¿Qué se necesita para transformar la experiencia clínica en política global?

[00:00:00]You have to tell the people, policy-makers, [music] populations, families, there is uncertainty, nothing is ever 100% we are so sure. In medicine, we know usually there's an incremental benefit to interventions [music] and potentially done together there's more, but there never one single silver bullet, [music] but I think what we have to be is honest with that, right? Like that we are somewhat [music] certain, we are not certain, we are uncertain, and I think those are important items to try to build trust [music] with the community and then communicate in a way that people understand and and be honest with what you know and what you don't know.

[00:00:32]>> Today's guest is Dr. Janet Victor Diaz, critical [music] care and pulmonary specialist who leads the clinical management and operations unit at the World Health Organization in Geneva.

[00:00:43]From Ebola to Marburg to COVID-19, she's advanced transparent, evidence-based [music] guidance, and expanded access to medical oxygen in low- and middle-income countries, showing how science diplomacy [music] turns information, equity, and collaboration into better care.

[00:00:59]>> When COVID happened, and the first question my boss asked me at the time, so what are we going to treat the patients with COVID? [music] And this was before we knew anything, right? It was probably like in March or February.

[00:01:08]And all I could say was like, well, if they're sick, then they need to be [music] put on oxygen. Safe critical care, I would say, is the intervention with oxygen. And that's all I could really say cuz that's all I knew. And then when we realized that the second question he asked me was, do low-income countries or low-middle-income countries all have access to medical oxygen?

[00:01:26]And at that point, I think it's actually didn't have an answer to that, and the global community didn't [music] have an answer to that because we didn't quantify the gaps of access to medical oxygen in low- and middle-income countries at that time at a global scale.

[00:01:38]>> Behind every discovery, there's a story.

[00:01:40]>> [music] >> Behind every research, there's a scientific breakthrough. And behind all of this, there are leaders [music] who challenge the limits. In a constantly changing world, bringing knowledge closer to reality is more important than ever. Welcome to Field Notes of a Scientific [music] Leader, the logbooks of those who are changing the world.

[00:02:00]>> Today we have a very special guest. Um Dr. Jeanette Diaz. Um she is a critical care specialist and he's currently leading one of the units of the World Health Organization, the clinical management and operations unit.

[00:02:17]Dr. Diaz has been in the frontline of um the world's most pressing emergencies from Ebola to the most recent pandemic of the COVID-19.

[00:02:29]And she's led different efforts to have certainly shaped how um nations prepare and respond to these crisis.

[00:02:38]So Dr. Diaz is an honor to have you here in um this series and welcome.

[00:02:44]>> Uh thank you so much Juan for um for inviting me to be part of this series. It's a quite an honor and a privilege to be here. So I look forward to the next uh the next few few moments together.

[00:02:57]>> To start off with um I would just like to ask you about your career. How was that and what um led you to this transition from a very clinical and uh you know academic field to a more you know policy making and um you know different scenario at the World Health Organization. What was um that that inspired you to move from um one scenario to the other?

[00:03:31]>> Gosh, well it's a it's a good question. Um I think sometimes you don't know how your career is going to to evolve and I and I think that's an important point that one has to be open uh to the career as it evolves um and uh go where your passion uh takes you. So I will say that I I actually really love being a clinician and being an ICU doctor. Like for me that was a It is a wonderful, um, a wonderful job. I I love taking care of sick patients, to work in critical care, to have to make rapid decisions, to interact with families, um, to, um, you know, bring compassionate care, quality care, safe care to those that are critically ill.

[00:04:17]And so, I find that it was a It has been and it Um, and I was also in academics, uh, training, you know, young clinicians, also very rewarding.

[00:04:29]But, I think in 2010, when I started, uh, doing some consultancy work for WHO, when I was still working clinically, and I I started to travel some to different parts of the world, um, and to work with intensivists, uh, pulmonologists from around the world, um, and and realized how much, gosh, information and resources we were working within our contra on our construct in, you know, I was in California, San Francisco at the time, and how others, similar professions, you know, similar patients, were working with less information, perhaps, less knowledge, perhaps less access to information, perhaps that's a better word, less access to information, and less resources.

[00:05:13]Um, be it the fancy machines of an intensive care, uh, the, uh, workforce or the staffing around an intensive care, or really just what was the last article published on, how to deliver, I don't know, lung protective ventilation as an example.

[00:05:28]So, so for me there was a disconnect there with what was what we were doing as the standard of care in our hospital, and then what other colleagues, you know, from maybe around the world, were doing in another place, and not able, you know, and not, um, uh, having access to all the information to make the best decisions for for their patients. And I found it I think around access to information, access to science, emerging science, emerging evidence, access to evidence synthesis.

[00:05:56]You know, and these things are are complex things that we debate a lot in in clinical medicine. And I just felt the the playing field, the equity part around access to information wasn't um uh access to science wasn't wasn't there. So, that kind of got me inspired in working uh in different parts of the world, working in global health. Um and some of the initial projects were around a critical care training project for WHO working in Central Asia. So, these are some of the former Soviet Republics. Um and and really just being so engaged and and seeing the similarities of clinicians all around the world because we're all doing the profession because it comes from our heart, right? We want to take care of patients and do the best we can. And we want to do the best we can. And then in order to do that, we need to have access to the information and the resources, the appropriate resources to do that. So, so maybe that was the the push to go into more global health. And and at first it was really around training, capacity building, um in critical care, basic critical care.

[00:06:57]And then that evolved over time into more policy work, humanitarian work, etc. >> And you've touched a very important point there, which is the access that we have nowadays to to knowledge and and to information. Back in the day, it was very difficult to access information, very different situations. But now it's more um accessible for for different for for different um groups of people. So, for us clinicians, it's very important um to have this information in order for us to be able to provide patients with the best care possible. Now, there's another situation where patients have now access to a lot of information, too. And through different platforms, they they can access this information.

[00:07:48]Which is good, but also these platforms have also had uh a very recent issue, which is misinformation, fake news, wrong information. And that I feel has made the scientific community um you know, lot lose credibility.

[00:08:09]How do you think we can reclaim that public trust? And what do you think we can do in order to strengthen that relationship between science, you know, um health practitioners and and the public and and society as such?

[00:08:23]>> Ooh, well, that's a it's a it's a really important question.

[00:08:27]I think a good example, you know, we have to do our best, I think individually all and that and as a group. A good example is in COVID-19, right? And and I think that was the biggest challenge probably for me in in my career to be in a position where um I was uh put in the spotlight, you know, forest as part of my job to develop uh clinical practice guidelines for COVID.

[00:08:52]Right? So, what what should we treat our patients with COVID? And if everyone remembers, that's when there was, you know, a lot of emerging evidence coming around, a lot of also misinformation coming around, a lot of uh overuse or of medicines that were not proven to be efficacious for COVID going around. And so, there was a lot of um a lot of mess, you know? And and in my job, we had to write a guideline, right? That was trustworthy and that clinicians would trust, that ministries of health would trust, that drug regulators would trust, right? To license new drugs, perhaps. And so, and so, that puts you in a position of of how can you try to make something that's trustworthy? And I think that that word is something that's very important to me in in the process of of evidence-based medicine and clinical practice. Um and transparency. So So one is that we have a lot of evidence that's emerging, right, in scientific journals.

[00:09:51]And And that we know people can access.

[00:09:54]Okay. And then you have to interpret that, synthesize it, do a meta-analysis, and do these things to it. But in that entire process, it has to be very clear how you're looking at one piece of evidence, putting it together with something else, you know, potentially to to to to bring you some, you know, a risk estimate of efficacy or non-efficacy, whatever. And And so that entire process has to be very um transparent, right? And it needs to be something in the public space so someone can nitpick at it if they want to.

[00:10:23]And at the same time, you need a bunch of clinicians, experts, and what we do at WHO is we work with clinician experts from all over the world, right? So make sure that we have regional representation. We have different specialists as well.

[00:10:35]And they need to And they need to be non-conflicted, meaning that they don't have any conflicts of interest with some, you know, manufacturer of drug X, which would make them we, you know, potentially have a bias towards something. And then bring these people together to look at this evidence that they weren't actually that it they didn't develop, right? They weren't the investigators either of this of of the trials. And then interpret that, right?

[00:10:59]And how can we make this process as robust as uh transparent so that when we write a recommendation that WHO says WHO says we strongly recommend drug X for this disease, that people will like, "Okay, we trust that because they had a process, you know, they went through these step A B C D. It's all written clearly. And now uh and although there's never, you know, there there's always some uncertainty, right? And And I think that's also important cuz you have to tell the peop- people, policy makers, populations, families, there is uncertainty. Nothing is ever 100% we are so sure you know in the medicine we know usually there's an incremental benefit to to interventions and potentially you know done together there's more but in every one single silver bullet but I think what we have to um be is is is honest with that right like that we are somewhat certain we are not certain we are uncertain you know where is our certainty at that and then that certainty can change over time that if there's another trial maybe okay we we have more certainty on this and if there's not or at some point we do have enough certainty that we will make a strong recommendation or we don't and we'll make a a a weak or a conditional recommendation because of this and I think those are important items to try to build trust with the community and then communicate in a way that um people understand and and be honest with what you know and what you don't know.

[00:12:28]>> Yes absolutely. Um I think that's that's the word transparency. Transparency is what will allow the scientific community to properly engage with with the with society as such. I think that's that's the perfect word to to wrap this up. Now you just mentioned that a lot of things a lot of processes that scientists and policy makers and health practitioners have to go through in order to you know be able to provide one recommendation.

[00:13:01]This process that connects these different stakeholders sounds very complicated.

[00:13:10]What what are what are those things that you think can make these collaborations across these different stakeholders make the collaboration succeed or what other situations do you think can make them fail?

[00:13:24]>> You know I I this question when you sent it to me and I was thinking about it and the first word that I wrote, I think you have to be um humble.

[00:13:33]And you have to listen.

[00:13:36]And you have to know what you don't know. And I say that as someone who was actually responsible for the right writing of these guidelines.

[00:13:42]Um I I think there are so many um uh skilled, smart, knowledgeable people around the world, right? And when we're faced with a crisis like COVID, which was a major crisis, but in any crisis, it is most important to bring as many people around the table that you can to help solve the question you're trying to solve, right? And in this in my world, it was trying to write the guideline at the time, but I can give you other examples. But you bring people together and the way you bring people together is by being open. One, being humble enough to know that you need to bring like expert X and this and this person from here and this person here.

[00:14:19]Being um inquisitive that you know the questions you need to ask. What are the unknowns we need to like resolve together uh so that we we try to address all the gaps that we can if we all think um and and and be at the same time focus. Like what are we trying to achieve with this collaboration? Because what you would what I do think we saw in COVID in many areas and and science as well in trials and and guideline development is the coming together of many different groups of people, investigators, clinical researchers, uh you know, specialists, blah blah. Um to to in a joint effort, right? To come together to to write research protocols, to write guidelines, to contribute, and to advance science uh you know, to save lives, right? So so I think if there's a common objective and a common goal and if that vision is something that can bring everyone together uh to collaborate, then then that's that's the recipe for success.

[00:15:17]And it's a you know, and I think people say this a you know, and I try to tell everyone I work with, alone, you won't be able to accomplish what you can't unless like that you can with a group of with a team, right? Or with an expanded team or with a global collaborative perhaps, you know, like the more you engage um with with uh you know, wise people to use the like the word wisdom, you know, knowledgeable, wise, you know, smart people, the more you can then know how to extract the goodness and the good ideas from everyone to come up with a better idea together. So So I think that's the That's the approach I have taken and continue to take to advance kind of large collaborative projects um for the for the greater good, I guess.

[00:16:02]>> Yeah, and that's and that's very interesting cuz sometimes um the people that lead us in project, maybe they have a a way of viewing things and and they don't always listen to other ideas and and I think that's very important to listen to all the ideas, the different scenarios cuz you don't always have the capacity to be at different places and the reality of um our scenario may be different from the reality of other parts of the world. So So that's that's very interesting to listen into, you know, come across all the different point of views and I guess create a consensus. Now, I was I was talking to um Dr. Reyes um who you've had the opportunity to work with and he was talking to me about one of the initiatives that you're leading at the moment and and one of the projects that you're working on right now, which is in the same way that um the world has throughout the last few decades made very important efforts to bring potable water to, you know, uh places that don't have access to to to potable water. Now, there is a project that you're working on which is trying to bring oxygen, you know, supplementary oxygen for critically ill patients. Talk to me a little bit about this initiative and and how does um this initiative and obviously the cooperation behind it help um build trust and solidarity among among nations that may have these resources to help other nations that perhaps don't have it.

[00:17:35]>> Many of the projects I work on are very exciting and um and I care about quite a bit, but this is one that's a little bit special because it's around medical oxygen. And as a ICU physician, you know, uh you know, this is like bread and butter of a treatments for me. For most patients in the ICU, you have them on on oxygen. Um so, when COVID happened and we needed to The first question my boss asked me at the time, he was the executive director of the emergencies program, Dr. Mike Ryan. He asked me, "Uh so, what are we going to treat the patients with COVID?" And this was before we knew anything, right? It was probably like in March of or February.

[00:18:12]And uh and all I could say was like, "Well, if they're sick, then they need to be put on oxygen. And if they go on oxygen, they need to have, you know, quality safe care and you know, some sort of acute care setting, you know, in some cases critical care. So, safe critical care, I would say, is the intervention with oxygen. And that's all I could really say cuz that's all I knew that that that that would be supportive care until the until the infection got better until we had treatments."

[00:18:38]specific treatments.

[00:18:40]And uh and then when we realized that the second question he asked me was um "So, do low-income countries or low-middle-income countries all have access to medical oxygen?"

[00:18:51]sufficient, like And at that point, I think I actually didn't have an answer to that. And the global community didn't have an answer to that because we didn't quantify the gaps of access to medical oxygen in low- and middle-income countries at that time at a global scale. So, I answered, "I don't know."

[00:19:06]because you have to be honest. And I would But then I said, "Well, I but I would venture to say, based on my experience, my personal experience in being in different countries that no, that no, there's definitely countries that don't have access to quality medical oxygen on sustainable.

[00:19:20]So, that put us on a path of of the project called increasing access to medical oxygen initiative at the global scale.

[00:19:27]Um and that led to two areas of important work. One was a policy area of work where we really actually needed to provide medical oxygen to countries um help countries build their medical oxygen systems in a sustainable way so that they could deliver oxygen to their sick patients. And this included the COVID patients, but obviously not just the COVID patients, right? Because there was also a sector of the population that probably wasn't receiving, you know, appropriate medical oxygen prior to this from, you know, severe pneumonia in kids to, you know, trauma injury, other causes of critical illness, etc. So, so that really that started us on a global collaboration where we had to work with many um international partners such as UNITAID, the Global Fund, the Wellcome Trust, NGOs such as CHAI and PATH. So, really a whole spectrum of and and and I'm not selling telling you all of them. Um but uh of people coming together, policies uh policy age agencies coming together, uh donors, funders to address this problem which is a, you know, it's a cost it's a health infrastructure problem cuz you don't have medical oxygen, right? It's a life-saving medicine because med med oxygen's actually a medicine, so it needs to be regulated.

[00:20:44]And then it needs to be produced. So, it's a technical complex issue. And then the clinician uses it. And I was always used to dealing with the end use of it, right? Cuz I was a clinician giving it to a patient. I wasn't the engineer, you know, in charge of the production of the oxygen or getting the liquid oxygen tank and connected in into the piping. But this was a whole under recognized area where the technicians, the engineers of the infrastructure of medical oxygen needed to be come into the into the game right now to help scale up access to medical oxygen at a at a high level and at a at a global level. So, so this was an amazing project that really required a tons of coordination amongst different agencies, different specialists, different technical areas, architects, logisticians. Is there enough access to electricity, right, to run oxygen generation plants? The the whole gamut of special regulatory and then manufacturers, right, suppliers that were actually producing oxygen. So, this really opened up a whole a huge area of work for for us here at WHO and for me personally to really get engaged at a policy level of how to strengthen the system with this one thing and realizing how complicated it was really to to provide medical oxygen, but how much how important it was for us to do it. And a lot of money was invested in this through many different partners. And it's still going on, right? At speed.

[00:22:05]Fast forward, we now have a resolution in the WHO to increase access to medical oxygen that member states have agreed to and a lot of countries making their roadmaps and getting sustainable funding to deliver medical oxygen to their patients and have it accessible and available. And and that's one area. The second area which Louise knows may know even more about is the area that like there are still unknowns around the delivery of oxygen in the sense in some low middle-income countries. The mortality rates are still high even on oxygen of some patients who get it for severe pneumonia. So, was there still something to learn around the best way, which device to use? Was it non-invasive or do we need a better training protocol on how to use medical oxygen? You know, what is it in the health system or what intervention do we need to improve to get better outcomes of patients with severe hypoxemia?

[00:22:54]And so, then we developed a respiratory support collaborative and also a study collaborative to study more the use and availability of oxygen and that was within a study called O2 coftu where we worked as multi-country multi-region study bringing together investigators from many places to to to study and an observational study on this topic. And now we're working with a bigger collaborative to conduct our platform for research. And so why then we doing the high-level policy at the same time as the research with academics clinicians around the world is because to bring them together, right? Because through science and evidence generation my belief and the belief of many is you can improve the quality of care and if we do that and that can inform better policy, right?

[00:23:42]Because then we can make better policy based on the evidence. And we do it with the group that's most affected so the collaborative is really based on clinicians working in resource settings lower resource settings where the burden of disease is highest and the mortality associated with the disease is is high. So so we've taken kind of that approach in collaboration on different levels to hopefully improve and save lives.

[00:24:08]>> Now now I have a very strong answer to that first question I asked you. You just love these. You love bridging these two worlds and you're beautiful at doing these. It's it's very wonderful and it brings hope to see the altruism of these NGOs and the private sector of investing in in these initiatives. It's really in you know in today's world where where we see all these very hostile situations these these initiatives really bring hope. Now as I was telling you before at the start of our interview I'm a medical doctor as well and I work actually at a intensive care unit. Um as an epidemiologist I'm I'm always you know observing and and looking at different patterns in in terms of disease behavior. And and I've come to realize that okay, COVID has passed.

[00:25:07]I haven't really seen many COVID cases lately, but I've seen other um cases specifically in terms of respiratory infections by viruses. I'm not going to name a specific virus right now, but these infections are being very um lethal. They are behaving in a way they weren't behaving before because these are viruses that have been around for a while. Now, now, what do you think about you know, pandemic preparedness, um disease X?

[00:25:41]What do you think we as clinicians, nations, and society should do to prepare for a next um pandemic scenario?

[00:25:51]>> I'll give you some examples um because I think, you know, it's a multi-sectoral response, like you said, right? There's a societal response, there's um it's not just the health system's response, right? Or the Ministry of It's not It's It's a finance, you know, ministries of finance uh that need to get ministries of infrastructure. I think COVID really challenged that, right? In a sense that it had to be a all government type of response to COVID on that scale of of a response and the preparedness and readiness activities need to be done on all those levels.

[00:26:21]Um and and I'm not going to go to detail on all those levels, but I think it's important to start there. So, remember, it's not just one doctor, like one clinician on the It's actually this It's all of us playing a role in a bigger bigger ecosystem that needs to be strength prepared and ready.

[00:26:37]I think from a from a clinician standpoint, um there's kind of practical things that need to be done and then there's um innovative thinking that has to both happen at the same time. Um And uh one of the terms we use these days is something called safe and scalable care, which means that care that you can scale quickly and be safe.

[00:26:58]So, you to deliver quality care and at the same time keep health workers safe while they're delivering and so that really comes to the importance when you're talking about an emerging infectious disease um or a highly path- you know, a high threat pathogen infectious disease like Ebola or something that the care is delivered safely. And when it's a new pathogen, you don't really know all those infection prevention and control interventions, but you need to kind of put that front and center.

[00:27:22]Um but the but with the clinical side, I think you need to to kind of be be clear. What do what do we need to be able to to do to take care of more patients? So, what does a surge mean? And I think you know, some of us if you work in emergency medicine or you work in critical care medicine, maybe you've thought about it at a unit level, but you need to think about it at a systems level at this point, you know, where are the patients going to be cared for? What are our structures? How many beds do we have?

[00:27:47]What is the the structural component of of the capacity we have that can surge for increased loads of patients?

[00:27:54]What are the um supplies we need? Do we have the surge supplies necessary for giving patients vent- you know, if be it oxygen, mechanical ventilation, non-invasive ventilator, you know, or medicine X if there was a medicine, um do we have all the supplies necessary to surge to deliver a higher level of care um uh an increased capacity of care?

[00:28:16]Um do we have our referral systems in place, right? Where will be the designated treatment centers? Where will be the referral centers? Where will the essential health services go? Where who will do the surgeries if we're going to postpone surgeries? Where will another place So, all these like details of operations of clinical operations need to be dealt with. And that can all be dealt with prior. You I mean, it may not be the perfect answer for the um for the emerging threat or the crisis, but you have to have something already pre-thought so that you don't have to make all those decisions at the time.

[00:28:43]You will have to pivot though at the time.

[00:28:46]So, I think about staff, structure, supplies, systems, and security. I think those are the kind of the five S approach.

[00:28:53]Another thing though, so that's a practical side, and then it becomes like if it's a new emerging disease, we need to rapidly gather evidence. And so, all the preparatory work and I I think this is as important for research readiness, um meaning the collection of standardized clinical data to describe the complications in the patients so we know or understand what kind of illness we're dealing with. Like you're saying, if there's a new virus, is it more severe, not severe? What are the complications?

[00:29:21]How much acute kidney injury is there?

[00:29:23]How much ventilator need is there? All this needs to be described, and if you can just prospective, you know, gather the data quickly, standardize, quickly describe it, share it with the world, then then we've gained something there, right? You you've shared something.

[00:29:36]And then, new therapeutics or repurposed therapeutics, whatever the prioritized drugs, and that's where WHO comes in, where they try to, you know, support with prioritization of research agenda, prioritization of therapeutics to be tested in clinical trials. But then, it's up to you at the clinical level in a hospital X or an academic university, am I ready that if there was treatments that needed to be tested in a randomized controlled trial, can our site also contribute to that? Can we be, you know, research ready, clinical trial ready to conduct research to, again, find an answer, hopefully, uh to you know, around efficacy or safety of a new drug intervention, if that's going to be the case, or another type of intervention. So, so you need to have the research readiness, and are we there? The the clinical operational readiness, and are we there? And then, that within a bigger construct of multi-sectoral readiness and preparedness.

[00:30:31]>> Thank you. Thank you. Yes, it's a lot of things to take into account that suddenly, um all the sectors, I guess, have to come together to be able to be prepared for for a next pandemic or a next um you know adverse situation that can come across in terms of health. Now, to close up our our very um fruitful interview, I would just like to ask you one last question, which is um what advice would you give an emerging scientist, an early career scientist um who perhaps wants to be part of um these science matter scenario policy making, you know, um guideline um creation um academia and you know who perhaps wants to make of his career um science diplomacy, who who perhaps wants to be a science diplomat. What would your advice be?

[00:31:35]>> Well, I think you have to be open to opportunities. So, again, I can only say what I was very open and I really didn't know this was what I would end up doing.

[00:31:44]I got to say when I went to medical school or if I went to when I was in training, residency training or fellowship training, I didn't know this was this was what I would do. So, so I think I was but I was open to opportunities.

[00:31:57]And so when an opportunity came to me to say, you know, there's a consultancy at WHO, maybe you should apply for it. I'm like, okay, that's interesting. Maybe we'll see what that's like. And so so I took I leaped into an area that that I wasn't part of though, right? Cuz that wasn't my training. Um I wasn't trained I didn't go to school of global health, right? I was in critical care training.

[00:32:17]And and academic research training. Um so but I got an opportunity and so you take it. Uh and I think that's what I would say to young young professionals, um you know, take it.

[00:32:29]You know, you can be a little bit nervous, but like be confident that your skills as a clinician, uh regardless of what the they're in in research, or capacity building, or education, or quality improvement, you know, the different areas of so many different areas of clinical uh, uh, training uh, areas of expertise that you have gained in your training um, and where you work, but don't say you're don't always think don't ever think you're limited just to that environment, right? Cuz you can take those skill sets and put it in a different environment.

[00:32:58]And then you actually have no idea how those skill sets may actually make you highly effective in a different environment. So so I would say be open, uh, engage when you go to meetings uh, or things, whatever you go to, you know, international societies, whatever.

[00:33:14]Engage with people who are doing things that you find interesting even if it's not what you normally do on a day-to-day, you know, so talk to people like me, right? Like, okay, well, she does something interesting, maybe she'll talk. You So talk to others to see how they um, what they do in their work life, so you can see whether or not that would be of interest uh, for you. And then join collaborative projects. I think for the young researchers, um, you know, our respiratory support platform is is one of those types of things where join the platform, right? Then we take young researchers, we take older research, you know, you don't have to be of any, but join the collaborative and there and through that you meet more people, you network, and then you you who knows what opportunities would come from that.

[00:33:55]Uh, some clinicians, again, I didn't do this, but some I know colleagues who who go because of their desire to work in humanitarian work, um, is sometimes a trigger, right? And to to work in those areas is work for NGOs, you know, and get a look at the way the humanitarian sector is working, um, and uh, uh, as well as another opportunity or see what's in the opportunities around, you know, WHO or other international organizations.

[00:34:22]So I think for me that's it's it's more that and get experiences. You don't learn this stuff from a textbook, I would have to say and maybe that's an important point. You learn it from from doing it. You learn it from engaging with a lot of different people. I've been in so many countries in the past 15 years. I work with so many different clinicians. I mean, I just was in the middle of DRC, Bulape, at the Ebola at the Ebola outbreak just a month ago um with clinicians from this small um town um mid-size province in the middle of the DRC, right? And I learned a lot about health diplomacy there, right?

[00:34:59]Like doing my job there was a challenge, you know, it it it a a big challenge, right?

[00:35:04]And also something that's very rewarding, so but I'm only who I am because of the experiences I've had, right? In a sense. And I think that's what I would say is you got to kind of get out there and have those experiences and learn from those.

[00:35:18]Outside of just, you know, textbook learning or anything else you may be learning.

[00:35:21]>> Thank you. Thank you so much. Thank you for your time. And also thank you for all the work you do day by day on, you know, helping the world and helping health in the world and around the world be better.

[00:35:38]So, really thank you for all the work you do.

[00:35:41]Uh I guess we take home very strong and important messages.

[00:35:45]And I hope we can have a meeting in person sometime soon.

[00:35:51]>> All right.

[00:35:51]>> [music] >> Thank you so much. It was a pleasure.

[00:35:53]And thanks for the Thanks for listening and to the audience for listening as [music] well. Thanks.

[00:35:58]>> For field notes on science and diplomacy are clear. Equity and information, [music] radical transparency in how evidence is made, and humility to listen. [music] Name uncertainty and invite many voices to the table. Build collaborations with a shared objective.

[00:36:13]>> [music] >> Plan for safe, scalable care, and prepare systems for search and research readiness so bedside data becomes guidance [music] people can trust. This is how policy and practice meet through clarity, inclusion, and honest communication. You just listen to the field notes of Dr. Janet Victoria Diaz.