IamA MD/MBA from the University of Chicago, building a floating hospital on the longest lake in the world, expert in the East/Central African oil boom, and former dominatrix. AMA!

What marketing classes did you take as an MBA? It seems they worked very well. Mention being a dominatrix, but refuse to answer people's questions about that part of your life until they donate money. University of Chicago taught you well.

Ah yes, Booth - the spiritual home of the free market! I had a fantastic marketing teacher while a student called Ann McGill. Better even than mentioning my former job, you should see the entire map of Lake Tanganyika tattooed on my back. Now that's marketing.

Hi there! First off, I'd like to commend your work on this project thus far. As someone who has lived in East Africa, I fully understand the importance of this for many people.

My question is: what makes your project one with longevity? One that isn't an act by a "white saviour"? Do you intend to educate doctors and engineers in Kenya? Rather than have a bunch of foreign doctors, will this be an opportunity for Kenyan/East African doctors to be employed and practicing?

This is a very loaded question, so please feel free to answer as briefly or detailed as you wish! :)

Hi thanks for your question. We work very closely with the Ministries of Health in the 4 countries around Lake Tanganyika (which are DRC, Tanzania, Burundi, and Zambia). We are actively working to build local health systems, not create parallel ones. We educate local health care workers and respond to the needs that HCWs express. We invest in local infrastructure and have excellent relationships with local communities viz. maintenance and joint expectations. We are actively NOT creating a "white savior" situation - we don't want that either.

I'm glad you answered it. There are too many westerners--often young and essentially unskilled--who only have a dream to save Africans and so they come here (I'm in Africa) to set up some useless NGO. And some of them end up making a western salary while paying the locals almost nothing. However, health care and access to clean water are things I can support, and I think very few people, even those who don't like NGOs, would object to what you're doing. Sounds like an interesting concept. But if I hear about one more 'capacity building exercise' or 'development conference' I think I'll stab my eyes out.

yep, I hear you!

Wait, so you really were paying your way through Medical School?

I have to rethink a lot of conversations now.

I was a Dominatrix in College to earn extra money, actually. I went to Medical and Business school simultaneously, and was also a single mom later. No time for dominating!

OP you do realize that by saying you were a former dominatrix you have opened up Pandora's box in reddit right?

In the immortal words of James Brown, you "got to use what ya got to get what ya want" -- human nature is what it is. If people's curiosity is peaked by BDSM, then why not mention it? Maybe they'll also be interested in my work serving some of the poorest people on the planet who are suffering?

*piqued

yes - thanks for the correction

So how did an overachiever like you become a dominatrix, and how did that work out?

Being a dominatrix was perhaps part of my overachievement? It was while I was in college and it was a very interesting (and short-lived) experience, which also happened to provide some extra income to me. It has only helped, not hindered, in terms of life experiences, so in sum - it worked out well.

Could you post a picture of the former dominatrix?

I was trying to find the commonalities of a Medical Doctor working for the betterment of humanity and a dominatrix. I guess both help people. I really mean that. What do you think?

Are there any reports of Ebola in the countries that border your lake?

Well, let me say being a dominatrix gives you great insight into the human personality. That is extremely important when one takes care of patients as well. Body language, understanding people's comfort zones, etc. This is part of effective human interaction and empathy. So I will say that doing that job has helped me in a number of interesting and surprising ways. No Ebola around Lake T, and we're hoping to keep it that way. DRC is actually very well equipped to handle Ebola outbreaks since they've been doing it since the 70's.

How valuable is having an MD/MBA and what other opportunities does it open up to you?

I think this can be an incredibly powerful combination in a variety of ways - even to practice medicine in the US whose system is dominated by issues of financing and administration. For my work, it's been very valuable and I really liked getting the degrees simultaneously.

Is there a specific need for a floating hospital, i.e resources, location, etc. or is this happening just because it is possible?

Yes, there is a specific need. I just answered another question which provides some detail on this.

Have you all reached out to the US Navy to see if they would donate decommissioned hospital ships?

A decommissioned ship won't work - Lake T is land-locked, so a ship would have to be cut up into pieces. At that point it is no longer useful or cost effective. You can meet some members of our ship building team here: http://floatingclinic.org/about/team/ship-building-team/

Interesting. Well best of luck!

thanks!

Thanks!

Thank you so much for doing this AMA! Before seeing this post I never would have imagined such a thing as a floating hospital, and was not at all aware of the implications this would have. I think your organization is doing doing wonderful work and I anticipate reading more about it!

I have two questions I would love to ask: 1) Do your colleagues know about your past as a dominatrix, and if so does it affect your working relationships at all? I currently teach pole dancing at a local studio and have been working as a carpenter for the last two years, but am curious as to how my moonlighting gig may affect my career should I seek a white collar job.

2) Can you suggest some resources where I can find out more about the East African oil boom, or if you have time to give a general explanation of it?

Thank you again for your time!

And thank you for your interest! 1.) Everyone knows about my past - i.e. I've talked about it in the press. I don't think it has harmed me in any material way. Of course people are judgmental, and I am sure there are people out there who think bad things about me. So maybe some people don't want to support what I do. But I am also sure there are others who think: this is a person who has lived in the real world, which may garner a different kind of respect. I feel the record speaks for itself. You shouldn't feel ashamed of doing something perfectly legal (and that people are interested in, btw!) to make ends meet. 2.) So glad you asked about this. We wrote a comprehensive white paper about oil and gas in the African Great Lakes. You can download it here: http://floatingclinic.org/download/

Why is building a ship more efficient than building a single large clinic central to the largest population and using additional money to create efficient patient transportation routes over the lake? From the schematic on the video, the ship doesn't have much actual clinic or lab space.

Healthcare systems in sub-Saharan Africa typically operate as a tiered system: health centers (often made of mud and thatch) serve ultra-rural populations, referring more serious cases to Regional hospitals. In the basin, this system completely breaks down. Difficult terrain and an absence of reliable roads and cellular signal prevent the majority of the basin’s 12+ million inhabitants from receiving care -- not even the basic skills of healthcare workers at local dispensaries due to lack of a supply chain. What is needed is the basin is a coordinating regional hospital. The ship will have operating rooms, intensive care, a lab, eye and dental care, etc., as well as a small inpatient ward.

Our vessel will serve that role described above and help to create a functional healthcare system where there previously was none. The ship will empower local health centers providing primary care while providing access to specialty care and healthcare worker training and oversight. With 12+ million people living in the basin being treated for preventable diseases, as well as the direct impacts of improved maternal health, the construction of the hospital ship translates to saving hundreds of thousands of lives over the next 10 years. Through investments in healthcare worker training and community education in nutrition, public health, and specialty services, the ship will be a tool for long-term wellbeing for communities in the basin.

The ship’s communications capacity will allow for effective networking, data gathering and logistics in the basin. Coupled with the LTFHC’s advocacy, these capabilities will transform the ship into a regional economic anchor; boosting local commercial dynamism while simultaneously preventing reckless exploitation and protecting Lake Tanganyika as a biological resource.

This is a model for environmentally and culturally relevant healthcare delivery in transboundary areas. We are currently writing a new white paper on water-based healthcare, redefining what healthcare capacity means, and we are eager to see this model replicated.

Thanks for doing what you are doing!

How do you provide food to staff and patients within your program? Does your program integrate with local farmers?

BTW I'm a UofC grad (BA '96) who has worked with a team in Kenya/Uganda setting up permaculture food forests at primary schools in the region. (Seven-Ravens.com/consulting/Kenya)

So glad you mentioned this! Food insecurity and malnutrition are main drivers of morbidity and mortality in the basin. As a result we spend a lot of time thinking about agriculture and aquaculture. We take a very cross-sectoral approach in our work, so are always reaching out to find partners who can bring expertise in a variety of areas. Ag is one of those areas, so send us an email! In the mean time, we are talking about some aquaculture partnerships as well. As far as our own team goes and patients, we source local food as much as possible.

Thanks for doing the AMA, Dr. Lehman.

I have a few questions for you:

1. How would you address sanitation, sewage, and sustainable practices in a project of this magnitude on a large body of water?

2. How did you find time to found and develop this organization?

Thanks :)

We are going to be engaging in some WASH programming this upcoming year, both collecting data and deploying a bridge strategy for access to clean water. As I mentioned, we love to partner with other organizations that have expertise in a variety of areas, so we are working with P & G and others. Access to sanitation services is really crucial in this area.

This organization is my full time occupation.

How did you end up founding LTFHC in the first place? What were you working on initially that led you to come up with the idea?

I had been interested in the African Great Lakes since I was a teenager, and interested in health systems. I visited Lake Tanganyika while I was a resident in general surgery, and at that time was in a typhoon and got stranded (airstrip washed away). That got me thinking about the millions living in the region and all the supply chain, logistics, and access issues.

How did you become and what makes you an East-African Oil Expert? Do you foresee swift taxation changes? Did you attend the EAOG Summit and if so what were the more important topics discussed? How is the job market for westerners that work in the field?

I have been watching the petroleum situation in Lake Tanganyika and the Great Lakes since 2010. We just released a white paper about these issues in the fall, which can be downloaded here: http://floatingclinic.org/download/ Taxation is a tiny piece of this complex puzzle. Many of the new petroleum producers in East and Central Africa do not have progressive petroleum laws, which affects the types of development partners they are able to attract as well as how they are able to harness extractive wealth for the benefit of their citizens. Given the Brent crude price is now around $60, there are going to be some shocks and reshuffles. The job market had been strong - we now have to see what happens over the next months.

Thank you for your contributions to global healthcare - it's not the easiest issue to tackle. How did you come to the decision to focus on this region (rather than regions of India, Asia, South America, where healthcare and economies are in similar shape)?

I have always been interested in the African Great Lakes, and Lake Tanganyika is a particularly compelling place to me as there is an overlap of so many issues: biodiversity, complex geopolitics, some of the lowest human development indices, 17% of the world's available fresh water, and oil and gas underneath it, to name some. It's at the nexus of a number of issues that are globally important.

Sorry, random Archer quote: we will never recognize an independent Tanganyika!

Now then...

Is the purpose of the boat to give it a central location for people to come to, or will it make the rounds so to speak, doing a circuit around the lake to service people? Will there be some kind of dedicated ferry docks to transport people and will you accept random drop-ins if they arrive on a raft?

I answered a question similar to yours a bit earlier, so copied the reply below. Additionally, the boat will travel at scheduled intervals moving between the districts/health zones. There will be water ambulances to transport patients. Patients will need to access the ship via their health centers.

Healthcare systems in sub-Saharan Africa typically operate as a tiered system: health centers (often made of mud and thatch) serve ultra-rural populations, referring more serious cases to Regional hospitals. In the basin, this system completely breaks down. Difficult terrain and an absence of reliable roads and cellular signal prevent the majority of the basin’s 12+ million inhabitants from receiving care -- not even the basic skills of healthcare workers at local dispensaries due to lack of a supply chain. What is needed is the basin is a coordinating regional hospital. The ship will have operating rooms, intensive care, a lab, eye and dental care, etc., as well as a small inpatient ward. Our vessel will serve that role described above and help to create a functional healthcare system where there previously was none. The ship will empower local health centers providing primary care while providing access to specialty care and healthcare worker training and oversight. With 12+ million people living in the basin being treated for preventable diseases, as well as the direct impacts of improved maternal health, the construction of the hospital ship translates to saving hundreds of thousands of lives over the next 10 years. Through investments in healthcare worker training and community education in nutrition, public health, and specialty services, the ship will be a tool for long-term wellbeing for communities in the basin. The ship’s communications capacity will allow for effective networking, data gathering and logistics in the basin. Coupled with the LTFHC’s advocacy, these capabilities will transform the ship into a regional economic anchor; boosting local commercial dynamism while simultaneously preventing reckless exploitation and protecting Lake Tanganyika as a biological resource. This is a model for environmentally and culturally relevant healthcare delivery in transboundary areas. We are currently writing a new white paper on water-based healthcare, redefining what healthcare capacity means, and we are eager to see this model replicated.

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I whip, I do not get whipped.