WEBVTT - Maternal Mortality is Solvable 0:00:15.076 --> 0:00:21.156 Pushkin. I'm Maybe Higgins and this is Solvable Interviews with 0:00:21.196 --> 0:00:25.276 the world's most innovative thinkers working to solve the world's 0:00:25.316 --> 0:00:29.676 biggest problems. My name is Nevine Rao. I'm the senior 0:00:29.716 --> 0:00:34.036 vice president for Health and Rockefeller Foundation, and I believe 0:00:34.516 --> 0:00:38.716 the crisis of maternal mortality is solvable. This episode, we're 0:00:38.756 --> 0:00:41.676 hearing from doctor Nevine Rau. You just heard him there. 0:00:41.796 --> 0:00:45.356 He's from the Rockefeller Foundation and he is a renowned 0:00:45.476 --> 0:00:51.396 expert in safe pregnancies and healthy deliveries around the world. Now, 0:00:51.436 --> 0:00:53.876 if you had to guess how many babies would you 0:00:53.916 --> 0:00:56.796 say are born every day, I'll give you a second. 0:00:57.596 --> 0:01:01.756 Now I cheated. I looked it up and UNISF estimates 0:01:01.796 --> 0:01:05.356 that an average of wait for it, three hundred and 0:01:05.476 --> 0:01:10.276 fifty three thousand babies are born each day around the world. 0:01:10.916 --> 0:01:14.716 Is not incredible. It's more than four births every second, 0:01:15.356 --> 0:01:18.156 and most of those they're safe for both the mother 0:01:18.316 --> 0:01:21.716 and the baby. But many of those births are not. 0:01:22.236 --> 0:01:26.476 In fact, nearly eight hundred and thirty women die every 0:01:26.596 --> 0:01:32.396 day due to complications during pregnancy and childbirth. Now, most 0:01:32.436 --> 0:01:36.236 of these deaths can be prevented through skilled care at 0:01:36.316 --> 0:01:41.716 childbirth and just having access to emergency obstretric care. But 0:01:41.876 --> 0:01:45.916 in Sub Saharan Africa, where maternal mortality ratios are the highest, 0:01:46.356 --> 0:01:49.516 fewer than half of women are attended to by a 0:01:49.556 --> 0:01:53.156 trained midwife or a nurse or a doctor during childbirth. 0:01:53.996 --> 0:01:57.636 So you can probably guess that maternal deaths mirror the 0:01:57.676 --> 0:02:00.596 gap between the rich and the poor. Less than one 0:02:00.676 --> 0:02:05.236 percent of maternal deaths happen in wealthy countries. But I 0:02:05.276 --> 0:02:08.636 wonder if you knew that America has the highest maternal 0:02:08.756 --> 0:02:13.276 mortality rate of all industrial countries, in fact, by several 0:02:13.316 --> 0:02:17.916 times over. Maternal and tile survival are the hallmarks of 0:02:17.956 --> 0:02:22.356 healthy communities, and doctor Rown knows that. But he also 0:02:22.476 --> 0:02:26.876 understands that although major advances in digital technology and data 0:02:26.916 --> 0:02:32.436 science are definitely improving health intervention effectiveness, the global health 0:02:32.476 --> 0:02:36.956 divide persists. All of these wonderful innovations, well, they're just 0:02:36.996 --> 0:02:41.596 not reaching the poorest and most vulnerable communities. Doctor Rao 0:02:41.876 --> 0:02:46.036 envisions a world where the data gap, and therefore the 0:02:46.076 --> 0:02:49.836 health gap, can be bridged, and we'll hear more about 0:02:49.876 --> 0:02:53.476 how he reached this thinking and also his daily work 0:02:53.596 --> 0:02:57.196 towards this much better future. Let's listen to him now 0:02:57.196 --> 0:03:00.996 with an apple bound What in your background led you 0:03:01.036 --> 0:03:04.076 to this problem? How did you identify this as a 0:03:04.276 --> 0:03:07.556 concrete problem that can be solved? And how must have 0:03:07.596 --> 0:03:11.276 been about twenty five part of my training as a 0:03:11.316 --> 0:03:16.276 medical student in rural India, and I remember this sixteen 0:03:16.396 --> 0:03:20.636 year old girl being brought in. She had twins, and 0:03:20.676 --> 0:03:23.316 these were the days when we didn't know she had twins. 0:03:23.316 --> 0:03:26.676 There was no echo cardiogram, and apparently she delivered one 0:03:26.716 --> 0:03:28.756 of the twins at home. It was a prolonged labor. 0:03:29.236 --> 0:03:31.916 And now they brought her in to the hospital because 0:03:32.156 --> 0:03:35.876 she had a second baby that was also obstructed. And 0:03:35.956 --> 0:03:39.156 I remember there and helping with that, and as part 0:03:39.156 --> 0:03:44.476 of that second delivery, she started bleeding and then literally 0:03:44.516 --> 0:03:47.996 bled out, and I remember trying to stem the blood 0:03:47.996 --> 0:03:51.396 and it's so horrific when you see blood gushing out 0:03:51.396 --> 0:03:54.196 of a woman's Wigiane's just and you could see that 0:03:54.236 --> 0:03:56.956 she was dying, and she knew she was dying. But 0:03:57.076 --> 0:04:00.436 I never forget that, but that stayed with me. And 0:04:00.516 --> 0:04:06.316 that was almost forty five years ago. And when I 0:04:06.356 --> 0:04:09.276 got to America and I finished my training and was 0:04:09.276 --> 0:04:13.156 a practicing physician, I was horrified to hear that this 0:04:13.236 --> 0:04:16.916 problem still exists and in fact is getting worse in 0:04:16.956 --> 0:04:21.916 some countries, and that even today woman died during pregnancy 0:04:21.916 --> 0:04:26.276 and childbirth. The tragedy is that we know how to 0:04:26.316 --> 0:04:28.956 save them. Most of the drugs and most of the 0:04:29.076 --> 0:04:33.636 procedures have been in place since the nineteen forties, and 0:04:33.716 --> 0:04:37.116 in some countries there is no materal mortality so to 0:04:37.156 --> 0:04:41.196 speak of, and so it is solvable. It has been 0:04:41.196 --> 0:04:43.796 solved in this day and age. There's some Scandinavian countries 0:04:43.836 --> 0:04:47.476 that have solved it. So it is truly solvable, and 0:04:47.596 --> 0:04:51.116 it has been solved. The fact that we still have 0:04:51.356 --> 0:04:54.676 eight hundred women dying every day. Literally that's two jumber 0:04:54.756 --> 0:04:58.876 jets crashing every day. I realized that we as a 0:04:59.476 --> 0:05:03.156 human race are not going to progress unless we say 0:05:03.196 --> 0:05:06.396 no to these unnecessary debts. Walk me through the nature 0:05:06.436 --> 0:05:08.916 of the problem. So you say, the medical profession has 0:05:09.156 --> 0:05:12.796 come up with solutions, we have ways to prevent women 0:05:12.836 --> 0:05:15.916 from dying in childbirth. What is stopping people from getting 0:05:15.916 --> 0:05:19.316 the healthcare that they need. I'll break it down. It's 0:05:19.436 --> 0:05:25.156 very traditionally broken down into three segments. They're called three delays. 0:05:25.316 --> 0:05:28.276 And this is very well researched and written about The 0:05:28.316 --> 0:05:32.276 first delay is delay in seeking care. So this is 0:05:32.276 --> 0:05:36.596 a delay in the woman herself going to the hospital 0:05:36.756 --> 0:05:41.156 getting prenatal checkups, understanding that this needs and should be 0:05:41.196 --> 0:05:43.876 a medical care and take care of her body and 0:05:44.036 --> 0:05:47.796 her health, or the family also understanding that this should 0:05:47.836 --> 0:05:51.196 be a delivery in the facility and that usually the 0:05:51.276 --> 0:05:55.076 feeling in these villagers is the mother in law saying, look, 0:05:55.116 --> 0:05:58.196 I delivered your husband in that back room. You go 0:05:58.236 --> 0:06:00.076 and do it. We're not going to spend money on 0:06:00.156 --> 0:06:03.036 hospitals doctors, and by the way, you still have to 0:06:03.036 --> 0:06:06.716 sweep the barn and make the cows. So the first 0:06:06.716 --> 0:06:10.396 delay is in seeking care even is a huge delay. 0:06:10.436 --> 0:06:13.916 And the second delay is getting to care. So they 0:06:13.956 --> 0:06:16.396 have realized, okay, they have done that, they've gone and 0:06:16.516 --> 0:06:19.476 seen and had some prenatal checkups, but they have not 0:06:19.676 --> 0:06:23.036 planned for how they're going to get to care. Either 0:06:23.116 --> 0:06:25.276 they have not don't have the money at the last 0:06:25.316 --> 0:06:28.596 minute to pay for the automobile the taxi, or they're 0:06:28.636 --> 0:06:32.316 no ambulances, or even in certain parts such as Zambia, 0:06:32.516 --> 0:06:34.756 if the flash floods have come and the road is 0:06:34.796 --> 0:06:37.036 washed out, there's no way to get to care. So 0:06:37.076 --> 0:06:40.956 the second delay is in getting to care. And the 0:06:40.956 --> 0:06:44.636 third delay is receiving care. So there sometimes they do 0:06:44.676 --> 0:06:47.676 that and they come and at the hospital there is 0:06:47.716 --> 0:06:51.036 either no alexity, there's no medication, there's no train doctor, 0:06:51.076 --> 0:06:56.036 there's no anesthesia, there no facilities, And so the third 0:06:56.076 --> 0:07:00.076 delay isn't receiving care. And so it's not just enough 0:07:00.076 --> 0:07:02.916 for us to say, oh, okay, we'll make sure they're ambulances, 0:07:02.956 --> 0:07:06.396 because if they don't get into the ambulance, it's meaningless. 0:07:06.436 --> 0:07:08.916 And or if they say, we say, we'll just put 0:07:09.156 --> 0:07:12.836 dication and we'll train doctors, but if you haven't done 0:07:11.956 --> 0:07:17.156 the community outreach to make them want to come, it's meaningless. 0:07:17.196 --> 0:07:20.116 So really all three delays need to be addressed together. 0:07:20.596 --> 0:07:23.996 And usually most of these women die a combination of 0:07:24.036 --> 0:07:27.876 the delays. Most often it's all three. So maybe can 0:07:27.916 --> 0:07:30.236 you give me some idea of what we're talking about 0:07:30.276 --> 0:07:35.716 in terms of numbers how many women die annually, but 0:07:35.836 --> 0:07:38.956 also how have those numbers been reduced in recent years, 0:07:39.556 --> 0:07:42.476 and how do you foresee them being reduced further in 0:07:42.516 --> 0:07:45.876 the next ten or twenty or thirty years. The goal 0:07:46.156 --> 0:07:50.516 is to reach preventable maternal mortality, to reduce it down 0:07:50.516 --> 0:07:55.476 to seventy by twenty thirty. I mean, no death is acceptable, 0:07:55.476 --> 0:07:57.996 but seventy is a number that the world has put 0:07:58.036 --> 0:08:00.716 us taken the ground saying, if we can make sure 0:08:00.876 --> 0:08:04.756 every country comes down to seventy, that would be achievable. 0:08:04.956 --> 0:08:08.116 Some countries today that number is five and in some 0:08:08.156 --> 0:08:11.636 countries that number five thousand, and so we have made 0:08:11.756 --> 0:08:15.756 huge progress in the last ten years. We've halfd metal 0:08:15.796 --> 0:08:19.676 mortality as a world, but we're still very far away 0:08:19.756 --> 0:08:23.676 from the seventy number. And the business is usual as 0:08:23.796 --> 0:08:27.076 the rates of reduction as we see it now will 0:08:27.116 --> 0:08:30.716 not get us to that number of seventy metal mortality. 0:08:30.876 --> 0:08:33.756 So there has been a huge progress, but the rate 0:08:33.796 --> 0:08:35.916 of reduction is not enough to get us where we 0:08:35.956 --> 0:08:39.356 want to go. Those are the numbers. And currently, as 0:08:39.356 --> 0:08:43.236 I said, eight hundred women die every day in the world, 0:08:43.596 --> 0:08:46.396 and by the way, seven hundred women die every year 0:08:46.756 --> 0:08:50.636 here in the US. It's almost two deaths a day. Wow. 0:08:50.716 --> 0:08:53.396 So how do you overcome this first barrier? How do 0:08:53.436 --> 0:08:57.156 you convince people to come to appointments, to come to hospitals. 0:08:57.196 --> 0:09:00.076 How do you get them used to the idea that 0:09:00.636 --> 0:09:03.556 birth is not something that takes place at home. So 0:09:03.636 --> 0:09:06.716 if you take India as an example. They have done 0:09:06.756 --> 0:09:12.676 a huge outreach to including conditional cash transfers to community 0:09:12.716 --> 0:09:15.756 health workers to bring these pregnant women into the facilities, 0:09:16.596 --> 0:09:18.996 and there was a push and there's almost been an 0:09:19.036 --> 0:09:22.836 eighty percent increase in facility birth rates in India, so 0:09:22.956 --> 0:09:27.556 it can be done, and behavioral change communications they've been 0:09:27.676 --> 0:09:33.876 they've used local storytelling, they've used the power of pure experience, 0:09:34.396 --> 0:09:36.996 so all that has worked, and in fact there's been 0:09:37.036 --> 0:09:40.876 a huge increase in facility births rather than birthing at home. 0:09:41.276 --> 0:09:46.836 But unfortunately that eighty percent increase in facility births has 0:09:46.916 --> 0:09:51.876 not resulted in an equalent eighty percent decrease in maternal mortality. 0:09:52.356 --> 0:09:55.156 The facilities were not ready for this onslaught and the 0:09:55.276 --> 0:09:58.276 quality of care they were receiving or the protocols that 0:09:58.316 --> 0:10:01.716 they had in place were not suffice and so they 0:10:02.156 --> 0:10:06.036 did initially see the eighty percent decrease. But the way 0:10:06.036 --> 0:10:08.916 India went about it is first is raising the demand, 0:10:09.156 --> 0:10:13.356 using the awareness and incentivizing women to give birth in facilities, 0:10:13.396 --> 0:10:18.836 including making the whole experience free, including the transportation, and 0:10:18.996 --> 0:10:22.996 now are very much focused on the quality that the 0:10:23.036 --> 0:10:26.396 woman will receive during that childbirth process. If you add 0:10:26.436 --> 0:10:30.236 to that data analysis and data predictability and predictive analytics 0:10:30.236 --> 0:10:33.236 to see which woman is a high risk and once 0:10:33.276 --> 0:10:35.956 they come into the hospital and to triage them, and 0:10:36.036 --> 0:10:39.236 to be able to use the latest and the best 0:10:39.236 --> 0:10:42.596 in data and technology is again leads us to believe 0:10:42.636 --> 0:10:45.756 this is solvable and hence is something we should be doing. 0:10:46.196 --> 0:10:48.556 Tell me a little bit more about data. You know, 0:10:48.596 --> 0:10:52.076 we're talking about remote communities. What kind of difference can 0:10:52.196 --> 0:10:55.556 data make? How does that help doctors in rural India. 0:10:56.836 --> 0:11:00.196 I have been in communities and it's amazing how the 0:11:00.236 --> 0:11:04.596 advent of mobile phone technology has so penetrated even the 0:11:04.676 --> 0:11:07.636 rural areas in a lighter way. They say, they probably 0:11:08.116 --> 0:11:10.796 more telephones than bathrooms in India, and so the people 0:11:10.796 --> 0:11:14.436 who have access to a phone more easier than electricity 0:11:14.556 --> 0:11:19.116 with that kind of penetration, I have seen, say in 0:11:19.156 --> 0:11:22.996 that village, in these communities, in a house, the husband 0:11:23.556 --> 0:11:28.116 who's usually the farmer, the male, the man has a 0:11:28.196 --> 0:11:31.916 phone and today on his phone, the farmer has a 0:11:31.916 --> 0:11:35.956 weather forecasting app that tells him went to plant and 0:11:35.996 --> 0:11:39.076 went to harvest. He's got an app that tells him 0:11:39.116 --> 0:11:42.196 the prices of his harvest and the produce in the 0:11:42.236 --> 0:11:44.876 market that day, so he knows when to sell. He 0:11:44.956 --> 0:11:48.676 also has on an app transportation like the equordent of 0:11:48.676 --> 0:11:51.076 the ubers, to be able to move his produce and 0:11:51.476 --> 0:11:55.276 his harvest to the cities for a better price. This 0:11:55.356 --> 0:11:58.956 exists today, We've seen it. And in that same house 0:11:59.996 --> 0:12:04.116 is the wife who's the community health worker, and she 0:12:04.316 --> 0:12:08.956 carries around six registers, does not have access to the phone, 0:12:09.556 --> 0:12:12.956 has twenty families that she's seeing, has no idea how 0:12:12.996 --> 0:12:16.516 to optimize her day, which household is at risk, which 0:12:16.596 --> 0:12:20.276 child in her community of who she's responsible is at 0:12:20.396 --> 0:12:24.596 risk for my nutrition? Why couldn't she have similar predictive 0:12:24.596 --> 0:12:28.556 analytic tools like weather forecasting that would help her do 0:12:28.676 --> 0:12:31.436 her job better. So it is not just the doctors 0:12:31.516 --> 0:12:34.356 having access to data, It is how can the community 0:12:34.396 --> 0:12:38.356 health workers, the frontline healthcare workers have predictive analytics tools 0:12:38.396 --> 0:12:41.796 that will optimize their work process but also in real 0:12:41.836 --> 0:12:44.276 time can give them insights and inputs on how to 0:12:44.276 --> 0:12:46.356 take care of these patients, of what tests to do, 0:12:46.636 --> 0:12:49.876 which ones are the triage, which ones are the ones 0:12:49.916 --> 0:12:53.156 at high risk. So this could be something as simple 0:12:53.196 --> 0:12:56.716 as community health workers having a kind of app on 0:12:56.756 --> 0:12:59.076 their phone that could help them give advice to pregnant 0:12:59.116 --> 0:13:01.596 women or help them make decisions about who needs what 0:13:01.716 --> 0:13:05.556 kind of care. That would be exactly the start. From there, 0:13:05.876 --> 0:13:08.276 you can envision where she could have the story of 0:13:08.316 --> 0:13:11.156 her village to know if there's a huge absence of 0:13:11.636 --> 0:13:15.116 children in one school in her community, she should now 0:13:15.276 --> 0:13:18.036 go there to see is there a diary outbreak, what's happening? 0:13:18.036 --> 0:13:20.116 Why are the children are coming to school? There are 0:13:20.196 --> 0:13:22.836 so many ways we can then build on it. What 0:13:22.956 --> 0:13:26.956 about doctors in these communities, how can they access data 0:13:26.956 --> 0:13:28.836 and how can that make a difference to what they do? 0:13:29.476 --> 0:13:34.796 So take supply chain. Most doctors in these villages, if 0:13:34.796 --> 0:13:38.996 there's a primary secondary health center, the doctor in charge 0:13:39.236 --> 0:13:42.316 is the superintendent of the hospital, and he or she 0:13:42.436 --> 0:13:46.516 has never been trained on stock forecasting, has never been 0:13:46.516 --> 0:13:51.236 trained on human resource distribution and how to supply and demand. 0:13:52.276 --> 0:13:55.956 If these apps can actually in real time keep track 0:13:56.036 --> 0:14:01.076 of stockouts demands, is there any way that the data 0:14:01.396 --> 0:14:03.796 can give a better insight to these doctors to be 0:14:03.836 --> 0:14:07.836 able to do a better supply management, better access to 0:14:08.636 --> 0:14:11.916 where the crisis and they can they have an access 0:14:11.916 --> 0:14:15.956 that tells them based on social media and other data inputs. 0:14:15.956 --> 0:14:18.996 Where are the migrants coming from, what's happening across borders, 0:14:18.996 --> 0:14:21.556 where is the water on area, what's happening, is there 0:14:21.596 --> 0:14:25.836 another ebola brewing? Data can help identify hot spots and 0:14:25.956 --> 0:14:29.116 cold spots. Cold spots could be a whole region where 0:14:29.156 --> 0:14:32.156 children have not being immunized and nobody's kept tracked and 0:14:32.236 --> 0:14:34.676 we don't know because they are in the blind spots. 0:14:35.196 --> 0:14:39.196 Hot spots could be where this flash pandemics or something 0:14:39.236 --> 0:14:42.156 brewing that we could get earlier warning. But what about 0:14:42.156 --> 0:14:46.716 specifically to deal with the issue of maternal mortality. Is 0:14:46.756 --> 0:14:50.116 there you know, are there particular kinds of programs or apps, 0:14:50.196 --> 0:14:51.956 or is there a kind of data that doctors can 0:14:51.996 --> 0:14:55.836 find particularly useful. So if the frontline healthcare worker can 0:14:55.916 --> 0:14:58.756 find out if there is a region where women are 0:14:58.796 --> 0:15:03.476 not coming to anti natal care for visits and could 0:15:03.476 --> 0:15:07.196 be very easily tracked based on whether the woman has 0:15:07.436 --> 0:15:10.396 made an anti natal visit and if she asn't, they 0:15:10.396 --> 0:15:13.236 could even make home visits or they could encourage the 0:15:13.276 --> 0:15:16.276 woman to come in and we know, for example, simple 0:15:16.636 --> 0:15:20.316 antenatal visit to check for protein in the urine, blood pressure, 0:15:20.916 --> 0:15:24.956 sugar levels make a huge difference. I've also seen an 0:15:24.956 --> 0:15:29.796 app it's in formulation stage. It's actually the camera can 0:15:29.876 --> 0:15:34.316 take a video. So I've seen where in India, the 0:15:34.476 --> 0:15:38.796 healthcare worker waves this camera her cell phone over the 0:15:38.836 --> 0:15:42.076 belly of the pregnant woman. An inside, there is an 0:15:42.116 --> 0:15:46.036 algorithm that based on that image and that picture that's taken, 0:15:46.996 --> 0:15:51.876 the woman's size of the pelvis is measured, and the 0:15:51.996 --> 0:15:55.956 baby's head is measured, and an algorithm predicts whether this 0:15:55.996 --> 0:15:58.636 will be an obstructed labor, whether the child's head is 0:15:58.636 --> 0:16:01.356 too big for the woman's pelvis. Wow, And that can 0:16:01.356 --> 0:16:03.596 be put in a cell phone. Yes, I've seen it. 0:16:03.596 --> 0:16:07.476 It already exists. Inside obviously has to be finalized and commercialized, 0:16:07.516 --> 0:16:09.596 but people are thinking that way. So if you think 0:16:09.636 --> 0:16:14.796 about how data and applications are changing in our lives today, 0:16:14.876 --> 0:16:17.556 there's so many people with the Apple Watch that has 0:16:17.596 --> 0:16:20.716 the health monitor on it. What can we do if 0:16:20.756 --> 0:16:23.196 we take that kind of mindset and those kind of 0:16:23.236 --> 0:16:26.836 assets to the developing world to improve public health, community 0:16:26.876 --> 0:16:30.676 health And to me, I'm using maternal mortality as a 0:16:30.756 --> 0:16:34.356 sentinel indicator the Canadian the coal mine, so to speak, 0:16:34.636 --> 0:16:38.116 where it tells me the status and the health of 0:16:38.156 --> 0:16:42.236 the community, because the first ones to die, the most vulnerable, 0:16:42.356 --> 0:16:45.836 are the pregnant woman, and if we can save them, 0:16:45.876 --> 0:16:48.676 it means very likely we have a system in place 0:16:49.276 --> 0:16:53.396 that is saving many people. And so these data, these 0:16:53.436 --> 0:16:56.676 tools are needed, are needed today. They exist. Is just 0:16:56.756 --> 0:16:58.796 that somebody has to put it together, and that's where 0:16:58.796 --> 0:17:02.196 we are. Do you get any opposition to the use 0:17:02.236 --> 0:17:05.196 of technology and data? Do you find that people distrusted? 0:17:05.236 --> 0:17:09.876 Do you have people rejecting it? In the countries that 0:17:09.996 --> 0:17:12.756 I am working on right now, I can presume it 0:17:12.756 --> 0:17:16.916 will happen. India is putting in place draconian and much 0:17:16.996 --> 0:17:21.436 needed and many aspects health data, privacy and security laws. 0:17:21.876 --> 0:17:24.756 So it is coming. But right now, when we show 0:17:24.836 --> 0:17:27.436 up and we talk about how we are helping women 0:17:27.516 --> 0:17:32.036 survive childbirth, there is open arms and even in even 0:17:31.796 --> 0:17:36.596 in communities. Here in the US, it's the only developed 0:17:36.596 --> 0:17:39.996 country in the world where metal mortality is rising. And 0:17:40.036 --> 0:17:42.916 that is really an absolute shame, considering that we spend 0:17:42.956 --> 0:17:46.036 more than any other country on healthcare. And is that 0:17:46.476 --> 0:17:48.956 is that for similar reasons you have these same kinds 0:17:48.996 --> 0:17:50.836 of obstacles in the US that you have here. Yes, 0:17:50.916 --> 0:17:52.556 they are the same three delays, but they have a 0:17:52.596 --> 0:17:55.876 different connotation. So the second delay is not that there's 0:17:55.876 --> 0:17:57.836 a flash fard and they can't get to The second 0:17:57.836 --> 0:18:01.356 delays she's in a housing project and taxis won't come there. 0:18:01.436 --> 0:18:03.956 She doesn't have money for a taxi, and she can 0:18:03.956 --> 0:18:06.076 see the hospital, but she can't cross it because there's 0:18:06.076 --> 0:18:09.956 a huge highway in between. So, yes, you can envision 0:18:09.996 --> 0:18:13.196 the delays. The concepts are the same, the details are different. 0:18:13.276 --> 0:18:17.676 Also here in this country we have slightly different causes. 0:18:17.716 --> 0:18:21.556 In the developing world. That three big causes are woman bleeding, 0:18:21.596 --> 0:18:24.356 which is postpartum hemorrhage, pre acclamps here, which is when 0:18:24.356 --> 0:18:27.356 the blood pressure shoots up and you get seizures and 0:18:27.436 --> 0:18:32.156 brain damage. The third is sepsis, which is infection. Here 0:18:32.156 --> 0:18:35.276 in the US it is coiegulation disorders, it is how 0:18:35.316 --> 0:18:40.796 do you askular disease, It's comordabilities, it's older woman, it's obesity. 0:18:40.876 --> 0:18:44.596 It's also general lack of health and women not engaging 0:18:44.636 --> 0:18:48.756 with the healthcare system. So there are similarities, there are 0:18:48.796 --> 0:18:51.716 some nuance differences, but the bottom line is the same. 0:18:52.156 --> 0:18:56.156 Women are dying from preventable causes, and to think that 0:18:56.196 --> 0:18:59.916 the rate is going up in this country is just unacceptable. 0:18:59.996 --> 0:19:03.316 I agree, it's very shocking. It's all very well talking 0:19:03.356 --> 0:19:07.676 about technology and apps and cell phones, but how can 0:19:07.716 --> 0:19:10.836 you use this technology parts of the world where power 0:19:10.916 --> 0:19:14.996 is unreliable and internet connections are unreliable? Do you have 0:19:15.156 --> 0:19:19.996 solutions for that as well? So any and all attempts 0:19:20.116 --> 0:19:25.556 at improving health will also have to buy nature address 0:19:26.116 --> 0:19:32.316 the data inequity gap. Yes, electricity, internet connectivity, all these 0:19:32.916 --> 0:19:37.196 are current barriers, but these have been bridged. There are 0:19:37.276 --> 0:19:41.436 solutions for this. They are off grade solutions. They are 0:19:41.556 --> 0:19:45.396 offline solutions. And in fact, most of the apps that 0:19:45.596 --> 0:19:47.756 exist in most of the ones that are working right 0:19:47.796 --> 0:19:51.876 now in parts of Africa by large part work offline 0:19:52.236 --> 0:19:55.516 and then when the internet connection is there, they do 0:19:55.556 --> 0:20:00.676 the upgrading. So these are solvable by technology. But it's 0:20:00.716 --> 0:20:04.476 that feeling that we can and should do it that 0:20:04.636 --> 0:20:06.356 is the piece that we need to cross. And once 0:20:06.396 --> 0:20:08.316 we've crossed that, I have a feeling we can get 0:20:08.316 --> 0:20:12.036 to all these current barriers. Even if you would have 0:20:12.236 --> 0:20:16.076 asked me twenty years ago if I was in charge 0:20:16.076 --> 0:20:20.356 of all health for a coastal village that was that 0:20:20.476 --> 0:20:23.756 was routinely hit by hurricanes, and they asked me, what 0:20:23.796 --> 0:20:26.276 would I have to do to make to save people 0:20:26.716 --> 0:20:29.636 when the hurricane comes. Based on what I knew then, 0:20:29.756 --> 0:20:31.996 I would have said, Oh, we need to build more shelters, 0:20:32.036 --> 0:20:33.916 we need to have more hospitals, we need to have 0:20:33.996 --> 0:20:36.716 more collar of vaccines, we need to have more clean water. 0:20:37.476 --> 0:20:39.596 How do I save the lives? Based on what I know? 0:20:40.236 --> 0:20:43.396 But today probably the thing that saves more lives is 0:20:43.436 --> 0:20:46.876 the weather predicting app forecast that tells me the storm 0:20:46.996 --> 0:20:50.876 is coming and I can evacuate people. And I would 0:20:50.876 --> 0:20:53.156 have never thought of that as saving more lives. Twenty 0:20:53.196 --> 0:20:55.996 five years ago, I'd have built more hospitals, more shelters, 0:20:56.036 --> 0:21:00.316 But today that single app is saving more lives than 0:21:00.556 --> 0:21:02.836 all the things we could have done. Similarly, today, if 0:21:02.836 --> 0:21:05.436 we were talking about how can we save these mothers 0:21:05.476 --> 0:21:09.036 from dying, we're talking about internet connect community. We're talking 0:21:09.156 --> 0:21:12.516 about more hospitals, better training, on and on and on. 0:21:12.636 --> 0:21:15.676 Perhaps there's technology out there that will take us to 0:21:15.716 --> 0:21:17.956 a completely different place. I just want to make sure 0:21:18.476 --> 0:21:20.716 that the current barriers don't hold us back, and that 0:21:20.836 --> 0:21:23.596 we do understand there's a data in equity and that 0:21:23.596 --> 0:21:26.556 that is exacerbating health in equities, and what are the 0:21:26.636 --> 0:21:30.316 obstacles to you, what's still standing in your way, what's 0:21:30.396 --> 0:21:34.636 keeping you from bringing down the this mortality rate more quickly? 0:21:34.916 --> 0:21:38.636 So I will I will start that by quoting doctor 0:21:38.716 --> 0:21:43.996 Mohammad Mahmata was an obstitation is an obstacian who considered 0:21:44.036 --> 0:21:47.916 the father of this whole concept. He very famously once said, 0:21:47.916 --> 0:21:52.476 and I'm quoting him, women are dying not because we 0:21:52.516 --> 0:21:55.276 don't know how to save them. They're dying because we 0:21:55.316 --> 0:21:58.396 have yet to decide their worth saving and to live. 0:21:58.516 --> 0:22:02.356 That it is very clear that for any of what 0:22:02.556 --> 0:22:06.556 solutions we come up with to stick, sustain and scale 0:22:06.636 --> 0:22:10.956 in country, first we need the country. We need a 0:22:10.996 --> 0:22:15.516 political sustainability. We need political will. We need the policymakers, 0:22:15.516 --> 0:22:20.476 the decision makers to decide that the woman are worth saving. Second, 0:22:20.676 --> 0:22:24.436 we need social sustainability. We need the culture to be 0:22:24.796 --> 0:22:28.756 where the woman is valued and where healthcare is considered 0:22:28.796 --> 0:22:32.676 important for these women to get and to deliver in 0:22:32.676 --> 0:22:37.956 a facility. And then we also need the commercials sustainability 0:22:37.996 --> 0:22:42.676 that whatever systems are put in place have to benefit 0:22:42.956 --> 0:22:47.476 society and that we do understand that these are not 0:22:47.796 --> 0:22:50.956 just programs that we can go in and set up 0:22:51.076 --> 0:22:54.956 as philanthropy and turn around and walk away, because we 0:22:54.996 --> 0:22:56.476 need to teach them out of fish, and then we 0:22:56.556 --> 0:22:59.436 need to make it commercially viable for them to fish 0:22:59.556 --> 0:23:01.356 rather than just give them the fish. So we need 0:23:01.356 --> 0:23:04.716 to set up systems where this is then sustained locally 0:23:04.716 --> 0:23:07.796 within the community. So that is the barrier is how 0:23:07.796 --> 0:23:12.476 do we sustain scale the solutions that we put in place. 0:23:12.756 --> 0:23:15.116 But it also sounds like, you know, there are these 0:23:15.116 --> 0:23:19.036 incredible pieces of technology available, but there's also a fundamental 0:23:19.476 --> 0:23:24.476 emotional or psychological obstacle, which is that not everywhere do 0:23:24.556 --> 0:23:28.036 people think that women's lives are important. Obviously that is 0:23:28.036 --> 0:23:30.716 true here in the US too. They are countries that 0:23:30.756 --> 0:23:33.916 have come together that have realized that saving the woman 0:23:34.036 --> 0:23:35.556 is not just that I think to do, but it's 0:23:35.556 --> 0:23:37.956 the smart thing to do. And there is equality and 0:23:38.476 --> 0:23:40.876 there is no mental immortality so to speak of. So 0:23:41.916 --> 0:23:44.436 it is just this that they are still communities and 0:23:44.796 --> 0:23:48.676 their countries that wage political wars on women's bodies, and 0:23:48.796 --> 0:23:51.916 even here in this country is no different. So we 0:23:51.996 --> 0:23:54.596 need to be able to break those barriers. But just 0:23:54.636 --> 0:23:56.556 breaking those barriers and not enough. We need to come 0:23:56.636 --> 0:24:00.036 up with the medication technology training to then actually really 0:24:00.076 --> 0:24:05.516 save them, because no amount of cultural training will help 0:24:05.556 --> 0:24:08.596 the woman who needs associated section. A lot of people 0:24:08.636 --> 0:24:11.276 listening to this might be inspired by some of the 0:24:11.356 --> 0:24:14.156 things you've said and might like to want to try 0:24:14.156 --> 0:24:17.156 and help solve this problem. Are there things that listeners 0:24:17.156 --> 0:24:19.476 can do? Do you have any advice for people listening? 0:24:19.956 --> 0:24:23.236 So the first thing, there are many organizations that are linked. 0:24:23.796 --> 0:24:26.916 I would say, be aware, get to know it, and 0:24:26.956 --> 0:24:29.796 if you depending on the sliding scale, whether you suggest 0:24:29.876 --> 0:24:32.556 your pocket, whether you can give some money, whether you 0:24:32.556 --> 0:24:36.116