Stories You Would tell

This is a talk that I am giving at a conference on technology and innovation, which means that the participants will be young, smart, have twitter accounts, and on the verge of changing the world.   My objectives are to get the audience thinking about the point of innovation and the types of innovation needed in places where people struggle to find work, put food on the table and send their kids to school, usually in this order.  The talk is not a sob story, but certainly a version of a story.  

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"Stories You Would Tell" 

Hello.  My name is Wilson Wang and I am here speaking on behalf of the International Rescue Committee, a medium to large sized non-profit doing emergency response in about forty-six countries across the world, where many cannot or will not.  Our goal is to help people affected by human and natural disasters survive, recover and thrive.

Today I wanted to walk you through a story.  Not tell you a story, but walk you through one.  It starts with the questions:  What is the story of technology, innovation and the Ebola virus in West Africa.  Who are the characters?  What is the plot?  How does it progress?  How does it conclude?  And maybe even, how does it involve you?

What is the story in hard to reach places like West Monrovia depicted on this map, a really poor part of the Capital of Liberia where the average adult earns less than the one dollar a day compared to those in the city center.  It’s October 1, 2014 and there are about 100 Ebola infections a day here, 70% of them fatal. There had already been more deaths from Ebola in Monrovia proper than the entire 35-year world history of this virus combined.  What is the story in a place like West Monrovia when there is no one with pen or paper to tell it?  Places like Hope Community and Struggle Community, which seem to recognize the disadvantage of their inaudible predicament by explicitly stating the need to hope, the prevalence of struggle.  If no one is there to hear the cries of agony or triumph in West Monrovia, what is the story then?

Let’s play a game.  Now that you know the setting, I’m going to give you the scenes and you tell me the story of technology, innovation, and the Ebola virus in West Africa.

Scene I.   This is a picture of a 14-month old child named Emily dying.  The mother walked two days to the hospital to be told that nothing could be done for her child.  She cried silently and we felt horrible but not as much as the mother.  Her daughter died about 10 hours after this picture was taken

Scene II.  This is a picture of health care workers training to take care of patients suspected with Ebola in full PPE or personal protective equipment.  This PPE is good.  You can get Ebola vomited on you and your not going to contract the virus.  The problem is getting the protective gear safely off.  This PPE is hot.  You put it on and you have about 1½ hours before fluid loss from sweat will lead to your collapse.

Scene III.  This is a picture of children dancing.  They are actually performing in front of a lot of “white” people who have given money to support their school.  Anyone in Liberia who is not black is white, which is seriously annoying to us Asians.  Like children everywhere, these children are making the best of their obligation and having a good time

Scene IV.  This is a picture of the medical records room of a typical hospital in Monrovia.  To the right is Augustine Koryon, a nurse helping me with a research study who is figuratively being crushed by this undertaking.  He would complain but I happen to be working with him and I am myself on the verge of tears.  These medical records span 5 years, more or less.  We are reviewing two years of them.

Scene V.  This is a picture of health care workers learning to use Sony Experia waterproof touch-pads running electronic medical records developed in partnership with the IRC and a private company called VecnaCares.  This was fun because the Liberian health workers had never used touchpads before, Liberia never had had an electronic health record and the world an EMR designed specifically for Ebola care and the infection concerns of paper and people rushing to get out of their rubber suits.  This was a challenge because Liberian health workers had never used touch-pads before, Liberia had never had in it an electronic health record and the world an EMR designed specifically for Ebola and the infection concerns of paper and people rushing to get out of their rubber suits.  

All right. I only have 10 minutes of talk time so you have 30 seconds to turn to the person next to you and decide the ordering of the pictures.  There is an answer.

So what did you decide?  By raise of hands, who here thinks they got it?  By raise of hands, who struggled?

I mean the story has to go some way.  How about there was a problem that couldn't be solved doing business as usual. We came up with a solution based on user needs.  The patients thus were served and there was resultant celebration

Or how about in the everyday of post civil war Liberia, there was a tenuous paradoxical mix of joy, disorganization and innovation.  Then came the Ebola virus, which exceeded the capacity of even rubber armies.  As a result, many people died, many of them small children. 

How about this is hopeless.  How about you can’t possibly tell the story if you don’t have more scenes.  I mean in a story, there are a many scenes and these scenes not only happen successively but happen together too.   In fact, a story can only be accurate if there are enough scenes to consider, each scene captured by multiple sets of eyes acting like independent corroborators of the event.  Later, it will be the calibration of the scenes amongst all the viewers that will makes sense of this necessarily collective story reel.  This calibration is not the job of a Director but rather every person who likes to listen to and learn from stories.  This is why one should never watch just one television channel or listen to just one radio station. This is why people shouldn’t watch too many movies by themselves.  It’s suspicious and fraught with bias.  Most stories cannot be understood on first pass.  The point of stories is to be discussed.  

Does this help, even for stories already begun?

If you would allow me, I’m going to cut to the chase and give you my version of the story of technology, innovation, and the Ebola virus in West Africa in Cliff Note form.  For those of you too young to know what are cliff notes, it was the old way you tried to skip reading books for classes in high school when you ran out of time before there was internet. You’re much better off today because cliff notes still made you read a book, it just replaced a 250 page book with a 50 page one.  

So here’s my truncated version, which will be fun to compare with other people’s telling of this story.  It comes in part from having lived in Liberia for two years 2011-12—the setting.  And comes in part from visiting Liberia twice for two months during the Ebola epidemic and listening to my field teams who are the all the time—the scenes.  This story has three chapters

Chapter I.  Liberia before Ebola had grim health statistics and a very rudimentary health system that always seemed on the brink of an emergency-- a fire waiting to happen when you knew the fire stations had little access to water.  15% of children didn’t make it to blow out the candles on their 5 year old birthday cake.  1 out of 100 women died in childbirth.  In the U.S. it’s 1 out of 10,000.  And yet there was hope.  The civil war was over- 7 years in counting.  There had been two peaceful presidential elections.  You just had to look at the face and spirit of children to know that things were on the upswing.

Chapter II.  Then Ebola struck which was complicated because everyone was obsessed with a really scary disease but there were still all the previous diseases to contend with. Diabetes clinics like this one happened ad-hoc, informally and not enough as all the main hospitals and clinics in Monrovia were shut down.  I suppose some health facilities might have stayed open that we didn’t know about, but then they might have been inadequately supported and their sites a place of infection or disease spread too.

The international community decided that it needed to build seventeen 100 bed Ebola Treatment Units to get the sick out of the community where they were a risk to others.  Partners like the IRC were asked to come to the table.  Because we had been in Liberia for over 15 years, we understood that care fundamentally had to be both the same and different with this virus.  We had to have medical records to show that our care met the highest standards of care, even under stress, but we had to make them electronic to control for the risk and fear of infection spread by the paper chart.  We had to work fast but in this case, this meant working with a private company called VecnaCares that had experience with EMR both in terms of software and hardware in an outpatient setting.  We worked hard for 1 month with VecnaCare to alter their system to the context of an Ebola hospital and to add new work flows and requirements.  We went to Liberia to train the staff on the new system and they basically loved it and after three days were ready.

But Chapter III, the Ebola epidemic waned and although we wanted so desperately to open and try out the system and realize one and a half months of medical preparations we concluded that this would not be responsible in light of changing needs.  The IRC decided instead to help reopen the city’s preeminent public hospital, Redemption.   This turned out to be a good strategy because there were many without a place to go seek medical attention and reopening the primary and secondary care facilities was the key to Liberia’s recovery as was reopening its public schools, businesses and institutions—a focus on the realities of the everyday instead of what you planned to do yesterday. 

But with hard work comes opportunity.  The post Ebola world must be vigilant for possible cases of Ebola.  A study of blood samples in 1982 showed that 6% had antibodies against hemorrhagic fever causing viruses including Ebola, meaning that Ebola can be considered endemic to Liberia and flare-ups in the future as in the past inevitable when met with the proper ecological and socioeconomic conditions. So now there is need for high-risk care units for patients who come to the hospital with symptoms consistent with Ebola, who probably don’t have the virus but need to be tested for the virus while being stabilized and treated.  This means we have a perfect setting to use our EMR.  This system is being roll out in Liberia as we speak.  This will be the first EMR in Liberia used in a public facility and what I believe will be the start of more EMR’s in Sub-Saharan Africa and South East Asia for the decades to come for use in the health care system generally.

Stories need not be sensational.  The story of the everyday is plenty interesting so long as we look.  The story of places we have not been to, even Liberia, are not a sob story.  People in other places in the world are not defined by disease, calamity and death despite the characterization.  Other scenes need to be included in the story- Scenes where children play, adults work, families go on picnics, communities progress socially, economically, spiritually.

Stories on paper end.  But, if you think about it, stories in the real world never end.  There is always more.  Each day’s end begins with the rising of the sun.  Even death continues as legacy, lineage, learning, love. This means that if we want, we can insert ourselves into any story we choose.  And having properly invested in the characters and context, we become part of the plot.  The stories that we would want to be a part of in West Africa abound.  I think there is special opportunity for season openers in EMR, rapid bed-side diagnostics, live saving sustainable technologies like infusion pumps and breathing support machines.  Outside of medicine, farmers still irrigate by hand and dig with a hoe.  There are few to no waste water treatment plants, garbage is strewn along the edges of rivers and beaches.  Internet is spotty.  It takes 4 hours to go 50 miles along gruesome muddy or rock-hard pot-hole laden roads.

I hope in this talk I have reinforced how and it is interesting and fulfilling this story-book like participation even when linked to the economies of healthcare, education, and public health.  Of course participation is not enough. You make sure you’re part of a good plot-line by constantly checking your focus and by considering the multitude of views that ultimately comprise stories worth telling.

Thank you.