Putting the Humanity (and Humility) in Humanitarian Work with Dr. Glenn Geelhoed

Living a life in full is a conversation you always wanted to have with that person who gave an amazing TED Talk or the author of one of your favorite books, or that inspirational Olympian you always wanted to know more about. It's graduate level conversations with those making a difference in the world and in the lives of others. This show brings you new ideas and approaches so that you can live a life in full. I'm your host, Dr. Chris Stout and I hope you enjoy this episode. This episode is brought to you by the new fellowship and certificate programs now being offered by the center for Global Initiatives. As you may know, the center is an all volunteer organization and the same is true for the faculty in these programs. So all the tuition goes to support the work of the Center. It has always been our ethos to open source humanitarian intervention and these programs use the same approach in that all the materials we use are freely available all the time to anyone, everywhere, even if you don't take a course. We have built a world class faculty and contracts with other universities, medical schools and partnered NGOs. There are two fellowship tracks, one for those wishing to start their own nonprofit or non governmental organization and one for those seeking mentorship for career development and advancement in humanitarian work. Our initial certificate programs include humanitarian intervention, social entrepreneurship and global health practice. Please consider taking a world class masterclass with us. Visit alifeinfull.org and click on the CourseWorks tab to learn more. Thanks welcome to another episode of Living a Life in Full. I'm your host, Dr. Chris Stout. As longtime listeners know, all of my guests have some type of involvement in humanitarian or philanthropic endeavors. But I have to say that today's guest may be an all star from that very deep bench of prior guests. Dr. Glenn Gilhud received his BS and AB degrees from Calvin College and his MD Cum Laude from the University of Michigan. He completed a surgical internship and residency through Harvard University at Peter Brent Brigham Hospital and Boston Children's Hospital Medical Center. Following that, he served as a Clinical Associate and Senior Investigator at the National Cancer Institute and the National Institutes of Health. After completing his Surgical residency, he joined George Washington University in Washington, D.C. as a full time faculty. Additionally, he completed Master's Degrees in International Affairs, Epidemiology, Health Promotion and Disease Prevention, anthropology, and a PhD in human sciences. Dr. Gilhud works as a Professor of Surgery, International Medical Education and Microbiology, Immunology and Tropical Medicine at the GWU Medical center where he developed both Medical Anthropology and Tropical Medicine programs within the MPH curriculum. There. He's a member of numerous medical, surgical, and international academic societies, and is an author with more than 800 published journal articles and book chapters, along with several books, including his most recent, Furthest People's first, which is based on his work as founder of mission to heal. Dr. Gilhud has conducted medical mission trips around the globe for over 40 years with some amazingly clever solutions to sustainable health care. He's received innumerable awards and recognitions for his global work in healthcare, including the prestigious Humanitarian Award for Outreach to the Underserved from the American College of Surgeons, one of the highest honors in the surgical field. His highlight reel also includes an appointment as Clinical Scholar at the Robert Wood Johnson Foundation, Humanitarian of the Year from George Magazine Faculty Distinguished Service Award from George Washington University Medical School. He is an inductee to the Paris Academy of Surgery, past president of the Washington Academy of Surgeons, traveling scholar with the James IV association of Surgeons, and a Senior Fulbright Scholar. He's also an avid runner, having completed more than 135 marathons across the globe, which is amazing. And when he's not overseas, he resides in his home in Derwood, Maryland, and enjoys spending time with his two sons and five grandchildren. All right, so welcome to the show, Glenn. It's an honor to have you on,

and thank you, Chris, for your invitation. I'm delighted to be with you.

Let's start with your latest book so we can somewhat set a context for understanding your work and the work of Mission to Heal, Entitled Furthest People's M2H's Mission to Teach Mobile Surgical Care to Africa's Sick, Poor, and Remote. Your friend Freeman Dyson penned a beautiful foreword to it just prior to his passing, and the book tracks your missions in three African transects during the first seven months of 2019. What spurred you to write it?

Oh, my. It's an honor to be with you, Chris. And it's even a special honor to have you mention a very wonderful fellow, Freeman Dyson, who was, I think this is the last, last book review he did. He was the New York Times Book review editor, as well as a very renowned physicist. Besides teaching people like Oppenheimer and being the office mate of a fellow named Einstein at the Princeton center for Advanced Studies. So to say that he would be admiring the work that has been done is a very humbling honor. Yes. I wrote it because people are constantly hearing about folk who have gone abroad and done something and come back and said essentially, what a good boy am I, send funds, because after all, I'm doing the right thing. I think that was a model that had been tried called colonialism, which probably didn't get the best of reviews. And my thought is that I have a different job. My job is to work my way out of a job and to put the skills that can be brought from the developed to the developing world and have them choose what they can pick from and push forward to the kinds of self help that they need. So mine is an educational mission. And when people say that to me, they say, yes, but only you can operate under a tree. I mean, I need air conditioning, I need electric artery, I need laser, I need, well, how about if we bring the operating room to them and let them use it in a fairly modern setting in the situations where the people live? After all, it's unrealistic. It's not only fatuous, but it's cruel to say to these folk, well, you know, you have a problem, I think we should refer you to a higher center of care. I mean, what would that be like the second ring of Saturn or something? Because they have the same capability of getting essentially out of this planet that they would to the capital city. And the reason for that is they have a different language, they don't have the same religion, they're in a different political system. The first and biggest barrier is they have no economic support once they're there. Remember, there's no diet kitchen in the places that I work. There's no nursing staff. That's the family. So you have to move the whole of them into an environment that they feel is not only foreign, but a number of times hostile to them. So let us go where they live the furthest people and then backfill those healthcare crevices that we find all around the world, including our own country. And what it is that they can do, which we need to learn from them, is how to handle bigger problems in larger numbers with far fewer resources. And that's a graduate school they've gone to. They have to cope. And we often just paper over all of that with essentially redundant and excessive and often cruel care because it doesn't result in the human benefit that it's really supposed to yield. I mean, the last five weeks of life is where most of Medicare funds are spent in an icu. Wouldn't it be better if we took those problems that the majority of the people have and don't say, we have this hammer in hand and therefore you're going to all line up as nails, you're going to say, what do you have that can be fixed? And that with the most transportable of Skills, that is information and hope. And that's the sort of thing that we try to carry with us. And that's what we like to indigenize, care. This isn't a white man off an airplane that just came and give you this benefit. No, it is your neighbor whose enhanced skills are what we leave behind. And that's our finished product. Not that someone has to remember the name or figure out the technique or anything. How is it that we can get care done by the people who are not only obliged to perform it, but the most acculturated, the most conditioned to do that for their neighbors and their family? And that's the goal of Mission to heal, to get out there, to show each side what the other has to offer. And we learn from them those skills that they have had in using improvisation and ingenuity to handle problems for which they have no stuff. And a lot of our stuff comes at a fairly high price, as you probably know, Chris, from all the other interviews you've done with a lot of other folk like this. Never have we ever done and been capable of doing so much to so few who are so little satisfied with the result. And as a consequence, let's go and ask those folk what they would like to have our help in having them carry out enhanced care.

I hear here there are so many things that makes me think of, you know, first and foremost, the aspect that you led with of the, you know, kind of the proverbial parachuting in, you know, coming in, slapping on a few band aids, feeling good about ourselves, and then, you know, leaving them, you know, off to their own, you know, continued survival and creating, you know, maybe almost a false dependency or expectation, you know, with us. And I think that's, you know, almost against the Hippocratic oath in the sense of, you know, inadvertently atrogenically causing harm. And I think, you know, your approach. I learned, I was a medical school professor for a while, the proverbial see one, do one, teach one. But you've kind of stepped that up by defining the objective with mission to heal around those issues of economical and sustainable systems. I mean, it almost, you know, needs to be part of that as well, too, that it's not just in. We'll get to your documentaries and the books and stuff too. But I mean, you have shown time after time the ability to work in partnership, in collaborative. I mean, yes, you're a teacher, but, you know, you teach these people how to do things, and there's the reciprocity of learning from them in their situation to be able to do with things. And maybe the secret sauce that it seems like you've brought with Mission to Heal is the ingenuity and the education aspect of it. So tell us more about the structure of Mission to heal. Is it 40 years ago that that was started? Or tell us about the genesis of it and in those activities.

Yes, indeed. In fact the genesis of this is largely my going out and doing that which I now have medical students in the same position I was now a half century ago. And that is I went out there and saw the great need and saw that there are people everywhere in any society has the go to folk who are the ones that you consult for healing and for the correction of certain problems. Well, let's learn them because somehow they got that and our own medical techniques all evolved in the same setting. It didn't start with MRIs and CAT scans. It started with something a little bit more direct. And that is what can I do to help this patient and that problem? Part company. Now what happened is that a long time away we had health programs and remember I'm a card carrying epidemiologist as well and I'm all aware of the fact that, that it is something we must do to clean up the drinking water, to improve nutrition, to do child and maternal health care. All of which I am very much aware of. And I congratulate a set of goals that were put together as we approach the millennium. Now that's two decades ago. And those Millennium Development Goals have not been met. In many cases they've been surpassed. Never have we done such a wonderful job internationally. And no one really is conscious of this because we keep viewing with alarm rather than pointing with pride that there has been a reduction in poverty worldwide. That didn't mean that we've eliminated it. It meant that there are greater numbers of people with more and more hope. And that hope will is frustrated in the inability to carry out what they consider curative care. Now we say preventive medicine is where it's at because it has a greater multiplier for a larger number. And I agree, I have degree in that. The answer to that is here is an unusual period of time in human history. This year 2021 is the time when plagues and pestilences of which everyone now is hyper acutely aware because of a pandemic that spread across the globe, have largely been brought under a modest control. And I don't mean by that we're not troubled by things like malaria or HIV or of course the pandemic of the Coronavirus. However, let's look at the total morbidity, mortality. Those are funny words that I use, and I can translate those very nicely into something simple. That is, mortality is the loss of years from life, and morbidity is the loss of life from years. And we don't want disability. And those who survive are preventive medicine processes. And here it is in 2021, when the world's collection of problems that are acute have surpassed plagues and pestilences, and the majority of those are now susceptible to surgical treatment. So that in fact, the people out there are asking now, wait, the water's a little bit better now. The nutritional supplements have been helping, but how did that fix my incarcerated hernia? And what about a woman who is laboring and has an obstructed leg? We can't tell her we're giving you folic acid and vitamin A. It's a problem that she has and it's an acute one. And I can't be out there fixing it. I know how to do C sections. I'm much better at teaching C sections than doing them because I can't be doing them in a language of the patient that's involved. I can't be doing it in a culture. I have to do this across lots of boundaries. Many of those are social, some of them are cultural, a huge number are economic. And as a consequence, let's ask those people best equipped, who are the go to folk, how it is that they address these problems and how can we enhance that care? So what has happened is that the world health organizations, and I say that plural because not only who, but many of the NGOs as well, have recognized that surgical care and access to it is a primary public health need. We cannot say that someone who is in sub Saharan Africa, we've now done something about antiretroviral drugs, we've now done something about malaria bed nets. And I'm sorry that you fell out of a tree and broke several bones, but that's your problem and not ours. It is in fact a problem they have to address. And as a consequence, we ought to say, as a medical profession, you and I and all the healing arts, the credibility of prevention rests on the curative care. I think it's a specious argument in the emergency room in saying to someone, if only you were healthier, you wouldn't be so sick right now. Indeed, you know, if, if you had worn your seat belt, you know, that's a lecture. I don't believe there's a problem right at that spot.

Yeah.

I think very appropriate for you and me to talk about seat belts right now because neither of us are driving. However, I believe that once we're going through the windshield, it is a time for us to be talking about care immediately. So. And I'm not everywhere to do that. So the question is, how can we get a multiplier? I know that I can go out there and I can fix folks, and I have done that in quite a few instances. Well, that means that that has done two things. Those are very happy and very comfortably fixed folks. But what it has done is convinced a whole lot of people around them that they didn't have to suffer lifelong with that deformity. And now they are extremely frustrated when we pull out of that silo and go home. And as a consequence, we actually create a demand for the surgical services by going there. So the only way we can legitimately go there is to create an ongoing skill that's sustainable if we are going to begin. So I never start a mission until they've identified the trainees that will carry it on after we depart.

That's great. And that is such a. To me, I think it's such an obvious, as you state it kind of thing. But gosh, Glenn, I mean, I'm sure you've seen this, too. It is very much an absent thing oftentimes in any kind of medical mission work. And it just. It seems like quite a failure. I had a. I wrote a book a while back called the New Humanitarians, and in it we did profiles of various and sundry NGOs and nonprofits doing work. And one of the ones that we had looked at creating an NGO whose kind of specialty in sweet spot was helping structure, helping create infrastructure to be able to do, you know, those supportive kinds of things and when. And those were in a bit more developed areas. But I mean, you. By. Again, back to the book title, you know, furthest People's first. There. There are some places where, like you said, you know, the.

The.

The resources are what's underneath the tree. And being able to, you know, think about put in instituting an electronic medical record or. Or pharmacy services or anything like that is just the second or sixth ring of Saturn, so to speak. So in the context of doing that, you also have developed sort of a mobile approach to conducting these kinds of surgeries, and you've got a fair amount of tech in that, and I kind of dig that and geek out on technology kinds of things. You also have developed these man cats in terms of being able to Provide these surgeries, tell us about what the specs and triple point failures and how they came into being.

Oh boy, you've uncorked that bottle for the genie. This is a wonderful swords to plowshares story of the kind that probably if one started with this as in mind, it dawned on me after the fact would be actually mind altering. Right on the get go I'll give you that mind altering concept and then we'll work our way back. And how it happened without my knowing it. In prospect, there's only an the mind altering component of this is the single most important and powerful destructive force that Europe has ever seen has turned into the largest humanitarian and most capable one. And that's a very unusual story. And maybe I can start with a couple of people and tell you how I got there. The two people, you've probably heard of them, one of them is named Mikhail Gorbachev and the other one is Ronald Reagan. And the two of them had an unusual, let's say direct personal interest in what was going on around them. And both of them felt threatened. In the case of Mikhail Gorbachev, he was holding together a very shaky empire, the last of the Soviet empire. And as it was a little bit uncomfortable for him, he wanted to make sure that he had a very strong, perhaps defensive but more likely offensive capability to take over some of the things that he envied most in Europe, European society, at least the economics of it. So he arrayed a large force against eastern Europe. An 880 armored tank group of assault soldiers of a 1.2 million man army. Well, there's no way that the United States is going to counterbalance that threat in the era of the bipolar world with a comparable army. And so what they did is supported NATO to develop the strategic not but tactical nuclear force, the theater nuclear force. This TNF was arrayed against those divisions of all of that armor that were headed westward. And this was going to go eastward in which a very capable but very nasty kind of weapon system that is highly intelligent, called the Pershing missile Mir systems. Each one of these had 10 independently targeted reentry vehicles. They were not strategic, they didn't go into intercontinental. They were simply to neutralize the threat against Eastern Europe. So when the Pershings were mounted on a platform, they said, we need a platform that will be Nonstop. It'll go 750km without hesitating. It will not need a bridge, it will not need a road, it will go in, over or around anything. And if a system fails, there will Be a backup system which is doubly capable if that system goes down. A quadruply capable triple failure point system. So what happened is that it's got brakes, yeah, it's got friction brakes, but it's got air brakes and then it's got an engine brake and then it has a separate braking system and the sort of thing that only the finest of European technology in Germany put together. A particular model in NATO owns the name Cat and this was made in Munich. Automotive national man. CAT was a six wheel drive platform that would stop for nothing. It didn't wait for a bridge to be built. It went through the river. High mounted engine, a snorkel and door seals, you just go right through it if you get stuck. It's unlikely. With six wheel drive you've got both four aft and lateral winch systems that are omnicapable. And they're not a power takeoff. They are the 550 horsepower diesel engine. And so it can actually make it all the way to that armored line against the West. Now what happened, and this is a historic fact which I give you in two segments. One of them is Ronald Reagan and Mikhail Gorbachev said hey, let's not threaten each other with these very nasty hostile things. Let's go halfway. And they did. They met each other in Reykjavik, Iceland, where I went to visit and actually sat where they penned the START treaty. Instead of just saying we're going to stand down and not develop more of these, they said let's have a Strategic Arms Reduction treaty. We'll have an international group of observers and for every Pershing missile that's destroyed, destroyed will wipe out a division of your armor. And that was done under very strict observation in Johnston island, the most western of the Hawaiian islands. A very guarded facility. I know that because I tried to see more than I was allowed to see. And in fact I watched as some of those Pershing missiles were incinerated under very careful observations. And then the same thing was actually Erbatovsky to get rid of those armored divisions. It's World War II technology. But here's the consequence perhaps he was not completely cognizant of. But obviously the world knew it Immediately after sending home 1.2 unemployed men from the army probably was a single thing that caused the dissolution of the Soviet empire.

Wow.

And as the world changed, no longer was it bipolar, no longer was it, you know, us against them. There's Reds and there's us and there's this and there's that. And the world had to say about big Issues like climate change? How about like a coronavirus? I mean, I'm not the one who calls this the Chinese Communist Party virus. I'm not the one who says that any one of these dead little pieces of nucleic acid have a life all their own and are looking around for a particular political group to sabotage. I mean, we are the human race and we would understand that, I guess, if some invader came from another planet. But since we have these rather parochial interests that end on the seashore where I'm standing here, and on the other side of that there is the other, because they don't have a currency to speak English to me or something like that, and all of these folks are now recognizing that we have a vulnerability as the human race. And now what has happened is that when I told you the incineration of the Pershing missiles and the meltdown of the armor, I snapped up the man cats.

So now I have nice army surplus, huh?

Six wheel drive. So we went to a place in Breda, Netherlands, which is a group called Bliss Mobile, and we actually asked them to custom make an operating theater that was as good or better than most first world settings, including my own in the university. And as you were a professor, you and I both understand tertiary healthcare facilities which teach the cutting edge. And we ask then the folks that come from the cutting edge to go out in the community and get out there in the remote areas and perhaps operate under a tree for which they find themselves untrained, unable to work that special stuff. So let's take the special stuff and try to teach the principle without the plumbing. Let's try to say, here's the thought about what it is that we must do with this and if you can do it with something else, let's hear what you have to say. Let's improvise. Let's do this with ingenuity, because they're not short on that. We are often. Because we don't need to think about alternatives. We don't look for workarounds, just print more of. As you heard, there was a call for another half million ventilators during the coronavirus peak. Well, what does that mean? I mean, let's ask the more important question. How many people who get to the stage that require a ventilator and ICU come back home to live normal and healthy lives? Isn't there something we ought to be doing instead of in stage illness mitigation? Isn't there something we might do? I'm all about treating advanced stage disease, but what do we get with A higher yield. So when you're talking to me, I envision myself as that medical student that went out to Africa, sort of a pioneer, thinking I was going to wear a pith helmet and get out there and retreat. I still have the pith helmet. I'd never have worn it, but I have it as a, I guess, object to art. But the idea being that yes, if I were home and let loose in New York City or Philadelphia or heaven help us, Washington D.C. i could possibly improve the healthcare environment there. With a lifetime of work, I could push it up another 0.2% if I were pretty consistent in my effort. The freshman medical student, or even a pre medical student will make 100% yield on his first day. You can't fall off the floor. And as a consequence, if there's something that could be done, let's get started. And that's the one thing, the lack of fatalism that says no, no, we were designed to be born and die in this environment and we can't get out of it is something that is a very mind numbing thing for those who are in extreme poverty. Those folk, thanks to Millennium Development Goals, thanks to international efforts and thanks to their own efforts, largely have come to the point where they wish not to have their wives die in labor. They wish not to have a child who falls from a tree die of a subdural or epidural hematoma. These are the people who are now saying yes, but thank you. You know, we've got vaccination programs and I'm all about vaccination. I'm a two month veteran of my second booster here of the coronavirus. And the reason for that is that I might go in and out among these environments for folks who are vulnerable and not have a very high likelihood of being a carrier of any of those diseases. So that's what they're asking. We want modernity. And modernity to them doesn't mean that they're going to be driving a sports car. It means that they have access, when needed to critical care that is totally absent in their community. Not because they don't have a tertiary hospital, but because there's no one there who has the first thought about what to do to approach this. So the basic surgical skills, those things that you and I and everyone who's got the degree are walking across the platform at the end of the day. The loss of four birthdays as a fundamental care giving. If you're a psychiatrist, you should know the basic treatment of shock. If you're a dermatologist you should know that this woman is not likely to survive a labor that's going on for a week. These are the sorts of things these people are asking for and for help in getting there from here. They know it's possible because they've seen it happen, but it's unattainable in that tertiary setting. When they live remotely, they can't get there. Once they get there, they can't pay for it. There's no one there to take care of them. And so what we try to do is bring to the community the skills that will remain behind.

Oh, fantastic. And so, again, so ingenious. I mean, it's. It's sort of this interesting counterbalance for me to conceptualize on the one hand, clever utilization, reutilization, repurposing of these former, you know, the swords into plowshares, example of these war tools to being able to do what you're able to do with them now, equipping them the way that they can go all the places that they need to go, that there's no excuse. Like you said, there's not a bridge. Well, too bad we can't go there. Well, here's a solution to that. And then working with the folk that have identified that they have skills in this. And maybe this is a good transition to some of the documentaries where these are exemplars. In the films that I've worked in projects where there have been, maybe it's a chaplain working in a church or maybe it's a midwife working in a Cambodian jungle. You find those folks who sort of self identify that they're interested in this, they have the capacity in this, they're trusted in their community, and those are sweetheart deals to be able to connect with those folks and be able to, to train, to teach, to support in whatever kinds of educational ways and things. And I guess I love, somewhere along the lines, in doing my background research on you, you were quoted as saying you're more of a workhorse than a show horse, which I thought that was terrific. However, having had you said that, there's at least two documentary films that have been produced on your work. One's called surgery on the 6th ring of Saturn and the other one's called We Are the Ones. And I'll have links to these, both of these films in the show notes. In one of them you said you'd like to be a Cheshire cat. Can you talk about what you meant by that and can you describe what these films cover?

Yes, indeed. And in fact, I'm probably talking with you as an antithesis of being the show horse. I'm not working at this moment. As a consequence, I'm showing off. No, I think it's a time for me to do that. And the reason is, once the workhorse is toddles over in the traces, I mean, that is the end of the effort, is it not? And I want not to have the whole mission in the forward thrust be discontinued if I am. And I'm not saying that I'm going to be retiring anytime soon. I have no plans with that. And I've already booked the next eight marathons and I can't possibly let them. So, no, we're going to be doing it until there is no capability of doing it. But someone should know, someone should care, and someone should carry on. Now, that's true. And among those. One of those things that we showed and we are the ones, for example, is the training of the locals who have graduated. The big deal is not, for any sakes, don't let anybody know that I've wandered close to the eyeball, because I'd probably get myself thrashed by ophthalmologists. But if I don't, they stay blind. And cataractomy is something that is a teachable technique. And there is a problem of corneal scarification that comes from a problem called trachoma, you know, chlamydia, trachomatis, the flies, the fingers, the fomites, the families and the feces that they come from. Well, those five Fs are something easy to teach. But now I've got these people with scarified cornea that are blind from an acquired very easily preventable thing. So we ever the lids. And when I do this, fortunately, all of us are carrying around two sets of eyelids. So I will assist you on this one, and then you will be assisted by me on that eye. And we will do five of those after that five, I will stand here and watch you teach someone else to go through those same five, at the end of which there's a letterhead of mine and I write it down, and this says, you are now qualified to do Liddy version for trachoma. And I've gone back to South Sudan and found that letter framed in the hut. It's the only diploma in South Sudan since Victoria's reign. I mean, the British, they've got it. I'm proud of them. So that we did 400 of these procedures is almost irrelevant. Here's the important thing. There are 2400 of those since I left. And that's the Scorecard. I want to keep. I don't want to keep the bean. Bean counters who are looking at how many of this or what did you do with that? I want to see the number inspired. I don't want to be succeeded. I want to be superseded. You've got to do this and do it better then, because every one of these is going to be done better than one before. And right now, when I go to a place with one of these trainees who's now graduated, when they ask me, you have to come and help me with this problem. I've done far fewer than he and I can't do as he can. I think you should, you white men on the moon, you know, we know that this can't be done. Except that you were, well, next week when I'm not here and you see it being done, how will you answer that question? And so, so the Cheshire Cat. What do I mean by that? I mean, once they were going to put up a little thing and they said, we've got some funds that some people have brought in. Can you match what funds mean? I mean, one and a half Sudanese pounds or something like that. No, no, no. They, they gathered up and they said, what are they going to do with that? They're going to make a little thing. They're going to have a marker on it anyway. So they, you know, that's, that's great. I'm glad you've raised some money. And I show Horror Story. Yeah. I would like to have some funding. I would very much appreciate that because it will keep it going well beyond me, and that's what I'm after. However, I will double that funding if you put that in the maternal and child health arm that we've got out there, because I don't want you to remember my name. My job is to be here as a Cheshire Cat and disappear. Tail the hind legs, the front legs, until there's nothing left but the smile left behind. And as a consequence, I love and it isn't. Hey, look, this guy taught this fellow. I want them to say, I don't remember how it is that I learned this, but certainly I'm making it better every day. That's the goal. We're after a continuous improvement, quality of care. And it takes a different person or at least a different mindset because you don't get rewarded for that as much as you would giving up four poster children and saying, look at. Contribute to me. Because these are four kids with cleft laps before. And now they don't. Well, I Agree with that, because we do that. And I want you to know that I have done none of them, and I have assisted the last several by not putting on gloves and standing in our twin table operating rooms. I'm right over here on this table. You have any question, you call me or let me know, because I can see you from here. And we're going to be always a teaching unit, never out there delivering care as the sole reason for our being there, because that creates dependency. Our sole goal for being there is to create caregivers and to see that that goes on in a multiplier.

Oh, Glenn, man, you're speaking my language. That is just wonderful. And I love the imagery of that as well, too. And knowing of you as I do, I mean, that really is a sincere ethos of yours, which is, I think, again, so absent, unfortunately, and so necessary. From a technical side, how do you select where you go or how do you develop your partnerships?

The first one we already mentioned, and that is, we will go nowhere that we're not invited. And part of that invitation is the identification of the caregivers that are going to carry it on so that we need trainees first. They can't say, we have great need here and we want you to come, because I know there's great need everywhere. So that would be an unlimited requirement. I mean, you can ask the question, what is the market for free surgical care? It's insatiable here. It's insatiable everywhere. Know that I cannot fulfill it. As a consequence, I am obliged to create the caregivers. I can't possibly do that in many cases. I've done a lot in my life, and you were talking about the workhorse. The workhorse is probably should be immediately not put to pasture, but put in that position such that the teaching role is the predominant one. And that's what I do for a living. That's what I love to do. I really relish the graduation exercises when that Cheshire cat smile is about all that will remain while they all say, congratulations, we're inflating the prestige and the value of the work that these people are doing. And if they see that Colonial is coming on over and pushing them aside saying, step aside. I know how to take care of this. Let me give you a byproduct of the technology, as you are perhaps a little bit geeky, as I am, too, sitting here with a piece of mobile computing in my hand, through which we're linked, that I have telemetry systems with these mobile units such that I can monitor and mentor every one of our trainees so they are never cut off. But I don't say them now. Every year we're coming back here, we're doing well. That means they're going to store up the cases. So I'm the one that's going to be doing all. No way. You have to not do that. You are asking me what can I do to advance. So the next mission, we don't repeat the first one, we would come back to push them up a level so that the next one we'd be doing goiter thyroidectomies, and the next one we're doing some ophthalmologic procedures. And we do a fair number of gynecologic advanced procedures like viscovagulo fistulae and things like that. So at the front end we need those emergency procedures that the world desperately needs out in the remote areas, the five of them, three of them include safe motherhood that would be dnc, ruptured ectopic and cesarean section. We need to have every one of the caregivers know those. We need every one of the caregivers to know something about a hernia, how it becomes obstructed and how that obstructed cause a death. That's the myocardial infarct of sub Saharan Africa is a vital man in his productive time. When he's out in the fields or doing whatever and he's suddenly and abruptly lost to them from a thing that doesn't take that much in terms of teaching and care. And when someone says, well, you're teaching people out there that they need surgical care and they use liver transplantation as the model. Well, just a moment. I understand. I was a chief transplantation for decades at least, and I understand what goes into that. But what does a hernia repair cost given the unit that I have and the facilities that we can teach them and compare that to, let's say HIV lifetime therapy of H aard, you know that that's a magnificent advance antiretroviral drug therapy. You know that a number of these other medical methods that we've already got out there are the model. I could use them as the liver transplant model against which to compete. And I can do a hernia repair for around $7.20. And of course none of that comes to the patient. That's experience free at the consumer end. But that's essentially with labor that is donated on the teaching side and some minimum materials. And I buy much of it at wholesaler generics and some of it which is donated and carried in if I can get it through on the basis of what kinds of customs and other clearances they would have. So we have a regular supply run, we have the monitoring and mentoring and let's give you a sideshow from the technology you mentioned. Triple point failure. I have these mobile surgical modules. They look like they're not made to the same specs as a container. They are. In fact they withstand 7G and a container withstand 2.

Wow.

Positive pressure air conditioning, overpressure air conditioning. Well that makes it pretty pleasant for us, doesn't it? We're in there, we're cool, we're not inconvenienced. Equator, I mean we're sitting in the tropics. Well, that's really nice to us, isn't it? Well, wait a minute. That sounds like a first world convenience done for my own purposes. Hold on. It's positive pressure. What does that mean? We have a sterile operating room. Not like retreat. But that means. Before I could never put in a prosthesis such as a patch in a hernia or put in a vascular graft or anything like that because the contamination would mean that that's a foreign body that's infected and would have. Now we can do that sterile technique. And what else does it mean? Well, no dust comes in and no bugs come in. Well, that's a nice thing because after all, here in the US a mosquito is an annoyance. In Africa a mosquito and an anesthetized patient is lethal. Therefore we keep all of that going. Not because it's nice to us, because I still have been able to do the under a tree, local facilities, but it is something of importance to the patient. So why is this air conditioning system there? I'll tell you what the engineers did. They ran with it when they're talking triple point. We have a 32 volt commercial grade air conditioner and it has all the stuff that you can get from any commercial regular. It's backed up by a 64 watt army military specs air conditioner. No moving parts, no belts, no fans. It's backed up by the 128 spacecraft air conditioning system. And three have to go down before the patient could get a mosquito into the room because the door is open. And as a consequence, since there are no reps out there, there are no mechanics, there's no insurance agent, there's no gasoline station, there's no marine. The facility not only goes, but it goes against all the things that can fail. Now, we had an experiment just now ensuring that all technology Is fallible little trip up here. Well, in fact, that's true there too. So in addition to the monitoring and mentoring telemetry, I have two systems that go up, up to the satellite as well as those that come out of the phone, as well as those that come out of the GPS marker which identifies where it is, where it's moving and the engine shuts off if it's on its way to cross a border or something like that. And all of the things are built ins. What it means is we've made a system that someone other than I can use.

Wow.

Someone other than I or whom I'm recruiting. Because this is not a monument to a single individual. This is what we need to have, not just in an organization. Mission to Heal is the name I used after talking about healing with a capital H. And I don't mean by that cutting and sewing and passing pills. I mean that this is the piece of the iceberg that you can see, but the rising tide that comes with this floats all of those boats. We have an educational program, nutritional one, maternal and child health one. We've got one that involves cleaning up water. We've got one that involves village solar. We've got any of these others that are riders on that where people are just not content to sit in despair but say, hey, look, we can't fix everything. This, however, is something amenable to a little effort and let's go for it. And with this kind of outside support, it should be able, with its own inertia, to move forward and not be a dependent that needs constant supply. So the third component of this, when I talk to you about, I don't repeat the first mission the second time. We move it up, but that's it. We're graduating at this point. Because at this point you ought to be floating in your own bottom. But if you identify a group in an area in the same stage you were when we first arrived and you adopt them as a daughter clinic, we will assist you in bringing them up to level two that you are now in. And as a consequence, you then will be the consultants to them. And I always take from one center. Let us assume that I'm out in an area if they use the same language. And many of these people make me rather embarrassed. One is very envious of the fact that I have a dozen graduate degrees and he only speaks 14 languages. And I'm saying, my goodness, come on, let's go. So he's the one we carry forward.

Wow.

And he then our trainee of two weeks becomes the trainer in the next setting, we take the star performance from that one and move it forward. So now what do they do if they have a problem? They don't go 17,000 miles to expect that supply chain to keep them going. Why? The same fellow who speaks Samburu is right over there. And so we've established networks and they can solve their own problems regionally by the expertise one may have and another won't. So we sort of focus on some one, I have an eye specialist, the other one is the gynecologist du jour. None of them have been to any of the centers you or I have graduated from. But what, what difference does it make if they are the ones who are the go to people? So as a consequence, I will teach non physicians to operate, I will teach non nurses to medicate, I will teach anyone who takes on the single component of health care, and that is the assumption of responsibility. So if they're willing to do that and not doing this as a ladder to get out of that, that community, they're going to be my students. And they come to daily tutorials, they come to the absolute requirement that they have a death and complications conference every month. They will talk about those patients who died and what was preventable about it. If they have a primary problem in technique or in treatment or in the patient's own disease as a cause of that death, and every significant morbidity, every complication that could be prevented, and they must have that, it's institutionalized or we have no second visit.

Brilliant. I just again, I think your model is so. Well, I guess after being tried and trued and developed and evolved over these decades, it really has become such a fine running machine, so to speak. No, no pun intended. So moving beyond the tech, moving beyond the training, I'm sure you've had to deal in certain circumstances with corruption or crime or safety. How do you manage those kinds of things with the people you work with? I mean, it's sort of highlighted in a war zone in one of the documentaries. But how do you manage those issues?

Oh, come now, Chris. How can you even imagine such things? I mean, after all, and in the developing world, and there are all kinds of poseurs to say we don't have a few of our own, they are in fact under almost unrestricted liberty to operate. And one of their keys is a little touch of the English language. And as such, they would like to become agents of ours and go on. And that's a typical response that you get from an agent who doesn't Have a job or a uniform or a position from the government but is the one who is your interface, he's going to be your engage who is going to take care of these things for you. You are going here to help people. Let me introduce you to the very first person you're going to help. Yes. Okay. I have a game going and I've not been on this railway for very long but my rodeos have numbered quite a few. So I am pretty dumb about that. And they say oh professor, you know, at that point I know they're shooting for their essentially retirement benefits.

Get their palm greased.

Exactly. It's hard. And so what I do is engage a local partner who's also experienced with this. And what we do is we go through the workarounds and if they say this is an absolute blockade, you can't bring in anti malarials for example, well then you know, here is our alternative list of places that we have been requested. And as it goes on up to some of the agencies and some of the ministries of health they generally understand that this is not our first rodeo and we can't shaken down. So typically it happens on one example. For example, I'm probably being monitored by people in Uganda right now who understand that in one of the places I arrived they said well you cannot operate here without some special certificate which we have already got. But they said that wasn't valid, it had to be local. But I must leave. But I must leave the mobile units. I said, said well it's good that you told me. On this side of the Nile river just before I got on the barge and turned around six wheel drive we went the other direction rather quickly. Oh my gosh, sooth Minister of Health, please, please. That was a fellow, he's not representing us. He's no longer employed by us. He was just doing this for his own. So it's not that it's like doing bargaining in a developing world. You don't come up to the selling a carving on the street, say how much is that? Oh what a good price. He doesn't get any thrill from having scalped a very innocent virgin. So no, they understand that we've already had this conversation and so we usually start a couple of levels down. No, it is never without some attempt by an advantage taker. And every one of those has survived by this moxie of getting an advantage over his near neighbor. And therefore what we are here to do. That's why it says furthest peoples first. We're not here to enrich the capital City. We're not here to. A fellow wearing a necktie is not likely to be one of our consumers. And if thereafter, oh, I'm here to learn everything I can possibly from you, but not here, of course, because it's of no value. We're coming to Washington D.C. with you and well, no, no, you can't do that because it's, you know, very, very highly credentialed and you have to show your requirements. No, no, no, I'm with you. You're the professor. And well, it's expensive to live in Washington. No, no, no, no, I'm not. I'm living with you. So those are the poseurs. And we have a filter about that. And it's probable that those folks who would like to skim what should be are identified fairly quickly by asking, how will you carry this forward? What are you going to be doing in six months? And how is it that you plan to set up a program such that you will attract a second visit from us to go up to the next level? Because if in fact your only reason for being here is that I'm the hook and ladder that will get you out of this poverty and bring you into Washington D.C. which is probably not ideally suited for your technology, then I will understand. And one of the most compelling things is to realize that African social systems, these are families, these are not people saying, I'm here to take care of these folk over there. In fact, in one instance I have people from Kampala, from the capital, who speak a Bantu language, who are with me in northern Uganda, which speaks a cushitic language. They have less in common with those people than I do. I at least attempt to agree with their own language. So they are more foreign than I. So they are with me largely in order to get bounce in their own community in the capital. I say, well, they are not the leave behind go to folk. As a consequence, give me those who are the ones responsible, responsible for the care of these folks. And what they do is come forward and say, let me tell you about my auntie or my uncle who was the one, one of them presented a story that's bone chilling. He had a toothache. Well, obviously a dental problem is not one that goes treated. It's kind of an elective thing. And in this remote area, the toothache went on to an abscess. The abscess blew up and he got the, and you know, the, the magnificent flag mon that closed off his airplane. Oh my gosh, right now, dental kits. And for anyone with a dental abscess these people are saying, that was my uncle when I said, he's got really severe problem and there was no one that was before my visit, no one to care for him. We're going to refer him, Referring him down the mountain is 27 hours to pavement. He made it of that trip when they finally got the Toyota Land Cruiser and got the diesel fuel and had to change the tire by that time. One hour in, they stopped at the side of the road and he was buried where he died. And now that's a story. And if I were to start uncorking those stories, there would not be an end of them because every one of them has the motivation that's primary. It's not, I want to get with you because I want to be seen with a Westerner or I want to learn from you because after all, I can now go upscale and I can be as wasteful as Americans and I can throw away three sets of gloves in the same case. It is my auntie died of a ruptured uterus and they have not allowed us or didn't teach us how to do C sections. Is there any way for the next one? Because you can't tell a woman to stick her knees together for 27 hours to get to pavement. Because when you are there, there is no anesthetist. And that is not a hospital, it is a clinic at the pavement end. So to go further, you would have to get a very high technology like an aircraft to take you to the capitol. And there's none that can afford the diesel fuel to get down from the mountain, let alone an air passage. So unless they were going to set up a helicopter squad that would take you from remote area to another. And I'm sure that each of these developing world countries have an air force, despite the fact that they don't have an operating room, that would be a valuable thing to add to their first responders. However, that's unlikely and that my first response is go where the people are not. See what we can do to get the people out. And the answer to that is the only way that someone in a remote area where they don't even speak the colonial language of the country, for example, French in much of francophone Africa or English and much of the anglophone parts of Africa, they don't need to. They speak a regional Francophone such as Kiswahili or Hausa or Fulani or one of the others that goes from one border to another. So find someone at that level. It's kind of a district hospital level. And a district hospital typically doesn't have a theater. And what they do have is ketamine as the only agent. It's not really an anesthetic, as you know, it's a neuroleptic. And what happens? They do pretty much everything under that, and it's hardly anesthetic. At least it gives them the capacity to do a few things. And one of those things is cesarean section. One of the nasty things about that is that an injection of that sort goes into the maternal fetal unit. First thing that happens, and I ask when I come back, we taught you to do C section. How'd that turn out? Here's the spinal kits that I taught you how to do. Spinal emergency. Oh, yeah. But they got picked up and brought to the capitol by a fellow who came through for their private clinic, and we gave them ketamine. And what was the result? No, no, it was a stillborn. What do you mean? What that means is you didn't learn from the neonatal resuscitation units that I've got here. You have ambu bags. You do all this? Oh, they went with the spinal anesthesia kits.

Wow.

So, yes, there are frustrations. And what I tell my students, when we're actually having a go at it, it they want to know, what do I get equipped with here? What do I have as a fundamental. What? I want to know how to suture, I want to know how to treat this, I want to know how to do this. I want to. Here are all these techniques. Which one do I have to have? I say the single requirement is an infinite threshold for frustration. Because eloquent reasons why you can't get there from here, what you do is smile, thank them, walk around them, and go do it. Telling that to a medical student when they've stood fifth in line, they've done a workup that was the third order workup behind that of the three residents and the house officer that did that before them. They're ready to take on. And they can see immediately in front of them, under supervision, what has resulted from their direct care. Yes, his son was my medical student. And he said as we got to the airport, he, you know, gave a big hug to his son. His son came, got his bag, and he came off the airplane, and we came through the passport control, and we walked in there, and he comes over and he wants to say something to me, and then he. Then he tears up and he's choking up because he's not that eloquent. But then he turned around, he said, to me. My son. My son went with you. A student. He come back a doctor. Oh.

Oh, gosh. Well, that's a perfect segue. You have noted that you have a lot of good clinical outcomes, but there seems to be, Glenn, a high recidivism rate in your volunteers.

Yeah.

So why do you suppose that is? And share with us what makes a good volunteer versus a not so good volunteer, in your opinion. And experience. Experience.

And that's a good volunteer becomes a really good volunteer, actually, quite quickly because there is no real option otherwise. Have a tombstone, Chris. And I don't know if it's granted or marble. What's in fashion today? I'm not sure I need one. But the fact is, the single data bit for someone else who looked at my volunteers, I don't remember the number because I don't keep them, but it's like 2300 or so. And. And they said not a single one has not gone back.

Wow.

So that means it is not I. It is the experience itself. And that's why I say this is an educational piece that I've written a thesis on, actually, for an educational doctorate. And that is. This is transformational learning. It's not transactional. No one says, after the mission, I learned a lot. That's so obvious it need not be said. They typically, to a person, say, my whole life is changed. I will never be the same. And they don't identify the professor. I don't know who it is that ever said that coming out of biochemistry class. I don't know who it is that has gone through all of medical school as they've accumulated transactional learning. Now they don't grow cynamics. Now they passed the physiology test. Now they've had a little bit of neurology. In this instance, the worldview changes and you understand what my place in life is and what the calling is to go forward and how I can relate to the other across barriers that are insurmountable for most. And I can say, you know, I am sitting there with a woman in the clinic with a freshman medical student who's now in her summer rising sophomore year, and she's passed the Krebs cycle through her biochemistry, and she understands now all about medicine. And this woman comes to her, and I have a translator, and a young lady is sitting there looking at her and says, okay, tell us her problem. And the woman says, through the translation, we learned she is a recent widow whose husband had a wasting disease of unspecified type and died after three months of losing a lot of weight. She had seven children, three of whom survive, two of whom live to age 5. The others were lost in childbirth. And she herself is carrying along a couple of other kids who happen to be those of her sister who died in childbirth. And she's looking at this freshman medical student, and she's seeing that this young lady is nervous and kind of worried because after the Krebs cycle that she passed, she didn't have a first thought about what she can do to help this. And the woman says something, and it's happened multiple times that I've often had it translated in person by the translator who usually says, no, no, no, it's just a saying. It's just a local rendili saying, well, what did she say? And the answer is, how can I help you? Now, that takes all the air out of the spinnaker there. I came here to help you, and now I don't know what to do. You obviously are a match to the art of coping, because you've had more life experience than I have, having been pretty sheltered and having my parents support me through the first year of medical school. And now I'm coming out and fixing the world. And the first woman that comes up to me is this subcultural giant, looks at me and says, I can see that you're not going to be likely to survive here for more than a few days without some encouragement. How can I help you? That's the teacher. I am the usher. I am one of the fellow learners. And if my job is to get people in contact with giant like that, their life will change. I can talk to them, and I've done it a lot. And they all understand that there's something on the other end of this rainbow other than a big hill that they have to get over. But now they see direct and in person up front, another human being that has gone through far more than they and has come out of it. And you thought your neuroanatomy exam was tough. This is what is transformational learning, and that's what we do. Every one of the missions results in that. There's nobody that comes back untouched by it. I know that because I was. And I've done it for the next. Someone counted. I didn't. 434 international missions or something like that. I don't remember the number, but it was. And I said, yeah. And every one of those, I'm one of the learners. And if I can be one of those that ushers you into the big teachers. Here's one of them right now. It's your first patient coming up.

Wow, that is indeed transformational. And I would imagine the experiences that those volunteers have had then come back with them, you know, throughout their medical career, even if it's in a, you know, a resource rich kind of area, that those kinds of experiences I think create a greater appreciation and respect and compassion for those that they work with. So I want to circle back maybe and just do a little bit of a wrap up with your book because there's some, you know, I'm again kind of nerdy and geeky about metrics and outcomes and things like that. And in particular there's kind of a greatest hits that is in the book about Mission to Heal. So I just want to do a little highlight reel of these as well too. So you focused in the remote areas of Africa, South America, the Philippines, Cambodia and Mongolia, there have been more than 2,250 indigenous health care workers that have been trained. Hundreds of thousands of lives have been saved or enhanced. Your approach is on simple and effective materials and means. You value and model ingenuity and improvisation. You hold a great respect and sensitivity to local culture and you foster an indigenous ownership of community medical resources and overall well being. And you've kind of mentioned this earlier in our talk too, but like to indigenize surgery I think is one of your mantras as well too. So from that great background and just myriad of wonderful experiences and great outcomes, what have been Mission to Heal's greatest challenges, do you think?

Keeping it going forever and onward. And that is the thing I am talking with you for. And that is not only that, but that is probably the fundamental yield. If you can check the missiontoheal.org website and see what goes forward. We'd like to recruit, sustain, hit the donate button, make sure that it continues and doesn't continue only as a one man operation, which of course it isn't because every one of my volunteers is still out there. Even if they're not carrying the Mission to Heal flag, they're doing that which they picked up from it. At the same time we're expanding. We're putting a mobile surgical unit on each continent. Right now we have one Asia and South America and pair that are going to be crossing from east to west to west to east in Africa. And now we're getting a new one, an American transect that will be coming down through us, down to Mexico and across Central America, back into Ecuador and then Peruvian in Amazonian areas of Paraguay. So yes, all these things are on the horizon and I want each person to be able to do this. This is a kind of reward. The Pandemic has done one thing and that has put a number of people who have been yearning and longing for this. And now they're told they can do an option on the screen, do a project that's going to be, you know, a quantitative thing that you can essay this. And they're saying, look, look, I wanted to do this since I was a little kid. If you don't report it to the medical school that I've left the country, can we do it just without any credit for it? I'm not going to have you kicked out of medical school. I have dreamed of this all my life and I won't let them stop me. I said, that's right. And so what we're going to do is get you to graduate or get you into the residency and then I'm going to make a special section. Remember, I am qualified now as a gynecologist for about 15 different institutions. I'm qualified as a family medicine guy and a number of, obviously a surgeon in all of them. And I'm a. And so whatever rotation you call it, you'll get full credit for it. When with me, this is not a holiday. This isn't the time you take away from your vacation with family on the beach. This isn't a creditable experience, just like taking a rotation to one of the other hospitals in your unit. It's just exactly the same as you say, I'm taking a radiography or an ICU elected for the senior medical student. And in fact this needs to be incorporated into the curriculum. This is the sort of thing that the students are coming to medical school demanding. This is a bottom up, not top down. The deans aren't saying, now, you all ought to go out there and see what the rest of the world is like. Then the students say, I'm going to the university that offers this experience because this is reality and I know a lot of what we're doing here is contrived. So yes, this is popular, meaning the medical students themselves are demanding it. And yes, this is where we need to be in the future and I need that support. Not for me. I'm not a salaried individual. I am not the sort of folk that has taken one nickel from it. I don't want, nor will I take anything there that comes directly to me unless it can be immediately used inside the unit and its sponsorship of further ones coming along. So by all means, anyone who hears or communicates with or wishes to Help the world is not running out of need. I pointed with alarm to a few things, but let us also say look at the wonderful things that have happened through such concerted efforts as learning of development goals. Okay? That doesn't mean we are finished. It means we got our really good running start. Now let's get started on what those people are requesting as an access to modernity. They don't need to have a ticket to a tertiary hospital in US Of A. They need to have someone who speaks their language, cares for them, can also feed and nourish them as a nursing staff right where they live the furthest. People's first well said.

I also then want to add a little bit of a postscript to this that I believe this is correct. All the proceeds, the royalties from the book go to support Mission to Heal's work. Is that correct?

100%. Excellent. Does it mean profits? That means I've paid all the expenses. So therefore 100% and as a consequence none of those. The books, each of the books that are there are a 100% contribution to mission to Heal.

Good for you, Glenn. You are just such an inspiration and you're just such a breath of fresh air too. I mean, it's there, I think there's little, maybe inadvertently, you have also been an inspiration to other centers I know here in the Chicago area. At University of Illinois College of Medicine in Chicago, there's a center for Global Health that was started by Tim Erickson some years ago. Steven Wine is now managing it. Tim graduated, graduated, so to speak, and went on to the Harvard Humanitarian Initiative or Institute. There's a center also for Global health out of University of Wisconsin Northwestern University. I think Loyola has something and University of Chicago, I know does have something. So I think you're spot on that a lot of medical students nowadays have more of an interest in looking at things globally. I think a lot of medical students, rightfully so, are from international venues themselves and have an appreciation for being able to get training and go back and work from whence they've come and with their families and neighbors and community. So we'll have in the show notes all these links to the book to Mission to Heal's website. And I just want to say, you know it is thank you for your time today. I know you're in transit so making it all fit. I much appreciate. But the world is so blessed with your work. I know you don't take credit for it, but I'm going to give you credit right now anyway because you are the spirit and the brains behind this operation. And you've touched so many lives and so many beneficial and varied ways. And your ingenuity and sustainability and modesty, I mean, you really bring the human into humanitarian. And I just want to say that out loud. It's a pleasure to have. I've been so looking forward to this conversation and just bravo for the work that you've done and I wish you continued success.

Well, thank you, Chris. Thank you so much. And as a consequence, I'll give you a slogan that came out of one of our partners in Uganda. They called themselves ham, which sounds kind of strange, but at the same time, it's the humanitarian African nation. And their slogan is humanity with humility. And last thing I would like to hear from anyone coming to help me is I know what's best for you. You don't even know me. How is it that you're possibly going to say anything as arrogant as that? Look at me and say, I have a solution to problems I haven't yet identified for you. So let's listen and learn and help where we can.

Wonderful. Thank you, Glenn.

Thank you, Chris.

Living a Life in Full is a production of Stout Media, a subsidiary of Gordian Knot, LLC. Assistant Producer, Gracie Wong Music Dan O' Brien Executive Producer and Host, Dr. Chris Stout to learn more, stop by our website at lifeinfull for show notes and please recommend us to your friends and subscribe on your favorite platform. And as for the obligatory disclaimer, this podcast is for general information uses only and does not constitute the practice of psychology, medicine, nutrition or other professional health care services, including the giving of medical or psychological advice. No doctor patient relationship is formed. Lastly, and perhaps most importantly, I take conflicts of interest seriously. For all of my disclosures as well as show notes, please see livingalifeinfull.org podcast and my LinkedIn profile. Thanks. And until next time,