♪ ♪ >> The global burden of injury, just how much people are suffering from getting broken, shot, burned, rolled over, fallen down, crashed into is astounding.

>> There's more fractures that occur in developing world than patients die of AIDS, TB, and malaria combined.

>> The people who carried me off the accident scene, my leg was broken and my fingers were crushed.

>> I've only treated the physical disability, but, in general, the surgery actually healed him entirely.

And now I see that life will be bright for him.

>> There are such dramatic disparities in the level of healthcare that people can't access depending on where they live.

It's really an outrageous injustice that some people living in some parts of the world can't have basic medical and surgical care.

♪ >> "Trauma Healers" is made possible in part by Kiwanis Pacific Northwest District.

For more than two decades, supporting organizations that work to heal traumatic injuries in low-resource countries.

For more information, please visit kiwanispnw.org.

♪ >> Planet Earth is very diverse and filled with inequity.

Recent data indicates more than 7 1/2 billion people live here, inhabiting 195 countries.

According to the World Bank, nearly half the people on Earth make $5.50 or less per day, which amounts to a yearly salary of roughly $2,000.

Of course, some countries are much better off than others.

Numbers from the World Bank again tell the story.

81 countries, including the United States and Canada, are considered high income.

56 are identified as upper middle income.

47 countries are labeled as lower middle income.

And 34 reside on the floor of the world stage.

They're identified as low income.

Dozens of factors contribute to this dramatic worldwide wealth disparity, including underfunded or corrupt governments, geographic location, and climate variations.

Millions of people in the 81 lower-resource countries are suffering, and they're suffering badly.

For the past several decades, most of the world's humanitarian efforts have focused on prevention and treatment of infectious diseases, such as AIDS, malaria, and tuberculosis.

In 2019, a planetary pandemic, COVID-19, began a devastating trip around the world, creating a public-health crisis rivaling the 1918 Spanish flu outbreak.

It appears the impact of COVID-19 will be with us for years to come.

Another major world-health worry is garnering less attention than infectious diseases, but it's definitely traveling in the fast lane on the roads of low-resource countries -- trauma caused by road-traffic accidents.

For the next hour, we're going to focus on the efforts of several extraordinary world citizens who have dedicated much of their professional lives to helping the poor survive and even prosper following traumatic injuries.

♪ Our exploration of this important subject begins at Medical Teams International, a nonprofit organization based in Portland, Oregon.

Medical Teams delivers medical care to people in crisis.

Their teams go where they're needed most, including low-resource countries, where people suffer life-threatening and disabling traumatic injuries.

>> Trauma is a tremendous problem in the world today.

There are over 1.35 million fatalities by road-traffic accidents alone each year in our world.

And there are 20 to 50 million people who are injured as a result of road-traffic accidents.

The smell of diesel and the smoke and the dirt that's in the air because of so much traffic, it's just every man for himself.

It's kind of like the Wild, Wild West.

[ Siren wailing ] It has tremendous consequences, not only on the individual, but on the economy of the country as a whole.

It's the entire family that's impacted, and not only an entire family, many times, it's the entire community.

The role of community is very important in many societies, and each person has a place in that community to function appropriately.

If we're able to train first responders from that community, we're actually making the whole community healthier and more productive, and it's giving them the sense of empowerment in order to enrich their own lives and take responsibility for their own health.

It's on the increase.

There's much work that needs to be done, and a crucial part is ensuring that the people who are victims of road-traffic accidents or other trauma receive the care that they need, because when you care for someone who is able to function again in society, that relieves other family members, caregivers to go to school, to get their jobs, and it improves the quality of life for not only the individual victim, but also the family, as well.

>> Founded in 1782, Harvard Medical School in Boston, Massachusetts, has a well-deserved reputation as a top-tier educational institution on the cutting edge of medical research and treatment.

Harvard's program in global surgery and social change is empowering surgeons, surgical trainees, and medical students around the world with the skills they need to improve the health of the world's most impoverished people.

>> Approximately 5 billion people in the world don't have access to safe, affordable surgical and anesthesia care, alright?

And that means the type of care that you and I have.

So if I break my ankle later today, I'll be in the hospital later in the afternoon, and that will be fixed today and I'll be able to go home and I will return to work and it won't be an issue.

What you see in many low-resource settings is that people have that type of an injury.

They break their ankle, something that they should really come back from, or they break their femur or their arm, and it doesn't get treated properly, and then they're out of the workforce for the rest of their lives.

So things like that can have a dramatic impact on the person themselves, but that can also affect families and whole societies.

The adverse impact of poor surgical anesthesia and obstetric care doesn't just impact the individual, it impacts the family.

It can also have dramatic impacts on the economy.

It's a little hard to explain in words what it's like to work in a low-resource setting.

There are a couple of things I would mention.

One is that poverty plays a huge part in access to care.

And so what many people don't realize is that when you look at trauma, it disproportionately affects the poor.

One, they might not have the safe environment that other economies do, but the other is that the poor aren't able to receive simple care that would solve that problem.

So, a simple injury, a simple surgical condition, a simple delivery of a child -- those are things that, in most developed economies, would be readily taken care of, but in developing economies and certainly for the poor and for the poorest billion in the world, they don't have access to what we would consider straightforward surgical care, straightforward trauma care.

I think it's very important to understand that, you know, there are 5 billion people who don't have access to surgery.

The large majority of them are knocked out of that access because they are poor.

There are certainly access issues, there are capacity issues, there are education issues, there are workforce issues, but the bottom line is that poverty knocks more people out of having access to trauma and surgical care than anything else.

It really is a cruel reality that the poor are disproportionately affected by trauma and all surgical conditions, really.

>> The worldwide impact of global trauma is tremendously under-recognized, and there's lots of reasons for that, and it's not a blame-casting or finger-pointing.

The global burden of injury, which is a fancy way of saying just how much people are suffering from getting broken, shot, burned, rolled over, fallen down, crashed into is astounding.

And, yet, to date, very, very, very little effort and attention has been placed on it.

Some of it's understandable.

There have been much more urgent challenges.

The HIV pandemic, the terrible contagions, the hemorrhagic fevers, Ebola, et cetera, sweep through an area.

Those are devastating and also reveal just how broken the health system is under it.

One of the problems, if you will, from an advocate standpoint about injury, is that we've been living -- As humans, we've been living with injuries as long as we've been human.

Depending which book you read.

and what philosophical or religious framework, you know, since Cain and Abel, we've been killing each other.

And so we're kind of used to it.

Maybe we are a bit dehumanized.

And so, as a result, it takes a bit of awakening our consciousness, our sensibilities to, "Well, that's not right.

That was a stupid death, stupid because the road shouldn't have slid out from under that truck.

Stupid because society shouldn't be allowed to live in a situation where roads and cars are so under-maintained and they fall apart with human beings in them.

Or ships sink or there's violence or there's access to weapons without regulation.

This domain of people getting hurt and either having their lives cut off or reduced in function needs attention and needs public spotlighting and it needs research dollars.

It just needs investment into the systems, the staff, space, systems, and social support to treat and to cure and to prevent in a way that hasn't existed yet.

But I think it can, I think it should, and I'm hopeful that it will.

>> Boy, it's easy to not care.

It's awfully easy to not care, and you can't catch trauma.

But the difference between a functional, productive society anywhere else in the world and one that is poor and falling apart and struggling is huge.

And the role of good medical care and good fracture care as a real component of that, in international development to make the world more stable and productive and easy to live in -- even if you leave aside the obvious of human suffering, even if you just are in it for yourself and you're just thinking, "What do I get by supporting or being interested in whether a little kid in Haiti walks and runs again after his broken femur or not?"

is that kid grows up to have a good living on his good two legs and supports his family and lives well.

And the standard of living in that country is notched just a little higher and not a little lower.

And that makes it a stable, more engaging, more engageable place for commerce, for peace and security in the world.

And I really believe that.

>> If you look at the demographics of the patient population that are mostly impacted by injury, trauma, it's the young people.

Up to age of 5, it's infectious diseases, but after 5, until 29 or so, number-one killer of that demographic of people in developing countries is injuries.

So we absolutely have to invest in it.

What's not happening is that the people are not responding.

When I say "people," these are policy-makers, big development partners, the people who are in charge of all the global health in the world.

Everybody is avoiding that kind of discussion.

And I'm here to tell you, we've got to start talking about it now.

If we don't invest in today, five years from now, 10 years from now, it's going to be more expensive to implement, because an imperative, and while we're waiting, innocent people will die.

♪ >> In low-resource countries, innocent people are dying from road-traffic-accident trauma at alarming rates.

For perspective on the how and why, we turn our attention away from Harvard to surgeons from Haiti, Nepal, Kenya, and the Philippines.

>> Mostly is from motorcycles.

Usually, before that, we had more traffic with cars, because we had big cars that usually packed with people taking the road, taking the mountain.

And, usually, every night, you're on call, you are going to face with a lot of people coming from some car accident.

But right now, the motorcycle is taking over.

After the earthquake, I think the motorcycle is back-to-back with with bad cases -- open fractures, spine surgery, spine fractures, pelvises.

A lot of people die by the accident, and some that came to you with a lot of bad things that you -- It's not good to see.

>> Most of the fractures that we have in my center are from two sources, mostly.

These are motor-vehicle accidents.

Kathmandu is in a crowded city with a lot of motorcycles, so most of the accidents, high-energy trauma is from motorcycle accidents or vehicular accidents.

And the other is, people fall from trees or cliffs.

Nepal is a mountainous country.

They go out to get fodder for their cattle.

So on the way, you know, they either fall from cliffs or they have to climb trees to get the leaves for their cattle, so they fall.

And most of the times, these people who reach us, you know, they present to us late, you know, with open wounds and already infection in their fractures.

>> Many things contribute in mostly low- and middle-income countries, like our country.

There's a problem of infrastructure, so the roads are not very car-worthy, and some of the cars are not road-worthy.

So that's usually a big problem.

And problems of legislation.

There's too much of drunken driving.

So all those things, you know, put together, definitely expect some disaster.

>> Road-traffic accident because of the cheaper motorcycle nowadays from China, so people get to buy a motorcycle at a lower price.

So most of our trauma cases are motorcycle accidents.

>> So, they don't go for any training on how to ride a motorbike.

So you just get a motorbike.

Somebody else who has had the experience just like for one week, and then you're good to go.

So you have them all over the country, in the remote areas, where cars are not accessible.

So they have the motorbike and they carry more than four people on the motorbike, and none of them, even the driver, has any protective gear.

So they have no training on road safety, so they drive so badly.

So we've been -- Most of my patients are almost 90% motorbike accidents.

And that's why you see the injuries so bad, because they have no protective gears, and, second, they have no training on road safety.

>> Out of -- I love that word, "out of whack."

It's such a gentle way of saying there are such dramatic disparities in the level of healthcare that people can't access depending on where they live.

It's really an outrageous injustice that some people living in some parts of the world can't have basic medical and surgical care.

A person living in Cambodia who has a simple epidural hematoma in their skull -- simple operation, but they can't access someone who can do this operation, and they die.

This is a reason why I work in this space, is that I find these things completely unacceptable and that some people have everything that we can get in a timely manner, and some people have no access to these basic surgical care.

>> I imagine sometimes a person living in a low-resource county, making their life with their body are like a person riding on a unicycle on a tightrope, you know, on a high wire.

It just doesn't take much to knock them off.

And for many people in a breadwinning role in a situation like that, it's not just them on the unicycle.

They've got a whole family with them.

And if they fall off that wire, they take a lot of folks with them.

So it does really matter.

And the beauty of it is that tuberculosis and HIV and those other things are very hard to prevent or to cure, and trauma is relatively not so hard to prevent.

And when it happens, it's not so terribly hard to treat.

And that's an inspirational opportunity to me.

>> Here's an in-depth look at the road-traffic-injury crisis in Uganda, one of the lowest of the low-resource countries.

>> Uganda is a blessed country with a very high population.

We currently have about 34 million people as citizens of Uganda.

However, amongst this vast population, we currently have only about 50 orthopedic surgeons.

That means each orthopedic surgeon, on average, has to take care of roughly close to a million people.

Hello, everyone.

My name is Dr. Edward Kironde.

I'm an orthopedic surgeon.

The burden of trauma and musculoskeletal injuries in Uganda is very high.

Its incidence is equally as high as that of other infectious diseases, like upper respiratory infections and malaria, despite this high burden of disease, not much attention has been paid to trauma.

♪ >> [ Shouting indistinctly ] >> In this country, it is the most depressed area, economically.

The work that is available for people here is in the fields, is basically tilling the fields, using rudimentary machines or horse.

And you see how agriculture in this region is weather-dependent.

It's not really a good area to be in.

I'm Dr. John Ekure.

I'm an orthopedic surgeon.

I'm also the C.E.O.

of Kumi Orthopaedic Center.

Road-traffic accidents are a menace, a terrible one.

They're like an epidemic.

They actually are going to pull back our economy.

They are actually going to pull down all countries that have been lifted up.

Boda boda is basically a motorcycle taxi.

These are the same group that injure others and they also get injured, and thousands of them are dying.

Every thousands of them have been maimed, and some of them are what is disabled.

Some of them have lost limbs.

Traffic accidents are causing poverty through disability, through maiming, through incapacitating families and the people.

So it's something that needs to be worked on and needs to be prevented, yeah, because the consequences are really dire.

♪ >> I was traveling from Kampala on Saturday with my colleagues in a Super Custom, and then we lost control around Arua, and we plunged into the water.

My name is Juliet Atai.

I'm 30 years old.

The people who carried me off the accident scene, my leg was broken and my fingers were crushed.

So, the next day, in the morning, I was rushed to Kumi Orthopaedic Center for immediate attention.

Yeah, when I saw the X-ray and I saw the femur was broken, I was worried that I wouldn't walk again.

I thought I was going to -- Either they're going to amputate my leg or when I recover, I'll walk while limping.

And yesterday at around 9:10, I was taken to theater, and the surgery was done, I think, perfectly well.

According to the doctor, it is a metal something that was fixed to join the bones together.

I saw it today on X-ray, and it's perfect.

At least the bones are aligned.

Though I'm still weak, I have to keep practicing how to move, but I know by next week, I'll be back on my feet.

I have one daughter, how I'd take care of her, how I'd carry her without a proper hand and how I would move with her around without a good leg.

I now that I can walk, I think we shall even start running together.

Accidents happen every day.

You can be prone to any accident when you least expect it.

>> Roughly 4 million people die around the world from AIDS, TB, and malaria every year.

Approximately 6 million people die from trauma and injuries.

So not that one is more important than the other, but it just shows you the scale of the human devastation that occurs from trauma and injuries, which is increasing as countries develop.

As they have high-speed transportation systems, you see more motor-vehicle accidents.

So this isn't something that's going to diminish in the coming decades.

It's something that all emerging economies will have to deal with in the future.

>> The number of people who were interested in alleviating human suffering from infectious disease has just been greater.

There are many more people who think along those lines, who are employed in that field of medicine maybe than there are surgeons.

So that's a very practical reason.

The more cynical one is that you can't catch a femur fracture from Africa, from Asia, but you can catch an infectious disease.

And so when a planeload of people come back from somewhere abroad and bring Ebola to Texas, let's just say, that really gets everybody's attention right away and it becomes a national emergency in a way that a planeload full of people with broken bones is not scary in that way to us.

That's maybe a little too cynical, but I have to believe that that's part of the disparity.

>> You know, when you talk about access to surgical care, access to trauma care, there are several implications for a lack of that care.

So, one is just human death, which is horrible, and it's a loss to the family and to the community.

The other loss that can occur, however, is disability, and with trauma, you can have permanent disability.

So if someone is in a motor-vehicle collision and they have a broken femur and that's not treated properly, that can be a lifelong disability.

So you end up taking someone who's 18, who could be in the workforce for the rest of their life, but because of the inability to just treat that femur fracture, they live the rest of their life out of the workforce, unable to care for family.

And that has devastating impacts on not only themselves and their family, but on that economy and on that country.

And the emotional and psychological trauma that goes along with that is devastating, because people can feel like they are not a contributing part of their family, part of the society.

And so you take someone who was healthy and 18 years old, and they are no longer able to function in the environment.

They're no longer able to help their family.

That can have terrible emotional consequences to people and their families.

>> If you look at the disparity between the attention that is given to trauma as a cause of death compared to infectious disease, it's just way out of whack.

And that leaves aside the multiples of people who survive their trauma and go on to live with disability, many of whom, their lives are just irreparably made worse, and they then -- Not only are they cast into poverty, potentially, but they can drag their whole family down with them.

♪ >> The volume of road-traffic accidents in the developing world is really an epidemic, and it's recognized as an epidemic.

But there really isn't a celebrity for trauma, for orthopedics.

There's celebrities like Bono for his causes and Bill Gates for his causes, and, you know, some of the movie stars have their little different causes in Africa, but nobody is really that celebrity cause for the injured patient.

And it's really an epidemic in the world.

It's becoming the number-two or -three killer and probably the number-one cause of disability.

And if you can really fix that, if you can fix a person who's injured and get them back to work, their family doesn't get into that cycle of poverty, because the person can get back to their productive life.

It really is a world-public-health issue, and I think it needs to be mentioned at many levels.

I think the United Nations, the World Health Organization, and I think some of the charitable foundations need to really recognize that trauma is really right at the top of the need pyramid, if you want to put it that way.

But if you really want to have an impact globally, it would be helping decrease the incidence of trauma problems, but also make the care of the traumatic injuries more standardized, and that really requires many different areas.

I mean, there's head injuries.

We're talking about musculoskeletal injuries here, but, you know, it involves the entire trauma system.

>> Founded in 1999, SIGN Fracture Care International is headquartered in an unlikely location -- Richland, Washington, known mostly for its decades-long interconnection with the U.S. nuclear industry.

It was here, not far from Hanford's deactivated reactors, that one doctor set out to change the world one orthopedic surgery at a time.

>> I've been an orthopedic surgeon for many years.

I've been a patient advocate for many years.

Our legacy is not just a nail in a bone.

There's more road-traffic accidents, there's more fractures that occur in developing world than patients die of AIDS, TB, and malaria combined.

It's a big problem.

One way to face it is to do studies and metrics and all that, but that doesn't do the people who are surviving this trauma any good.

Our vision is equality of fracture care throughout the world, and we believe that a fracture in another country, a developing country, should have the same result, after treatment, as a fracture in United States.

>> I'm happy because I can walk now.

Now I can finish my studies and my works.

>> Nothing is more confused than to be ordered into a war to die or to be maimed for life without the faintest idea of what is going on.

>> SIGN came by increments.

One of the initial seminal events was my service in Vietnam during the war.

They evacuated U.S. military, Vietnamese military, and Vietnamese civilians.

The Vietnamese civilians were directed to another facility.

And I went over there and visited that facility, and that was not adequate.

Neither was the personnel.

So I came back and asked, "I would like to treat the Vietnamese civilians here in our hospital."

After a lot of debate, which went all the way up to Generals Westmoreland and Abrams, I was given permission, and pretty soon, the whole Quonset hut filled with Vietnamese civilians that we treated.

And to see these patients leave this hospital -- I remember specifically one boy who came in with a 90-degree contracture of his knee, and he couldn't straighten his knee and he couldn't walk.

He was 10 years old.

That's a horrible sentence.

He came in, and we put him in traction and brought him out straight.

He did his therapy, learned to walk, and he walked off with his father into the sunset.

It sounds like it's a Hollywood makeup, but it's not.

And the father gave me a mango.

The mango had a thumbprint in it from riding on the bus with the father.

And I looked at that mango.

I said, "This is the best gift I've ever received."

That was the beginning of wanting to treat people equally no matter what their station in life.

When I returned, I had post-traumatic stress syndrome because I felt so bad about the civilians.

I felt bad that this whole episode of conflict had to go on.

After Vietnam, I went to Indonesia, where I taught for 10 years.

And I realized when I returned there -- After returning to Vietnam, I went back to Indonesia and found a man who was lying in the bed for three years.

And I asked, "Why is this?

We taught you how to take care of the particular fracture that he had, which is in the distal femur."

They said, "Well, he can't afford to have an implant," which is the device to hold the fracture in the proper position until healing.

"And not only that, but the implants you use in the United States can't be used here.

We have irregular electrical power.

We don't have X-rays in the operating room, which severely restrict the type of implant that can be used."

So I realized, with a sinking feeling, that I had wasted 10 years and came back home with the idea that we would try to design a system using the present state-of-the-art fixation devices, but designed so they could be used in developing countries.

>> When I invited him to the factory, you know, he had called, and we said, "Come on down and see how these products are made."

And I thought that he would see how difficult it was to actually do this and how expensive it was and that he would likely leave not wanting to do it or seeing that it was just too difficult, too much energy.

But to his credit, he came right back and said, "I can do this.

I want to do it."

And so -- And I think just working in the field, doing orthopedic implants, I mean, that's really the essence of designing something that purely helps people that's irrespective of money or anything else.

Dr. Zirkle had an idea of what he wanted to accomplish, and one of the main requirements is that it could be made inexpensively, had to be very durable, and had to use as few instruments as possible.

He envisioned these implants that would function as well as what we were using here in the United States, but would be simpler and made of much lower cost.

He understood, right from the very beginning, that once they have these tools, they can learn these new surgeries, and it's a platform to learn more than just that surgery and to become more sophisticated in treating orthopedic injury.

♪ >> Because there is such an enormous need for orthopedic treatment in the developing world, most fractures are managed by non-orthopedic specialists.

Many people have no access to any medical care.

Dr. Zirkle has made an enormous contribution to the developing world with the introduction of an intramedullary nail that can be put in without X-ray.

So he's taken a procedure that I would consider to be only safely done in a Level I trauma center and he has allowed that procedure to be done in a rural clinic, and that is an amazing accomplishment.

>> I think you've seen the pictures.

Every year we go back to these countries, there's more and more motorcycles.

There's more and more patients in the wards.

The road-traffic accidents have become such an epidemic that now there's people on the floor, people in the beds, people in the hallway, people in the corridor that leads to the entrance.

So when you walk in that room, you see humanity on the floor waiting to get surgical care so that they can get up and leave on crutches the next day.

>> SIGN Fracture Care International has more than 350 projects in nearly 60 countries.

Since 1999, Their implants have been placed, at no cost, in almost 400,000 patients.

>> Before I left for the U.S., I was blessed to do the 200,000th patient for SIGN.

I mean, that's just one surgery, and, you know, I'm just overwhelmed because it's not me.

It's everybody in, say, 60 countries contributing and doing what they can to serve our poor patients so that we can bring them back to their functional and working status.

After the surgery, in the recovery room, I was talking to Ishmael, and he likes to be called Clinton.

So I said, "Clinton, when you had your injury two months ago, and then you went home because you could not afford the surgery --" His parents are separated.

He's only living with his grandmother, and his grandmother is -- she is actually working and weaving what we call banig.

It's indigent -- They're of an indigent tribe.

So the banig is like a mat, where, you know, people can sleep.

So she earns around $2 a day, at most.

So, what struck me there was when I asked him, "What did you feel, that, at 18 years old, you would not be able to walk, your life would not be normal, and for the rest of your life, you may be a cripple?"

And he just said, "I guess I have already accepted it."

And that's how it is, and I really felt for him, because I said, "At 18, you're supposed to be vibrant, you're supposed to be active, and you're supposed to look at your future with anticipation and excitement."

And this guy just gave up on life.

But when SIGN came in, we did the surgery.

The next day, he was already up early in the morning when I did my rounds.

His spirit was different.

I can see that he was starting to hope again.

And two days after, when I saw him walking, I could see that smile, and, you know, he just told me that -- He didn't have to say anything.

And for me, that was it.

I think SIGN -- Whatever SIGN does for people physically cannot be compared to what it does to the whole person, whether it be emotionally, psychologically.

Because I have seen this guy.

I've only treated the physical disability, but, in general, the surgery actually healed him entirely.

And now I see that life will be bright for him.

>> Tolstoy said, "We all have a patch to hoe," and that means it's a part of the world that we want to improve.

I kind of visualize that SIGN is the whole.

SIGN is the ability for a person -- an orthopedic surgeon or other people involved with medicine -- to help people overseas.

And the patch grows up -- healed patients -- and grows up satisfied surgeons who are staying in their country because they can treat people just like they can be treated here.

>> Hi, guys.

>> Hi.

>> How is today?

>> Fine.

>> Let's discuss.

I'm Martha, I'm 16 years old, and I attend Gogarty Girls' Secondary School.

>> This is an orphan.

And she was crossing the highway, and people were running.

And she got stumbled and fell.

Somebody stepped on her, and she had a fracture.

And then she was operated and she did very well.

>> Martha is my student.

She's very academically disciplined and she's punctual in everything.

She's a good student.

>> She said she wanted to be a doctor to help people like her the way she was helped, and I hope that dream will come true.

She's very smart and she is very determined, very focused.

>> My name is Giuseppe Gaido.

I'm a doctor.

Originally, I come from Italy.

For the last 20 years, I've been living and working in Kenya.

I decided to agree on a mission in Kenya with the idea of starting something in a very remote village, a central part of Kenya, the village called Chaaria.

I reached there and I was actually shocked, because I was not expecting to find what, really, I met there.

I had to treat everything from heart conditions to pneumonia to malaria, because there was nothing else.

The Kenyans of that area do not understand is the idea of a specialized doctor.

For them, it is not making any sense.

For them, that is God.

So they take everything from God, even when a child dies.

So they do not complain so much.

But when there is a doctor, that doctor is just a little step below God.

So he is supposed to do everything.

They do not really agree to the fact that the doctor can say, "I'm specialized in something else.

I cannot help you."

So it has happened to me like that from day one.

I was very much specialized in my HIV knowledge.

I knew everything.

I found it completely useless, because I had no laboratory, I had no drugs, and no facilities.

But I found, on the other hand, that people were asking me totally different services for which I was not prepared.

I never decided to become a general surgeon, but the few hospitals doing general surgery were charging so much money that people could not really afford.

So I've been re-specializing myself, using this time not a classroom, but using people coming to visit me.

The orthopedic surgery became a possibility in 2012, and in between, many people were not treated.

We started building a theater.

There was need of a good theater, a theater dedicated for orthopedic surgery.

The second need was for implants.

Implants are very expensive, and if I had to buy them, I had to charge the people.

The fact that 80% or I may say more of the people in our area would never be operated because they do not have the money -- So 80% of them will be just there, unable to take care of the family, maybe disabled, maybe divorced.

So that is where we found that orthopedic surgery had to be a priority for us, an area in which to invest our knowledge, our commitment, and a lot of money.

One and a half years ago, I write to SIGN, and they replied.

[ Laughs ] They replied, and to my shock, they were trusting me so much.

Dr. Lew has never asked me for anything.

It is strange, because we never knew one another before.

We knew through e-mail.

So, that is what happened.

I explained, to Dr. Lew, our problem and the fact that we could not have the implants because my donor could not support us there, the fact that I would never make anybody pay for them, because that is my mission.

And what I found is, he trusted me.

He believed in me.

The only request, of course, was to have the training, and the training was to be done in Kenya, because I've explained to him it would have been difficult for me to come to the U.S.A. because I'm the only doctor, practically.

So we arranged training in Kenya.

We did it.

We started it.

I think we have changed the lives of so many, so many.

It is amazing.

It is amazing if you think that all those people would not have paid for another implant, would be at home in a cast, and probably, after two or three years, would still be there bedridden.

Now, yeah, they are treated.

They are treated for free.

And what do I say?

I'm so happy.

I'm so happy.

>> I'm hopeful and optimistic.

I don't yet see the structures through which we're going to make substantial and meaningful change, where there is a real inflection point in care, care for others, and delivery of care and improvement of the quality and the outcomes that, over time, will and should -- and this I am optimistic -- will and should reap global economic benefit, because if that 20-something-year-old mom or 20-something-year-old man who are trying to get to work and now they're either not hurt or their injury gets treated effectively and quickly and they're back to work -- if we decrease that burden and get people to productive livelihood, that's just going to make stronger economies, which ultimately will build the systems to protect ourselves from harm, so what we've done for ourselves.

If we can get through the part that I'm only hopeful about, which is building institutions and the infrastructure to actually care and deliver care, then I'm quite optimistic that it will reap the rewards that we're hoping for.

>> I think we're in an era where we recognize health as the most important component of the society.

Without health, we can't have wealth.

Without health, you can't get good education.

Health is essential to everybody's well-being.

We're starting to see now people who are speaking out about investing in health in massive scales.

Universal health coverage is now the North Star for the World Health Organization.

It needs to be clearly defined.

What that means, the actual delivery of it, has to be defined, has to include things like emergency surgical care, obstetrics, including vaccinations and all those things.

But it should be a comprehensive set of essential health services.

They should be affordable.

It should be timely.

It should be safe.

There's political will to achieve it, and I think there's no other time in history where we have the amount of push to make sure that everybody in the world has healthcare, everybody in the world has a right to basic healthcare.

Prevention of injuries is important, but it should not stop there.

We actually absolutely have to invest in trauma systems in the developing world, and its time.

This is 21st century.

We don't need health systems that are there to deal with just dispensing drugs and giving hydration, you know, things like that.

It's time to invest in strong health systems in the developing world, and that includes, first and foremost, a trauma system.

>> Dr. Joseph Murray, who's a Nobel laureate at Brigham and Women's Hospital, who directed the first successful kidney transplantation between identical twin brothers over 50 years ago -- his quote is that, "Service to humanity is the rent we pay to live on planet Earth."

We -- to quote my former boss and mentor, John Tarpley -- "Won the pre-birth lottery."

We have lots of stuff, we have so many privileges, and I really did nothing for it.

Right?

It was all given to me.

My parents are immigrants who had that immigrant dream for their kids.

My mom grew up in a slum in Buenos Aires.

And, still, I would say that when you look at my life growing up and even her life growing up, on a global scale, we were given everything we have on a silver platter.

Yes, hard work matters.

Yes, focus and diligence matter.

But that matters most if you have the building blocks upon which to build on, right?

And, so, "compassion" is a word that can be twisted away from its origins.

Solidarity, standing next to, standing with is another critical word that should drive how we behave on this planet, you know?

So I think that is why we should care.

♪ >> I think it's important to understand that all people matter.

You know, I have this thing that I say -- You know, I don't like the term "refugees," I don't like the term "the homeless," because it's just a generic grouping of people.

We're talking about real people, real people with real names, and they're valuable.

Every life is valuable.

It gets discouraging at times to see the overwhelming need and perhaps the lack of progress in some areas.

But that just makes us more stubborn and it makes us seek out new partnerships to fill those gaps that are needed so that we can truly make a difference.

And that is so very rewarding.

♪ >> ♪ Let the sun rise again ♪ On a new skyline ♪ Let the gray skies up above ♪ Turn to starlight >> [ Laughs ] [ Indistinct shouting ] >> "Trauma Healers" is made possible in part by Kiwanis Pacific Northwest District.

For more than two decades, supporting organizations that work to heal traumatic injuries in low-resource countries.

For more information, please visit kiwanispnw.org.

>> ♪ I walk this lonesome road ♪ See concern ♪ Lie fixing my bones ♪ So I wander away ♪ And let the sun rise again ♪ On a new skyline ♪ Let the gray skies up above ♪ Turn to starlight ♪ I am longing for a change ♪ A destiny I create ♪ Lift me up off my knees ♪ Let me start again ♪ Ooh, ooh, ooh ♪ Ooh, ooh, ooh ♪ Ooh, ooh ♪ Ooh, ooh ♪ Ooh, ooh, ooh ♪ Let the sun rise again ♪ On a new skyline ♪ Let the gray skies up above ♪ Turn to starlight ♪