Dr. Raj Panjabi Goes the Last Mile in Liberia

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To solve this, we’re partnering with the Liberian government to create a model where lay people from these rural villages are hired to serve as community health workers. We train them in about 30 lifesaving practices.

We then give them backpacks with medical supplies and smartphones connected to nurses based at clinics. The professionals on the phone supervise and coach.

An obvious question: Why is this important to do?

The first reason is moral: Why should anyone die from diseases that others don’t?

There are economic and security reasons, too. It turns out that blind spots in rural health care can become hot spots of disease. The Ebola epidemic of 2013-14 started in an isolated region of Guinea. Patient Zero was a boy named Emile.

The disease spread quickly and was not detected because the early victims were so out of the range of the health care system. Within three months, it had jumped over borders and moved into cities. We lost 11,000 of our people in Guinea, Sierra Leone and Liberia.

You say “we” — are you African?

I was born in Monrovia, the capital of Liberia. I’m not a citizen. My parents are from India. When I was 9, the civil war broke out. Charles Taylor’s rebel army marched on Monrovia. Some foreign embassies organized evacuation flights. My mother told me to pack one bag.

At the airport, foreign nationals were separated from Liberians and allowed to board outgoing flights. Liberians were not. My family and I were stuffed into the cargo section of this old military airplane. The hatch was left open, and I could see other Liberians, including soldiers, trying to escape.

Leaving those people on the tarmac was something I never forgot.

Where did your family go?

First to Sierra Leone. Ultimately, we ended up in High Point, N.C., where a family took us in. My sister and I grew up like ordinary American teenagers. I went to the University of North Carolina. The plan was for me to go to medical school and practice in High Point.

Then came Sept. 11. It brought back memories of Liberia and got me thinking about the roots of extremism. I also read Paul Farmer’s book, “Pathologies of Power,” which made me realize that medicine could be a way to bridge inequality, one cause of extremism.

Soon I was rethinking my future. I wanted to go back to West Africa and to find a way to serve those I’d left behind.

How did you make that happen?

I began by researching programs that had brought health care to the rural poor. While in medical school, I went to Alaska, where the Community Health Aide Program had brought access to the most remote areas. They had done it by training local people to become providers.

Then in 2005, I took my fiancée, Amisha Raja — later my wife — to see where I’d grown up. In the wake of the civil war, there were 51 doctors in the entire country. We volunteered to work at a rural clinic.

The first patient I saw, a newborn, died of pneumonia in my arms. I’d never seen anything like that before. The mother had lived too far from the clinic to get prenatal care.

When we returned to the United States, I wrote a proposal to start a clinic modeled on what I’d observed in Alaska. Amisha and I raised the funds for Last Mile Health at our wedding. Instead of a gift registry, we asked people to donate cash.

We got $6,000, enough to hire and train 30 community health workers. As of today, we have over 500 working directly for us.

Was there any resistance to your doing this?

Not from the government. The minister of health was positive. Liberia was now headed by Ellen Johnson Sirleaf, Africa’s first elected woman president, and she was open to new ideas. With other partners, Last Mile Health is now supporting the government by helping to train 2,000 of its own health workers.

However, the general rhetoric among local professionals was that it was not possible to provide health care in the rural areas — so why try? What these critics didn’t recognize was how new technologies had changed things.

Smartphones can connect lay workers to supervising nurses at clinics who can coach them on what they’re seeing. There are apps now that help diagnose disease — at least in uncomplicated cases.

For instance, a village child shows shortness of breath. There’s a smart watch that helps count the number of times he breathes. If it’s over 50 per minute, it might mean pneumonia. The community health worker has antibiotics in her backpack.

A life that might have been lost is possibly saved.

What else is in that Last Mile backpack?

A digital thermometer to check for fever, blood pressure cuffs to screen pregnant women, zinc for dehydration, testing kits for malaria.

Now, that’s something new. We have a test kit that costs a dollar and that you can take anywhere and use without electricity. Within 15 minutes, it can tell you if the patient has malaria. Before this, it could only be done by a trained person at a hospital.

Do you think of yourself as Liberian?

Well, that place gave me so much: a sense of purpose and meaning. But I am an American citizen.

I often think that some of what I’ve learned in Liberia about increasing medical access applies to the United States. We have lots of places where community health workers would help. Look at how much pain there is in those rural American regions where there aren’t doctors.

In North Carolina, people are dying of things they don’t need to die from.

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