Speaker 1: Pushkin, this is solvable. I'm Jacob Weisberg. So a lot
Speaker 1: of funding from international agios are focused or earmark on
Speaker 1: diseases such as HIV, h A, malaria. But the downside
Speaker 1: are focusing on shall I see popular diseases, is that
Speaker 1: you're missing the neglected diseases. Providing healthcare around the world
Speaker 1: is noble work. Governments and international donors often have excellent
Speaker 1: intentions when they focus on high impact diseases and when
Speaker 1: they zero in on maternal health, but that can also
Speaker 1: lead doctors to skip past other health issues. For doctor
Speaker 1: Lutfi Lackman, focusing on maternal health and that the impact
Speaker 1: he could have on the community where he was working
Speaker 1: was too limited. I even gotta and in war from
Speaker 1: the United Nations because I was focusing on a montunity health.
Speaker 1: But I kind of feel I don't deserve it because
Speaker 1: it is not something that is very high impact. So
Speaker 1: now I'm just focusing on what the committee needs. That
Speaker 1: meant walking away from large international grants. It was a
Speaker 1: scary proposition, but doctor Lachman knew there had to be
Speaker 1: a way to establish care for a wider range of
Speaker 1: ailments and to make those medical clinics financially secure. It
Speaker 1: was cross subsidization. You follow the principles of Muhammad Yunis,
Speaker 1: the Nobel Prize winner, founder of the Grameen Bank, and
Speaker 1: I think the inventor really of a microfinance exactly, but
Speaker 1: I think most people do think of him in the
Speaker 1: field of economics and lending. But here you've taken some
Speaker 1: of those ideas and applied them to provision of healthcare,
Speaker 1: so destimdel cross epsidizing community helping themselves. I really thought
Speaker 1: that this is a very good idea, and just this
Speaker 1: year we've managed to become fully sustainable. Doctor Lutfi Lackman
Speaker 1: is the co founder of Hospitals Beyond Boundaries. They hired
Speaker 1: doctors locally and provide a broad spectrum of care to
Speaker 1: meet the needs their community's request. The problem that I'm
Speaker 1: trying to solve is providing a healthcare for marginalized communities
Speaker 1: in the financially sustainable way. Doctor Lackman didn't come to
Speaker 1: the idea for Hospitals Beyond Boundaries easily or quickly. It
Speaker 1: began on a faithful night back when he was in
Speaker 1: medical school in Malaysia. He and some friends got together
Speaker 1: to decompress after a long week. They decided to play
Speaker 1: a game and they broke into two teams like armies.
Speaker 1: Everyone had small water balloon type ammunition, sort of like
Speaker 1: a version of handheld paintball. This is in the dark
Speaker 1: of night and in the jungle, and a warning here.
Speaker 1: Some of this description is little graphic. So it's a game.
Speaker 1: It was at night and people were separating two teams,
Speaker 1: and we were in the jungle. You kind of attack
Speaker 1: each other. So what happened is that it was really dark.
Speaker 1: I couldn't see anything, and I hear like someone was
Speaker 1: running towards me and had this plastic bullet smashed directly
Speaker 1: at my ear. So the pressure was so strong that
Speaker 1: my ear drum was busted and it fractured the mastoid bone.
Speaker 1: So that's where our brain fluids also flows too. When
Speaker 1: you get brain fluids looking out of your ear, it's
Speaker 1: pretty dangerous because if it gets in facted, you can
Speaker 1: get brain new factions. So I was rushed to the
Speaker 1: hospital and I was admitted for two weeks. I had
Speaker 1: to be on antibiotics continuously. I was a still a
Speaker 1: medical student. I'm not sure with the fear of, you know,
Speaker 1: whether what my future will be. That really changed the
Speaker 1: trajectory of my life, and so it's not just physical
Speaker 1: but mental pain that I go through. So I guess
Speaker 1: why I wanted to start something is to have a
Speaker 1: sense of doing something that is part of bigger community
Speaker 1: and trying to contribute to that community. How soon was
Speaker 1: it after that injury that you opened the first clinic?
Speaker 1: When I've started the organization, it was half a year,
Speaker 1: but three years after that that I started the clinic
Speaker 1: because we had to fundraise for the whole three years.
Speaker 1: I mean, it's very hard to fundraise when you're a
Speaker 1: medical student. You come to people saying I want to
Speaker 1: build a hospital. I want to build a clinic. The
Speaker 1: one trust you you see a student, right, So it
Speaker 1: took us a long time to get enough funding to
Speaker 1: start our first clinic. So what's the difference. I understand
Speaker 1: the idea that it's more of the community and I
Speaker 1: guess more culturally sensitive. Is it that people who otherwise
Speaker 1: wouldn't seek access to medical care will be more comfortable
Speaker 1: in the kind of institution you're setting up. Yeah. In
Speaker 1: a conversation of Global health, we talked a lot about access,
Speaker 1: but a lot of people forget that access is not
Speaker 1: always geographical that you can have a clinic disc next
Speaker 1: to where you live, but there are the barries, such
Speaker 1: as a cultural barrier in which you are not comfortable
Speaker 1: going to the clinic. So one of the first project
Speaker 1: that we started was building a clinic in Cambodia and
Speaker 1: the community around on there. I do have access to
Speaker 1: clinics in the area. Cambodia has one of the highest
Speaker 1: densities of and use in the world, second to Rwanda,
Speaker 1: and a lot of these clinics are run by Foreignan
Speaker 1: Jews and are manned by foreigners. So I'm not discounting
Speaker 1: their effort and their expertise, but it's just that the
Speaker 1: community don't feel comfortable discussing their health and their concerns
Speaker 1: because of I guess language barriers or cultural sensitivity. So
Speaker 1: in the end what they decide to is to go
Speaker 1: back to the community and see traditional healers. So there's
Speaker 1: the basis of the idea of hospital monitor is just
Speaker 1: buildings hospital or clinic that is modern available for everyone
Speaker 1: to come and feel comfortable getting a treatment. Yeah, I
Speaker 1: mean you're not a native to Cambodia either, you're from
Speaker 1: that part of the world. Broadly defined that you're from Malaysia,
Speaker 1: which is I don't know, I think over a thousand
Speaker 1: miles away. I'm if I'm visualizing the map correctly. So
Speaker 1: what's different about you as technically a foreign NGO setting
Speaker 1: up a clinic versus the kinds of international NGOs you're
Speaker 1: talking about. So what we do is everything behind the scenes.
Speaker 1: We hire from the local community, So we seek doctors
Speaker 1: from that community, nurses, midwives, and so it is one
Speaker 1: hundred percent staff by the local community. So the things
Speaker 1: that we do are basically fundraising, consultation, giving advice. But
Speaker 1: in the end, it is them who's running the show,
Speaker 1: and it is them who's getting the credit, and we're
Speaker 1: not looking for any profit or any credit. It just
Speaker 1: makes us feel fulfilled and happy to see the clinic
Speaker 1: being sustainable and having an impact towards the community. Right,
Speaker 1: So you're providing access to local doctors and local medical workers.
Speaker 1: Presumably a lot of the people who come to your
Speaker 1: clinic would have access to those kinds of doctors, but
Speaker 1: is that they couldn't afford for them, and you're going
Speaker 1: to subsidize it or pay for it. So the model
Speaker 1: that we use as cross subsidization. So I guess there
Speaker 1: is another difference between US and other charity clinics that
Speaker 1: are funded by international organizations. So most charity clinics are
Speaker 1: giving free treatment for the poor one hundred percent, but
Speaker 1: they are perpetually dependent on that funding donations or grants
Speaker 1: at hospitals grant boundaries. We are not dependent on any
Speaker 1: of those grants or international engels. We are open to
Speaker 1: all patients, not just poorer patients, but those who are
Speaker 1: able to pay will pay the normal fees, and all
Speaker 1: the profits that is gained from that will be used
Speaker 1: to fully subsidize the poor. So it's kind of like
Speaker 1: a virtuous cycle, and it's proven to be sustainable because
Speaker 1: you will never know if you're dependent on funding when
Speaker 1: that funding will end if anything happens. I guess that's
Speaker 1: the difference between US and other clinics. So the local
Speaker 1: providers are paid, and are they paid what they normally
Speaker 1: expect to be paid a bit more actually, so we are.
Speaker 1: The rate that we're paying is the same as what
Speaker 1: other for profit or private clinic in the area would
Speaker 1: pay their staff. And that is also one of the difference,
Speaker 1: because we don't want to like project an image that
Speaker 1: because you're a clinic that treats the poor, so the
Speaker 1: condition or the appearance must be of the of a
Speaker 1: poor clinic, right so, and it's open for all. So
Speaker 1: it also eliminates the stigma of you know, when someone
Speaker 1: goes to the clinic and the community sees them going there,
Speaker 1: oh so he's a poor person going to that clinic.
Speaker 1: So we're eliminating that stigma. It's also a good way
Speaker 1: to retain patients because as a clinic doing primary care,
Speaker 1: it is very important to have your patient seeking treatment
Speaker 1: with you continuously because you want to if someone has
Speaker 1: a chronic disease, you want to manage them if possible,
Speaker 1: for a lifetime. But we also see a lot of
Speaker 1: patient who who climb up the social economic letters. So
Speaker 1: I'll say started as a poor person and then becomes
Speaker 1: you know, gets more income and climbs up the short
Speaker 1: social or economic letter. And after he has been able
Speaker 1: to get more income, he's still able to come to
Speaker 1: the clinic and now he can pay and contribute to
Speaker 1: the clinic so that other appropriopole will be able to
Speaker 1: be treated. So it's a it's a very tight knit
Speaker 1: community and the pieces that we work so whenever you
Speaker 1: come to this clinic there's a sense of belonging. Yeah,
Speaker 1: I know you. You follow the principles of Muhammad units
Speaker 1: the Nobel Prize winner, founder of the Grameen Bank, and
Speaker 1: I think the inventor really of a microfinance and a
Speaker 1: big principle of him is the kind of sustainability you're
Speaker 1: talking about, right, that the business doesn't have to make
Speaker 1: much profit or necessarily any profit in the conventional sense,
Speaker 1: but it has it has to be able to pay
Speaker 1: for itself and support itself. But here you've taken some
Speaker 1: of those ideas and applied them to provision of healthcare. Yeah.
Speaker 1: So a lot of funding from international energyos are focused
Speaker 1: or earmark on diseases such as HIV, h malaria, maternity.
Speaker 1: So these are all very important diseases. But the downside
Speaker 1: of focusing on high level and shall I see popular
Speaker 1: diseases to eradicate is that you're missing the neglected diseases. Right. So,
Speaker 1: for example, at the place where we work in Cambodia,
Speaker 1: a lot of patients come with genital and urninary track affections.
Speaker 1: This is mostly has to do with hygiene, and nowhere
Speaker 1: can I find funding for that. So when I read
Speaker 1: the book by Mohammad Yunus. I really thought that this
Speaker 1: is a very good idea in which cross subsidizing community
Speaker 1: helping themselves. So a particular chapter that in the Unit's
Speaker 1: book is about patient who has talasemia. It's a blood disorder.
Speaker 1: It's genetic, so anyone can get it, so it doesn't
Speaker 1: select your social economic status. So they are the poor
Speaker 1: people who has that, as the rich people who has that,
Speaker 1: and middle income. So the middle income and the people
Speaker 1: who with more means are able to pay for the
Speaker 1: treatment of talasemia, but for the poor they die by
Speaker 1: the fifth birthday. So in moment Unit's book he tells
Speaker 1: the story of how they cross subsidize the treatments between
Speaker 1: the rich and the poor. So I thought, that's really
Speaker 1: good idea, and we're going to do that in Cebuia,
Speaker 1: Doctor Lack, when I know it was your goal to
Speaker 1: build a hospital and clinic that would be modern and
Speaker 1: available for everybody and would be comfortable. How do you
Speaker 1: make people feel comfortable in a hospital. Oh, it's a
Speaker 1: lot of I mean, it's a feel of study by itself,
Speaker 1: but I believe number one is the interaction with the staff.
Speaker 1: You'll feel comfortable when the staff are friendly when they
Speaker 1: treat you well, they understand your concerns and treat you
Speaker 1: with respect. And there's also a good thing about running
Speaker 1: a clinic that is open to all. Although you're focusing
Speaker 1: on the poor, the staff don't know whether you're rich,
Speaker 1: or your middle class or your poor, so they have
Speaker 1: to treat you equally whether wherever you're from or whatever
Speaker 1: the social economic status you're from. Is it a model
Speaker 1: that can work all over the world or does it
Speaker 1: work best in small, clothes knit communities. I mean, how
Speaker 1: are you thinking about the potential growth of it? Yeah,
Speaker 1: I would say places like rural areas where everybody is
Speaker 1: poor and don't have the means to pay, it wouldn't
Speaker 1: work in those places. There's no like a blanket solution
Speaker 1: towards the problem of access to healthcare. But the model
Speaker 1: that we're using is something that would work in places
Speaker 1: like peri urban areas, on suburban areas, and even in
Speaker 1: urban areas where people there are poor people like in Qualumport,
Speaker 1: there's still the homeless people. That would be the best
Speaker 1: model to follow. Yeah, I mean, part of what's so
Speaker 1: interesting about this this idea is that it removes the
Speaker 1: you know, almost colonial legacy of a lot of the
Speaker 1: scare of the idea that rich countries are providing this
Speaker 1: out of charity and generosity to very poor people in
Speaker 1: poor countries. And you're you're not looking, at least in
Speaker 1: the main for foreign doctors to come and volu tier.
Speaker 1: You're not trying to raise money that I can tell
Speaker 1: is that really viable? I mean, can you really finance
Speaker 1: this and provide the quality of care without some form
Speaker 1: of subsidy. Yeah, that's a very good point. And we're
Speaker 1: very familiar with the story of a European organization or
Speaker 1: from America coming in a community and becoming kind of
Speaker 1: like the savior of these communities. But coming into a
Speaker 1: community and thinking you know best what the community needs
Speaker 1: is actually a colonial legacy coming in and deciding things
Speaker 1: without consulting what actually the community wants, right, And I've
Speaker 1: also fallen into this trap in the beginning. It's very
Speaker 1: difficult to find funding for diseases that we want to
Speaker 1: treat in the community. So in the beginning we were
Speaker 1: focusing on modernity health because there's a lot of funding
Speaker 1: on moltunity health. But after a year it didn't sustain.
Speaker 1: Nobody came because a lot of these global goals are
Speaker 1: a lot of efforts are being done by the government
Speaker 1: and also by international organizations. So I guess as a
Speaker 1: social enterprise or as a local angio, what you need
Speaker 1: to focus on is on the needs of the community
Speaker 1: and what they want what not the funder wants. So
Speaker 1: it really took us a while to think about that,
Speaker 1: and I even got an award from the United Nations.
Speaker 1: I was selected as a United Nations Young Leader for
Speaker 1: Sustainable Development Goals because I was focusing on moltunity health.
Speaker 1: But I kind of feel I don't deserve it because yes,
Speaker 1: I did that service, but it is not something that
Speaker 1: is very high impact. So now I'm just focusing on
Speaker 1: what the community needs. It's better for them to decide
Speaker 1: what to focus on and have the credit. Yeah, doctor Lackman,
Speaker 1: I always like to wrap up by asking what our
Speaker 1: listeners can do to contribute to the solution to the
Speaker 1: problem you've taken on. And this one poses a bit
Speaker 1: of a challenge because you're what you've been telling me
Speaker 1: in a way is that you're trying to find a
Speaker 1: solution to the problem of healthcare in these places that
Speaker 1: doesn't require help from abroad, but people listening, I think,
Speaker 1: who be excited about this idea? What can they do
Speaker 1: to be supportive? I believe it's not that we don't
Speaker 1: need any support or funding from abroad, but my advice
Speaker 1: not to earmark or make it specific. Have trust in
Speaker 1: the community, and have some kind of accountability mechanism. Yeah,
Speaker 1: hopefully little work. Doctor Lutfi Lachmann is the co founder
Speaker 1: of Hospitals Beyond Boundaries, an organization that works to provide
Speaker 1: culturally competent and financially sustainable healthcare options regardless of the
Speaker 1: financial means of the patients in need. Solvable is brought
Speaker 1: to you by Pushkin Industries. Our show is produced by
Speaker 1: Camille Baptista, Senior producer Josin Thrank. Katherine Girardo is our
Speaker 1: managing producer, and our executive producer is Mia Loebell. Special
Speaker 1: thanks to Kobe Guildford, Heather Fame, Eric Xandler, Carly Migliori
Speaker 1: and Kadija Holland. I'm Jacob Weisford