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>> 2nd panel of the day the 1st you know most of you were here as you know sort of more locally focused on it Linehan Georgia this panel is it is sort of zooming out and why and to think about the way that some of the issues that we accessed this morning was resonate at the national and local registers so.

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Now we're after a new moderator is Professor Michael Allen Yes and I'm. Sure when you're David the catalyst you can be an actor who had a good time tonight you can with Alex he's going here for a I'm. Not We'll let him drift and. Michael. Is the 1st out of Georgia Tech's quality growth and regional development.

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Center for regional development and he joined the appointments this was a City Regional Planning and Public Policy and he is the co-founder and to serve as the co-director of the Consortium on because she and conflict resolution in the southeast southeast negotiation network before coming to tech Michael served as the executive assistant for current development for the New York City Deputy Mayor of economic development.

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Michael a service principal investigator on 37 research projects and Copiague on 13 others he's conducted over 50 professional training workshops in the field of Public Policy Collaboration conflict management and negotiation and internationally he's provided dispute system in process design consultations for resolving environmental and land disputes in a studio Israel Nicaragua Kazakhstan and Germany.

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And Michael has other wonderful compelling academic. And internationally cage work that he will not strategically deploy as I'm. MODERATOR So thank you Michael he's also done me a huge favor and I am grateful to his. He is the professor to have another class in our report on community health.

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Sustainable food systems and at least a couple of his students I think their presence here along with Dr Singh students. From sociology of medicine and health Don't forget to check each other when. We have a really exciting and I'm so thrilled to welcome. And David and I'm going to tell you a little bit about each of them.

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I'm going to try to be quick so I'm not going to do their bias justice. Is just that he is an assistant clinical professor School of Nursing and 2016 and this is actually something. To the previous panel of 2016 she was awarded the Robert Wood Johnson Foundation clinical scholars award for the wicked project oral health in communities and neighborhoods which you can call can just Q I can get it today.

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Today that I can team is develop technology to bridge clinical practice education and training research and health policy she's also traveled to Haiti to explore how life can conserve local communities there and she was appointed as the faculty athletic representative to represent an advocate for student athletes in the classroom.

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Nest written by me. As a public health professional who holds a B. it be a in international relations from not wholly and in ph from Rollins. She currently works is the reproductive health. Medical Center and she has 5 years of experience working to build a sexual and reproductive health.

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Is on raising knowledge and awareness of sexual and reproductive health within the refugee and immigrant communities in Georgia. And she works closely with medical center's clinical staff to highlight it overcome the different challenges the refugees and immigrants face when attention to navigate the health care system in the United States being an immigrant herself she's passionate about her work and lives the community that she serves stately.

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Dr David Adeste is the director of the focus area for compassion and ethics at a tough task force for global health after working in migrant health as a general medical practitioner. Study public health at Johns Hopkins University and worked as a medical epidemiologist at the U.S. Centers for Disease Control and Prevention we're focused on epidemiologist and control of the lab to tropical diseases one of which I think up here on the was that we were discussing earlier the World Health Organizations I'm talking facts.

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He directed the Fetzer Institute research program in science and spirituality and let the children without words program that at the task force between 20112016 He's an adjunct professor at the at Institute for Global Health University of Notre Dame and the Rollins School of Public Health and Mary is interesting clue prevention and back to tropical diseases global health at 6 and the role of compassion in global health and thank you let's welcome back thank you.

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Thank you thank you Michel. OK I'm going to begin by asking each of you to say a little bit more about what you're working on now just to put this in context to make a connection between what you do in the overall theme of Community Health about how this in fact is that in the community.

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OK sir would you start as certainly Well 1st of all thank you for this invitation in coming today. So most of my work in the last 5 years. However my overall profession has been all over the place with most of my work is internationally in Haiti. I've kind of streamlined it more to.

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I want to do it the school of nursing with the Robert Wood Johnson Foundation the World Health project that was just mentioned and what we have done is looked at how we can use technology to better engage and evaluate and assess what we do in the community and so we have to take in on the this nice project developing a smartphone it's my 2nd smartphone so I've been able to app excuse me learned quite a bit from my 1st step so as I've been quite as challenging but it is still something that we're working hard on in trying to provide a smartphone app that is culturally sensitive and also informative so we've worked at different ways of doing that with in our community and we're focusing and Westphalian as Dot and I mentioned earlier so that has been launched it's called the I can.

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And we have a repository connected to the app so we have real time data that comes in every time our providers and our patients use our app so it's working very well we're collecting the data quickly and we've also developed a website where our students go directly to the website and do education and training and you in learn how to use the app and then we launch it out with our students so the model is working well we're still working hard in how to better connect and engage all the above with our stakeholders and our partners in the community but that's where most of my effort is at this point.

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Before we continue oral health is not normally work people think of when they think of Community Health could you make the connection between why oral health is so important to Howard or think about it in terms. Community OK so if you place facts here in Atlanta is that the number one reason that children go to the emergency room for true non-traumatic conditions is oral health is the number one reason they missed school and it's the number one reason that parents call in with complaints of not being able to go to work or coming into work late it's also the 5th leading cause of death and it was in West Atlanta in our or home near a town or health worker I should say mouth and neck conditions in adults so we have a great deal of cancer or help cancer in our community as well so that's just a few facts to throw out there with putting the mouth back into the body so a lot of what we've done in our training in our education of the years we have someone excluded them out though the one of the most important cavities of what we use all the time so we're working on efforts.

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Within the state in nationally and internationally. To make sure that we are reminded how important this oral health in the wicket problem that we're meeting and what needs to be done to bring more attention and education to it very quickly because just got even more reports from the data I get are here are great thanks and if I don't you know please point out there.

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Thanks and again I appreciate the chance to be here it's really a pleasure and I'm looking forward to our conversation with you I guess I would say that for me community has been rather dispersed across the globe I. Spent most of my career working on what are now.

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17 and 22 seasons that have been bundled together for advocacy purposes they're called neglected tropical diseases as a whole. They're really diseases of neglect the populations often rural areas away from centers of power a lot of these are spread by mosquitoes or or wise and there's a certain group of 6 of these diseases that can be addressed or even eliminated by mass Drug Administration In other words everybody in the community lines up once a year takes a pill and that over a period of years will eliminate the infection because the factors are the insects that are picking up the organism or the parasite there's no organism to pick up in the blood and so they can't reach transmitted to humans so we've got several of these large diseases that are neglected or and they've been addressed primarily through this one senior master treatment.

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Be. To do that to it to convince everybody in a community to light up and get a pill once a year you have to actually take stock of what the community is is the community want to do this to they understand the benefits so there's been a lot of emphasis not enough in my view but a lot of emphasis on what is a community how do these defer turns out that rural communities are a lot easier to convince to to do this then urban complex urban communities so this whole idea of community and community health is imbedded in this whole attempt to address these neglected tropical diseases to give you an idea of scale Last year 1000000000 people largely in tropical areas of the world receive mass drug treatment that's a lot of people.

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And these these programs are having major success they are based on complex partnerships on the pharmaceutical companies which don't. The drugs the ministries of health that administer them the communities the N.-G. O. partners organise stations like USA ID and D U K. Humanitarian relief groups so these very complex partnerships which themselves are communities.

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I would say that. My son myself because I've done so much work in global health my own personal sense support system or my community is is dispersed I'm not a very good citizen here in Atlanta because I'm not here that often that's my excuse I could do better but.

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But but the advantage of this global perspective is that you you're actually you have a whole network around the world that you're content constant touch with and there's an exchange of. Energy and. Friendship that I think really animates a lot of this work. I have some other things to say about local and global but I'll save them for the later but I think this this dialectic between the local and the global what Bill Fagan called the faces of each of us and populations that global health focuses on is the essential problem and ethical challenge that we have been in global health and it relates to this issue of what is the community and the communities too large Can we still see the individuals and can we recognize individual voices.

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You have been very well but before I let you go OK you know one of the things that the United Nations has indicated as a major health threat in the world is. Kind of the tendency for people not to or in fact get vaccinations Yes this is a different type of approach but it has many of the characteristics.

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I want to say a little bit more about this this idea that what it takes for an individual to accept the notion of a medical intervention that's not clear to them at the moment. Is pretty complex and it takes working with the leaders It takes working with the communication networks the networks of whom people get their authoritative information from which may be cross the backyard fence.

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And it's much more than just a talk down message and it takes also some degree of. Pollens for. For people for not accepting that So if you talk to the people at the C.D.C. who are responsible for. In as a nation policy and immunization safety they will tell you that if you have you insist on everybody getting vaccinated.

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It doesn't work. Often especially in a complex society like we have because. The pressure from the anti VAX years you used to give them ammunition this is the big government squashing us and you need some safety valves to allow this especially a small number of people not to be vaccinated so you can have authoritarian decrees without some pressure release on the edges to keep the whole thing together so if so which which gives some.

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Recognition for that community voice and pretty diverse people opinion there so the gist of that context or measles is now starting to rise in the United States because of opposition to vaccination there is this whole notion that the protection of the community isn't just about the protection of the individual but rather as you expressed.

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There are vectors in the. Air of the diseases of the system you can disrupt people you can actually disrupt the disease itself. Doesn't have to be for everybody but once you start getting to critical you start getting the disease that you are welcome back to this question is a lot to say yeah.

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I think you for the invite and having me here. Actually work there regularly and the community I work for Opus Medical Center and the International Rescue Committee which serves specifically rescue would be to read the resettlement work and I mean project that I'm currently working on is a foreigner ship quest which is a.

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Health Center which means they get a lot of money from the government before they are able to form a partnership with and. Rescue Committee will. Work and one of the things that makes this partnership really really unique is usually the big challenge that a lot of Christian immigrants face is.

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A place they would have services available but they provide access to care but then of course knowledge and awareness something that's really important and that's lacking in the community which. Really has the ability. To want to provide but that connection was never meet I work specifically with in their present health center and what happened about a year and half 2 years ago we ended up getting really good funding from advocates for you with which there is an E.C.V. to a lot of work with you and we partner with them and the whole idea is to be able to really empower the refugee you within the community to WHO them the main idea is to empower them and have them through the work with and their communities we would be.

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Ideally in the back ground really doing the education kind of letting them that's kind of a model that advocates. Hughes's So we were able to form this partnership and what has been great is well what it is just to give an example what would happen is when a refugee women who are young person come comes to the U.S. get arrested and we settled by the International Rescue Committee they go through a process they have classes around language culture a lot of just things to help them resettle here so one of the things that was incorporated into this was the would actually be able to get different services Chris and specifically.

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Care is provided for free because we are which is we provide contraceptive care pretty much for free for. Mainly low income individuals so we're told they're able to get the education awareness around the health specifically. And then if they wish to get the services they have access to we cater specific beef from their transportation if he wants an extra 30 minutes of conversation with me for example because they're not sure what they need so we really try to keep it to the individual and thinking about the global community I always bring in the individual because one of the things that I've really learned from working in this program is even I'm an immigrant myself.

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Went to school here. Being an immigrant we have a lot of people from the East African population which is kind of who I am but even for me talking to different individuals really highlights that people are different you can it's just kind of an umbrella where you can say old people from the community have such beliefs and be with her full by such access but it's and being really different based on the individual so we're right now this program is really great and that we're able to really cater to the individual but also.

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Will. Address a lot of the. Interests and the community and I also want to lead have been within. All the diseases I wanted to mention and that's actually one of the biggest challenges for peace and immigrants have. It's it's a much actually much more bigger challenge than regard to health which is its own set of challenges but in terms of the numbers that we see in terms of the clients but come in and a lot of these really started back in their home countries a lot of them you would think that refugees have been an account for a year that was my assumption there are young people who have been born in Cambs and then does the all the world they know and become here they don't speak the language they have to survive they have to still be able to navigate the health care system we want them to get preventive care which is a concept that's just completely foreign to them so a lot of challenges to try to bridge.

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All of these gaps. You're in a medical center the or curse Medical Center is a nonprofit organization can you say the role of the medical center a livery of health care or are there how that relates to community so it is what is known as a Fed to be quite a federally qualified health center which means they get a lot of money from the government and.

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The exception that they have insurance but a lot of it is based on their income so there's a sliding scale fee and they're able I think the basic idea is we cannot turn anyone back regardless of your income regardless of their legal status anyone can should be able to come in and get the services and a lot of people as a provider especially that work there have been there for decades and they're very.

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True into the community the know what they're being told that they work and it would be depend on the population of the rest of the U.S. So yeah OK. It's evil to provide a lot of service for a lot of peacetime about $20000.00 individuals a year. And in particular the the population you're talking about is concentrated around Clarkston and I'm not sure how many people recognize that Clarkston is one of the biggest centers for refugee resettlement in the United States it is that this is a community that has undergone enormous change in the last 1520 years as a result of that and it's very type A suite there are people countless communities that.

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Are so. Great so all of us have talked about the notion of community and but we're talking about it from different perspectives and so what I'm interested in is no question about whether or not there's a classes ready to start and stop going to going to. The so interested in this question about.

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The issue of scale because of the problems we're dealing with our problems which are problems that are occurring in a systematic way at the global scale that have national policies and then we get down to the question of what happens within individual communities and we've made different references to the fact that for instance funding comes from the federal government or whatever so scale poses a challenge to community the challenge it poses to community is that if we so I mean if you look at sort of learned sustains ideas about what constitutes good health care delivery there are very specific ones about community one of them having to do with each community is a unique set of inequalities and should be according to court and which requires knowledge of community and then the 2nd one.

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Which is community help should be community led with community members serving as co-producers which suggests a very active involvement of the community so that as we think about the fact that these are problems which are sure all around the world in fact in an international setting often how much more complex What does that actually mean just think about community at a scale where you are doing a project in a particular community but want to scale it up to say Haiti or other places you're doing a project which requires many many communities which you can't possibly visit.

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And then you're in a clinic that is in 6 different locations dealing with very different kinds of populations in different places so how do you see that how does that inform your work. In any way to have the bold go 1st and I'll dive in 1st snow so this actually what you've just asked kind of describes my career and how I've gotten to where I am today in that I started trying to collect data in Haiti.

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About 25 years ago and I found myself using my students in using community leader in trying to focus in on and then at that time it was type what we were dealing with a great deal of typhoid in several communities that town that was working in in the northern region and Haiti and so I felt myself going this is almost impossible we have all this knowledge and we have community strong leaders that really are so passionate interest so much for their communities how do we do this have how do we better improve this process so we can have representation of the.

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Unity in a voice within our community so I started and I've been doing this trickling over the last over in the ninety's making 4th and found myself saying you know I'm not sure what the answer is but there's got to be a better way of holding Stickley coming in to this approach and found it landed with technology is where I landed.

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So since that time. I have been able to use smartphone apps and websites and so forth to and not only educate and train students healthcare providers partners stakeholders on both ends so we have the app where will it will which is in the process of being. One of the though I can is in the process of being translated into Spanish and creel but we also have the 1st ad there's just a number game truly that has already been launched in Haiti in years seeing actually in about 30 countries now so it's it's one of the stepping processes of using technology we're been able to say you know most folks even though it's a smartphone and in our developing world.

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Is there's about 80 to 85 percent of people individuals who elites have access to some form of smartphone technology and they may not own one but the Internet and the access to these smart phones provides an incredible opportunity so using that form of. Digital communication it's a it's been a model that I've taken from here locally with my nursing students and my other students that I use it that are in several my courses here in West Atlanta and and we watch programs all the time in taking that from a local.

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Form to a global platform and then back so it's actually a bi directional process in which we use take knowledge and be able to connect it to our riposte stories have our numbers come in real time collect our data in pretty much instantly be able to put it back into the community so what is happening here which I did not foresee in any way when I'm in Haiti and I go about 2 times a year now I am actually use in these apps in my community able to pull up my reponse to you in the film and say you know what after that 40 percent my 1st step is a pediatric hypertension I'm actually is able to say you know this community is suffering from 40 percent of elevated blood pressures I need to go back and look and see what's going on here whereas a community that may be and it is no 10 miles from this.

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From this site may be at a 20 percent elevation so it's able to go to the in bring that knowledge Green those community leaders together and say Let me share with you let me show you what we've just been able to do to date as we've seen these 200 patients and outcomes that we're having and what makes steps we can do to be able to improve this process and improve was going on in your community with diet with access to care with so forth so forth so it's kind of been a career path a career My experience but I've landed there in bringing that knowledge in that leadership together to where more and more communities can use it and it's easily accessible and without with very little cost involved so it's so this is the least in part taking the knowledge you have because of the training you're either in terms of medical knowledge or looking at.

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They there were does partially generated by the communities themselves and giving real time responses and you going into communities to understand how it actually functions on the ground is that correct it's a good David. It's a real challenge a lot of projects look really good when they're pilot projects and then when you try to scale them up they alter and I think some of the challenges is that often with pilot projects you have a champion who really is the driving force behind the success of the project and and so when you scale up you need to create champions and advocates greater levels both numerically but also hierarchically and the systems get more complex so than the networks the communication networks are are pretty simple at a community level project where they're confined you start going hierarchy and wider and you have other constituents to deal with other programs save for dealing with the health program where does it fit but in the ministry are you competing with someone else so you have competition and you've got challenges at the interpersonal level as well as organizational and bureaucratic levels that are there challenging.

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I think at the heart of what makes successful partnerships or successful scaling up is a sense of belonging a sense of community and a sense of each of these local communities feeling like there's some benefit from being part of the whole and that requires a very skilful messaging it requires a presence that allows local communities to the art of something larger sometimes that's relatively easy depending upon the nature of the partnership or the project in.

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Other times it's quite challenging. I think. To the extent that communities can see themselves as local communities can see themselves as part of a global whole that actually interjects a lot of energy and gives a lot of authority to local communities to know that it's not just us we're not alone as we have.

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Colleagues around the world who are dealing with the same say health issues and we can draw on their experiences sometimes stepping back from what's right in front of your face gives you a perspective that actually allows you to see possibilities that you couldn't see because you are so focused on your own specific locality so there's a tremendous amount of benefit to local communities to be part of these larger global efforts and and as as Hope said there is this by directionality this flow of information of energy of encouragement of dreaming together between the multiple entities in all there are as many as those are and the global issues as well and the global And that's that's really essential so that the communication exchange of ideas exchanging information and also this or motional sense of belonging to something that's important and so 2.

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Questions or one of them having to do with the your particular role it going into commuted to you as a person who is in the 2nd part of it is related as a person who comes in the United States what does that mean do you do that you just work at the higher levels how do you actually engage communities.

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You know. Most of us in the field of global health feel like we spend too much time sitting on chairs behind a computer screen. And we just get bored or we're just dealing with these numbers and bureaucracies. And programs you can see what are you going to try like that.

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Whereas we get energized when we go out to a community and actually see for example of mass Drug Administration taking place we say all of that's actually a concrete example of what I'm doing back here but I can't really see it so so in the early days of my career I spent most of my time in those communities working with local colleagues to work out what drugs you give how do you mobilize communities working out those mechanics in a sense.

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The biology the immunology of all these and that was immense fun. And it was the the the influence was relatively limited to those communities. In the last several years I'm much more likely to go to Geneva for his nation or to London or you know where these decision makers are and talk to ministries of health and heads of N.G.O.s and I only get a glimpse sort of a dim glimpse of what what what's behind that sort of the next stage so there's a level of abstraction that.

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That sort of creeps in as you know the progress in your your career. I come largely as a learner. When I was at C.D.C. I came up all the C.D.C. baggage and all of that but I think. What makes these things happen is engaged at the at the personal level.

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And the one of the the things that you mentioned was community health should be community led Well that speaks to the need for humility and I think unless I as someone from the United States or from C.D.C. go into a community whether that's a meeting in London or a meeting in.

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Nigeria. A Must I approach it with the sense of not knowing and I'm there to learn and maybe I'll have something to offer or maybe I can influence somebody on my side to get a clearer picture of what's going on without that humility all of the stuff just stops or becomes very dysfunctional.

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Actually in the learning process currently because so the model that we're working under right now is really creating a partnership between a health center and a usurper going to. Every set of an organization so that has been really successful hit here Don so that i actually has many locations across the U.S. soldier right now we're actually in the process of discussing how we can scale this program up to the national level so it's actually in the process where a lot of the things that you're describing we're learning as we're going right now so we have to why do we have to get a lot of people on board for example a lot of the individuals that work in my program really passionate about what they do to ever be really believe very strongly and it's but contacting a lot of the other and a naturist can reduce the amount of the issues there and they're really not sure that they're not for the need is there they're not sure if they have.

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The staff and there's just different excuses stuff that they have because they're really not familiar with the work because they're mainly focused with their resettlements and the they don't because of different reasons they really don't have the capacity to deal with a lot of the health challenges that refugees come in with so right now if we are successful that there's a process that's taking place and ideally the end goal would be to be able to have.

[00:37:57]
Partnered up with the health community where people are not really being left behind in the SO. I think in the long term this is what the program hopes to do is also do a global leave just making sure of the health aspects specifically with such a pact of health because that's something that's really lacking in a lot of these populations so yeah I should have more than a year from now and do.

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A little bit with there I was presuming you know. Discussions of reproductive health. Of the group or presume it also includes issues of birth control and other kinds of things or sensitive to coach or significant ways and sort of how do you actually engage that question you know way that is responsive to the fact that there's a wide range of cultures that you're working with yeah it's it's hard actually it's complicated because even me being kind of had experiences different countries I am not from the US.

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A soul a lot of the populations that we serve a very conservative. Just don't see the need for contraception for example some think it's said Phyl. Some just do not want to talk about it at all what is so when a lot is so one thing that we should try to do is when people walk into the clinic for the educational such that we have that at the.

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First we just introduced this topic just to let people know he said they have options. And then it's individuals really matter because of the really really really do have that individuals. Who have a lot of experience working with this population you really have to keep it to the individual and the individual but having conversations with especially because this is just not a topic that people want to discuss or if the wife does she's there with their family and it's not something the husband would dare discuss the same thing with young people a lot of young people would have this Congress.

[00:40:05]
Within their own circles but not with a health care provider one thing that we have at present is we they do help us design a new family groom where the can feel confortable to come and talk to a provider but even then they would maybe talk to me because they're not confident talking to a provider so there are different challenges and one thing I try to do a lot of providers are on America and so we have a lot of meetings where we're trying to communicate the different cultures that individuals come from we have meets all the way from the front of the we to the back so it's very easy as opposed to you very focused on individuals very focused on.

[00:40:51]
Trying to deliver the very sensitive culturally appropriate cancer them to vigils So how do you kind of scale that up without in the sort of the in bed and a vigil that are. Aware of these issues and that find it important enough to actually invest their time and energy that's the tricky part I guess and but I'm hopeful I think because it has been successful here I think that they have somewhere else.

[00:41:16]
So let's think about this individual community intersection here a little bit because. You know the health care system in the United States is generally oriented towards healing individuals I mean it's it doesn't often intervene at the level of community so I'm wondering when you take the step it obviously takes work it's hard work to do to actually engage the community and just think of the health issues as community in bed and what difference does it make what changes is it the same material that you're that you would have gotten if they had gone but deliver different leaders or something else something more profound changes.

[00:42:04]
So we reversed the order. Of targeting. And have interested you correctly and being so. Specific it's different I think it's kind of a little bit different when you're talking about sexual health. For example I'm part of this research. That's looking at S.G.M. which is female genital cutting in the U.S. because there really isn't a lot of research that has taken place specifically and they do as.

[00:42:35]
We have had different meetings with and try to engage people just within the community and try to address the community. Itself within a group so we'd have different sessions where we're talking to different people from different communities so we're kind of looking at the refugee community and a lot of.

[00:42:54]
Soul meetings would be productive but it was something I personally be honored is that you engage more when you're doing it individual be you people are more open. And find it it's more productive Aciphex it was sexual health it's more productive when you're dealing with the individual but of course programs have to be designed for the community and there's always of course an underlying factor where we do have a lot of similarities there are similar challenges there are in design Umbrello that can that would be to be addressed but in terms of ease and success I think for such a health specifically when you're given the individual.

[00:43:35]
Therapy so the community part of it is about entree to the individuals. About having a background conversation that there is more of a buy in by a viewer who we need to engage the state voters so we have you moms pastors different leaders in the community because what we find is a lot of the individuals actually have some tips with these community leaders and they're highly influenced by them so on this you get buy in from the leaders.

[00:44:04]
If you just not going to get it from the individuals so there's this to eating sequel there is the biggest part of it OK David I would say what your question or what she does I'd say there's there's 3 things One is that things become much slower initially.

[00:44:23]
You don't necessarily get things started in scale up that's quite as quickly as your grammar might have said you know so that creates a bit of tension. But you're optimally more effective you have fewer surprises later on. And you're more relevant as you you learn things through that process that allows you to actually improve your intervention or to make adjustments that make it much more effective.

[00:44:55]
And I would say finally it's more ethical part of the global in public health ethics are about delivering a certain benefit while minimizing the harm that might be inflicted and maximising the autonomy of the people that that intervention that so. Basically it's just good public health practice but we don't do it very often.

[00:45:21]
Because of takes longer because it's you no longer also applies more resources right of lies right tension Yeah Oaklands because we're the great hope so I think that it's I was in the military and I did my training in the things that was most impactful. Is the process of mental stability and sustainability within our training and it did you know I did have the opportunity to go through many of the steps that many of our.

[00:45:57]
Soldiers Do I came straight in as our officers so I took on a totally different role so I really leaned. On. So many that with through so much more than what I went through to learn the military. World in and how things just work within our training and through that process you know this was something that I didn't really see coming my way but it's been so and have for what I do now professionally within my of my filter is that I had this thing over and over this drilling into listening to your community and that you must understand to be understood so it's one of those process that when now in training doing the training that I do with my students and so forth is committed to the case by case thing going in and take in that I don't care if it's 2 or 3 different times we go to the community of being silent and actively listening to our community before we can actually start to understand what those needs in that community are and I've got you know all of us would have said you know so many examples of this and personal all have how it's impacted as personally I'm in looking through the mirror and coming back and say How could I have bettering gaged with you know that person or how could I get better understood what was going on with that you know person that has the box under the bridge and that's their home and you're going to them every day to make sure that they have water and they have food and they are taking their medications and so it's a case by case community by community assessment and growing step by step according to what the what you're learning what you're experiencing group.

[00:48:01]
I have other questions but I'm aware that we are all. Romeo a little over 5 minutes left and I want to give you a chance to ask questions. Is everybody. Just went out about. You how right. Now are you trying to sign your life that's the. Language and language of the heart.

[00:48:40]
You know these are people within the community that hears. His or. Her Own Words actually this. Is not right or. Well. So it's actually one the 1st steps I'll take I going to compete to a community I was all find that a community leader whether I'm here in.

[00:49:08]
The early part of Haiti or rule Georgiou. I will find that committee or or or whomever makes most of those decisions within that community and is well respected within that community to make to take their 1st step because I have found in a very unfortunate way that if that is overlooked and you go straight into the community there's going to be pushback it even if everybody agrees in his own or with the project that you're.

[00:49:44]
Here it is trying to do and OK if you even have that money look if you have all the resources there is a level process a stepping on a says that happens in those communities where if you do not take the appropriate steps to engage the leaders that are respected within that community then.

[00:50:04]
It's hard to branch out it take the next steps I'm not going to say that all the time but most of the time in my experience no matter if it's international or here in the states taking that process of finding that community leader is crucial. It's crucial that they answer your question and I absolutely said it's almost impossible as we try to work on.

[00:50:31]
I think someone like that I like what I do right now because I feel like one of the. Purposes that I serve is real B. because I speak to other languages I kind of buy part of the community at these I know people view me that way. And then I make sure that I have strong leadership with different community leaders.

[00:50:54]
To give a specific example working on that people at G.M. research we I was having conversations different people and I met while woman and some of the community and she's what you might consider a community leader and she was instead she was very you know well call about how to get into her community you have to go through her purse because she is has she works has worked with different organizations the C.D.C. every everyone really for many many years and there's this sense where the communities there have been incidents where the pill you lose the No Way and that's especially with the community I work with you have to exercise that to that and it's all the after you get comfy buy in from the theater is that after they have really vetted program through with you to be able to get good and productive work and with the community so absolutely.

[00:51:46]
They're working to say something about these are really special people and you need to make different levels with him from your global program or durable to having a sense of the dual identity of a community member but also be open to. The community drug dealers the community very small interior.

[00:52:04]
If the liberalists mass treatment are embedded in the community which makes them effective but they also represent this global community to their local community and so there is a certain internal tension that they take on themselves and part of it they're curious about the outside world they they like the relational and the they see themselves as translators but there's a there's a little bit of a psychic burden that we put on these people who may not fully be any longer members of just the local community they're seen as something outside as well so there's this ambiguity of the identity that gets.

[00:52:47]
They that becomes part of who they are and we haven't fully acknowledged that or provided resources for them or understood some of the challenges that that might face. But these are really special people. Really have. One more question. If they're in your earlier life I. Was wondering. If you were.

[00:53:27]
Hearing. There was the. Money is there. You know I think it's just such a basic principle of. That and unless you adapt you're not going to scale. And play. Through these things lot of the examples so. The pilot project succeeded because it was scaled up from the community level it does.

[00:54:04]
It makes sense then to impose that another community because you're violating the very principles that created that success so you can compass my ideas you can engage in a conversation but it's not about imposing an idea in other places it's more about bringing an idea for consideration by other communities so that it can be adapted.

[00:54:30]
Is one of the tensions. In these global initiatives others now several initiatives to eliminate diseases globally. If you're just having a control program where you're not trying to get to 0 eradication then community autonomy is just great they didn't they can be part of this or not nobody on the outside it's going to get upset.

[00:54:54]
If it's a goal eradication program then there's a lot of pressure on those communities to get with the program and so this idea of and so the adaptability becomes lost the the larger the scope the more rigid it has to be in terms of following certain standards and the less adaptability it can support and yet without enough adaptability the whole thing will fail because those in those local areas you won't succeed so it's it's a balancing act and we never quite get it right we have to have our in town as well for steering off into each of those directions too for.

[00:55:38]
I think we could continue the conversation to hoping you'd stay around a little bit for people to ask additional questions but we have reached the time we're closing this down. Like to thank you all were participating in this.