Dr. Deane Marchbein: MD, President of the U.S. board of directors of Doctors Without Borders

Mark Masselli: This is Conversations on Healthcare. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret the number of covered Americans continues to increase
even after the close of the open enrollment in April . More than 7.2 million Americans
are newly covered under Medicaid expense including those earning up to a 1 3 8% of
poverty line.

Margaret Flinter: And it should be noted Mark that, that number includes the newly
covered American to eleven states that did not expand Medicaid. There are tens of
thousands of newly covered Texans under Medicaid who had been uninsured heard all
the talk about the healthcare law sought information about their options only to find out
there were already eligible under the exist ing Medicaid guidelines and we have s een a
lot of that right here in our own backyard.

Mark Masselli: And it also should be noted that the federal government is covering up
to 100% of the Medicaid expansion for three years. States that choose not to expa nd
Medicaid have left billions of dollars on the table that would have helped them ensure
more of the ir residence about 25 states thus far refusing to participate.

Margaret Flinter: And I am still waiting to see what happens after the mid - term elections
o n that because healthcare has become a truly partisan agenda and people’s health
and well - being is hanging in the balance. GOP analyst are now trying to promote the
party’s image as the party of yes. The new strategy is going to focus on changing the
law and I think we will see a lot more on this new approach as we get closer to those
elections.

Mark Masselli: And there is another story that continues to unfold the Ebola epidemic in
West Africa which has spread to several countries. The World Health Org anization is
issuing strict warnings about travels to that region. They fear the epidemic is months
from being brought fully under control.

Margaret Flinter: And American ai d workers who have fallen ill have been given an
experimental drug that had not b een tried on humans. Until now some promising
results and so the question is how much the manufacture of this drug containing and
treating this deadly virus continuing to pose just an enormously serious global health
challenge.

Mark Masselli: And that’s something our guest today knows quite a bit about. Dr.
Deane Marchbein is President of the US Chapter of Doctors W ithout Borders. They
have clinicians on their ground in West Africa, in Gaza, Afghanistan in numerous
hotspots around the world.

Margaret Fl inter: And we will also hear from Lori Robertson the managing editor of
FactCheck.org.

Mark Masselli: But no matter what the topic you can hear all of our shows by going to
chcr adio.com and as always if you have comments please email us at
[email protected] or find us on Facebook or Twitter because we 'd love hearing from
you.

Margaret Flinter: Now we will get to our interview with Dr. Marchbein in just a moment.

Mark Masselli: But first here is our producer Maria nne O’Hare with this week’s headline news.

Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines. T here is a
drug development boom underway. One of the upsides of the deadly outbreak of the Ebola virus instead of West African nations. W ell the World Health Organization warns
the epidemic should be considered a global concern. Drug manufacturers who have been working on experimental treatments are fast - tracking their efforts. Well two
American healthcare workers have shown improvement a fter being given an
experimental treatment. The FDA is approving its limited use in this current crisis and the federal government is providing funds for these drugs to be rapidly developed
cautioning that Ebola could be used in a terrorist attack.

The co mputer engineer said to be the fix - it man for the troubled federal health exchange
website healthcare.gov, Google computer engineer Mi key Dickerson has been tapped
to run a newly created US digital service a government agency created by the White
House to fix any other troubled governmental websites with the same private sector
wizard (inaudible 03:39) applied to the fix of the belligerent federal exchange. The goal
is to lower smart technologi st from the private sector and bring them in - house .
M eanwhile healthcare.gov continues to be evaluated and tweet as they ready for the
next open enrollment which happens in November.

Newly installed Secretary of Veterans Affairs Robert McDonalds vowed at a recent
gathering of disabled veterans that he would restore c redibility and trust to the VA with a
series of actions. McDonald highlighted plans to conduct an independent audit of all VA
scheduling practices and penalize VA outpost performing poorly. He acknowledged a
long tradition at the agency of cover - ups, att empts to game the system and a failure to
protect whistle blowers and said that all that is going to change. I am Marianne O’Hare
with these healthcare headlines.

Mark Masselli: We are speaking today with Dr. Deane Marchbein President of the
Board of Dir ectors at Doctors without Borders winner of the 1999 Noble Peace Price a n
International Organization dedicated to offering healthcare and medical training in war

torn and impoverish countries around the world. Dr. Marchbein is a anesthesiologist
practicin g at Mass General Hospital in Boston. She earned her MD at the University of
Pittsburg and completed residency at Mass General and the Boston Children’s Hospital.
Dr. Marchbein welcome to C onversations on H ealthcare.

Dr. Deane Marchbein: Thank you very much.

Mark Masselli: You know doctors without borders was formed 40 years ago in 1971 in
the context of the crisis it would be offering and you joined the organization in 2006
taking over leadership of the US chapter in 2012 . A nd during that time there 's been no
end to the world conflicts, doctors without boards finds itself in. I think people know
about doctors without borders in the abstract but what’s the core mission of doctors
without borders and who are you serving around the world?

Dr. Deane March bein: So you're right doctors without borders was founded 40 years
ago as a result of a very difficult Civil War in Biafra and Nigeria and the premise was
that we thought there needed to be an organization that could both deliver direct
emergency medical care but also speak out about the underlying causes and what we
were seeing . S o the primary mission is as I said direct delivery of medical care and
emergency aid to people affected by arm conflict, epidemics, malnutrition, natural
disaster and also situa tions where people are excluded to access from healthcare . A nd
we ' re currently operating between 60 and 70 countries worldwide , so we have more
than 30,000 people who are working for us an d about 10% of those are our international
staff . A nd then we work very closely with locally acquired staff in the places where we
work and they really are the backbone of the work that we do and those people as the
international staff are doctors they are nurses, th ey are logistics experts and even
mental health workers (inaudible 6:50 ) an important mental health component of most of
the projects that we do.

Margaret Flinter: Well Dr. Marchbein we are watching humanitarian and war zone crisis
just unfold before eyes it seems almost every day your members are on the grou nd in
West Africa where the Ebola outbreak has led to hundreds of deaths and seems to be
spreading and I know has affected healthcare workers on the ground conflict in Ukraine,
the ongoing Syrian crisis . S o maybe you could share with us a little bit about in these
hotspots what are your healthcare workers experiencing there and how do they grapple
with delivering both the emergency medical care but also you are delivering almost
some primary care in an emergency environment I would think.

Dr. David Marchbe in: So all of these are really very diverse context and one of the
issues in Syria is that Syria had been a country where people had access to a very high
level of healthcare . S o this was a middle income country and obviously the needs and
the expectatio ns of the community are very different in a middle income country than

they are in Sub - Saharan Africa . S o for instance if you decide that you need to do a
vaccination campaign where we are working in the countries around Syria and Lebanon
and Jordan getti ng access to say the Pneumococcal vaccine is $30 a dose versus the
pennies to just a few dollars that we would have access to those supplies in the poor
countries . S o logistically, financially in terms of our resources it’s very different and you
are righ t our resources are incredibly stretched at this point. A colleagues said to me
jokingly I don’t want to go to the Paris office this summer because I know I will be sent
to the field immediately.

Mark Masselli: Back in 1971 you had 13 physicians and as y ou just mentioned today
you employ some 30,000 health professionals and support staff all over the world . S o
tell us a little bit first of all about the types of people that are coming to you who were
offering their services sort of is there a screening m echanism that gets used and then
sort of down into the internal workings the logistics of your field mission teams of
doctors and nurses and support staff how those are structured and how do you get
them ready for medical missions?

Dr. Deane Marchbein: Fi rst of all it’s a global organization so we are recruiting around
the world . S o for instance if we have a project in the Democratic Republic of Congo we
may identify people in that project who are really strong, capable people and we may
incorporate them into our international pool of volunteers. We require that people have
professional experience in the area that they are purporting to go to. A doctor would
already have to be a doctor and have worked in their area of specialties for things like
logistic s experts they also have a test and the test attempts to analyze their ability to
solve the kinds of problems that they are going to encounter in the field . And but more
importantly how they think about things, their flexibility of mind, their ability to take
experiences that they've had in one setting and apply them to another. And then there
is training that happens before they go to the field but honestly the best training that
people get is the handover the one on one training in the field. And one o f the things
about MSF is it's really not the kind of rigid bureaucracy that you might imagine in such
a large organization. And there's a lot of really grassroots experimentation and working
out different problems in the field that then gets reported and incorporated into a
broader space and exported to different projects.

Margaret Flinter: Our organization started not at such a different time with a great idea
and a mission and certainly we are well familiar with all organizations that seek to do
good i n the world. Start with a great idea and the challenges of infrastructure catch up
with you as you're growing and expanding. So we'd be really curious to hear from your
perspective what have been the major changes within doctors without borders. What
ha s really carried through from the beginning?

Dr. Dean e Marchbein: There are lots of good ideas in the world and there are lots of
people who want to do good. But the measure of your success is how much good do
you really do. And when they first started and I look at what the first volunteers did they
literally came with the medical bags that they could carry into places like Afghanistan
crossing the mountains. And when I think about the sophisticated kind of medical care
that I have personally delivered in some of the places very remote places but we
delivered it. I think about how amazing it is that we've been able to do that. And first
and foremost I think it's our logistics. So I'll give you an example I got a phone call a
few hours after the earth quake in Haiti and at the same time that I was dispatched from
Boston to Port - au - Prince a plane left our logistic center in (inaudible 12:21 ) and on it, it
had an inflatable hospital with everything that you could possibly imagine that would be
needed for a hospital. So there's -- this great thought process that went into if I have a
color epidemic, if I have a surgical emergency what kind of hospital do I need. And so
all of that has been carefully thought out and is ready to go. So I think the logistic s is
really important and when I go to field all I take is myself and know that there is
systemization of the material that I will find there and that allows me to really hit the
ground running. And it's delivering medical care to the people most in need. We may
have disagreements about what those needs are or how best to do it but we're all
focused on the patients that we treat.

Mark Masselli: We're speaking with Dr. Dean Marchbein, President of the Board of
Directors of Doctors Without Borders USA, int ernational organization dedicate offering
healthcare and medical training in war torn and impoverish countries around the world.
We talked about hitting the ground and we hit the ground most often you're running into
women and children who have suffered t he most and are most in need. And so you're
dealing with a lot of maternal and child health issues. I would expect you've got the
logistics and the technology there but I'm certainly interested in the cultural competency
that comes in where people approa ch these issues in different ways. How well
equipped are you in that sort of cultural context to deliver care?

Dr. Dean e Marchbein: Actually I think the cultural component and competency and
awareness and sensitivity is super important. There's always a cultural briefing but you
would have to ask our patients and the people where we work about our cultural
competency because I'm not sure that I can answer that question. But a perfect
example of how important that cultural sensitivity is was Afghanistan basically in a state
of war and conflict for the last 25 or 30 years with some of the world's highest maternal
mortality figures. And one of the places that we opted to work is a town called
(inaudible 14:42 ) which is on the border with Pakistan. And so the team that was
investigating what kind of mission we should do sat down with the community, sat down
with men, sat down with women to let them decide and inform us about what their most
pressing health needs were. And it was the community that said we really need help

with maternal health because the levels of maternal mortality are just unacceptable.
And so we opted open maternal hospital and more than that we would staff it entirely
with female staff in a place where education has not been in the for efront of their
agenda especially for women for the last 30 years. So there were international staff that
came and each of the international staffs job was to train local people to do their jobs.
Midwife needed to be trained obstetricians or doctors with obstetrical skills. The guards
who would check every person entering the hospital for weapons needed to be women
and they needed to be trained. And during the time that we have been there which I
think is almost two years now there has not been a single death of a mother who arrived
at our hospital not already practically dead. When you're doing 12 to 15,000 deliveries
a year it doesn’t take very long before you've had a major impact on the community.

Margaret Flinter: Well that kind of directly segway s into what I wanted to ask you about
which is really population health which we certainly are talking a lot about in the United
States certainly population health takes on a whole new meaning in the areas where
you are working. And I know that you've had some such as your campaign for essential
medicines and your nutrition programs in Sub - Saharan Africa and elsewhere. I mean,
tell us what you've learnt about successful population health management in some of
these targeted zones, you know, maybe you coul d share some success stories about
both what your organization and the other NGOs and entities that are working to
achieve the goals of the UN Millennium project or learning from this experience.

Dr. Dean e Marchbein: The reason that we decided that we nee ded a campaign to
assure access to essential medications was because we found that in the field we did
not have access to the kinds of medicines that we needed or either too expensive or
they were simply not geared toward the needs of the populations that we were
addressing. And so that was really the basis for the campaign for a essential
medicines. The UN Millennium goals are a little bit different, our goals are a little bit
different from the millennium goals. The millennium goals are basically to in crease
human wellbeing over a period of time through economic and social development. And
MSF is an emergency organization so some of our work can and does contribute to
global strategy. So one of the global goals is reducing childhood mortality and one of
the projects that we have implemented is seasonal malarial chemoprophylaxis and so
it’s an approach that you go to a place that has seasonal malaria where there is a very
high mortality deaths especially in children under 5 years old.

These are children often with comorbidity that includes malnutrition and anemia and in
addition to taking the usual preventive measures to prevent mosquito bites and you
treat them with medicines during that period of time. It’s been a huge success. So we
started it first in Niger and it’s now being trialed in a number of other places and the
results have been so exciting that recently UNITAID announced a $67.4 million grant to
the malaria consortium to implement seasonal malaria prophylaxis in places like Burkina

Faso and Chad and Guinea, Mali, Niger, Nigeria and Gambia. And according to
UNITAID they are expecting that this will protect 7.5 million children and it’s estimated
that this will prevent 50,000 deaths. So this is an area where the access campaign the
millenniu m project and the goals found an area of corresponding interest in work.

Mark Masselli: We have been speaking today with Dr. Deane Marchbein President of
the Board of Directors of Doctors Without Borders USA known internationally as
Médecins Sans Frontièr es an international organization dedicated to offering healthcare
and medical training in war torn and impoverish countries around the world. You can
learn more about their work by going to Doctorswithoutborders.org. Dr. Marchbein
thank you so much for j oining us on Conversations on Healthcare.

Dr. Deane Marchbein: Thank you very much for having me.

Margaret Flinter: At Conversation on Healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.Org a nonpartisan
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: We ll we continue to feed democrats and republicans attack each other
over the Affordable Care Act and Medicare. For instance in the Montana senath race
and ads from the republican candidate Steve Daines features a 67 year old breast
cancer survivor who says the ACA puts her Medicare at risk. Meanwhile an ad from the
democratic candidates centered at John Walsh features a senor woman pointing that
Daines voted to cut Medicare benefits. We are seeing similar misleading Medicare
claims and races across the co untry. First the republican ad the claim about the breast
cancer survivors Medicare being at risk is based on a tired attack that democrats cut
more than 700 billon dollars for Medicare to pay for Obama Care.

The Affordable Care Act doesn’t flash 700 bill ion dollars from the current Medicare
budget instead this is a cut in future growth of spending over a decade. And a slower
rate of growth which applies to payments made to hospitals and other non - physician
providers extends the solvency of the program. It remains to be seen whether this
would translate into reduced services. In terms of breast cancer however the ACA
expanded benefits from mammograms covering them fully without cost sharing for
Medicare beneficiaries on a yearly basis.

Now the democratic ad, it features three senor women, one of whom says that
representative Daines voted to cut Medicare benefits. A reference to Daines’s vote for
representative Paul Ryan’s Budget Plan. Ryan’s proposal for Medicare would mix the
ACA’s free preventive care including cancer screenings and flu shots and it would get
rid of the law's closing of the prescription drug donut hole. But relatively a few seniors

have a drug cost high enough to put them in that coverage gap. So far roughly 16% of
Medicare beneficia ries have saved money on prescriptions. Thanks to the ACA’s
extended benefits and that’s my fact check for this week. I am Lori Robertson,
managing editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the countr y’s
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked email us at
chcradio.com. We will have FactCheck.org's Lori Robertson check it out for yo u here
on Conversations on Healthcare.

Each week conversations highlight’s a bright idea about how to make wellness a part of
our communities in everyday lives. One of the conditions that results from the tens of
millions of surgeries that take place in t his country every year is called Postoperative
Ileus a condition which causes the intestines to shut down temporarily due to the trauma
of surgery in the effects of exposure due to anesthesia. Put simply patients could
become dangerously ill if given soli d food too soon after surgery which can lead to
serious complications and longer hospital stays. Up until now there has been no more
sophisticated diagnostic tool than the stethoscope where clinicians listen to a patient’s
belly for a short period of time waiting science of intestinal activity.

Dr. Brandon Spiegel : So this is a major problem because it’s so common and the
problem is we are not always sure when to feed people. So we either feed too soon in
some cases and that can cause problems or we wait too long and people linger in the
hospital when they could easily be discharged.

Margaret Flinter: Dr. Brennan Spiegel, professor of the David Geffen School of
Medicine at UCLA led the team to develop a new solution Ab S tat s an acoustic g astro
i ntestinal d evice placed on the patient’s abdomen that can monitor the colons activity in
real time. Dr Spiegel says the disposable abdominal monitory seem deceptively simple
but were the results of a long time collaboration between many departments that UCLA
that a re working towards a common goal of finding ways to improve healthcare.

Dr. Brandon Spiegel: So we have worked with electrical engineers, we have worked
with clinicians, surgeons, gastroenterologists, even health economist to understand
what would the rol e in placing therapy would be for at disposable device of this kind.

Margaret Flinter: Spiegel says with the rising epidemic and obesity as well as intestinal
disorders a device like this could become standard diagnostic tool in primary care
settings in l ong - term care as well.

Dr. Brandon Spiegel: As we continue to move forward con currently in testing it in other
types of patients like obese subjects and other common populations like those with
irritable bowel syndrome and inflammatory bowel disease and s o forth.

Margaret Flinter: The Ab S tat s an inexpensive disposable abdominal sensor that has
the capacity to quickly and accurately determine the quality of function in the intestinal
track helping in work complications in the post upsetting, improving pati ent outcomes
and saving significant money by avoiding lengthy hospital stays, now that’s a bright
idea.

Margaret Flinter: This is Conversations on Healthcare. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli. Peace in health.

Conversations on Healthcare broadcast from the campus of WESU at Wesleyan
university. Streaming live at wesufm.org and brought to you by the community health
center.