Surgical Care to Remote Regions with Dr. Glenn Geelhoed: Rational Wellness Podcast 188

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Dr. Glenn Geelhoed speaks about Providing Surgical Care to Remote Regions of the World with Dr. Ben Weitz.

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Podcast Highlights



Dr. Glenn Geelhoed is a professor of surgery at George Washington University in Washington, D.C.. He has also completed masters degrees in international affairs, epidemiology, health promotion and disease prevention, anthropology, and a philosophy degree. He has dedicated part of his life to providing surgical care to people living in some of the most remote regions in the world, who ordinarily have no access to medical care. He has written several books, including Furthest Peoples First.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.



Podcast Transcript

Dr. Weitz: Hey, this is Dr. Ben Weitz host of the Rational Wellness Podcast. I talk to leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. To learn more, check out my website drweitz.com. Thanks for joining me and let’s jump into the podcast.

Hello, Rational Wellness Podcasters, Dr. Ben Weitz here. Today, our topic is something completely different from what we usually talk about. The Rational Wellness Podcast, as you know if you’re a regular listener, is usually focused on functional medicine and the ways in which diet and lifestyle changes can play a role in health and especially in chronic diseases and how we can modify diet, lifestyle, nutritional supplementation to prevent and reverse such chronic diseases and promote longevity. We typically talk about topics like gut health, bioidentical hormones, nutritional deficiencies, cardiovascular disease, how to promote longevity, how to engage in detoxifying heavy metals from the body, etc.

Today, we’ll be talking about serving humanity in a different way. To providing badly needed surgical care to people in the remote regions of the planet such as in parts of Africa, we’ll be speaking with Dr. Glenn Geelhoed who has dedicated his life to this. Dr. Geelhoed has a medical degree from the University of Michigan and he complete his surgical residency with Harvard University. To assist in developing further volunteer surgical services in underserved areas of the developing world, Dr. Geelhoed completed Master’s Degrees in international affairs, epidemiology, health promotion, and disease prevention, anthropology and a philosophy degree in human sciences. There we have something in common, I also have a philosophy degree. He works as a Professor of Surgery at George Washington University Medical Center in Washington, DC and he’s a member of numerous medical surgical and academic societies. He’s an avid runner and has completed more than 135 marathons across the globe. He is a widely published author, accredited with several books including his latest book, Furthest Peoples First which is going to serve as sort of the basis for our discussion today. Dr. Geelhoed, thank you so much for joining me.

Dr. Geelhoed: Thank you, Ben. Appreciate your invitation.

Dr. Weitz: Why have you chosen to devote yourself to bringing surgical care to the remotest places on the planet?

Dr. Geelhoed: Oh, that’s a good question and a large one but I really appreciate your asking it because it’s the sort of thing that may be counterintuitive. Why in the first world environment with all the high technology we have is perhaps something that your guests have already been discussing for some time. That is, how is it that this is a unique period in history when we can do so much to so few who are so little satisfied with this healthcare? How is it that we kind of expect some other professional to take care of us when, in fact, we have lived irresponsibly? I think refocusing on that brings us to that developing world. An active verb, developing. When you suggested to me this is a matter of service to humanity for those who are underserved, I certainly agree with that. Remember, I go constantly as an educational experience and it’s both ways on that street. What can I learn from them? I mean, you’re on the West Coast there and you go to the nearest hospital and you walk into that ward and you take a look about and you find out that the beds are filled with diseases that they haven’t yet learned how to develop. I’d say, what are they doing right? Why is it that we talk always about what weird and wonderful conditions they have out there in the tropics. These people in the middle of nowhere that’s inaccessible, how is it that we can get to them and where these strange diseases are? Well, let me take that little notepad that I carry all around the globe and write down a few of those notes about what I see that I wouldn’t see here. More importantly, flip it over and write down those things that are so common everyday events here that they don’t have. Varicose veins, irritable bowel syndrome, sigmoid colon cancer, coronary artery disease, thrombophlebitis, hiatal hernia. Tell me why don’t they and if they have none of that, what can we learn from them? My goal is always to learn as much as I teach and when I’m out there, I find that they have a skill that we need.

Dr. Weitz: Let me stop you for a second because that’s an interesting insight. We often get into discussions in Functional Medicine and there’s a percentage of practitioners who talk about looking at what ancient cultures did because they didn’t have these chronic diseases and therefore if we go back to a paleolithic template for how to eat and how to live our lives, then that’s a way to avoid these chronic diseases. Given your experience, is it the case that these people in these remote regions don’t have atherosclerosis and some of these chronic diseases or is it that they have more pressing problems that they’re dying from like infectious diseases and from trauma and things like that before those chronic diseases would actually pop up?

Dr. Geelhoed: Well, the answer to that if I don’t want to equivocate, is yes and yes. There are a couple of reasons for this. One of them is if you look at the population pyramid, there are a lot of youth and there are fewer older people. However, let’s look at those youths and we find out that the under fives are very susceptible to contagious communicable diseases such as malaria, dengue, …

Dr. Weitz: Well, what is the average lifespan in some of these places where you go?

Dr. Geelhoed: When you look at one of the populations in which I’m serving, you can look at it and ask what the median age is.

Dr. Weitz: Okay.

Dr. Geelhoed: It turns out in a place such as Uganda it is 11.

Dr. Weitz: Wow.

Dr. Geelhoed: What that means is that there’s an enormous base to this pyramid and there are fewer elders. However, what it means is there’s a fairly high loss rate. Now, if you medicalize the social conditions and get a higher salvage of the youth, what then happens is you get a broader middle age and middle we’ll talk about the reproductive years, the 20s and the 30s and up to the 40s. Now, look at those people. When we look at those young people, they are susceptible. They haven’t yet acquired the immunity to several things such as chronic malaria, develops a somewhat relative resistance to the really tragic forms of the disease. However, if they get to the age of survival there, they are very healthy adults. I say that when you look at the nutrition and you look at the individuals, I will give you three-fourths of a [inaudible 00:08:11] equation. You figure out the fourth. They have young children that are in nutritional peril because they don’t usually have enough in a balanced diet of some sort.

American kids, they run straight for the french fries. They’re chubby and they are running around using up energy. Now, you look at their diet and ours and you ask about their adults and ours. They have healthy, very functional adults. Muscular women that are out there gathering roots and berries and they’re out there foraging. Now, look at that same population in our group and you would ask, is their diet and their exercise and their lifestyle contributing to the health of the elders that we may find in the reverse here. Yes, you are correct in both instances.

Number one, to develop heart, cancer, stroke is the number one, two, and three problems in this part of the world, you have to survive long enough to develop them. That’s the disease of 60, 80-year-olds. Now, if you’re talking about the number one through five killers on planet Earth, I say it’s a dammm shame, D-A-M-M-M. Diarrhea, acute respiratory disease that is pneumonia, malaria, malnutrition, and measles. Number one through five on planet Earth are all diseases that are typically of the under five children and it’s a high children loss rate.

Dr. Weitz: Measles is one of the top five killers.

Dr. Geelhoed: It still is and the reason for that is one of our millennium development goals has been the Expanded Program in Immunization, EPI. It is a very effective one. You can prevent it. You can prevent all five of those number one through five. You don’t need a nickel’s worth of research to find out what causes them. We know and there are relatively effective and cheap methods of solving them. For example, diarrhea we’ve taken on the oral rehydration salt program. That’s saved more lives than every antibiotic developed. The area of the acute respiratory right now is one in which we’re working very diligently. One of those having to do with antibiotic resistance in some instances particularly with some of the short-term courses of treatment for tuberculosis that are discontinued and then you get the development of resistant tuberculosis organisms. Nonetheless, each one of these has treatments and each one of these are relatively effective. Our millennium development goals have targeted them and has been quite effective.

Dr. Weitz: Interesting. There’s probably when I was reading your book and talking about parts of Africa and South America, I couldn’t help but think there’s probably places in America that could probably badly need your care as well given that healthcare is not often widely available in rural parts of America. I was just listening to a discussion, they were talking to potential voters in some rural part of West Virginia and they haven’t voted for years. They say, “We don’t even have the Internet. We don’t have running water. We don’t care about who’s the President.”

Dr. Geelhoed: You’re right. Developing worlds are two terms that I use regardless of political boundaries or geography. Right next to me here in the city of Washington, DC, there are big chunks of a third world within sight of the gleaming first world medical towers. In Karachi, Pakistan, there are the [Kachiabodies 00:12:07] and they’re sitting right next to the women and high quality restaurants that are talking about their children in the Serbonnes. There are people all over the globe, the first and third worlds are very close together sometimes in the same geographic area. The barriers are not simply economic, although that’s a major one. It can also be political. It can be religious. It can be language. It can be a number of these things that are barriers at our hospitals to be bridged. Some of which are very, very difficult.

I don’t have to tell you that in the Middle East, there are barriers to people who live on either side of the same street that might not have anything different in the place they shop, the food they eat, even the language they speak. In fact, I talk about the holes of inaccessibility. It’s a geographic term. In the middle of each continent, there’s a spot you can’t get to easily. You can’t get to at all in some instances because there’s no access by river, by road, by air, by mountain or otherwise.

The one that I’ve worked in fairly often is the subject of another book. That is a mission to heal book which comes from a place in Obo now called the Central African Republic used to be the eternal empire of Central Africa. Eternity only lasts two and a half years in that instance under Jean-Bedel Bokassa but that is inaccessible. Now, those people are the kinds of folks you would say, “You have a problem? Just go to the local medical center.” That local medical center is five time zones away and there is no road between them. When they get there, they don’t have the same language. Furthermore, there are three wars going on between them that are tribal and also international proxy wars. As a consequence, they are totally isolated there. Similarly, there’s a spot in Kazakhstan which is the Asian pole of inaccessibility.

If you were, for example, in a, if I use the term, ghetto environment in the middle of a good city somewhere and weren’t able to access the healthcare, once again because of perhaps citizenship, Medicaid availability, language accessibility. All of these reasons are the barriers that we artificially erect to isolate humans from each other. Those are so easily bridged if only we can overcome the most fundamental prejudices and see what we can do. My goal is not to say, “Look, I’m going to build a road. Now, you can go from remote Uganda down to Kampala where they have first world medical centers.” I was a participant in developing a couple of those. Well, in fact, when they get there, they speak there a Bantu language. The people from northern Uganda speak a Cushitic language that’s from the Kingdom of Kush. There’s not one word in common there so who’s to say and how are they going to be … Furthermore, there’s a civil war between those two groups only recently resolved. They still have skirmishes.

As a consequence, they had a very not so much just by geography but by a lot of artificial constraints that are political and economic and a whole lot that we could overcome if what we recognize is the commonness of humanity. Physiology is made very much the same way. The anatomy doesn’t look a lot different to me when I’m inside there looking around. As a consequence, if we can recognize how much we have in common, how little those differences make, how trivial some of them can be. I mean, for example, if we think of the enormous complexity of one human to another and all the fascinating differences in culture, something as trivial as skin color is a remarkable barrier to having been invented as an inhibition to healthcare. Our goal is inability that they have to get to healthcare, let us bring it to them and to capitalize on the assets they have and learn from them in the process.

Dr. Weitz: Yeah, I think it’s interesting. This is not really a medical point, this is more of a historical point. I think those of us who are sort of paying attention have learned from reading about the situation that occurred in Iraq since our country got involved there. How you have these three different tribes and how they were all put together in one country. Basically, that happened because the Europeans came in and said, “Okay. This is the country of Iraq.” Not respecting that there were these different tribes with different religions and different languages and just throw them together. That sort of issue occurred all around the globe where we just went in and said, “Okay. This is West Africa. This is the Congo. This is this country.” We drew lines irrespective of different tribes with different languages and different cultures. What you’re talking about partially is that the inability to different tribes in the same country that speak different languages and the different issues that occur with accessing healthcare with people who don’t speak the same and etc.

Dr. Geelhoed: You’re right, Ben. In 1850, a group of Europeans sat down in Berlin and curved up Africa never having been there. What they did is they would write a red line down the middle of the river. Now, isn’t it reasonable to think that perhaps my cousin lives on that side of the river and I’m on this bank and how did it suddenly happen that he belongs to the different nation state and that I’m at war with that nation state because although he’s my cousin, he now has a different flag. They would not know from that. They identify with their cultural groups, their language and their people that are responsible. One of the things that Africans have to make up for lack of stuff is very strong relationships so that if I speak your language and have some blood kinship to you, you are obligated to come and help me in my time of need. You have eaten today, I have not. We share the same things, language and religion and I believe you probably ought to do something to help me. That’s true for all humanity. The original-

Dr. Weitz: Now, you know that whole concept of, I have eaten today and you haven’t, is something that we have forgotten about a long time ago in the United States. It’s important to remember that. For most of the history of humanity, the biggest threat to survival was starvation. Now, a lot of our physiology is designed to help us overcome that starvation and that explains some of the issues around understanding insulin resistance and fat storage. There’s a whole series of physiological concepts. They’re all really built around that. We often forget that because in America we’re so far from ever facing starvation for most of us anyway.

Dr. Geelhoed: You’re right on there, Ben. I understand the paleolithic prescription and the stingy gene hypothesis hanging on desperately to the salt and the sugar which gives us greater problems of both the diabetes and the hypertension. Yes, in fact, that origin and the pressures that were put to bear on the early genetic population that became ours, is a number of things that we can learn from. Remember, they there have to do something which is a skill we must learn from them. They cope. They are resilient with both imagination and resourcefulness and some sort workarounds, they are able to take on what I consider bigger problems and larger numbers with far fewer resources. That’s a lesson we have to learn from them.

When I go out there, I don’t come and say, “You poor [inaudible 00:20:46] savages, I’m here to tell you about the wonders of the first world.” No. I go out there and I ask, “How is it that you’ve done so well with problems that we find insurmountable? How is it we might be able to assist you who have the obligation to care for the Indigenous folk with an enhanced method for caring for them?” Mine is an educational mission and that education is two ways. It is never coming over there and saying, “We’re going to tell you what it is that you should do.” Only politicians say that. The most arrogant statement made to anyone, “I know what’s best for you.” Well hey, you don’t even know me. How can you possibly come up with that statement because, in fact, I am adapted? By definition, I exist. I’ve come through all these stresses that you couldn’t tolerate. I am a pretty good outdoorsman. I’m a pretty reasonable athlete and I could survive in the Ituri Forest for perhaps three to four weeks, I’m good. They live there. Come on now. Not a word from you.

Dr. Weitz: We often have discussions in a functional manner so we’re all about what the paleolithic diet or what the Indigenous people’s diet actually is. Is it a lot of meat? Is it consist of this? We often extrapolate and say we should not eat this because this was not eaten. Maybe you could provide us with some insights since you’ve had so much experience and exposure to various Indigenous cultures. Some of the insights into what Indigenous people around the globe eat.

Dr. Geelhoed: Well, I think that is a correct question but there’s always a balance. The intake of those calories and nutrients has to be balanced against the output of them. I would say exercise and lifestyle balance against that intake.

Dr. Weitz: Of course. Yeah.

Dr. Geelhoed: Remember that for the majority. The majority of the world’s population foraging with an occasional hunter gatherer trophy. Not often successful but obtained with a great deal of effort. Here is a cultural agronomy-

Dr. Weitz: Let me just stop you for a second. You’re pointing out something which is that you just said most of the world’s Indigenous population … By the way, most of the world is in this … Most of the people in the world are in the developing world, right?

Dr. Geelhoed: We all are, I hope.

Dr. Weitz: Okay. I meant in some of these poorer countries we have the larger part of our population. You’re saying that most of them are gatherers rather than hunter … What term, foragers rather than hunter gatherers.

Dr. Geelhoed: Right. That has changed a little bit with settled agronomy. Remember that hunter gatherers are those who have to move and they don’t stir up stuff. What they have is an occasional bonanza especially of protein and some scattered lipid whereas, in fact, the settled agronomist can come up with a fairly successful largely grain-based or tuber-based diet. What happens, they store up food. Hunter gatherers store up favors. Remember back four weeks ago when I got the antelope? Obviously, I can’t eat it all. I have no refrigeration so what I’m doing is I have a feast and I supplied all of you. Now, I’ve been hunting for three weeks and I haven’t scored. I surely could use some of that grain from your granary. Remember me, remember where I speak your language? You were my third cousin. You’re related to my second wife’s cousin. That sort of kinship pattern is one I can trust.

Now, who was elected, that’s kind of arbitrary and who is that came through from a city, an urban center and said, “I’m your leader.” Well, what have you done for me? Most of the people in those developing parts of the world fear their own army. After all, they’re not worried about an invasion. They’re worried about their own army that travels without a supply line. Without a supply chain, they live off that population that already is rather timid about having any of these people that come from fancy environments such as urban ones. Yes, I appreciate those folks and how they live. How they live is by having care for each other. Remember, if you can say that about this rather unique epoch, it’s an epic of an epoch [inaudible 00:25:42] for us.

We’ve just come through seven or eight months of something that none of us have experienced. That wasn’t true for your grandfather because he came through the 1918 flu. That wasn’t true for people 500 years ago because they came through the Black Death. It wasn’t true for the ions of lepers and small pox. They all lived through this. You are not designed to survive COVID-19. You should thrive under its pressure. This is not [inaudible 00:26:18], I’m taking 2020 off because according to my … I mean, the destiny that I have is [inaudible 00:26:26] circumstances around me. I must do something to overcome perhaps mitigate and more specifically modify me in order that I might do more. One of the ways we do that is by going out seeking to help others because remember if there’s some degree we can administer them, there’s a whole lot that we learned about ourselves in that process that may helpful in developing our own humanity. Therefore, this began an unusual era.

Dr. Weitz: What do most Indigenous cultures … What are some of the food patterns you see in these Indigenous cultures?

Dr. Geelhoed: Well, the food patterns are largely those right now carbs whereas before they were very high in protein and high in protein not very often meaning that [crosstalk 00:27:20].

Dr. Weitz: Are you saying that before we were mostly hunter gatherers or were there always foragers and hunter gatherers?

Dr. Geelhoed: Yes, they were always … In fact, the most fascinating story there comes from experience in the Ituri Forest. You’ve known the term [inaudible 00:27:36] for a while. They don’t use that term. They would use the Efe and the others. Now, the Efe, the female and the hunter gatherer could marry. In fact, they’d produce a fairly stable society because she was an agronomist, he was the hunter. There was never a situation of the reverse. You didn’t marry one of the female hunter gatherers from the other … What happened is that they developed an integrated status and a role society. They actually settled on that basis because you couldn’t pick up a fire or the garden. In that case, they killed the [shamas 00:28:18]. You had to do that. Now, slashing and burning occurred often the [inaudible 00:28:24] agronomy meaning that there’s very little soil in the tropics. Much of that is eluded half the year from inundation. That’s the key to the other half of the year because on the Equator there’s only two seasons, dry and wet. I know beautiful falls shooting out [inaudible 00:28:40].

What happens is that they would move from point a to b but there was say relationship. Slashing and burning they would get some agronomy going while the hunter had to go further and further out. Going further and further out he did a lot of exploring but always recognized his base because there’d be long dry spells for him in which he wasn’t able to capture. As a consequence, then they said, “Look, we can’t find the animals or this has been an off year or some plague has come through the animals. Maybe we should domestic a few of those, grab what we can and see what we might do.”

Then, the whole of the Great Rift Valley where I’ve been working a lot in the last several years, is a cattle culture. They live with their cattle and, in fact, some of them it’s become a real problem for them. The cattle are not only a source of some devastation to the environment. In a desert environment, they overgraze and decertify it. Second, those cattle also spread a layer, a veneer of coliform bacteria all around every place in the water supplies for the children which is why the diarrhea’s such a high problem. Third, they become a source of considerable enmity. If you think the Wild West wasn’t full of rustlers, cattle raiding is their favorite sport. It used to be that you would go out with a spear and you would grab four cattle from over the other side of the village and bring them back. Now, they would get two cousins and an uncle and they would come with a spear and try to reclaim not the four cattle, they’d try to take eight back.

Well now, with the introduction of automatic weaponry that had nothing to do with the fight they didn’t even know. They had no dog in that fight at all. It was a first world environment that suddenly spilled AK-47s into their environment. Now, the lethality in the conflict is considerably greater. Now, when you rustle four cattle and I’ll ask you the question why do you need those four cattle? Then now, your cousins and uncles can’t protect against the RPGs and AK-47s that are coming. That are so redundant in that society because the conflicts for which they were imparted actually forced on the population have either been resolved or moved on to something else. There’s nothing so indestructible as an AK-47 tried to Crazy Glue and the [crosstalk 00:31:14].

Dr. Weitz: Benefiting for [crosstalk 00:31:15] for American culture with weapons being our greatest export.

Dr. Geelhoed: What happened there is some put Crazy Glue in the [inaudible 00:31:22]. What they did is put it in the fire and they burned the Crazy Glue out and they put it on full automatic [inaudible 00:31:28]. I mean, there is nothing that is indestructible and that isn’t. What happens is I need the cattle. Why is essentially because everyone can see in the distance what my wealth [inaudible 00:31:43]. My bank account is all around me. In fact, why do I need the cattle? First, for my status and second is, it takes 25 cows to get a bride. If I would show you my fertility and my fecundity is standing out there chewing its cud.

The irony is about threefold. If you have a lot of cattle, number one is surviving children you have are going to be fewer because of the diarrhea, another thing we talked about. Number two, they have a placental disease named after the fellow in the United Kingdom [inaudible 00:32:20] that was Bruce, Brucellosis. Number three, cattle are a source of great enmity and an easy exchange for rustling. What I considered that first of all, they are an economic drone because, after all, you don’t eat the cattle very often because that’s pretty high. You would only do that for a marriage ceremony and the chief or something. Second is that they devastate the environment so you have to move on after the grazing and water’s exhausted. Third, it’s going to bring upon you a whole lot of armed resistance that’s going to try to scramble. I think cattle right now are not only … I call them an economic drone. No, they are more than that. They are a hazard.

They are an inhibition to fertility more than its access. If you have one sheep plus 500 cattle, he can purchase eight or nine brides. Well, Ben, this is just between you and me and I’m sure no listeners are ever going to repeat this, one of the fundamental things that I learned in obstetrics is that maternity is a matter of fact. Paternity a matter of opinion. As a consequence, the number of brides that an old chief and a lot of cattle can purchase, they seem to be having children rather regularly even if he’s perhaps not what he used to be. As a consequence, society absorbs this impact [inaudible 00:33:53]. Then, the main feature a cattle culture is simply one of worship. You worship the cattle there. I point that out that we can say, “Look at these people. They are so primitive that they have this animus tradition in worshiping their cattle.”

What’s in your garage? Do you need a Ferrari to get to the 7-Eleven? Do you perhaps use that Ferrari to attract nubile age mates that could possibly give you more children? I am telling you that one of the wonders of my travels is getting a close look at myself. All true exploration is an exploration of self. I have become a lot … I lean less lightly on the planet. I do a bit of grains and berries and things like that in our nutrition. I haven’t stopped running. I, in fact, am going to … Oh here, I didn’t even think about it but my running log right here will tell you that I just crossed because of the COVID pandemic and I live in the woods, it’s isolated, I’m socially distanced, I just crossed 2,400 miles for the year. I am going to say on search of the land, live as though you’re responsible for your neighbor even if you don’t know that neighbor even if you can’t talk to him in his language.

I used to say, people asked me, “Why are you going there? Do you know anybody there?” “Yeah,” I would say. I mean, they have the courtesy to speak English to me. Now, when we look at people, we have a lot to learn from them because they’re at the cutting edge. We don’t have that close of a scrape with survival until recently I suspect. That’s why we are now wearing masks. We are socially distant and that’s why we are asking ourselves, “Are all these other people threats to us?” I mean, every one of those potential vectors, they could carry something nasty too. Well, maybe that’s your hope coming toward you. [crosstalk 00:36:13]-

Dr. Weitz: Your mission is to go out into these remote regions and you bring a mobile surgical unit to these parts of the world where they have virtually no hospitals or very limited medical facilities. Then, you perform surgeries and teach … You bring medical students with you. Then, you also help to teach some of the local doctors. Is that right?

Dr. Geelhoed: Yes. That is correct, Ben. As you just mentioned, in the book it shows the brand new mobile surgical units that are going there. Very, very sturdy units that can go anywhere without any need for bridges and all of that we could discuss. They’re six-wheel drive, solar powered, consistently make their own electricity, purify their own water. Add salt and sugar and you have IV fluids. It’s an amazing device. However, it’s not that purpose of going out and delivering aid. You don’t come and say, “I’m coming to help you. Step aside because I know how to do this and you don’t.” It is to say, “What do you really do to handle this problem? How can we help enhance the skill that you must carry on?” Because we don’t want to go there and do something and then vanish leaving a vacuum behind us. That parachuting is not going to be a success. It’s just going to lead to more frustration.

This is an unusual era. I don’t have to tell anyone here that it is, of course, unusual year 2020. There’s another reason and here’s a reason not too many people recognize. For the first time in human history, despite the pandemic going on now, plagues and pestilences which have been the great limiting step for development for a lot of people have come under control to a degree. Remember, we’re talking about the current pandemic. It’s seven months old and we’re already talking about a vaccine to eliminate it. I mean, before this you have to go generations until there’s a susceptible population and it’s all gone. For the first time in human history, the majority of mortality is related to surgically fixable conditions. Meaning strangling the hernia, a uterus that ruptures in labor, a fall from a tree collecting mangoes. The perpetual problems of automobile and trauma and other things that come from hostility and the development of things such as the cancers and other things that come along at a later age.

In addition, there are these congenital things they don’t even know can be fixed, cleft palates or [inaudible 00:39:08] defects or burn scar [inaudible 00:39:10] is a very big one because they have open cooking fires and children are falling into them. What happens is that all of these things can [inaudible 00:39:18] fixable. The mark of modernity in healthcare is a surgical operation. What do we do? Do we tell them again, “Come to the capitol? Come to Washington DC.” That’s 17,500 mile in a supply chain. What we do is we go out and we teach how to do that locally and I will take Indigenous practitioners whether they’ve been to medical school, whether they have more degrees than a cerometer which they consider kind of silly if you can’t use them. [crosstalk 00:39:48].

Dr. Weitz: They actually learn to do surgery? Can they actually learn to do surgery with such limited education?

Dr. Geelhoed: Absolutely. How did surgery evolve? Who did the first caesarian section? Where did that come from? Was that a tertiary medical center? Are you asking me we can only start where we are now in a tertiary hospital because, in fact, obstructed hernias don’t usually happen in a parking lot of a tertiary hospital. They happen in Sub-Saharan Africa. I’ll just say, “Go to the [inaudible 00:40:33].” The majority of those folks don’t have a healthcare practitioner. One in 20 see a health practitioner. I didn’t say doctor. I didn’t say nurse. Someone who was health capable. If I said to somebody … I’ll give you an example. A beautiful village named Gatab sitting on the mountain in a [inaudible 00:41:00] of the Great Rift Valley. Someone comes there and needs a caesarian section. They’ve been in labor for three days.

I don’t know if you can imagine someone in California undergoing labor for three days and not having something move. There being some action in the … What do you do? Tell her to put her knees together and hold on because we’re going to refer her … Gatab is 47 hours from pavement. If you have a Toyota Land Rover four-wheel drive vehicle, and you have the diesel fuel and you know someone who can drive it, all of those are rather big blocks. Then, bouncing up and down on the roadless terrain over those mountains, you get to the Great Rift Valley, you will come to Marsabit, you will actually come to Laisamis which has a hospital but there’s no doctor. I stood in there and I tried to make an operating room out of it and talked to one of the local nurses into doing it. We actually got her capable into doing C-sections. There they would transfer you to Marsabit. Marsabit was the first place where you would see a doctor who is capable and who understood what a C-section was.

I don’t know after three days of labor, 47 hours on roadlessness, then getting to a paved road and going another 90 minutes to [inaudible 00:42:30] to a Californian. Now, why should it be different for some [inaudible 00:42:36]. Remember who is worthy of medical care. I mean, how could that statement even arise? These people considered modernity reflected as an operation is one of the things that they are finally recognizing they are worthy of such attention. That means their own self-esteem says, “Well, this man, he fell from another planet like an [inaudible 00:43:07]. However, he didn’t do that operation. He came out and told everybody, “Look what Rose did. Rose is one of my wonderful midwives. She is such a wonderful person who said, ‘I am so happy that you have taught us something rather than coming in and taking over because now I feel I can not only do the things that you’ve taught but I might even be able to approach some things that we didn’t have when you were here using some of the same ideas and principles.'” Rose did this, I didn’t.

[inaudible 00:43:44] back and get on your podcast and say, “Everyone send money because I’ve done some good things. I did 128 operations.” No, no, no. I’m going to tell you right now, I just came from a mission in which 128 operations done. I did none of them. I assisted each one of them and the last two dozen I assisted without putting on gloves. I’m over here because our operating room is a two table unit. It’s a teaching unit. I say to them, “Now remember, this is just like the last ones we did. I’m over here. I’ll start this one. I’ll watch you do that one. If you have a problem, go through it the way we did before.” Our two table operating theater is continuously a teaching device and it enhances the care that they will give when we’re gone. I don’t say, “Okay, we’re coming here, we’ve done our operations and are miracle machines. Now, we’ve driven off.”

Now, we’ll come back in five years and we’ll do it again. Well, I don’t know how many pregnancies would still be going after five years. I don’t know how many people would be tolerating their life-threatening conditions. They have to be cared for by the people there. In addition, if they know that I’m coming back, well we don’t have to do anything, it’s just like America now. Health is the responsibility of the practitioner not mine. I’m not going to do anything to prevent my cancer. I’m not going to do anything to keep me from having heart disease because don’t you know, we have coronary bypass. We have minimally invasive techniques where you can do it with a scope. This is now. I don’t need to live responsibly. As a consequence, the people are taking the responsibility for their own healthcare and their own health.

I go there to learn how it is that we could become healthier and perhaps while I’m there they learn a few things that they can adapt. Innovation and substitution and improvisation is what we teach. They don’t all have to graduate from the same schools I did because it’s impossible. They don’t all have to say, “I’m going to be just like you in having gone through how many different” … I can’t tell. Who is it that is the go-to person here? How can we get to them and help them and enhance the care that they’re already obliged to give to make it better than witchcraft, more than … I’m not telling you that witchcraft is practiced in Africa. There’s a fair amount of it going on in California. I don’t have to tell you that I’m in Washington DC and there might be a little bit of it around in a couple of the large buildings here who’s ownership is subject to change only at intervals. One of those a week away from today.

The question is, how is it that we can assist others and by looking at their problems and how we might be able to give a new mindset to them, change that mindset of our own. That’s the single thing we do best. In fact, it was the subject of the other book that I had which is called Gifts From the Poor and is the subject of transformational learning. How did I encounter the other and thereby become changed by it? How is it that every single one of the medicals that I think someone else kept score, I’m not the bean counter of 2,300 people that have gone with me over this extended period of time. I’m half a century in practice in the developing world. Not one of them says, “I learned a lot.” That’s so obvious, they don’t need saying it. They say, “I will never be the same. My whole life has changed.” You don’t get that from a biochemistry course. You don’t do that from gathering six more facts, that’s transactional.

Now, we have a new mindset that we can understand a little bit better how it is we might help them and thereby perhaps even us. The problems we have seem to be stuck. The stuck problem isn’t, “Let’s find several different new ways of treating lung cancer.” Well, what’s the probability of coming out of that once you have it? Why don’t we put all the marbles where we know it’s effective? Why don’t we change that mindset? Why don’t we say, “Hmm, these are problems that we seem to be stuck on. We can change a couple of them transactionally.” If I worked all day long for the rest of my life in Washington DC, I might be able to improve the healthcare there by a fraction of a percent. The freshman medical student gets 100% yield on his first day. You can’t fall off the floor. Let’s start.

Can I answer everyone’s question and can I solve everyone’s problem? No. Is there a reason we shouldn’t start on the basis of the fact that we can’t complete it? We can start it because we should never complete it. It’s a continuing process and not just for us, for them. They must continue that in our absence and so must we. We must step aside to look at ourselves in the same way that we are doing in the developing world because I should hope while alive we are developing as well.

Dr. Weitz: That’s great. On that note, I think we’re coming to the end of our time. What final thoughts would you like to … You’ve already given us some great things, important things to think about. Is there maybe one final thought you’d like to leave our listeners and viewers?

Dr. Geelhoed: Oh thank you, Ben, for that because I agree. I put a few of those into the book that you just started with. That’s a publication date this week. You are number one, by the way, in its promotion. You were the first to hear about it. I would say this transformation, how is it we are able to learn the lessons that we are attempting or said to be teaching others and find out, oh my goodness, we are actually learning something that might transform our own lives. Thank you for time. Appreciate it, Ben.

Dr. Weitz: You’re welcome. Your book is available, I’m assuming, from Barnes & Noble and Amazon and all the other popular booksellers.

Dr. Geelhoed: All of the above.

Dr. Weitz: Great. Thank you so much, Dr. Geelhoed.

200 episodes