On Harnessing Tech Innovation to Improve Healthcare - A Conversation with Dr. Ernest Darkoh & Dr. John Sargent

Episode Transcript

Claire  0:00  

Unlock exclusive content and access to our podcast while supporting our show. How is that possible? Become a Narratives of Purpose patron at patreon.com/noppodcast

Claire  00:28

Hello dear listeners, and welcome to Narratives of Purpose, you are now tuned into a new episode showcasing unique stories of changemakers; stories of people who are contributing to make a difference in society. This show was created to amplify social impact by sharing individual journeys of ordinary people who I believe are making extraordinary impact within their communities and around the world. My name is Claire Murigande. I am your host on this podcast. If you want to be inspired to take action, then look no further. You are in the right place, get comfortable, and listen in to my conversations. 

On today's episode, I have two guests. I will be speaking with BroadReach Group founding partners, Dr. Ernest Darkoh and Dr. John Sargent. Ernest and John's company is a global social enterprise that seeks to transform how health work gets done. In fact, the BroadReach group consists of two businesses; The first one is Vantage Health Technologies, an AI-enabled platform that creates solutions for complex health challenges. And the second one is BroadReach Health Development, which implements high impact population health programmes. In our conversation, John and Ernest, talk about their almost 20 year work in health equity. They also share their vision of a world where people flourish through access to good health. And for this episode, to reach more people, I invite you to take a moment and share your feedback by giving us a review on Apple podcasts, or on our website at narratives-of-purpose.podcastpage.io. This will help other listeners find our show and further amplify the stories we bring you on the Narrative of Purpose. For now, let's dive into the discussion with John and Ernest, there is just so much to learn from their work. 

Claire  02:32

Gentlemen, welcome to the podcast. How are you doing today?

 

John, Ernest  02:36

Good, Claire. Great. Yeah. Thanks for having us.

 

Claire  02:38

I'm curious to know how you both became business partners. So I have gathered from your LinkedIn profiles that you both were graduates from Harvard Medical School - So that's where you met. But I'd like to know a bit more about your background and how you two met and started up with this idea of putting BroadReach together.

 

Ernest  02:55

Sure. So I'm your typical third culture African diaspora kid. My parents are from Ghana, but I was born in the US, however, from age four I grew up in Tanzania and Kenya, and went to the US for undergraduate. But I guess I always felt drawn back to Africa in the sense that this is where I wanted to work. And this is where I wanted to make a difference. So in medical school I bumped into John Sargent. And we became fast friends, John also has a very interesting sort of multicultural story. And we both had this real passion for in essence, "how can we improve things in the 'developing world'?" and we connected around that particular passion. And ultimately, when we did form BroadReach, we sort of connected again to form the company.

 

John 03:46

Ernest's Mom always says that Ernest and I are like cosmic twins, because when we first met in medical school, we immediately hit it off, it was the first week of medical school. But like Ernest, I'm also multicultural and mixed. So I'm half Asian, I was born in Taipei, my mother was Taiwanese, my dad was American. And then because of his job, we moved around and lived in lots of different places. And so I always grew up never really identifying with one spot and instead growing up in multiple cultures, hearing multiple languages, all the time. So I've always had a fascination with anything International and because I chose a career in medicine, international health made sense. And I had spent time before I met Ernest in medical school, working and volunteering in refugee camps, both in West Africa and in the Middle East. And I think that's sort of got me jazzed. And so when I met Ernest in medical school, instead of studying like we should have, we probably spent a lot of time chatting about, "hey, you know, when we grow up one day, what are we going to do to change the world?" And sharing our common observations and dreaming of what could be possible.

 

Claire  04:47

From what I gathered, you actually have two businesses within BroadReach Group. So Ernest, would you like to start and explain to me what these two different businesses are and why you actually structured it that way?

 

Ernest  04:58

I think in medical school, the two professors who sort of John and I really felt like we wanted to be like them when he grew up, were Jim Kim and Paul Farmer, who formed Partners In Health. That model of doing international work of high impact really did appeal to us. And little did we know we'd end up doing that. So I ended up in many ways actually kind of following John. John was sort of my guide through a lot of the moves I made in my career, there was a time in medical school where you could go out and do an external experience. And John went and worked at a consulting firm. And at that particular point, I had no idea what consulting was, so through John I learned about that area of management consulting, and I found it absolutely fascinating, because for the first time, here is a field where someone's gonna pay you to know a lot about many different things. And so at the end of medical school, instead of actually going into practising medicine, I went into management consulting, and I worked for McKinsey and Company for a number of years. And then that actually led me to working in the country of Botswana at the time when they were launching the first public sector HIV treatment programme on the continent. And I worked on that project, it was a pro bono project that McKinsey did back in the year 2000. And after that, I was asked if I'd resign from McKinsey and come and be the operations manager of the programme. And, that was a life changing experience for me. And in the middle of that experience, big funds like the Global Fund and PEPFAR started. And lots of countries were looking for expertise in terms of "how do you scale up and manage large scale HIV programmes and TB and Malaria programmes as well?" And at that particular point, I reached out to John, who had been doing best practice work with top hospitals in the US. What he knew about how top hospitals in the world performed with what I knew now about how the public sector worked, the question was, can we create a better way of delivering large scale health services that was more effective than previous models?

 

John  06:58

So similar to Ernest, you know, I think I knew pretty early on that while clinical medicine is great, and you can help individual people, it's really tough to help entire populations. And I think that externship that Ernest talked about in my fourth year of medical school, really changed my life. I spent three months working with a small boutique firm that worked with hospitals in the US. And we were working with a hospital in the southeastern United States that was about to go into an experimental Medicare capitated care programme. So the very early days of population health. And we were asked to design what a population health programme could look like, so you could take care of a number of senior patients and keep them healthy and keep them out of the hospital - I just fell in love. I was like, wow! You can actually do these sorts of things, you can work on health systems. So when Ernest had the project in Botswana, funnily enough, I was actually with another colleague of mine, we were looking at potential opportunities to do international health care. And then I met Ernest and had lunch in Washington DC, and literally that turned into BroadReach. But at the end of the day, we are a mission driven organisation, we are a social enterprise, our only mission in life is to make sure that people get access to good health. And our feeling is that if people don't get access to good health, ultimately, you can't meet your potential as a human, you can't flourish and contribute what you can contribute during your lifetime. And so this is really important to us. And Ernest's project in Botswana rapidly became our very first project. So we quit our jobs. We took Ernest's job in Botswana and flipped it into a BroadReach contract. And at the time, BroadReach was a consulting company. So we would win grants like in Botswana. Very quickly, we won a large grant from USAID under the PEPFAR programme, the President's Emergency Plan for AIDS Relief. And we did all sorts of stuff. So that first business which today we call BroadReach Health Development morphed into what I would call a classic consulting and implementation services business. So when large scale grants from these big donors and do things like help with policy and strategy at a country level on how you deal with HIV, or get down to the nitty gritty and put people in rural clinics and hospitals, and help improve the performance, and even augment with doctors and nurses do. Anything that you could do to ensure that as many people got tested on to treatment, and stayed on treatment for HIV and TB. I think 10 years into the process, we realised that it's really hard to do any kind of health systems work if you don't have data and if you don't know what's going on. We collected so much of our own data, we built these massive Excel spreadsheets, it just wasn't working. And so we started building our own software. And we realised that anybody running a health system, whether you're a minister of health, down to a community health care worker, there's two things that you have to get right. The first issue is you need to make the right decision at the right time. In your role, in their geography, what's the decision, they need to make that week - number one. And number two, even if you make the right decision, it doesn't mean you can implement it. And so how do you guide somebody or teams of people to implement it? So it really becomes about making the right decision for the right person at the right time and helping that person and their team implement it. And that's really how Vantage, our technology platform evolved. And we can go into a lot more detail. But it's been a really interesting journey. And I think if you would have asked Ernest or myself back in the early 2000s, when we started BroadReach, if we thought we'd be a technology company, I would have laughed at you. But we're here today in 2022, and we are doing a lot of technology.

 

Claire  10:32

And that's actually an interesting development, I would say, because it's also in phase with the whole digital transformation we're all going through. So the fact that you have your own technology, is that a specific advantage that you don't need to count on another company using their own tools that you need? Or how do you see that?

 

Ernest  10:52

So for us, one of the things when we started Vantage was that there was still quite a bit of technology out there, right? Even though it was old school, and in the old model, before there was a Cloud, you had to buy a server on your premises, install it, but you'd have HR systems, finance systems, lab systems, you have reporting systems, like VHIS at the time. Then you have a lot of apps and little tools that people are also developing in parallel. But the problem was, there was nothing that pulled it all together. Right? In fact, it became "well, how do I integrate all this information from all these paper and non paper resources and how do I integrate it all, ideally in real time, to make a decision?"  And what happened was, attempts at integration usually meant hiring a consultant, who would physically go around, gather this data, create an Excel, then analyse that, then put that analysis in a PowerPoint, present it to people. But usually, it took three months or four months to do that analysis. So what ends up happening is, yes, you have some intelligence from that data. But it's usually three or four months old, sometimes six months old. And then you're trying to make decisions about the past, in order to guide the future, it doesn't really make sense. So we felt with Vantage in particular that it's a really unique tool of its kind. It finally could sit on top of all of these systems, and in essence, mind the benefit from them, and make it much more real time and timeless for people to get the right insights about what's going on. And for us, the 'right insights' means insights that allow you to really focus your very very scarce resources in the most powerful way possible, because you've got no other choice on this continent. And then secondly, was the issue of realising from our work that actually implementing, that implementation was always a struggle. And therefore, then how do you support people to now do the fixing that needs to be done in the right way, in particular a large team of 5000 or 10,000 staff who are in a particular geolocation? Who needs to be doing activities well, and you can't manually supervise all of them appropriately. So could you use the technology to also support them all in a much better and more effective way. So what we found was, it was a game changer in the sense that one, people have invested billions in all these other tools, but weren't really getting the benefit from it. So Vantage allows you to unlock the benefit from all these existing investments. But then more importantly, it sort of helps you bridge that gap from data and knowledge to actually effective implementation, which we found on the continent that's actually the most important thing that we need to do is implement effectively, because that's what's really keeping us from the results that we need to have.

 

John  13:39

I think for us, the digital health ecosystem is massive, and there are so many opportunities to make a difference. We have a very niche area that we're focused on as Ernest described. So for us, we prefer to partner because we're not solving every problem as Ernest said; we're trying to help decision makers make better decisions and implement them. That's our unique focus area. And in order for us to do that, we have to partner with lots and lots and lots of different health systems, digital health solutions that are out there.

 

Claire  14:08

Tell us a bit more about where exactly you're operating. And you also spoke about some partners. Do you have any specific partners, you could mention perhaps?

 

Ernest  14:16

I’d say to date, we've worked across maybe 30 countries. We've worked in China, Vietnam, Eastern Europe, Caribbean, but I'd say the bulk of our work is focused in Africa. And in Africa alone, I'd say, we've worked extensively, mostly in Sub Saharan Africa. We haven’t done a lot of work in North Africa. We've worked, I'd say, in at least 20 African countries. So this has really been our foundation. And then from this foundation we realised, particularly with COVID, COVID revealed that you needed a public health model everywhere, right? Because COVID was the public health issue of our time in terms of emergency. And I think that woke up the US to the issue of health equity, and we realised that a lot of what we were doing in essence is Health Equity, what we've been trying to solve on the African continent. And we felt that we could translate some of what we were doing to the US.

 

John  15:09

I think the big picture is we’re about 1000 employees globally. And of those 1000 - I'd say 97% - 98% are all in Sub Saharan Africa, either our headquarters in Cape Town, we've got multiple offices in South Africa, we've got work and presence in Kenya, Uganda, Nigeria, Zambia, we also have projects here in Switzerland, we work for example of Medicines for Malaria Venture here in Switzerland, we've worked with a number of pharmaceutical companies as well. We've really been doing health equity for the last 20 years. But 20 years ago, they didn't call it health equity, it was health access and health quality. And our feeling was that we worked in some of the toughest places in the world, right, you're talking about severe, severe capitation settings, where you're working with governments that are spending maybe $30-40 per patient per year. Contrast that to the US at $16,000 per patient per year. You're working in extreme resource shortages, in terms of doctors, nurses, everything, and you're dealing with extreme social determinants of health issues, are you dealing with people who are maybe eating every other day. Maybe people who didn't have access to an education, people who have very different cultural and behavioural beliefs about health care. So very extreme settings. So the thinking was that learning in those really, really tough settings, could we do something with our knowledge and our experience and our Vantage platform to bring it back to the US? And so interesting enough, we did a number of projects in the US as pilots just to test out, is our technology valid? Is there stuff we can do with it? And we've worked in a wide variety of settings, but we've actually decided to focus on oncology, and in particular Community Oncology. So for the listeners out there when people think about oncologists, they typically think about large academic medical centres and Mayo Clinic, Johns Hopkins, Harvard, what we're talking about are doctors who are not, sometimes they're affiliated with academics, but they're, but they're not in these big hospitals. They're typically in an outpatient office in suburban or rural America. And these oncologists see roughly 60% of all the cancer patients in the US. And it tends to be that those patients they see tend to be the ones that have a lot of social determinants of health issues. They tend to be Medicaid patients, or patients who require a lot of assistance and help. And so we see a lot of things where people are not eating healthy every day, or they don't have reliable transportation, so how do they make it to their chemotherapy on time? And so all these types of issues, social determinants of health issues, if they're left unaddressed, people will have horrible outcomes with their cancer. It's the same sort of thing we're seeing in Africa, different variations on the theme, but the same core principles are the same. And so we've just launched a really big pilot initiative, actually, it's an initial demonstration project called the Hope Initiative, in partnership with a large oncology group in the south of the US, along with a National Alliance of cancer organisations, the Community Oncology Alliance. And so we're really excited. I think there's a lot that we've learned from Africa that we can now do sort of a south to north transfer of knowledge and information.

 

Claire  18:06

That's an interesting point, actually, because it's very rare that you hear from, as you say, south to north transfer. So what are the learnings that you've taken from your experience in Africa, that you are now implementing in the US, that you say, "Okay, this is something maybe people hadn't realised, but actually, it actually works even in the setting such as the US?"

 

John  18:24

I think the first big one is what we call 'the next best action'. What we found very, very quickly in Africa was that there weren't enough people who were able to look at big data visualisations, and dashboards and all that sort of stuff. And you're asking a nurse manager of a rural clinic, who's got 200 Patients out the door on a Monday morning, and you're asking her to look at a beautiful data visualisation, and from that make her management decision? Not going to happen. And we realised that very early on, people don't look at data, people don't look at analysis, they don't look at analytics. What they want to know is what's the "so what?" Based on the pattern of the data, what are the three decisions I need to make? And so we spent all our time with Vantage creating our machine learning algorithms to interpret that data and make it into plain English. So it'll say things like, "Hey, Claire, good morning," an email that's auto generated to you and say, "For your district this week, we think COVID is coming into this particular sub district and the three clinics there are understaffed by five nurses. So you might want to reallocate five extra nurses this week. And by the way, you're short on PPE. So you might want to talk to national supply chain and try to get more masks. And by the way, you need to implement contact tracing. And here's a link to that." And when we went to the US people were like, "Oh my God, you can do that?" Because in the US, it's even worse because they have so much data, you know, they were getting data feeds from these external third party companies that had all this crazy data that you'd ever want to know about a patient, but then you're forcing somebody in a doctor's office or an insurance company to sort through the data and say, "Okay, what do I do with that?" Oh, and then by the way, here's another company that's got a catalogue of all the food kitchens in its neighbourhood. How do I take this data here and match it over here? Oh, and by the way what's the taxi company we partner with in this particular area? And so you were asking a social worker or case manager to literally connect 15 dots before they could actually help the patient. And so when they saw this 'next best action' concept, just give me an email, just tell me, "John, as a case manager on Monday morning, these are your 10 patients you're dealing with this week. For patient number one, these are the three things we recommend, here's the workflow, this is how to do it." Or at the executive level, "This is what's happening with all your patients. And we see a really big gap in this area, you might want to consider this." That was what was missing. And so I think this whole next best action is now, it's starting to become like the hot trend in the US market. But I'd like to claim that we thought about this about seven or eight years ago in an African setting. I think the second piece is really understanding deeply about communities and where people are coming from and how they think about healthcare. So again, we just sort of assume whatever training we've had, we just assume that the patient comes to us, they come to our clinic, and they listen to us, because we're a doctor, we have an MD next to our name, and they'll do what we say. But that doesn't happen at all. Because we don't understand what life is like in their community, we don't understand what distrust they have in the health system, we don't understand who they trust in their communities, we don't understand their cultural and social beliefs and understanding of health and illness. And so I think a lot of the work is really building trusted relationships with organisations in the communities that people trust, and working together with them to empower patients. Because at the end of day, if you can't empower patients to take charge of their own health then we've failed at this game.

 

Ernest  21:36

I'd say that one of the biggest lessons we've learned also about working in this environment is just the power of partnerships, in particular, public private partnerships. Because I think often we've come into environments and you're like, "Well, there's no resources, there's no way this can be done." But when we just literally come in and do our partner mapping, we're like, "actually if you put everyone together, you can do an orchestra now that can actually play this song effectively, right?" So I think we've become good over the years at assembling the right partnerships around a particular mission that needs to be accomplished. There's so much more that could be done, right. And it greatly often exceeds what on paper, for example, people will tell you are the resources available.

 

Claire  22:17

So jumping off of that, when you say there's just so much more that can be done. Can you give us a bit of an idea or flavour across these two decades, what has been your impact so far?

 

Ernest  22:27

There's a couple of highlights, I think, first and foremost, the Botswana programme. Basically, we operations managed the first public sector HIV treatment programme on the continent. And it's been successful. And I think most recently, Botswana is the second or third country to actually hit the triple 95 targets. I say a second was where we worked in South Africa (South Africa is sort of ground zero for the global pandemic. Of the 38 million cases in the world, South Africa represents 8 million of that). And then in South Africa, Kwazulu Natal is the epicentre, and in KwaZulu Natal, there's a district called Ugu District, which is the worst, most affected district in KwaZulu Natal. And we were asked to assist that district with their HIV programme. And when we engaged with them, they were really doing badly, instead of being in the triple 90s, it was in the triple 60s or so. And then over an 18 month period, using our technology enabled approach, we were able to graduate them as the first district in the country to reach triple 90. And then I'd say another big point of pride for us, I think, has been the province of KwaZulu Natal taking on at a provincial level, the entire province using our technology. And they are now the leading province in the country in terms of being about to graduate the most number of districts with the triple 90 measures. So I think for us, this is huge - it can be done at a very large scale. I think we have a great proof of concept that if we can just scale up these approaches, we can really make a difference, despite the fact that we don't have that many resources. But more importantly, I see it as an opportunity for Africa to show that we can actually develop a better health system than anybody else. Because if we can actually solve these problems with the low level of resources that we have, effectively, to me, that is the best health system in the world, not a health system that costs trillions of dollars, right? So I think we can actually show leadership globally on how we do this. And using technology the right way, I think is key to us being able to do this.

 

Claire  24:33

Before I switch to you John and your highlights, can you just explain what the Triple 90 and Triple 95 measures are because probably our listeners may not know about that?

 

Ernest  24:41

Triple 90 is a framework that was created by UNAIDS to guide the global response to the pandemic and it says that basically 90% of people who are HIV positive should know their HIV status, of those 90% should be on treatment, and of those on three went 90% of the virus should be undetectable, meaning the virus should be suppressed. And then that has recently been changed with triple 95.

 

Claire  25:06

Excellent. Thank you. And how about you, John? What are your highlights?

 

John  25:09

I think maybe to add on to what Ernest was saying, I think the technology we've built at Vantage today, we are supporting organisations and governments that are running HIV programmes that are helping over, cumulatively, over two and a half million patients on antiretroviral therapy. That's a big number. We had a really interesting project we worked with, before COVID, with a consortium of donors, NGOs, pharmaceutical companies and governments called Access SMC it's basically it's Seasonal Malaria Chemoprophylaxis, so there's a specific drug you can give to children five years old and under, one dose, prior to the malaria season, if they get that their chance of getting malaria goes way down during the season. And in that particular programme, that year in 2019, we helped that programme do supply chain forecasting, which ended up in 19 million children getting access to this medication. So I think that the scope and scale of what we've been able to do has been interesting. And I think one of our key partners, from one of your prior questions is actually Microsoft, we are built on top of Microsoft Azure. And we are what's called an ISV independent software vendor. So anybody who builds technology on top of Microsoft, and sells that is considered an ISV. And we're actually Microsoft's largest healthcare ISV in Middle East Africa. So, I think it's been a lot of hard work but we've got great partners, and a lot of interesting results. And I think like Ernest says, my personal belief is that Africa will become sort of the place for Greenfield creation of the health systems of the future. Because if we can use technology in a relatively Greenfield setting, I think we can really redefine what's possible. I think that's what the exciting thing is for the next 20 years.

 

Claire  26:52

So jumping off on what you're saying, what have been your major challenges, or what continues to be a major challenge for you at this point, in really developing this and bringing that word out, and growing your model globally from Africa?

 

Ernest  27:05

First and foremost, a lot of people claim to be innovative, but they actually are not. When you actually confront people with real innovation, they want to take baby steps, they don't really want to do big, revolutionary things, as a frontrunner in using AI for population health and this type of application, we run into a lot of that. Second, is policy, it definitely lags the pace of technological development. And often you find that becomes a bit of a barrier in terms of mindsets when you encounter people. And it takes a while for people to become comfortable with this new concept of, for example, The Cloud, which actually provides massive cost savings and scalability, right? But if something happens again, people sort of fight because the existing system was built around this sort of non-scalable framework that then people tend to adhere to.

 

John  27:55

Even if you look at a lot of the people who are involved in healthcare today, whether they're a donor, whether they're in the government, whether they're working in NGOs, I think they still have a very outdated view of healthcare. In many of the countries we work in, there's lots of big buildings, big tertiary care, hospitals, lots of big clinics, and these were built, I think, really a 1940s/1950s sort of mentality that you had to have a big physical building, that you had to have a certain ratio of doctors, to nurses, to patients. And we know, that's simply not true, because we cannot in the continent of Africa, or actually, even in the United States, we cannot produce enough doctors or nurses to meet the demand of the future. And so a lot of the programmatic thinking, a lot of the funding, a lot of how people think about healthcare still stuck in this mindset. And I think we've got to throw that all away. Because in the future, I mean, we're just not going to have enough doctors and nurses and there's always going to be more demand for patients wanting medicines than there is actual supply. And so I think in the future, a patient doesn't need to be in a clinic to get diagnosed with diabetes. And I don't think they need to go to a clinic to actually self manage their way through diabetes or any other disease. I think that the whole model is ripe for change. But I don't think we're there yet, in terms of the mindsets. And I think it leads to a lot of things being overly simplified. So you get "if only we fix this one little thing, we could solve the problem. So here's a really cool app to do this, or here's a cool app to do that." And one or two apps aren't going to change the world. I think it's much more systemic, thinking through how we are going to actually change old paradigms and shift into new paradigms.

 

Claire  29:30

But speaking about the future, you say, you've been pioneering and you've been really implementing these large scale changes. So how do you see the future evolving? Now, let's say in five to 10 years?

 

John  29:40

I think in five to 10 to 20 years, we're gonna be able to empower patients before they even become sick. So think about today, you've got apps like Strava or Fitbit or the Apple Watch, and we're keeping track of how many steps and all that. I think that's gonna go to a different level where we start really thinking about what we are eating? How are we living? What's going on? And so that we're much more aware. So hopefully we're healthier when you get sick later. 

Ernest  30:05

And it’s worn by a genetic risk.

John  30:08

Exactly. So in the future, could your genetic profile match that with your lifestyle? Could we then start identifying for patients that "yeah, you're probably going to be at risk for type two diabetes. And by the way, here's a home kit, you can test whether it's a smart toilet or whatever, you can test if you're actually diabetic, then you schedule a telehealth call to the initial provider, and they've got the information from your devices and all that?" And they could potentially, you know, make a prescription. And if you're in a rural area, maybe a drone comes and drops it off. And you take that and then there's an app to help you self manage, and self test along the way. So you may not even need to physically go in to see a doctor unless something gets severely bad. And I think that's just scratching the surface, I think precision medicine will be another big area, and especially when precision medicine becomes affordable and scalable, to areas like Sub Saharan Africa, I think will completely revamp how we deliver health care. And so things like the old, big tertiary care hospital, I don't think are going to exist in the way we think about it today.

 

Ernest  31:07

Right now, WHO defines health as physical, mental and social well being not just the absence of infirmity and disease. Unfortunately, too much of what we call healthcare is leaning towards that latter part of the definition around how we are managing infirmity and disease, we're probably going to see a much bigger swing towards "How do you stay well? How do we actually keep you 'healthy'?" as a counterbalance to all this capacity, we need to address disease when it occurs. And I think right now, because there's too much over emphasis on the disease side, I don't think we adequately 'turn off the tap' that's creating all this disease. So what is that? And that is us making decisions everyday about usually things that put us at risk, and then social determinants that put us at risk systemically, right? So, if I'm growing up in poverty, no job, no proper housing, living next to a mine dump, I'm probably not going to end up healthy. So I think we're going to see probably a bit more of a shift back towards 'what keeps you healthy'. And by definition, you're talking about having to intervene with me, in my home, in my community, in my family and my community, and therefore using technology as a modality to help deliver 'the wellness supporting services', the linkages to the right sort of services that head off my risk. And in essence, the way I see the future is what I call almost like, 'cradle to grave,' almost like a profile - these are all of the interventions I need to have that maximise my life expectancy, and my quality of life. And a much better way of assuring that all those interventions are on board. So from my childhood vaccines to making sure I'm using a seatbelt to avoiding exposures with salt, sugar, smoking, whatever, right? All these interventions along the way, including mental health interventions along the way that keep me as healthy as possible for as long as possible. And then when I do need the health system, hopefully there'll be less people who need it. And then those who need it, hopefully will have more access, again, facilitated by technology through whether it's Telemed, or all these other modalities that in brief radically improve access compared to what it is now where I'm expected to go to a fixed facility for the most part. And in particular, in Africa, where some of these distances are literally thousands of kilometres, it doesn't make sense for that to be your only option. So I see a future which is much more balanced in terms of wellness as well as the curative part.

 

Claire  33:47

So really caring for health as the 'healthcare' word says, right? And more in the direction of prevention, so to speak. To make sure that you're taking the right steps to stay healthy and to age healthy as well, because this is something we don't talk about a lot, the population is ageing, and ageing healthy is a big concern, right?

 

Ernest  34:07

When you take something like childhood mortality, right, and children dying of diarrheal diseases, the best intervention is clean water, not medication, right? And if you really want to save lives, make sure people first have clean water. So sometimes it's as simple as that. And so I think, unfortunately, the mindset is still very much, "we'll build hospitals and train paediatricians and buy lots of drugs to treat this"  But we have to also start thinking about the social determinants as well as the curative issues and you have a more balanced equation that maybe you can actually balance as opposed to now. Now we're sort of saying, "let everything go wrong, and then we'll figure out how to mop it up" and we're, we're clearly already failing miserably, and we're gonna fail a lot more miserably and God forbid another COVID or something comes along. I mean, we're really in trouble. So I think COVID should be a wake up call to what we need to start doing right. And we should use it as an opportunity to leapfrog ourselves into better healthcare systems.

 

Claire  35:07

I have an interesting question. I don't know if you really have an answer to this. But something that I observed, and I guess people observed as well, is we speak about global health and global solidarity. And COVID was the first thing at least like I would say, in modern history, where the whole world was affected. But then even though there were some initiatives and some projects to help the countries where vaccines were not produced, we didn't see that solidarity really play out. So my question to both of you is from your experience, you've been working 20 years, especially at large scale projects, what do you think is still needed? Or, how would we get there?

 

Ernest  35:42

COVID, I think we could have easily predicted that it was going to play out that way. We're talking about a global pandemic, where it's life and death matter for everybody, people are going to take care of their own first. So if you're in a position where you can't take care of yourself, you're in big trouble. And this is why I think if you're a leader of a country, or in any leadership position in the country, that’s your job. It’s to make sure that you can take care of your population. And to me COVID is a wake up call for us is that look, this is what is gonna happen again, the next time as well. So this is our chance now to realise you will probably be on your own. So what do you need to do this time to get your act together so that you can actually survive

 

John  36:20

the challenge with humans, I think we're wired evolutionary, to only see the immediate threat. So when the Sabre toothed Tigers coming like you're worried about the Sabre toothed Tiger, as opposed to getting that next meal. And I think that's just the challenge of human nature. And we know eating the sugar, "it's really awesome eating it. And yeah, I might get diabetes in 10 years, but I'm gonna have another slice of cake." And I just think it's human nature. I think people need to realise global health is global health. And global health isn't, you know, it's the LMIC's - the low middle income countries and their stuff, and then we in developed countries are different. It's global, everything is global, by nature, and what happens in Zambia will actually impact what happens in Switzerland in healthcare, but I think the needle is moving.

 

Ernest  37:01

Yeah. And I think the lesson here to me is really understanding if our fates are really tied together, it's really being able to respond in a way that it doesn't become all out mayhem. Because when it's mayhem, people retreat into their boxes, and it's like, "I'm locking down," having a better global response is the way of preventing it descending into all out mayhem. And I think hopefully if we can maintain that appreciation, these seedlings of solidarity can become much more concretised and systematised. And part of our operating system, as opposed to by exception. One of the things I did when I was doing my master's of public health back in the day was just studying emergency responses. And the number one reason why emergency responses usually fail is because the people all of a sudden, who need to work together have never worked together before in that way. And therefore, it very, very quickly disintegrates into chaos and disorder and I think COVID is a template for how we need to now learn and practice to work to keep the vigilance up, keep practising how we work together. Because on the day we have another outbreak, whose phone rings? What do they do? What is the next phone that rings? What do they do, right? That's exactly what determines our response, right? The very practical things that get kicked off, when an emergency actually arises, not theory on a page. It's having your system ready to respond in time. And that means having the relationships, having the working knowledge of each other, having protocols that we've practised, to some extent, so that we're not caught flat-footed, like we saw with COVID. But more important, just maintaining that appreciation for how this can take us all down, and truly take us all down. So therefore, keeping the resources prioritised for this purpose is important.

 

Claire  38:55

Now looking back 20 years, what has this brought to you personally? And where do you see yourself continuing on this journey together? And perhaps if you also have family or children, what do you see yourselves passing along with the work that you're doing?

 

Ernest  39:09

The best part of doing this work is to be able to do it with my best friend, and the fact that we still get along and consider ourselves best friends is quite miraculous as a personal journey, and what better than to wake up every morning and I can work on things that I enjoy working on. And to be doing it with my best friend in life. I definitely see our partnership enduring no matter what. We may, over time, focus on other things and not exactly this. But I definitely feel that we always still continue to be friends and to continue to identify things that need to be done. And our wives are going to look at us and shake their heads again like "oh these guys what are they up to now again?" or "What crazy scheme are they hatching?” and we will run off and do some other interesting adventures as well. It's been a singular, singular honour and a privilege to do this, but also to work with this gentleman here.

 

John  40:06

Likewise, I couldn't imagine doing this journey with anyone else except for Ernest. For me, in the early days of BroadReach, when employees came on board, we used to always give them the book, The Alchemist Paulo Coelho's The Alchemist. And we also gave them From Good To Great. And the whole idea was finding your journey in life, so this idea that our days are numbered, and what we do with those number days matter. And our job and our sole responsibility is to figure out what our path is, along that, so we gave them these two books as sort of guide posts to help encourage people but as Ernest described, it's been a journey for us in self discovery and self development. How we've evolved in the last 20 years, who we are today is completely different from who we were 20 years ago. But it's all been along this theme of discovering our path in life and our journey and supporting each other as soulmates and I would like to think that for our children, that hopefully, we can also be an example that you can find your passion, and find your calling and find your path in life. And hopefully, we can be an example of that to them. Because what a horrible way to live, if you sort of go every day, you know, to a cubicle absolutely miserable, about what you're doing, can't wait till you're done, so that you can go off and do something else that you enjoy. And so I think that for me, it has really been a big takeaway. I mean, it's been awesome to do this and have this impact. But I think first and foremost, it's also been this personal journey of growth and development.

 

Claire  41:39

You just mentioned two books there, The Alchemist and From Good to Great. There's one thing I also like to do at the end of the show is to ask if the guests have any recommendations. It could be books, even a movie, whatever, that you would absolutely want listeners to look into. And would that be something you'd recommend? Or do you have something else to recommend?

 

John  41:58

For me definitely, because I think that The Alchemist really talks about finding your personal path, From Good to Great, so that’s sort of the right brain, and then the left brain is Good To Great, sort of how do we think more analytically and merge that with the journey. So I think for us, that's why those two books were significant in the early days.

 

Ernest  42:15

One newer book that I've read that was life changing, for me, was Thinking Fast and Slow by Daniel Kahneman. So much of what we're talking about is based on people changing their behaviour in some way, and what they believe and what's been wired and that book really sort of makes it clear why it's so difficult to change that, but insights into if you're going to change it, these are some of the things you can begin to do to, to think about how you change how people behave.

 

Claire  42:43

Thank you. So the stage is yours. If you have any parting words, for our listeners, please go ahead.

 

John  42:47

I think for the listeners, especially for those who are students, still, I think, don't give up on your dreams, figure out what it is that you're passionate about that gets you excited, and follow that passion. Because I think life is this amazing journey, if we choose to make it an amazing journey.

 

Ernest  43:04

Along the same theme, I came up through a system that I felt, you know, always tried to put you in a box and asked you to be in a box and people don't understand when you want to go outside that box and do something non traditional, or something different. But I think that's where the journey is, that's where life is, it’s when you break out of those boxes, and really push yourself to follow that journey of your heart. My parting word is, particularly in the world we live in right now, I think we need to appreciate that so much of this is what we're going to make it you know, as humanity. Life is what we make it. It's about the choices we make. And we can make this heaven on earth or we can make it hell on earth. But it's up to us, right? It's not about anybody else, each of us has to make choices. And I think we need so much more just love and compassion and understanding. We just need a lot more of that. And everybody should be more empowered to love and to be understanding and to be more caring to begin changing and turn things around tomorrow if we choose.

 

Claire  44:07

It's been a great pleasure speaking with you both and I hope that our listeners have learned a thing or two about your organisation, about BroadReach group, and also what you've been doing for the past two decades and how you're growing. So thank you very much for your time.

John  44:21

Thanks Claire. 

Ernest  44:22

Thank you so much for having us.

 

Claire  44:30

I met John in the summer of 2022. Little did I know that our brief conversation back then would lead to today's episode. I am truly grateful that both John and Ernest accepted to join me on the podcast to talk about their company. If you are an avid listener of our show you recognise that the majority of our guests are entrepreneurs, in fact, social entrepreneurs. But this is the first time that we heard from global social entrepreneurs with a track record of almost two decades. This just goes to show how change is possible at scale. Find out more about the BroadReach group on their website at broadReachcorporation.com. The link is also available in the show notes. 

Thank you so much for tuning in today. I appreciate you taking the time. This was episode 46, a conversation with Dr. Ernest Darkoh and Dr. John Sargent, on harnessing tech innovation to improve health care. Remember to share this episode with your network and your friends. If you are enjoying our show, we would love to get your five star rating on Spotify. We are always keen on hearing from our audience, so feel free to connect with us through our social handles. You will find us on Instagram at narrativesofpurpose_podcast, on LinkedIn at narrativesofpurposepodcast, and you can leave us a voice message anytime on our website at narratives-of-purpose.podcastpage.io 

Until the next episode, take care of yourselves, stay well, stay healthy and stay inspired. 

 

This podcast was produced by Tom at rustic studios.