Why Raj Panjabi Returned to Liberia for the Last Mile

As a 9-year-old, the future co-founder and CEO of Last Mile Health escaped the the civil war that erupted in Liberia—but it would not be the last he’d see of the country.

In 1990, rebels had surrounded Panjabi’s hometown, Monrovia, where Raj Panjabi’s parents had migrated from India. His family soon ended up on an airfield in the center of town, where people were divided into 2 lines. Panjabi stood with his mother and sister in one of those lines, until they were stuffed into the cargo compartment of a relief plane. And as he sat there on a bench and looked out, he said, “I saw hundreds of other Liberians, many with children with strapped on their backs, and as they tried to jump in with us I watched the soldiers restrain them. There were not allowed to flee.”

Panjabi’s family was lucky, resettling in the US, in North Carolina—inspiring Panjabi to share a lesson his father drilled into him: “No condition is permanent.” Those words, commonly seen on bumper stickers, proved apt as Panjabi ultimately renewed and followed his dream—to go to med school. He then went on to study epidemiology at the Johns Hopkins Bloomberg School of Public Health—where he returned last Thursday, March 29, and marked Global Health Day by sharing the story of why he went on to become co-founder and CEO of Last Mile Health.

Now an associate physician in the Division of Global Health Equity at Harvard Medical School, Brigham and Women’s Hospital, he recalled that as an MPH student in his mid-20s, he couldn’t escape the memory of those 2 lines in the airfield. He wanted to go back and contribute—so he pulled in support to return 15 years after his family had fled.

The destruction he saw shocked him. “There were 51 doctors left to serve a country of 4 million,” he said. In the remote rural communities where he was asked to serve, he said, “I was seeing my patients die from conditions no one should die from in the 21 century.”

The profound inequality hit him hard as well: Places with the most severe health problems were the places with the least spending. In rural Konobo district, for example, spent $0.76 per capita on health—versus the national average of $44.

“Illness is universal … Access to care is not,” he said. And while global health can point to great progress since 1990—such as cuts in child mortality, increase in access to HIV treatment—“we haven’t seen these innovations reach the last mile,” he said—the estimated 1 billion people who lack access to quality health care. That’s when he resolved to devote his energy to reaching the people most in need, inspiring him to set up Last Mile Health.

To reach those billions without care, he’s zeroed in on what he believes is a key solution: supporting community health workers (CHWs). He sees no better way to achieve global health goals of saving 30 million lives by 2030 than through training and equipping more local health workers.

Noting also that “blind spots in rural health care leads to hot spots of disease and that places all of us at risk,” he pointed to Liberia’s Ebola crisis in 2014 as a key example of the how CHWs can make a critical difference. “When Ebola threatened to bring humanity to its knees Liberia’s health workers didn’t bend to fear.”

He’s now working on Community Health Academy, a global platform to train and empower CHWs with a free online guide to optimize community health systems and make use of technology. “CHWs shouldn’t be trained with flip charts and markers; they could do so much with technology,” he said, adding, “There’s so much technology already sitting on the shelf that we haven’t gotten into the hands of the workers.” The platform gives ministries of health access to digital training and evaluation tools, like training videos that help CHWs with diagnostic skills, such as differentiating between severe and non-severe pneumonia. He hopes this academy will contribute to training of hundreds of thousands of workers, and urges everyone to sign up and share the platform with health professionals around the world.

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It all goes to show—“No condition is permanent.”