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

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Mark Masselli: This is Conversations on Health Care. I am Mark Masselli .

Margaret Flinter: A nd I am Margret Flinter .

Mark Masselli: Well Marg a ret , it's the season of giving, and I am not talking
about things you find in the shopping mall. I n our line of work we run across so
many organizations that are truly doing meaningful work to ease the suffering of
folks around the world.

Margaret Flinter: Well I have noticed a trend in recent years, Mark, and it’s a
really promising one; people givi ng to a charity in someone’s name in lieu of a
traditional holiday gift. And whether it’s a organization that brings water wells to
Africa, building schools and medical clinics in war - torn areas, a small or big
donation can make a huge difference in the l ife of somebody who is suffering.

Mark Masselli: Some of the guests we have had on this past year would fit that
bill. We had the CEO of Save The Children on our show, bringing health, shelter,
substance and schooling to children living in the frontline s of war around the
world. A small donation could provide a goat for a family, or tuition for a school
girl for a year. There are so many ways to make a difference through their
organization.

Margaret Flinter: Another guest that’s really stayed with me is Dr. Deane
Marchbein, the Director of the US Chapter of Doctors Without Borders or
Medecins Sans Frontieres , who bring health care to some of the bleakest, most
beleaguered places in the world. So we thought that we would revisit our
conversations with Dr. Marchbein. She is overseeing some incredible delivery of
care and compassion in places like Syria, Gaza, Afghanistan, and West Africa,
and during this time of year I can’t think of a better person to highlight.

Mark Masselli: You are absolutely rig ht. It was a terrific conversation . They are
doing the really tough wo rk out there across the globe.

Margaret Flinter: And Lori Robertson , the Managing Editor of FactCheck.Org will
look at more false claims spoken about healthy policy in the public dom ain.

Mark Masselli : And as always , if you have comments , please e - mail us at
www.chcradio.com , or find us on Facebook or Tw itter ; we love hear ing from you .
Margaret Flinter: We wi ll get to our interview with Dr . Deane Marchbein of
Doctors Without Borders in just a moment .
Mark Masselli: But first , here is our producer Marianne O'Hare with this week’s
Headline News.

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Marianne O'Hare: I am Marianne O'Hare with these Health Care Headlines .
After months of being held in limbo, Congress has finally approved President
Obama’s nomination for Surgeon General . Dr. Vivek Murthy, a physician at
Brigham and Women's Hospital in Boston, and Professor at Harvard School of
Medicine, won confirmation in 51/43 vote. He is cofounder of Doctors for
America, whose goal is to ensure affordable health care for all Americans.
Murthy said his focus will be on reducing obesity, reducing tobacco use and
creating healthier communities.

More states facing opposition by GOP opp onents of health reform are forging
ahead to expand Medicaid in spite of political pressure , governors in Alaska and
Tennessee among those moving strategically ahead with efforts to expand
Medicaid to include more uninsured residents to gain coverage. And a survey of
smaller US businesses shows more are foregoing expensive insurance
coverage, taking advantage instead of more comprehensive health plans being
made available on the insurance exchanges. Companies with fewer than 50
employees represent about 2 0 billion Americans in the workforce. These
employers are not required under the Health Law to provide coverage, and many
have found the deals on the exchanges including tax subsidies for their
employees who buy on the exchanges are far better than both t hey and their
employees could afford purchasing private insurance.

E - cigarettes, the new gateway drug . The Centers for Disease Control ’ s most
comprehensive survey on E - cigarette use among America’s school children
shows there has been a dramatic rise in E - cigarette consumption. 70.1% of high
school seniors reported smoking E - cigarettes in the past month, and almost 9%
of eight graders reported doing so, suggesting E - cigarettes are making smoking
seem more normal. There was some good news in the survey t hough; the abuse
of prescription drugs among America’s teens is down from a high in 2004 where
roughly 9% had tried opioids like Vicodin or Oxycodone . Many of those kids
went on to heroin abuse, a cheaper but more deadly route to the narcotic high.
The n umbers are now below 6%.

I am Marianne O'Hare with these Health Care Headlines .

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Mark Masselli: We are speaking today with Dr. Deane Marchbein, President of
the Board of Directors of Doctors Without Borders , winner of the 1999 Nobel
Peace Prize, an international organization dedicated to offering health care and
medical training in war - torn and impoverished countries around the world. Dr.
Marchbein is an anesthesiologist practicing at Mass General Hospital in Boston.
She earned her MD at the Un iversity of Pittsburgh, and completed residency at

Mass General and the Boston Children’s Hospital. She also serves on the board
of Fanconi Anemia Research Fund . Dr. Marchbein, welcome to Conversations
on Health Care.

Dr. Deane Marchbein: Thank you ver y much.

Mark Masselli: You know, Doctors Without Borders was formed 40 years ago in
1971 in the context of the crisis in Biafra , and you joined the organization in
2006, taking over leadership of the US Chapter in 2012 , and during that time
there has bee n no end to the world conflicts that Doctors Without Borders finds
itself in. And 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. Dean e Marchbein: 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 as we were
working in those places. So the primar y mission is as I said direct delivery of
medical care and emergency aid to people affected by armed conflict, epidemics,
malnutrition, natural disaster and also situations where people are excluded from
access to health care. And we are currently operati ng between 60 and 70
countries worldwide. So we have more than 30,000 people who are working for
us and about 10% of those are our international staff . And 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, they are logistics experts , administrators,
epidemiologists, laboratory technicians and even mental health workers. There
is 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 our eyes it seems almost everyday. Your members
are on the ground in West Africa where t he Ebola outbreak has led to hundreds
of deaths and seems to be spreading, and I know has affected health care
workers on the ground, the ongoing Syrian crisis. So maybe you could share
with us a little bit about in these hotspots what are your health car e workers
experiencing there and how do they grapple with deliver ing both the emergency
medical care but also you are delivering almost some primary care in an
emergency environment .

Dr. Deane Marchbein: All of these are really very diverse contexts, and one of
the issues in Syria is that Syria had been a country where people had access to
a very high level of health care, and obviously the needs and the expectations of
the community are very different in a middle income country than they are in
Sub - Sahar an Africa. So for instance if you decide that you need to do a
vaccination campaign, getting 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. So you are right ; our resources are incredibly
stretched at this point.

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

Dr. Deane Marchbein: First of all, it’s a global organization so we are recruiting
around the world. So for instance if we have a project in t he 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, so a doctor would already have to be a doctor and
have worked in their area of specialty. For things like logistics experts, they also
have a test to analyze their ability to solve the kinds of problems that they are
going to enc ounter in the field , but more importantly, how they think about things,
their flexibility of mind, their ability to take experiences that they have 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 of the things about MSF
is there is 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 in 1972 wit h a great idea and a
mission and certainly we are well familiar with all organizations that seek to do
good in t he world start with a great idea and the challenges of infrastructure
catch up with you as you are growing and expanding. So we would be really
curious to hear from your perspective what have been the major changes within
Doctors Without Borders or Medeci ns Sans Frontieres MSF. What has really
carried through from the beginning?

Dr. Deane Marchbein: When they first started and I look at what the first
volunteers did, they literally came with the medical bags that they could carry.
And when I think abou t the sophisticated kind of medical care that I have
personally delivered in some of the places, very remote places that we have
delivered in, I think about how amazing it is that we have been able to do that,
and first and foremost, I think it’s our logis tics. So I got a phone call a few hours
after the earthquake in Haiti, and at the same time that I was dispatched from
Boston to Port - au - Prince , a plane left our logistics center in (inaudible 11:23),
and on it, it had an inflatable hospital with everythi ng that you could possibly
imagine that would be needed for a hospital. So there is this great thought

process that went into if I have a cholera epidemic what do I need to treat cholera
for 10,000, if I have a surgical emergency what kind of hospital do I need. And
so all of that has been carefully thought out, and when I go to the field all I take is
myself and know that there is systemization of the material that I will find there of
the pharmaceuticals, and that allows me to really hit the ground runn ing. It’s
delivering medical care to the people most in need, and that is core to our DNA

Mark Masselli: We are speaking today with Dr. Deane Marchbein, President of
the Board of Directors of Doctors Without Borders USA , international
organization dedi cated to offering health care and medical training in war - torn
and impoverished countries around the world. You talked about hitting the
ground, and when you hit the ground, most often you are running into women
and children who have suffered the most and so you are dealing with lot of
maternal and child health issues. You have got the logistics and the technology
there, but I am certainly interested in the cultural competency that comes in.
How well - equipped are you in that sort of cultural context to d eliver care?

Dr. Deane Marchbein: Actually I think the cultural component and competency is
super important. There is always a cultural briefing. The perfect example of how
important that cultural sensitivity is was Afghanistan, Afghanistan basically i n a
state of war and conflict for the last 25 or 30 years with some of the world’s
highest maternal mortality figures . And so MSF decided that we really needed to
be working in Afghanistan, and one of the places that we opted to work is a town
called Khos t , which is on the border with Afghanistan. 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 in the community to let them decide
and inform us about what their mo st 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 to open a maternal hospital, and more than that we decided to
make ourselves really valuable to the community. We would staff it entirely with
female staff so every single job in the hospital. So there were international staff
that came, and each of the international staff’s job was to train local people to do
their job s. Midwives needed to be trained ; obstetricians needed to be trained;
the interpreters needed to be hired; the guards who would check every person
entering the hospital for weapon 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. And in a community where women have
children on average one every 15 to 24 months, when you are doing 12,000 to
15,000 deliveries a year, it doesn’t take very long before you have had a major
impact on the community.

Margaret Flinter: Well that’s a profound example, and kind of directly segues into
what I wanted to ask you about which is reall y population health, which we

certainly are talking a lot about in the United States under health reform, but
certainly population health takes on a whole new meaning in the areas where
you are working . And I know that you have had some such as your Campa ign
for Essential Medicines and nutrition programs in Sub - Saharan Africa and
elsewhere. Maybe t ell us what you have learned about successful population
health management in some of these targeted zones, and maybe you can share
some success stories about b oth what your organization and the other NGOs
and entities that are working to achieve the goals of the UN Millennium Project
are learning from this experience.

Dr. Deane Marchbein: So the Access Campaign is a campaign that we
developed using the proceed s from the 1999 Nobel Peace Prize, and the reason
that we decided that we needed 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 , were either too ex pensive or they were
simple not geared toward the needs of the populations that we were addressing.
And that’s pretty typical of medical research which is geared towards the drugs
and the diagnostic tests that are being developed on the basis of their fut ure
market potential rather than the needs of particularly people who live in poor
countries. So that was really the basis for the Access Campaign.

Our goals are a little bit different from the Millennium goals. The Millennium
goals are basically to inc rease human well - being over a period of time through
economic and social development, and MSF is an emergency organization so it’s
not really the same platform but some of our work can and does contribute to
global strategies. So one of the global goals i s reducing childhood mortality, and
one of the projects that we have implemented is seasonal malaria
chemoprophylaxis . And so you go to a place that has seasonal malaria where
there is a very high mortality deaths especially in children under 5 years old, and
these are children often with co - morbidity that includes malnutrition and anemia,
and in addition to taking the usual preventive measures to prevent mosquito
bites, you treat them with medicines during that period of time. And while
seasonal malaria chemoprophylaxis is not a cure, in conjunction with other
methods to prevent malaria 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 UNI TAID 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 , so this is UNITAID ’s
information, not ours , they are expecting that this will provide 30 million
treatments every year, and this will protect 7.5 million children, and it’s estimated
that this will prevent 50,000 deaths. So this is an area where essentially the
Access Campaign, the Millennium Pro ject and the goals found an area of
corresponding interest and work.

Mark Masselli: We have been speaking today with Dr. Deane Marchbein,
President of the Board of Directors of Doctors Without Borders USA, known
international ly as Medecins Sans Frontiere s , an international organization
dedicated to offering health care and medical training in war - torn and
impoverished countries around the world. You can learn more about their work
by going to www.doctor swithoutborders.org . Dr. Marchbein, thank you so much
for joining us on Conversations on Health Care.
Dr. Deane Marchbein: Thank you very much.
(Music) Mark Masselli: At Conversations on Health Care, we want our audience to be truly in the know when it comes to the facts about health care reform and policy.
Lori Robertson is an award - winning journalist and managing editor of
FactCheck.org, a non - partisan, non - profit consumer advocate for voters that aim
to reduce the level of deception in U.S. polit ics. Lori, what have you got for us
this week?
Lori Robertson: Well, the Urban Institute is out with a new report that looks at how the Affordable Care Act has affected the number of uninsured. Its survey data showed that the number of uninsured adults dropped by 8 million between
September and June . The percentage of uninsured in the United States was an estimated 13.9% in June compared with 17.9% in September. The drop in the percentage of uninsured was more pronounced in states that expanded Medica id under the ACA. In those states, the rate of uninsured was 10.1% in June, a 6% point drop from September.
Meanwhile, the states that haven’t expanded Medicaid, there are currently 24 of them, have an uninsured rate of 18.3%, down slightly from a 20% ra te in September. These are of course only estimates from a survey, taken a few months after the first open enrolment period under the Health Care Law. The
data don’t include a breakdown of these sources of insurance for the previously uninsured. They do however show that insurance gains overwhelmingly
occurred in families whose incomes were below 400% of the federal poverty level. That’s $95,400 for a family of four this year, making those families eligible for subsidies on the insurance marketplaces or Medicaid coverage. The survey,
which has been taken quarterly since 2013, is funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute. And that’s my
fact check for this week. I am Lori Robertson, Managing Editor of Fact Check.org .
Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’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

chec ked, e - mail us at www.chcradio.com . We will have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on Health Care.

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Margaret Flinter: Each week, Conversations highlights a bright i dea about how
to make wellness a part of our communities and everyday lives. As the saying
goes, music soothes the savage beast. And according to a recent study
conducted by Queen’s University in Belfast, Ireland, ther e is some empirical data
to back tha t up. In a first of a kind longitudinal study, children suffering from a
variety of behavioral and emotional conditions were exposed to music therapy in
addition to traditional therapies had far better outcomes than those children in a
control group that offered traditional therapy without music therapy.

Dr. Sam Porter: Basically it’s about treating children with emotional and
behavioral problems with music therapy in addition to normal psychiatric care.
It’s not a matter of them being given music or ch oosing music; they actually make
music along with the music therapist assisting them. So the idea is for them to
express themselves through music.

Margaret Flinter: Lead researcher Dr. Sam Porter said there has been anecdotal
evidence that music improve s mood in children and adolescents as well as
adults, but his study revealed just how effective the music therapy was.

Dr. Sam Porter: Our primary outcome was an improvement in communication.
Now there were two very interesting secondary outcomes on lev els of depression
and levels of self - esteem, and in the secondary outcomes we find a statistically
significant difference between the control group and the intervention group.

Margaret Flinter: Dr. Porter says in the group given musical therapy it showed
overtime more interaction with their surroundings and a better response to the
traditional therapies as well, and he says the effects were sustained overtime.

Dr. Sam Porter: I mean that’s one of the marvelous things about music therapy
is the thing tha t (inaudible 23:49) . There are no side effects; it is not a dangerous
therapy to get kids involved in. It is a productive way of getting kids to improve
their health. That is just such a good way and a harmless way of doing things so
it’s really satisfy ing to know there is also an effective way of doing it.

Margaret Flinter: The study was conducted in conjunction with the Northern
Ireland Music Therapy Trust, which sees the promising findings as an incentive
to incorporate this relatively low cost non - invasive therapy into standard protocols
as an additional tool to enhance outcomes for the youth population which often
suffers negative side effects from powerful medications. A simple targeted
musical therapy approach, age appropriate and showing great efficacy in

improving outcomes for young patients with minimal side effects and lasting
benefits, now that’s a bright idea.
(Music)
Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org and brought to you by
the Community Health Center.