creole. UM. Maybe you could
Speaker 1: say a few words about how you learned it, and
Speaker 1: then you had to design a campaign in Creole, you know,
Speaker 1: to reach very poor people. Can you talk a little
Speaker 1: bit about how the um you know, how you thought
Speaker 1: about preparing the education campaign. Yeah. I've been blessed to
Speaker 1: speak a couple of languages. I speak about five languages,
Speaker 1: and so I learned Creole in South Florida growing up.
Speaker 1: And you know, I think anything that we do. You know,
Speaker 1: I'm an American and when I go to Haiti or
Speaker 1: go to Malawi, I try to stand on the side
Speaker 1: because this is not my place, it's not my country,
Speaker 1: it's not my culture and not my people. And so
Speaker 1: I want to be there to support the local staff
Speaker 1: to be able to roll out those things. So when
Speaker 1: we talk about the survey that we did, we had
Speaker 1: five different Haitian organizations. There was ten people in the room,
Speaker 1: two of whom were foreigners, and eight who were Haitian.
Speaker 1: The survey was written in Creole. It was never written
Speaker 1: in English and then translated. It was carried out in Creole.
Speaker 1: The results were entered into a Creole spreadsheet. We had
Speaker 1: to teach an artificial intelligence program to interpret the data
Speaker 1: in Creole because we didn't want to translate it into
Speaker 1: and lose that authenticity with it. So same thing with
Speaker 1: our awareness materials. The pictures in it, and we're all
Speaker 1: drawn by a graphic designer who's the son of a
Speaker 1: patient of ours. The videos we have on our website,
Speaker 1: concert Point Coom, it's an all Creole website, have all
Speaker 1: breast cancer and cervical cancer survivors as the actors and actresses,
Speaker 1: and they're the ones who wrote it actually, So I,
Speaker 1: you know, I've had very little to do with it
Speaker 1: other than you know, to facilitate um, you know, help people,
Speaker 1: give them the resources. The Haitians are in particular super
Speaker 1: creative and so they're they're really good at at at
Speaker 1: those kinds of things. And the videos are you know,
Speaker 1: they're not just someone talking to the camera. It's a conversation.
Speaker 1: It's a little bit of a soap opera and people
Speaker 1: get involved in them even though they're only three minutes long.
Speaker 1: So it's more about accompaniment and helping our colleagues in
Speaker 1: low income countries to express themselves. And you know what
Speaker 1: they need is they need some time space money to
Speaker 1: be able to accomplish those things. And it's not really
Speaker 1: about um us doing it. It's about us standing standing
Speaker 1: aside and letting them do their thing like we would
Speaker 1: do here. But we just have a whole lot more resources.
Speaker 1: Give me some examples of success. So how do you
Speaker 1: know you're succeeding? This is a vast problem. You're tackling
Speaker 1: it from different angles. You're doing prevention, you're doing new
Speaker 1: kinds of treatment, you're training doctors. What makes you think
Speaker 1: you can can solve this problem? You know, we talked
Speaker 1: about the personal aspect. Now I'm by sitting in office
Speaker 1: and talk and write grants and think of ideas and
Speaker 1: look at numbers and so those numbers are really what
Speaker 1: we're talking about, and it's it's impersonal. But at the
Speaker 1: same time, if I say we screened four thousand women
Speaker 1: at a factory for cervical cancer, then we know we
Speaker 1: saved at least ten lives. We know that that was
Speaker 1: a successful program because we did what we set out
Speaker 1: to do it with the budget we had. We know
Speaker 1: that we've handed out sixty thousand booklets for breast and
Speaker 1: cervical cancer awareness. We know, like I said, we've trained
Speaker 1: fifty doctors and ninety nurses and cancer treatment over the
Speaker 1: last three years. That I said, the statum most proud
Speaker 1: of is the fact that we've decreased the number of
Speaker 1: women coming in in stage four breast cancer from forty
Speaker 1: percent to twenty two percent in five years. Because I
Speaker 1: know that is huge numbers, A live saved. Our populations
Speaker 1: also getting younger, there's more women under forty coming in.
Speaker 1: We're going to treat close to three hundred women with
Speaker 1: breast cancer this year alone. We've already we've treated over
Speaker 1: a thousand in the last couple of years. So the numbers,
Speaker 1: while impersonal, are certainly telling. And then you know, you
Speaker 1: look at like on our website, there's Nadine who's twenty six.
Speaker 1: When she came in with breast cancer. She had the
Speaker 1: support of loving husband, so she not only found the mass,
Speaker 1: but sought out care and got to us quickly, and
Speaker 1: you know she's cured she's now thirty years old, she's
Speaker 1: got two kids. Every time I see Nadine, you know,
Speaker 1: it makes me smile. It's those two sides. It's the numbers,
Speaker 1: number of doctors trained, the number of people that were
Speaker 1: treating and screening, and the lives touched. We know we
Speaker 1: have the tools, we know we have we're making progress.
Speaker 1: The fact that I'm sitting here speaking with you tells
Speaker 1: me that we're onto something, that this is an issue
Speaker 1: that people care about and want to hear about, and
Speaker 1: this is an issue that's moving forward. You know, we
Speaker 1: just gotta we gotta get over that hump to the
Speaker 1: point where we are now rolling these programs out. We're
Speaker 1: not talking about pilot programs or small scale that. We're
Speaker 1: talking about national, international, global, and really decreasing that number
Speaker 1: of half a million women dying every year from cervical cancer,
Speaker 1: and it's totally solvable. What kind of decrease are we
Speaker 1: talking about and by when? What would be your guests?
Speaker 1: So even if we were to test every woman in
Speaker 1: low end, middle income countries for cervical cancer even once
Speaker 1: in their lifetime, one papsmere, one HPV test, one test
Speaker 1: with vinegar, we'd reduce cervical cancer mortality by eighty or
Speaker 1: ninety percent, So we really don't have to set up
Speaker 1: an infrastructure where they're getting paps members every three years.
Speaker 1: That would to get to one hundred percent, we would,
Speaker 1: but to get eighty percent, which then we're talking about
Speaker 1: four hundred thousand lives saved, we just have to screen
Speaker 1: them once. That's why we're talking about mobile screening. We're
Speaker 1: going to go out into a clinic in the middle
Speaker 1: of nowhere with a community healthcare worker with a backpack
Speaker 1: full of HPV swabs. She talks to the women, gives
Speaker 1: them a lecture on not only cervical and breast cancer,
Speaker 1: but also sexual reproductive health. They do breast exam, she
Speaker 1: teaches them how to do a self breast exam, and
Speaker 1: then the women do insert the HPV self swab. We
Speaker 1: come back to that same town two weeks later with
Speaker 1: a midwife and for all those women who are HPV
Speaker 1: positive it's around twenty five percent. We treat them right
Speaker 1: then and there with a battery operated piece of equipment
Speaker 1: that basically uses heat to remove the pre cervical cancer
Speaker 1: from the cervix. It's battery operated, it's portable, it's about
Speaker 1: the size of a large cell phone or a tablet,
Speaker 1: and it can be done anywhere a woman can lay flat,
Speaker 1: we can do it in a church on a church pew,
Speaker 1: behind a curtain. You know. Those kinds of things are
Speaker 1: or I think what makes this feasible. There's other technology
Speaker 1: from Mobile ODT. It's the Eva Culpa scope and it's
Speaker 1: a it's a connected to a smartphone and it's got
Speaker 1: a little camera and magnifying glass to look at the
Speaker 1: cervix and we can take pictures and stream video and
Speaker 1: quality control with it. But the machine is actually going
Speaker 1: to be able to tell a normal servix versus an
Speaker 1: abnormal service come this fall. That's interesting. So you're talking
Speaker 1: about actually a combination of low tech and very high
Speaker 1: tech potentially. So then so part of the way to
Speaker 1: solve it is to combine them together. Well, so we're
Speaker 1: talking about doing tomorrow's test for cervical cancer today, HAITI
Speaker 1: is leapfrogging in the United States. By using these HPV tests,
Speaker 1: our daughters will not be getting pap smears, and so
Speaker 1: HAITI is moving past that and leapfrogging, and that's that's important.
Speaker 1: We're pairing it with education and engagement we're coming to them,
Speaker 1: We're going to their workplace, We're going to their their
Speaker 1: church on a Sunday and screening fifty women. And everything's
Speaker 1: battery operated. Everything can be you know, use internet or
Speaker 1: not Internet if there's no service out where they are.
Speaker 1: It is beautiful, simple technology, which means you don't have
Speaker 1: to train the people as much. The cost of the
Speaker 1: you know, equipment is two three thousand bucks, which spread
Speaker 1: out over you know, is nothing comparatively speaking, and you know,
Speaker 1: because you're paying a community healthcare worker instead of a doctor,
Speaker 1: the costs have dropped significantly for the human resources side.
Speaker 1: So using technology, going out there with a backpack full
Speaker 1: of supplies and engaging on a human level, convincing them
Speaker 1: to take the test, telling them how important it is,
Speaker 1: and then treating them right then and there in this
Speaker 1: one room schoolhouse in this church. That's what makes this
Speaker 1: a solvable problem, is is getting out into the community
Speaker 1: to community based education, screening and treatment. So people listening
Speaker 1: to this program, what can they do to help solve
Speaker 1: the problem of high rates of cervical cancer in the
Speaker 1: developing world? I mean, I think the first thing we
Speaker 1: can do is make sure you're getting screened and make
Speaker 1: sure we're getting vaccinated at home. I think that's got
Speaker 1: to be baseline, and we have to have real conversations
Speaker 1: about the effectiveness of these interventions so that we understand
Speaker 1: how effective they are in other places. If there's any
Speaker 1: doubt of how effective HPV vaccine is here in the
Speaker 1: United States, it's going to be hard to convince people
Speaker 1: of the solvability of this problem. I think advocating for
Speaker 1: cancer research is always helpful for us. You know, the
Speaker 1: cancer moonshot in the United States. Those are the things
Speaker 1: that produce technologies that help places like Haiti Leapfrog. I think,
Speaker 1: you know, it doesn't make sense to have this discussion
Speaker 1: without talking about voting. Um you need you need to
Speaker 1: vote your conscience and vote where to make things better
Speaker 1: where people live. If we're talking about mass immigration and
Speaker 1: Europe and Central America, that that's partially because there's services
Speaker 1: don't exist where they live and they are coming for
Speaker 1: a better life. And then vote your conscience through your
Speaker 1: wallet by purchasing from companies like Gap and Levis and
Speaker 1: other companies that are using fair trade practices and providing
Speaker 1: healthcare to the people who in the supply chain. And
Speaker 1: then finally be open with your with your heart, and
Speaker 1: with your wallet. I think it's important. America is the
Speaker 1: most generous country in the world. Two percent of all
Speaker 1: of our income goes to donations, and that's by far
Speaker 1: and away more than any other country in the world,
Speaker 1: and so I want to encourage people to get out
Speaker 1: there and give. The money does end up helping people?
Speaker 1: You know, do your research, do your due diligence, but
Speaker 1: donate your time, don'tate your money. It matters. Such a
Speaker 1: great conversation now, cervical cancer, it's still a threat in
Speaker 1: the global north. But isn't it crazy how those of
Speaker 1: us lucky enough to live in some of the eighty
Speaker 1: four countries around the world with this HPV vaccine program.
Speaker 1: It's like we've almost forgotten about the diseases it's protecting
Speaker 1: us from. And an interesting side note is that more
Speaker 1: than twenty of those countries now give the vaccine to
Speaker 1: boys and girls. I'm sure it struck you as it
Speaker 1: did me. How practical minded doctor de Gennio is at
Speaker 1: the same time as being really compassionate. He mentioned this
Speaker 1: book called Scarcity, The New Science of Having Less and
Speaker 1: how it defines our lives, which weirdly I happen to
Speaker 1: be reading at the moment, so I want to add
Speaker 1: my endorsement for what that's worth. Now that is your
Speaker 1: homework before next week's episode. No, it's not. I'm just kidding,
Speaker 1: Thanks for listening. Solvable is a collaboration between Put Industries
Speaker 1: and the Rockefeller Foundation, with production by Laura Hyde, Hester Kant,
Speaker 1: Laura Sheeter, and Ruth Barnes from Chalk and Blade. Pushkin's
Speaker 1: executive producer is Neia LaBelle, Research by Sheer, Vincent, engineering
Speaker 1: by Jason Gambrel and the great folks at GSI Studios.
Speaker 1: Original music composed by Pascal Wise and special thanks to
Speaker 1: Maggie Taylor, Heather Fine, Julia Barton, Carli Mgliori, Jacob Weisberg,
Speaker 1: and Malcolm Gladwell. You can learn more about solving Today's
Speaker 1: biggest problems at Rockefeller Foundation dot org slash solvable. I'm
Speaker 1: Mave Higgins. Now goost solve it.