Doctors Have A Lot to Learn

by Prabjhot Singh, MD, PhD

When I was starting my career, a mentor gave me an important piece of advice: “Whenever you find an issue or topic you’re interested in, you have to observe two things — how people are currently speaking about and trying to address it, as well as the more challenging and true nature of the problem itself. The gap between these two observations is the place where you dive in because your contributions will build upon what we know, but bring us ever closer to the truth.” This really stuck with me, and then like all good advice, it disappears into your mind until, one day, it shows up again at just the right time.

When I moved from Kenya to the US, my parents were advised by my new elementary school that I should have a regular pediatrician. They were surprised at first, because I wasn’t sick. The idea of a regular doctor, with whom you just visit, struck us all a bit strange! But the new normal set in, and over the next few years, I came to see a basic primary healthcare system as a fact of life. Years later, when I learned that most of the world’s population doesn’t have access to high quality primary healthcare, I thoughts the solution was simple: just build it in the image of what I had gotten used to in America. And that is what most serious people think we ought to do: it’s how people currently try to address it.

I was in for a surprise, years later, when I spent time in two seemingly different settings: rural countries in sub-Saharan Africa (Uganda, Nigeria, Liberia, Kenya, etc.), and in urban New York City, where I trained as a physician. In the former, I learned that the ratio of health workers to people was 1 to 28,000. To put it another way, at the rate that these countries were graduating physicians, you’d never have enough physicians to build a health system the way that I experienced them when I grew up. In the latter, I learned that despite having a ratio of health workers to people at 1 to 500, people who were being treated for chronic conditions only received 50% of the care they were supposed to get! So in the former, there would never be enough health workers, and in the latter, they seemingly didn’t want to finish the job even if they were there!

Along the way, I thought about my mentor’s advice. It led me to think more deeply about how we design systems. Especially systems as complex as healthcare for everyone. The basic assumption most people had was that if you build a building that has the title “clinic” on it, it would just work. In both poor rural settings, as well as relatively wealthy urban settings, this wasn’t exactly true. So what was the gap? This is where I dove in.

I’ve spent the past 15 years thinking about how we can design systems that incorporate different levels of health workers — including nearly lay “community health workers” — to take part in care where there is no doctor, and to complete and enhance the work even if there is. This has meant overturning my own assumptions about what people can and can’t do, and then working with others to prove that it’s safe and effective. Do you think a rapidly trained lay person can treat malaria? Do you think the same type of person can improve the health of a diabetic? If you asked me these questions a decade ago, I would have laughed — why would I be getting an MD and PhD if this was true? Now, I’m humbled by what people can do.

It’s been 3 years since I launched the One Million Community Health Workers Campaign across sub-Saharan Africa, and 5 years since I helped launch City Health Works, a thriving social enterprise in New York City. They are both very much alive, and each one has taken a passionate network of problem solvers and dreamers to sustain and succeed. We never “solve” healthcare for everyone, but I do know that we’ve been able to get a little closer to the basic truth that everyone on earth needs it to thrive.

Dr. Prabhjot Singh serves as the Director of the Arnhold Institute for Global Health and Chair of Health System Design & Global Health in the Mount Sinai Health System. Prabjhot completed his undergraduate studies at the University of Rochester, his MD from Cornell, and his PhD from Rockefeller University. A social activist and prolific writer, he has been featured on MSNBC, NPR, and Huffington Post Live, and he has published pieces in the New York Times, the New England Journal of Medicine, and the Lancet.