WEBVTT - Culturally Competent and Financially Sustainable Healthcare

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<v Speaker 1>Pushkin, this is solvable. I'm Jacob Weisberg. So a lot

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<v Speaker 1>of funding from international agios are focused or earmark on

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<v Speaker 1>diseases such as HIV, h A, malaria. But the downside

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<v Speaker 1>are focusing on shall I see popular diseases, is that

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<v Speaker 1>you're missing the neglected diseases. Providing healthcare around the world

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<v Speaker 1>is noble work. Governments and international donors often have excellent

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<v Speaker 1>intentions when they focus on high impact diseases and when

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<v Speaker 1>they zero in on maternal health, but that can also

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<v Speaker 1>lead doctors to skip past other health issues. For doctor

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<v Speaker 1>Lutfi Lackman, focusing on maternal health and that the impact

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<v Speaker 1>he could have on the community where he was working

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<v Speaker 1>was too limited. I even gotta and in war from

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<v Speaker 1>the United Nations because I was focusing on a montunity health.

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<v Speaker 1>But I kind of feel I don't deserve it because

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<v Speaker 1>it is not something that is very high impact. So

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<v Speaker 1>now I'm just focusing on what the committee needs. That

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<v Speaker 1>meant walking away from large international grants. It was a

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<v Speaker 1>scary proposition, but doctor Lachman knew there had to be

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<v Speaker 1>a way to establish care for a wider range of

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<v Speaker 1>ailments and to make those medical clinics financially secure. It

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<v Speaker 1>was cross subsidization. You follow the principles of Muhammad Yunis,

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<v Speaker 1>the Nobel Prize winner, founder of the Grameen Bank, and

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<v Speaker 1>I think the inventor really of a microfinance exactly, but

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<v Speaker 1>I think most people do think of him in the

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<v Speaker 1>field of economics and lending. But here you've taken some

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<v Speaker 1>of those ideas and applied them to provision of healthcare,

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<v Speaker 1>so destimdel cross epsidizing community helping themselves. I really thought

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<v Speaker 1>that this is a very good idea, and just this

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<v Speaker 1>year we've managed to become fully sustainable. Doctor Lutfi Lackman

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<v Speaker 1>is the co founder of Hospitals Beyond Boundaries. They hired

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<v Speaker 1>doctors locally and provide a broad spectrum of care to

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<v Speaker 1>meet the needs their community's request. The problem that I'm

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<v Speaker 1>trying to solve is providing a healthcare for marginalized communities

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<v Speaker 1>in the financially sustainable way. Doctor Lackman didn't come to

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<v Speaker 1>the idea for Hospitals Beyond Boundaries easily or quickly. It

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<v Speaker 1>began on a faithful night back when he was in

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<v Speaker 1>medical school in Malaysia. He and some friends got together

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<v Speaker 1>to decompress after a long week. They decided to play

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<v Speaker 1>a game and they broke into two teams like armies.

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<v Speaker 1>Everyone had small water balloon type ammunition, sort of like

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<v Speaker 1>a version of handheld paintball. This is in the dark

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<v Speaker 1>of night and in the jungle, and a warning here.

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<v Speaker 1>Some of this description is little graphic. So it's a game.

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<v Speaker 1>It was at night and people were separating two teams,

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<v Speaker 1>and we were in the jungle. You kind of attack

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<v Speaker 1>each other. So what happened is that it was really dark.

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<v Speaker 1>I couldn't see anything, and I hear like someone was

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<v Speaker 1>running towards me and had this plastic bullet smashed directly

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<v Speaker 1>at my ear. So the pressure was so strong that

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<v Speaker 1>my ear drum was busted and it fractured the mastoid bone.

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<v Speaker 1>So that's where our brain fluids also flows too. When

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<v Speaker 1>you get brain fluids looking out of your ear, it's

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<v Speaker 1>pretty dangerous because if it gets in facted, you can

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<v Speaker 1>get brain new factions. So I was rushed to the

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<v Speaker 1>hospital and I was admitted for two weeks. I had

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<v Speaker 1>to be on antibiotics continuously. I was a still a

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<v Speaker 1>medical student. I'm not sure with the fear of, you know,

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<v Speaker 1>whether what my future will be. That really changed the

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<v Speaker 1>trajectory of my life, and so it's not just physical

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<v Speaker 1>but mental pain that I go through. So I guess

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<v Speaker 1>why I wanted to start something is to have a

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<v Speaker 1>sense of doing something that is part of bigger community

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<v Speaker 1>and trying to contribute to that community. How soon was

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<v Speaker 1>it after that injury that you opened the first clinic?

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<v Speaker 1>When I've started the organization, it was half a year,

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<v Speaker 1>but three years after that that I started the clinic

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<v Speaker 1>because we had to fundraise for the whole three years.

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<v Speaker 1>I mean, it's very hard to fundraise when you're a

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<v Speaker 1>medical student. You come to people saying I want to

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<v Speaker 1>build a hospital. I want to build a clinic. The

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<v Speaker 1>one trust you you see a student, right, So it

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<v Speaker 1>took us a long time to get enough funding to

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<v Speaker 1>start our first clinic. So what's the difference. I understand

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<v Speaker 1>the idea that it's more of the community and I

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<v Speaker 1>guess more culturally sensitive. Is it that people who otherwise

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<v Speaker 1>wouldn't seek access to medical care will be more comfortable

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<v Speaker 1>in the kind of institution you're setting up. Yeah. In

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<v Speaker 1>a conversation of Global health, we talked a lot about access,

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<v Speaker 1>but a lot of people forget that access is not

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<v Speaker 1>always geographical that you can have a clinic disc next

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<v Speaker 1>to where you live, but there are the barries, such

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<v Speaker 1>as a cultural barrier in which you are not comfortable

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<v Speaker 1>going to the clinic. So one of the first project

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<v Speaker 1>that we started was building a clinic in Cambodia and

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<v Speaker 1>the community around on there. I do have access to

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<v Speaker 1>clinics in the area. Cambodia has one of the highest

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<v Speaker 1>densities of and use in the world, second to Rwanda,

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<v Speaker 1>and a lot of these clinics are run by Foreignan

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<v Speaker 1>Jews and are manned by foreigners. So I'm not discounting

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<v Speaker 1>their effort and their expertise, but it's just that the

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<v Speaker 1>community don't feel comfortable discussing their health and their concerns

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<v Speaker 1>because of I guess language barriers or cultural sensitivity. So

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<v Speaker 1>in the end what they decide to is to go

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<v Speaker 1>back to the community and see traditional healers. So there's

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<v Speaker 1>the basis of the idea of hospital monitor is just

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<v Speaker 1>buildings hospital or clinic that is modern available for everyone

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<v Speaker 1>to come and feel comfortable getting a treatment. Yeah, I

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<v Speaker 1>mean you're not a native to Cambodia either, you're from

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<v Speaker 1>that part of the world. Broadly defined that you're from Malaysia,

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<v Speaker 1>which is I don't know, I think over a thousand

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<v Speaker 1>miles away. I'm if I'm visualizing the map correctly. So

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<v Speaker 1>what's different about you as technically a foreign NGO setting

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<v Speaker 1>up a clinic versus the kinds of international NGOs you're

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<v Speaker 1>talking about. So what we do is everything behind the scenes.

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<v Speaker 1>We hire from the local community, So we seek doctors

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<v Speaker 1>from that community, nurses, midwives, and so it is one

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<v Speaker 1>hundred percent staff by the local community. So the things

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<v Speaker 1>that we do are basically fundraising, consultation, giving advice. But

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<v Speaker 1>in the end, it is them who's running the show,

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<v Speaker 1>and it is them who's getting the credit, and we're

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<v Speaker 1>not looking for any profit or any credit. It just

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<v Speaker 1>makes us feel fulfilled and happy to see the clinic

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<v Speaker 1>being sustainable and having an impact towards the community. Right,

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<v Speaker 1>So you're providing access to local doctors and local medical workers.

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<v Speaker 1>Presumably a lot of the people who come to your

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<v Speaker 1>clinic would have access to those kinds of doctors, but

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<v Speaker 1>is that they couldn't afford for them, and you're going

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<v Speaker 1>to subsidize it or pay for it. So the model

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<v Speaker 1>that we use as cross subsidization. So I guess there

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<v Speaker 1>is another difference between US and other charity clinics that

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<v Speaker 1>are funded by international organizations. So most charity clinics are

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<v Speaker 1>giving free treatment for the poor one hundred percent, but

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<v Speaker 1>they are perpetually dependent on that funding donations or grants

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<v Speaker 1>at hospitals grant boundaries. We are not dependent on any

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<v Speaker 1>of those grants or international engels. We are open to

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<v Speaker 1>all patients, not just poorer patients, but those who are

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<v Speaker 1>able to pay will pay the normal fees, and all

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<v Speaker 1>the profits that is gained from that will be used

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<v Speaker 1>to fully subsidize the poor. So it's kind of like

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<v Speaker 1>a virtuous cycle, and it's proven to be sustainable because

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<v Speaker 1>you will never know if you're dependent on funding when

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<v Speaker 1>that funding will end if anything happens. I guess that's

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<v Speaker 1>the difference between US and other clinics. So the local

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<v Speaker 1>providers are paid, and are they paid what they normally

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<v Speaker 1>expect to be paid a bit more actually, so we are.

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<v Speaker 1>The rate that we're paying is the same as what

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<v Speaker 1>other for profit or private clinic in the area would

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<v Speaker 1>pay their staff. And that is also one of the difference,

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<v Speaker 1>because we don't want to like project an image that

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<v Speaker 1>because you're a clinic that treats the poor, so the

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<v Speaker 1>condition or the appearance must be of the of a

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<v Speaker 1>poor clinic, right so, and it's open for all. So

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<v Speaker 1>it also eliminates the stigma of you know, when someone

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<v Speaker 1>goes to the clinic and the community sees them going there,

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<v Speaker 1>oh so he's a poor person going to that clinic.

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<v Speaker 1>So we're eliminating that stigma. It's also a good way

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<v Speaker 1>to retain patients because as a clinic doing primary care,

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<v Speaker 1>it is very important to have your patient seeking treatment

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<v Speaker 1>with you continuously because you want to if someone has

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<v Speaker 1>a chronic disease, you want to manage them if possible,

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<v Speaker 1>for a lifetime. But we also see a lot of

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<v Speaker 1>patient who who climb up the social economic letters. So

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<v Speaker 1>I'll say started as a poor person and then becomes

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<v Speaker 1>you know, gets more income and climbs up the short

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<v Speaker 1>social or economic letter. And after he has been able

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<v Speaker 1>to get more income, he's still able to come to

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<v Speaker 1>the clinic and now he can pay and contribute to

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<v Speaker 1>the clinic so that other appropriopole will be able to

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<v Speaker 1>be treated. So it's a it's a very tight knit

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<v Speaker 1>community and the pieces that we work so whenever you

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<v Speaker 1>come to this clinic there's a sense of belonging. Yeah,

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<v Speaker 1>I know you. You follow the principles of Muhammad units

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<v Speaker 1>the Nobel Prize winner, founder of the Grameen Bank, and

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<v Speaker 1>I think the inventor really of a microfinance and a

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<v Speaker 1>big principle of him is the kind of sustainability you're

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<v Speaker 1>talking about, right, that the business doesn't have to make

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<v Speaker 1>much profit or necessarily any profit in the conventional sense,

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<v Speaker 1>but it has it has to be able to pay

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<v Speaker 1>for itself and support itself. But here you've taken some

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<v Speaker 1>of those ideas and applied them to provision of healthcare. Yeah.

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<v Speaker 1>So a lot of funding from international energyos are focused

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<v Speaker 1>or earmark on diseases such as HIV, h malaria, maternity.

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<v Speaker 1>So these are all very important diseases. But the downside

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<v Speaker 1>of focusing on high level and shall I see popular

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<v Speaker 1>diseases to eradicate is that you're missing the neglected diseases. Right. So,

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<v Speaker 1>for example, at the place where we work in Cambodia,

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<v Speaker 1>a lot of patients come with genital and urninary track affections.

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<v Speaker 1>This is mostly has to do with hygiene, and nowhere

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<v Speaker 1>can I find funding for that. So when I read

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<v Speaker 1>the book by Mohammad Yunus. I really thought that this

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<v Speaker 1>is a very good idea in which cross subsidizing community

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<v Speaker 1>helping themselves. So a particular chapter that in the Unit's

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<v Speaker 1>book is about patient who has talasemia. It's a blood disorder.

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<v Speaker 1>It's genetic, so anyone can get it, so it doesn't

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<v Speaker 1>select your social economic status. So they are the poor

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<v Speaker 1>people who has that, as the rich people who has that,

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<v Speaker 1>and middle income. So the middle income and the people

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<v Speaker 1>who with more means are able to pay for the

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<v Speaker 1>treatment of talasemia, but for the poor they die by

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<v Speaker 1>the fifth birthday. So in moment Unit's book he tells

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<v Speaker 1>the story of how they cross subsidize the treatments between

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<v Speaker 1>the rich and the poor. So I thought, that's really

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<v Speaker 1>good idea, and we're going to do that in Cebuia,

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<v Speaker 1>Doctor Lack, when I know it was your goal to

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<v Speaker 1>build a hospital and clinic that would be modern and

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<v Speaker 1>available for everybody and would be comfortable. How do you

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<v Speaker 1>make people feel comfortable in a hospital. Oh, it's a

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<v Speaker 1>lot of I mean, it's a feel of study by itself,

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<v Speaker 1>but I believe number one is the interaction with the staff.

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<v Speaker 1>You'll feel comfortable when the staff are friendly when they

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<v Speaker 1>treat you well, they understand your concerns and treat you

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<v Speaker 1>with respect. And there's also a good thing about running

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<v Speaker 1>a clinic that is open to all. Although you're focusing

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<v Speaker 1>on the poor, the staff don't know whether you're rich,

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<v Speaker 1>or your middle class or your poor, so they have

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<v Speaker 1>to treat you equally whether wherever you're from or whatever

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<v Speaker 1>the social economic status you're from. Is it a model

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<v Speaker 1>that can work all over the world or does it

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<v Speaker 1>work best in small, clothes knit communities. I mean, how

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<v Speaker 1>are you thinking about the potential growth of it? Yeah,

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<v Speaker 1>I would say places like rural areas where everybody is

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<v Speaker 1>poor and don't have the means to pay, it wouldn't

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<v Speaker 1>work in those places. There's no like a blanket solution

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<v Speaker 1>towards the problem of access to healthcare. But the model

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<v Speaker 1>that we're using is something that would work in places

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<v Speaker 1>like peri urban areas, on suburban areas, and even in

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<v Speaker 1>urban areas where people there are poor people like in Qualumport,

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<v Speaker 1>there's still the homeless people. That would be the best

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<v Speaker 1>model to follow. Yeah, I mean, part of what's so

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<v Speaker 1>interesting about this this idea is that it removes the

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<v Speaker 1>you know, almost colonial legacy of a lot of the

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<v Speaker 1>scare of the idea that rich countries are providing this

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<v Speaker 1>out of charity and generosity to very poor people in

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<v Speaker 1>poor countries. And you're you're not looking, at least in

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<v Speaker 1>the main for foreign doctors to come and volu tier.

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<v Speaker 1>You're not trying to raise money that I can tell

0:15:12.716 --> 0:15:15.436
<v Speaker 1>is that really viable? I mean, can you really finance

0:15:15.556 --> 0:15:20.036
<v Speaker 1>this and provide the quality of care without some form

0:15:20.076 --> 0:15:23.836
<v Speaker 1>of subsidy. Yeah, that's a very good point. And we're

0:15:23.916 --> 0:15:29.756
<v Speaker 1>very familiar with the story of a European organization or

0:15:29.796 --> 0:15:33.476
<v Speaker 1>from America coming in a community and becoming kind of

0:15:33.516 --> 0:15:37.476
<v Speaker 1>like the savior of these communities. But coming into a

0:15:37.516 --> 0:15:43.676
<v Speaker 1>community and thinking you know best what the community needs

0:15:43.916 --> 0:15:48.836
<v Speaker 1>is actually a colonial legacy coming in and deciding things

0:15:48.956 --> 0:15:54.476
<v Speaker 1>without consulting what actually the community wants, right, And I've

0:15:54.516 --> 0:15:58.116
<v Speaker 1>also fallen into this trap in the beginning. It's very

0:15:58.116 --> 0:16:02.916
<v Speaker 1>difficult to find funding for diseases that we want to

0:16:02.916 --> 0:16:06.596
<v Speaker 1>treat in the community. So in the beginning we were

0:16:06.636 --> 0:16:10.636
<v Speaker 1>focusing on modernity health because there's a lot of funding

0:16:10.836 --> 0:16:15.796
<v Speaker 1>on moltunity health. But after a year it didn't sustain.

0:16:15.876 --> 0:16:20.076
<v Speaker 1>Nobody came because a lot of these global goals are

0:16:20.516 --> 0:16:23.636
<v Speaker 1>a lot of efforts are being done by the government

0:16:24.196 --> 0:16:28.796
<v Speaker 1>and also by international organizations. So I guess as a

0:16:28.796 --> 0:16:32.956
<v Speaker 1>social enterprise or as a local angio, what you need

0:16:32.996 --> 0:16:36.676
<v Speaker 1>to focus on is on the needs of the community

0:16:36.836 --> 0:16:41.756
<v Speaker 1>and what they want what not the funder wants. So

0:16:42.036 --> 0:16:45.236
<v Speaker 1>it really took us a while to think about that,

0:16:45.756 --> 0:16:49.116
<v Speaker 1>and I even got an award from the United Nations.

0:16:49.596 --> 0:16:53.436
<v Speaker 1>I was selected as a United Nations Young Leader for

0:16:53.756 --> 0:16:57.916
<v Speaker 1>Sustainable Development Goals because I was focusing on moltunity health.

0:16:58.516 --> 0:17:02.396
<v Speaker 1>But I kind of feel I don't deserve it because yes,

0:17:02.556 --> 0:17:06.836
<v Speaker 1>I did that service, but it is not something that

0:17:06.996 --> 0:17:11.876
<v Speaker 1>is very high impact. So now I'm just focusing on

0:17:12.596 --> 0:17:15.236
<v Speaker 1>what the community needs. It's better for them to decide

0:17:15.236 --> 0:17:20.036
<v Speaker 1>what to focus on and have the credit. Yeah, doctor Lackman,

0:17:20.076 --> 0:17:23.436
<v Speaker 1>I always like to wrap up by asking what our

0:17:23.516 --> 0:17:27.516
<v Speaker 1>listeners can do to contribute to the solution to the

0:17:27.556 --> 0:17:30.796
<v Speaker 1>problem you've taken on. And this one poses a bit

0:17:30.836 --> 0:17:33.356
<v Speaker 1>of a challenge because you're what you've been telling me

0:17:33.396 --> 0:17:35.996
<v Speaker 1>in a way is that you're trying to find a

0:17:36.036 --> 0:17:39.396
<v Speaker 1>solution to the problem of healthcare in these places that

0:17:39.516 --> 0:17:44.236
<v Speaker 1>doesn't require help from abroad, but people listening, I think,

0:17:44.236 --> 0:17:47.236
<v Speaker 1>who be excited about this idea? What can they do

0:17:47.236 --> 0:17:50.396
<v Speaker 1>to be supportive? I believe it's not that we don't

0:17:50.516 --> 0:17:55.116
<v Speaker 1>need any support or funding from abroad, but my advice

0:17:55.356 --> 0:18:00.516
<v Speaker 1>not to earmark or make it specific. Have trust in

0:18:00.596 --> 0:18:06.436
<v Speaker 1>the community, and have some kind of accountability mechanism. Yeah,

0:18:06.436 --> 0:18:13.916
<v Speaker 1>hopefully little work. Doctor Lutfi Lachmann is the co founder

0:18:13.916 --> 0:18:17.516
<v Speaker 1>of Hospitals Beyond Boundaries, an organization that works to provide

0:18:17.556 --> 0:18:22.716
<v Speaker 1>culturally competent and financially sustainable healthcare options regardless of the

0:18:22.756 --> 0:18:26.516
<v Speaker 1>financial means of the patients in need. Solvable is brought

0:18:26.516 --> 0:18:29.156
<v Speaker 1>to you by Pushkin Industries. Our show is produced by

0:18:29.196 --> 0:18:34.236
<v Speaker 1>Camille Baptista, Senior producer Josin Thrank. Katherine Girardo is our

0:18:34.276 --> 0:18:38.876
<v Speaker 1>managing producer, and our executive producer is Mia Loebell. Special

0:18:38.916 --> 0:18:43.196
<v Speaker 1>thanks to Kobe Guildford, Heather Fame, Eric Xandler, Carly Migliori

0:18:43.516 --> 0:18:46.076
<v Speaker 1>and Kadija Holland. I'm Jacob Weisford