Service is The Only Way: The ECHO Movement

Welcome to beyond you'd why podcast. I'm your host, Dr. Gary Sanchez. At the Y Institute, we've helped over 40,000 people discover, make decisions and connect using their why. This show will be much more powerful for you once you know your own why. So head over to why institute.com and discover your why. Today you're going to meet one of the leaders who've discovered their why with us and is going to share their story and the powerful lessons they've learned.

Welcome to beyond you'd why Podcast where we go beyond just talking about your why and actually helping you discover and then live your why. And so if you're a regular listener, you know that every week we talk about one of the nine whys and then we bring on somebody with that why so you can see how their why has played out in their life. And so this week we are going to be talking about the why of contribute. So if you remember, people with this why yearn to be part of a greater cause, something greater than themselves. You don't want to be the cause, rather you want to contribute to it in a meaningful way. You want to make a difference in the lives of others in an organization or a cause that you believe in. You love to support others and relish the success of the greater good, the company growth and the victory of the team. People with this why seek to add value in all they do, do their part and help in whatever way possible. You are often behind the scenes looking for ways to make the world a better place. When you show up in a more public forum, it is often to trumpet a message or support a movement. People with this why are the go to people the ones you look for when you need help with just about anything? You make reliable and committed teammates and are often found in all areas of athletics, performing arts and cause based nonprofits. Virtually every organization must have contributors in order to operate successfully. They act as the glue that holds everyone else together. They use their time, energy, resources and connections to add value to other people. Now today I got a very special guest for you. I'm excited for our talk today. Our guest is Dr. Sanjeev Arora and he is the founder and director of Project Echo. It's a nonprofit that uses technology, a disease management model, case based learning and a web based database to arm primary care providers with knowledge needed to treat those with complex health problems that would otherwise need to travel for medical care. Project Echo and ECHO stands for Extension or Community Health Outcomes was developed to improve both capacity and access to specialty care for rural and underserved populations through service delivery, education and evaluation. Now Echo is a hub and spoke model and currently operates with hubs in 39 countries and spokes in over 125 countries. Over 78,000 health and education professionals have participated in echo telementoring networks. Dr. Arora is also a Distinguished and Regents professor of Medicine with tenure in the Department of Internal Medicine at the University of New Mexico health Science Center. Dr. Arora, welcome to the podcast.

Thank you Gary for this kind invitation to speak to you.

This is going to be fun today. Now tell everybody a little bit about yourself. Let's just start with where did you grow up and how did you get into medicine? And then how, how did this Project Echo come about?

Yeah, you know I grew up in India. I came to the United States in 1980. I did my medical training here and became a gastroenterologist and always worked in universities where I practiced and also taught the new generation of doctors how to be gastroenterologists. Essentially that was my Life. And in 2001 I had gone into my clinic at the university and there was a 43 year old woman sitting there and I asked her, how can I help you? And she said I have Hepatitis C so I'd like you to treat it. And I said okay, I think we'll do that. How long have you had it? And she said I've had it for eight years. And what was different about this visit was in the room with her was a 14 year old boy and a 9 year old girl were also sitting there. And so I said if you've known about it for eight years, why did you not come earlier for treatment? And she said, you know, I live 200 miles away from you. And I had called your nurse and she said there was an eight month wait to see you. And I would have to make 12 trips to Albuquerque, New Mexico while I was getting this chemotherapy like regimen of weekly injections and pills and I'd be feeling sick. I would have to take this time off work to come here and I just don't. That's not my economic situation that I could take that much time off work. My car is old, I had a one year old child, I'm a single mother so there was no way I could do that. And I decided I'm not going to get treated. So I said why did you come today? And she said I'm having pain in the right upper side of my abdomen here. I got worried. I did an ultrasound of her abdomen and found she had a cancer of her liver, which was about slightly smaller than a tennis ball. And now, of course, she was willing to come as many times as I wanted her to, but it was too late and. And she passed away six months later. I asked myself, you know, I've been living in the United States now at that time, for almost more than 20 years. And I said, we have all the medicines, we had all the tests, I have all the knowledge. Why did this young woman have to die of a treatable disease? And the answer came was that she died because the right knowledge didn't exist at the right place at the right time. And without the right knowledge, it's impossible to get the right care. Even if money is existing in that place, even if you have insurance, you need that knowledge to be available to you for you to make the right diagnosis, for you to get the right treatment. And then later, I have discovered, Gary, that this problem is occurring all over the world continuously. Six billion people in the world don't have access to the right knowledge at the right place at the right time. And millions die every day. So in India, for example, 1100 people die of TB every single day, even though the medicine is free, the tests are available, 1800 children die every single day in the world from diarrheal diseases which are imminently treatable with oral rehydration and sometimes antibiotics. But, you know, we take this for granted, that if it's just knowledge, it won't harm you. But absence of knowledge is a very, very fatal disease often. And so that's why I started Echo with the idea that first I would test it to help everyone in New Mexico get treatment for hepatitis C. And then if I could do that, I would have a model to manage complex diseases anywhere in the world.

When did you start Project Echo?

I started in 2003 because this story of this 43 year old woman was being repeated again and again. And I was saying, this is not. This is. I was so frustrated that, look, I knew how to do this. It was a life threatening disease. I had the treatment, but I couldn't get it to Everybody. There were 28,000 people in New Mexico who had it. Less than 1500 had been treated. So I launched Echo with the purpose to get treatment to every single one of them.

So tell everybody that's listening, you know, kind of describe what ECHO is. How does it work?

Yeah. So at that time, when I was having this trouble, I said, how do I treat so many people? I don't have the time myself. So I said I would mentor other people to become as good as me. So the first principle is I would use technology to leverage expertise. Actually, we use the technology you're using today. Zoom. And so I went around the state of New Mexico. At that time we were using a different technology. And I set up 21 new treatment sites for New Mexico in rural New Mexico. Sixteen were in rural areas and five were in the prison system in New Mexico in five separate prisons. And I requested a primary care clinician to treat hepatitis C there under my guidance. And I gave them my protocol, but not a single one of them was willing to treat it. They were afraid of the side effects of this treatment. It was chemo. So I asked myself, how did you become an expert? And that's when the answer came, is that when I was doing my training in Boston, Massachusetts to become a gastroenterologist.

This is what happened. I would see a patient and present to my professor. I would see another patient present to my professor. And as I did this week after week, after two years, they started calling me a gastroenterologist. I said, aha. I'm going to use this model to create new hepatitis C ologists in New Mexico, brand new experts, my mentees. And I would make them as good as me. And we call this case based learning an iterative guided practice. And the fourth principle was to track outcomes on the Internet to evaluate. So it was to use technology to leverage expertise, sharing best practices, case based learning and iterated guided practice and then tracking outcome. And so I started having a weekly tele echo clinic with all 21 of these mentees of mine. For two hours, Wednesday three to five, they would join me and one by one, they would present patients of hepatitis C to me without patients names and to each other. They would listen to each other and then me and my team, expert team, would discuss those cases. We would ask for everybody's advice. We call this idea all teach, all learn. So we had these all teach, all learn sessions for two hours a week. And lo and behold, I found in one year they became total experts. The weight in my clinic fell from eight months to two weeks. Anybody in New Mexico could be treated close to their home within a week or two. And thousands of patients got treated. And what we were able to show in our research, since I'm a professor, as you said, that echo was producing joy of work for these rural clinicians because it was building community of practice. It was a social network in addition to a knowledge network. And then we did studies to show that using the echo model, they could give chemotherapy in a rural area or the prison and get exactly the same results as us at the university. And what we call force multiplication had occurred. The capacity had gone up 10 times. And once we knew that, we knew that the sky was the limit of what we could do. And we wanted to change the world at that point. Wow.

So it sounds to me like the ECHO project was a Dr. Sanjeev Aurora cloning project.

What, Hepatitis C? It was.

Yeah. So it started off with a Dr. Aurora cloning project, but then I realized that there were thousands of experts like me and you, Gary, who had the same problem, that they could only help those people that they could see directly, but they wanted to have a much bigger impact on the world. So I said, let me find those people who want to have massive impact on the world with the gifts that they have received. I was a very fortunate person. I had the best education, I got the best training, and in a sense, I had struck the birth lottery. So now I thought, hey, I've got to get back here. And now I found this model and I'm going to change the world with it by finding other people who have the same desire to serve. And then I found thousands of them around the world. And now we have 900 such networks operating in the world out of more recently, 41 countries with learners in 158 countries at this point. And we had only touched about 100,000 or so providers earlier. But since COVID 19, now we have trained 500,000 healthcare professionals for COVID 19 all over the world using the ECHO model, who in turn have helped millions and millions of patients. Because.

For COVID 19, Gary, the same problem is existing.

This expertise is so rapidly evolving. There have been more than 100,000 publications already in the last several months. There's no way a doctor or a community health worker or a nurse can keep up. So we said we need to do that cloning project for COVID 19 so that we have millions of experts in the world who can help their communities, their neighbors, their families and so on and so forth.

Wow. And so currently you said all in total, you guys have helped 500,000 medical practices, medical professionals. So now, you know, if they each help 100 people or a thousand, let's say a thousand people. I mean, you're at whatever that is. 50 billion. No, 50 million.

But the issue is our goal is to help a billion people. Yes. So we have not. We barely scratched the surface, Gary. But the thing is, we have massive momentum. Echo is a movement. We train anyone in the world who wants to do Echo, including you. We train them for free and we give them our entire technology for free, and we give them our software for free, and then we give them the technical assistance that they need for free so that they can fulfill their life's mission of service to others. Wow.

And how are you able to do all of that for free?

We get broad philanthropic support from people who buy into our mission.

Of democratizing knowledge and democratizing the implementation of best practice. So it's really important, Gary, not to think of Echo as a dissemination of knowledge platform. That is Google. Of course we do that too. We disseminate knowledge. But what we mainly do is we democratize the implementation of best practices. That is, we help people implement this knowledge through mentoring. We call that guided practice. We help them until they become experts, and then we let them go to do good in the world. And so it's a way to scale up practice.

Yeah, I remember your three words when we were talking before and kind of looking at your message, I think they were like, connect, mentor, and grow.

Yes.

Yeah. So that you connect people together, you mentor them until there is become experts in their own community, and then that grows your network to be able to serve and service and help more people.

Yes, yes, yes. And we think we have to mentor at least 3 million providers. Do we have any chance of getting to a billion? But more important than just our number of helping a billion people, Gary, is the idea.

That, you know, knowledge tends to get trapped in the heads of a few experts everywhere in the world. And of course, knowledge is money, knowledge is power, knowledge is fame.

But there is one real, real problem is that when this knowledge doesn't get to low income people everywhere in the world, lots of deaths occur and there is a lot of instability that causes everywhere in the world. And if we want a safer world, a more pleasant, joyful world to live in with peace and harmony, we need a more equitable world. We need a world where there is more social justice. And the primary message I'm trying to get across is that yes, there's. There's not enough money to help every poor person in the world, but there is enough knowledge. And the reason is this, that Gary, if you're a very generous man, and if I asked you to give half your wealth to someone else, you would only be left with half of it. You would be poorer. But if I asked you today to democratize your knowledge, the importance of the why. Yeah. You would actually become richer. You know why? Because all teach, all learn would come into play and you would Learn as much from your learners as they would learn from you, and the world would become a better place. So what I like to say is the physics of knowledge is different from the physics of material resources. When you split a material resource into two, each has half like an orange. Whereas knowledge grows with sharing, with community, and new knowledge is created and everyone becomes better off.

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So what comes to mind first for me is when you've got that doctor who is the expert, and he is known to be the expert, and he's got the title, and he's got all the stuff that goes with it, and you ask him to share that, how is that being received?

Not every person in the world is interested in democratizing their knowledge. Yeah. So most people. But on the other hand, there are so many people. So I never go and ask somebody to democratize their knowledge. They come to me and say, hey, I heard about echo. I have this very specialized knowledge, and I'm not able to have enough impact on the world. I want to use ECHO to democratize my knowledge. So, for example, we have some judges in the United States who are using ECHO to train other judges to give better judgments. We have master school teachers. In fact, in New Mexico, where you and I live, we are using it to mentor school teachers of how to do virtual classrooms. And we are just about to start another program in our schools on social and emotional learning. We have programs for mentoring school principals to be better leaders. We have programs on water security. You'll be surprised, Gary, how much goodwill there is in the world of people who want to spend their life in service to others. There was this very important philosopher physician by the name of Albert Schweitzer.

Albert Schweitzer said this, and this is definitely true. As true as any quote can get. He says, I don't know what your destiny will be, but one thing I know for certain.

The only ones amongst you.

Who will be really happy are those who have found and learned how to serve.

It's a very profound quote, Gary, because it says the only ones amongst you who will be happy, essentially saying there is no other way of True happiness other than service to others.

Wow. Service creates happiness.

Yes.

Wow. You know, it's interesting because in dentistry, we are very willing to share with any other dentist around us. It's just part of who we are. It's not a competition. It's if another dentist walked into my office and said, hey, can I hang out here for the day and just see what you guys are doing and see how everything works, we'd say, sure, yeah, bring your team whatever you want. However, we can help you. We help each other, and it makes for a great community where we enjoy being with each other. But I don't think it's that way in most businesses. It's more like, this is my stuff, my specialty. You keep yours to yourself.

That is true, Gary. On the other hand, it's also a stage of life thing.

At some period in their life. It's also about Maslow's hierarchies, is that in the beginning, people are very much more focused on educating themselves, building their own resource pool so that they have enough resources for themselves, for their family to educate their children to have a comfortable house.

But there also comes a time when people say that this is insufficient for me to be totally happy their children have left home.

They start asking the question, what next?

And this is the time when these people have the maximum amount of expertise. They've often been practicing or doing their business for 20, 25 years. They are ready to now spend it a different way. Take the example of a very famous man, Bill Gates. He was a very, very fierce businessman, very fiercely competitive and highly successful. And lots of people thought he was too competitive.

But then he moved into a new stage of life where he said, I'm going to devote the rest of my life in service. Look at Warren Buffett. I mean, giving up 90 plus percent of their wealth for service. I think these people are on to something. They understand there is only one way. All other ways lead to dark alleys, basically.

When did you realize that in your life?

Honestly, I was in the same rat race like everybody else. And before this total realization that service is the only way came to me. It came around 2002, and essentially at that time, I was already 36 years old. It was already late for me. But the thing was, when it came, it became very clear that there was no other way. And I was a pretty logical, analytical person. I said, look, if there's no other way, then this is the way I'm going to go.

What was the moment that you realized that? Was that when you read that quote or was that when something happened? Or how did that happen for you?

Yeah, you know, I. I had two daughters and two daughters. Both went to. Had gone to.

You know.

You know, they. I was becoming empty nesters. They went to college. They were now. And so essentially.

When they became empty nesters, I think I misquoted the date. I was. It was. I was 46 years old, not 36 years old. Yeah. So I was 46 years old. And when my daughters left for college, I had a lot of emptiness in my heart.

Both had gone. I was empty nester. I had spending. I had been spending many years of my life sort of devoted to their growth, their mentoring them, teaching them, their friendship was very meaningful. And then when they left, it left this void. And I was asking this question. I like to meditate. And I was asking this question, what's next for me? And.

That'S when this answer came to me that service is the only way. I read the quote later, but it came during a meditation session that I was in asking this question to the universe. Okay. I've spent so much time and energy in this phase of my life, but now, obviously, my kids have gone away. They have to look forward in their life. They're not going to look backwards towards me. They have to look towards their families and their education and on their careers and what is it for me? And I'm still 46 years old, and it's. It's sort of. I still have a lot to give, and. And that's how this idea came.

Did you ever imagine that it was going to be where it is now?

No, I didn't imagine it could achieve this much scale so quickly. But the idea is resonating with a lot of people of giving knowledge. Of course, all of us give money, right? You must give money to your church, to your favor. Giving knowledge is another form of service. But, you know, you'll be surprised that actually when you realize how much fulfillment it brings to you. And the other thing it does is it produces joy. We have about 80 publications showing that Echo produces joy of work. So it produces joy for the experts because it builds for them a community of practice rather than their own practice. Often, experts are used to working with one organization at a time or one mentee at a time. This builds communities for them. And so they are getting a lot of emotional reinforcement and can see the results of their efforts that they put in the previous 45 years of their life.

Wow.

You know, I. I think back to when I. When I'm doing dentistry for free, it's much more rewarding than when I'm doing dentistry for money.

And I don't even know how to explain that. But, you know, we did the Mission of Mercy and some of the other different events like that, where you just go and you help whoever needs help and it just feels so good. And you do as much as you can do versus, you know, with all the other things that come along with having to do it in a dental practice and dealing with insurance and money and all that kind of stuff. And it just feels a lot better. I don't know. I don't know why. But I mean, like you said, it produces joy.

Yes.

Creates energy.

There's a lot of studies now, there's a lot of evidence in randomized control, other kinds of studies showing that this is a real deal, this is not our imagination, that this is happening.

Do you have, and I should go look myself, but do you have on the Echo website that quote service is the only way I will.

I can send it to you personally, so I will email it to you. Gary.

Well, no, what I'm thinking about is when we look at the why of Echo.

That is the why of Echo. That is the entire reason it exists. The entire reason it started. That is exactly where it came from. It came from you. Yes, but because you meditated and you came to the realization of that quote.

That's the bottom line right there.

I've never thought of it that way. But the last time you came and helped us, Gary, it really helped me change the way I talk about Echo. The constructs that you talked about. Why, how, what? Yes, I often use that all the time. I'd heard it something from on a previous TED Talk, but I think that workshop you did with us really helped us reflect more on it and it was helpful. And I have adopted that in my communication style.

I love that I just used it yesterday. By the way, your ears were probably burning. But I was working with a bunch of other businesses yesterday and I read your why, how, what and story. And it was so powerful for them. And they were like, man, we got to hear more about that. But what we didn't get to, we did not get to. Service is the only way. And that is really the bottom line essence of everything that you're about and that it's about and what attracts people to it. And we need to include that.

Yeah. So we have to figure out how to do that. But by the way, our whole team was grateful that you volunteered so much time to spend with us and that was your service.

Yes, it was. And I'm happy to come do it again and re get whoever's new and bring them in the room with us and.

Keep it going bigger and bigger and bigger and then getting that out to everybody else. But I'm so glad we got to talk about this today because now I'm getting it at a different level of how this actually happened, because had you not met, had your daughters not left.

You.

So this is actually because of your daughters. We need to thank your daughters.

It is true. Because before that I was mostly mesmerized by them and I didn't have time for anything else.

And then you had to go meditate on, now what the heck am I going to do with my life?

Exactly. That was the question I was asking.

Well, service is the only way really makes me think a lot, too, and I'm. I'm so glad that you shared that with us. So you started with just you, and then you had the 21 health professionals that started with you. Are they now mentoring other people as well? Is it kind of expanding out that way?

Some of them do that. Some of them just adopt that one expertise and then they go with that. But most of them definitely spread what they've learned to all their colleagues in their local community, because changing a community's disease pattern requires them to educate their community. So they'll often give lectures in their community about what is hepatitis C, who should suspect it. They give. They talk to their colleagues in their own clinic and in their town about when should they suspect and diagnose it, because so much is of it is not diagnosed. And if you cannot diagnose, you cannot treat. So it is sort of like the way it works is think of a pond. It's a placid pond in a rural area, and you go and throw a big rock in the middle of it. That's that expert. Then that knowledge actually operates like waves. And you'll go back after an hour and you'll still see very tiny waves still emanating from the place where you dropped the rock. You see? So you cannot drop such a massive piece of expertise in a community and not change it. It changes it because that knowledge is disseminating. Nurses find out. Pharmacists find out that, oh, there's a treatment for hepatitis C in the community. Patient groups find out, oh, now I can get treatment in my local community, and so on and so forth. And it just changes the game.

Yeah.

How does it feel for you personally to see what an amazing direction and speed and scale this has Come and gone.

I think the most important emotion I feel is gratitude.

And the second gratitude that I was given the opportunity to come up with this idea and then spread it around the world. But then the second emotion I feel is hope. Because I see so much good in the world of people who want to do a lot of good. They just didn't have the means to do it. And when you provide them a means to do it, which is within, without them having to sort of give up half their wealth or sacrifice their own welfare.

That creates a sort of a magnet that essentially a lot of people who have the desire to help but haven't had the means to be drawn to the mission. And since the mission is much larger than healthcare. You know, there was a PBS documentary that came out in the National PBS on Echo, in which I said this. And I believe it truly that the ultimate impact of Echo in the world will be much greater on education than it will ever be on health. Because school teachers, I mean, students all over the world are not getting the best education because their teacher doesn't know this is true in rural New Mexico. So currently we are in the process of raising funds from philanthropists for our education Echoes. Because what has happened, Gary, is that all over the world, schools are locked down.

And these students are stuck at home, and their teachers don't have best practices on how to educate them. And can you imagine if you are 5 years old and you lose a year of brain development that way? So there's a lot. This lack of knowledge is a very serious problem. It's a very serious problem, and we can fix it relatively easily. So, I mean, that's why I'm very interested in spreading this movement based on service to others is the only way. But then using knowledge as that primary source that you share, that you use the knowledge you have as a gift and then you share it with others.

I love that. Yes, we need to get together again and kind of re and talk again about this message, because I'm seeing it even clearer now. And I know I promised you we would get off, we would finish on time for you to go to your next call, which is like two minutes from now. But I'd love to for us all to get together, get all these same people and more in the room, and we'll go through this again. Because service is the only way. And knowledge is the primary source is pretty dang strong. And it's what you've been doing. And now we've got the words to really focus on the message. So I Love that.

Thank you. Thank you for this time, Gary. And I'm really honored to be on your podcast and thank you for all your service to humanity, service to us, and really appreciate what you're doing.

Thank you. Well, heck, you too. I mean, you've impacted millions of people and soon to be billion. And so if people are listening and they want to connect with you, they want to learn more about you, they want to give to your cause, they want to be part of this. They're a doctor that wants to be part of this, what should they do?

They should reach out to me. My website is Echo Unm Edu. That is Echo Unm Edu. Excellent. When you put your podcast, if you, you could, if you wanted, put a link there for it.

Yes, I will do that for sure. Thank you so much for being here. And we will, I'm sure, be in touch. And I'll probably see you this weekend, actually.

Yes, look forward to that. Thank you.

Thank you.

Bye. Bye. Bye.

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