A two-year-old child in rural Liberia has a fever. It could be malaria, and the only way to get treatment is for her mother to carry her on her back, cross a riverbed by canoe and walk through a forest for at least two days to get to the nearest healthcare clinic.
This was the type of devastating circumstance Dr Raj Panjabi encountered when he returned to his childhood home of Liberia as a medical student almost 15 years ago. In the country that his family fled when he was just a boy to escape a civil war, Panjabi saw that people were dying from diseases that modern medicine can treat. But in a country of 4 million, there were only 50 doctors, and in the most remote areas of the country access to them was almost nonexistent.
Since then Panjabi, a doctor at Harvard Medical School, has built a nonprofit, The Last Mile Health, that trains community health workers in Liberia to administer simple health care procedures in places where treatment is hard to come by.
Now, with the help of a $1 million prize awarded to him at the international TED conference Tuesday evening, Panjabi plans to fulfil his dream of training healthcare workers in rural communities all over the world.
"This isn't just a story in Liberia, it's the story in rural south Dakota, in Appalachia, it's the story of folks in rural Alaska, and it's the story of various rural people throughout the world," Panjabi told reporters. "So, if there are a billion people on the planet who live in these remote communities, how do we solve that issue? The idea is that help for these communities might not come from places we expect. It may not come from the outside - it may actually come from within."
Panjabi's windfall could not come at a more crucial time for global health as the Trump White House considers major cuts in foreign aid that fund many life-saving resources in developing countries.
Panjabi wants to use the money to create the Community Health Academy, which would be a global entity that trains and equips lay healthcare workers with real life-saving skills, whether that's giving vaccines or testing for malaria or treating pneumonia. In a single backpack, the worker has the tools and medicines to employ 30 different life-saving services, Panjabi said.
Through Panjabi's model in Liberia the workers are not volunteers, they are paid for their work, which gives them a sense of agency, he said. During the Ebola crisis a few years ago, his organisation trained 1,300 community health workers to "hunt down this virus and stop it in its tracks."
That experience taught him that "we as people are not defined by the conditions we face no matter how hopeless they seem, we're defined by how we respond to them," he said in his own TED talk after accepting the award. "I've seen the power of this idea to transform ordinary citizens into community health workers, into every day heroes."
Before the TED Prize, Panjabi's work had already received wide praise, even earning him a place in TIME's list of the 100 most influential people in the world with a tribute in the magazine written by former President Bill Clinton. "To spend time with Raj Panjabi is to see up close what happens when someone with uncommon courage and compassion puts himself on the front lines of the world's most complex challenges," Clinton wrote.
Now Panjabi wants to create a global system, including in rural North America, where those workers are treated as renowned professionals in the medical field. To earn that level of credibility, Panjabi plans to leverage technology to get the workers access to high-quality digital education that can be accessed from their smartphones.
The health workers can't take the place of doctors or nurses. They can't perform surgery or fix a broken limb; they are more like first responders. They can administer some basic care, will know when to get a person more serious medical help and then is in the community for follow-up care. But most of all, they can save lives - 30 million by 2030 is his goal.
"My dream is that this academy will contribute to the training of hundreds of thousands of community members to help bring health care to their neighbours... from the forest communities of West Africa to the fishing communities of rural Alaska, from the hilltops of Appalachia to the mountains of Afghanistan," Panjabi said.
He ended his talk with this story: He was visiting in West Africa and was seeing a pregnant woman in a rural area that had never had healthcare services before several of her neighbours became trained community health workers. The woman had never received any prenatal care with her previous children. Panjabi pulled out his ultrasound to check on her baby and she stopped mid-conversation to ask, "Doc, what's that sound?"
It was the first time she'd ever heard a baby's heartbeat.