📷 Harvard University
Journalist: Emily O'Halloran
Emily: Hello and welcome to SciSection. My name is Emily O'Halloran and I'm a journalist for SciSection radio show broadcast on the CFM 93.3 radio station. We are here today with Dr. Richard Heinzl, the founder of the Canadian chapter of Medicines Sans frontieres, also known as Doctors Without Borders, who currently works as the global medical director for World Care International. Thanks so much for joining us Dr. Heinzl.
Dr. Heinzl: Thanks Emily, great to be here.
Emily: So let's just jump right in. Do you think you could start by giving us sort of an overview of your journey from maybe the point where you decided to go to med school to where you are now?
Dr. Heinzl: Yeah, sure. I mean, you know, I'm from Hamilton originally right so I grew up with this amazing University McMaster and their med school in the background and both my mom and dad are psychologists so that planted, obviously the health but it's sort of their version of humanitarianism, if you will. And because my dad was a psychologist and then he went to McMaster and became the Dean of Students there and so for many years my dad was the dean of students and I can actually remember as a young kid, literally his five year old walking around the campus and falling in love with academics and McMaster and so I don't know exactly which path to take me to but it was pretty amazing to end up there in medical school after, after, sort of, you know, the path I didn't take. I mean, what happened was I went to undergrad at University of Toronto. And, you know, pretty straightforward wanted to do medicine. And so I took all the sciences and, but even that at that point started becoming extremely interested in international health global health and sort of seeing the world that way and so I did some work with UNICEF and some other committees back in the summers I traveled back in the day when you could hitchhike all over Europe for a few dollars a day and I did that, and that sort of has been a theme in my life is always combining health and medicine with travel, if you will and putting that all together. So that's what took me to McMaster and then I got into the medical school there and that was obviously life changing extraordinary school. And you know, that led me towards Doctors Without Borders.
Emily: So, what specifically about doctors that borders, kind of drew you to the organization?
Dr. Heinzl: No, I mean, a lot of people at that stage this is in the late 80s right. This was a time of yuppies and sort of consumerism, people getting rich on the stock market and stuff like that and then there was a sort of a counter offering to that a bunch of us sort of much more focused on humanitarianism and trying to involve ourselves and do something about the world because we saw that we were the rich world, we had all this material stuff and all the money and all the power, and yet we see every day on TV what was happening in Africa in Asia. And when we saw that, something went off in our heads saying that that disparity that complete imbalance versus the have nots something wasn't right about that and we wanted to do something about that. And so we started looking at the world and I looked at the, you know, there were certain offerings and that one was taking a long term career path towards like the United Nations or something like that and one of the big existing groups like UNICEF etc. And it would take you a long time to get somewhere with it and we'll look at those bureaucratic and a little bit dated we were looking for something more, more exciting and long behold we started hearing about this crazy organization Doctors Without Borders people who were not just doctors but nurses, other healthcare workers, logistics people, administrators, people who believe in the stuff we did, and saw some injustice in the world wanted to do something about it. And here were these people who were just gonna do whatever they could, stop doing whatever they could go overseas to the worst affected places and try to do something about it, stand up for what needed to be stood up for. So it was kind of natural for us we became very excited about it.
Emily: Yeah, that's awesome. So, you kind of really have made like genuine and significant change in the world through creating this a branch of Doctors Without Borders in North America. Do you have any tips for people who, you know, kind of look up to you, in terms of making aspiration into action?
Dr. Heinzl: Well thank you for the nice words. We are, I am and we are very proud of what is happening with Doctors Without Borders. It’s a very important organization and shows a gap in the geopolitical scene. That is so important. You know, we, we hope one day we don't have to have an organization to do this kind of stuff, that things get better but I'm afraid over the next many years we're gonna still be in high demand and so we have to double our efforts and keep working in that area. And I guess that speaks to a tip, I guess, is that you try to find something that you're totally passionate about. Try to find something that you believe in and you just clean it up you dream up what you think you could do most people use your aspirational tip right most people kind of trip themselves up. Just can't do that, that's too much that's too big or how could I possibly do that. And it's almost, you know, 90 something percent of the time it's that internal self-doubt that really stops people from trying to do these things so I'm saying the first tip I would give you is just following your dreams, sounds corny but really do that just dream it up don't stop yourself, dreaming-
Dr. Heinzl: dream expansively, figure out something because the world has to keep changing and your generation is the generation that's going to change it for the future.
Dr. Heinzl: But don't say you can't do something. Don't sell yourself short in the beginning, don't stop dreaming just dream it up. Take the discipline the concrete steps you need to do to get there, which in your case may be finishing university finish your training become the whatever kind of professional you want to become because that gives you a certain currency in the world, a standing in the world a certain know how gives you something tangible that you can share with people, but again that's the tip I would give, just dream it up don't get in the way of your own dreams and then figure out how to get there and truly anything is possible. We just were a bunch of people who said hey you know this is, this is a biggie. Don't we think we can figure out how to do it. And basically, people let us do it. We didn't know you're not supposed to be able to do that, we didn't know you're supposed to be a big, you know, expensive world organization first of all this experience, we knew what we believed in, we wanted to do something about it. And the good thing about organization of young people, or at least young, certainly young thinking people who go with that idea. Just, frankly, again as corny as it sounds, they do want to change the world.
Emily: I love what you said, the dream expansively, that's a great kind of mindset to be in. So, during your first year working as a field, a field officer, is that we call it?
Dr. Heinzl: Oh, sure, a field placement Sure. Okay.
Emily: So you lived in Cambodia for a year, correct? So while you were there, what specifically were you doing to help rehabilitate the healthcare system and how, kind of as an external consultant to their system, did you facilitate change?
Dr. Heinzl: So, you know, Cambodia is this amazingly beautiful country, very peaceful wonderful people. And honestly, to this day, and I'll always say this I don't understand how the things that happened there actually happened. Such a peaceful wonderful people but I don't know how you want to put it the country went absolutely berserk. In the face of geopolitical tensions from the Vietnam War and the US bombings in the countryside and Cambodia. You know the population turned against the West turned again, and stole those wars and was looking for something completely different and that created a vacuum of power vacuum pumps like the Khmer Rouge and left and all these other groups were able to get in and sort of lead the people in different directions. Didn't take them too many months before that whole new leadership especially by the Khmer Rouge went absolutely psychotic and more than a million people died, directly or indirectly because of war and famine. And so you had a country that was by 1979 absolutely, completely decimated. Something that’s very hard for Westerners, people living here in Hamilton and elsewhere, you can’t even imagine what that was like but I walked around those villages completely flattened by, etc. So this was a country that was broken. The infrastructure did not work, it was lawless. You can't turn on a tap and get clean water, you can't turn a switch and the electricity works, positive reliable food chain supply. And of course it was no nothing functioning to a great extent in terms of medicine hospitals, etc. Especially in the countryside so there was a brand new province created called Benjamin Shea in the northwest near the Thai and Laotian border that, you know, hadn't had any support or help for almost 20 years at that point. And we marched in and we were there to support the fledgling efforts that were going on to rebuild the provincial health care system. We just started with rebuilding a hospital. a bombed out hospital that had chickens and goats in the wards and no supplies, no running water, no electricity and all kinds of soldiers with guns around. And, you know, that's what we were presented with. We started with that and we started with the very basics we said let's, let's make the infrastructure the hospital work right let's get water. Let's have some sterile procedures let's have some basic supplies. Let's add some basic treatments to basic problems that happen medically. And let's obviously work hand in hand with local people I mean I remember I spent about the first month everyday spending a couple hours at the cafe learning how to speak Cambodian because that way you're able to understand some of the local people directly what's going on and what you need to do instead of hearing it from someone else who has their own agenda or isn't on track with what we're trying to do. We built it from there we started vaccinating we use the hospital as a, as a starting point and tried to earn trust and I think we got done and then more and more people came to the hospital and we were able to push hard on a pediatric approach and a mother child approach. And to some extent working quite well and we were able to support that all the time Emily we learned as much as we were giving blown away by what they were doing and they taught us and we taught them and we came together and it was us very lucky to have such amazing leaders locally so that what we were trying to do actually was on track because they guided us and and had a lasting impact. That's great.
Emily: That's great that you guys have a lot of local participation Do you have sort of like a specific proportion of medical personnel working for MSF that are locals like local to the area that you're focusing on?
Dr. Heinzl: Yeah, I mean you can kind of look at it this way, ‘cause you want to look at it from our perspective and Westerners going in there it's typically the place like I just described the team of four, you have a, you would have an administrator. Okay. And you'd have a logistics person, and you'd have a nurse and a doctor and a team of four would be the MSF. But for those four people there's going to be another 10, 20 or 30 local people, physicians midwives car drivers, people who give you a security people can fix electricity people who can transport vaccines, on and on and on so overwhelmingly it's the local people who outnumbered foreigners coming in. And that's an important thing I myself, you know, in the beginning days we were sort of Rambo cowboys going in there and all the focus was on us and we knew that wasn't right. The focus really should be on the local people in every single way and we've done a better job last numerous years have recognized people. If you don't, if they're not really running if they're not really doing it, we're going to go one day, and then nothing will be there so they've got to be the ones to own it. So we support them. When we can, you know, other times in a big emergency, you just do whatever you can. And it doesn't work out so every single time that's the nature of problems.
Emily: And so it sounds like kind of when you went to Cambodia, it was a very obviously unstable place, probably a lot of the places you go are pretty unstable, but are there any circumstances under which MSF will refuse to enter a situation? Like is there any kind of protocol surrounding those decisions?
Dr. Heinzl: Yeah, I mean, well you have to be realistic, right, and if things are so bad, right. And it's happened in various places in Somalia in Afghanistan, certainly in in Syria, where we are targeted, were targeted, MSF as an organization is targeted our people, our doctors, nurses, etc are the targets of bombings and shootings or whatever it is. And although we will save this as a last resort and we, there's many things we can do to negotiate, our safety and the safety of the people we're working with locals who are working hand in hand. If that's the case, you simply can't work there and we're not willing to risk the lives of people volunteering with MSF whether there are national local staff or expats who are coming in like myself. There's just a reality there at some point that doesn't happen very often but it is, it has to happen when it's necessary. And when it does happen it's a pretty, pretty intense international statement, it means things are so bad in that country that they're targeting a completely apolitical, fiercely independent organization that is only there to improve the health care of the local people we have no other agenda and, and so we get to stand up and say that loudly and often that can bring about some change and better seats for us.
Emily: Yeah, that totally makes sense. So are there any like specific medical fields that Doctors Without Borders, sort of recruits the most? I guess my guess would be like emergency physicians or also kind of public health. What kind of positions are generally needed?
Dr. Heinzl: I think you're on the right track there Emily it is, you pick the specialties that match the need there right so somebody who's a you know a hematologist geneticist who can only work in a big city hospital in North America or Europe. We don't really have too many jobs for those people on the front line. We always have jobs for pediatricians, for public health doctors, for surgeons, for anesthetists, for obstetrician gynecologists. We have, you know, clearly want. So, anybody who's a physician, nurse, other healthcare expert who has worked in these places before who understands those kind of the unique needs that happen in situations like that in the cultural context, etc. So we'd like people who have been to those places probably who have already at this point worked with another organization and have some experience, we know they can appreciate it, we know they can survive in these places and do well and bring something really helpful to the local situation. So, as time goes by, there are more and more fancy kind of physicians and others who are needed. We're doing studies we're doing some leading edge technology we're doing some telemedicine we're doing much more in the zone of psychiatry and psychology people affected by trauma or etc. So they'll always be changing but the bread and butter is what you were hinting at, it’s emergency, it’s basic doctors with Tropical Medicine experience, if you will, public health doctors. Mother child focused physicians.
Emily: Interesting. So you just mentioned telehealth and from what I gather You are a pretty big advocate for the importance of Tele, telemedicine. Can you kind of give an explanation of what you mean when you refer to telemedicine?
Dr. Heinzl: Yeah, I mean telemedicine, telehealth, tele anything really just means a digital version of what you would normally do in a normal bricks and mortar world. So, when you're in the middle of Cambodia or anywhere. Normally what we do is, we're seeing one person at a time and we're seeing them and we're near them and touching them and seeing them and we're helping. But you don't need to do that to have a big impact on healthcare for people, huge issues are always just about basic diagnosis and treatment planning and what you should do, and testing, and we're in a day and age when everything from a tuberculosis test to a blood smear to an X ray to ultrasound to telepsychiatry visits. All of this can be digitized all of this can be put securely on the web. And then something magic happens. Means the geography disappears. And when geography disappears, it means me in the middle of Cambodia and I don't know what I'm looking at which happened frequently. And I didn't have the expertise and I really needed what I could have had back home, which is a hallway consultation or send somebody down to the clinic or pick up the phone and ask a question. We didn't have that there we just had a couple textbooks with us. Nowadays, of course, now we are instantly linked to the richest resources of health care all over the world and so you can get a supersized specialist from Boston or Toronto, or McMaster helping, talking, sending, reinterpreting data to somebody in an extremely remote location. And to me that's a paradigm shift and that's, I got to see the importance of that because I used to be stuck in the middle of these places with no way to get that knowledge no way to help the people in front of me. So I really understand the power of this and it's exponential. It's going to get better and better and better and we're pushing hard, you know, to make sure that MSF benefits from the tremendous potential of telemedicine.
Emily: Right. And have you seen that, I mean of course we've seen telemedicine gain huge popularity during COVID has that occurred worldwide as well like have you seen MSF sort of adopt telemedicine kind of more fervently during this pandemic like even in terms of social distancing in places that are kind of conflict ridden?
Dr. Heinzl: Yeah, I mean, you're seeing it grow. You're seeing it grow because it has to grow, we have to do our job we have to make our contributions. under our mission, and when you can't go somewhere freely and see somebody and touch people and do all that, you got to do it a different way. So yeah, we're seeing. Are we seeing it as much as North America probably not as much as North America because here we have the infrastructure of everybody's got a computer everywhere, and we were pushing hard to get telemedicine going. And finally the pandemic just let it go explode. I don't think we're seeing an explosion yet but I think we're going to I think we're going in that direction. Oddly, Doctors Without Borders is a bit of a Luddite organization, you’d think they'd be the first organization to adopt telemedicine and all these digital technologies but because of the nature we do, because we're so sensitive culturally because we're in difficult situations because people don't always trust it that way they're much more in some of these countries just the here and now and we've seen something physically been given what many people have been through that's how they want to do it. There's a little hesitation on our part and. And so I'm trying to change that other people are trying to change that. On the other hand, I have always had the greatest faith in the actual patients around the world and the patients that we serve in Africa and Asia. I think that they will carry the day eventually they'll see that this has great merit, it works, it's trustworthy, it's a tremendous it's somebody said it was like a godsend right, suddenly, you know, for years and years they're just trying to, you know, grow their communities, you know, so one telephone pole at a time and they can't afford too many telephone poles and that's how slowly. You can be now connected to the rest of the world. Throw that all away because everybody can have a simple cell phone now and smartphones are becoming ubiquitous all over the world and as soon as you do that, you're putting the power of the entire world's internet with instantaneous translation and and artificial intelligence driving human understanding, and it absolutely is going to absolutely transform healthcare.
Emily: That's great. Yeah, for sure.
Dr. Heinzl: No You heard it here that's my prediction. Already, it's already happening.
Emily: Yeah, that's interesting that you, I hadn't even thought about kind of the cultural aspects of people being a little bit more hesitant to partake in tele medical procedures. So I'm sure that's kind of made social distancing in places that are maybe a little bit more sensitive, a bit more tricky. Have there been any changes to protocol in the wake of the need to social distance?
Dr. Heinzl: Yeah, you know, MSF is pretty darn good at this stuff right we lead the world's response to the Ebola outbreak in the DRC, about three and a half years ago. Really the world bodies participated but they just. We really did an amazing job there, extremely proud of what we did there. And that was really our foray into understanding, you know isolation strict isolation all the barriers to do so that really has become sort of, you know, sort of a you know something, well, that we're, we're good at and we're familiar with. And so, jumping over to COVID was a pretty easy jump for us to be able to do this kind of stuff. And it's different in every country. But it's worth pointing out right now if I can that the, you know, COVID here we're so lucky in southern Ontario and the rest of Canada even compared to the United States, compared to other countries that have done poorly. We don't really know what's happening in many of the countries in Africa, India has a huge toll right now. And and many many countries are really going to have a toll from COVID that, that is, is as so often happens it's going to be harder there than it is here and they're not going to get the vaccine as quickly as we can. They don't have respirators to save people's lives with. And so again it's the rich world versus the less industrialized world who are gonna have a hard time of it and that's one of the things we stand up for, to make sure that health healthcare access is the truest for everybody. It's a big job though,
Emily: Huge job. But it's a good thing that you guys are doing it. Yeah. I think that's about all the time we have. Thank you so much, that was, this was so fascinating to hear about all your experiences and about what MSF is doing and has done historically, I so appreciate you coming on our show.
Dr. Heinzl: It's really nice to meet you, Emily. Good work on SciSection and I'm glad we were able to inject a little international thinking into what you're doing. Appreciate it.