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Okay, so I'm going to a follow up on some of Dan's recommendations to, to talk about things. It might be different as opposed to talking about cases. I'm gonna talk about the global help.

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And I hope that's interesting, but it's really a talk about people and how you get to know people how you get to become interest in treating people, how you persevere.

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I mean, you may think one of the best ways to learn to be first to persevere in something is to be a Cubs fan, because we only see a championship every hundred and eight years. So that that's good.

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But I'm gonna talk about global health and a very personal basis so you might learn a little bit about me unit. So that's good. But I hope you learned some lessons about what it's like to have a life. We take two steps forward one back a lot.

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Now you persevere and what you learned at step of the way.

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So, let's see if that works out and you guys ask questions whenever you want I will ask them. 

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Okay. Okay.

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So, it's an ambitious a title, but I really want the rest and think about what they're doing.

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Why they're doing it and often the motivations that people starting medicine are really still very pure and very noble. It's kind of important to preserve that to your life.

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So,

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what's the,

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what's the issue and global health first thing is surgery is finally beginning to think we've been literally decades,

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one hundred years or so individual clicks of universities or cities sweep,

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etc.

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The reason is, is that the disparities in specialty healthcare are greater than any when I was in school I was told that I can only really do global healthcare.

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I did infectious disease, and I, it's been one to not pay attention to years.

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So I said about proving that especially care what's important disparities between what we have here what you'll see in the rest of world are start.

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Special the surgery that wasn't clear to everybody until the last five years, but it was clear to me a long time ago. Maybe we'll see why the numbers are all well known.

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There are twenty eight nations that have none any that have one for every eight million. You see, one for might be eighty thousand people in the US. What does that?

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Well, it means that if you don't have a nurse search, you have access to a new search, even though we are one percent or less of the healthcare system.

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Us you get a mail just to be to have a central services.

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You can't really address diseases, which are is important as infectious disease type CNS defects in general defects nine, ten humor, cancer stroke without it.

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And what happens is your trauma system collapses. Now, I've given that speech to numerous ministers, helping countries from the world. So I'm pretty good at it, but it's the shock.

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Can you see what happens when you actually get out and see people?

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So, it's the next lesson that I think you need to learn is we have a very isolated bubble that we live in and you have to get out to see other people work. How they sound their smart. They are.

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Be proud to work with. Can you guys see all of my, my screen there. They can see the yes, you can see the images told you.

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This would be kind of a personal journey. So it is, this is Chicago.

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This is where, and when I grew up this is that city that Carl Sandberg called stormy husky brawling city of big shows ever taken off from a plane from here.

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Is you swing and off the southern runway? She'll see.

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Massive rail yards and locks and Dan's along the river and the railroad connections and that that real yeah, it's about five miles by three miles and sites.

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That's the next to the south of that is the canals and locks and barges and rail yards in that are the factories. So I grew up in a neighborhood where to the South.

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They made all the diesel locomotive trains in the world.

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Let the motives to the East to me was the huge,

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mild by mile factory,

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a Western electric that meet every phone in the Western world to the North was the factories for International Harvester,

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make the tractors farms.

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Down the block from my house was Al Cola, aluminum factory, and a Cory and around, it were these rail yards, which was the story.

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My father, my grandfather and my great father, and where I was expected to work and get and the future was of that. I was starting to work when I was eight.

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I was a teacher I worked on the Docs, it's supported those rail yards. I was expected to join the army. If I was lucky, a couple of funny things happened along the way they were, you know, they just happen.

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I'd love to read. I tried to read every book, getting a local library. I got used to that. I still love to teach. I started to teach my family and I started teach. School is important, because I went to terrible stools.

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I actually gotten the trouble for teaching the, my fellow students too much. But it was that brawling area. That was my life. I love where my people may have aspired to join the army.

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Some of my classmates inspired to join the Mafia and did I learn quickly?

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It was pretty important not to have reputation just to have a brain or brainiac, because they didn't live very long. So, I, their true reputation as an athlete, just much more safe.

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Then,

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a funny thing happened,

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they're called scholarships and suddenly I had a bunch of scholarships to go to nominally colleges and eventually med school the first for both athletic academics,

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but they changed my life.

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There were opportunities. Other people don't have on the lessons. I learned also. Take advantage.

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Along the way I worked, and I became interested in people didn't live in the city.

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So at one point in my life, I was building houses in West Virginia and we noticed the most people on the second best roller skater, and give them our counting West.

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I met people like this gentleman, best carpenter I've ever met my life.

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Learned what was to be a master something. I also learned that I was better at some other things.

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And I was very interesting that in healthcare, and that these people left and I did want to do something about that.

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So,

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after I got one of those scholarships is the University of Chicago,

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which is such a change in culture from what I grown up with the no in my neighborhood,

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actually,

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new where the University of Chicago is to walk to the hospital with a Nobel laureate.

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My first day into the med school, I literally singled out full professor, took me aside and said, what are you token? Irishman here I got in this space and said, yes, and he loved.

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Which was a lucky thing for me, because yeah, I got called the games a couple of times too, but I was different. I enjoy.

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And so when I became a nurse surgeon, it became part of my.

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To go there, and I spent twelve years in Appalachia. I worked at the University of Kentucky, and my global health was in the United States.

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This was where my clinics for I knew more country singer is families than you could check the stick at. This is, as it hasn't Dukes of hazard or B*** hazardous. Here. It is story in this typical.

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This is the economy you'd see laundry on the porch and world's largest TV antenna. I liked it. I learned about people I learned. We're all the same. I learn their needs for great.

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Their opportunities with you. I've been very lucky to have opportunity. So.

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I was interested in service. The opportunity is changed for me when people here in Kentucky said what I joined them to go to Guatemala for a service mission. I said, sure.

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It changed my life because the need there was spectacular so it's time to unmute young one, whereas block Guatemala.

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My, we're telling if anybody's there, somebody can help her.

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Any resonate squares Guatemala. That's good. That's good. What's different about it?

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It's all about the people, this is where the majority of the people are indigenous.

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It doesn't happen anywhere else, just because of disease that came when when post Columbus, but this is indigenous. So it's very special needs.

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The needs are overwhelming there, but I certainly enjoyed the work. When I went there. I learned several things. I was very, very ineffective.

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This was more about me, I was becoming fulfilled by doing medical care. There. I learned things. I learned that. People were crowding into the capitals to the city, which meant that.

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The country side was completely devoid of care learned. That that meant. There were unique transportation problems. How do people get to a doctor? How do how does medical care get distributed healthcare?

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One of the most important things besides that we're all. Like, does I learned that? I couldn't do a D*** thing in awards.

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This guy here is literally just been shoot away from my clinic by the nurses, because he stuck a rifle to the window of my exam.

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I am have often asked you guys to do a focal nerd focus,

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Neuro exam,

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this focused minor example,

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but this was the middle of the civil war and I learned that the people like,

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train were being singled out for harm because as educated people,

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they were threat.

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So that if I was gonna achieve anything, I couldn't be alone. I had to have a stable country, and a stable government.

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But there was tremendous need and I would never forget.

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So,

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I moved and I began to think that this young lady she's in my office is the lady that I look at every day,

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because I had seen like,

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a hundred people that day.

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And she was healthy, I wasn't coming back to that town for years. Who's going to take care of her? I realize had trained somebody to be there.

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So I began to train doctors, starting what to do that.

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I needed a more stable country and needing more stable and so I began to think that it's service through education makes more sense, just service because, and I'm not there. Nothing gets done. So that's insufficient.

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Not sustainable and begin to learn from my mistakes. I couldn't maintain any educational system if I didn't have peace, so stability, enough food and basic medical care.

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So people I trained could stay and do services. I couldn't do it alone and I couldn't stop or alone. So, at that time, I stopped doing the doctors without borders sort of things started looking at places.

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We can be patient. So the next place I went to was Ecuador, because although it's very diverse, large, indigenous population it had as strong, possibly for economic growth.

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We had a middle class and although it really turned over governments rapidly and often, but they were relatively non violent.

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And people welcome you to come stable middle class.

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So it went to work, went to work with that, working with their doctors, and teaching one on one and teaching, anesthesiologists, teach and to quickly understand the teaching nerve surgery was insufficient.

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It had to be horizontally spread across the health system.

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That could grow that could and people could go on when you're not there. And I also learned this. I learned that I could incorporate my family.

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Sage, my kids started to go, it was, it was very important. It is very important as far as you teach what you do lectures don't really cut it.

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People watch what we do and so that's what our family go up doing.

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This is my daughter at the age, she said she was really tired of going on a health mission, and just lifting boxes around the store. So she taught herself Spanish and took over the recovery.

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She literally would tell the doctors this, the sick baby. This one's crying. Come here. Where is this? Where are you gonna go?

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She was eight years old, but at that size, when there was a prices she would run the get me, and she could distinguish me from everybody else in.

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So, I started to where the red cap, where the red cap so she can find me your. And that tells you a little bit about me but that's that's where it came from.

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And that's why I do this. So, what did we did when we learn? Well, we learned that you look at what they've got, what's their strengths and what's achievable?

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I think that became clear at that point, was the thing to try to achieve would be a residency.

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There were some smart surgeons that are overwhelmed. They need resources, need partners but I can partner on my trips, which I was doing on my vacation time when I was here.

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Now, it's part of our global health issue but there was vacation and to do that. We need work with needs.

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I learned about Guatemala about the transportation we began to look at distribution. There's two ways to do that. You bring the patients to you are the doctors to patients we need and to learn that.

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The key to the whole thing was to get the Ecuadorian documents ownership.

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If you dropped in, do a million, sean's or cleft lips and fly out, hate you because they do the post op care. You've completed their resources. If you build their program, they take it over.

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They would love you to come each or their mentor. And that's really what you have to do.

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That's the lesson I learned you teach at every level nurses talked the doctors taught the residents med students, talk mixed.

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That really became important. And what I learned was presence is everything most of your communication, most of what you teach people.

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Are you present do you care? Did you mop the floor? Did you see growing instruments? And, of course, the person teaching me how to clean the instruments is my watch equipment. Can we get the basic equipment?

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And I learned to operate without all the fancy tools I have here, teach them how to maintain. And that means I need infrastructure and need Biomet.

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And I need more than neurosurgeons so, modern techniques with minimal equipment, bring useful equipment train the people build the infrastructure and learn from the people there.

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Here's my daughter, a little bit older marveling at the fact that they reuse the gloves. Yes, we're doing that now with our.

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Where we learn it. So there's always challenges. You might think this is just an uninterrupted story of what you did.

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It isn't the two steps forward, one step back and all the time. The power goes out. Every day. You have to learn to become lights go off what you do.

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What's one wants to at once drop the wall into a courtyard just to get to the when the backup generally last equipment means it was stolen. What do you do?

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Well, I carried on back and then I begin to get the local volunteers to be involved with voluntary illness and be fatal civil unrest transportation government over, throw my favorite organic eruption.

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That'll slow down.

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Go out, you finish a case and you find you have two body guard to say, well, the government fall today, they say, see.

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Oh, so and this is the volcano. This is the hospital. This is the volcano and literally, only because the winds blowing the other way.

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So, fortunately, this stuff, this is the need, this is the end of my.

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So, I just didn't say, well, I'm going to keep going another next day next day next day. As long as I'm here this needs always there. I can't sell. I have to train people.

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So, we succeed when we think about care equipment and ownership by the people to mentor. So were teachers and that's really important.

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Comes teaching by what you do, not so much what you do do you come when you present these medical students with Slack?

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Because I would teach in between cases, and they would come throughout the whole country that became pretty special began to think teaching medical students was equally important.

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This is I began to think teaching BioMed people.

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So, I became more and more involved then it became more involved. I came to the attention of this organization foundation for surgery. I don't share it, but I started out just they were interested me.

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They had started fifty one years ago, and they had started serving. They were on hospital shifts, and I said, that's great what you're doing, but you need to think about education. You want to be sustainable.

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So, be careful what you wish for is the next lesson, because they made meeting secretary, the chair.

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So, what is it, it's an organization of partnerships. It is very little power. That's like a chair. They very little power. They can come up with good ideas and get lots of other people to work together.

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Then you'll create some mobile neurosurgery need through education, primarily trying to get a self sustaining program. Here in my model was start and maintain residencies.

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Because if you have a residency, you have to have a hospital with equipment. You have to have a government buy in, you have to have the support you have to have a, and then that naturally those needs with sold out infrastructure.

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That may mean that they could then recreate a second another city to spread throughout country and took care of that transportation centralization onto the capital.

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Like, so many countries.

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And so we began to develop our own curriculum. We refused to dummy it down space on the US curriculum because I was head of the senior society when we wrote the US.

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Equipment and aid that's difficult, but volunteers and people are built to repair cane.

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We began to look at other special sides and if you do curriculum and you want the people to stay in their own country, you have to get local certification and you have to have close graduate education. That seemed to be natural.

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So, we began to look at this idea, it's service through education and teaching was academics and academics for teaching.

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Okay, so that meant that we would get as many partners onboard to develop the training program with multiple countries, not only curriculum materials and drills, but we would need champions.

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That meant someone in that country that had been trained in neurosurgery. Maybe in England maybe anything. Israel, maybe Chile.

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Who was trying to make their way that we could designated as the program leader, and then a medical school in the states or Canada, or Europe would adopt that as a die and begin to understand what the needs were.

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Carried out, so we went to many countries, so I'll see. Where's the fault?

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It is an Asia. Very good. What's it? Famous for?

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It has the numbers that it's too.

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So,

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this is the mountainous country in Asia extremely poor,

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bad history of governments rate possibility for positive change caught between two of the largest and most warlike countries in the world,

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Indian China.

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But it had some bright people and Kathmandu,

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it had and this is where,

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when bake it former,

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a chair of the foundations or national education went there,

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adopted that set up a diad with his own program,

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and develop the first training programs there.

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So,

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this,

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this was being done this was,

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this was India when it was called by me,

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and doctors giving back to their own country,

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trained in the us here and and Madison,

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and in London went back to develop programs in the areas of great need sixteen years ago after working,

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mostly in South America and Central America.

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We became interested in East Africa, that was the enormous need at this time. Our Ecuadorian program really already had a training program, so there was need and could we import those lessons elsewhere?

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So this is East Africa, four hundred million people, and nobody being trained in nurse surgery. So we've gone young one.

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We've run Kelsey, Sarah, sub, Sahara East Africa. What countries count.

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Sarah needs who can help her yeah. Yeah, I see. You know.

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What are the countries of here in East Africa?

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Kenya Uganda, Tanzania. Okay. Ethiopia, Somalia the point being that very few people live in this Hara huge amount of money Egypt, Morocco and South Africa.

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No surprise. That's where the neurosurgery programs. So.

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Nothing at that time here, four hundred million people, a lot of need here, which were just beginning to address based on Nigeria.

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But this is where we started, mainly because we were inviting.

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And I'm not wanting to turn down an indication.

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So, we started to work to develop a programming Kenyan. That meant you had to be present. You gotta go. Listen, you gotta make mistakes and you gotta correct them. You got to be presence.

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This was one of the first people we train, he runs a magnificent program and elder, which, if you know anything about Kenya, this where all the distance from really his truck.

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And we had local support, because we're invited. There were eight neurosurgeons in this country of thirty, seven million only two could operate. But the others had governmental connection. So guess who is gonna be the program director?

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Yes. Who's gonna be the major teacher? Two different people, but we needed to take advantage of that.

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And my speeches about the need to change the trauma program, and to train doctors there, if they would fund the residents hey, their salary, I would provide the education equipment, etc.

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And in two thousand and seven, it works again, this time the Kenyon ministry of health said they would found the residency program.

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We found it a pretty unique thing, because the program span the countries we get a good pizza experience here in adult experience. There a mentor, you're there, it wasn't in a prayer, but that's what we started. Remember that thing.

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I said about transportation. Everybody had collapsed on the capital in Nairobi, one hospital, three thousand beds, five thousand patients. They get nurse surgical care one day a week.

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Wait now the Jack room,

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the trees hoping they get nobody gets cared for if you're in Boston,

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and you have a benign brain tumor,

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or causing seizures,

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or how many paralysis you're gonna close your shop,

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or your farm traveled in Nairobi your family loses everything.

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You get unsuccessful surgery, or you die waiting for Boston collapses. There's no trauma system. Anywhere. That was my speech to the ministry.

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What we did was, we meaning mostly that I, Robin Doctors without setup clinics in the major cities.

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Miro, whereas the family of Obama is from once a month operate, get the nurses trained acceptors.

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So the graduates, the Nairobi program could be cited there and develop that their program that meant we had to be looking infrastructure that we had to be thinking, how do you set up a program?

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Well, that's what the senior society did in the United States. We can import those lessons, so the outreach clinics were started this the clinic. So the graduates could be cited there. Infrastructure.

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You can't be near a surgery without narrow pathology took me a while to revise that Dr radiology equipment supplies.

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So, everything had to grow at once, but if we could get excitement among those documents and minimal equipment, donated, they, they were very, very resource very bright. It wasn't our program. It was there.

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We would helps by the curriculum more of the confidence. So, or run interference with the government, because they were hoping we would help out really helping out. I learned how little you need for an upgrade, right?

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Doing a case with this little equipment. Well, you do this a few times. It becomes very focused in your or our back home.

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This is the, the first neuro pathologist in East Africa it was because I went and taught how to do tumors and children.

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I had done these wonderful surgeries and I have the doctors thinking they got it. Yes, I understand these principles and oh, I can do the post to your phosphate surgery. On the last day.

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The head nurse took us to the cancer ward where the kids were, and they saying is Corpus SWAT he, the champ response to us and tears in your eyes. You couldn't believe how beautiful it was. A nurse told me there.

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I said what, you know, and then they said we have no chemotherapy for that, because some would need that. I said, I'll get you the chemotherapy. I'm an American.

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I understand what you're saying, and not listening, and I think it can be solved by money and she said, you don't understand that I kept ranting about. I get things and she said, you don't understand and then third time I said what?

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And she said we have no pathology in East Africa. No idea what Timmy you took out. We don't know what to treat.

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I never thought of that, because I hadn't shut up and listen. So I learned lessons. I learned to be persistent. I learned to listen and I learned to think about the picture. How do you sell things you do it by developing teams?

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So, I went to the head of pathology said, who's your newest assistant professor to see mine traveling?

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And then I went to Sharia and said Sharia doctors aren't allowed to touch patients, but, you know, your acute mind running a black market methodology program you said? Sure.

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And this is how the, the staff we have cancer.

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And that's because we build teams. Sorry came.

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We got donated we talked to a lot of equipment companies in the States and said, you know, if you really want us to buy this stuff here in the States, how about the old ones be donated and ship to and maintain?

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So, I taught people the first aneurysm in many cities, a few countries. Now, they're wide spread in December.

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Neary had done their twenty s in a year and it's quite doable. And it's care.

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That was unheard of, is one of those satellite cities that had nothing for and that's just because teaching and let them teach each other.

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So we began to develop diets with link.

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Can you can you W, you can then do Harvard and Uganda, Henry Ford and mirror in on and on and yet?

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No, and they would go and say this is to the needs. So we can only that equipment. This is the sites.

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Hey,

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why don't we begin to teach and doing we began the link online because people smarter than me about electronics these people access to WI fi you don't have to bring books passwords

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and they began to begin to correspond with us doctors.

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Us universities and teach us and so every time I went, I learned, and every time I went, I took the Red Hat, then the government began to get involved. This is the president of Tanzania. This is the day.

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He promised me he put fifteen percent of his national budget healthcare. Oh, we don't get that from the state of Wisconsin.

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Is the first microscope I've ever seen? He bought it for his hospital in Tanzania. I had to set it up and then say this is cool.

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I want them here for stuff for me and everybody else who comes so you learn things you learn things everywhere every day.

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This is very active idea of a diet program meant that equipment is important, and that we would publish on this.

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And we actually published that we raised the quality of critical care anesthesia general surgery by building nurse surgery goes completely the opposite with equal where I had to start with primary

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care,

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because primary care would run the catch up.

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And that would really wonderful. And it's very important, because I have been, I've been arguing this for for years, and suddenly was beginning to make sense. The do program really took over. You know, this is their ministry.

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And the Ecuador program became self sufficient until their own programs. So I'm not saying it's the same as it is in the US.

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I'm saying, it's really substantially real care. Nothing something that's something is being there. So they can grow. That's tangible to expand it more.

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We needed more, so I went to the world federation or a surgical society. Is this.

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Troubles program, that links all programs and nurse surgery in the world and that has access to some brilliant, brilliant people. Some people have great political connections.

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And some people that are just very, very thoughtful teachers and they were teaching. But they're teaching in places like St Petersburg, because they wanted to go to the museums.

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So I thought it, and they said you should be on this committee I said, okay, but I want to help plan and let's do it in Kenya.

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Let's do it in Southeast Asia and let's begin to teach not how cool I am with doing spinal Angie grams but how do I do practical problems? And that changed the way they did their education.

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And we partner with other programs this is the hospital exams bar before,

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but this program,

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which is a program of Spanish surgeons,

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adopted it and this hospital there,

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a surgical center in where they pretty and no care whatsoever and staffing entry.

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So, and Sydney and graduate won't be here.

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The grew as he began to look what you could do, we sited the courses there and we brought people worldwide.

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These are some virtual also, Japanese surgeons demonstrating their techniques and learning from the modifications that the Africans had used, how they could be practical.

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And it may be efficient, and they can work lives and resources and I said, grew then it began to get better and better electronics came to Africa. Long time. I was there. We started with catscan.

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Now, we can get a, at least in every capital.

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And then one say, hey, you should, because why not not only is their need in Southeast Asia, but there's a enormous, enormous resources. And so in Korea, we found it several of our training needs.

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In Turkey in Korea are now professors.

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Very grateful for the training that they got here and more than happy to be in and donate time equipment resources, because it's not about us. It's about how we get to care to people.

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There are very, very difficult site, so I wanna say two of them that we've been working on more recently, Zimbabwe is one of the more troubled countries in the world. It's just because of remarkably poor government.

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But when the Robert, and we've got the reached ninety one years of age, these young people said we're going back, it's going to change. Would you bring your education program?

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These are residents and young doctors that had left and came back.

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So we're trying to start programs to it's very difficult because they blackness to building in that country, but rebuilding infrastructures. What we're trying to do, and we're doing it in a well built hospital from the British colonial times.

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But that's what they have. That's the available resources. Hardest project is, Haiti is, you know, is suffered from remarkably worked out.

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And the earth quake only made things worse. The US response is not very well thought through, but we did was for a service onto this.

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What does that mean when we poured so much food into Haiti that all their farmers went out of business? It could compete, because they could sell their food.

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We made them a, a, a dependent country, not a self sufficient.

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And the problems with education were worse, because the governments would say, well, these people are flying in to do the care, and they did not allow a training program we developed.

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So I said, well, my friends from Miami, I have a lot of titles. That's all.

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I've got, let me go and help and then meet with these ministers and because I was the head of this foundation and, and the national coordinator for the world set.

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Said you need if you wanna have a trauma system, wanna have care regional care, you need a training program and then then we got it. So we have a very rudimentary training program. There. The need is enormous.

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My favorite sign has this in your, or at the latest stops working abruptly for this eight people to about four patients for four models. So I learned that the needs are great.

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They are not overwhelming, but they're going to take a long time, and a lot of steps forward and steps back to solve and I can't solve them alone.

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I need to buy in by local people, and I need them to take ownership. And then we can be something.

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Huge thing happened five years ago after years of telling people that essential surgery central nervous surgery was important as infectious disease. The lancing commission came out with the evidence. It's true.

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They said that five billion people back a central surgical absence that you have forty seven series that makes it look like a small time.

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And indeed, this lack of care, especially in stroke will suggest infection.

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So suddenly people began to have scientific data, but what we say, and everything changed, the World Bank said this is costing us seventeen trillion dollars.

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And this lack of care addressed the World Health Organization, which is part of the UN unanimously that never happens. Every minister health said surgery must be a priority.

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We must train them, must train them in their own country. Because otherwise we've taken thing when and train them.

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Because there's no infrastructure back home who train surgeons next thing. I know. It's like, you need everything to cost. Next thing. I know. I'm doing five comments a year.

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I'm trying to set up programs and you don't do that along. Do you think of the people?

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We can partner with web based computer, create curriculum, your curriculum rewritten for the web grants and training scholarships from philanthropist web learning some W. A. S. C. S.

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the milestones the boot camps. Why not do them? Development work? I can dummy it down the senior society and ministry support.

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So that's what we did things to the post graduate education, boot camp six, and we began to highlight. I gotta call from this lady.

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She's both nerve searching in a senator in China. She said, we have one point three billion people you have just given a lecture in Africa about credentialing curriculum and standards.

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We have none of that in China, the best hospitals in the world and some of the worst we have herbal neurosurgeons for state. Would you say?

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Sure, I'll, I'll try so I spoke about revolutionizing teaching of nerve surgery setting national standards.

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Chinese Congress in neurological surgeons,

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and I learned another valuable less,

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which is be careful what you wish because the next thing I know on the honorary resume education in China deal.

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We began to roll it out. We did the first boot camp, just like you go to, in another country in South America. We learned that if we force half of the teachers to be from those countries, they learn.

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They can teach these Bolivia nurse surgeons who had thought with each other because they thought that's what they should do as rivals would come up to me and say why that person can teach better than. I thought.

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Yes, yes, you should work together and they built a teaching Institute for neurosurgery, Bolivia never heard of before and it wasn't just for was for the five were punchy. Switched around that area.

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And we use simple models been tricky.

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Last week models made out of a, just just hand me, they made a beautiful model last year, three D, microscopic anatomy out of latex.

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We brought to Africa,

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we brought it back to Southeast Asia back to South America and it grew and grew and grew,

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and as a group became an international objective from Japan,

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some Saudi Arabia from Congo from India from Pakistan.

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And that's the idea is not about us. It's not about America. It's really about the countries then invite us when they take ownership.

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So you've gone to program began to decentralize my friend Ben worth and built the hospital in the eastern part of Uganda teaching is exclusively Pediatrics.

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The in the western part of you, this is Solomon and this is his university in the West, which would become the third new surgical center in that country and yes, I did the first in years.

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And then boot camps went to Miramar, which would spread through Vietnam, etcetera and in Chile, this wonderful man, who ran a rich private practice.

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Really wanted to train people.

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They build models three D models with model skills,

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detectable vessels for microscopes and taught five countries and got them involved so that they were doing half the teaching American or Saudi

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Arabian or Julia and this is the program in Neary.

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Neary is an area of about four million people with no care whatsoever.

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Based on this, we cited one of the trainees there, but we did just send them and leave them alone. We threw a big course. We've brought people worldwide. We told the local ministry of health. This is important.

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You need to be defined things as we will continue to, to work with them. And this is amazing.

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I mean, in the first year, he's done a dozens upon dozens of big, big cases, and hundreds and small ones and solve the trauma problem, but he's working alone.

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We need to train apart we need to make it grow. He only has four million people careful.

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So, it's a start, it's a really significant buy in the local hospitals. Governments. Church is enormous. There. It's very, very important.

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Great problems remain poverty for in the end. So, what did that affect? It affects everything if this breaks out I can't train it. Forget that these are the facilities they're working in.

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I have to think about infrastructure have to think about sterilize. It's linens, nurses, but that's okay. That's what we do. We're good at it. And what happens?

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Well, we have to support the trainees, what happens after they're done, they need equipment, they need unity and the local certifying bodies to accept them. I'm gonna have to have a sustainable practice.

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They can't just be sent out there. Not be able to see it, you know.

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So, there has to be some sort of being government or partial private practice and charity models are different need continuing education.

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So, no, we can't do it alone. We partner finishing graduates such as who's gone back to camera. Sound the first academic West Cameron.

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We have philanthropists, the class ambassadors to fund is extra training. Is that extra training coming working in the simulators working with the dissection lab observing in our hours.

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It's a gold star on them back home. They've had extra training and teaching them within ice funding. Being academic means they might run a trade.

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It might change things within might be very simple. This is the base nurse, surgical set. This is the base microscope we can set.

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We can take a modern in East Africa and change it into a nurse search are with a lot of help from these companies. And from this for twenty six, that's doable.

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When it gets them starting, they will always want to pentair a microscope, but we can get them a small and we can make it work. Diets became essential without the diets. We don't get this.

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And so, at adopting of a program, which we've done in Kenya, hope to do in Olivia, our program, after this clears, government has to be supportive. I've never been successful in a war here.

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I need somebody that I can convince this is for their own. There are many good people in the world, the president and how do we get the community?

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Well, we must get a certifying body. Is this certifying body for general surgeons.

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We taught them the certified nurse surgeons and so when we cited the doctor and my boss,

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we brought people some Japan and Spain,

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North Africa prod,

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India,

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Pakistan,

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Kenya,

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and said,

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this person's important is program is important.

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And the two people that got us starting the two neurosurgeons train and staying in Kenya.

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I know the real leaders of the programming Kenyan and these people I've trained this gentleman now, is there a surgeon for four million people in Eastern Kenya yet? Move us?

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So we have to see, can the doc is the same stuff without that model nearly never works and man can live as a doctor, ever family and support it.

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Because there is enough income, some cases through the government payer pyramid program now, which is new to Kenya. That's been the government.

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In education, wesite these courses where they are so that they may be recognized and trained and other people there left from there. They began to interact and never left alone.

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Horses go on to and with this, we begin to develop diets.

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It's amazing what you, you know, we began to train nurses, we began to train students and the students become our residents.

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The residents become more and it's very intriguing when we put them together it overcomes traditional borders. When we did, the boot camp in South Africa, everybody came up and said hello hello hello?

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And they say,

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why do they all know you I said,

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well,

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that resume was our student that we encouraged to go into the program in Uganda that one is now a professor,

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but he was our resident at the Kenyan program and the,

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the teachers that we had worked together with come up and say,

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you know,

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I didn't know that that try one used to hate.

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We're still going to teaching. I'd say yeah, you should work with them. Then I have another drive. I didn't know that one was went on over and over again. So, education is where you break down barriers and that's a lesson.

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You can't all the self sustaining care. The key idea. Is that throughout life? Oh, you're persistent, but you're learning.

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And I learned a lot by mistakes I pay attention to. Everybody's cases is, I don't want to go to life without learning new things.

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I want to see what works I want to to Eminem and see what didn't work,

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why and corrected and we try to fix everything because if you go into volunteerism,

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there's agents,

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you're overwhelmed because you try to do it all yourself.

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That's the slideshow stage when you try to fix everything and then you need something that's lasting.

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It's not about you, you see everybody as opposed to the global as these role models slides were in West sub, Saharan Africa. He was a role model.

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We encourage lots of people that go into it,

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but the impact in West Africa really ended when is when Eva is a doctor Tom,

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duly that that was a role models for me in Asia,

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went to my college,

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but nothing was lasting without education.

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So the first lesson I learned is service alone doesn't last developing world is full of these clinics that were built and staff in a band,

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because it wasn't the idea of infrastructure,

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education training people shooting in good stuff in left people behind.

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This is the contract example. This has been more then work with my partners and talking went to South America.

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He went to Africa, he built this hospital and he's got and the educational program in the last teams sustaining program, which is there.

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He becomes the mentor to the program that's lasting. So now where we had nobody, we have hundreds that are new nurse surgeons or training.

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We're become peripheral will become forgotten. And that's what should happen is their training needs should surpassed. So that's the challenge residence. You've got a surpass us.

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That's what I, that's the standard that the second lesson I learned is never assume, you know, more than the people around.

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It's I call it shut up and listen when you just send saying, I've read the Lancet report. I know what you need. I'm gonna provide it. You're gonna find these local doctors are moving teach you how to work with fuel.

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Oh, this lady works and lives in Haiti brought this child down from the mountain with obstructed hydrocephalus. She was tapping the kids brain.

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No fun daily for a month, and brought the child in the US fresh air for. I have never been so shocked.

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Amazed or amazed by what the people would be, how they would care for each other.

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And I learned from them and I've learned in Ecuador when I made a mistake thinking, I knew what the Amazon is talking to their local health and fish. I said, what's your biggest need?

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I thought it was to me.

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Such, and he said, no, it's dug out. Can you? So, I need to bring the patients from the Fortunately I had been why?

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Because if you don't shut up and listen, you're going to look like, so do that next lesson is very little education takes place effect in a war zone.

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The people you educate or threat, ostracize and become like, this is my favorite resin. Sorry, she is training to be the first female neurosurgeon as true. What was her?

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Biggest threat? I thought it was supplies and equipment and she said it's.

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You know, cover ROM is it means depth of education, email, educated in.

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Came back and told our residents. You have no problems. I have no problems. We're gonna support this person.

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And that's what I love and you learn you may have to think on your feet.

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I once working in a war zone and out of the pickup truck and nothing but rifles I've literally put on a juggling act for the children in that village.

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Until they decided I was either harmless or stupid. Let me go. But sometimes she learned to juggle more than jobs, learning that school aside a junk human very hand.

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Sometimes you have to think many more times.

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Progress comes in partnerships if the army is your friend help,

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organize the healthcare if the government does,

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you can have six because you are responsible the responsible for the people you train maybe ostracize or helps.

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You responsible to the volunteers you take with the families your all and the people, the patients families and there are many threats, illness, transportation, civil unrest, violence. You know, this is real.

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Dysentery is my major concern. Not equal.

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Once had eighteen volunteers fall sick the same time literally felt to the ground during their cases because they have not we,

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I never think anything,

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but water taking or crackers when I'm there.

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So I was healthy. The next time I brought a strict criteria and be a doctor to take care of them.

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I was tired of being what's the effective covet on this work? All international travel programs, postpone the past two months.

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I postpone five continents of progress and that hurts,

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but guess what the need will even greater when this clearance and it will clear because we have to continue the lessons we taught to.

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Work online and trust the work that we did the setup, their systems of care to help them get through the prices until we can be back and address the bigger needs such. It's true.

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Transportation, so problem you, this literally is train. I was on. You may not know it, but long before you came here W, had a group of medical students in South Africa medicine if I'm training.

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So I wanna know who's driving.

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Where are you going? How is it? Safe? Natural disasters they happened, but they're not major. Civil unrest is I pull whole programs out of countries near the election time.

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I'm concerned and violence is real.

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This day I daughter was unexpectedly placed in the.

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This jeopardy, which we got her out of.

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It changes your life for first rule service, with education.

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Second rule shut up and listen, that's why should be everyday education requires stability. You can't do it alone.

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You partner you partner here today anesthesia with orthopedics, with vascular surgery. You don't fight, you joined and your actions of make you responsible for many. These are lessons learned learned.

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You have obligations the obligations that bring those lessons home to the patient because what you learn from global nearer surgery, the benefits all of us. And that's how you make it part of your everyday practice.

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What you learned here comes here what you've learned in med school you never go.

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Because it only makes sense if you spend every day making a world better patients once in front of you, the ones that aren't your training people care about.

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So, I leave you with my favorite quote, because Christine found the nurse surgery, and he had a pretty high opinion of what a doctor he is. The reason that doctors in the United States are.

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Is he was the model of scholars searching that people points doctors up to prior to that? I think so. I want you to dare to dream. That's the less than I have.

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I'd like you open up your Mike's and ask questions thanks.

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Questions.

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That was a great talk. Don't be. So alright, I will take that. Where? Ethiopia one of the top. Okay. Gotcha.

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Yes. Yeah. Yeah. Do you do you think that we are developing similar problems in the US and various rural areas? Oh, absolutely absolutely.

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This idea of centralization of the population is destroying rural areas. It's so very obvious in Latin America, but of course, it's happening here.

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It's very hard to get a good care and, and especially United States, because the jar is so huge quest. And then, as I made the point, Eastern Kentucky is is a developing country.

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It's needs are huge so, for that matter is inner city Chicago, my own neighborhood, where I was born, needs this, these lessons every bit as much is East Africa.

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And that's why you never.

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Never lose sight of that. That's why we started the stroke program on the on the Native American reservation. It's fine under our notes.

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They have the worst stroke risk in America so I'm gonna put out there.

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Thanks a lot everyone appreciate it. Thank you. Appreciate it. Thank you. Thank you.