Dr. Emmanuel d’Harcourt, Senior Health Director, International Rescue Committee

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

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

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret , we a re heading into the t raditional summer season of
getaways and we just want to remind our listeners , don't forget that sunscreen .

Margaret Flinter: It's a national epidemic s kin cancer on the rise there are over 5 million
cases of non - melanoma skin cancer diagnosed in the giv en year but the number of
melanoma cases also on the rise and that is a deadly form of skin cancer leading to
over 10,000 deaths per year.

Mark Masselli: An estimated 40 % to 50% of Americans over 65 will eventually be
diagnosed with skin cancer , a condition almost exclusively related to sun exposure , so
always use that sunscreen .

Margaret Flinter: And you know the American Cancer Society notes that when used
consistently , even a sunscreen of 15% SPF will greatly reduce your chances of
developing skin cancer . But any sunscreen and any prevention is better than none.

Mark Masselli: Well in this country we are focus ing on the summer holiday experiences ,
there is a kind of travel that’s on our mind today Margaret an d that's the 16 million
refugees around the world who are fleeing violence or strife in their home country . The
refugee crisis has reached epidemic pro portions .

Margaret Flinter: And the United Nations just sponsored the first World Humanitarian
Summit to address this ongoing crisis and people would not have access to healthcare
if it weren’t for the amazing agencies and individuals that put themselves on the frontline
everyday to do this care.

Mark Masselli: Absolutely . And our guest today was among that gathering .

Margaret Flinter: Dr. Emmanuel d’Harcourt is the Senior Health Director for the
International Rescue Committee .

Mark Masselli: Lori Robertson will stop by, she is the managing editor of
FactCheck.org. But no matter what the t opic, you can hear all of our shows by going to
chcradio.com.

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

Margaret Flinter: And as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter because we love hearing from
you. We will get to our interview with Dr. Emmanuel d’Harcourt in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

(Music)

Marianne O'Hare: I am Marianne O'Hare with these healthcare headlines. 24 million,
that’s a number of Americans expected to lose health insurance coverage if the
Affordable Care Act is repealed . In a study conducted by the urban Institute some 14 .5
million children and adults would lose coverage under the Medicaid Expansion program
and just under 9 million would lose subsidized coverage. While the move would save
over $900 billion in costs over a decade , there would be offsets to those savings and
states would also end up picking up much of the cost to cover their uninsured residents .

In the wake of the most recent mass shooting leaving 50 d e ad in Orlando the question
of gun violence is a public health hazard is back on the front burner . The American
Medical Association is calling on Congress to end a 20 year ban on researching the
impact of gun violence on public health more than 33 ,000 death s per year in this
country , Dr. Steven Stack, Preside nt of the American Medical Association who said
“ Congress must act to repeal the act banning US dollars for research of this deadly gun
violence epidemic” which he says “M ust be tackled as a public health threat.”

According to a study published in JAMA In ternal Medicine , JAMA Medicine could be a
useful in a multipronged approach to helping veterans deal with the a ffects of post
traumatic stress disorder which affects just under 20% of the nation's veteran
population . The study found having a nurse their cases along with in - person talk
therapy through primary care provider and regular checkups via Smartphone yielded a
good result for about a quarter of the patients in the study .

And do you want to live longer? Well th e fountain of youth could be inside your church.
Another study published in JAMA Internal Medicine showed that people who went to
church generally lived longer . Researchers used data from a long - term study of more
than 75,000 women after controlling for more than two dozen factors they found that
compared to those who never went to church , going more than once a week was
associated with a 33% lower risk for death from any cause . As the church lady would
say “ Now , isn't that special ? ” I am Marianne O'Har e with these healthcare headlines.

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

(Music)

Mark Masselli: We are speaking today with Dr. Emmanuel d’Harcourt, Senior Health
Director for the International Rescue Committee , a nonprofit global organization
dedicated to helping those affected by the worst humanitarian crisis around the world a
pediatrician , Dr. d’Harcourt has lived and served throughout much of sub - Saharan
Africa . He earned his m aster’s in Public Health from Harvard , his medical degree from
Johns Hopkins and completed a Pediatric Residency at Children's Hospital of
Philadelphia . Dr. d’Harcourt welcome to Conversations on Healthcare .

Dr. Emmanuel d’Harcourt: I am happy to be here.

Mark Masselli: And w hat a tragedy out in the world , 60 million refugees , you just
returned from a major gathering of global health experts at the World Health Assembly
in Geneva , a nd what dominated this particular world health gathering and who were the
participants and what was a specific goal of events in the face of this enormous
humanitarian crisis ?

Dr. Emmanuel d’Harcourt: The situation in the world is terrifying and on a huge scale ,
but the focus of this event was really more inward looking and trying to fix the shop
before went out and try to fix the world . All of the governments who are part of the
World Health Assembly who in a way make up the World Health Organization all h e ad
delegation s, and then on the margins you had group s like the IRC and others who are
part of civil society . And the first focus was really on fixing the WHO itself which a
number of people felt hasn’t really performed as it should , s o this may seem like a small
scale but people felt it was really important to first fix what was wrong with WHO before
they would go and address the enormous problems facing the world .

Margaret Flinter: Well Emmanuel I would like for our listeners to talk about an issue that
we are hearing more and more about , and close to a t housand healthcare workers have
been killed in just the past two years as somebody who lives and works and practices in
the field providing healthcare in most vulnerable places . What are your thoughts on this
latest deadly trend ?

Dr. Emmanuel d’Harcourt: Well unfortunately it can be called almost more than a trend.
It's a massive phenomenon that has been going on for a while but we are getting more
reports about this and there is a feeling that the WHO report probably is on the low side .
The problem is as we see it is that the response seems to be outrage , but our concern
is that outrage alone is not going to solve the problem . The people who are
perpetuating these attacks are not being held accountable and none of the current

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

resolutions in the Gen eral Assembly or the Security Council are really going to address
this impunity . So what we really need to do is to start putting peace [PH] in those
resolutions , and that's politically a very difficult thing to do . But until both the big fish ,
people at the heads of governments who are condoning the attacks on healthcare
workers , and a small fish , the warlords and the soldiers who are looting health centers
and killing healthcare workers , until both people at the top and the bottom are being
he ld accountable more that it's going to continue .

Mark Masselli: And I wonder if you could share with our listeners the refugee
experience , what it's like on a daily basis , hard for many Americans to put our heads
around to the level of desperation that e xist for a family to risk everything , flee their
home , then they find themselves in refugee camps , the human experience and the toll
it's been taking on the larger populations .

Dr. Emmanuel d’Harcourt: Well Mark there is really different kind of refugee
experience where on one hand it's the acute situation where people are literally running
for their lives with a constant sense of worry about survival , t hey don't often last that
long. And then there is a different kind of experience which is what happen s when you
are in a refugee camp and increasingly we have people s t aying in refugee camps for
years and where the people in the refugee camps have often an experience less of
anxiety than boredom and hopelessness , refugees aren’t allowed to work . But what it
really means is they can't build a career , they can ’t become more skilled and they can't
really establish themselves . And so that sense of boredom and hopelessness is in its
own way as damaging as the danger that marks the beginning of their refug ee
experience .

Margaret Flinter: Well Emmanuel I think that the scale of what you try and do is so
massive in terms of the need for infrastructure – right , for food and shelter and
education as well as healthcare , and you have got the responsibility as t he senior
director of health for overseeing the care of millions of people , may be you could share
with us some of the flat - out logistical challenges .

Dr. Emmanuel d’Harcourt: The overwhelming majority of the work that the I R C does is
done by local people for local people . The one thing that just about every place on
earth has is people , a nd for us the key thing is understanding and taking full advantage
of the vast wealth that exists in every country in terms of people . The reality is most
people are actually intent on helping themselves than helping others and we often go to
places where there has not really been an opportunity for people to help and they are
actually very keen on doing so. A good example of this in the South Sudan where there
are indeed no clinics or no hospitals , but we find that equipped with very simple

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

medicines people who don't know how to read or write are actually extremely skilled at
figuring out what the right medicine is , we give them very clea r instructions and giving
basic treatment s for children who are sick with malaria, and pneumonia , and diarrhea ,
people who might ha ve been seen as victims are actually our biggest allies in providing
that aid for something that we do all over the world and that makes our work possible .

Mark Masselli: We are speaking today with Dr. Emmanuel d’Harcourt, Senior Health
Director for the International Rescue Committee , a nonprofit global organization
dedicated to helping those affected by the worst humanitarian crisis around the world .
We hear that there are a plethora of NGOs trying to do good work but even with their
best intentions sometimes they are not able to achieve their ends , and I am wondering if
you could talk a little bit about your outcomes and evi dence framework and perhaps
share some of the tools you rely on to ensure that the right care is delivered to the
greatest number of people .

Dr. Emmanuel d’Harcourt: Sure . Mark, you know good intentions are not enough good
intentions can often not necessarily lead to good results so we need to measure , we
need to know what's actually being done and we need to do so in ways that are
somewhat independent and objective . There ’ s a great sign o n a Congolese border post
between Congo and Rwanda that says you know “ Trust doesn't mean that I can't check
you ” yes , we can be glad of our mission and we could trust an organization but we need
to actually see the data . So the outcomes and evidence framework is a way for us to
clarify across a range of areas such as the health but also safety , education , power and
economic well - being , what exactly we are trying to achieve you would be astonished
that how many times that basic question hasn’t been answered . And then once we
know what we are trying to ac hieve , we are not trying to distribute food , we are trying to
make sure that people have enough to eat , then we need to figure out ways to measure
this.

Now one common way we do it is through surveys and that means going out and going
into the population s that we are trying to help and actually going house to house and
checking what people have . And that has the benefit that it generate s numbers for
example if we are giving out mosquito nets we can measure what percentage of
households actually have a bit of mosquito net being used as it should be . But it's also
a way for us to learn all sorts of intangible s and this is one of the most valuable things I
found in my time in the field is doing home visit s and we don't always like what we hear
but it's alway s very instructive .

Margaret Flinter: I wonder Emmanuel if I could go back to our earlier conversation
about the issues of hopelessness may be lack of purpose and all that adds up to lost

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

potential, particularly I think when we talk about children a nd it's estimated that a child
refugee could spend a dozen years in a camp b efore finding a permanent home . How
do you build a bridge to the future ? I know there is great efforts to provide education
but how do you build a bridge to the future ? What are so me of the programs that you
have developed at the IRC that helps these families re build ?

Dr. Emmanuel d’Harcourt: There are several programs that we have that look at the
longer term and often the crisis that cause the problem gets you know a few minutes of
airtime but we realize the disruption to the people we serve often is that as you said for
over a decade and sometimes generation . So the first thing we do courses is focus on
education , you know a few things that replace some [PH] basic primary and e ven high
school education and we work on providing that in all sorts of context in refugee camps
but also in places where people aren’t even as lucky , or lucky enough to actually get to
a camp.

The other thing that we do is we work on economic recovery an d development . We
help people to set themselves up in a way that they can generate income and also
make choices about what to invest in . So increasingly for example we a re looking at not
just giving people blankets but giving them cash so that they can make the right
distinction between immediate needs but also kind of b uilding for the future . And our
experience has been that when people have the option of getting cash they o ften make
very good decisions about balancing the short term for the long term .

But another thing that we are doing , t w o other things at least , one is also looking at
early childhood development s they are learning how to read and learning basic math
skills is important , part of what can get disrupted in refugee camp s a nd other settings is
the basic bond between parents and children s o we work on this program . And maybe
the most important , we have refugees participate in activities at every turn so that they
are people who are participating . And this really make s a difference for the future as I
saw most directly when I was working a lot in Sierra Leone and there were people who
had spend decades in refugee camps . And what those people reported of course with
some sense of loss , they had got ten married much later th an the y intended and delayed
starting a family but they had also learn ed valuable skills . So a lot of the refugees in
Guinea for example had learned French , a number of them had learned healthcare
skills . So that experience for them of being in a refugee camp wasn't entirely a
hopeless or passive one , it was also one of being involved in the work so that often the
people I worked with in Sierra Leone the way they described it to me wasn't as
recipients , they say they were employees of IRC beca use they had also been paid by
IRC to do work and train .

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

Mark Masselli: Dr. d’Harcourt, CEO of IRC David Miliband was at the World
Humanitarian Summit large gathering of World Aid Organizations seeking better ways to
address the crisis and he spoke eloqu ently as you do about the need to transform relief
from humanitarian sector to humanitarian system , and I am wonder ing if you can talk a
little bit about the best practices that IRC is out there trying to promote , what types of
systems do you depl o y that should be scaled up ?

Dr. Emmanuel d’Harcourt: One of the things that David Miliband looked at when he first
came to the IRC , he made an effort try to understand why NGOs acted certain way ,
because he was coming , he was familiar to some extent with t he wor k of charities and
NGOs . He you know I think was able to see some of the good things that were
happening , the current more scientific work and the attempt to be more rigorous , but he
quickly came to grips with things that were being done because we had been doing
them that way for a long time a nd that's a little bit what the humanitarian sector look like
to him, this is how we do things . And the distinction between a sector and a system is
that the system is actually designed to accomplish something and we need to figure out
what that something is and make sure that we are actually accomplishing it versus a
sector that’s just looks well - intentioned in our case .

Now there is several elements to how we are trying to reform the system , and key
aspects are the outcomes and evidence framework that we talked about earlier , so what
we are trying to do is to share our objectives with others , not unilaterally but to arrive
with other organizations at common objective . In Sierra Leone for exa mple recently we
have been working with a coalition of more than 20 organization s, and the idea i s that
instead of all of these different organizations all doing the ir own separate projects which
might be slightly different in each contribute something a l ittle bit different that we would
all agree on the outcomes framework . For example when it came to maternal health
what were the key elements to making sure that women did not die in pregnancy . And
what we found to our surprise is that partners were very open to it because I think it ’s a
pretty widely shared frustration when really we should be more than the sum of her
parts.

So what we are trying to do is be very transparent . We have just today put up on our
website information that's available to the public about what our outcomes are , what the
evidence is , we know that those outcomes and certainly the evidence will evolve with it .
But the idea is that instead of you know just having IRC projects with IRC ob jectives we
have common outcomes , it can seem like a tough sell but David Miliband is an
outstanding salesman so I am very hopeful .

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

Margaret Flinter: Great. We have been speaking with Dr. Emmanuel d’Harcourt,
Senior Health Director for the Inter national Rescue Committee , a nonprofit global
organization dedicated to helping those affected by the worst humanitarian cris i s around
the world . You can learn more about their work by going to rescue.org or follow them
on Twitter @ theIRC . Dr. d’Harcourt, thank you so much for the work you do and for
joining us and Conversations on Healthcare today .

Dr. Emmanuel d’Harcourt: My pleasure Mark and Margaret .

(Music)

Mark Masselli: At Conversations 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: Donald Trump made misleading claims about California’s drought and
water issues . First he suggeste d , there is no drought in California because the state
has “plenty of water” , b ut California indeed is in its fifth year of a severe hot drought, the
kind that’s expected to become more frequent with global warming.

Trump also said water is being shoved out to sea to protect a 3 inch fish at the expense
of farmers , b ut officials release fresh water from reservoirs primarily to prevent salt
water from contaminating agricultural and urban water supplies. And the New York
Tim es has reported that some farmers believe that, but e xperts told us water
management practices, the state’s natural climate and global warming have all
contributed to the state’s current drought and water issues. And while California’s
climate is prone to long term drought, this one has been the driest since record - keeping
began in the late 1800s that’s according to the Public Policy Institute of California . And
2014 and 2015 were the warmest years on record in the state making this what's called
a hot drought , that affects the amount of snowpack in the Sierra Nevada mountains
which typically provides one - third of California’s farms and cities with fresh water in the
dry season.

As for the 3 inch fish , that’s like ly the delta smelt which does requir e preservation by the
state but the Chinook salmon and other species with the loss of habitat also benefit from
the relief of fresh water from reservoir s. T he infrastructure that was developed to
deliver water to farmers in the Central Valley has itself disrupted the d elta’s natural

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

ability to flush salt water out to sea , 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 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 checked, email us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

(Music)

Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Tel Aviv computer scientist and
developer Oded Ben Dov has been coding since he was 6 yea rs old and has always
been interested in hacking systems to make them better. So when this young
entrepreneur unveil ed the hands - free gaming system on Israeli TV, a local quadriplegic
in the viewing audience took notice and urged him to think about adapting this hands -
free gaming system to help quadriplegic s interact with their Smartphones by using
simple head movements. Ben Dov couldn’t resist the challenge from Giora Livne who
had been paralyzed for eight years following an accident.

Oded Ben Dov: And the guy in the call said, hello my name is Giora, I can't move my
hands or legs, could you make me a Smart phone I coul d use a nd that really cut my ear,
cut my heart .

Margaret Flinter: The two hit partner together on the project deciding to call the device,
Sesame Phone as in Open Sesame.

Oded Ben Dov: So someone could opt for big head movement or very small head
movem ent. You could use it like expanded voice commands or you could use a built in
Google dictation capabilities.

Margaret Flinter: Ben Dov says he has seen both children and adults formerly locked in
by paralysis literally come alive.

Oded Ben Dov: It fe el s emotional, and every user uses it differently. Someone
immediately called his wife, children you know rushed to the most popular game and
played that.

Margaret Flinter: The Sesame Phone now has hundreds of users around the Israel but
they are gather ing funding to make the Smartphone software available around the world

Dr Emmanuel d’ Harcourt, Senior Health Director, International Rescue Committee

and Ben Dov says, they have got bigger plans for developing this and other systems
that are geared to assist the handicapped community.

Oded Ben Dov: We have broadened our vision to e quality through technology we are
positioned as well within the special need space and we can keep supporting and
developing our current product but we use new technologies and offer a completely
different product as we are exposed to more and more needs.

Margaret Flinter: Sesame Phone, a simply devised hands - free interface that allows the
paralyzed and physically handicap to interact with their world through their Smartphones
using simple head movements, allowing them a new level of independence, and a n ew
chance of self - driven social interaction, now that’s a bright idea.

(Music)

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

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.