3 | Neoliberalism and Health | Tinashe Goronga

Staying in the academic realm alone for us has not been tenable and that's why social medicine has been a way for us to express praxis, right, the beautiful marrying of education and action. Either you're a part of the system by either not seeing the system or choosing to not address it or you're fighting it. Welcome to Social Medicine on Air, a podcast where we explore the vibrant world of social medicine. We learn through conversations with healthcare practitioners, researchers, and activists who are working to create a more just and healthy world. Welcome everybody to another episode of Social Medicine on Air. Today we have the honor of speaking with Dr. T'Nashe Goronga, who is a physician from Zimbabwe. Dr. Goronga, would you mind telling us more about yourself? Thank you, Brandon. My name is T'Nashe Goronga and I'm a medical doctor by profession. I trained in Zimbabwe and I practiced in Zimbabwe for three years before pursuing my masters in public health, which I recently completed. I'm also part of the social medicine consortium network where I'm involved in the global leadership of the global campaign against racism. So basically we campaign for social justice and health equity through dismantling racism and capitalism. Well, thank you. So one of the questions that arose for me when I was doing some of the readings that you had sent is this idea of structural adjustments and the way that various international financial groups and institutions have helped to shape policy around the world, but especially in low and middle income countries. Could you tell us what structural adjustments are and maybe the history of how those have played out in Zimbabwe? So what happened is most of the low income countries, soon after independence, were trying to get into a path of trying to improve the economies, and one of the key issues that they needed were to access loans and funding from the major institutions so that they can start promoting growth because during the colonial era, the growth was disproportionate in some sectors where benefiting only a small section of the community, but not the entire country, the majority. So as a way of bringing about or of stimulating economic growth, what the IMF World Bank and the major institutions did is they came up with conditions that came with the loans. So ideally the conditions were for them to free up their markets more and to make them more productive. So countries had to inverse more in the productive sectors and reduce their spending. So they were also required to privatise as much as they could in some sectors. So the hope was all these measures would promote economic growth, and that economic growth would also translate to social progress. But in the process of trying to cut on the spending, some governments would spend their spending on health and education because this was considered to be constructive sectors. So that resulted in the introduction of user fees and some of the conditions back then. So in the case of Zimbabwe, Zimbabwe, from soon after independence, it took on more like a socialist trajectory in the 1980s where they were trying to invest as much as they can in improving the social issues and delivering of health and education as a way of bridging the gap. That was during the colonial era because there wasn't much investment in the rural sector. So they wanted to improve coverage for primary healthcare. So they invested a lot in building clinics and an expansion for that. So there was a lot of government spending in that regard. Then in 1990 now, when they started to access loans, that's when they had to cut on their spending. They introduced user fees in clinics and hospitals. They had to freeze some of the posts, for example, in the health sector. So they had to cut their spending in the so-called constructive sectors. And the idea was for that to translate into economic growth. But unfortunately, the outcome did not happen as expected. So these were, in some sense, the conditions of the loan that would be implemented in exchange for the ability to access those monies. And one of the papers, too, I thought it was helpful. They mentioned some of these four central principles of neoliberalism, like liberalization of the economy, deregulation, and privatization as certain ways of pursuing the idea of growth, although as you're saying, that didn't translate into actually improved health and well-being in many cases. But actually, one more question as well. You mentioned the 1980s and 1990s as some kind of key moments in Zimbabwean history. But can you put this in the larger context of what's been happening in Zimbabwe in maybe the last 50 or so years? What was the transition from Zimbabwe away from its colonial status under the British? And how was that progressed? So Zimbabwe was a British colony initially. Then in the 1950s, they formed a federation which is where there was a federation with Northern Rhodesia, which was Zambia at that time, Nassaland, Malawi, then Southern Rhodesia, that is Zimbabwe. Then the federation did not work out. And after the federation, that's when there was a unilateral declaration of independence whereby the then colonial government decided to declare independence away from the British government with Ian Smith. So that's when Rhodesia came now. It was independent from the British colony, but it was still racist policies where the white minority were in control of the power and the resources and everything. And the black majority did not have access to land and other key economic resources. So then that's after the unilateral declaration of independence, what happened is following up the sanctions that were imposed on the then Rhodesian government and the liberation struggle started happening with the black majority fighting for independence, which led to 1980, which resulted in the Lancaster Agreement whereby there was the agreement that resulted in the independence of Zimbabwe and some of the conditions for that were that they would observe, they would respect private property and in exchange, what would happen is there would be an elections and that's when we had the first black president. So the focus now shifted. So during the colonial year, the focus was mostly on developing, was centralised in developing white communities. So the economy benefitted mostly the white minority. So even the land acts and other policies that were there were mainly for the benefit of the white community. Even the health structure and system there wasn't much investment in the rural community. So you'd find that the investment was more for the black communities during that time was more to keep them healthy so that they could be labour. But it wasn't really a comprehensive approach to their health and way of wellbeing. So in 1980, the new government inherited those an eco-society where the majority were living in poverty and where the majority were excluded from the entire system, they were excluded from the economy and they didn't have access to education and health facilities. So the 1980 most of the work that was done was to try to bridge that gap and that's when there was a lot of investments in the primary healthcare sector for example in the health building of the rural communities. So I think what made the 1980 the highlight was Zimbabwe was on a very like it was on a very admired and progressive route where the maternal mortality improved, child mortality, the child mortality again started going down because of the positive developments that were happening. So in 1990 now that was the phase that happened with the structural adjustments afterwards where now they had to start cutting on the spending and because the economy was also beginning to struggle during that time. So the 1990s now the highlight of it was the structural adjustment program and also the worsening economy and also that's when the ruling party started losing popularity and the emergence of an opposition party. So now in the early in the 2000s in the 2000s the economy started continued worsening and there was the land reform program then there was cross violation of human rights and the political crisis worsened and all this also affected negatively affected the economy and also negatively affected an already ailing healthcare sector. So the most of the problems are now continuously worsening. The political crisis continued unfortunately it's still there up to today and the economy crisis also continued but around 2008 and 2009 they formed a transitional government, a government of national unity which included the opposition party to try and improve to solve the political crisis. So during that period they dollarized the economy. The economy improved a bit and so did some of the sectors. Then the Zanipi government came back in power with Mugabe who was then toppled in 2017 and is outing in the current government in place. So when the current government came in they wanted to access loans and debt facilities so they continued on an imposing authority measure so as to cut spending on an already ailing health sector. So they continued having frozen post and they continued having poor remuneration for health workers bringing us to day now where there's an economy crisis, political crisis and we have health professionals on strike as we speak. So it's been a lot of factors coming into play like you'd find the political and economic developments trajectory that the country was on post independence with corruption and corruption, authoritarian rule and human rights violation. Then we also that is in the background of they were coming from a system that was not equitable. Then the structural adjustments where instead of bridging the gap it also increased the inequities that were there existing in the health sector. So it's a lot of factors that were playing together to resort to the situation in the state that Simabwe is in. When I was listening to the first part, your first comments and you say like the one they play for the structural racism, the structural adjustment, it didn't go as they planned, it's going to go on the other way instead of like bridging the gap, it just may keep its widening. But sometimes I'm curious that if the main reason for structural adjustment is to bridge the gap, I'm Haitian, I grew up in a country where they also have to make some structural adjustment. And if there's one thing that I've seen, it's like the people were poor become poor and the people were rich, they get richer because the power stay concentrated on the richest people, they have more political, economical and all the power like stay like on those hands and the people, let's say like my grandparents or my parents who were always marginalized or excluded, those people stay into poverty. And when you look at Haiti, so many people are living in the country, so many people are looking somewhere else to go. So I'm curious to ask you or I'm curious to know like and Simabwe, while the intention was really to close the gap or to have a major control over the country wealth and decision making? Okay, yeah, that's an interesting question. I would say I'll answer it in two words, like face informants who also have to acknowledge the most of the colonizers had left there when along a fiscally present in the colonies, there were other ways that they continued having control over the economies because you'd find that what happened is the former colonizers used to take raw materials from those. So they didn't much develop the industries as much in those individual countries. So that dependency continued. So you'd find that most of the exports from African countries, a lot of African countries are raw materials that are processed in Europe then come back as finished material. So after these countries got independence, in a way, those policies, those neoliberal policies, in a way, continued maintaining those power dynamics, which resulted in and continue that dependency that African most of the African countries had on the former colonizers or on the Western powers. So in the case that now, when it comes to the the structural adjustments and all the way that they were introduced, because obviously, I don't think any country would sign up to something that that upfront is they're told that this is not going to benefit you. But the idea is the way that they presented is they told, okay, this is the neoliberal policies. That this is the best environment for for this. They create the best environment for for development. And the standard that usually used is the is capitalism in in Western countries where they say, okay, the United States or whichever country shows the success of capitalism. And they don't really talk much about the inequities that existed in those countries. They were told that there will be an overflow like of the like when the economy grows, that means you have enough money to spend for your sector. When you privatize, that means that the government is no longer concerning like no longer has a huge burden as far as spending on some some sectors. And because the idea was to create efficient systems. So the idea was, if you create efficient and transparent systems that are very competitive globally, they will promote growth of the economy, they'll come, they'll promote industrialization. And that will result in in the profits from that will overflow. That means that we increase the pool of money that the government we have access to, to to develop the to develop health sector, develop the the the education sector. So I guess the idea was they were trying to model these countries, despite their complicated historical context, into suit into the capitalist frameworks or context that's they have in the in the in the western in the western in the western in the western countries. And in the process, they were ignoring the complexities of the society and then ignoring the impact of those on on in on inequities. Because as you rightly mentioned, it's usually the poor because those same systems will increase the gaps because if you privatize, if you privatize, let's say for instance, privatize the transport sector, what will happen is it means it's no longer receiving government subsidies, yes, but it means that people in the poorer communities will never will not have access to to transport because it becomes expensive. If you introduce, if you introduce out of if you introduce a use of fees at hospitals, it means yes, those use of fees, the assumption is the hospital will generate some income from that and might help in the operations. But you're you're reducing accessibility to the to the poor, to the poor people who cannot afford. And if you look at the employment dynamics, you're also coming at a introducing these measures when countries have unemployment, countries have other social have very, very, they have so many social problems that wasn't the social problems instead of of of solving. Yeah, and I think what's interesting too is is at the time that a lot of these structural adjustments were coming into play in the developing world, they were also coming online and in a lot of wealthier nations and you actually see very similar effects like in the United States and the UK, which, you know, through Ronald Reagan and Margaret Thatcher started implementing these policies, especially, like, that was also the beginning of the large rise in inequality in the United States and the hollowing out of our own systems. And you see this similar rhetoric of austerity that that happens in a lot of countries, or if you look at the way that Greece, you know, transformed politically and economically after the 2008 crisis. What's interesting too is like, even in the history of these neoliberal policy changes and the structural adjustments that they're tied to, is like you're saying, Taneche, they're like, they make a certain amount of kind of common sense like transparency is good. You know, markets are a good way to to distribute goods and services, potentially. And so kind of, and neoliberalism was formulated as a way to move away from these like, sclerotic and kind of over determined, opaque, kind of state driven ways of running the economy, which, you know, like, again, those are probably good goals to be pursuing. But at the same time, you know, when when the neoliberal ideology started to take effect, as we've seen, that it just heightened the inequality and heightened many of these same problems. And it just it just quite simply doesn't work. And I think that the discourse around neoliberalism is something that is thankfully being increasingly recognized. And we are able to name neoliberal changes when when we see them more. But I don't know about you guys, but something that I often struggle with is to say, like, was this intentional? Because the the neoliberal policies have caused a huge regression and many of like quality of life, life expectancy, child mortality, all these, all these things and have been kind of an a means of capture of massive amounts of wealth to move to the, you know, proverbial 1%, as it were. So so to what extent did these come out of kind of like well meaning changes and what extent were they done in poor faith to begin with, I think is is a very complicated question. But I think like you're saying, just the track record alone kind of invalidates their their claims. But but tell us more to maybe bring it home to a more clinical setting. When you're seeing patients, when you're out in the community, what does it look like to see these structural adjustments at work? How do you notice this in your day to day life as a clinician? So the first thing is, you look you look at human resources, for example, you would find that we haven't we don't even meet the WH or recommendations for the patient to health professional health professional ratio. So but you'd find that frozen frozen. So you look at nurses, we have unemployed nurses in our qualified nurses who are unemployed, but they're not they we don't have available posts for them. It doesn't mean that there is no need for those. No, actually, we need them in the in the out sector. Then you find the same applies to doctors. But with doctors now, because these are more specialized, you would find that who are generally in lower supply because of the the the the educational educational system and other factors, you'd find that most of the some of the hospitals we have a stuff establishment of like one of the hospitals that I that I worked for was meant to have a stuff establishment of five doctors or so but you'd find that it any given point to be one or two doctors at most. And these are serving large communities like a population some so you find situations where you find a doctor or two doctors serving a population a district with a population of about 140 140,000 people. Then these same health professionals are poorly denumerated. So that affects the motivation to work. So that means people are forced to as a way of of basically surviving that mean people are forced to find ways to make extra income be it working in private and also in government at the same time so that they can they can supplement some of the some of their money. Then some actually choose to leave the country. So there's a result of the end result is brain drain. So this actually has been more documented a lot. As far as the impact of sexual adjustment, they've contributed to to brain drain in the in so many sectors, particularly the the health sector. Then when it comes to resources that are available for use, so you are attending to patients, but your hospital is poorly resourced, you do not have some of the basic drugs available. Sometimes even some of the emergency drugs and you have to ask the patients to go and buy those drugs for them. And they can't afford the drugs, especially when you're working in a rural area where they have to walk long distances, where they don't have that they don't have a source of income, they're already leaving below the poverty line. So then you look at the social determinants of health. Now we are looking at access to food access to basic services, access to employment, we look at the quality of life that that that the community is serving has like so there are a lot of things that a lot of factors that predispose them to to poor health outcomes. So it affects accessibility, it affects the quality of care that you're that you're giving patients, it also affects availability. And the end result is usually some some of the some of the some you end up having some some preventable that's because you don't you don't have the the basic the basic resources that you that you need, you don't have the basic emergency drugs that you that you that you need. And on the end, the same thing is the most affected usually at the majority, particularly the poor communities, which are already lagging behind as far as access to some of these services concern. Because in the private sector, the rich will have access to to other drugs that they that they need, the private sector actually strives to some extent. Because of that, they will have state of art equipment, they'll have step of art infrastructure. So you end up having a situation where most of the most of the specialists are found in the in the in the capital. And you find a lot of specialists working in the private sector, sometimes they save both the private and the in the public sector. So you find those are equal and equal distribution as far and then equal outcomes between the poor and the rich with the rich with the poor being the most affected by by everything. One of the reasons like those policies, they keep pushing them, or they keep trying to implement them, even though they're side effect or even due to bad consequences. I think one of the reasons is because the people where those policies apply to or not among the people or not among the decision makers, what I mean by that, we certainly have been looking at, for example, my country, the people who take like big decisions, or the people that like have a say on so many things. Often, those people don't have a day to their life with the with those their life are most affected. And Haiti, if you're part of the carbon methamphetamine, you feel sick. Flowida, I think flowida is one hour 45 minutes away from protocol and something like that, or even less, they can cause the border to go to Dominican Republic. So that that's mean, they have more resources, more access to health themselves. So when they take a decision to build a hospital, the hospital may take 10 years or 20 years to be built, because the people that take decision are not going to be served by those institutions, is what I mean. So I think one of the one of the way we could change like health in our countries is by having those politicians, the people who take big decision to be served by those hospitals, because if someone is in Zimbabwe, and then they have access to Kia in Europe, why should he or she invested in Zimbabwe when he can fly to Europe? Are you sort of mean? So so I think I don't know how we can bring more power to the people. I don't know how we can bring more people into the decision making. But I think if we really want to change health and make it much better, like higher quality access and make it equitable, like when it's come to cost, people who take decision, like the people that need it the most, the people that is most affected have to be, have to be listening, have to be among the decision maker. I don't know what you think about that, or if this can be related to your situation in Zimbabwe. Yeah that's true. Our past president, Robert Mgabe, and some of the current government officials were worn on for flying to China as soon as they get sick, or Singapore, China or Singapore, they get the treatment outside the country, and they get the best of care. So you'd find most of the political elite, they have best of care in private hospitals, in private centers. But the poor majority are the ones who affected the most, and the poor majority are the ones who go to the public hospitals, which are poorly resourced. So already they have access to better conditions themselves, and I think that also contributes for them not to be as deliberate about some of these issues, because they're not directly affected by them. It's something that's affecting the majority. Then another issue to look at is what worsens the war issue is when the loans come in, and when the funding come in, it's the same political elite. Usually they use them to benefit themselves. There's corruption and many other factors. So already lack of transparency and poor governance contributes to everything. So the loans are coming in, so sometimes they're repaid post for what they were initially intended to, and it's not even clear how the loans are spent, like there's no accountability frameworks between the people and the government in place. So the poor governance and having the, and the whole paternalistic approach, because if it was, if there was transparency, and if there were accountability frameworks, I think that would have been, that would have helped as far as the one the public being involved, not only in decision making, but seeing how the funds are being used. And even recently they've been exposed, like they've been exposing some of the government officials who are being accused of being involved in corruption. So it's as many factors that are at play, because these, the political elite are benefiting from the system, from the system, and they're the ones on the negotiation tables. And they are the ones who, so they're the ones on the, they are the ones who are saving their main interest. And the poor people, the most affected people were supposed to, were expected to benefit at the end of the day. They excluded in the decision making. And it seems, I guess maybe that explains in some ways why there's a correlation between a lack of full political democracy and a lack of kind of economic democracy, as it were. And I've been reflecting even on the way that there's a whole new wave of voter suppression in the United States in the last 10, 20 years, at the same time as there's been increasing inequality. And, you know, I think you see the same thing in many other places, including Zimbabwe, it sounds like, I mean, if that was a lack of full democracy, either under kind of the colonial regime, obviously, or under Mugabe, and like those are also the times when inequality was increasing in the country. And you saw kind of a backwards movement on the robustness of the healthcare system as well. Well, something we like to ask all of our guests is a little bit more about your own story and trajectory. How did these issues start to become important for you? Or how did your education proceed? Were there certain patients who you saw or experiences that you've had in your life that started to connect these dots for you and started to increase your engagement with social medicine? So when I started medical school, one of the things we had community medicine, we had behavioral sciences and we have various attachments that brought us to the community. But a lot of emphasis was on the clinical aspect and on the physical. But so we didn't see much the relevance. Even when we started doing public health, most of would talk about the social determinants of health, would not talk about the structure, would really draw into the structural issues or have in-depth conversation. So there wasn't, as much as they tried, but it didn't, there wasn't, it didn't arouse as much interest during that time. And everything was just academic and focused. But it's like there was still the dominance of the biomedical model of study. Then I did the social medicine course in Uganda. So this was quite an interesting course for me because during that time now, we had to move away from the, from the biomedical lens and continue asking a series of questions like why, why, why and to try to get to the root cause of a lot of the problems. So the thing is, start exposing some of the structural, the structural determinants of health. And so my perspective to things became less about, about blaming the patient that you are seeing for, for poor heart-taking behavior, but trying to understand the circumstances around the surrounding the patient. And even going on to practice when practicing and as a medical doctor as an intern, if when, when patients would come along, you, you actually see the trends in the, in the health outcomes from central hospitals, you would see the trend between the rich and the poor. You would even see the people that would be coming to your hospitals and public health hospitals. It's mostly the poor cause the rich would be going to private hospitals. So you see, even, so you start sitting this trend and even, even when I went to a rural, at a rural hospital, you start looking at the distances that the people had to walk and when you, when you get time to sit with the patients and start appreciating the complexities of where they are coming from and listening to their stories and I think stories, patient stories are one of the most powerful tools that because they, when you start, they allow you to view things from the patient's lens to some extent, because the, the patient is telling you their perspective, sometimes which legs, and I know in the clinic or sitting with men, we might, we might not have 10, like a whole hour to listen to a single patient, but the few moments that I had, that I had to listen to what patients were saying were quite they really made me question a lot of things and they made me, they made me think about question the various systems and they, they made me see how a lot of things are not, are not isolated but they're interlinked and how we can't ignore, we can't ignore politics, we can't ignore the economy because usually when you start talking about such issues of structural adjustments with my colleagues, some of them, they look at you and say, this is politics and this is not something that's relevant to us, because it's far-fetched. Why do you waste time discussing these things? Do they solve anything? And what I always tell people is, you know, we can't, we can't talk about inclusive development, we can't talk about inclusive programs, we can't talk about inclusive health systems if we ignore what was happening in the past, if we ignore where we're coming from. So the mistakes that, so the mistakes, so learning about the impact of structural adjustments gives us, so that means if you're a leader, for example, who is aware of this, you will be able to make an informed decision knowing the impact of what you're signing on to affect the, the people that you're serving. So these are some of those things that, so being in those, having those conversations and being in a, in a, in a moment of reflection and also interacting with like-minded people and hearing perspectives from, from different countries and, and different contexts and seeing the similarities across like when, when Jonas was talking about Haiti, like some of the similarities between the two countries, even though they are miles away and then they, as much as some of the historical aspects are similar, they still had different trajectory that they, that they went through. So having all these conversations again made me, made me realize that there is more to the, to, to it than the, than the clinical medicine that, that they're doing. So you have to get a more broader understanding of, of where your patients are coming from, on what influences, what makes them vulnerable to that. Yes, you're, you're treating the bacteria or the virus, so they immediately, because, but you have to understand what makes this particular patient vulnerable to this bacteria, but there are the particular patient who stays in a, in a different worthier neighborhood is not at risk of that. So those conversations now, when you, when you, when you start exploring and doing root cause analysis, beyond that, help me a lot and they, they tip in my interest in, in, in this, and the most important thing, it puts the patient at the core, like the patient becomes the center of it. And I think that's one of the most important things for me that helped me, again, in realizing the point is like when I put the patient at the center and say, okay, we are, this is the most important person I'm serving. I need to understand from their perspective what they're going through. I need to hear their concerns or need to hear what matters to them the most. That already, I need to learn from them. That already brings a different dynamic or even the, it also does away with the, with the patriarchal, what paternalistic, sorry, or the power dynamics existing in between. And it, it shows you how oppression works because you're taking it from, from the count. I can go on and on. But sort of, yeah, that's, that's been one of the, one of the, one of the, one of the key factors and also having mentors in other professionals who've been in public health for, for longer than me hearing their stories, hearing their experiences because this is not something new. And there are some people who've been in, who've been doing a lot of work. And I've, like I, there's a, one of my professors in community medicine when I, whenever I sit with her and she's talking about it. Sorry. So sometimes as a young, excited professional, you are, you are saying, oh, this is something new that you're just there. She says, well, I said, no, actually some of these things we've been having these conversations for, for quite a long. So also those intergenerational conversations have been helping in, in putting things to perspective, I think. I'm Kyo Yustinashi. What keep you going? What, what's your motive? What's, what's encouraging you to keep pushing forward, no matter what? So I think what keeps me going is, I think when you are really exposed to how systems of operations operate, um, be it on a personal level, and when you hear stories about how systems of operations from affect your, your loved ones affect other people around you. It's one of the things that, that push you and that drives you to continue wanting to make a difference. And I think when you're a medical doctor or a health professional for that matter, you are interacting with people at the lowest moments and it's there when they, the greatest need and they are vulnerable to you. And when they open up to you when you hear that sometimes that feeling of hopelessness that you have, um, drives you to want to be, to do more if I'm, if I'm to say, and you start realizing some other things like what, um, like certain privileges that you may have as a health professional that can help, as a health professional that can help you to be part of the change or the solution to, to other people, to, to the circumstances that you are, that you're, that you're faced with. So I think what keeps me going is continuously realizing or seeing the different form systems of operation manifest and realizing the need that we can't really talk about equity or when these systems continue persisting and we may treat a person, we may treat an individual, we may treat the disease, but if we do not address the structural issues or continue, they'll continue coming back. And I have to say it's not an easy process because sometimes it's draining because you're finding, you find in a situation where you don't have a direct solution to something and you find in yourself in situations where you feel powerless. So I guess another thing that keeps me going is the network, the networks that I have continued having over time, like the relationships in the networks that I have built of like-minded people. So that means you have, you get inspiration from the work that they are doing in their different contexts where they are working. You get people who listen to you or you, to exchange when you're encountered with the problems and they give you a different perspective or sometimes they just listen to you and you also learn from the various tools that, that, that they have. So that has been, and I think that has been very important, particularly for my mental well-being as an individual because that's, I think that's one of the key things that, that is very important, particularly in the, in, in, in this work, the self-care aspect. Having people that you can turn to, having people that remind you to deliberate about your, your self-care has also been something that's, that's keeping me, that's keeping me going. I love what you were saying about the vulnerability of the patient and recognizing that and being able to sit with them and, and using that as kind of the locus by which we look at all these other systems and, and seeing the many forces biological or social or structural that, that will be influencing their life and their health and disease. And, you know, I find that helpful too because that, that's always like a lens that we can look through as we analyze other, other problems in society. And also it helps us, I think, to not allow medicine to become like a way of pursuing our own personal political projects or something, but really keeping it located in like what is best for the patient. And I think if we, if we keep it there, keep our focus there, then that allows us to engage with, like you're saying, other disciplines or other ways of analysis, even our armchair economics today. But I think those are, are profoundly important influences on the lives of our patients. And, and I also loved what you were saying about the networks of like-minded people who helped to support us in, in this journey and in this, this kind of task, which is professional and vocational, of course, but also very distinctly personal. One of my professors is named Stanley Howarwas. And he had a wonderful article in which he discussed the role of medicine as a practice by which some folks are, are set aside in order to sit with the most vulnerable at the worst times in their lives. And kind of this idea like being in solidarity and being present with those who are vulnerable. And that what is required for that is not only the initial movement towards the vulnerable, as it were, but also the community of people who's, who support those who sit with the vulnerable and who like make that possible. And I just learning from you, I reflect on the very large importance of that in our own professional growth and our growth as individuals and humans as well. And it's, it's a communal task and it's not something that can be done just as an individual. And actually maybe that's, as I think about it too, that kind of connects with even some things about neoliberalism and structural adjustment because Margaret Thatcher famously said there's no such thing as society. There's just individuals, right? And so this conversation has even been a way for me to think about the ways that, in which that is not true. But thank you so much for your time today. Jonas, if you, do you have any other questions? No, not at all. I think I'm so grateful, you know, Tarnashi for me, it's like, it's like a mentor, it's like a good friend. And I've learned a lot from him since the first time I met him and in New Mexico, actually, and visiting the Navajo Nation. And he has a lot of knowledge and also I think the most thing that I appreciate about him is our humility. It's like he's never trying to show you he knows, he's trying to show you, you know, what you already know. So I like that about him. And, you know, it's someone that I would, I would always encourage people to reach out to him to talk with him because he has that sense of mentorship, what he would stung in him. And I feel grateful and privileged for him to come to our podcast and talk to our listeners today. Well, thank you so much for your time. Thank you. Thank you for the conversation. I also learned a lot and it was, it was amazing hearing your experiences again and the similarities that were coming in. And I'm grateful for this opportunity to learn from each other. This is Social Medicine On Air, co-hosted by Brandon Johnson and Jonas Adles, produced by Brandon Johnson and myself, Raghav Goyal, intro music credits to Savage on YouTube and outro and incidental music to Smith the Mister. And a huge thanks to Clara Brand for our logo and visual work. You can find her on Instagram @_off_brand_. If you would like to share your story on the podcast or have any questions at all, please reach out to us at [email protected] or at Twitter @SochmedOnAir. And if you haven't already, please do subscribe, join our social media and leave us a review wherever you get your podcasts. It would mean so much to us. Thank you so much for listening. [Music]