 Good evening, everybody. I'd like to start by welcoming you all to this evening's presentation, Life and Death in Colophonum, an American doctor in Africa. I would also like to thank the Green Mountain Matern Peace Corps Association, a global health program at the Museum, Warner College of Medicine, and Western Connecticut Health Network, and Dayard Detach Attack for sponsoring this evening's presentation. And finally, my gratitude to you all, the audience, for your attendance here tonight to learn more about Dr. Einstein's important work in international development and global health, and for thinking beyond the borders of the Green Mountain State. In John L. Kennedy's inaugural address in 1961, he famously uttered these words that inspired the generation and beyond. He said, and so my fellow Americans, ask not what your country can do for you. Ask what you can do for your country. My fellow citizens of the world, ask not what America will do for you, and what together we can do for the freedom of man. Finally, whether you are citizens of America or citizens of the world, ask of us the same high standards of strength and sacrifice which we ask of you. For the good conscience, our only show of reward and history, the final judge of our deeds, let us go forward to lead the land we love. In this speech, President Kennedy asked Americans to engage, to be citizens of the world, to create impact, to lead, and to build bridges in America and abroad. This calling is still very timely today. Having grown up in a large religious family dedicated to being of service to others, Dr. Einstein's heard this clarity called clearly. In 1974, she left for Niger to teach English as a Peace Corps volunteer. Her time as a volunteer was sportive. Her firsthand experience with extreme poverty and the heartache of human suffering, particularly as evidenced through family drought in her village, allowed her to pursue her illustrious career in Monson. In 1982, she graduated from McGill University with her MD in Seattle, and Dr. Melsen a Master of Surgery degrees. She later went on to prepare her Master's in Public Health and Tropical Medicine from Tulane University. Her training and education prepared her for work for over 30 years in some of the most underserved communities in Africa. Her early work was in Nakhon, Nigeria, where she managed a 50-bed hospital in the village. Most recently, she was the medical coordinator for the Ebola treatment team in Buchanan, Liberia during the 2014 epidemic, and I say at least one of her colleagues sitting in the front there. We'll see her at the end of the day. Her most prolific work in Mobile Health and International Development Program came in Colophane, Canada, where she served for 24 years as the district medical officer for 131,000 people on the Nigerian-Kameranian border. She remained here until the insurgencies of Boko Mara did not allow her safe return to Colophane. The criteria for her posting in Colophane was both every block in real and unmet need for a doctor and a community that could provide housing. She soon discovered that Colophane was a perfect match. She committed to an initial two-year assignment and with a one-way ticket and a $250-a-month stipend hand, she set off to the South Island, 3,000 kilometers in three days' travel north from the countless of the all-day Rilla Hospital. In 1990, when she arrived, she found a clinic that was corrupt, a biohazard, a recent expensive waste kit that was provided likely unnecessary treatment. Those are my harsh words, not hers. More eloquently, she described the 90s-era Colophane as a place for civil servants who had caused trouble elsewhere when posted to Colophane as a punishment. Schools were generally scored, languages were multiple, daytime temperatures during the three-month hot season covered around 115 degrees in the shade. Children were unvaccinated, tropical diseases and the diseases of poverty were among them. The district had no paved roads, no electricity, or running water, no telephone or post office, no hospital, no doctor. She goes on to say in her book in the namesake of this presentation like in Article 5 of the American Doctorate in Africa, near as I can tell most people, particularly the children, have in the state of almost continual ill health, which is more or less accepted as a matter. The need for medicines and understanding among the health professionals of how to use them is a key. The government hospitals cannot serve the poor as they are now set up in the poverty as a red chain. People barely eat out of living from the dust. Whole villages are populated by emaciated children and adults. A patient may scrape together enough money for a day or two is worth a treatment. But not a whole week's worth, not a little more. Prescriptions for useless medicines are dulled out and the ignorant sick have no way of knowing which are truly needed for care and which are first left. From that dubious starting point, she built a sustainable and economically solvent hospital that has remained operational, even today, in the face of bombardments and attacks from local problems since 2015. Her vision to create a primary health care center for all aspects of the World Health Organization of hospital of primary care that could be applied in both preventive and curative cases was resoundingly successful. She ended up creating a 10 hectare, 13 pavilion hospital, 120 beds, where approximately 150 patients were treated daily, very often had their cataracts surgically removed every day. The hospital now includes a children's ward, an x-ray machine and ultrasound, a pathologist about orders, a surgical unit, a maternity and female medical ward, an isolation ward, and there's also a robust vaccination and wish-care pain for the hospital rats. She supervised and trained 120 medical, paramedical and support staff in six cortical hospitals in one district hospital. She also conducted six trainings a year for medical personnel, all the while doing that very small task. She also continued to publish over 50 scientific journal articles in the lands of the universe. Because of her efforts, she was decorated twice by the government in Cameroon, first as officer of the Cameroonian Order of Merits and subsequently as Knight of the National Order of Valor. And this year, she received the Astor Poem Well-Dried Award from the American Medical Women's Association for her work in international health. After 24 years of living, global health care nation as a community development projects, all a lot of lives transformed. Medically, measles, polio, metacoccal meningitis, neonatal tennis, leprosy, bidding work and charcoal have disappeared from the district. Girls grossly increased their enrollment in school and 51 primary schools were built in the area. The Center for Role Women's Development hosted daily classes and had a chicken husband program. Several secondary schools, including one for technical training were built and infrastructure improvements occurred throughout the town including the installation of cell phone towers, bridges and boreholes for women. On top of all of her responsibilities, she also guided countless medical residents and interns in their rotations and tropical medicine over the years. She mentored eight key square volunteers in their rural development work and helped in sustainable agriculture. When I arrived as the first key square volunteer ever in Palo Alto, I didn't yet understand the cultural landscape or the actual task of doing my job in the woods. In response, Dr. Ellen definitely steered me towards the hospital polio vaccination campaign that was privileged to vaccinate 1,000 local children. She encouraged me to instruct elementary age girls who didn't have the opportunity to go to school at the Women's Economic Development Center. She opened up the hospital grounds to me to conduct trainings and seminars with waiting patients. And when I, too, invariably succumbed to malaria and the maybe dysentery, she kept me healthy and productive. As a key square volunteer who served with academic influence in Colofara, I am astounded and inspired by the extraordinary impact she's had and continues to have in this small African community. Her passion and her belief in serving other sentient beings and approving their health and well-being is unparalleled. And for that is my great honor and privilege to present Dr. Ellen Meichertz today to speak to your honor, to speak to you, of her experiences, and what everything you're working on for now. Can you hear me? Yeah, okay, good evening. And thank you very much, Wendy, for that lovely, long introduction. All tallied, I lived for 33 years in West and Central Africa, most of that in the Sahel, that band of land right under the Sahara Desert. Most of the countries in the Sahel are very hot. And my body got so used to that heat that even now, three years later, I cringe when the temperature drops under 90. When it gets under 80, I reach for my scarf and gloves. I kid you not. So you can imagine my concern when Wendy asked me to come and I read that Vermont is the seventh coldest state in the union. I looked it up. It turns out that people love to talk about your seasons. Four of them, right? Almost winter, winter, still winter, road construction. Or two of them, winter and the fourth of July. Nine months winter, three months, not very good sledding. On it on. I'm happy to say that I found it not quite that bad. I studied at McGill University in Montreal, all of it undergraduate, medical school, postgraduate training. So I would think that I'd be used to the cold and I guess at some point I was. For students at McGill, Vermont was Mecca. There's a favorable exchange rate back then. No tariffs back then. So cheap goods, passportless travel back then. American TV, midterm breaks and long weekends always saw a mass exodus of students from the dorms on University Street down to the marvelous, magical Burlington. Overly bookish, generally broke. I never made it to Vermont during my many years in Montreal, so this is a treat. And I'm grateful to Wendy Rice, to the University of Vermont Medical Center, to Tetra Tech, to the Return Peace Corps volunteers and to all of you for this chance to be with you tonight. To talk with you about refugees and global health and to share with you some of my experiences as a frontline doctor in Africa. Since leaving, I work a lot with refugees now, so that's why I'm gonna talk to you about refugees as well. But before I do, just a nod to Sonexelence, her excellency, Wendy Rice. I hope I'm not embarrassing her too much here when I tell you that for one shining moment, Wendy was the US ambassador to Cameroon. We had just built our women's education center, a sort of school for girls and women who had not had the chance to go to school. And for its inauguration, our local town authorities had planned a pomp filled ceremony. The American ambassador and the Canadian High Commissioner promising to be among the invited guests and participants. The problem was that this was October, 2001. And you all know what happened in September of that year. Because of 9-11 and our subsequent invasion of Afghanistan in the days preceding our planned inauguration, American ambassadors in many places that October were more or less confined to their embassies. And certainly, if it could be avoided, they were not venturing into the more Muslim parts of their countries as ours was. So at the last minute, the American ambassador sent her regrets, asked PCV Wendy Rice as the most senior employee of the United States government for miles around to step up and fill in. And she did. She delivered a spot on ambassadorial address, had a beautiful blue outfit. I remember it to this day. Played her part with perfect panache and made us all proud. Your fellow New Englander, John Fitzgerald Kennedy, was fond of the aphorism that a rising tide lifts all boats. Like many, he believed that when underlying conditions improve, then everyone is raised up. This is a goal of global health. And although we probably come at it from a variety of different angles, my guess is that most of us in this room today aspire to raise the tide with the aim of lifting all boats. Kennedy's critics were quick to point out that not everyone has a boat. And without a boat, in a rising tide, you drown. We're going to see more boats in a little while, so I'll ask you just to hold on to that thought for now, and we'll come back to it. I started working in Africa in 1974. That will seem like a long time ago to a few of you. But to me, it was yesterday. I remember well the heat that hit like a furnace blast when I stepped off that plane. The smells of smoking wood, and of onions frying in hot palm oil. I remember the sand everywhere, and all along the roads at night, in that capital city in which we landed, lines of little orange cooking fires set by the thousands of thin, hungry, homeless, internally displaced people, men, women, and children, who had migrated down from the Sahara to seek refuge from an historic, devastating famine. The term global health had not yet been invented when I started doing it. But it ended up occupying the better part of my life and bringing me to some of the most impoverished parts of Africa. Over these next few minutes, I will try to explain to you in a way that I hope is not too round about, what led me and kept me there. In years of grave famine, grave drought leading to grave famine, in northern Cameroon, during the most difficult months after the millet has run out and before the okra is yet ripe, people resort to eating wild plants and insects, whatever can be foraged. But during the hottest, driest season, when the ground is grassless dust and the more edible six-legged species are burrowed invisibly away, the hungry must find other sources of sustenance. One of these is cattle manure. At such times, people roam the countryside, collecting buckets full of dried dung. They pile the patties onto a fire, let it burn, and then spoon the cinders into a clay pot whose bottom has been punched with holes. Boiling water is poured over the ash and the bullion collected from the strained drips is mixed with dried leaves or petals. Ample seasoning and a slow simmer follow and with that, a savory stew is set to serve for the evening meal. Although it might be quite delectable and not entirely devoid of nutritional value, I have never knowingly dined on dung. I hope I never do, but it is helpful for me to know that there are people who must. For ignorance, not knowing, not knowing about things like this is blinding and can lead us as individuals and as a country to make terrible decisions. I went to medical school, yearning to become a doctor in some hard-scrabble place like the one I had served as a Peace Corps teacher in rural Niger. Some place where life was at its most elemental and fragile and where a doctor could bring hope. Three insoluble problems or conundrums or mysteries made this choice as clear to me as a mountain stream above the treeline. Some friends said to me, but we have our own poor on our own shores. Let's look after them and leave other people elsewhere to look after the rest. The children in distant lands dying of hunger. The parents fleeing persecution. The women trapped by oppression. The teenagers gobbled up by war. We owe them nothing. Let other people take care of them. My first problem or conundrum or mystery always was that I could not ever figure out who these other people were who were supposed to be doing the caring or what made me not one of them. On a hot, breathless night during my first months in Cameroon before our hospital was yet up and running, I took a woman into my home. She was in her late 30s, maybe 40. Two days earlier, she had delivered her 18th and 19th children prematurely on the dirt floor of her thatch roof mudbrick hut. Both babies had died. In fact, of her 19 children, only one, a nine-year-old boy was still alive. The others had passed at different ages, a week, nine months, three years. The living boy had sickle cell anemia and in rural Africa, nine is a ripe old age for a sickler. And already his eyes were yellow where they should have been white and white where they should have been pink. The woman was tired, exhausted, spent as if her whole life had flowed from her. All of it right down to these last two tiny premature drops. I think that if that woman were among us today, right here where we could see her, her cheeks tear-stained, her hands calloused and cracked, her cloth faded to an indeterminate color, patched and torn. I think there's not a person in this room who would not offer her a word of encouragement, an outstretched hand, a piece of bread. We would not close our doors to her or deny her food, shelter or medical help for her son. We would not turn away, we would not turn her away. If we saw her, we would not do any of these things. So my second problem always was realizing that it could not possibly make any difference, whether that exhausted woman or any woman like her was here beside me or was across the room or across the street or across the ocean she was. She was in desperate need of someone to offer help. And not only could I do that, but I could not not do that. Abba was a seven-year-old boy, brought to our hospital one late November morning. His body slung over the back of a donkey. A teenage boy walked on either side. I would learn that the three were brothers whose mother had died soon after Abba was born. Their father died a few years after that so they had been on their own for a while. I watched out my consulting room window as the older boys lifted Abba from the donkey and I could tell already from the way the back of Abba's head nestled between his shoulder blades that the culprit was going to turn out to be meningitis. The brothers carried Abba into my room, set him on the examining table and then stood erects and laconic at his side. As I questioned them and examined their young sibling, the boy's skin was fiery hot, his breathing was rapid and labored, he was so thin his skeleton could be traced and raw source had worn through at both hips. I wrote up orders and called health workers to convey Abba to the ward while the brothers went to the hospital pharmacy to collect medicines and materials needed to start treatment. Once satisfied that everything was being done that could be done, I resumed seeing other patients. About half an hour later, I happened to look up out my window into the courtyard and I was stunned to see the older brother untieing the donkey from its tether and leading it over to the door of the ward. The boy entered and seconds later he came out again bearing his ailing sibling in his arms. I jumped out of my chair, rushed outside to ask what was going on. We are going home, the older boy answered, eyes downcast. A quick inquiry revealed that the bill for Abba's treatment had come to the equivalent of nearly $12 and for this family, $12 to save the life of a seven-year-old was out of reach. The brothers explained that they would go to market on Saturday, three days away, sell their millet and then they would come back. I tried to have them understand that without treatment Abba would not make it to Saturday. Our hospital, which depended in part on patient fees to stay open, had a system for these kinds of cases. The system wreaked havoc for the person doing our accounts but when patients or families were unable to make a payment upfront, we let them leave something in-hoc. A string of beads, a piece of cloth, an old watch and then redeem it however they could over time. I offered this option to the boys. The two older brothers withdrew to talk it over and I, fearing we were going to end up with a pond donkey, started to calculate whether it would cost us more to feed the animal than it would cost to treat Abba's meningitis. Fortunately, I needn't have worried for the middle brother disappeared and a few minutes later came lumbering back, trailing a seatless, rimless, breakless bicycle that we took in-hoc instead. Abba was treated, recovered and a week later was discharged well. In the scheme of things, his seven-year-old life had the value of a sack of grain. What kind of world, I asked myself as I watched the threesome and their donkey dwindle down our hill, what kind of world do we live in and how can we, the rich and powerful, accept a world where the life of a seven-year-old boy has the value of a sack of grain. And I wondered how I would feel if that boy were my cousin or my brother or my son. That was my third problem and it kept me in Africa doing the work that I did for over three decades. I always considered myself the luckiest doctor on earth to have that privilege, which was for me a source, a font of never-ending challenge, enchantment and joy. Back in the 70s, one of the tasks the Peace Corps asked us to undertake before we were shipped out was to read the book The Ugly American. I don't know if volunteers still do that, but they should and I did and the novel impressed me immensely. Published in 1958 and set in a fictionalized Southeast Asian country, the book was critical of America's typically brazen, big project diplomacy and are typically brazen, self-important diplomats while being admiring of down-to-earth, unattractive, you might call him ugly American, who was exceptional in that he had gone to the trouble of learning the local language and culture of the country in which he lived and worked. Senator John Kennedy was so moved by the book that he gave a copy of it to each of his Senate colleagues and then used it for inspiration when two months after his inauguration as president he created the Peace Corps. By insisting that we get some grasp on the language and culture before stepping foot in our village, Peace Corps reinforced the notion that only by being immersed in a community could we hope to begin to understand it and to contribute meaningfully to it. Once in our village then we were respected all the more for that, however, bumbling our efforts and that dictum that learning a language was always a necessary first step stayed with me and in later years when I went to a new place I would keep a small notebook in my pocket and pull it out as I walked around town and men playing cards under trees and women pounding millet in courtyards knew that when the notebook came out they would be asked to teach me some new word or phrase. This would cause them to laugh with splendid mirth that a skinny, bespectacled white woman from a far away place and a doctor no less wanted to learn something from them. I work now on a team that provides newly arrived refugees from war torn countries their first encounter with American healthcare. Most of the people we serve have lived through horrendous tragedy. In Cameroon after the arrival of Boko Haram I saw the plight of refugees from the other end as we cared for victims of bombs and burned villages for people, families who had fled for their lives with whatever they could carry on their backs and on their heads and with whichever of their children they could find in the smoldering, terrifying chaos. Witnessing them trek in their weary, bedraggled lines from over the border into our village always left me reflecting on how only the randomness of our respective parents nationalities had given me from birth a life of luxury and by luxury I don't mean monetary wealth but the luxuries of freedom, peace, opportunity, enough food to eat and them lives of such deprivation and pain. I had done no more to deserve that luxury than they had done to deserve that pain by a chance bordering of the universe, a quirk of citizenship and geography over which none of us had any control. They had drawn the short straw, I and most of you had drawn the long and found ourselves surrounded all our lives by pirate chests brimming with glittering treasure. It's really hard to see how our wellbeing or the wellbeing of our world is best served by hoarding that inestimable good fortune. I find in speaking even with highly educated Americans there is a lot of confusion around the words immigrant, refugee, asylum, asylum seeker. An internally displaced person first of all is a person who has been forced to leave his or her home but has stayed within the confines of the borders of their own country. An immigrant is someone who has left their country with the intention of going to another country to live permanently. It is a very broad term and compasses a bunch of different kinds of people who have come, who have been foreign born and are now living in another country. But in common everyday parlance the word immigrant is often taken to mean economic migrants, somebody who decided, who chose to leave their country to come to another one in order to better themselves or to have a better chance for their family at an easier life. A refugee is a very specific kind of immigrant and there is a definition that has been accepted by the United Nations and most countries of the world. It's very particular and it has to do with someone who has been forced to flee so there is no voluntary aspect to it. They have been forced to flee if they wanted to stay safe and alive. They have been forced to flee their country because of a well-founded fear of persecution in that country based on these factors, race, religion, nationality, political opinion and or membership in a particular group. The two main operative words here are flee and persecution. They have to have fled their country. They had no choice in this and because of persecution. And a government, their own government either unable or unwilling to protect them. Most refugees go first, they flee first obviously to whatever country is right next to them. So a Somali will flee to Kenya, a Congolese will flee to Uganda, whatever country is right next to them and they seek first asylum there. Often in those countries they are put in a refugee camp. It is while they're in that country that they apply to the United Nations for refugee status and the United Nations is the one that designates this person as an internationally recognized refugee or not. An asylum seeker is someone who comes for example to the United States, not as a refugee but comes on some other visa, student visa or a work visa or a tourist visa. And while here claims if I go back to my country I will be persecuted and in danger, unable to be protected by my own country. So they apply then for asylum status. If it is granted they become asylees and in the United States are given almost all the same rights and responsibilities as a refugee. A few unfun facts. There are 68 and a half million people who are displaced from their homes in the world. And of these 28 and a half are living as refugees, asylees or asylum seekers that is outside their own countries. Most refugees are living in low income countries. Often we think that refugees are, they're mostly in Europe and United States or whatever but the Europe and United States has a minority of refugees. Most are living in dirt poor countries. Two thirds of them are living in those four, Turkey, Bangladesh, Uganda and Sudan. Numbers are very difficult to imagine and you get that big, they're meaningless. So it is helpful sometimes to put them in other terms. If you put all the world's refugees into, all the world's displaced people into row boats such that each boat exceeds its maximum three times. You can line the boats up from Damascus to New York and you'd still have over 700,000 boats left. Or if we come closer to home and you look at Centennial Field, everybody knows what Centennial Field is, right? I had to discover it. You can fill Centennial Field, every single seat in Centennial Field, every single day, 365 days a year. You put people in and you take them out. The next day you put more people in, you take them out. More people in, you take them out. You can do that for more than 17 years, 17 years of doing that before you're able to seat all of the world's refugees, not displaced people but refugees. The problem is huge. Antonio Gutierrez, who used to be the head of UNHCR, High Commission for Refugees, now as head of United Nations. While every refugee's story is different and they're anguished personal, they all share a common thread of uncommon courage. The courage not only to survive and to persevere and rebuild, not only to survive but to persevere and rebuild their shattered lives. And it's a huge privilege and pleasure to be working with refugees now. I see this every single day. They are incredible people, the refugees who come into this country. The international community has identified three what are called durable solutions to refugees. So you have these millions and millions of people who are refugees in different countries, displaced outside of their own country and there are three things, three possible solutions that will get them out of this stateless state of limbo. One of them is voluntary repatriation, that is they could eventually go back to their own home. The second is local integration, that is they could go become integrated, accepted as part of the society of whatever country they have fled into, Somali into Kenya for example, given the rights and responsibilities of a Kenyan citizen or they can be resettled. Almost all refugees want the first solution. They don't wanna leave their country, they wanna go back to where they came from, they wanna go back to their homes. The problem is that most of these conflicts are not conflicts that last for a year or two, they last for many years, often they last for decades and once refugees have left their country, what they're leaving behind has been burned, destroyed, taken over by other people, there's often very little to go back to. Local integration, well you've seen how well that's worked in the United States, which is a rich country and yet when refugees or asylum seekers come and want to integrate into our own country, how much difficulty we have, we say that they're gonna be problem, they're gonna take our jobs and so on and how much more of a problem is that going to be in poor countries? How many refugees can a country like Kenya really absorb or a country like Uganda, how much can they really absorb before their own economy starts to suffer? Resettlement is a last resort and a resettlement is where refugees go into a third country, so they've gone to a first country of asylum, they've been designated as a refugee by the International United Nations and then there are 35 countries in the world that will accept a certain number of these refugees for permanent resettlement in their own country and the United States has always been a leader among these 35 countries. We say come in, we will give you some help for a while and we will put you on a path to permanent residency and citizenship. That's resettlement. There's always a concern about security and that's a very legitimate concern. If a country is going to be accepting foreigners, it's reasonable, especially if they're coming from conflict-ridden society, it's reasonable for countries to say, well, how can I be sure that you are not gonna bring those problems into my country? So are refugees bedded before they come to the United States? Well, yes, of course they are. And how do we do it? Do we give them a piece of paper and we say you check, yes, if you're a terrorist, you check no, if you're not, and as long as you check no, we'll let you come in, no, we don't do that, we do a little more than that. Well, do we look at them and we say you look like a dangerous character, we're not gonna take you or you look okay, yeah, we'll take you? No, we do a little bit more than that. In fact, refugees go through more than 20 different steps before they are bedded from a security standpoint. I think there are six different government departments that are involved and it takes years. It takes years for them to get through this and every time they get through one step, there's an expiry date on all those documents so that if they don't get through all these other steps in time, certain documents are gonna expire and they're gonna have to go back to the beginning of the queue and start all over again. So refugees are bedded far, far, far, far more than any other person coming to the United States. We don't look compared to this, we don't look twice at immigrants, we don't look twice at people coming on tourist visas, people who come on work visas, people, refugees, it takes them years to get through the gamut of bedding. Last year, it was decided that these 21 steps were not enough, that we really needed to add a few more steps. Those 21 steps, by the way, they've been in place for decades, that's nothing new. What's new since last year is these. We've increased, we're taking even more data than we did before, going through all their social media accounts and so on, going back generations into their family to see if there's any suspicion of foul play, more information sharing among the different law enforcement agencies and people who interview the refugees are being better trained to spot inconsistencies in refugees' stories. If a refugee doesn't tell exactly the same story every time or if a husband tells story and the wife's version is a little bit different that now gets spotted as an inconsistency and reason to suspect that something's going on. There is an international legal framework for the protection of refugees going back to 1948. These have been signed by most of the countries of the world and the United States is among those who have signed them, saying that we recognize that the refugee problem is a problem that belongs to all of us. It doesn't belong just to the neighbors of the countries that are in conflict, that when it could happen anywhere and we as an international community understand that we have some responsibility in taking care of people who are or protecting people who are caught in this kind of bind. These protections include respecting the principle of non-refoulement, which means non-refoulement not sending back. Literally it's a French word, means not to send back. It means that if somebody comes to the border of your country, and this is any country in the world who has signed these agreements, the person comes to the border of your country and says that I have been persecuted in my country. He has every legal right to enter your country. And it's up to you then to decide or to listen to the plea and decide whether it is true or not. We have said that we are responsible for admitting these people in a safe way to ensuring fair access to fair procedures, humane standards of treatment, and to implementing and to trying our best to implement at least one of the durable solutions. So how are we doing? The durable solutions again, voluntary, patriation, local integration, and resettlement. Fewer than 3% of refugees find one of these solutions. The UNHCR has determined that for the calendar year 2019, there are going to be a need for 1.4 million places for refugees needing resettlement. 1.4 million, that's a lot, but it's not a lot when you look at the number of refugees in the world. It's really a very small percentage. They're saying we need, we have no other solution for these 1.4 million people unless they can be resettled. And the 35 countries in the world who are willing to take refugees for resettlement are expected, all 35 of them together to provide places for 75,000. So how are we doing? Well, sometimes cartoonists speak more eloquently than essayists. Sometimes I think our fear of refugees is fear of our own shadow as we remember what the first refugees to this country did to the indigenous population. My last boat slide, I promise you. And this went a big ship in the middle of the ocean and a uniform captain standing on the bow leaning over the railing, calling out, where are you from? Far below his bow, a rowboat filled with people. So jam-packed, their heads look like kernels of corn on a cob. They are clearly migrants, refugees from some situation so dire they were willing to be stuffed into a rickety rowboat and face near certain calamity on the open sea. So where are you from? Captain shouts and someone from within the depth of the boat calls out, earth. In other words, we are all in this complicated world together. I get asked sometimes what is the best field of study for someone interested in global health or international development in places of great need? And the list of options is endless because the issue is less one of technicity than one of willingness to do it. Business people, lawyers, engineers, environmentalist doctors, writers, artists, nurses, teachers. Everyone with a passion for making the world a better place has a role to play and a road to take. Peace Corps set up the bridge for me. I walked across it and then I just kept on going, never overly concerned when the course ahead seemed to disappear. Another of your wonderful New Englanders, Emerson, said or advised us not to worry if the way ahead is not always evident. In fact, he said, do not go where the path may lead, go instead where there is no path and leave a trail. We are all in this complicated world together. As surely as all boats are raised by a rising tide, all will be pulled under if the millions who have no boat go down. Ensuring that everyone has a boat maybe beyond us, maybe beyond even the most ardent global health enthusiast, but ensuring that everyone has access to a boat is most definitely not. Global health is everything that goes into ensuring access to health for all. We may do it in some far off part of the globe or we may do it in that part of the globe we call our own backyard, but whenever we make life better for someone else, we help make life better for all. Thank you very much. How many time for questions from the audience? It depends on what you mean by interaction. I've spoken there. I've been involved in programs that they have funded. They usually fund huge programs by just a part of it. What was the most shocking thing that I saw? I suppose the most shocking things that I saw were the things that happened at the end of my stay in Kuala Fata when we were being troubled by Boko Haram and the attacks on the people and the decapitations and suicide bombs and that sort of thing. If that's what you mean by shocking. On a social level, the most shocking thing I guess was the corruption and the all-pervasiveness of the corruption which maybe shocking isn't the word because you're so used to it, it's been tiresome. You're never ending this up. I was just wondering if you could tell me about these corruption in Niger and then going back to Niger since... I haven't gone back to Niger since I left. So I can't really speak to that. I only know what I read. Obviously, Niger is still suffering greatly. It has gone through periods when it looked like it was going to make some great improvements and Boko Haram has had a big effect on that country particularly out towards the eastern side of the country and it's set things back. It's a tough place. Thank you so much. I'm from Niger. From? In the right hand of Poland. Do you remember Poland? Yes. So I'd like us to thank you because in this sacred job I remember when I was in a physician because back home when we were... we were done with medical school in the same way that you were practicing in the village so you need to learn, you need to practice a lot. I'm so used to being in my favorite language. So I remember when I was in the village so my parents were not involved. I looked very hard. I think one day when I went to the hospital after doing like three centuries a physician's session for a physician and when I went back home I opened my bedroom. I found one pizza, a snake. So imagine what's happened. So I know they went to help a physician to understand how the world... because when a student finished class here they have a lot of materials so they can practice easily back home very very very difficult and it was hard for some physicians that didn't practice the dance so they moved to South Africa, in Kanchana so one day we found a physician from Poland who had practiced very very well so I got just a friend who was very very good at this so everybody needed to make something to change the world. So here I am a student in Park Health I think my goal is if I'm done with a program make sure I handle those things I can sometimes get the used equipment to bring back home because sometimes it's happened while you are doing the surgery you have only one clothes so imagine what's happened it was not very simple but in my people I'm in here because I work at a hotel I have a lot of energy so it's very very important. Thank you, thank you. I had a story it reminds me of... I had a Congolese surgeon working with me for many years and during the first months of his stay in Colofata, my town he also came down from the hospital into his home and found a snake in his house and he panicked really seriously he was on the phone and we were so I don't... I mean snakes were pretty common and Colofata were used to snakes but maybe the Congolese snake. As a student I need to go into medicine and I need to go into humanitarian aid do you have any words of advice? Do it. What else can I say? Do it. And once it gets in your blood it doesn't get out. Which is a good thing. I want to start off by saying I'm an aging analyst and there are some students here who are interested in Peace Corps and I'm going to be a Peace Corps volunteer and I would love to speak with you which is a lot of people and I'm starting to position there and I'm going to be a part of it. All of this today I know that sometimes some of my experiences and some of my experiences are a little bit historical but I also I'm very careful to explain my feelings and I'm not going to be here because I'm not sure if it's going to be there or if it's going to be there in the back and so all of this has to be one of some aspects of the culture that I'm going to be in and I'm going to be a part of it and I'm going to say it I am much more attracted to people than I am to animals or land so Cameron is a beautiful place and we do have game reserves and that sort of thing but it's the people that I just they fascinate me endlessly just their whole way of looking at life which is so different from ours and I never stopped learning probably just had so much to teach me about life and living that I really prize and they love to laugh just nice being with them even when they're suffering they have a sense of humor and a sense of down to earth and realistic and accepting and they don't complain and they don't expect a lot and they just want to get on with life they want to take care of their families and it's just very refreshing that's what I love most and this one two questions 33 I'm wondering we've been back in the States for a few years now three years first I was wondering what your transition happened in the States after being involved for so long second I'm wondering if you still are involved with your work and do you still go back in front of that and are you definitely involved with your work? I'm still very much involved in Kola Fata I'm in touch with them every week anyway still have people supporting their the hospital the hospital in spite of being overrun by this conflict the hospital has kind of been a steady presence to you at all it's never shut its doors and it's still going strong so we're still supporting that as much as we can and other things going on in that part of camera as well transition you know to this day I still literally get a thrill when I flip a switch and a light comes on I can't get used to that or a turn of tap and the water just comes out you don't even have to wonder is it going to come out or is it just going to come out and so that I don't know if that'll ever go but I still do I think wow so that's been nice our politics are a little bit more is something difficult for me to get used to because it doesn't die with what I thought America was for all those years and I don't know whether that's because things have changed here or because I was living under a cloud elsewhere so that's been a little bit hard for me to get used to to kind of mesh that with what I always thought we were are you trying to involve with refugees in America? so that's what I I work with refugees not I work with resettlement agencies but I'm not employed by them I work with a local health department so we are the ones who take care of the refugees from a health point of view for the first first few months of what they're right on are you doing this nationally or are you doing it with with refugees? yes locally in my own community very in county Indianapolis, Indiana and you have not only with this passion and this work and you just you just you just have to you just have to you just have to you just have to you just have to you just have to you just have to so it's Thank you that's so nice Your raise for your hotel your poetic way of speaking it's just beautiful and if you can raise really important to a more if you that what is the difference between being born here to unfortunate a way of dial and some ed or they don't have the same opportunities reflect that out a little bit more and just talk about, for those folks that aren't engaging in global development or both managerial work as a career, how to think about what we can do. Righto check is obviously what we think about doing. Many of us don't write a check and forego that with coffee at the same time. I think the first thing that we have to do as Americans is educate ourselves. My impression was that when a lot of these terrible things came down against refugees at a national level, the people who were making these pronouncements didn't even know what a refugee was. And I think a lot of our politicians, in fact I know a lot of our politicians, I've spoken with some of them, maybe they do now, but certainly when this is all going on, they didn't know what a refugee was. Imagine people sitting up there representing us and they don't even know what a refugee is. So we have to educate ourselves. We have to vote. Those are the two main things, I think, because America should be doing so much good in the world. Yeah, and it's up to each and every one of us whether we're over there doing it, whether we're here supporting those who do it. It's all the same. But we have a huge, huge, huge moral responsibility. And any of you who have worked in poor countries, you know how America is seen by poor people. I mean, there are those who denigrate it, but there are those who look up to it. And I would say that that is far more common. They look to the United States for moral direction. You know, and everything else, every other country is doing stupid things. They say, well, depends on what America is going to do. And we have some weight in the world. And we swander a lot of, a lot of that. Hi, thank you for being here. I just wanted to also sort of piggyback what you were saying about PISCOR. And I was a PISCOR volunteer back in the 80s. And PISCOR has a wonderful another program for PISCOR Response Volunteers. And this is for professionals who are already working in medical positions or with therapists or sorts of positions. So when you're commitment, PISCOR is for a good career. So there are some things that you can do. You don't even have to admit a PISCOR volunteer to be a PISCOR Response Volunteer. And I guess I would just also say that for those of you who are my demographic, we also can send our kids off to PISCOR. So lots that we can do. PISCOR is amazing. I don't know if it's the people who go into PISCOR who are amazing or PISCOR does something to you. But if you look around at the people in governments, people in public health, people in universities, how many of them have been in PISCOR. And they remain socially engaged. Again, I don't know if that's because it's the kind of person who goes into PISCOR in the first place or you get that into your blood and you can't let go of it. There's an engagement, a commitment that comes out of that experience, I think, that is very beneficial to our country. So more people should go into PISCOR. Even though you talked about the level of correction, I'm wondering how you actually accomplished maybe a lot of what you were able to say about the level of correction. Boy. Just keep putting one foot in front of the other and just keep going. That's all. And you don't give into the corruption, which is very difficult and it puts roadblocks in your way sometimes. But you don't give into it. Eventually you get known as somebody who will not go along with that system and that is helpful. But at the beginning it's tough because of that. People expect you to pay up just like everybody else has paid up. And if you don't, you're punished for it. But stick to your guns. I think Serena is playing. Thank you. Okay. I'm wondering how they gave up the corruption and the challenges that you faced. Surely there must have been moments or three decades where you felt frustrated and I'll use the word jaded. What was it in you that helped you put one foot forward? Where did you find strength to overcome that? That's an easy question. Anytime I got like that and I got like that a lot. I would go find a baby. A little patient who was suffering and needed help that had been helped or something and that made all that go away instantly. You find a baby. Good evening everyone. I just wanted to say thank you to Ella and then just listening to you working with you three years ago now. I didn't know a lot of this but just listening to you talking the last hour really gave me hope for our world. I mean I really hope that there are going to be a lot of people here. Like you said, you're kids you can send out into preschool and I really, this really lifted my heart that you could take out of your time from where you came from to go cold fucking. Like I told you earlier, I said I'm jealous. I could have some places in Liberia would love for you to be but in Kodafapa I mean you're there for 30 years, boom this kind of work and that's just this my heart and I think you gave me hope for our world. I know she's terribly not self-pollution so I'll give you a copy of her. She released a book of her experiences in Cameroon. Really heartfelt and heart-wrenching stories of all the medical care that she provided as well as her experiences with Boko Haram and in Kodafapa and Target and being under Jandarm Guard for over 15 months and experiencing having the marriage. So the name of the book is Life in Death in Kodafapa, an American doctor in Africa. It's a really good way. I'm a little biased but I encourage you to buy one. Thank you so much for coming.