Health Care Is A Human Right

Quinn: [00:00:00] Is healthcare a human right? Does everyone, as the late Paul Farmer put it, deserve a fair shake? That's today's big question. It shouldn't be a question, but my guest today is Dr. Sheila Davis, and she's the CEO of Partners in Health. Sheila entered the global health arena in 1999, responding to the global HIV and AIDS pandemic.

A few years later, she co-founded a small NGO that worked in both South Africa and Boston on a wide array of health projects, including the operation of a rural village nurse clinic. She joined PIH in 2010 as their main operation in Haiti was just torn apart by the earthquake there and worked her way up over the years, becoming the Chief of Ebola response during the 2014-2016 West Africa epidemic. And then as the Chief of Clinical Operations and the Chief Nursing Officer, a big job there where Sheila [00:01:00] oversaw nursing efforts as well as the supply chain, medical informatics, laboratory infrastructure and quality improvement activities.

Dr. Davis is, I'm so lucky to have her here, she is a frequent national speaker on global health and clinical topics, including HIV and AIDS, the Ebola epidemic, leadership in public health, and the role of nursing and human rights. And folks, if it is not clear enough for the past few years, just in the US, much less everywhere around the world.

Yes. It is a human right, and yes, everyone deserves a fair shake. We need nurses. We need empathy and care more than ever. Welcome to Important, Not Important. My name is Quinn Emmett, and this is science for people who give a shit. In these weekly conversations, I take a deep dive with an incredible human who is working on the front lines of the future to build a radically better today than tomorrow for everyone.

Along the way, you and I are going to discover tips and strategies, [00:02:00] stories you can use to get involved to become more effective in this world around us. Now, look, we have made so much progress and we also have so far to go. That's our job, that's our opportunity. We need a half million more nurses here in the US alone and millions of them and community health workers, the world over.

And that's where Partners in Health, and the tens of thousands of community health workers and teachers and hospitals and training centers they've built around the world in 11 countries, that's where they really come in. And I'm so excited to share their story and their model with you today,

Dr. Sheila Davis. Thank you for joining the show. It worked. We did it.

Sheila Davis: We did it a few attempts, but we made it.

Quinn: I feel like perseverance is really the name of the game here. I'm hoping we get to the end of this. That's my goal for literally this entire week is that we get this thing done.

I'm so thankful and appreciative and [00:03:00] cognizant of how important your time is. So before we do get going though, as I hinted to you a few moments ago, I like to start with one question and I've asked it a hundred and I don’t know, 150-something times. So it sounds ridiculous, but we do get some great answers out of it.

Sheila, if you don't mind, why are you vital to the survival of the species? And I encourage you to be bold and honest.

Sheila Davis: I think I'm vital to the survival of the species because I firmly believe we can be a better species than we are now. And see that we're all critical to, our survival is so interconnected.

And what I'm doing is making sure that people around the world also have the same ability to survive in a way that allows them to live a full life.

Quinn: That sounds pretty reasonable to me. It doesn't seem too farfetched or full of bravado. It seems simple, but pretty important. I think I mentioned to you, I would like to start with talking about Paul a little bit for folks who aren't familiar with him and how it all started. But [00:04:00] one of my biggest takeaways has always been that's his ethos, which is, all lives really should be valued equally. Everyone deserves care, some level of care at least. I have a few notes here just so I don't forget anything, and please just stop me and correct me wherever I'm wrong here.

Just starting with Paul Farmer, the father of redistributed justice. And I always think of that idea of that moment of him stealing the microscope from Harvard to take to Haiti. And so in 1985, I believe, co-founded Partners in Health, which again, it's right there in the name.

And we'll come back to that, but you all are legendary now among the public health community. Started in Cange, decades of incredible tireless work there and around the world seeking health justice. Paul died in February, I believe, 2022 at such an early age. So I wonder if you could get us up to speed a little bit because Partners in Health has changed and grown so much.

So how many folks would you say the organization serves [00:05:00] now?

Sheila Davis: So we serve in direct care, meaning that we touch the person about 8 million people a year. I think in terms of who we are, hopefully influencing the amount of care that they're getting around the world is over 40 million, many, many million because of the work we do in changing global policy on treatment for HIV, MDRtb, and now with oncology, mental health.

So I think our direct touching is 8 million, but the impact is far greater than that.

Quinn: And that is such a important nuanced point. And I want to dig into that and I actually have a, a semi-personal story about that. That's also, I imagine a struggle to be able to do both things at once.

You're in, is it 11 countries now? 12 countries? Again, directly.

Sheila Davis: We're in 11 countries and we have about 19,000 employees around the world. The vast majority, about 12,000 are community health workers.

Quinn: That's incredible. That's so amazing. I want to ask [00:06:00] now. Gosh, now it's May, which is incredible.

2023. I'm not sure exactly how that happened. It’s been almost a year and a half for you all since Paul's unexpected death. How is the organization, you folks who know him best, and all of these other tens of thousands of folks who are trying to emulate his work and learn from his work and your work, how is everyone healing because you are still a small organization really?

Sheila Davis: Yeah. I think the personal loss will continue for a lifetime. For many of us, he was a part of our daily life. His family's here in Miami, so me being able to be close to his wife Deedee and children, and brothers have been great, but it's a huge loss.

I think he was our North Star. He's the one who continued to, I think, just really put a mirror up to the world and say this is just crazy that there are stupid deaths that happen in the world. And he could say things that other people could never say, and he really believed that it's a big tent.

Everybody should be in the tent and would talk to [00:07:00] people who you would think would be on the other side of our political agenda. He was a once-in-a-lifetime human being, a once-in-a-generation. I think the beauty of Paul though is that he didn't ever think that it was one person who could do this.

Part of the ethos of PIH is that we've trained people from day one in every place that we are and we work. Even from a small clinic in Cange and Haiti. Part of the, it's delivering care, but also making sure others are learning how to deliver the care. So in all the countries we work, the care is delivered by people from those countries.

We don't fly in and drop people from the US there, our care is delivered by people in those countries. And we, our leaders are all from those countries too, and have, all knew Paul and were able to I think, were able to see what his impact has been. We have a strong strategic plan that he worked on and he imprinted all of us.

I think none of us embody Paul solely, [00:08:00] but we all have a piece of him in us. And it's fascinating, who takes on what role when we're together as a leadership team. Because he was also the disruptor, he was also the cheerleader, he was the visionary. And there's not one person who's doing that now.

There's a group of us who are doing it, which is also I think the beauty of Paul, and I think he would be pleased to see that.

Quinn: That's beautiful. Thank you for sharing and I'm so terribly sorry for your loss and how abrupt that was for his family and you all who are obviously part of his family and so many folks who he helped so directly and intimately, but also increasingly indirectly over, over time, obviously.

As he tried to, seemed like he was almost dragged into it and then tried to really show how your organization and work in Cange and then in Haiti specifically could be a model, at least some base elements of it for so many other places to train other people. That whole idea of no one can replicate him specifically.

But at the same time, almost in a Captain America, [00:09:00] not Captain America, what was his name? Captain Planet. The creepy guy with the kids, with the fire rings on one arm, you had the, God, what was it? Earth and wind and water, whatever it was. These pieces came together and it's interesting because I've been reading Paul's work and reading starting with Mountains Beyond Mountains, like everyone for so long.

But this was a person whose focus and intensity and very direct way of doing things, whatever it was he was doing, it was so difficult to replicate. That he was very much pulled in truly a thousand different directions. Over time and I think that applies to any job or role, whether you're a parent or one part of a band or whatever it might be.

But I always tell the story and it's so funny, I thought about it because, relates directly to PIH. So my sister, who hopefully doesn't kill me for sharing this story yet again, actually interned with PIH years ago, 2014. She is the best of my [00:10:00] siblings, like by long shot. It's not even like a close horse race in this regard, we've come to terms with it a long time ago. She went to Tanzania and built a school with her bare hands. She also has been a teacher for children with learning disabilities and low income children. And she's also run volunteering for both of the Obama campaigns and struggled always with this sense of, do I want to affect eight kids today for sure.

And change their lives. No questions asked or do I want to work in policy and maybe affect millions of lives in a slightly more vague way. And it's really difficult to do both. And it's really difficult to find an opportunity to do both. And I've always thought about that through my work and everything, but it's so specific to you all, I'm curious now with tens of thousands of community health workers and after Paul, how are you all doing the hands-on work, continuing to do the hands-on work, and definitely affecting a few lives directly [00:11:00] and simultaneously the policy work because as many people as you all touch now directly, there are millions that could use the care that you all provide.

Sheila Davis: Such a good question because I think we also have this conversation of who are we? And with Paul, we would have this conversation and because the need is endless in terms of direct care, we could raise billions and we still wouldn't fill that need. And so I think the decision was made a long time ago to really look at like a theory of change.

You can just provide care, super important and a very important thing that people do that and to do that solely will impact that community. But I think the goal of Partners in Health is we create models that then can be replicated because we don't want to be in a hundred countries.

I can tell you, I get an email every week saying, I'm sure can you go to this country? Can you go to this country? And that is not who PIH is. Our goal is to do the direct care so we know what we're doing and we'll always do that. That's our credibility, that's [00:12:00] our heart. But then also, how are we then training and educating along the way, because we need that generation behind us to be doing this.

Then how are we influencing with evidence? How are we taking, starting people in Haiti with on HIV treatments, and how we're able to then change the global policy of changing the drug prices for antiretrovirals to challenging the world to say people have the right to have lifesaving HIV treatment.

And then how are we influencing that to make great change? And then how are we replicating that? We opened a university five years ago in Rwanda, the University of Global Health Equity, and the goal of that is how are we taking all these lessons? Educating a whole new generation of healthcare providers and those who work in healthcare delivery in a really different health equity lens.

And how are we going to change the world because we made the decision a long time ago, even though it's a hard decision every day [00:13:00] of do I hire a midwife or are we hiring a policy person to be working with the ministry in Sierra Leone? But then by the work we're doing at Sierra Leone with the ministry, they're able to get money from the World Bank they couldn't have gotten, and they're able to roll out the PIH model of care to the rest of the district. So I think it works in this crazy way. One only works because of the other part of the puzzle. We would have no credibility in public policy if we didn't do direct care and we can do direct care constantly, but we're not able to really push that systemic change if we're not working at the national and global level.

Quinn: Thank you. That seems like an easy answer for you to be able to put forth, but that's decades of struggle. I imagine it's still, I feel like the question I answered most for folks, or the best advice I could give folks at the beginning of COVID when the best answer to what can I do was nothing, is control what you can control.

And you all identifying [00:14:00] the fact that we shouldn't raise billions of dollars. We should not be in every country, because we would have to sacrifice one of those two tent poles. And if you sacrifice one, the other one becomes weaker. It's got to still be a struggle. So you've got the university now and you've obviously, you're in again, 11 countries and training all of these community health workers who train each other, sort of formally, structurally, what does a pipeline look for someone who joins, who wants to join to train to be a community health worker in one of those countries. Is there a version where they graduate to the broader community level wide administrative or management to statewide, to countrywide? Or are those really two different sort of paths?

Sheila Davis: I think that's a really good question.

I think both, I think that the vast majority of people from those communities who will stay in those communities, and we certainly have people who become supervisors, community health worker supervisor, and may [00:15:00] move up to train to be a nurse's aid or may go to nursing school, that type of thing.

But I think, by far people stay in the community part of their role. There are always opportunities for people to grow. We don't have an endless, limitless supply of jobs. So I think part of it is also training people so they can get a job other places as well. We think it's a success when people move to a different place and get a job, because even when that's people in the US we just found out that one of our long-term people is leaving and immediately you thought is, oh no, like, how's it going to impact us?

But then, this is a win because she's going to bring 11 years of great experience to a different place that doesn't really run like Partners in Health and be able to infuse that in a way that is going to just further our mission. And so we see it as a win. But I think community health workers do have moved to work in the depot.

We actually in Sierra Leone on our construction team [00:16:00] to build this paternal center of excellence. We have women construction workers for the first time. And they're like the brave, paving the way. And it's a first in Sierra Leone, in this area. It's now our major welders are all women because she's gotten her friends and built this cadre.

It's this amazing thing that you see that, who would've anticipated that's going to change the life of so many people by little girls saying that there are women and little boys saying that there are women doing these jobs. That in itself is such an amazing transformation.

Quinn: I love that. Which is it depends, basically, we are open to it.

It obviously, if someone leaves and moves on to something else we might have to scramble a little bit or think how do we fill that hole? But in the end, the overall win is, hopefully we can spread this a little further. My wife and I were very lucky recently, longer story, to spend some time at the Mayo Clinic, and we have some wonderful medical folks and health folks in our life of a huge variety.

But, you go there and you're like this is Star Trek. Nothing is perfect, but what on earth [00:17:00] is happening here? And truly from the way the buildings are structured to the way the institution and the patient flow is structured, it's very difficult to walk away and not go, one, how do we do this other places?

But if you're at all familiar with at least, the healthcare structure in the United States, at least to go oh, you really probably can't pivot what we've already got. It's going to require starting some things new because a couple people leaving from Mayo Clinic or a couple people leaving from Partners in Health.

It's very difficult to really have an influence on these big institutions that are already there, that have all these incentives in a thousand different ways. So if I'm someone who grows up in your organization and does well and then thinks about, You know what? I think I can actually really go have an impact here.

What's the best way for them to do that? How do they go? Because your situation is so unique and hard to capture.

Sheila Davis: I think we, part of our goal is always that we're seeking opportunities for people to grow professionally, educationally. We have started these residency programs in Haiti, for [00:18:00] example, and that's training the first emergency room residency program are people all trained at our university hospital in Mirebalais.

And that's an opportunity for people to become a specialist that they didn't have in Haiti. Training nurses to become nurse anesthetists, like another pathway for people to learn. Some people get an opportunity to travel and study at a university in Norway or in the US for master's programs.

And then they come back and they're able to share their information. I think why we have started the university though is we know that those opportunities are, not everybody doesn't have access to a Fulbright Scholarship, for example, and there are so many amazing people. So how are we also giving our amazing doctors and nurses who work in Lesotho to be part of this university in Rwanda and bring their lessons learned?

Now there's going to be students from Lesotho who go to study in Rwanda for the first time to be exposed to a really different world. I think the [00:19:00] goal is that we're trying to always cross pollinate. Everybody and each other and see where there's partnerships and Partners in Health means we partner with everybody, with other great organizations, partners with Ministries of Health around the world.

And so part of it is too is are there opportunities within the government for people or do we need to provide our government colleagues an opportunity to go to a conference and learn and train? So I think it's this big kind of ecosystem that we're trying to continue to build and it varies greatly in where we can get visas for people.

We were all supposed to just meet in Peru and found out that we couldn't get visas for some of our Executive Directors based in Africa, for racist reasons, basically. It's also confronting and battling those structural violence that is embedded in our culture and our society too. And trying to see what can we do to change that and address that and where do we have to say we have to move the meeting because we're not going to have it in Peru without half our people.[00:20:00]

Quinn: And that's always the hard one, right? Is going back. So my wife is the greatest human alive and a hardest worker and talented and successful and all these wonderful things. And she's a screenwriter and producer who are on strike as of eight hours ago.

Sheila Davis: Yes, I saw that. Heard that.

Quinn: Ugh, Hollywood. It's a nightmare.

But part of the reason people work with her so much is because she's so good at what she does. She works so hard. The second part is she's the most wonderful human. But the third part is that part you just talked about, which is going Hey guys, we have to move the meeting, where she can take her writing personally and care about the words on the page and care about how an actor's feelings are, or this budget or this.

But the end goal is always, we're trying to make a movie. And in the end, same thing. You know, this is why I come back to Mariana Mazzucato’s book, The Mission-Based Economy, about these clear, measurable outcomes. Look, if the goal is to put someone on the moon, everything you do up to that point has to answer to that, all your processes and your teams. And if the goal is like, we have to have [00:21:00] this meeting or we have to get this movie made, some things are going to be sacrificed along the way and that doesn't make it better or worse, but it has to be measured against can we have this meeting, which I'm sure there's some intended outcome out of that or process out of that. So I want to talk about that because as much as we've talked about pipelines and I want to talk a little bit about how you actually recruit folks to be community health workers in these countries or in the US. Your path, you went from doing the on the ground work to running an organization like this.

And just for a moment, again from my notes, and please correct me everywhere, I'm wrong. I'm used to it, it's my day. I have children. Chief of Clinical Operations and Chief Nursing Officer at PIH. You oversaw the nursing and the supply chain and everything. Chief of Ebola response for PIH in 2014-2016, co-founder of a small NGO before that was in South Africa and Boston.

You worked on HIV and AIDS. How important do you feel like now, especially now that Paul has left us and everyone's trying to both fill his shoes, but in a [00:22:00] different way? How important is it for someone to run an organization like yours to have so much on the ground experience, and where do you feel like a few years in that it's an obstacle in some way?

Sheila Davis: I think I was uncommon or unexpected choice for this role because I'm not a Harvard trained physician. I'm somebody who was definitely from the ground up working at PIH for about 10 years before I became CEO. And didn't want the job. I was asked to interview with the search firm because they were trying to see, get ideas and at the end of this kind of interview of just, getting ideas, the woman said, I think you should put your hat in the ring.

And I thought, there's no way in hell they're going to choose a nurse. But I thought this is a chance to get my ideas on the table that are not just my ideas, they're ideas of having worked in every country. We are working, spending long nights, up late, long travels where you really get to know people and these amazing people around the world.

So these weren't my ideas as much as the synergy of all of them [00:23:00] together. So I just was super painfully honest and my word of advice always, if you don't want something then you're always at your best because you're going to be authentically yourself. So I was really authentically saying, I think this is where we need to change.

This is what we need to do. And I think because I had worked in all of the country sites or most of them, and knew people, I could speak authentically to really where I think we need to be pushing decision making to those in closer proximity, where I thought that we could shift the way that our leadership structure was, which is very US focused and was able to, I think, speak honestly about how I think that was important. And then had built up political capital through the years so that when I did take over the role four years ago, I made some pretty drastic changes, but had some political capital because people hopefully knew that I was not somebody from the outside. They trusted that I kept the patient at the [00:24:00] center.

And so I think that's been, that allowed me, I think to really do things a little differently than had I come in from the outside. I do think though, I miss the interaction with patients, I even miss the interaction even with the frontline staff in a way that I fly in and fly out, which I always used to hate when people did that.

And now I'm that person who flies in and flies out. Which is like my own issue. That was a personal loss of, wow, and how do I make sure I don't lose what I think makes me a good leader the further I get away from it? And I think all leaders struggle with that. I think about that probably more so than I should, of worrying about that because I do think so many errors are made in life and in organizations when there are people who don't have good proximity to what you're trying to do, make all the decisions.

So that's why I restructured the leadership team, did all this, to put systems in place to help [00:25:00] counteract that. But there's a personal loss of feeling like I'm not, I don't have the same connection with people in the same way, of patients.

Quinn: Could you possibly make bandwidth make time to do that in some way?

Is there some, I think of Google for what it's worth now, had forever their sort of, whatever, 5% time or 10% time for people to work on side projects. And we've talked a little bit here about this idea of helping organizations, other organizations, not like a PIH, empower their workers to use 20% of their time for something that is future positive in some way, whether it's related or not.

Is there room for you to spend some time with patients at all? Does that exist? Do you feel like it would, I don't want to say check that box, but do you feel like it would fulfill what you're feel like you're missing?

Sheila Davis: I think I was, when I first started at PIH I did keep my practice at Mass General and was able to combine worlds.

And then when Ebola happened, and I was in West Africa most of the time, and when I wasn't in West Africa, I couldn't get into a hospital here if I wanted to because of the Ebola scare. [00:26:00] So that kind of had to abruptly stop me taking care of patients. And now that I'm further away from it, I'm probably not the best one to do it anymore because I'm not up to date on the same HIV medications in the same way.

I think when I do go do visits or visit sites, I try to spend some time in the hospital just to connect with the staff and talk to patients. I feel like there's, at this point with what my role is that would be self-serving for me, but not necessarily benefit the whole. I try to get snippets of it, but I think it is, it's hard to incorporate that.

But I do think in a lot of instances, I'd hope more and more companies do that. And I think our, most of our clinicians who are US based all have their clinical practice that they've kept, even though it takes a lot of maneuvering to get time to be doing the big chunks of time, but I think that's what makes them still effective.

So I try to in infuse it in others.

Quinn: My children now are, I mean they think they're 20, but they're 10 and [00:27:00] 8 and 7 or whatever. They're all convinced they could live an apartment and have a job by themselves. It's this thing where you, like you talked about the fly in and fly out, and now you're that person.

And how I try my best to be a father that's there, to be a father that is, I'm very privileged to be able to be there as much as I want to be, and that they're healthy and these things. Those moments where you can, I'm sure you had this with your kid who seems to be an actual adult now, those moments where you find yourself saying to some small child because I said so, and then you're like, oh my God.

Like, how am I, now I'm that person. Everything I did to not be. How do you wrestle with that? Do you feel like those are some of those decisions you made, those radical decisions and new systems you put in place to make sure that it's okay for me to be the fly in, fly out because we're actually more in touch in better places.

Sheila Davis: Yeah. Yeah, exactly. I think, by dismantling the executive leadership team in Boston, day 10 or something and creating a leadership council, so our 11 site leaders are our leadership team. That's who is helping making [00:28:00] the strategic decisions about budget, about growth. And it's hard because they also are running their own countries, but I think it's been built in the system and the structure so that it's not a sole decision maker.

And I think that's where, as I've gotten older, I appreciate systems and structures more in a way than I did before when I was an anti structure person because that is building in the systems that when I'm gone that exists. Somebody could come in and change it, but hopefully they couldn't by the time we've morphed this to really be an organization that has leadership that is not just in the US but the person who takes my job some day shouldn't be sitting in the US.

We're a global organization and I'm hoping that we're infusing enough of that, of those systems in place so that we've changed the way that PIH operates.

Quinn: Again, part of my job and I'm like a dumb liberal arts major, to be very clear, like generalist is a gentle use of the term.

Like flash [00:29:00] cards were never my thing. I learned, I can ask good questions. That's it. There was no, you didn't want this guy as a doctor or scientist or any of those things, but those constraints as we'll call them were very illustrative to me once I threw my ego aside which is, it makes you ask this question of, okay, what can I do? And I always love that formulation, those four words, because it's one, the one we hear the most. And we base all of our work on whatever it is, whether it's COVID or health or climate, because you can say it so many different ways. You can say, what can I do? You can say, what can I do?

You can say, what can I do? And those are all actually really different questions. And there's been a thousand different systems. What do the kids call 'em on Twitter these days? Constructs, I don't know. To frame that. And the best one is usually what are you into? What are you good at?

And the intersection of those two things, I can point you to 70 different measurable, reputable places like PIH, where you could be put to use, whether in a donation role, volunteer role, full-time role, whatever it might be, a [00:30:00] lateral move. It's very easy to answer that. And for myself, I started when one of my dear cousins got cancer and I didn't know, this was 15 years ago, and I was like, what can I do?

What can I do? I was like I can't literally directly help her because I'm a moron, but I was a college athlete, which this is a long time ago, I can sweat. And so I found Team in Training, which is the fundraising arm of the Leukemia Lymphoma Society, and they've been around for forever. And I was like, this is amazing.

I can do this. I can give the money to the smart people who know what to do with it. And that's fantastic. The point is, we have to throw the kitchen sink at so many of the things we're doing these days, which is a problem and an opportunity, and it's wonderful. It's proven. We did it with smoking from the courts, to marketing, to regulations, whatever it might be.

We have done it in some ways with COVID and we're working on it with climate and clean energy and food. How do you talk to young folks who are trying to get into public health, whether you're directing them towards PIH or not, and we can talk specifically about how you would recruit or entertain, new classes of [00:31:00] community health workers in these countries, but how do you talk to those folks about how they can get into this sort of thing, knowing what you knew about really the people who need help the most and aren't getting it.

Sheila Davis: So much of this is a lived philosophy in a way. And I was just talking to a group of nursing students the other day who all, you know from the US who wanted to like, what I want to do global health.

And I always say global health is like in Miami, it's in Boston, it's in New York. It's, to me it's the lens in which we do we care, which is focused on equity. And it's basically saying if you're living under a bridge in Miami, you just deserve the same treatment for your breast cancer then if you live at the Fountain Blue kind of thing.

And so that getting involved with social justice issues in your own backyard is literally the PIH’s mission, even if it has nothing to do with PIH because it really is, this has to take a transformational shift of our society. And it's really seeing, [00:32:00] not in a charity way, but more of this is a moral responsibility that we care for each other.

You can do that if you are an athlete and you can raise money this way, if you are a scientist and can do something, if you're a travel agent and can help get good flights. There's a way that you can contribute. Paul used to talk about something called Expert Mercy. And Expert Mercy was we need expertise in so many different ways. And it's what you bring to it from what your gifts are or your skills are. So if I'm a teacher, Expert Mercy is, I'm making sure that kid in the classroom who's from Haiti is proud of where they come from because, so when we talk about geography, we talk about how Haiti's an amazing place, not just the horrible things you hear in the news.

Or as a nurse, it's spending time with somebody. So I think it's, it truly is this getting engaged with these justice issues, whether it's about, incarceration or whatever, because it is all about seeing humans as equal and deserving of care and dignity. So I think that is [00:33:00] where there's so many in every place we live, there's so many places where people need help.

And I think seeking out organizations where you work and actually being that help, and whether it's driving meals or doing this or doing that and being okay with that and leaving your ego at the door to do that, I think is a big piece of it. I think obviously raising money for organizations like PIH is critical.

We can't do what we do if we don't have the resources to do that. We also do a lot with advocacy, and I think this is whether PIH is your thing and our big issue is global health funding or it's gun control or whatever. Really taking the responsibility to not just turn off the news when we all want to do that, but to get actively engaged.

Even if it's hard, I think is an important thing. The Paul Farmer Memorial Resolution was launched, was it was put in the congressional floor last year and it really is trying to change the way global funding happens. Right now the US gives about [00:34:00] 12 billion a year. We think the US should be giving about 125 billion a year, and it's still a minute amount of money compared to what we spent.

Quinn: Oh my gosh. That's nothing compared to the whole budget.

Sheila Davis: It's nothing. It's nothing. And so advocating and getting, learning about that process to call your congressmen or doing that seems like it's not a lot, but it's when those little pieces all come together, it is a lot. So I think all those things are ways that people can remain engaged.

And also ways that we can hopefully get people to also look beyond your own backyard and pay attention to what's happening in Haiti now. Pay attention to what's happening in other parts of the world. That, I think opens your mind up, open your kids' minds up, and that I really think is going to take this major effort to change our society.

And I think those are ways that can happen.

Quinn: I love that. Thank you for sharing that. One of my biggest takeaways from all Paul's work and his published work and work published about him over the years and all of your work in [00:35:00] doing this model and then trying to prove this model in other places, both the work, but also what you've gathered from the work, the TB treatments and things like that, is this idea of and I feel like we can apply this to so many different problems, which means it's probably too simple.

But that's the point, is it's this idea of, it doesn't have to be this way, in the sense that our basic necessities are very, there's very few of them. And they're shared among all of us. But at the same time, these systems we've built to either enable access or to enable qualified access or to deny access in some way.

Or to make expensive more access. We've made them so much more complicated over time for a long litany of perversions and reasons. But I always come back to this idea of when people get frustrated with voting or community health or air pollution in their neighborhood, whatever it is, which is community health, again, is this idea of it doesn't have to be this way.

It's just a series of decisions that people made over time. But [00:36:00] also why is it this way? And this is where I use, again, something I've taken from my children, which is this just relentless barrage of why to get to the bottom of this problem. Because then we can start from the bottom and go, these are the immovable pieces of the things everybody needs.

Which I believe you said in your statement about Paul, and he's always talked about, again, everyone have an equal opportunity. This idea of the power of accompaniment. How do you build that into the culture so that it is transferable among all these different countries? Because especially in the US, someplace that's the richest country in the history of the world per capita, spread it around. We've really lost that in a lot of ways because most of these medical institutions do not operate in that way. No matter how much money you've got. Again, that was this big thing, but it's just been floating around and floating around. Because I try to think about if the base element is we don't have community health because we're not spending enough time with one another. We don't know each other well enough. If that is, and those are the base elements we need, how do you build that and institutionalize that and then [00:37:00] hire people to do that?

Sheila Davis: Yeah, I think Covid was eye-opening.

I think many of us knew that the US health system was really inept in a lot of ways, and I think COVID illuminated that. We build phenomenal hospitals. If you have, you need the highest tech gene therapy. Like this is the place to be. If you are a young struggling mother who lives in a community that's one zip code or two T stops away that our health system doesn't serve you at all because all of our care, our reimbursement systems are all based in hospitals and that's the most expensive care with the most expensive providers.

Like it's, we're so skewed. So when COVID happened, And all of a sudden it was like, wow, we don't have basic public health departments because they've been defunded for decades. And insurance companies don't pay for that. And we see that healthcare as a commodity, not a right in this country. That's where it's been built.

So it was eye-opening for people to say, why the hell is [00:38:00] PIH being involved in the US? What can you, who works in Haiti and Sierra Leone, help us in Chicago? And I think it was an interesting moment to see that. It really showed that we had a lot of value add because our whole ethos is grounded in the community.

We have 300 hospitals around the world. We do hospitals too, but our care is grounded in the community, and we know that you need trusted messengers. So when it came to starting vaccine efforts in Chicago, for example, and there was not uptake in certain communities. We knew why, because it's the same thing that happens around the world.

We don't have people in the community. So we work to build trusted messengers and ambassadors around vaccines. None of it's rocket science. Part of it is, are you providing food for people who you're asking to quarantine? Like stuff that we do innately as part of the PIH model, was earth shaking for the US healthcare system, which is so surprising.

So we've stayed in seven communities in the US [00:39:00] and some of those communities are building community health workers into their systems. And I think, our goal is going slowly, seeing where we can be of added value. We're not providing direct healthcare here like we do around the world, but we're working with different entities, systems, health departments, to try to look at the community health worker model.

And it's happening in some places in the US really successfully. How are we making sure that becomes part of the care that happens and how we pushing care into the community? And there's such a huge need and it's much cheaper to do it that way and high quality to do it that way.

Quinn: And it's preventative based and it's all of these things because, I always came back to this idea, and again, you thought about during COVID when the most instructive thing you could tell people is stay home, don't do anything.

Lose that power of accompaniment. You lose because we're social beings, whatever it may be, this trust because, I imagine coming back to working in a place like the US and I know again, like you [00:40:00] have a bunch of folks who still share practices back and forth and I know Paul did the same thing, but there's a fine line between saying, hey, these base practices, we have proven in 11 different countries and we use in our teaching, in our hospitals and in our community health clinics.

But then going to a new place, because like you said, it's the messenger is just as important as the message. Going to them and saying now, Let me ask some questions about how this might work in your specific culture, whether that's Chicago or Uganda. And one of my earliest conversations, please don't listen to it because Lord knows I was terrible at it at the time, was with this incredible nurse, Karen Huster, and she talked about her experience in the Congo with Ebola, and how important it was for the messengers because so much of the folks who were not interested in care were because of religious beliefs or whatever might have been.

And it's not super helpful from some white guy from the UN or wherever to fly in and say you need this vaccine. So how do you bridge that gap? How do you constantly go to new places and [00:41:00] say, look, this works, but also let me have some modesty about this because I don't know your situation as well.

Sheila Davis: Yeah, and we only go if we were invited, I think part of it is, because we know that there has to be catered to where we are. And that's why the US I think is a great example of, we were at 19 different places during COVID. What was happening in each 19 place looked totally different because it depended on what was needed.

So I think we always come in with humility to say, we don't have all the answers. I've never delivered care in Chicago. I can't tell you what it's like, but this is some things that have worked in other places. And how could this work here? Or what do you need? When we first started working in Newark, for example, they needed basic things like money for phone cards.

For the initial people to doing outreach or we pay for electricity in some places, in other places of the world. Like we don't say we're healthcare providers, we're going to do this. We say, what do you need to take care of your people in your community? And then accompany them and do what they know the [00:42:00] answers are, but often don't have the tools to do it.

Whether it's analysis, it's monitoring evaluation, it's statistics, whatever. It's creating community health workers in Florida. But it's always based on champions on the ground who have the same kind of ethos of people are people and we need to treat them the same. And like finds like which is the beautiful part. And then it's saying not this is the PIH model because the PIH model looks different every place we work, there's some core components of it and it's more like we're pragmatic solidarity. So we'll stand in solidarity with you. Not just hold a sign, but if you want to create a vaccine ambassador, like this is what we think we can do.

Whether it's money, expertise or whatever, but you know better than we do. So we are here to be with you and accompany you and not lead you. And I think that's why we continue to iterate. What happens in Chicago is influencing now what we do in Liberia. No one place has all the answers.

Quinn: It [00:43:00] seems like that if anything is most transferable.

And again, going all the way back to, it's right there in the name Partners in Health, this power of accompaniment. It does seem to be the, it doesn't have to be the way, this way. Why is it this way? Come down to what is the one thing that is the most effective no matter where you are, regardless of who is doing the accompaniment.

Who can be trusted because of the institutions that are already here? It is this idea, right? That if everyone's going to have equal access, that's got to come from the people around them. And that powerful, like you said, but that can also mean organization to organization.

Sheila Davis: Yeah. We work with organizations all around, like we're not experts in so many things. During COVID, we were asked to help build oxygen plants. We're not going to build an oxygen plant, but we partner with Build Health International who does our amazing oxygen plants. And so together, now we're working in all the places together. So I think it is acknowledging what we're good at, but acknowledging what we're not good at. But also saying what's good when you work in the Miami [00:44:00] is not good, it may look really different. It's not the same formula that's going to work in Sierra Leone or Haiti.

The basic premise is though, it may look different, but the end of the day, everybody deserves a high quality of healthcare. So just because you live in Haiti doesn't mean that you should get second rate care. It's a long road. We're really trying, but basically it's not less than, when we're really saying, that's why we're still operating all of our hospitals.

Even now in Haiti, all of our residency programs are still open and running because there's still an entire community to take care of. And that doesn't come from me, that comes from 5,000 Haitians that work for PIH in Haiti because of all of our staff are people from those communities.

That's the beauty of it, because they're building capacity for their mother and for themselves and their kids. Like it's a game changer in that way.

Quinn: Thank you for sharing that. It's so instructive and illustrative of, again, there is no one best path forward. But there is a bedrock here that has been [00:45:00] proven in so many different places.

And the more places it has proven and to be so fundamental and useful and helpful and reassuring to folks, it seems like the more places we can adapt it to. I have some questions I ask everyone, but before I get to those, I do want to talk for a moment about disaster relief a little bit because you, I believe you started at PIH in Haiti.

Was it shortly after the earthquake? Right around the earthquake? Wasn't that right when the hospital was opening or something like that?

Sheila Davis: Shortly after, the hospital opened in 2013, but the major earthquake was 2010, but I started in September of 2010. So after the initial response, but still the very, a lot of the disaster stuff was still operating.

Quinn: And since then, obviously there have been hurricanes, there's all kinds of things. And obviously, all these places around the world, there's been natural disasters as we call them, forever. But now we know that in a lot of places they already are increasing in volatility and frequency. That is something we need to just all talk more about in the sense of like, how do we [00:46:00] talk about climate change?

We talk about it more. That's one of the best things we can do. Yes, we need to mitigate as much as we can, but adaptation means trying to do a better job of really planning and building infrastructure for this. So I wonder if you can talk a little bit about what you all have learned from that sense that might be applicable as we learn to really try to take these things on in the meantime. Especially for so many of these frontline communities who've suffered these forever, who already don't have care or don't have insurance or whatever, home insurance or health insurance. What have you learned that might be transferrable for how we best operate going forward?

Sheila Davis: Yeah. I think when there's disasters, a lot of money appears, and that's great. Like you need money when disasters appear. But if you really look at how much money is spent and what gets left behind, disaster relief is the worst way to spend money, right? Because it's not building systems. So we firmly believe that.

Disaster resilience, pandemic preparedness, whatever you want to call it, is best done by having a strong health system. When we look at Ebola, for example, Ebola was in [00:47:00] the US, did not take off because we have a health system, right? It was able to stop it. Got stopped in Nigeria very quickly. It didn't get stopped in West Africa because there was not a functioning basic health system.

So we firmly believe that, instead of just throwing money at emergency disasters, use that money to actually make these health systems stronger. That is how we're going to be so much more effective at battling climate issues, pandemics, et cetera. And it's so much as how funding is allocated.

There's a whole pot of money for disasters. Tiny bit of money for health system strengthening. I think what we're saying is it's all the same thing. And in the US a lot of funding now is under global security. It's not under healthcare. There's a lot of reasons that we could go into around that, good or bad, but I think what we're saying is the best global health security is community health workers, right?

Who, they're the first ones that are going to pick up what's happening around the world, much more so than some extensive drones and surveillance systems. Like surveillance systems are people, [00:48:00] but you can't just plop 'em in when there's an Ebola outbreak. There has to be that you have people who are trusted in the community.

So when people are sick, they know, and it's much cheaper, so much more effective. So how do we shift away from this disaster response to building effective health systems?

Quinn: Again, it seems so I know it's so frustratingly obvious. I've talked to the folks who are building up called Biobot Analytics, are building up wastewater monitoring in the US out of Boston.

And it just seems so easy. It is so cheap. It just helps, it gives you like a two week lead time for at least COVID, which is crazy. Someone had told me two years ago and now they're like, look, we can also do Norovirus. Let me tell you what your school doesn't want to deal with.

Norovirus. Can we have a heads up? So I think about those things and it is frustrating because prevention can go such a long way in that respect and building up these more resilient systems. And I think about what Ed Yong wrote so long ago when COVID first kicked off.

We had two different metaphors, and obviously his is a hundred times better, which is, it [00:49:00] was the, I believe it was like the flood that exposed all the cracks that were already in the sidewalk. And mine was like, look, here's the pop quiz. Let's test all of your societal and economic choices to date and let's see how you did.

And the answer was like, not great. Again, it comes back to control what you can control. And do what you are supposed to do and what you were best suited to do. And we can start to mitigate for climate and we can mitigate for pandemics and public health and all these things, but we can also level the playing field.

We can have cleaner indoor air, we can have cleaner outdoor air, we can have cleaner water, more water, all these things, because those things will happen, but they don't need to be so bad. And they don't need to happen so often to so many people. Especially the people who keep suffering them the most.

And yet, like you said, disaster relief, so important, is the sexiest thing.

Sheila Davis: Part of it is I think, trying to acknowledge that people feel like they're having impact. They see something and then they're like, I'm giving $5 and I can see what it's going for. It's going to buy water or do whatever.

And I think what we need to do is also just shift that there's suffering that happens all the [00:50:00] time. Suffering is horrific. And I think we see it in the media. We bear witness to it in the media when there's an emergency. We don't in the same way. And we don't do exploitive type of media at all.

We're always very respectful and about that but we are suffering every day, everywhere. So I think part of it is how do we, again, shift this mindset of, there's a moral imperative for a woman who has breast cancer in Malawi. She should get the same care my sister would get. If you acknowledge that and you absorb that as a human, then you could say to do that then there she needs to have a hospital to go to and she needs a lab and she needs chemotherapy, she needs a nurse.

So we can start doing that and rather than, I think just throwing hands up in the air and also saying, oh, there's too much to do. Because there's also a pessimism that gets, the world is horrific and we can't fix what's happening. And I think we always say that it's only the privileged who can afford to not be optimistic.

And we can't make that choice for somebody else. And I can't give up on behalf of [00:51:00] somebody else. We're in a place of privilege and we can't do that. And I think it's, that's where it's not turning away, but saying we can do something about it. Like we really can. And that's why we're trying to do it in what we touch, but then also beyond.

But it really is, a lot of it is, I think at this. This acknowledgement of each other as human beings, and we are our brother and sisters keeper, regardless of, you'd never see that person.

Quinn: And again it's just, so it's this idea and it can seem too optimistic of this idea of like problems are opportunities, but there is suffering every day.

And so I look to organizations like yours that are doing the side of the mitigation of public health to look and say, yes, but there's people and there's organizations and institutions and models that are working to alleviate that. Again, if it doesn't take much to scroll Our World In Data to see how much better it's gotten.

That was all low hanging fruit. Let's keep doing those things. And then we'll keep having those issues, we can't control if some hurricane's going to come much less an earthquake, but we can just keep making the baseline better. And [00:52:00] so again, that is what is so appealing to me about your organization, is the work you do to say no, this works and it works for the people who've never had any sort of support before. So I really appreciate that. I know your time is obviously, and this is like the fifth time we've tried to do this, so I'm not going to abuse it anymore.

Sheila Davis: But we made it. We made it though.

Quinn: We made it. We're not done. Hold on. We're going to get out of here when I see those files in my folder.

We're out of here. Last couple questions I ask everyone, if you don't mind, and then I'll let you run away. Is that okay?

Sheila Davis: Totally.

Quinn: Okay. When was the first time in your life, could have been, probably not yesterday, considering our conversation and your history or when you were a small child, when you felt like you had the power of change?

The power to move the needle to do something meaningful. When you took a step back and were like, oh shit, that's interesting. I did something. When was that for you? Because we often find that's the catalyst, even if folks didn't realize it in the moment to doing what they do.

Sheila Davis: I think I grew up in a family that was very focused on justice and, the no nukes sign [00:53:00] and the passing or save the seals.

Like we were always into things like that. And, but I grew up in rural Maine, right? Which was like in the middle of nowhere. And so we were a bit of an oddity anyway, this family that had moved from Rhode Island, but where it was boycotting a store that had, I don't even know what they did. They did something and the store ended up closing. Which was a good thing. And I remember thinking, wow, like that was because people stood outside and said, don't go here because they treat people poorly. So I think that's like an example of seeing the power of people doing it. I think as a person, I became a nurse because I wanted to help people.

I didn't grow up thinking I wanted to be a nurse but saw that I could get skills and really make someone's life a little easier that day kind of thing. Whether that was from a skill that I had. So I think that was also where that is fundamentally what I'm trying to do now on a really different scale than what I did then.

But still, I think the core of why I am doing [00:54:00] it and I think that was patterned from my parents and my siblings who all were in some type of human services that was just who we are and was expected, but in a good way.

Quinn: I love that. I'm just going to play that for my children.

Who is someone in your life, who has positively impacted your work in the past six months? We're getting specific here.

Sheila Davis: So there's a nurse leader in Haiti. Her name is Marc Shillmeese, who's this powerhouse of a woman who lured away 10 years ago to join PIH and now she's running our Haiti project.

And Haiti's tough, like so much is happening, but she is, and we talk on WhatsApp every day and I just saw her in Boston last Friday and she's somebody who even in the midst of pure hell, she can just see the goodness in it and see and just infuse that even if this is really tough.

You know what, we're going to get to the other side of this. And she's somebody who, it should be the other way around. I should be the one who's [00:55:00] rallying her, right? But I find that she's the one who is just such an amazing leader that is keeping this entire family of 5,000 people in Haiti that we work with going during a really rough time.

And when I need inspiration, I just check in with her and she inspires me.

Quinn: That's awesome. Thank you for sharing that. She sounds incredible. I have done this variety of advising and philanthropic, and I always participate in the sweating side whenever I can. And one of the things I've loved to do is Cycle for Survival for rare cancers.

It's oh gosh, I'm totally blanking right now, but with Dana Farber. It's great. It's a bunch of people on basically Peloton bikes at a gym and it's playing music and you watch the ticket go off for how much money you raise and you feel like you're in good shape and you're contributing and like it's inspirational and maybe someone else will see it happening.

And then they inevitably roll up both researchers and doctors to talk about how they're actually using the money you're raising, but also a current patient [00:56:00] or a survivor who has overcome this and is also biking. And definitely like biking farther than I am and doing all these things. And I'm always just wow, Jesus.

Like it's incredible. Yeah. And anyways that's my very low key version of that. Last one, Sheila, in all of your free time, what is a book you have read the past year or so that has either changed your mind in some way or opened your mind to maybe a different perspective or idea that you hadn't considered before?

And we have a whole list of these things that we threw up and people loved to investigate them.

Sheila Davis: So the past year, this is probably not what you're looking for, but I have loved poetry. Poetry is what kind of feeds me. So wasn't new to me, but I hadn't delved into Mary Oliver for many years.

She was my mother's favorite poet, and when my mother died, I just put it away kind of thing. And the past year, and even I read, have thought and passed around a bunch of her poems in the past year or so because it has offered me [00:57:00] comfort. I spoke at Paul's funeral and I quoted the Maya Angelou When Great Trees Fall, that poem.

And so I think it's gives me the words that I don't always have as a person to talk about the emotion I'm feeling or to be that mirror. So I, over the past year have started to just read a tremendous amount of poetry and pass it on. I'm sure people are sick of it, but pass it on because I think it's such a amazing gift.

And so that is what the books I read now other than work books.

Quinn: All I read is work books. I love it, but oh my gosh, but I think, I don't think people are sick of it, I know you haven't shoved poetry at me yet. Yet, but at the same time it is such a break from work books and these things.

But at the same time can be such an end around to influencing how you put those work books to use. If that makes any sense. If I can recommend one new book for you. There's a gentleman, a writer named Clint Smith. He wrote an incredible book a couple years ago called How the Word Is Passed.

But he has a new book of [00:58:00] poetry about being a Black man in America and being a parent, and it's called Above Ground. It came out two weeks ago, something like that. It is beautiful and wonderful. Check it out. You'll blow through it and fold all the pages over and it's great.

He’s an incredible, he writes for the Atlantic sometimes. Listen, this has been famazing. Where can the people follow you or support PIH, what's the best way to do so directly? Give it to me.

Sheila Davis: So our website is www.pih.org.

And on there is PIH engage, our chapters in high schools and colleges and communities of how to get engaged with our advocacy efforts around the country. And how to talk to congressmen, how to make a call, how to even write a letter. Like it has a low threshold for kind of engagement.

And also on the website it talks about our work. Obviously if, people have a skill, if you're somebody who is a critical care nurse who can come for three months, to another place in the world, we're always [00:59:00] looking for certain skills of like high tech care.

And not a week at a time. We only take people months at a time. I think that's always of interest to us. And then I think just learning about our work and talking about PIH and donating, if you're able, any amount is super helpful, is also the way that we keep it going.

And I think really just opening your eyes and bearing witness to what's happening around us and really making the push for a moral imperative to work with each other is a win for us, even if it's not directly impacting us.

Quinn: I love that it seems horribly cliche at this point, but it's so instructive because it's so simple and it speaks to me so much about your work.

But I always come back to the find your helpers idea, right? Find the helper. And that's you all. And it's incredible. There is suffering every day, but you all have proven this over and over again and it's amazing. So thank you for your work. Thank you for recording with me five times at this point.

Sheila Davis: Great. Thank you so much. I'll check out the book. [01:00:00]

Quinn: Oh yeah, absolutely. We will talk to you soon. Thank you so much, Sheila.

Sheila Davis: Yeah. All right. Take care.

Quinn: Important, Not Important is hosted by me, Quinn Emmett. It is produced thankfully by Willow Beck. It is edited by Anthony Luciani, and the music is by Tim Blaine.

You can read our critically claimed newsletter, get up to speed on upcoming podcasts and ones you've already heard, whatever @importantnotimportant.com. We've also got t-shirts and hoodies and all kinds of things to carry coffee in at our store there. I'm on Twitter in most other places at Quinn Emmett, or at Important, not IMP or LinkedIn or what have you.

And of course, you can always send us guest ideas, feedback responses, comments, whatever you've got, questions to us via email, which doesn't usually break, at questions at important, not important dot com. That's it. That's it for this week. Have a great weekend. Enjoy yourselves. Go outside and thank you as always for giving a shit.