billion to v va. to legislation authorizes va enter into the seven leases in tostates and puerto rico give them more space for clinicians to treat patients. newlaws grant v.a. authority to remove or transfer senior executives based on misconduct.or that is what we call accountability. the vast majority of va employees are dedicated to the mission and core values. where that is not the case, where there has been a violation of trust of the nation, there will be accountability . this is about restoring the

trust of veterans. our elected representatives. all americans. that legislation is another sign of the strong support we have for veterans. i appreciate the work of chairman sanders, chairman miller, and the other members of congress who came to pass the law. 's role ofte amvet candidly informing congress of how they saw things. we could not have done this without you. i know that is not the first time or the last time amevts will share its recommendations. clear, and i loud, hear you. i want to continue hearing from you. you are not just stakeholders, your shareholders and customers. we need your input. as acting secretary sloan gibson

was doing some great work, he has been hitting us in the great -- right direction. i support the efforts we have in place. theas grabbed hold of problems like a snapping turtle and not let go. we have suspended performance awards. 14 day access measures have been removed from performance plans. that is to eliminate motives for inappropriate scheduling practices or creator. -- behavior. we have frozen central office headquarters hiring. we are making good progress being veterans office waiting lists and fixing scheduling product -- problems. in the last two months, we have made over 830,000 referrals for veterans to receive their care in the private sector. that is up more than 166,000

over the same time last year. each of the referrals -- [applause] each of these referrals on average results in seven visits or appointments. we are talking about more than 1.1 million appointments in the private sector over the last two months. get systems up to capacity, we are expanding our use of private care and other experienceth care to -- improve access for veterans. non-va care tong make sure veterans deserve -- received the best they deserve. we will enhance the existing system in the short term. we will get an off the shelf

scheduling system. we will expand digital technology to free up people to care for veterans. facilities are adding more clinic hours. we are adding mobile medical clinic units in providing care for mayor -- for more veterans. we are contracting with the -- in outside organization to conduct a independent audit of scheduling practices. that is across the entire system in beginning early next fiscal year, october 1. dispatched teams to provide assistance to facilities requiring the most improvement. there is a multidisciplinary team on the ground in phoenix. every medical center and is conductingtor in person inspections of clinics.

that includes interacting with staff to assess scheduling practices and identifying obstacles to timely care. so far, over 2300 of these visits have been conducted. we have taken action on every one of the recommendations. we are going to improve forecasting for resources. foran develop a strategy meeting the higher levels of demand we are experiencing. we are determining which processes need to be streamlined and where we need to reorganize. to more efficiently use our resources. i amlp with that process, establishing a board of physicians and nurses to help me with best practices. aggressively to fill physician vacancies. let me cause. -- paz. -- pause.

i have heard it takes too long to bring people in and the hiring policies and procedures are time-consuming. we are going to fix that. we need about 1000 doctors, nurses, and clerks in feet -- phoenix and 500 in las vegas. we will need more beyond that. i want your help. to go recruit the best doctors, nurses, and clerks will make it the best health care system in the country. i will be out there recruiting these people. if you have names, please send them to me. we are building a more robust, can you -- robust system to provide site-specific information on patient satisfaction. we are going to learn more about what other leading health care systems are doing to track patient access during says.

-- experiences. we are improving communications. othern the a -- va and organizations. high-performance companies get their best innovations from those closest to the customer. we are going to create a more open and less hierarchical altar soin full -- culture employees can contribute ideas and help us improve. islaborating closely with -- a top irony. -- priority. it is not enough to listen to your concerns and ideas. our collaboration in changing this department -- we are going to gather your ideas and make them happen. the eight leadership is going to levels toamvets at a

improve communication. 19 44, it was collaboration between federal employees and veterans that produced this great organization, amvets. that same spirit of collaboration will bring needed change to veterans affairs. we have huge challenges ahead. the rents are in need -- veterans are in need. it will be tough work to transform va as the provider of choice. we have people rolling up their sleeves right now. we can and will get it done. we can't do it and won't to do it without you. the best technology and systems are no substitute for looking at ourselves through the eyes of every single veteran.

amvets has been doing that for 70 years. let me close by saying how grateful i am to president obama and congress for entrusting me with this opportunity to leave the department of veterans affairs. for being avets friend of the department. thank you for your work. thank you for your commitment. thank you for your enduring devotion to veterans. thank you for sharing your time with me this afternoon. thank you. >> here are some of the highlights for this weekend, friday at 8:00 eastern. saturday, at 6:30, the communicators. political q&a, commentator and presidential candidate pat buchanan. books on hillary clinton, barack obama, and edward snowden. eastern.at 10:00 p.m. the weekly standard's daniel.

and we too are the literary sites of casper, wyoming. in the negro league kansas city monarchs. slavery inon of movies. and sunday, on real america at 4:00 p.m., an interview with herbert hoover. aoutus know what you think the programs you see. e-mail us or call us. like us on facebook. follow us on twitter. >> in a few moments, a forum with cdc disease detectives. they track and investigate dangerous diseases. health care professionals will then discuss their work in developing countries. after that, deputy national security advisor ben rhodes.

>> this event took place prior to the ebola outbreak in africa becoming widely known so we have asked a time reporter to join us to discuss what the cdc's response has been to the outbreak. it profiles some of the cdc officials that have gone to africa to investigate. what exactly are they hoping to accomplish? >> they have cdc detectives

also known as epidemic intelligence officers. since march. but they have announced it is sending a search of 50 more disease specialists to guinea, liberia, sierra leone, and nigeria to fight the ebola outbreak. following up with them and if someone is sick, they can be isolated and treated. if not, they are informed of their risk and workers can follow up with them. >> do we know where the outbreak emerged from? >> preliminary research is showing that it is possible that the outbreak started in decca do -- a village in guinea close to the borders of sierra leone.

that is why it is possible that it spread from there to the other countries. >> you mentioned the epidemic intelligence services. what kind of person joins that service? >> a two-year postgraduate program and these are people who are doctors, phd's, veterinarians, pharmacist. people that have a very strong background in public health and a very strong interest in infectious diseases. they are trained by the cdc to learn how to track infectious disease, how to handle an outbreak, and being an officer means they will go to these hot zones. >> how is this outbreak compared to past outbreaks? >> it is unprecedented.

the largest ebola outbreak in history. the cdc is very concerned about it which is why they are sending in so many people that try to get ahead of it. >> how fast is it spreading? >> there are over 1000 cases and over 1000 deaths. it is a couple different waves, it has been the largest number of cases in a short period of time. >> is the cdc concerned about the danger to the u.s. population? >> international travel does mean it is possible that an ebola patient could end up in the u.s., the concern is very low. even if there were to be a patient that travels from one of these countries in the u.s. and starts presenting symptoms. because of how advanced the u.s. health-care system is, there

won't be any spread. you can easily treat a patient here. >> sierra leone will prioritize physiciams for experimental drugs? what is the latest on the drug supply. who is getting them? >> the world health organization late last week did announce this was a public health emergency. it is ethical to use experimental drugs and vaccines not yet approved. there is a very limited supply of what is available. we know that one of the experimental drugs had been used onto american patients, they say their resources are exhausted but they are trying to quickly scale up.

while countries are trying to decide who would get experimental drugs if they get access to them, it is unknown how much there will be and how many people will really be able to actually benefit from them. >> alexandra sifferlin is on twitter @acsifferlin. thanks for joining us. >> and now the discussion with cdc disease detectives. health experts that investigate diseases around the world. this forum took place before the ebola outbreak and runs one hour. >> good evening. my name is robin hogan and i am the vice president of communications for the robert

wood johnson foundation. we are very proud to be the sponsor of spotlight health. welcoming you to tonight presentation. everyone likes a good epidemic because this is a sold-out session. it has been a long day, started at 8:00 this morning in a tent across town. it will end at 8:30 p.m. tonight. i commend you for your stamina. 12 hours of learning. it has been a fabulous first day. fabulous first day. .e are really delighted thank you. my job is simple tonight. to introduce the panel and inspire you with their brilliance. dbmave two md's and a

tonight to talk to you about epidemiology. laseft, dr. neil vorra. he has distinguished himself as a physician. he is a newly discovered virus infecting humans and cattle in the republic of georgia. rabies cases associated with organ transplantation's. you will be hearing from neil on those stories and others i'm sure. to the far left is jennifer mcquiston. jennifer is a dbm by training. has investigated some exotic tests associated with monkeypox outbreaks. more somberly in 9/11, part of the cdc advance team to monitor possible

bioterrorism. flanking these officers is their boss. cdcis the director of the and we are honored to have him with us tonight. sort ofrom new york, the capital of new england. i think of tom not so much as the director of the cdc but the commissioner of health where he was heroic working with mayor bloomberg in almost eliminating smoking in that city if you can believe it. he also drove down and almost eliminated trans fat in their diet of most new york residents. and eliminated: cancer screening disparities among his many .istinctions

he is here as director of the cdc and will moderate the panel. they will moderate the panel, asking questions of his colleagues for about 35 minutes and then we will open it up to and heask them questions will field those from his chair. we will have about 25 minutes of questions and at 8:30 p.m. we will a you go. >> i hope you enjoy aspen during the next hour as well. we will tell you what it is like to be a disease detectives. for those of you that saw the movie "contagion." diseaseslet is a detectives and it is pretty realistic. it is a boots on the ground experience of what the cdc does to keep all of us safe. officers, the program is

and is a 60 years old really unique type of training. it is the epidemic intelligence services and a clever fellow figured that if he could highlight that we needed this kind of specialist to protect ourselves from biological warfare, he would probably get funding from congress for it. and they would both protect us from biological warfare and from lots of other health threats. what it has done for more than 60 years. victim and of health problems are things that officers can potentially investigate. i was assigned to new york city. often or maybe usually happens, the person that ring the alarm bell and called the health department was an alert clinician.

in this case, they called us and said i think i am seeing a lot more drug-resistant tuberculosis. call basically took 10 years to answer. figure first we had to out what was going on in new york city and we found that, in lot -- way more than had been anticipated. it was largely spreading in hospitals. patients and health-care workers were getting infected, coming down with tb, going to hospitals, sometimes dying and maybe making other patients sick. able to track the epidemic and we were able to apply the tools to control it. on it, weg a light galvanize action and changed medical treatment. we also identified were the lapses were and where the lesions were.

what was going wrong in our hospitals. so we had to call team after team of eis officers as there were outbreaks in the intensive care unit, outbreaks in public hospitals and private hospitals and in the jail system. we began to figure out what was going on and very rapidly we figured out what the answer was. it waswer was that spreading and we could stop it. even drug resistant tuberculosis we can stop the spread by treating it and isolating patients if needed. it allowed us to rapidly reduce drug-resistant tuberculosis. within the manuscript off to new england journal of medicine asking them to publish this rapid control after a decade of

increasing with basic good management. the new england journal wrote back and said we are not sure it's a real trend. wait another year. it came down another 15%, a dramatic decline. it, how iswe print it going the first quarter of this year? of the really rewarding things about solving the mystery is not just the intellectual rewards of solving it, but the human rewards of the health benefit that comes from it. after that experience i went over to india where we helped the government implement a program that has resulted in millions of patients treated and millions of lives saved using this same system of establishing effective programs and identify them when they come first.

let's just go to each of the officers and hear a bit about what they are doing. will start with rabies. a bad disease. onmuch of my work is focused rabies which is caused by a virus and is typically transmitted to the bite of an infected animal. person that gets rabies will unfortunately died. maryland, a patient developed rabies and i led the investigation to figure out how it had become exposed. this patient did not have any of the typical risk factors we associate with rabies but he did have a history of kidney transplantation 18 months before his symptoms started. it got us thinking that maybe he had somehow been exposed to rabies through his organ transplantation. it is a life saving intervention

diseases butf infections can actually be transmitted from organ donors to organ recipients and that is what we thought might have happened here. died ofn donor had rabies that no one recognized 18 months before. it became our job to figure out going back in time whether or not the donor really had died of rabies. as you can imagine, it's not easy going back that far in time. but we were able to locate samples belonging to that donor that had been in the freezer for the last 18 months. and within hours of receiving them, we generated definitive results showing that the organ donor had died of rabies. we proved the transmission had encouraged transplantation but the job was not over. three other people received organs from the same donor and they were still alive.

we were racing against time because they had organs inside of their body. we immediately vaccinated these people and still to this day, they remain alive which is an unprecedented situation. one point to the investigation highlights is the link between animal and human health. donor wasut that the an avid hunter and had been bitten by reckons multiple times. raccoons multiple times. another is bats. rabies andso carry other diseases like ebola. type of work actually took me to nigeria last year where every year there is a bat festival that takes place where

people capture live bats from this cave and they are prepared as food. of concern was in the course this festivity, people might be getting exposed to deadly viruses. you might wonder why the cdc would take an interest in an activity on the other side of the planet. keep in mind that we live in an interconnected world. vigilant, weaining can better prepare ourselves for the next outbreak. animals are often the source of human outbreaks. that's are a particularly problematic species because they are mammals. the things that affect them might infect us and they live in huge colonies. diseases in the community can perpetuate themselves for long periods of time.

i was in a cave in africa called python cave. i saw the python and it is enormous. they did research to figure out how it is an ebola like virus that cause bleeding and death, he had killed one person and nearly killed another and had localized it. manhattan research to capture bats, release them, figure out what portion carried the virus. margie scared? -- weren't you scared? the bats did not scare us because we were wearing protective equipment and the python did not scare us but the cobras scared us. underneath our protective gear, we wore leather chaps.

one of the reasons researchers do investigate animals is the emerging diseases topeople often traced back animals. one situation was in 2003. the first hint that something had gone terribly wrong, this was a three-year-old girl that lived in wisconsin and she developed these very odd and very disturbing skin lesions. i am too young to have been vaccinated for smallpox. whoe are many researchers dedicated their early careers to eradicating this disease from the world. they took one look at this picture and said, that's smallpox. we were worried when a second case was reported just a few days later from another part of wisconsin. these patients did not know each other.

one is a three-year-old girl, one is a businessman. by sixd both been bitten pet prairie dogs. ?ho here has a prairie dog not a good idea. it is a very odd history. these are two diseases that we know prairie dogs can carry but these lesions look like smallpox. they sent the samples to the cdc and while we were waiting for them to be tested, more cases started to be reported. it was clear we had some sort of dramatic out rake happening. i remember waiting for the results to come in and we were saying, "please don't be smallpox." told itrelieved to be was monkeypox. known to occur in

africa. never been reported in north america and certainly not in a north american mammal species. we had no idea how it got here. as a veterinarian i'm privileged to get to work on a lot of things for the cdc but i was --ed to leave the animal lead the animal tracing investigation to figure out what we would do about it. the first step is to interview 70 human by now we had cases associated with this outbreak and everyone had a pet prairie dogs. . from a dealer outside chicago, illinois. he was literally running a pet dealership out of his garage. we actually sent a team of there to investigate and he not only sold prairie dogs, he also sold african rodents. andome point they had mixed

they had gone on to infect all those people. the pet industry is not very well-regulated. go by word-of-mouth and you have to traced back through multiple intermediate dealers where these animals have come from. we finally located a shipment of rodents that had come in from the pet industry six weeks before. the problem was, there were 800 animals in the shipment. when we started tracing out where they had gone, many of them tested positive for monkeypox. we had to presume the entire shipment was infected. a very long investigation. we identified a real problem being able to import rodents from africa for the pet trade. cdc enacted emergency legislation during this outbreak banning the implementation of

rodents from africa. it stopped the outbreak and kept it from happening again. we have to worry about the illegal pet trade. raise them in nice, clean facilities. whatever diseases they are harboring can come over and be in a child's bedroom before we know it. we remain worried about it, we remain vigilant. >> did you activate the emergency operation center? >> it was activated for the entire response. like this is an incredibly important capacity for us to have, some of you may remember the fungal meningitis cases from a year or two ago with injections, steroid thousands of patients exposed, many that became ill. working with 23 state health

departments, we had to notify 13,000 patients within a few weeks. that ability to mobilize rapidly was so important but it is not common enough around the world. we help other countries develop and thed of disease emergency operation capacity because if they can find a problem sooner, it is better for them and better for us. >> monkeypox is just one member of this group of viruses which also includes smallpox. it was eradicated in the late stoppednd we have regularly vaccinating people against smallpox. againstlly protects more than just smallpox. it protects against other viruses such as monkeypox.

one of the questions we are interested in, people no longer have the protection that they want got -- once got.; countryake you to the of georgia formally part of the soviet union. last year, we were contacted by our georgian colleagues. they had a mysterious illness characterized by fever and these skin lesions filled with pus. testing showed that both of these men were actually infected with a never before seen virus closely related to smallpox. i led the investigation that went out in georgia so we can learn more about this virus and one of our concerns is that the cases were already heard about were the tip of the iceberg and maybe more people were actually

infected back in georgia. the team i lead was composed of a diverse array of people including veterinarians, epidemiologists. experts broad array of so we can take a conference of approach to this investigation. and we found that people in the region had a history of exposure . though the exact circumstances behind their exposure remain unclear. is thatr thing we found we suspected this virus probably originated from animals and indeed we found evidence that it circulates among jordan -- georgian rodents. for me, one of the most amazing aspects of this investigation is that we heard about these two patients in rural georgia all the way in atlanta georgia.

thousands of miles away and we still had it brought to our attention. it speaks to the work that the cdc does with building local capacity for public health which is part of our overall global health security strategy. bee of you might also wondering why we spend time studying obscure viruses like this. and particularly for a virus like this, it has the potential to mutate into a more deadly virus like smallpox is believed to have done many years ago. smallpox is a potential agent of bioterrorism. by understanding this virus and others, we can better prepare ourselves for these types of threats. >> some of our partnerships around the world -- the cdc is pretty well known for what we do in this country. they end up being the most trusted agency and the u.s. government. but not too many people know what we do around the world.

the work that cdc does is better known outside the u.s. and inside. have staff in 60 countries, 2000 staff working on a wide range of issues and i think one of the most exciting ones is building the capacity to do this type of investigation and response all over the world. the u.s. ambassador to africa is likeme that the cdc 911 for the world. that's great. really what we like is to make sure that every single country has its own public health 911. >> they mentioned bioterrorism as the underpinnings of why we do some of the work we do. bitll talk to you a little about 9/11 today. most of our lives were changed forever.

i remember standing in the cdc lobby and the guards put it up on the television strain -- screen. i know all of america was so devastated by this. unlike most americans, i was pulled into action that day. i was able to feel like i was doing something because i was pulled on the plane that flew into manhattan that night. this is not a story that we necessarily talk about a lot but the cdc was the only plain allowed in the sky that day. it was thought to be so important to get public health people on the ground working with the new york city health department is infrastructure had their offices were very close to the world trade center. and making sure they get surveillance started. and we were a team of four people initially.

we liaison with the health department and we came up with a plan. put 40 officers in the belly of an air force cargo plane and flew them to new york city several days after the event. that every person i came to the emergency room was checked out in some way. we were looking for signs and symptoms adjusted for bioterrorism. we also ended up with surveillance associated with recovery efforts. public able to implement health beyond bioterrorism. by the end of those six weeks, the first anthrax letters that have been mailed to the u.s. postal system and started to be reported. all those officers got called back to atlanta to begin working on the next outbreak

investigation and i think it really characterizes what eis is all about. you're never still from very long. you're always moving from one outbreak to the next. the world trade center response illustrates that we have a group of people ready to respond at any moment at any time and we can mobilize 40 people to go work on an emergency. i think that is the real value. is both broad and deep, 15 thousand staff including some of the world's experts in just about every condition imaginable. one of the things were very proud of in terms of the work the cdc did, now the world is really at the cusp of polio eradication. is solio program important and so challenging.

this is a polio vaccination program in nigeria. there are currently two countries in the world that still have polio that's never going away. every polio virus is either in nigeria or in pakistan. we can study their whole genome and figure out which is which. nigeria has made tremendous progress in the past 18 months. part of the reason is a great government,he state the gates foundation. world health organization. programs like it and other countries. and the program in nigeria started about five years ago and were started by a graduate of the canyon programs. it is a great example of self learning. that program is getting the best and brightest and i met with

them a couple years ago. all know people that talk about smallpox eradication because it was the most meaningful moment of their career and they are proud of it. polio will be your smallpox. class and wese the tripled the class size. go work on polio. they ultimately went to more than 100 communities. aery month they would go into specific investigation control measure, come back a month months,nd within a few they had dramatically improved vaccination rates. it was one of many different things it had been used so far this year. we only had four polio cases in nigeria. of problems and challenges with polio eradication. in pakistanolence

and nigeria. outbreaks in cameroon. we just had a positive specimen from brazil from the sewage system that matches gina typically with a tutorial ginny polio. some one came over in advance of the world cup, deposited something else in brazil. we have outbreaks in syria, positive outbreaks in israel. the don't want you to begin taking it so blessed. when we began this work in 1988, there were 350,000 polio cases each year. and now we are really on the cusp of eradication. think we have a reasonable chance getting rid of polio from africa and it will only be the pakistan polio virus that we need to deal with. get over thee can finish line. eradication is so exciting and has been a goal because it is the ultimate in sustainability

and equity because it is forever and for everyone. that is what smallpox eradication has brought. that is what polio eradication will bring. in so manyprogress different areas but i want to ask you each a question or two and we will open it up to the audience. what are some of the most important take-home lessons you have gotten from the outbreak investigations you have done? respect local expertise and be the outside expert? >> i think along these are the investigations i described, we always work alongside our colleagues in those countries. particularly the eis programs. of thoseigeria, some officers took a break from polio and actually worked with us.

it is not so often a case i am learning from them as vice versa because they bring so much to the table with their understanding of the cultural circumstances and local epidemiology. i found it really asked -- inspiring. develop a type of very healthy respect for how dangerous some of these diseases are. we talk about ebola or rabies, and in addition to that, there are others in this case. it really opens your mind to the challenges that we face around the world. cause of death and americans traveling outside of the u.s., one of these

training programs, one of the analyzed morend than 10,000 traffic incidents and came up with an analysis of some of the causes of fatalities and his work led to the enactment of seatbelt laws and drunk driving laws and associated with the decline in motor vehicle fatalities. what you're developing is a capacity. the ability of countries to collect, analyze, interpret, and use their own data to improve their own health. one of the challenges, of course, if you're working internationally, you don't always speak the language or understand the culture. what we do sometimes transcends politics. many times we have the opportunity to work in countries

where maybe americans aren't always welcome but because we are there in the health capacity we are. i was try to keep in mind that i am there as an ambassador in many ways. that the impression i leave will have long-term ramifications, either positive or negative. on an outbreak investigation, the thing i will always try to keep in the back of my head going into it is to never presume you know what the cause is. never presume that you know what you will find when you get there. let the data and investigation carry you to the conclusion. there is an expanding outbreak of a disease called rocky mountain fever. disease,ickborne something that had never occurred in arizona before. it is not really a climate hospitable to text. but we begin to get cases and american indians in the early part of 2000.

we sent an officer out and we really thought what she was ofng to find is the range that kick would have expanded southward to colorado down into arizona. when we got there, no matter how hard we looked, we couldn't find that kick. we found a completely different tick. it acted totally differently. it was a lesson to me that i .hought i knew we had to trust our instincts. more questionone and open up to the audience. how about your own personal safety? concerne, the biggest is the traffic. you drive these long distances and you hope that someone doesn't fall asleep at the wheel. we were traveling in these bulletproof vehicles with armed guards.

, in we get inside the basket love animals so i was in heaven. the whole floor is literally alive with vermin. you don't know if it is condensation or bat urine to be frank. when dealing with these animals, you have to have that healthy respect. you always have to realize that you are dealing with unknowns. you have to be careful for yourself and others. people's safety you're responsible for. >> i wanted to continue to care for patients individually. so i arranged to see patients in the tuberculosis clinic, unrelated to the fact that i ended up working on tuberculosis for many years.

clinic, iwork in that became infected with tuberculosis bacteria. i did not get sick with it. you can be either infected or sec and i will probably have that affection other rest of my life with no adverse effects. but no good. should not have happened. they were getting patients took off into a cup -- to cough into a cup. all of the infectious particles were coming out of that room. boss here today a note theng that you have to get induction rooms fixed. it doesn't take much. all you have to do is put an exhaust pan in. it kills the tuberculosis bacteria so we were able to do

that in days. one thing you can do is analyze what might have happened or what could happen and use that to make everyone safer. >> i am a woman and i travel sometimes internationally by myself. for my personal safety i am always aware of what the situation on the ground is and making smart decisions about how to protect yourself. i always make sure i locked the hotel room and always make sure that i am in my room my 7:00 or 8:00 at night. i do that in the united states as well, i guess. it's hard to predict what your personal safety on the ground will be. i never worried i was going to catch the disease. we know more about how to protect yourself and we get thousands of vaccinations before we travel internationally sometimes.

for me it is more the uncertainty on the ground. crying on the phone saying, don't go. i think that is what differentiates. we go even when we don't know. >> you have your bag packed at and if you are not on a flight by sundown, someone else will be. that officer is all raise ready to go. we have one here and one here. >> we heard in the last hour about a recent law enacted in making it unlawful to treat homosexuals with hiv. you will have some sort of

serious relationships with the nigerian government and i am wondering if this is something on which the cdc has a position or has made any effort to ameliorate. >> cdc provides half of the treatment in the global aids program. we have seen anti-homosexuality legislation in uganda, nigeria, and elsewhere. and we are very concerned about it from both the human rights perspective and a disease control perspective. if people aren't comfortable coming forward, they will be more ill and spread infection more. issues have gotten very politicized in some of the countries. what we are hoping is to gradually move it back to a right based at roche, a care-based approach so we are providing services to individuals. it has real implications for us.

in some of our programs, we no longer record the risk factors that have resulted in the hiv infection because it could result in negative consequences. we want to figure out a way that we can get to services that people need and also work diplomatically to the state department to try to get these laws changed. sometimes the worst way to do this is for americans to say they should change them. it is important to figure out the most effective way to get change to occur within countries. >> in the early part of the 20th century, we had quarantines of people with tuberculosis. instancesow of other where that power had to be exercised. a scenarioase sketch where quarantines could be necessary on a broad basis and

indicate what police powers there are that we can enforce such a state of affairs? >> quarantines is a separation of healthy people in case they have become ill. isolation is the separation of sick people so they don't make other people infected. both of those considerations come into play. tuberculosis, mers and sars> . in tuberculosis, we have people that have tb and refuse to take medications and are endangering others. philosophically, we say your right to swing your fist. and you are right to not take your medicine does not extend to developing a drug-resistant form that you cough into my face.

new york city was at the epicenter of the outbreak where i helped document as an eis officer. and we rewrote the law because the law had been written in 1959 and there wasn't much in terms of safeguarding it there. we made sure there was an individualized view of the situation. we did not forcibly medicate anyone. but they had to stay until they were cured. we did not put them in a jail, we put them in a hospital. tuberculosis is an area where isolation is sometimes mandatory. quarantines was crucial. it was one of the main things that allowed them to control the sars outbreak. even though we didn't have a treatment. we knew that if we isolated the people that had sars and

scrupulous infection control, they would not spread it to others. but before they had been diagnosed, they exposed many people. isolated,y weren't they might have spread it to soe and more generations that we globally quarantines .uite a few people it was one of the most effective ways to stop the outbreak. it has been voluntary so far. we had two patients in the u.s., they exposed 14 to 50 health-care workers before they were diagnosed. those health-care workers were furloughed. they were said to go home, don't in thentact with others incubation. was 14 days -- incubation

period was 14 days. i don't know if you want to mention anything more. >> the cdc is not generally thought of as a regulatory agency. we had some small powers with respect to things like this in terms of what is being imported into the united states and patients moving from state to state. there have been some not cases.ned -- unrecent do it in a prefer to voluntary fashion than a regulatory fashion. >> other questions? >> i know that we learned quite a bit from the anthrax bio

terrorist threat. you give us information about how we can handle a threat from people that would be very devastating and obviously very lethal? what about prevention of bioterrorism? >> i will comment that there is a strong network throughout the united states and we really partnered with local and state health departments. it starts with an astute clinician. someone who recognizes there is something odd. characteristic of a possible bioterrorism related pathogen. once that decision or clinician alerts the local health department, they can sometimes do the rapid testing locally. the cdc is often involved at an early stage.

>> one of the reasons that we do sendingrian efforts, staff to investigate ebola outbreaks is that there is still a lot to learn about it. the event it is used as a bioterrorism agent, the cdc is involved in research that helps us establish whether there are vaccine candidates and all sorts of things in the hopes of better preparing us for something. is the mostk ebola likely agent of bioterrorism. it doesn't last very long in the environment is my understanding. the ideal agent is a little more long-lived than ebola. import, play, to or work with it, one of the things we can do is ensure that laboratories that worked. >> can you extend on that comment that was just mentioned

as it relates to various viruses that are resistant to existing antibacterial medication in how you handle that? do you work in conjunction with or theeutical companies fda to accelerate a cure? do you understand the question? i think there are major challenges that face us in the infectious disease world. emerging infections like monkeypox or sars, resistant infections. and intentionally created infections, something the terrorist makes or unintentionally gets out of the laboratory. we really are at risk of losing antibiotics. that we haveings

done is shine a light on it, do surveillance to track what is happening around the country and sound the alarm. certain organisms are very concerning. and now we have implementation programs working with cms and and a top priority right now is to make sure that every hospital in the country has an antimicrobial stewardship program to make sure antibiotics are being used correctly or excessively. so we want to get it right so patients have the right treatment. the global capacity is also very important. let's take a few more questions. >> can you hear me act oh the evening. -- can you hear me? good evening.

people are coming into america and coming in from south america and places unknown. what is being done by the centers of disease to protect americans because those children are being sent to relatives throughout america. what is being done to protect the rest of these people? we can take the microphone and bring it here. it is very moving. there is a federal response run with a veryis doing complex legal and humanitarian project. they walk for 15 hours, coming in quite ill. actually, vaccination rates are very high. there is one disease, chickenpox, that is not routinely vaccinated for.

when they being done come in? there are certainly medical needs that need to be addressed and we have been advising in a consultative fashion folks that are dealing with that full-time. microphonea second >> what are the significant between human and nonhuman originated disease? if you look at emerging infections by which i mean new infectious diseases, the majority of them, 70% have originated from animals. a lot of this sharing of have certainey

viruses that they can pass on to humans as opposed to other non-mammal animals. you look at the array of pathogens and it is really astounding. from sars, hiv, rabies, even malaria. , wet of it worked out looked at how humans and animals interact because of that possibility of transmission between animals and humans. i studied comparative anatomy and i look at humans as just another animal in many cases and i think the viruses and bacteria that infect many animal populations are naturally going to infect us. that a disease can jump species unless proven otherwise. >> i am curious about

implications of climate change on the outbreaks we are seeing in the u.s.. >> the emergence of this species in arizona has taken us by surprise and we're looking at if warmer weather might be accounting for the population numbers. data thathere is suggests that particular ticks bite humans more readily at warmer temperatures. if climate change is happening, that there canht be public health repercussions we have not thought about. >> i'm for a few more questions. >> i have heard you talk a lot about physical illness. concern, which is very evident in the multiple now,l shootings, 15 a year it is really the mental health of america. i am wondering how you guys are addressing that are tracing that

potentially back to antidepressants or pharmaceutical companies? i think that is the biggest killer, especially with suicide in my generation. i think it is going to get worse. we start with shining a light on a problem. right now, we are seeing a huge problem with prescription opiate abuse. and it is entirely caused by doctors. we have seen a 400% increase in the prescription of opiates. sometimes the treatment becomes a problem. prescription opiates kill more people than heroin and cocaine combined. i don't think we are going to

find a simple solution. i think we have a need to deal with supportive school environments. we need to deal with a whole dot of things that they can to address violence. like whatat things are the things that work to reduce injury? it is the leading cause of that includes car crashes and suicides. of our programs are as well-funded as we would like them to be. >> to questions. the ebolais about virus. it is emerging in the middle almost 250.

what starts at and what is the hose. the second part you shared with us is the management when it comes to the human part. what do you do with infected bats orwhen it comes to cattle? with are working closely the government of saudi arabia to help them get a handle on the outbreak. we have learned a great deal. it is increasingly clear that the large increase in cases was spread in a hospital. it is bad news because it shouldn't happen. it is good news because it is easy to control. we began doing studies. where did the first cases start?

there may be a camel source of this. the more we investigated, they were almost all associated with hospitals. that is the first important finding we have had. ofhave seen a plummeting cases since we identified that. we have embedded staff with the saudi response. we want to identify those initial cases to understand what the source maybe. >> i think it's important understand that the cdc is a human health agency. we don't have a lot of authority or ability to work on diseases when they are happening in animals unless they are associated with an active human outbreak. there are many effective physicians who work on animal borne diseases at cdc. we liveis we recognize in such interconnected world at the idea of ones health becomes

important. , withk with our partners united states apartment agriculture. we work with local veterinarians. when we don't have a piece of the puzzle we tried to connect with partners who do. we try to make sure we are covering those bases. >> give time for 1-2 more questions. there are two in the middle. >> i have a question. interest inhas an whether the cdc is working on anything in particular, is there something on your website to ask a question to find out if you guys are doing research on a particular issue? somewhere they are planning on visiting? >> you can store the cdc website. we have apps, including the yellow book, the bible for anyone who wants to travel anywhere in the world.

what to do, what to worry about. 1800 cdc info. >> good evening. i have a question regarding the spread of open call for which has now in southern california, there are outbreaks in certain areas. recently i had friends fly from lax with a woman infected, and i would like to know what regulatory body would have input or control, or authority guys late people, because so many are exposed. rushend has spent a year to the hospital several times. when this one was coughing, she

was whooping. she was sitting between them, both were infected. what can we do as citizens who happen to travel quite a bit to put pressure on those individuals or that particular authorities to control this? it seems to be getting out of hand. during bird flu when i was flying back and forth i would see a of individuals coming from china or parts of the asian continent wearing masks. that?n't we insist upon what role would you have in that? that is a big concern of mine. off -- whooping cou

gh is resurging. we are not vaccinating enough people because people have misconceptions about vaccines and think these are things of the past. the vaccine is not as effective as we would like. -- wane afterayne 00 three years. coughthe whooping bacteria has evolved and seems to be invading our vaccines. this is a question of working with the fda to come up with a better vaccine. in terms of regulatory action, certain things are appropriate. it is often the state or local government that has the authority in terms of people coming into the country. operates quarantines. but the solution is not to try to build a perfect moat around the country.

safer andle will be we will be safer as well. i don't know if you want to say any last words. >> we are out of time. >> i think i'm going to sleep i would knowing these incredibly talented people [inaudible] [applause] [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] >> more now from the aspen ideas festival. they discuss the use of technology to diagnose infectious diseases and prevent hiv aids. withhour-long event began the daughter of former president george w. bush.

[applause] >> thank you. i am so excited to welcome everyone here. i work with an organization called global health court. we bring new talent to the field of global health. we work with amazing young leaders to bring their voices. which is why i love the aspen new voices fellowship read it ensures we have diverse thinkers raising voices to affect social change. en new voices fellowship read it ensures we have diverse thinkers raising voices to affect social change. we'll have the opportunity to listen to great stories and meet 10 great innovators who will bring them to live for us. storytelling is a powerful tool. any great storyteller is a great teacher, which is something i knew growing up. teachermother who was a and librarian. sometimes defined seem like it would never stop with a mother

who was a librarian. but my mother knew the powers stories had to open the world for my sister and me. my mother realized stories could her.our world to every day when i got back home from school, she would say tell me a story. we would just talk. that is the way we learn to communicate in our family. now that i work in global health my world is dominated by numbers. we look at databases and spreadsheets. we read percentages. the biggest lesson i have seen in global health is that for us, numbers don't inspire people to act. stories do. if you work in global health you have to remember every single day that statistics aren't just a random number. they are action representing people and families we are trying to serve. those people stories desperately want to be heard. with that, i am excited to turn the microphone over to two

people who have been enormous neworters of the aspen voices fellowship. john and courtney. tonight many of us will never have the opportunity to visit the congo or kenya, but by getting to listen to their stories we can bear witness to the courage they have brought to their work and clemson to the little moments they get to witness every single day. i want to turn it over to john and courtney. i want to end with a quote i read this week. we were coordinating for this week. it is the quote that is in her signature. it is perfect for tonight. "engrave this upon your heart. there isn't anyone you could love once you heard their story -- there isn't anyone you couldn't love once you heard their story." [applause] >> good evening. it is fantastic to see so many

people here to share in stories that our aspen new voices are about to bring to the stage. courtney and i are partners in life and in work. my name is john. we work to help people tell their stories. it is amazing work. the best part about it is watching people share their lives. they have the most incredible tales to tell. when cory knight will reflecting back on the year that we had previously, 2013, both of us without reservation said meeting the new voices fellows in japan this. johannesburg was the most extraordinary thing. they have very unique, humanizing stories. we are just delighted to be able to share with them today. >> here is a little bit about

the structure. we wanted to keep it fast, surprising, something that would be a fresh shift from the panel experience you have been having. this is going to be unlike anything else that happened. we're going to have a three-minute stories, and each scholar is answering the question why do you do what you do through a story. image.ntly, one you will see one image appear and here one three-minute story. what i want emphasize is that all of these fellows, and you're not actually hearing from all of policyll of them are experts, essentially. they could stand up here and do the data saying, and the policy thing, any give you an analysis. all of them are deep experts in our field. if any of you are media looking for experts, funders looking for

amazing organizations, all of them have them. you're not going to hear that side of them. we wanted to bring that story omen. i just want to say that clearly. there is a lot more where this came from. you are only going to get these personal stories. i want you to be there with them. they are often sharing vulnerable things. the best thing you can do as an audience is receive that gift and return it with your warmth, attention. that means turning off your cell phones and actually being present here and receiving the gift that you are about to receive, which i feel, as john said, is one of the biggest gifts, working with this grip people who are warm, kind, and making true change in the world. i'm going to welcome our first a country director from in gender health. she loves home-cooked mills, but

-- meals, but hates cooking. [applause] >> thank you courtney. it was back in 1989, after five years of going through medical became one oft i the few medical -- stethoscope around my neck like most senior doctors do, i felt so proud of myself. theeems my addition to medical doctors would change the landscape of health and disease.

and, when i was first assigned as an intern to the i met withal world, a senior gynecologist and a resident, and we went to the room labeled abortion. of beds, 10 on each side. a girl fighting for her life. undergone, had through backstreet abortions, arriving at the hospital losing so much blood and having serious infections. the fragile bodies of these girls lying on the beds, iv

fluids attached to their arms, oxygen, each one gasping and fighting for her life, and parents and relatives in the back frantically crying, and chanting prayers. these tragic situations change me deeply. life i first time in my felt guilty. i felt guilty because of the shelter life i had enjoyed. sufferingvious to the my community, my peers were undergoing. i felt angry at the same time. these were preventable situations.

i came to realize what is driving this underlying injustice and vulnerabilities that these women have to go through in their lives, when i las born it was such a joyfu occasion. , it is therls beginning of discrimination. --ls are considered and are unfairly discriminated. i was already in grade one having fun, playing high jump with my friends while girls at that age in real communities are burdened with taking care of other siblings. when i was aged 15 years old, i

was already deep into my studies and in high school while girls, many girls in my own community, are forced to drop out of school to get married to a man they have never seen before. their first sexual experience is a coerced experience, and these girls have to travel several toometers barefoot collect water for the household. they work from dawn to dusk. when i was 23 years old i was already an intern. looking forward to embrace the good life. already in the end of their life's journey. too young to die, in the loss of

goodwill.lent, and i chose to marry my husband, and went to marry him. i went to get pregnant, and decided the number of children i wanted to have. decided the type of contraception i wanted to use. i strongly believe that these choices, these critical decisions, should be made available to all girls and women regardless of when they l ive. that is why i work with women's health, and that is why i'm committed to the present to the voices of those girls, and i'm whentted until the time

sexual and reproductive health quality health services are available to each girl and woman and their rights are respected. i thank you. [applause] >> wow. thank you. fellow is dr. utay effune. him wearing michigan apparel every single minute of the day. right now here it is -- right now he is sporting socks.

he says i blink three times whenever i feel a sense of danger, and i think it keeps me and my family safe. [applause] >> i remember this as if it was yesterday. i had walked a mile that that shrinking water. without thinking, i thought i was going to be a medical doctor. of age and the care from a poor neighborhood. that dream was real to me. dad taught-- my me to believe in myself. nine years later as i traveled 12 hours on the bus, within

weeks i became ill. my dream died as soon as it became real. clutching headaches, morning fevers. i went to class. wended -- i wanted to be in medical school. but i died. i lapsed into a, and remained unresponsive for two weeks. when i came back to life i had lost my hearing to complications of meningitis. meningitis is common in northern nigeria. northern nigeria is in a climate extends from the east. to the hills in the

year,egion every thousands of young adults get ill with meningitis. 10% die. no matter what you do. i'm one of the few who survived. i was lucky. i had never been to the north of my country. when i travel between the north change,h, the climate and i wonder was climate change widening the belt? was that why i got meningitis? was i vaccinated? was that vaccine any good? dream again, of doing things to stop this from happening. i became a physician. researcher of public

health. the reality still goes on. we speak, nigeria is battling the worst outbreak of meningitis in recent years. this year alone we have 70,000 cases, 1000 deaths. but i dream. i now walk at the global intersection of health and global diseases. very the filling. i dream of a day when having --ources is not put o [inaudible] it has impeded good health care.

but i still dream. i know that as we walk together this dream will come true. thank you. [applause] >> next up, the executive director of psi haiti. she loves to sing in the shower. she was belting out whatever song she wanted for this. there are no statistics involved. [applause] i always knew i wanted to change the world. i knew i wanted to change haiti. i wanted to have an impact.

here i was doing it every single day in and out. i was working with youth, with ,omen and reproductive health and hiv prevention. i was going all over the country anding, providing services activities that would change their lives and have an impact and help them change their behaviors. the more i started working, the more i had responsibilities. withame frustrated because responsibilities, i started to understand the bureaucracy around our work. i do started to understand the priorities that did not always meet the priorities of the people. i started to see programs that had a huge impact on the population, and programs closing and not being able to continue because of lack of funding. worst of all, i started to see my people, the ones we wanted to

help, sitting around and waiting for the international community to come and help. i was mad. my optimism was diminishing. i was beginning to ask myself, is this the life i want to have? do i want to continue doing this work? is it worth it? on generate 12, 2010, the unbelievable happened. i was at home with my husband and children. the ground started to shake beneath us. we had no idea what was going on. we were not prepared for this. we had not talked about it. i was scared. we were -- it was unbelievable. mywere fine, but what about friends and family? city?bout my what was going on. all we could hear were the screams. all we could see were the smoke coming from the city. i felt powerless.

here i was wanting to change my country and i couldn't do anything. my government was on the floor. i felt i was shaken to my core. the next morning at sunrise we woke up to see what was going on, to see the city. as i drove, i was speechless. there were no words to describe what i was saying. the city was destroyed. there was so much fear, so much pain, so much suffering. we had no idea how we would stand there and be able to continue as a country. in the middle of all of this, i saw something unbelievable, something unexpected. i started to see courage in people's eyes. i saw men pick up rocks from rubble to clear a house where a stranger was stranded. i saw a baker opened a store to give bread to people that had been there all night long.

i started to see health professionals leave their families to be able to be there to help others. i saw haitians wanting to be there for each other. and being a solution instead of having to wait for the international community to do the work. i saw that lie in their eyes. i saw the possibility, the glimpse of the possibility that together we could come as one to be able to help each other. in the middle of the chaos i was if i did want to just leave the chaos, leave the country. there was no way that this could get better. there was no way that haiti could stand up again. my answer was no. it was not because i saw that light in their eyes that showed me that we as a people can come together and make this country better. [applause]

>> thank you. fellow is dr. mary sando. unicef. specialist with you will be even more impressed loves tohat she seeing and can do a mean imitation of celine dion. [laughter] [applause] >> thank you. two of my happiest days of my life were in 2009 and 2010 when i gave birth to my two children at a consultancy hospital. joy, ands i felt the

the dignity of having survived to safe deliveries, i could not forget that five years earlier, i was not the woman on the stretcher, but the woman trying to save the life of a woman on a stretcher. i failed. we all failed. and it was brought to the labor room while i was working as an intern in that hospital. state. in a very weak her eyes were barely open. she was pale. her gallant was stained with blood. own was stained with blood. we took her vitals. she needed emergency blood transfusion. annae span of 30 minutes,

had difficulty breathing. we did everything we could to save her. all our efforts were in vain. anna in a looking at pool of blood and felt this data even though i didn't , i knew she must've had a whole life in front of her. how could she have just died like that? later, i gathered courage and tot down to the labor room meet her husband. i recall a painful moment of having had to inform him of the unfortunate passing of his wife of just one year. was so difficult because their baby girl died just a few hours

earlier in childbirth. , i gathered medical records to certify and his death. i realized she was anemic from the time she was pregnant in the beginning until the end. her anemia made it difficult to severe following the bleeding she suffered after the birth of her child. despite all of our efforts, anna became one among many women who suffer due to the severe mayding after birth that most succumb. seeing anna in so many after that died because of maternal complications continues to be very heartbreaking. even today, 24 women die each

day in my country because of maternal complications. we know now that more than 90% of these deaths can be prevented using simple things. that any pregnancy danger signs identified and managed. using simple medication such as delivery women after to prevent them from the possibility of bleeding like anna. medicationsimple like magnesium sulfate and would be able to prevent and manage women who may be complications following high blood pressure induced by the pregnancy. controlling infections, after birth, and improving emergency care. they have been proven to work. ,s a doctor and a mother myself

i chose to make the difference because it was a life of all onee women and the death of that inspired me to do that work. anna would have been 10 years older. her daughter would have been 10 years. i do my work for them. thank you. [applause] >> that really hits me. i gave birth seven months ago and i was severely anemic in my pregnancy. it feels so recent and relevant. maria's work is so important. we have a bit of a shift. this fellow is a doctor. not like the others. cofounder of bio

since technology. he is a fountain of ideas. he came to me a couple of minutes ago and said i have an idea. we should build an app where we count coral reefs. he is just constantly having incredible ideas. you are so lucky to hear from and absolutely energetic infectious human being. his interesting facts, he was named after a character in a novel, and he is glad no one in primary school was into russian literature. [laughter] mishkin. guys whoone of those

just loves technology. the latest gadget. i can't help myself. how it works. i'm one of those guys. me, iqind of people like citrate marketing and marketing and evil.incarnation treat marketing and marketing people as the incarnation of evil. i was happy to get a innce to work for nokia india. that was a big thing for me. it was big in india at the time. i was pumped up for the first day of foreign. hundreds of ideas buzzing. we can do this. we can change this. just poured it out to my boss, who listened patiently.

understand the mobile phone business is not about mobile phones. he explained to me how it works. i didn't quite get it. i was a young kid that had optimism about technology. slowly i started understand. it hit home to me once. i was in a shopping mall negotiating a contract with a distributor. i went out of the office and i was walking through the mall. it was a nice, big mall. i could see different brands, people walking past getting into the shops. it was wonderful. suddenly, everything moved in slow motion. i could see how it worked.

i could see that it was not about technology. it was not about the phones in the washing machine. kidsld see parents and running around. they could see what was happening. i could see their lives -- and see their eyes light up. they are buying a new life. they are buying an idea and hope that their life will be better or different. that is what marketing had done to them. this is not really a bad thing. in india this was changing the face of india. i walked out of the mall. i still love technology but something change inside of me. youarted thinking, what if could use capitalism, this idea, this hope and apply it to other stuff. sanitation, water, energy. what if you could do that?

if you years later i happened to be working with a team of doctors, and we had a big idea. we could use mobile phones, android devices to take health care to places where otherwise it did not exist. we eventually ended up building a platform on android that could bloodne testing and testing. it could diagnose diabetes and other complications less than $.10 per test. it and used it. my doctor friends said let's try to sell it. i realized the mall thing. build it together.

we worked with users and entrepreneurs. issues.re a few design about a big was not idea. it was about being a small part of a big user story. days, i get a lot of big ideas thatet come to me and say they have this fantastic thing. i just did $1 million to prove it. y bests why i put my keanua reeves faced -- reeves face and said no. [applause] keanu.k you

wonderful. thank you. our next fellow and speaker is an amazing person. amanithe founder of global works, the proud parent of four children, and a choral director. when fromlasting mark the other side of the world he recited almost arrayed him in article courtney and i had written, focus on dignifying and design. since that time every time we interact we talk about the word dignity and what it means to us. it is with no greater pleasure than now that i get to introduce my special friend, jaques.

>> when we hear about congo in the news it is always about genocide, women being raped, worse. fromtiny island where i am of 20,000 people, that is building innovative health care , --em [inaudible] nine years ago my wife and i couldn't stand by while many were dying from preventable diseases. we couldn't stand by while girls were being married just to be taken away from their families and given to men so they could be fed. and live't just sit

the good life. we decided to go back. the best way we thought to ourge and bring contribution to this community, by building. we thought by building that would provide jobs to people. we believe that if people have jobs they will be able to take care of their families. later, while exploring possibilities, and where to build them, we stubbled into the native village. we learned to children have died.

[inaudible] no one would look at us. no one would touch us. i couldn't believe that in the 20th century, pygmies were marginalized. they still exists. pygmies believe they are not humans. other members of the community believe they are not humans. they are not seen or heard. i ask what they thought about this. the eldest said we love the idea but what if you built it for us? will be treated like other human beings. it is not what i thought was good for them. with a believe it is good for them? the weaker, the powerless.

communities and they made it clear that they were the only people who will have to build their infrastructure. although they did not have money, we decided that they had to use whatever they had. with sticks and mud they built their first clinic. for the first time, those who consider themselves humans and nonhuman's work together to build the first clinic. they felt the need to expand the clinic. i believe in a dignifying design. i believe that if you build in the community, a beautiful building that is part of the community, that gives them hope. we didn't much learn.

a powerful land owner planted sugarcane. sugarcane plantations can be a breeder of mosquitoes. people up treated at the hospital would leave suffering from malaria. we did everything we could. the sugarld not take plantation away. we couldn't shut down the clinic until we solve the problem. upn one morning, i was woken hopeful. we finish theid job and the clinic is safe. -- these powerless people who have been looked down brought this beautiful idea of

building a clinic. a hotust we will reopen hut with solar power, running water. it is this determination, this courage, this belief that they the deserve being part of community that wakes me up every morning to work with them. that is what i do what i do. thank you. [applause] y we weren see wh moved by that man. our next speaker is a gentle soul. i have had the pleasure of working with him on his writing.

i have been touched by hal gentle and insightful he is. gross medicalare stories with me that freak me out. most of the time he is gentle. clinical director of the university hospital. he broke my heart. he loves walking in the rain. here he is. [applause] >> we humans are in a battle with life. here is the story. wherein a medical mission school thatoly

accommodates priestess and deacons. the church was home for the poor and destitute. clothes,om change and are infested with body lies. -- lice. many people were sick and they were an epidemic of fever. priestsar, one of the told us, this is the result of body lice infestation. them manually.l we spray holy water on them. they continue killing us. how could this small