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ASHISH JHA: Raj, thank you for coming and doing this.
RAJ PANJABI: Thanks for having me Ashish.
ASHISH JHA: I was hoping we could get started by just you talking
to me a little bit about your interests in Liberia, what
have you been doing in Liberia well before the Ebola outbreak.
Kind of, how did you get involved, Last Mile Health,
just tell us a story about your engagement with Liberia and health care
there, and what motivated you to get involved?
RAJ PANJABI: Well my motivation starts quite a bit with my own origin.
My parents had emigrated from India to Liberia.
And I was born there and lived most of the '80s in Liberia.
And it's a beautiful country despite what's
been shown more recently in the news about Ebola.
I grew up in the capital, in Monrovia, where a lot of those images come from.
And in the '80s, and still now, it's one of the most beautiful countries
on Earth.
It's got one of the largest rainforests in Africa,
but was also filled with incredible people, incredible leaders,
and an enormously fascinating history of course tied to our own country
here in America, having been founded by freed American slaves in the 1800s.
So you can you imagine, a really great place to grow up.
Also challenging because politically, the '80s was a difficult time,
was led by a dictator at the time.
And things went south.
And when I was nine years old, civil war erupted.
And that was in 1990.
So within a few months, the rebels led by Charles Taylor-- who's
known as war criminal now-- advanced on the city, captured the International
Airport.
And many of us were evacuated.
So my family were evacuated from a landing strip in the middle of town
and a lot of memories during that time, leaving people behind there
on the tarmac, but also just positive memories of the place stuck with me.
We ended up in Freetown, Sierra Leone initially, and then got
resettled in North Carolina.
Some very generous people took us in.
I had a chance to go to medical school.
And when I was, about a decade ago, in medical school, went back.
And that was during a very opposite time, lot of revival in the country,
and 15 years of conflict between 1990 and 2005, when I went back.
Lot of devastation, surely, but also a lot
of hope after having things like our only hydroelectric dam destroyed,
no running water in the capital, no signal lights in the capital,
no electrical wiring in the capital left.
We also had elected, at that moment in time,
Africa's first woman president, Ellen Johnson Sirleaf.
And that was a very exciting time because it
was a democratic election, because she was the first woman
president in Africa.
And so I went back with really a heart full of hope.
And yet when we got there, and this has a lot
to do with what we're seeing today, utter destruction.
I mean not only of the things you'd expect after war-- clinics destroyed,
schools destroyed.
My school was destroyed-- also of human capacity loss.
And we just had 51 doctors left for a country of 4 million people.
So yeah, it'd be the equivalent of the entire borough of Manhattan
having less than 20 doctors, or the entire city
of San Francisco having 8 physicians.
So you can imagine trying to take care of anything in that situation,
whether it's caring for a mother in childbirth
or a seven day old with pneumonia like myself and others were trying to care
for, it was a difficult thing to do.
But if you fell sick in the city, you might stand a chance, in Monrovia.
If you fell sick in remote rural villages in the rainforest,
you'd often die anonymously from things that really, people
shouldn't die from in the 21st century.
And so that was the situation we found ourselves in 2005.
And we set out with a number of other returnees
from the war, American health professionals,
really trying to answer a simple question.
How could we extend and improve the quality of primary care
in the most remote villages?
How could we save lives in the world's most remote villages?
And really, after a lot of work initially
helping the government start its first rural HIV clinic
and tying community health workers and non-physician clinicians to that,
realized that this problem was more systematic than just one disease.
In fact, was a problem everywhere that primary care was not
reaching remote areas.
So that that's what got us to think about Last Mile Health.
And Last Mile Health's focus is really to try to strengthen the primary care
system in remote villages by professionalizing community health
workers and converting them from typical village health workers
as we might imagine to something more closer
to on the spectrum of what a nurse might do, and then tying them to nurses,
tying them to clinics and extending health care.
And that's what we were involved in for the last, about eight years-- seven
years before Ebola struck, but the last eight years.
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