Let's Put Healing Into Healthcare with Dr. Marc-David Munk

Jennifer Norman:
Hello beautiful humans. Welcome to The Human Beauty Movement Podcast, your source for hope, healing, happiness and humanity. My name is Jennifer Norman. I'm the founder of The Human Beauty Movement Podcast and your host. This podcast is here to guide you on your journey of self love, empowerment, soul alignment and joy. With each episode, I invite beautiful humans from all corners of the globe to join me for open conversations about their life lessons and the important work that they are doing to help heal humankind. Take a moment now to subscribe to this podcast so you don't miss an episode. I'm so glad you're here, joining me for today's show.

Jennifer Norman:
Now, if there's something I love celebrating, it's the resilience of the human spirit. Even in the darkest days where everything seems hopeless, I'm always amazed at how beautiful humans are able to shine their light, to touch others with the transformative power of healing. My guest today is Dr. Marc-David Monk. Marc is a former international emergency medical doctor who is now a prominent figure in healthcare. After seeing and experiencing the unimaginable, he's dedicated his life to driving change in emergency medicine and healthcare management around the world. Marc recently released a new book called Urgent Calls From Distant Places. He's here to talk about the book, his experiences in East Africa and share his life lessons. Welcome to the show Marc.

Dr. Marc-David Munk:
Thanks Jennifer. Terrific to be here.

Jennifer Norman:
I am so happy to have you here. And I just want all of our listeners, all of our viewers to hear about your story of how you chose a career in emergency medicine and then all of the experiences that led you to Africa.

Dr. Marc-David Munk:
Sure. Listen, it's sort of a comedy of 1ft in front of the other to a certain extent. I was kid in college studying the humanities. I really would have never expected to have gone into medicine at all. I was studying philosophy and religion. Not exactly set up for a great career, I think. But I was almost accidentally volunteering for the local town ambulance in college. And what ended up happening over a period of years is that I started to find that work incredibly fulfilling.

Dr. Marc-David Munk:
It was an opportunity to step into other people's shoes and to spend time in their lives and to really serve for them as a rock in a time of crisis. And as I came to the end of my four years in university, the question was, what do you do next? And I knew at that point it was going to be medicine. I had taken out a single science class, so I had to go back. I had to take some science. I had to work pretty hard. I didn't have a natural aptitude for basic science. But ultimately, I ended up in medicine and emergency medicine primarily because I was really interested in people's stories and being available in times of crisis. Those were two appealing things for me.

Jennifer Norman:
Certainly predicated about your early experience while working in ambulances.

Dr. Marc-David Munk:
Yeah, no, it was one of those fortuitous things which is sort of an accident. There was an opportunity that came along, and I was like, hey, this sounds really interesting. Let me do it. So the book brings us really starts, I think, with me finishing my training and finding myself at a bit of an impasse as a young attending doctor, I had spent all that time preparing for that career. And in my first couple years in practice, I would find that I came to work and started to dread my shifts, that I would look around the ER and I'd realize that this place was so incredibly dysfunctional, and that my colleagues and I were really bearing the burden of what was a really broken american healthcare system, that no matter where the dysfunction was in the healthcare system, ultimately it all ended up in the emergency room. And we weren't really prepared to deal with the kinds of things that came through the door.

Jennifer Norman:
Yeah. So your take was that it really wasn't just the location or locations where you were working. The entire system was broken in some way.

Dr. Marc-David Munk:
The system was broken. I mean, we had trained to treat heart attacks and strokes and really complicated things. We trained to treat less acute conditions as well, sprained ankles. But what we weren't prepared to do was deal with patients with complex chronic disease or behavioral health issues or complex socioeconomic issues that we just didn't have the resources to deal with. So we started to feel sort of useless. We were having to cut corners in order to see all. All the patients that were coming through the door. And we just were ill equipped to deal with a lot of our patients.

Dr. Marc-David Munk:
And so we put a band aid on a bleeding wound and sort of put it out the door. And so it was a time of reckoning for me at that point.

Jennifer Norman:
I heard this quote, I will look for the attribution, but it was something to the effect that medicine or doctors, people who are in hospitals and whatnot, and God bless the fact that we have great hospitals, and that's not to discount the fact that there are a lot of good things that are available in the system. However, "you can cure the body, but you can't necessarily heal the soul". And that's where the difference is, I think, between what you might have been experiencing and what you were looking for, what your soul was seeking.

Dr. Marc-David Munk:
I think that's right, Jennifer. And there's such a magic to medicine, right? I think when it's done correctly, the one on one relationship, the healer-healee relationship between a doctor and a patient is just so primal and important. And it's been, to my mind, commodified to the point that the relationships don't matter. And it's just a question of getting in and checking the boxes and trying to fix something and leaving. It's not the same.

Jennifer Norman:
Yeah, I actually, in my experience, having a son who has gone through just years and years of chronic illness, disability, in and out of emergency rooms, in and out of hospitals, there was definitely a trend towards seeing the box checkers. And you can tell. I can almost spot them now at an initial hello. It's just like, the ones that will come in and almost treat you like you're a number. And there...I think that there has to be some sort of emotional detachment, otherwise you just turn into a puddle of mush, as a doctor, I think because you are seeing so many atrocities and there is a level of distance that I think that your heart needs to have versus every single patient.

Jennifer Norman:
With my son right there present, a doctor would come and say something like, "Well, you seem to be enjoying him, so if you want to keep him alive, then, yeah, that's your choice". And I was like, are you kidding me? Or, "We have to think about life expectancy here. So is it really going to be a cost benefit to us?" And I was just like, whoa. There is something either wrong with the training here or with the way that we prioritize patients versus what the work is. It was very, very eye opening to me that there could be a lot of work done there.

Dr. Marc-David Munk:
What we realized, I think, is that these doctors are actually injured themselves. A lot of these doctors are carrying around this concept of moral injury. They train to practice in a certain way, to spend time with their patients, to get to know their patients. And they've been forced by the system to behave in ways that prioritize other things. Yeah, minimize the time spent on a visit, maximize the number of rvus that you deliver. Try to move through as many patients as you can.

Jennifer Norman:
Efficiency, productivity, efficiency.

Dr. Marc-David Munk:
All those things are the antithesis of what the doctor patient relationship should be. And so sometimes I really hold a great deal of compassion for doctors in those situations. I think I may have been one of them. I'm sure I was many times. But it's because the system doesn't work.

Jennifer Norman:
It's a great point, because there are really good people working in bad systems, and if you're incentivizing certain behaviors and actions, people are going to aim towards those behaviors and actions and potentially lose sight of the more important metric, which is -- how's the person? How is that whole person? How is the well being of the person that you're treating?

Dr. Marc-David Munk:
Oh, there's no question. And that's, of course, what patients want. Sometimes I think doctors think patients want something, but it's actually not what they want. They don't want a prescription. They want reassurance. Right? They want to feel like they've been listened to. They want to feel like the doctor understands the situation that they're in and the complexity of what they're working through.

Dr. Marc-David Munk:
So the answer isn't always intuitive or obvious. It's not about more resources. Sometimes it's just about an ear.

Jennifer Norman:
It's complicated. So you've experienced burnout, which is very, very common in emergency medicine, and I think in healthcare in general, that led you to your next step, which was volunteering for AMREF. Is that correct?

Dr. Marc-David Munk:
Yeah. It was a total unexpected pivot in my life. But I decided to reach out. It was an unsolicited email that I sent to Nairobi, and I said, listen, I'm an emergency doctor. You guys run a terrific air ambulance service, renowned air ambulance service. Are you looking for somebody to work with you? And they got back within a day or two and said, absolutely. We'd love to see you pack your bags. Come join us.

Dr. Marc-David Munk:
And I realized, almost without thinking about it, that it was exactly what I needed to do to clear my mind and to help me reprioritize what I should be doing with my career. And so I found myself soon after on an airplane flying to Nairobi. And that kicked off several months with the AMREF Flying Doctors.

Jennifer Norman:
Wow. And so, for those of you who aren't familiar with AMREF, AMREF is the largest African based healthcare nonprofit. They serve millions of people every year across 35 different countries in sub saharan Africa. They began on the continent as Flying Doctors, bringing surgical services to remote communities using light aircraft. And they've expanded now. And they train African health workers. They respond to the continent's most critical health challenges. They are a nonprofit, and they are still in wide operation today. So if you are interested in looking up AMREF, then I will put the information in the show notes.

Jennifer Norman:
So why don't you tell us a little bit about your experiences? Because I believe that your book really does focus on a lot of what was going on during your time there.

Dr. Marc-David Munk:
Yeah. The book is some part of discussion about my life and the decisions I've made sort of incrementally over the years and how they kind of piece together into a narrative. But really, it's, I think, a more entertaining collection of 22 stories of rescues in East Africa that I did in 2008 and 2012. And so the way these things would work. AMREF Flying Doctors was founded back in 1953 by the chief...he was actually the chief surgeon of the Royal Air Force in the UK, who was a reconstructive surgeon, putting together soldiers who'd been injured in the war. And after he retired, he went and started Flying Doctor service. And as you say, it was an opportunity to send doctors out into the field.

Dr. Marc-David Munk:
Over the years, it emerged, actually, into Africa's primary...East Africa's primary air evacuation service. And so they knew every landing strip, they knew every county hospital, they knew every politician, they knew all of the security issues that were pertinent, and they can kind of get in anywhere and pick anybody up and bring them back to Nairobi, which was the center of healthcare for East Africa. And so that was really what one branch of AMREF turned into. The other one still does, as you say, teaching and public health work and clinical outreach. But AMREF Flying Doctors is sort of the go-to world renowned medical evacuation service in East Africa.

Jennifer Norman:
Wow. So you have some stories. Can you share some of the more prominent stories that you can recall of your time there working with them?

Dr. Marc-David Munk:
Sure. I mean, they were all so profound. And so we did flights to eleven different countries over the course of two separate tours with AMREF. The first one was in 2008. And I almost say it was like sort of the...there was a period of innocence in Kenya. We were flying to pick up tourists and locals who had been gored by animals and people with bad malaria. There was a certain innocence to the whole thing.

Dr. Marc-David Munk:
Some of the trips were terrifying. Some of the trips were just plain weird. Some of the trips were medically complex and fascinating tropical medicine. Some were really serious security concerns where we weren't sure whether we would make it out. When we got to 2012, which was the second tour there. There had been a pivotal change in Africa, which was this rise of insurgency in Somalia. They were undergoing a terrible civil war, have for years and years, but the insurgency started to spill out of Somalia into Kenya, and there were multiple episodes of extreme terrorism in Kenya, where malls had been bombed and people had been shot and kidnapped, and it kicked off this period of heavy militarization of East Africa.

Dr. Marc-David Munk:
So we found ourselves on the second tour, flying into Somalia to pick up African Union soldiers, flying into refugee camps filled with Somali refugees, trying to pluck aid workers out, flying in to pick up an American soldier. We didn't notice that there were Americans placed all up and down the coast of East Africa trying to contain this insurgency that had popped up. And so two completely different stories, but just people who read it say, these are just the wackiest, wackiest stories. I can't believe, like, you find yourself in this situation.

Jennifer Norman:
Right. So do you want to elaborate on those stories at all?

Dr. Marc-David Munk:
Sure, sure, sure. So give you my two favorites.

Jennifer Norman:
Okay.

Dr. Marc-David Munk:
Some people really love the story of the little boy. So, Little Boy was a trip that we took to the Tanzanian border. There was a family who had been...they went to a party in Tanzania, driven across the border from Kenya. They had spent the night at the party. They had a wonderful time. And they were driving home, and their SUV, at high speed, hit the back of an unlit tractor that was driving in the middle of the night. It was pitch black.

Dr. Marc-David Munk:
And their SUV was destroyed and rolled over, and there were seven injured people. And so we got the flight and responded with two aircraft the next day to go pick them up as soon as we had first light onto the landing strip. And the story really is about one little boy who had been ejected from his mother's arms into the windshield and was really critically sick. So that's one that really sticks out of my mind. It was a great rescue, a great save of this very delicate little boy. The other one that people comment on a lot is the story of us picking up a young man from Ethiopia who we realized on the tarmac may actually be suffering from a hemorrhagic virus like Ebola, which kicked off all of this complex decision making, because certainly we were exposed. It's highly infectious, these diseases. But the other concern is that you don't want to take a patient with Ebola to a big city like Nairobi without preparation.

Dr. Marc-David Munk:
And so it kicked off the huge degree of decision making and soul searching about what we should do, whether we should abandon our patient on the tarmac, basically leave him to die in Ethiopia, or take the risk that he was heavily infectious and bring him to Nairobi. And so the book, I think all 22 of those stories, they're all kind of filled with these complex decisions, a lot of reflection on the places that we're traveling to, whether it's bureaucracy in Ethiopia, whether it's corruption in the Democratic Republic of Congo, whether it's insurgency in Somalia, the histories of these places, but also sort of my feelings as I went through these experiences of being somebody who tried to hold himself really open to the experience without an ego, really trying to embrace what I saw and just how I felt about those experiences, they were very profound.

Jennifer Norman:
And interestingly enough, you say that certainly there's differences between the emergency medical care in East Africa and western healthcare system, yet there were some interesting positives that you found during your time there. And so I would love for you to just share what you mean by that. What were some of the notable differences that you saw and some of the things and practices that you felt could actually be taken back to the west?

Dr. Marc-David Munk:
Yeah, the notable differences, I mean the primary difference is the lack of resources in Africa. Theres no sugar coating the fact that there just isnt enough to go around in a place like Africa. So people with really treatable diseases are not treated because there isn't enough money to treat them, and medical supplies are washed and reused, then people really try to stretch money as far as they can to deliver the most service that they can. We don't necessarily have that resource problem in the United States. In fact, if anything, we're throwing a lot of resources at a system that just doesn't use them properly. But I think the things I really learned in Africa, number one, is they do the basics better than we do, meaning their access to community clinics, basic primary care services, management of the most common things, is readily accessible almost on a walk in basis. There's absolute transparency about the pricing. I mean, for a malaria test will cost you a few bucks. They put the price list outside on a painted sign. And so people know what they're getting into when they go to the hospital.

Dr. Marc-David Munk:
And the basics, in many cases are free because the government and county governments provide these services for free. I contrast that the United States, which is, we're in the midst of a terrible healthcare crisis. Access is awful, costs are killing families. I mean, they're absolutely bankrupting families, whether it's paying for premiums or unexpected health emergencies that result in bills that bankrupt people, literally bankrupt families, it's the leading cause of bankruptcy in America. And so there is something, it's an interesting question, because what I walked away with was the sense that there is a greater sense of immorality in the American healthcare system, where we take advantage of people and provide poor access and poor quality and poor service at extremely inflated prices that hurt people, versus the African system, which tries the best that it can to provide service with the limited resources that it has. To me, feels a little bit more honest, honestly, than what we. What we deliver at home.

Jennifer Norman:
Yeah. I cannot tell you how confusing I find it, having been working with various providers, insurance companies, different levels of insurance between primary and then Medi-Cal and Medicare and Regional Center. It's just the stacking and the confusion between how to get care, what it's going to cost, who's responsible for the billing. I mean, I know that a lot of people are just, they throw up their hands because they just can't deal with the system. And it's almost as if system wants them to have to go through so many hoops and red tape, and then you'll get the prize at the end of it. And if you're tenacious and if you can figure it out, it's like, congratulations, you cracked the code. Otherwise, it's helpless.

Jennifer Norman:
It's so, so difficult.

Dr. Marc-David Munk:
It's shocking when you actually take a look at the rise of a side note for a second. If you take a look at the rise of both clinical workers, doctors, nurses versus administrators, the number of administrators has skyrocketed over past years, whereas the doctors have just modestly increased. The reason is you need administrators to help you deal with the terrible complexity of the system. But of course, they add complexity to the system that justifies their own jobs, which creates more. So it's this, like, unbelievably byzantine system of payments and healthcare delivery, which is confounded by the fact that there are so many people at the trough making money off the system unabashedly. I mean, huge, huge, huge amounts of money on the back of people who pay premiums and receive healthcare, pay for healthcare that you've got this system that I think doesn't have a lot of incentive to change because there are a lot of people who doing very well in that system. It's just not the patients or their families.

Jennifer Norman:
Yeah. Going back to Africa. Now, you said that you visited the world's largest refugee camp, and it had a profound impact on you. Can you tell us what that was like?

Dr. Marc-David Munk:
Horrifying. So Dadaab is a town in northern Kenya, which is not far from the Somali border. And what happened with the outbreak of the somali civil war was that there was this massive migration of people out of the country because it was not safe to stay in Somalia. And many of them congregated in refugee camp that was not far from the border. This was like over 20 years ago when the conflicts first broke out. And so there was this expectation that the Dadaab refugee camp would be there for a short period of time and Somalia would be fixed and people would go back home. Somalia was never fixed. Somalia is still today in a state of crisis.

Dr. Marc-David Munk:
And so you've got these people who have lived at that refugee camp now, in some cases for 20 years. Children have been born. This is the only home that they know.

Jennifer Norman:
And so how many people are we talking when you say it's the...

Dr. Marc-David Munk:
I'd have to take a look at the numbers, but it's. It's very large. I mean, it's, I'm guessing hundreds of thousands of people.

Jennifer Norman:
Hundreds of thousands.

Dr. Marc-David Munk:
We could look it up, but it's. When you fly over it, it stretches for miles and miles and miles. And what you see underneath you are these temporary accommodations, mainly built of branches and garbage bags, sort of branches turned almost into an igloo type structure with garbage bags pulled over them for weather control. And then there are a couple more robust buildings that are feeding centers and clinics that are run by non governmental organizations. But it is this massive, sprawling place, and there is an airstrip in the middle of it which serves as the primary way of getting in and out. And so we were called many times the Dadaab to get aid workers and bring them out of there, sick aid workers and bring them out and take them to Nairobi. And the experience was always awful. I mean, to give you an example, I mean, we flew in to get an aid worker who had actually had a nervous breakdown and needed to be flown out.

Dr. Marc-David Munk:
And when we landed, a) There was a lot of security concerns because even in the camp, there were terrorists and hijackings and bombings that happened with regularity. And so we were very cautious about our own security when we landed there. But as I looked across the tarmac where a plane had parked, I saw that there was a chain link fence and there were children there who were bored out of their minds. They'd spent their entire lives in this camp who were staring at the airplane with their fingers through the chain mesh, staring at us with just these hollow eyes. And what you could hear in the camp was just the sound of children wailing. They were a constant soundtrack, was just children crying in the background. This place was like, to me, felt like it had the least amount of possibility of any place in the world.

Dr. Marc-David Munk:
It was a black hole of just hopelessness on some extent. And what I started to realize flying into this place was that I didn't feel at all good about the work that we were doing, despite the fact that we were airlifting somebody out and saving their life in some cases, that there was just this sense of feeling very self conscious about the good fortune that I had in life and feeling very self conscious about the fact that within 2 hours I'd be back in Nairobi and free to leave and free to live my life and was just filled with so much optionality that these children didn't have and wouldn't have that I felt so self conscious. I actually was itching to get out of there. It was a deeply uncomfortable place.

Jennifer Norman:
I can imagine that. There's so many questions.

Dr. Marc-David Munk:
I quote in the book, this fellow called Loren Eiseley, who was an American writer anthropologist, who wrote a short story called the Star Thrower, which you may come across it every so often because...

Jennifer Norman:
I's an Internet fave.

Dr. Marc-David Munk:
It's an Internet fave. It's like every LinkedIn real estate timeshare kind of has Loren Eiseley. And what the story really is about is a fellow who's on the beach, sea life is stranded on the beach because the tide has gone out. And he sees a fellow on the beach catching the starfish, taking them from the sand and putting them back in the water. And he looks at the guy and says, why are you wasting your time with that starfish? The entire beach is filled with dying sea life. Why bother? And he says, it matters to that starfish. And sometimes I think to myself, gosh, when you're confronted with a place like Dadaab, when youre confronted with the average American emergency room, which is just this never ending flow of patients coming in with these complicated problems, you cant really fix. And the charts, rack up the charts.

Dr. Marc-David Munk:
Just stack and stack and stack. Patients are waiting forever. When youre confronted with a sense of hopelessness, all that you can do is put one foot in front of the other and try to make the best contribution that you can. Were not all of us politicians or powerful people who control big financial resources or a lot of political power, and so many of us don't have the capacity to make great change, but all of us, I think, do have the capacity to make small change. And I think throwing a starfish back in is a first step and an important step. And if we were all to throw a starfish back in, that would be the difference.

Jennifer Norman:
Yeah. And that's the additional part of that parable that I've heard is that then the other man decided to also start throwing starfish back in. And then other people saw and all started to throw starfish back into the ocean. And soon there were no starfish on the beach. And so, yeah, it's like the impact of one person can have a ripple effect and impact on a much larger scale if attention and awareness can be brought to it and people recognize that their impact matters. I think that that's what a lot of people find hopeless, is that they feel that they can't make a difference. Their actions won't matter or don't matter. When it is not true. It seems like it is when you're first starting out, but then little by little, it can make a difference, and...

Dr. Marc-David Munk:
It makes a difference for you. Even if you're not fixing the world. What it does for your own sense of self is very important.

Jennifer Norman:
Yeah, yeah. I had actually heard about...there have been some recent articles about the whole 'wellness movement', if you will, and the fact that when people are in...say they're working for a company, say they're working for a hospital, and they're like, "I'm burned out. I'm not feeling well." Sitting down and watching a PowerPoint or doing just a simple meditation is really not going to cut it. A lot of times it makes people feel worse. What actually is pretty much one of the only things that has helped was volunteering, because it changes you. It changes your soul somatically.

Jennifer Norman:
You are physically doing something and getting all systems working at the same time. Rather than just reading about some hypothetical situation and feeling like you can integrate that into your life, you really just, like you did, you went and moved your body to another part of the world to volunteer, and it changed you probably just as much, if not more so, than some of the other people that you're helping.

Dr. Marc-David Munk:
I love that you raised this point. Yeah, I love that you raised this point, because when you pay too much attention to the wellness literature, it's about...they're always about, it's about you. What do you need? What do you want? Create space in your life. Right? You, you, you. And I think what you come to realize at the end of the day is that it's actually not about you. Like, if the way to fix you is not by looking inside and tinkering with what's inside, the way to fix you is to look outside yourself and find something that needs to be fixed or improved. I mean, philosophers have told us this.

Jennifer Norman:
And then you see how much it feels...yeah, it helps depression, all of those things. It's like, get outside your own head, do something for somebody else, and then see how that happens. And the reciprocal can be true if you've given so much that you're depleted and then you need time out. But it's really just like this wonderful balance we're recognizing that is going to help us get up off the couch, get off our phones, stop the scrolling, the doom scrolling, and then actually do something. Take some inspired action to make something better, and then in turn, you're making yourself better. How enlightening is that?

Jennifer Norman:
So now you also talk about the concept of frontiers in your book. This is a recurring theme. So I'm curious what frontiers represent to you.

Dr. Marc-David Munk:
Yeah, frontiers comes up a lot. I quoted Dag Hammarskjöld, who was the second secretary general of the United Nations. He was a big thinker who wrote a book called Markings back in the day. And it was also, of course, instrumental in setting up the UN and kind of getting it to work in a peacekeeping role in Africa.Dag Hammarskjöld and I think both kind of hit on the same thing, as did one of the founders of AMREF, who I met in Santa Fe. It's sort of described in the book, a guy called Tom Rees who was a plastic surgeon in New York society. A plastic surgeon who I think did the most important nose jobs in New York City for like decades, but also took a lot of time every year to go to Africa and to volunteer with Flying Doctors and to provide clinics and outreach. And he describes finding his bliss. And Dag Hammarskjöld, in other words, sort of describes the same concept.

Dr. Marc-David Munk:
But the idea here basically is what youre trying to figure out in life, I think, is what you are put here to do. What is your purpose? What are the skills that you have that can contribute? Its a process of introspection and self discovery. And the classic way that people find this out for themselves is that they put themselves in unfamiliar environments and they test themselves. And as they cut out this noise, as they create a sacred space to listen to themselves, the answer becomes apparent over time. That's why these books like Eat, Pray, Love have been bestsellers. And travel is one of these classic examples of taking you out of your comfort zone. I think the main reason for that is because travel forces us to really drop our ego. I mean, you are on some level quite powerless in a foreign country where you don't speak the language and don't know the people.

Dr. Marc-David Munk:
And so you're forced to drop your armor in order to function in these places. And when you drop your armor and you expose yourself to the benevolence of the world, oftentimes what you find is, of course, it's reciprocated and people treat you well, and it's this wonderful experience, but it is very much a frontier. And I think at that frontier, it creates the space for you to listen to yourself and to reassure yourself that the life you are living is the one that you ought to be living. That's the key question. And so for me, the frontier was rural Africa, where it was different language, different culture, different people, different experiences. But it was all about a period of self discovery. For me, your frontier may be different, but I think it's a question of taking you out of the daily quotidian and putting yourself in an unfamiliar environment.

Jennifer Norman:
Beautiful. Beautiful. Yeah, those challenges. And it's almost like resilience testing and really diving in to see what you are made of. And a lot of times we don't know until we're tested and put into unfamiliar territory and charting some new frontiers. Really, really interesting. So I am curious because you had those experiences with AMREF, and then you came back and you became a healthcare administrator. I'm just really curious about how your experiences impacted the work that you're doing and the impact that you are striving to make now your frontier that you're currently on and continue to be on to make some change and impact.

Dr. Marc-David Munk:
So Africa, for me, people ask me, it's 2024. I mean, why are you publishing a book now about your experiences in 2008? Are you some sort of like a sentimental old guy who's, like, writing about the good old days? Maybe. But I think really more, I realized in retrospect that it was this inflection point for me where I made the decision to step out of full time clinical practice and into more leadership roles. And what I realized was that nobody was going to fix the system from within, from within the emergency department. In order to fix all of the dysfunction in the system, you had to actually move a little bit upstream to where the decisions were made and the models were created and the payment models were negotiated. And so I went back to school, I got some management training, and then really committed myself to working in organizations that were what they call value based organizations as a brief primer for your readers, because this is really like inside baseball, boring stuff. To my mind, the reason the system doesn't work well is because it's paid the wrong way. We reward people for widgets that are produced and we don't reward for outcomes.

Dr. Marc-David Munk:
And so if your doctor can shorten the visit and do more of them and do more stuff and do more procedures, it generates more money for the system. It's illogical, because you maybe don't need more stuff. Maybe you need inexpensive preventive care, or visits with a nutritionist, or simple social interventions that don't cost much money. There's no provision in the system to provide those things, but there is lots of money to pay for complex interventions and care. So it's kind of a perverse system. And when I came back, I decided that I really wanted to only work with organizations that were thriving in this value based care delivery space and really delivering different care models that generated better outcomes. So the one I was most proud of working for was a startup that did primary care for seniors, that just delivered an awesome, awesome model that was so much better than anything else at a much lower price because of the way that we were paid differently.

Jennifer Norman:
I love that. And just as an aside, like 25 years ago, when I went to business school at Georgetown, one of my classmates was Todd McGee, whose father founded Operation Smile. And one of the projects that we did in our class was we broke up into these different...it was an organizational behavior class. We broke up into different organizations and had to create a business. And then from that business at the end, we had to show what our results were. We were the only business that incorporated Operation Smile into our business model. So it was almost like a internship, if you will, in social impact or conscious business.

Jennifer Norman:
And to me, that experience really changed my life. Bringing a girl from Africa who had a facial malformation, she had this large tumor that we then, through our business, were able to raise enough money to bring her here, have the operation and reintegrate her back into her village was like, this is the way that business should be. Why is it just about profits for profit's sake? Why can't it also be about people? And it's one of the reasons why my business now, The Human Beauty Movement, is a Certified B Corporation. It's about people and planet as well as profit. And so I carried that with me throughout my life, because I know that there's so much dysfunction that happens not just in the healthcare system, but in systems in general and capitalist society in general, when so much focus, or the only focus is really put on dollars. Dollars are very important, but they're just a tool so that you can do a greater good. And so from that standpoint, it's almost like we have to reinvent a system. We have to do it from a different way, with people who are willing to hold themselves accountable for doing things differently and for creating better impact. That is going to be healing for the planet, whether that be for climate or waste management, what have you, or for people and their overall well being.

Dr. Marc-David Munk:
I love that, Jennifer, and I think you're 100% right. I mean, some of the organizations that you respect the most, or, I think Patagonia is an example of this...

Jennifer Norman:
Yes, yes. Patagonia is a B Corporation.

Dr. Marc-David Munk:
They say, you know, yeah, we need to make a profit, we need to make a margin, but we also need to take care of the people who work for us, and we need to take care of the environment. And, gosh, what a great organization.

Jennifer Norman:
Stakeholder value instead of stockholder value. It's really about creating an entire economic ecosystem. Understanding that you report to your suppliers, you report to your employees, you report to your community, to the land that you have the privilege of having your business on. All of that is like, can we operate in such a way that we are regenerative and positive, net positive versus extractive? And so, yeah, taking cues from looking out into these other frontiers and not seeing a situation as hopeless, saying, like, there's always something that I can do, there's always some radical responsibility...I say that a lot on my podcast. There's always radical responsibility that I can take for my actions, for my values, for my behaviors, and then see how just by being me, just by doing what I know best, and that is either in service to others, in service again, to just keeping myself as healthy and well as possible, that will have inspiration for other people to do the same. And that's when all the starfish get off the beach.

Dr. Marc-David Munk:
I love that. It's funny in healthcare, because it should be so obvious. And in fact, most healthcare in America is not for profit. These large healthcare systems are ostensibly not for profit, but, you know, and I know that not for profit doesn't necessarily mean that you're doing the right thing. I mean, a lot of these organizations are still gouging patients and charging too much and coming after them with collections agencies, and all the other stuff. So it's time, I think, for a bit of an ethical overhaul in American healthcare.

Jennifer Norman:
Yeah. Just as a parting thought, if you could wave your magic wand and poof, the healthcare system would be fixed, whatever that means, how would you see things operating differently?

Dr. Marc-David Munk:
I think two things. One is we need to encourage more regulation policy. And I say this as a guy who hates paperwork and bureaucracy, but healthcare is not a purely capitalistic setup. I mean, its just not. It needs to be regulated. If you take a look at healthcare costs, for example, in Canada, which has its own issues, right, I mean, they have issues with access. But if you take a look at pharmaceutical costs, the reason drugs are so much cheaper in Canada isnt because they cost less to make. Its because theyre regulated by the Canadian government.

Dr. Marc-David Munk:
The Canadian government says this is what were prepared to pay and the drug companies say fine, well just charge more in the US. Theres no regulation in the US. So I mean there's no reason why these medications should cost as much as they do other than the fact that the drug companies charge as much as the market will bear. That's it. That's the only reason. There's no rationale otherwise. I think the second thing is that we need to really focus on different ways of paying for healthcare. This current model, I think is the great toxic way of paying for healthcare, this fee for service. And we just need to be more thoughtful about that.

Jennifer Norman:
Everyone, this is Dr. Marc-David Monk. Please read his book, Urgent Calls From Distant Places to be inspired about some things that you can do to expand your frontier and your horizon. Marc, thank you so much for being a guest on The Human Beauty Movement Podcast today.

Dr. Marc-David Munk:
Thanks for having me Jennifer. It's been great.

Jennifer Norman:
My pleasure.Thank you for listening to The Human Beauty Movement Podcast. Be sure to follow, rate and review us wherever you stream podcasts. The Human Beauty Movement is a community-based platform that cultivates the beauty of humankind. Check out our workshops, find us us on social media, and share our inspiration with all the beautiful humans in your life. Learn more at thehumanbeautymovement.com. Thank you so much for being a beautiful human.