INTERVIEWS

Dr. Paul Cook, MD, MHA, CPE, SCLA, Member of GHEF Board of Directors

"Relationships are the basis of knowledge. The ability to form relationships is where GHEF excels. Other organizations may not combine education with access to health care. They don’t provide education with the provision of medicine and food for displaced persons. Technology and education needs to be provided where the displaced population lives."
— Paul R. Cook

This interview was conducted on July 25, 2011

I first met Tayeb several months ago, in Miles City. Tayeb and his staff described Global Health Equity Foundation. I was quite impressed from the get-go. Tayeb is very dynamic, outgoing and personable. His excitement is infectious. He has a Middle Eastern, European demeanor with which I’m very comfortable.

My background is in academic medicine and surgery. Physicians need help with and training in health services management. Some need to be trained in healthcare administration, in population health management, in understanding economic and political factors, and in how different health care systems work.

Physician-executives are rare. It’s rare to find the skills of a physician and the natural leadership of an executive in one person. Being able to work with a visionary like Tayeb, a man who has a world-wide focus, who is a physician and a leader, is a pleasure.

When I took part in the Consensus Building forum, I was struck by how different stakeholders came together to develop concrete action plans. And now those plans are being put into action. Momentum has built.

I would describe the geography in Eastern Montana as not just rural, but “frontier,” or “wilderness.” The remoteness presents problems. There’s a lack of access, or incomplete access, to health care. We urgently need to provide patients with information they need, in a form they can use to decide what steps to take next.

We need to build a society of health and wellness, not of disease. The education, the knowledge, should be available before anyone ever becomes a patient. We should put access to knowledge, in the hands of everyday people, no matter where they live.

A simple directory of services needs to be developed. There’s a lack of providers for suicide prevention. There’s a lack of access to mental health services in general. There’s a lack of knowledge about mental health at all levels. Education is needed at the community level.

Physicians need diagnosis guidelines for mental health, help with research, help with applying for grants and awards, guidelines for targeting specific problems.

One of the community members at the first forum held in Eastern Montana was the wife of one of my physician colleagues. Her child needed mental health services, and there were no adequate resources locally. Now she and other community members have come together to form a chapter of NAMI (National Alliance on Mental Illness) in Miles City. At a GHEF forum, she connected with the people she needed to know to get that done.

Relationships are the basis of knowledge. The ability to form relationships is where GHEF excels. Other organizations may not combine education with access to health care. They don’t provide education with the provision of medicine and food for displaced persons. Technology and education needs to be provided where the displaced population lives.

In the second forum that GHEF hosted in Eastern Montana, that was where an executive group made sure the action items were carried out. People were motivated. I would tell anyone in health care that a GHEF conference is one they don’t want to miss.

It’s amazing to me that a person like Tayeb could have such a grand vision. He has built from ideas to tangible results. His list of advisors reads like a who’s who of global health, and includes specialists in economics.

We are looking forward to leveraging health-information technology. The Semantic Web project gives us a whole different way to conceptualize and to search for knowledge. We are setting up a pilot program using the City Health Department in Miles City. Among other issues, it will cover questions related to sexuality, adolescence, aging, and access to care. One of our community members who is a nurse is working to develop a social networking overlay for the semantic web technology.

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Jackie Muri, Director Bus. Development, Strategy & Foundation, Holy Rosary Healthcare

"The forum brought together a diverse group: city leaders, nurses, hospital CEOs, physicians, business owners, and other community leaders from across eastern Montana. The sheer excitement of these participants was impressive. People met and discussed what the real issues were and how to potentially solve them."
— Jackie Muri

I met Dr. Alhafez about a year ago. There are a lot of common threads in our organizations’ respective missions. I have tremendous respect for Dr. Alhafez. He’s extremely bright and he maintains a holistic view, with his patients at the heart of that view.

Who is doing suicide prevention? Who is collaborating on this issue? Based on patient interactions, how do we identify recurring problems? Recurring themes related to patient care delivery in eastern Montana are present without clear solutions and consensus among key stakeholders. For example, we have a high suicide rate, drug abuse, and limited access to health care in our county and region. Working in our facility as a hospitalist, Dr. Alhafez confirmed our findings, and he identified additional patient-care needs. Together, Holy Rosary Healthcare Foundation and Global Health Equity Foundation focused on finding solutions that will impact these trends long-term.

For a physician to take the kind of leadership role Dr. Alhafez has taken is unusual. He brought the idea of a consensus-building forum to us. The forum brings together community, healthcare, and business leaders to collaborate on setting priorities and identifying solutions. Dr. Alhafez's leadership and perspective as a physician are highly valued. He has taken this project to a different level.

The forum brought together a diverse group: city leaders, nurses, hospital CEOs, physicians, business owners, and other community leaders from across eastern Montana. The sheer excitement of these participants was impressive. People met and discussed what the real issues were and how to potentially solve them. They set priorities, and decided where best to begin. It worked because we involved all the key stakeholders. We moved the envelope as to when things could get done.

Holy Rosary Healthcare (HRH) provided resources for the forum and for the action plans, including the information needed for a fact-based conversation. Eastern Montana is our organization’s home. We brought local relationships and contacts to the partnership with Global Health Equity Foundation. The forums in Eastern Montana worked so well that we are confident about expanding the project and are exploring our options in Northwestern Montana. We're just in the beginning stages, but so far the response in Northwestern Montana has been encouraging.

This is a very manageable and well-run project. It is reasonable in scope, covering a reasonable area, with the expectation of reasonable outcomes. Knowledge from patient-care delivery is used to develop community action plans. The speed at which Global Health Equity Foundation works is also impressive. Some of the concrete results so far include:

a suicide prevention meeting each month
the development of a healthcare directory, with online access
a change in attitudes and in trends thanks to community engagement

GHEF personnel excel at community outreach. This is an ongoing project, to increase communication and to expand communication over a larger region. Local media have become involved. Future plans include a 2 1/2 day continuing education conference, with the focus for the conference coming from Dr. Alhafez’s work with patients. Topics may include:

prescription drug abuse
mental health issues
over-medication issues
gaps in healthcare
appropriate diagnosis tools and methods for mental health issues
elevate the level of care for all patients
measure the impact of action plans, and note outcomes for patients
connect the dots for multiples causes and effects
connect potential collaborators

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Chris Hopkins, V.P. of Strategy/Business Development, Montana Health Network

"One of the best outcomes of the forums an increase in involvement on the part of rural hospital CEO's, nursing home directors, and other healthcare professions from areas surrounding Miles City. The Miles City community as a whole has been improved as a result of GHEF strategies."
— Chris Hopkins

It was a hospitalist position that brought Tayeb Alhafez to Miles City, but he didn't limit himself to that work. It was great to see his excitement and his willingness to get involved with health issues in the region. He didn't just complete his hospitalist requirements and then go home, instead he helped us improve health and wellness in the community.

My connections through my employer, Montana Health Network (MHN), are valuable to Global Health Equity Foundation. Many of the healthcare leaders that attended the Consensus Building Forums are members of MHN. At the forums there are opportunities to collaborate, and to gain wider market exposure very quickly. The Foundation's goals and MHN goals sync well on a local level. We bring to the table different, but complementary, methods of achieving those goals.

The community-based health forums have been eye-opening. The forums generated some very good discussion, and I think we are to the point where work is going forward. It's exciting to see. The number of talented people coming together to work on these projects is phenomenal. For example, GHEF's focus on eastern Montana's suicide problem has brought some very creative people to Miles City. Their talents have created an awareness of approaches that would not have been thought of otherwise.

The focus on eastern Montana's high suicide rate created the biggest splash immediately following the forums. There are other urgent healthcare issues that will take center stage as we begin to work on those projects.

One of the best outcomes of the forums an increase in involvement on the part of rural hospital CEO's, nursing home directors, and other healthcare professions from areas surrounding Miles City. The Miles City community as a whole has been improved as a result of GHEF strategies. Creating contacts and generating awareness encourages the community to define problems and to work together on solutions. So far, community leaders have identified healthcare issues, and the forum participants are excited about working on some of these issues through various media channels. Different media channels allow providers to contact patients, and to give them crucial information. Information is provided on a broader and more appealing level.

Seeing rural American communities as having issues in common with other underserved populations sets GHEF apart from most global healthcare organizations. Global Health Equity Foundation is a good group to work with.

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Stephanie Goode, Consultant, and one of the Foundation's earliest supporters

"Tayeb is a visionary. He chooses to put himself in challenging situations. There are very few people who consistently choose to go outside their comfort zones to learn... Arm him with information and he can distribute it in a useful way, in a way that’s effective and rewarding."
— Stephanie Goode

I acted as a consultant, developing ideas for a presentation at a Global Health Leadership Forum that was held at Berkeley. This presentation was the seed for Global Health Equity Foundation, which has evolved rapidly.

Brainstorming is how Tayeb works. He collaborates and communicates with other people, including a wide range of leaders in the global health sphere.

Tayeb is a visionary. He chooses to put himself in challenging situations. There are very few people who consistently choose to go outside their comfort zones to learn. He has so much energy and optimism, and that’s part of his charm. He gets along with everyone. The forums in Montana were successful, in part, because of Tayeb’s almost uncanny ability to meet the right people and to get them interested in his ideas. He starts a chain reaction of interest. Arm him with information and he can distribute it in a useful way, in a way that’s effective and rewarding.

It’s difficult to start an organization intended to have global influence. There are so many interconnected issues that everything feels urgent, and at the same time nothing stands out as more urgent. Diving into a project like the one in Eastern Montana focuses the community and the Foundation on goals. People focus on priorities, and a proof-of-concept comes out of that. The consensus forums in Montana have had an effect that’s larger than regional.

Everything is still growing, still being refined, so it’s hard to choose one thing if you ask what accomplishments we’re proud of, but the technology-oriented projects, the open-source technology that will provide information even to disenfranchised people, that looks like it will be successful very soon.

GHEF has taken some good steps because everyone involved is also involved in the development of the Foundation itself. Dr. Paul Cook is an exemplar, and any community would be lucky to have him. The Foundation is grateful to be collaborating with Dr. Cook.

A lot of organizations are working on global health issues. Global Health Equity is sort of a meta-leader. Tayeb Alhafez is a natural meta-leader, it’s just an extension of his personality. It’s who he is. “Health equity” is an abstract term, and it’s open to definition, so one of the main things that’s needed is education. With Tayeb as a leader, GHEF, is primed to work well with other groups, with education as a core element. There are other groups ready to take on part of the challenge, but someone has to pull the whole picture together.

Tayeb’s radar is fine-tuned for spotting people who can help move things along. The projects that he’s passionate about deserve support. He’s leading a smart, open discussion about health equity, and he’s doing it in many ways, including filming a documentary, including story-telling. And that’s personal. But he’s also aware of the problems that are ingrained or institutional when it comes to caring for underserved populations. As as doctor, he sees the problems close-up, but he has the skill to see that blatant inequities affect everyone, not just those who are underserved. Inequity affects the whole society.

Some people are in such difficulty that they can’t answer questions like, "Where is my home, what is my identity, and what are my rights?" To address the inequities that cause a situation like that requires someone like Tayeb, someone who is a visionary, but someone who has that practical side, that practical knowledge.

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