Selfless Acts Have Power: A Message for Harvard's Newest Doctors

02/12/2017 10:24 am ET | Updated Feb 12, 2017

Below I share the full transcript of my speech, “The Power of Selfless Acts”, at the 2015 Harvard Medical School and School of Dental Medicine Graduation on May 28, 2015.

Commencement Speech at Harvard Medical School Graduation

As Delivered on May 28, 2015

By Raj Panjabi

Thank you Aaron. Thank you Dean Flier, Dean Donoff, Dean Oriol, fellow faculty, graduates and loved ones. I am honored to share in this special day with you. I’m honored to be chosen by your class to speak. But before we go on I have to make a confession.

When I applied to medical school 13 years ago every one of the 15 schools I applied to rejected me – every single one – including Harvard Medical School. Harvard is ultra competitive to gain admission to. The acceptance rate is only around 3 percent. So, if after failing to get in, I ended up on this stage just think about how far you’re going to go. Congratulations again on reaching an extraordinary milestone.

I did finally make it off the wait list and into medical school at the University of North Carolina at Chapel Hill and as I thought about what inspired me back then to choose medicine it’s the same thing that inspires me about it today: the power of selfless acts.

As a caregiver, you see selfless acts everyday. The wife who puts all on hold to prepare daily meals for her husband who suffers from terminal brain cancer. The hospital cleaner – tired from working two other jobs – who goes the extra mile to wipe spills near the patient’s bedside. And you experience it, when your pager goes off during family dinner and you drop everything to return the call.

Selfless acts have power. As you step into the sleep-deprived world of after-hour pages, night call, and the stress of the clinic these selfless acts can become an antidote to the pressures of caregiving and a source of inspiration. So today, I want to talk about those selfless acts. And I want to talk about why I believe selfless acts give us caregivers the power to change the world. I believe this so strongly because selfless acts have transformed my own life.

I had privilege of being born in Liberia after my parents emigrated there from India. You know Liberia from the horrific media images of West Africa’s Ebola epidemic. To me, Liberia was and still is one of the most beautiful countries on earth. But, when I was nine years old civil war erupted. The rebels launch the war in the countryside and eventually they surrounded our town.

Our school shut down, and when the international airport was captured people started fleeing – leaving everything behind. My mother came knocking one morning. “Raj, pack your things. We have to go.” We were rushed to a landing strip in the center of town, and there on the tarmac, we were split into two lines.

I stood in one line with my mother and sister. We were stuffed into cargo hatch of plane. But, in another, much longer line stood hundreds of poor Liberian mothers, children strapped to their backs. When they tried to jump in hatch with us, I watched soldiers restrain them. They were not allowed to flee.

We were the lucky ones. We were resettled in North Carolina. And here in America, I learned the power of selfless acts. A family took us in and sponsored our application to become naturalized citizens. My mother put her dream to become lab technician on hold, taking a job as an Avon lady to help us make ends meet. My father became an apprentice to a friend who ran a small clothing shop and then he started his own. And an American woman I now call Aunty Leessa, a long-time volunteer at the Boys and Girls Club, showed me the power of serving others –and said four words I’d never forget: “I believe in you.”

These people, these caregivers, all paused their own lives to help me restart mine. Because of them, in 15 years, I went from having my hopes crushed in a war to pursuing my dream of becoming a doctor. And a few years later, Harvard finally took a chance on me – when I started residency at Massachusetts General Hospital. I now have the privilege of teaching here in the Brigham & Women’s Hospital Division of Global Health Equity and Harvard Medical School Department of Global Health and Social Medicine.

Selfless acts can heal us. Selfless acts can even feed our soul. Some of the caregivers who acted selflessly in my life – my mother and my wife – are here today along with our two boys. I’ve counted and they’ve already attended five of my own graduations – but they can’t get enough of graduation. So they’ve come to celebrate yours too. And your caregivers are also here. The people with you under this tent – your parents, your partners, your relatives, your mentors – one way or another, have acted selflessly to help you reach this point. And I want to take a moment with you to celebrate and honor them.

The selflessness of these caregivers doesn’t only transform us; selflessness is also contagious. And selfless acts give us – caregivers –the power to change the world.

Let me tell you what I mean. In our world, illness is universal, but access to care is not. And the fight to change this... the fight to bring modern health care to ALL – including the billion people who live without any real access to care in the world’s most remote villages remains our greatest challenge – for physicians and for dentists. Many of you in this graduating class – including those I’ve had chance to work with — know this first-hand from your work in places like rural Haiti, Kenya, West Africa, and even rural America. And I have learned it from Liberia.

When Liberia’s war ended a decade ago, I was eager to take part in it’s rebuilding. As a 24-year-old medical student I went back there with my wife and a heart full of hope. Yet, what I found was utter destruction. The war left us with just 51 doctors to serve a country of four million people. To put that in perspective, your graduating class alone has three times as many doctors than all of Liberia did.

If you got sick in a city where those few doctors were, you stood a chance. But, if you fell sick in remote villages, where my colleagues and I were working, people often died anonymously. If you lived in a remote rainforest village and your two-year-old son fell sick, you’d have throw him on your back, walk to the river, get in a canoe, paddle across to the other side, and then walk two days – two days – through mud paths and over log bridges just to reach the nearest clinic.

You and I know it doesn’t have to be this way. While you and I have watched patients recover from complex conditions like cancer and heart disease at Mass General, Beth Israel or Brigham and Women’s Hospitals, we have also watched too many in our world die from basic conditions – from malaria, from childbirth, from untreated dental abscesses.

While you and I have seen the promise of 21st century health care right here on the Quad, we know for far too many in our world, health care looks no different than it did at the turn of the last century. And, while you and I know we can change this, we are told by those who are cynical and complacent that we can’t.

They tell us it’s not possible to deliver care to people in the most remote stretches of our planet. They tell us the economics won’t work; there are too many villages spread too far apart and it costs too much. They tell us it’s impossible to deliver health care to ALL people.

If I know one thing, it’s that cynicism and complacency can kill – and we all recently found this out the hard way. About 16 months ago, in December 2013, in a small, isolated village in southern Guinea – in the same rainforest shared with Liberia where my colleagues and I have worked for the past decade – another two-year-old boy named Emile came down with fever, vomiting and diarrhea. Hours from the nearest doctor, Emile would die unknown to the world – at least initially. His mother then died of the same disease and so did his grandmother and his sisters and people across dozens of other remote villages in Guinea and neighboring Liberia and Sierra Leone. It wasn’t until 3 months after Emile died that an Ebola epidemic would finally be declared and Emile would come be known as “patient zero.”

By then it was too late. And, now Ebola has already infected over 27,000 people, killing over 11,000 of them, and it’s cost the world billions of dollars. We have to ask why? In many of the remote villages where Ebola has spread, investments in health services had previously been lower than a dollar per person per year – all because we failed to believe things could be different

In our march to bring health care to ALL, cynicism will often stand in our way. And the best antidote to cynicism is selflessness. I couldn’t think of a better example of how selflessness fought cynicism than in the acts of caregivers like Lorenzo Dorr who stepped up to fight Ebola. Though most of you have never met Lorenzo, you have some things in common. Like you, Lorenzo is a clinician. And like you, Lorenzo trained at Harvard – he completed our Global Health Delivery Summer Institute here 3 years ago. But before he came to Harvard, Lorenzo was a refugee of Liberia’s civil war. When he returned after the civil war, he dedicated himself to serving patients as a physician assistant in remote villages.

Lorenzo would later join our non-profit Last Mile Health, where our goal is to save lives in the world’s most remote communities. At Last Mile Health we work with clinicians like Lorenzo to train, equip, and employ community health professionals who save lives in the most isolated communities – communities that previously had no care.

Our vision has been simple: a great health worker for everyone, everywhere, every day. The Ebola epidemic increased the urgency of this vision; for if threats like Ebola anywhere are threats to people everywhere, then key to our response has to be ensuring a health worker for everyone, everywhere.

And in November 2014, this vision, Lorenzo’s vision, met its greatest test. A woman infected with Ebola in Monrovia then traveled 15 hours into the heart of the rainforest in Rivercess. She quickly became sick and died. The village didn’t have the resources to bury her safely and 14 days later, 14 more people died – all of them had attended her funeral – forty others were infected, and ninety more were exposed.

Responding to Ebola deep in the rainforest is no small risk for a health worker. The virus spreads from person-to-person and from patient-to-provider. Hundreds of local health workers – nurses, doctors, and community health workers including some of our friends – have died trying to fight Ebola.

Lorenzo knew the risk. Yet, Lorenzo went the extra mile. He left the safety of his own county 8 hours away to go to Rivercess. Working alongside our partners at the Liberian Ministry of Health and groups like Partners In Health, Doctors Without Borders, UCSF and graduates from Harvard, Lorenzo trained 1300 health workers and community members who went door-to-door to draw blood samples, find sick people, get them treatment, trace their contacts to prevent further spread and staff triage points at remote clinics.

We were told back then if nothing more were done, Liberia and West Africa could soon see up to 1.4 million people infected with Ebola — and most of them would die. We never heard projections that bad, even during our civil war.

But cynicism – and even despair ― can be fought by selflessness. Not only did Lorenzo and team stop that outbreak, but the work of countless caregivers like him – locals and expats, clinicians and relatives, mothers and fathers – helped fight Ebola in villages around Liberia. Earlier this month Liberia was the first of the three most-affected countries to be declared Ebola-free. “For tireless acts of courage and mercy, for risking, for persisting, for sacrificing and saving,” TIME Magazine named Ebola fighters as their Person of the Year. We know this fight is not over yet. When the hotspots of disease are gone, the work to eliminate the blind spots in health care goes on.

But what if we pause for a moment to ask ourselves why? Why did these caregivers risk their own lives to serve others? When I asked Lorenzo he spoke about his first days practicing medicine, right after graduate school: “People would come and get me overnight, I’d have to travel for hours over log bridges, in canoes and on motorbikes in the forest to tend to labor and delivery cases far away from the clinic. There were a lot of challenges – we had no ambulance. That prepared me to go the extra mile. I was the only person they had.”

Fellow Caregivers, Lorenzo’s work, your work, our work, is only beginning. In this world, where we can otherwise be crushed by inequalities; in this world, where we partner with patients in moments of profound adversity; in this world, where our pagers go off at midnight, training seems unending and cynicism can all too easily creep in.

Fellow Caregivers, in this world, I challenge you. I challenge you to practice selflessness as a discipline. And I challenge you to start tonight. At your graduation dinner, turn to those who carried out selfless acts to help you reach this point. Turn to them, and ask why? Ask why they went the extra mile for you. Then reflect on how you will respond when your pager goes off again in a few weeks and you’re asked to go the extra mile for others.

Fellow Caregivers, I believe selfless acts can feed the caregiver’s soul. I believe selfless acts give us the power to change the world. And I believe in you. Thank you.

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