You're listening to TED Talks Daily, where we bring you new ideas and conversations to spark your curiosity every day.
I'm your host, Elise Hu.
Today's talk is part of our TED Fellows film series adapted for podcasts, just for our TED Talks Daily listeners.
We'll be releasing these special episodes showcasing our impressive fellows on certain Fridays throughout the year.
The TED Fellows program supports a network of global innovators, and we're so excited to share their work with you.
Today, we'd like you to meet physician and social entrepreneur, Johannes Reich.
What if the people of the world's newest nation shaped their own healthcare future?
Johannes, who went from herding cattle and fighting as a child soldier to becoming the first doctor in his community in South Sudan, shares how he founded YoCare, a nonprofit that brings primary care to remote communities, empowering locals to take charge of their own health.
And after we hear from Johannes, stick around for a deep dive conversation with TED Fellows Program Director, Lily James Olds.
That's coming up.
I'm Johannes Riab.
I'm a doctor and a social entrepreneur based and working in South Sudan.
When I was growing up in my village, my future was to be a cattle keeper.
Through being someone mobile, the nomadic culture we became adaptive to other new culture that we learn as we migrate.
And that experience enabled me to connect with a lot of other people.
And so future keep changing based on the new life I was experiencing.
The future was, you know, to be someone successful, someone who can be able to help back community.
When I was around 14 or 15 years I don't know the exact age, but by estimation at that time I was conscripted into the army forcefully.
And that's how I became a sharpshooter.
The course of that civil war was being failed by everybody.
So the regional neighbors decided to bring the two warring parties together for a negotiation, which led to the peace agreement in 2005 and that was supported by the United States government.
And I was sponsored by the government to go to school.
When the negotiation started, the first thing first was to demobilize Charles Rodriguez from the army.
And the immediate activities to do after the demobilization were go to school.
The first immediate motivation for me to become a doctor was seeing my family members die because of diseases that could be treated.
My dad particularly my sister, who was young at the time, you know motivated me when I learned about the school to study something that can help fight the disease burden in my community.
I was the first to go to school in my family, and also the first to become a doctor.
And not only my immediate family, but in my community.
2009 was my first year at university, and that's when I also started my non-profit organization called You Care South Sudan.
Your Care South Sudan is a non-profit healthcare organization that is focused on infectious disease control and management, as well as the primary care part of the health system, through static health facilities and also through mobile medical teams that go to communities that are far away from our health facilities, where the gaps are huge and people continue to die every day.
For the last 17 years, we have many successes.
We are proud that we have saved lives.
When we vaccinate children, children are able to go to school and they are able to become an important member of the society.
There are children that have gone to school now.
If we did not do that vaccination maybe they would have died from those childhood diseases that are preventable.
We understand that as an organization, we cannot be able to do everything by ourselves.
So we help the community organize themselves.
The people who come to our health facilities, we train them.
Many patients that we have served become service providers themselves.
One of our patients, called Lillian, later on became a peer navigator.
Now he's able to identify people who are also suffering and repairing them to the health centers for them to come for testing and also to come to get their medication, as well as delivering the training, delivering medical services to the people who cannot access medical facilities.
People must be able to take charge of their own health.
Actually, our name, EOCARE, means the care we provide is yours.
Wherever we work, we organize the community, we train them so they can take charge of the future.
EOCARE focuses on long-term health solutions because we understand that health is not just an immediate need.
It's a long-term need.
And because of that, some of the solutions we provide have been funded by external donors such as USAID or US government.
And when the current US government came into power, we got an abrupt notification.
Tomorrow, we suspend all activities.
So that had an immediate effect on us.
The first immediate effect was on the patient.
Before this happened, we have more than 60,000 people that were relying on our medical services.
As of now, we are supporting 32,000.
Thousands of communities are not able to access basic health care services.
And also from having health facilities that we were directly supporting to only Two facilities right now that we are supporting.
Our manpower reduced from 53 to only eight essential staff.
Now when that suddenly cut, they asked us, where do we go?
Where do we go?
Patients are also asking us, where do we go?
Why did you cut this?
It didn't allow us time to prefer to close.
It didn't allow us time to look for other financing alternatives.
That threatened the very existence of the organization.
The most important thing to invest in is the people.
There is no country without people in the first place.
We are the youngest nation in the world right now.
In 2011, South Sudan became an independent country.
Given that it's not part of that global community.
Yet, in terms of technology, in terms of media, in terms of other connectedness, we feel neglected.
We have an ongoing conflict.
We have natural climate issues.
Our voices are not being heard.
My hope for the future, first, as a doctor, is a healthy society.
And that is what we are working for.
Because when the community is stable, when society is stable, we will contribute meaningfully to the world.
And people will know us for positive things instead of being known for conflict and suffering.
Having a new country is just like when you have a new home.
You just bought your new house.
You are very excited.
You are very happy.
You finally have something you can call home.
And that is the experience that we have as a nation.
Even if we are in crisis protracted crisis, persistent crisis we are very happy that personally, I'm very proud that I have a country.
Because I believe one day, through the contribution I'm making or through the contribution of others, we will be better, despite the challenges we are currently facing.
And now a special conversation between Johannes Reich and TED Fellows program director, Lily James Olds.
Johannes speaks with Lily about why it's so vital to have locally led health care solutions in fragile and conflict affected settings.
How his organization managed to survive and even thrive when faced with the abrupt loss of USAID funding in twenty twenty five, and why their work in South Sudan is a model for how to rebuild trust, save lives and reshape global health care from the ground up.
Hi, Johannes.
Welcome.
Thank you, Lili.
You've had such an amazing journey, which you talk about.
Could you give us a brief overview of what the healthcare system in South Sudan looks like today, and then how your organization YoCare, fits into this?
South Sudan got independent in 2011, making it one of the youngest nations on the continent.
And, as a result of that, the independence was achieved after a very prolonged period of war, civil wars, which led to a loss of life, properties and system.
So, as of today, South Sudan health care system is still very young and many areas still have no hospitals and still many have very few trained health care workers.
And that is to say, from nurses to doctors.
And, as a result of that, our people still experience very limited access to essential medical services and medical personnel.
Lack of medicine such as vaccine.
So this means that preventable diseases that are currently in other parts of the continent have been prevented or are no longer existing, such as malaria.
Diarrheal diseases and complications during childbirth, can still become deadly in South Sudan.
Myself, I have experienced this lack of medical services.
And now, given the little knowledge I have about health care.
So that's why I step in to create Your Care.
South Sudan.
When I was in my first year of medical school, to fill this gap.
And basically what we provide under Your Care, South Sudan is to focus on the primary health care services.
Because as I mentioned, South Sudan is a new country.
So this means majority of the areas have not yet a period or have not yet had a government service in place.
So most of them rely on work of community members to be able to access the health care services.
And this approach.
You know we designed it to be locally owned and be sustainable in a way that communities are partners to us.
And not just people who will receive the services that we'll be providing.
Yeah.
And I know that you know you had mentioned that at one point you all were serving over 60000 people focusing on this infectious disease control.
Primary care, just very basic, necessary services for people that didn't have them.
You mentioned that the name YoCare means the care we provide is yours, which I really love, and that it reflects your belief that communities need to take ownership of their own health.
Why was this philosophy important to you from the very beginning?
Yes, from the very start, I believe that healthcare solutions must belong to the people that need them.
So people should not see it as something that is imposed on them from outside.
So they need to understand that if they're suffering from malaria, for example, or diarrheal diseases, they have a right to have access to health services, which they can demand from the government.
But in a community that has been affected by war, such as ours in South Sudan.
When communities get organized themselves, they can be responsible for their own health services.
This includes, for example, if there are few people who have the chance to have and additional education, such as myself, I can take advantage of this knowledge and train my own community members who, later on, can be able to provide medical services on their own, rather than them waiting for a government to be able to do that.
So if anybody provides medicine, they should be able to distribute this.
If there are vaccines available, they should be able to give this to the children in the community.
You know, you deserve it.
And also you can provide it yourself.
Yeah, I love that.
People can take for granted that when you think about what is needed to structurally give that kind of care in communities as you say, it really is about people coming together as a community to support and educate one another.
One example that really struck me of that that you shared the meaningful story of Lillian, who went from being a patient with YoCare to working for the organization as a peer navigator and is now training others to do the same.
Are there more moments or stories like that that you think really capture what this community-led model has made possible in South Sudan?
Lillian is one of the example of our community-led models.
We also have another support group called Mothers to Mothers support group.
Those mothers that are able to come for bringing their children routinely to our health facilities for vaccination.
We're giving them education about the importance of child vaccination against basic killer diseases.
And then we give them key messages in local languages and then they will be able now to take the same model, the same messages to the community.
So while they are in the community, they will let other mothers know that if you take your child to a health center, He or she is going to benefit from vaccination and is more likely not to fall sick and is more likely to go into school, because now he's very healthy.
And the mother is also more likely to focus on other work because the child now will not be falling sick every now and then.
And we have trained hundreds of them.
So they are the ones who do that on their own.
And those are the community-led models that have successfully worked for us even, most importantly, in hard-to-reach areas.
Our role as your care is basically facilitating that process of people coming together, of people being able to lead their own health care.
I know that last year you received abrupt notification from USAID that funding would be suspended almost overnight.
It's been an incredibly trying time for you and your organization.
And I've really seen that throughout this entire situation.
I mean, you've shown remarkable resilience and somehow managed to keep YoCare's doors open.
For Where do things stand now Johannes, and what does the organization look like today?
What has it taken to survive during these past months?
Yeah, this time a really challenging time for South Sudan as a country, because 90 of it is Basic services from health education, food security are provided through non-governmental channels and that is to say, through NGOs.
And when we received notification of the funding, which was very abrupt, it was a huge challenge, both for us as an institution and also for our community.
So overnight we faced the risk of closing, But the resilience of our staff, the volunteers that we have and the community partners that we have established over a long time, we became adaptive to this situation.
So we began to prioritize the most critical services.
For example, we stopped focusing on infectious diseases.
Now we focus on maternal and child services making sure that vaccination can continue, making sure that mothers that require nutritional support because maybe of anemia, you know are able to get this so they can have a better health outcome for their children and for themselves.
And of course, we mobilize local resources and also through NEAR, the global network.
And this platform was very instrumental during the USAID suspension.
So, for example, individuals started to contribute to that network, and South Sudan was one of the priority countries.
And as a result of that, Yorker was able to benefit from such a flexible and very quick support.
So we enabled us to continue with our emergency response that we were doing at the border between South Sudan and Sudan and basically focusing on children and mothers.
So...
That has taught us that yes, financial support is very important, but also a strong relationship, trust and flexibility are the real backbone of any sustainability as an institution and also as a community.
I mean, I think it's such an incredible testament Johanna, as to what you've built, the fact that you could lose that kind of funding and still manage through the incredible trust and relationships that you've built.
I think I'm curious, given where you sit, to go a little bit deeper in hearing your thoughts on foreign aid.
You're in such a unique position to reflect on this, given that, due to the US peace agreement and support, you were able to go to school and get training there, but then also that you lost significant support for your organization.
That really left you guys in a perilous position.
So I'd love to hear your take on global collaboration between nations, and particularly those that are more affluent with younger nations like South Sudan.
How do you see this relationship and what do you think it should be structured like?
What should the responsibilities, do you think, be on some of these more established nations versus younger nations?
As someone who has been in the humanitarian space now for close to 20 years, I believe that external aid itself, in the way it is currently delivered, is not working.
Because most of the design of this humanitarian or external aid support, you know, have been designed where local communities or maybe receiving country are not part of the design process.
They only play a role in the recipient part of this.
And now the results, they are not understanding that this is for short time, and it can go away.
And because of this understanding, communities and countries have not been able to be adaptive to time when there is a disruption of such a support, as it happened last year.
So I truly believe that to empower local communities and maybe country in the global south, you know, partners need to provide support that build capacities, not the current dependency on it that we are seeing now.
So this will mean that you know we need to have a flexible funding that is not having any string attached.
And this funding must be based on the program of the host country or the host communities.
What are the plan?
It must not be based on donor priorities.
If it is there, it must be there to support ongoing program of the communities.
Also, it needs to be long-term partnership so that people can be adaptive, people can learn from it.
Current funding are always one year.
In one year, what do you learn?
In a country that has problems, such as South Sudan, to build a health system, take time.
If the government can't do it overnight, then I believe also a donor cannot do it overnight.
So to achieve the Sustainable Development Goals or to contribute to this other country, we need a long-term partnership.
And also, of course, mentorship.
Low-income country or such as South Sudan itself.
They need mentorship because they don't have experience.
Just like all of us, when we want to get a job, someone who has experience might take you through what you need to do, and such a mentorship is very necessary.
And of course, focus on local leadership.
So most of the funding programs have not been focusing on local leadership of the communities or the host country itself.
So this means they need to listen to the communities, they need to understand their priorities and they need to support solutions that are defined by the local leadership.
In South Sudan, for example, we have local leaders such as, we call them sultan, sheep.
They are very powerful and community listen to them more than anybody.
Community listen to them more than the president.
So when you empower these local leaders...
And they are the ones going back now to their communities to reorganize their communities.
Any support is more likely to succeed.
And only then can organizations, for example, like your care, you know reach a point where they can stand on their own and continue delivering services, even if we had external disruption withdrawn or reduced, as we have seen last year.
So it sounds like really what you're speaking about is collaboration, right?
In the design, in the structure you just said.
You know that it would be long term, that it would include mentorship, infrastructure support and really support and education for local leadership.
I think that's really fascinating to consider and think about.
What might that process look like going forward?
How could we design it in that kind of capacity?
There are already existing mechanisms for how this can be designed.
The implementation is a problem.
So my view has always been that people are already thinking of how to get out of this.
Because Africa, as we know, has been through humanitarian support for the last 50 years.
And then we are not ready to continue for the next 50 years.
If we really need to go through this, very simple.
Let us listen to... to the local gatekeepers of that communities.
If you ask me today, Johannes, what are the challenges of South Sudan and what do you want to do?
We will highlight to you our problem and how we intend to solve it.
And then, of course, if you want to support, you have to support along.
What we think is more sustainable is resilient to us.
And then in this way, we become partner.
You become partner in what we ourselves want to achieve.
The other way also is system cannot work.
In the long term, most of these basic services are supposed to be provided by the government.
So any support has to be streamlined with what the government is providing, because in the long term it can be able to absorb any shock, because the government is there to stay.
So I believe that any new program that meant to support low-income country or communities should have a program that is linked closely with the government.
And the government should be strengthening the health system of the government or education system of the government.
So in that way we become a facilitator of how the community can demand for service from the government and can in the long term, even if we are fulfilling certain gaps, then our role here is to make sure that the government understands they are responsible for providing these basic services to the community.
And the community understands they have the obligation to hold accountable the government or to demand from the government that these services they need them.
I mean you've built something really remarkable Johannes, with YoCare, which is a model of healthcare in settings where traditional medical infrastructure simply doesn't exist and where communities can really take ownership of their own health.
I'm curious what lessons do you hope other healthcare organizations, especially those working in crisis or resource-limited settings, might take from your approach and journey?
For the last 17 years now, I've been working in a resource-limited setting, in conflict, in humanitarian and in health sector.
This has taught me that solutions must be locally led and they must be adaptable and resilient, because a solution that will drown when problems become more is not a solution.
It should be able to adapt to that situation.
And that is what I have been trying to design as YoCare.
When we train community members to deliver the care.
And, of course, our work now will be just empowering them to make decisions that they locally understand and that they're more sustainable than relying solely on external experts.
In Africa generally, you will find local organizations or international NGOs are led by country directors that don't understand the context.
But other organizations that are led by the local people themselves are able to be more resilient.
I always tell the people, let us be adaptable.
Let us focus on capacity building because tomorrow we will not be there.
But the knowledge you give will always remain for generation and generation to come.
And any infrastructure support will also remain there.
Johannes, after all that you've been through, you continue to decide to stay and rebuild.
And how do you, on a daily basis, maintain this sense of hope? and possibility and forward motion.
What allows that for you?
My hope comes from action.
And I always believe that I have made the best decision to stay, never to go anywhere, because living would mean that I'm abandoning my people.
I believe that even a very small win can save life.
A mother educated, a community leader trained on how they can be able to, you know, promote their idea, prevent themselves from infectious diseases, you know, show that progress is possible.
So every challenge is an opportunity for me.
It's an opportunity to innovate.
It's an opportunity to strengthen the health system that we have already started to establish.
So my hope is built on tangible impact that we have seen and the resilience of our people.
And yes, the current approach is good.
We go to the community, we train them, and then they are able to deliver themselves.
But we also need to upgrade this skill.
People who are being part of our local support at the community can be able now to come to upgrade their knowledge and be more like myself.
You know, I have a specialty that they can be able to help the people in a very specific way.
It reminds me that I should not move away, because if I choose to go, maybe specialize in the US, in the UK condition may be good for me.
I will decide.
Let me not come back.
So that is why I'm choosing to stay here, acquire all the necessary education that I want, all the skills that I want to be able to provide further support for my people, for my community in South Sudan and the region.
Thank you, Johannes.
I'm really honestly just inspired to know you.
It's been such a joy to get to follow your journey.
So thank you for joining us today.
And thank you for all you do in the world.
It's a gift.
That was TED fellow Johannes Reich.
To learn more about the TED Fellows program and watch all the TED Fellows films, go to fellowstedcom.
And that's it for today.
This episode was produced by Lucy Little, edited by Alejandra Salazar and fact-checked by Eva Dasher.
The audio you heard at the top comes from the short film made by Divya Gidangi and Owen McLean.
Story edited by Corey Hajim and produced by Ian Lowe.
Video production manager is Searing Dolma.
Additional support from Lily James Olds, Leonie Horster, and Allegra Pearl.
TED Talks Daily is part of the TED Audio Collective.
Our team includes Martha Estefanos, Oliver Friedman, Brian Green, Lucy Little and Tansika Sangmarnivong.
Additional support from Emma Taubner and Daniela Balarezo.
I'm Elise Hu.
I'll be back tomorrow with a fresh idea for your feed.
Thanks for listening.
