Transcript

'Rx for Survival: A Global Health Challenge'

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Barry and Andrea Coleman
Featured in 'Delivering the Goods'; Part of 'Rx for Survival'
Thursday, November 3, 2005; 2:00 PM

The series "Rx for Survival" highlights public health breakthroughs and interventions that have more than doubled life expectancy in developed countries within the past century. The series, filmed in more than 20 countries, also explores how the lack of access to basic health interventions leaves many impoverished countries plagued by preventable diseases. The series airs on PBS Tuesday, Nov. 1 - Thursday, Nov. 3. (Check TV Schedules.) Brad Pitt narrates.

Barry and Andrea Coleman, featured in the "Rx for Survival" program "Delivering the Goods," were online Thursday, Nov. 3, at 2 p.m. ET to discuss Wednesday night's episode of the series.

About Episode II: (Aired Wednesday, Nov. 2, 9-11 p.m. ET)

"Delivering the Goods" -- This first hour of the episode explores the paradox of global health: the failure to deliver health care to millions in need. What are the obstacles to providing care to populations in need? How do we overcome these barriers and build effective, sustainable delivery systems? From Kenya to Thailand, from Chad to Bangladesh, the program chronicles health programs and leaders who, against all odds, "deliver the goods" to millions of individuals.

"Deadly Messengers" -- This second hour of Wednesday's episode recounts the stories of scientists and health workers who battled the mosquito, and examines current efforts to control mosquito and other vector-borne diseases, including the development of new vaccines to protect the world's most vulnerable populations.

About Barry and Andrea Coleman:

In 1989, Barry Coleman and Andrea Coleman, who is also featured in "Rx for Survival," became aware that development initiatives relating to disease control and progress-out-of-poverty in Africa were constantly and often fatally undermined by the lack of reliable mechanical transportation. They devised an innovative system and built an organization capable of tackling the problem.

Philosophy graduate and ex-journalist Barry Coleman worked with African colleagues to develop Riders for Health's transport resource management system (TRM), a replicable mechanism for managing vehicles where there is no conventional support infrastructure. Andrea Coleman, an ex-motorcycle racer, used her long experience and knowledge of the motorcycling community to devise fundraising methods, such as providing events and services in the motorcycling community, to build the unrestricted funding necessary for the organization's survival and development.

The transcript follows.

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Barry and Andrea Coleman: Hi.

this is Barry Coleman. I am co-founder and CEO responsible for operations of Riders for Health

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Vienna, Austria: I am a U.S. citizen living in Vienna finishing my Masters in Biochemistry. I think about public health issues on a daily basis, it is an issue that interests me very much. Do you know of any organizations in my region involved in public health on a global scale? I would be interested in an internship with real hands on experience (not just collecting money for a good cause).

Best regards

Barry and Andrea Coleman: I am sorry to say that the immediate answer to this is no. But if you would like to email me on bcoleman@riders.org, I am quite sure we can make the necessary inquiries and connections.

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Mt. Lebanon, Pa.: What role will Global Heating, if it's an active physical process now at work on earth, play in aiding or hindering the efforts to improve the health care delivery infrastructure throughout the world?

As an engineer, we use the word heating not warming as energy associated with "heat transfer" is a scientific process and one well understood by our profession. Warming is a touchy/feely attempt to minimize the impact of this mechanism/issue.

So, have you put the earth's environmental trajectories into your assumptions and calculations? Or are you ignoring what could make your job impossible or worse, pointless? And if not, what are you doing in this regard.. exactly?

Thanks much.

Barry and Andrea Coleman: As a matter of fact I have a suspicion that global warming could have a catastrophic effect on many of the communities with whom we work. This is because food security in most African countries is very marginal and people are used to a very threatening cycle of food availability followed by something close to famine. That in turn is because subsistence farmers do not usually have good food storage systems. So a very small change in temperature that led to seasonal changes could quickly make a bad situation a lot worse.

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Silver spring, Md.: I have a relative who does not believe in vaccinations for her kids. She and her husband have college degrees, and seem to be relatively well-informed, in general. They live in New York City and will only consider living in states that do not require vaccinations.

What are the points in favor of their belief and how valid or invalid are they?

Barry and Andrea Coleman: This is a very serious and complex philosophical question.

It seems to me that the strongest argument at their disposal is that they are and must be free to make choices for themselves and since they are making choices for their children by proxy, at least in the early stages of their lives, they are fully entitled to make such decisions.

On the other hand, this is not a decision that has no practical consequences for other people. Not participating in a campaign to eradicate a disease such as polio can only possibly mean that the disease cannot be eradicated. So the moral choice is not really one that comes under the heading of 'oh well, it doesn't affect anyone else'. The decision to smoke is much closer to that, but even then your relatives and friends might not like it much if you die. So it seems that before we get to the public health issues, we have to have a serious ethical discussion.

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Arlington, Va.: What is a good plan, in your opinion, to create continuous improvement with "delivering the goods"? Can you explain some of the reasons for failed delivery attempts/goods not reaching those in need? Thank you.

Barry and Andrea Coleman: A very straightforward answer.

It is simply non-negotiably essential to set up in every single country on the planet a management system that permits 21st century mechanical equipment (cars, trucks and motorcycles mainly) to function perfectly normally. This doesn't happen now and the consequences are awful. What it means is that all the instruments for combating disease that we have developed in laboratories and all the policies we have thrashed out in conferences mean absolutely nothing to the rural poor, especially in Africa, as by an large none of this good stuff reaches them. There is a huge disconnect between what we create for public health care and what we deliver. Another big constraint: people are unaware of it (probably because they make the assumption that everything is fine) so nothing gets done. People want to inject babies, to protect and save them. We all do. But unless we have very large-scale vehicle-management programmes, we won't be able to reach them. Not even once, most of the time, let alone reach them at regular intervals until the end of time as we know it. That's how we are reached by public health measures in the US and Europe -- all the time, and so effectively that we don't even notice. Except of course when we get some horror like Katrina and then all of a sudden sewage is floating down what once was the street and people in protective suits are out spraying against malaria. In Louisiana!

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Munich, Germany: For a disease whose cause was first isolated in 1896, a cure for malaria has certainly been long coming.

I've read that the Gates Foundation has granted a lot of money towards malaria research and treatment, especially in Africa, but where are the other big players that have the money and know-how to eradicate this disease?

By the way, I also just wanted to mention that your Web site is great. Thanks.

Barry and Andrea Coleman: The Gates Foundation can't cure everything but they can and do take the kind of lead that governments are necessarily slow to do. Malaria is a poor people's disease and hasn't attracted much research attention or funding except when it has threatened the military of developed nations fighting in the jungle. But things are changing and with the fuss kicked up by Jeff Sachs, Bono and others, it is almost becoming 'sexy'.

But the problem isn't just preventive measures. We also need to make sure that we can deliver these things and others like them down to village level -- time and time again. And that means having reliably mobile public health workers throughout the poor regions.

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Arlington, Va.: What do you think this series will teach people overall? How did you get involved in it?

Barry and Andrea Coleman: I hope it will teach people that given a bit of will and a bit of good, clear thinking, most of the threats presented by disease can be overcome. We really do know what to do in most cases but we are a bit slow and a bit stupid about actually doing it. All the people in the series really are setting about their problems in a very encouraging manner.

We got involved because the producers, WGBH, were looking for organizations and people to fill the slot they had designated 'delivering the goods' and they found it hard to find anyone. They found us by searching the web!

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Delivering the Goods ...: This part of the series intrigues me. Why do you think it's a problem and how do we work globally to solve it? If this system works, how much would it benefit global health in general? Thanks.

Barry and Andrea Coleman: The reason why it is so difficult to deliver the goods to village level is that mechanical transportation fails. But it fails for silly reasons. It fails because it works in the US and Europe but transport users never really think about why. It works because dealerships actually call up and ask car owners to bring their cars in for service at the appropriate intervals. That doesn't happen in rural Africa! So all the big agencies just send vehicles without thinking about how they are going to endure in a service-less environment and they fail. And with them, programme after programme dedicated to public health measures. It's got to change and change soon. Get this bit right and global public health will be transformed. Benefit would be an understatement!

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Alexandria, Va.: I was very pleased to see some of the non-medical aspects of public health, such as access to care, highlighted in "Rx for Survival."

I was wondering if you could share some of the barriers/difficulties you have overcome in providing transportation to health services in Africa.

Thank you for your excellent work in public health.

Barry and Andrea Coleman: Thank you for your encouragement. It really helps.

The biggest barrier from our point of view is that there is no commercial network to provide ordinary, everyday serving of cars, trucks and motorcycles in rural Africa. There are no shiny Toyota dealerships out there. So we have had to invent a maintenance system appropriate to rural Africa and, thank God, it works. What has to happen now is that everyone, from ministries of health and the UN to small-scale vehicle users, have to sign up to use it or something like it. Otherwise all the talk of public health advances in Africa is a bit of a waste of breath.

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Washington, D.C.: Thank you for putting together such an informative series. I especially appreciated your treatment of the volunteers who helped wipe out small pox. They make for a telling contrast to the current generation of 'activists' who think carrying signs, posing for the TV crews, and screaming vitriol at the top of their lungs counts as making a difference. Thank you for pointing out that people can truly make a difference by positive action, rather than incessant whinging.

Barry and Andrea Coleman: I'll pass on your congratulations to WGBH. As you say, the series highlights positive action, not least by communities, rather than the traditional moaning.

But you do have to moan as well as act sometimes, just to get attention for the thing you are trying to do.

But the series shows just what can be achieved by getting out there and getting on with the abundantly obvious.

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Washington, D.C.: In your opinion, what is the single most critical public health challenge the world faces?

Barry and Andrea Coleman: I know I would say this anyway, but given what we know about the engineering of sanitation, about pharmacy, about hygeine and so on, I say it is the almost total failure of ordinary mechanical transportation in rural Africa. How can African public health workers do their wonderful work if they can't get around?

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Munich, Germany: For a disease whose cause was first isolated in 1896, a cure for malaria has certainly been long coming.

I've read that the Gates Foundation has granted a lot of money towards malaria research and treatment, especially in Africa, but where are the other big players that have the money and know-how to eradicate this disease?

By the way, I also just wanted to mention that your Web site is great. Thanks.

Barry and Andrea Coleman: I think we have looked at this question already.

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Barry and Andrea Coleman: I think that's about covered it. It's been a pleasure answering your questions. If you would like to know more about the work of Riders for Health we are on www.riders.org and if you have any other questions you think I can help with, please drop a line on bcoleman@riders.org.

I'll be out of the office for another week, so please don't expect a quick reply.

Thanks for taking such a keen and well-informed interest!

Barry Coleman

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Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.


© 2005 The Washington Post Company

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