WHONET: Groundbreaking and Free – Dr. John Stelling – United Planet Radio Ep. 8

Instructor of Medicine at Harvard Medical School – Dr. John Stelling

Dr. Stelling, who spent time volunteering with the Peace Corps in Mali, spoke with us about the groundbreaking technology that looks to gather data in hopes of combatting large scale epidemics. His software is free and is designed to be implemented in hospitals across the globe. In addition to the software, which is used by the World Health Organization, Dr. Stelling is an Instructor of Medicine at Harvard Medical School. He is an extremely well traveled individual and is diligent in his yearning for a broader understanding of the world.

Listen to our entire conversation below:

Full Transcript:

Charlie: Welcome back to United Planet Radio. I’m your host Charlie Leaner. For those who don’t
know this is a show designed to promote education sustainability and cultural understanding
through conversation. Today, we have Dr. John Stelling who is currently an instructor of medicine at
Harvard Medical School. He holds a bachelor’s in biology from John Hopkins University. He also
holds an advanced degree from Johns Hopkins School of Hygiene and Public Health and he received
a doctorate from Harvard’s Medical School. He is also working as the co-director at the WHO Worth
Health Organization Collaborating Center for surveillance and antimicrobial resistance. Welcome,
Dr. Stelling.

John: Thank you, very happy to be here.

Charlie: So, I had bunch of questions for you, but I noticed that you brought a book — two books
actually — The Story of Doctor Dolittle. Why did you bring that with you on today?

John: Well, in chatting with my friend Dave, he said that you’d like to know a bit about where I came
from and my background and how I sort of ended up where I am today, overlooking the beautiful
Boston Harbor. As I was thinking about this, part of this goes way back to elementary and it is for
many people and I just loved the Doctor Dolittle series in terms of — it just opened my eyes to the
world and cultures and travel and languages so it just raised a fascination. Along those times, my
great-aunt Mildred also started giving us annual subscriptions to the National Geographic
magazines. So we go through the pictures and the stories about all these worlds that were so far
and so unusual, just something I had no familiarity with. So to speak, I had this growing interest in
trying to understand the world out there — a very appropriate subject for United Planet. I do have
this one thing here that for me it has always just stayed with me. This is from the book The Voyages
of Doctor Dolittle and this is about his time he was in Spain and the next chapter, he goes to a bull
fight, saves the bull, his adventures continue from there. But this is one sections that had always
stayed with me: “Well, we finally agreed and as a good friend; and as our good friend had no spare
bedrooms, the three of us, the Doctor, Bumpo, and I, slept on the beds set out for sale on the
pavement before the shop. The night was so hot we needed no coverings. It was great fun to fall
asleep out of doors like this, watching the people walking to and fro and the gay life of the streets. It
seemed to me that Spanish people never went to bed at all. Late as it was, all the little restaurants
and cafes around us were wide open, with customers drinking coffee and chatting merrily at the
small tables outside. The sound of a guitar strumming softly is the distance mingled with the clatter
of chinaware and the babble of voices. Somehow it made me think of my mother and father far
away in Puddleby, with their regular habits, the evening practise on the flute and the rest — doing
the same thing every day. I felt sort of sorry for them in a way because they missed the fun of this
traveling life, where we were doing something new all the time — even sleeping differently. But I
suppose if they had been invited to go to bed and on a pavement in front of a shop they wouldn’t
have cared for the idea at all. It is funny how some people are.” So it just occurred to me there are
different kinds of people and for me, what was exciting and different and really drawing me in one
direction to explore the world. For other people, it might not be as fun or exciting as I think that it is.
So that always just stayed with me in terms of one of my passions.

Charlie: Now were you always kind of geared towards working for the WHO or did that come as you
went through schooling or just when it clicked that you were like “okay this — the World Health
Organization — that’s what I want to do. This is my path.”

John: From high school, I did have this interest in health and in the world, and in my high school
yearbook, I was the valedictorian and so they did have a little interview there and it did say in the
high school yearbook that my plan was to go into the Peace Corps, become a doctor so a lot of that
was actually in my thinking from early on. Then I went to college, and I went to this one biology
building where we had our lectures frequently. Every time I came out of the biology class, I saw the
poster on the wall with the number 1800-424- 8580. The number just got seared in. That’s the
Peace Corps number. So I knew I had sort of this international interest, but at that time I was not
sure whether it was a short-term interest, a long-term interest, personal interest, a professional
interest exactly. I wanted to explore the world to some degree, but I was not yet sure at that time
how this might relate to a possible professional career so I went to the Peace Corps. My plan was to
go to medical school, but it was uncertain. I just knew that I didn’t want to go to medical school yet,
and so I did the Peace Corps. Went to Mali, West Africa for two years, taught high school
mathematics, at school I spoke French, outside of school I spoke Bambara. If you saw the movie
Roots, some of the languages are a similar language, also the movie Amistad, there are similarities in
the language of those West African dialects. Lot of elements to the Peace Corps, but one of the
things that helped to set me up is this. This is the career that I wanted, something in international
health, something overseas, something exploring the cultures. So what else about Mali — I found
living in this environment, you learn more about yourself than anything else.

Charlie: And have you been out of the country before the Peace Corps or was this the first time?

John: I went to — I vaguely remember this — I think the 1969 World Expo in Quebec. The only thing
I remember are the stuffed animals that we got at World’s fair, and I think in college I made an over
the border trip to Mexico. So this was the first real meaningful trip off the North American continent
so yes, it was my first significant international experience.

Charlie: And what would you take away most from your trip?

John: The time in Mali?

Charlie: Yep.

John: Part of it is what I learned about the world, part of it is what I learned about myself. About the
world, people are different, but people are also the same and it’s important to recognize those.
Differences in parties, differences in values, practices, traditions, but similarities in a desire for a
better life for yourself, a better life for your family, for your children, you only desire to do good, to
enjoy community, to enjoy friends. There are differences, there’s one leading book in Senegal — the
literature is L’Aventure ambiguë, the Ambiguous Adventure, particularly for a number of Senegalese
intellectuals being caught in between words. The author goes to France, doesn’t quite fit in there.
Goes back to his own village, doesn’t quite fit in there. One of the traditions that he has trouble with
is the ability to take control over your life. I want this for my future, I want to advance versus in a
traditional village often a lack of control and satisfaction with what you have, trying to be grateful
for what you have. So these are some of the differences, but some of the similarities are friendships,
family, fun, safety, health, security. Regarding myself, I was — growing up — always a fairly social
person, friendly to a lot of groups, but in Mali, I realized that sometimes you need your own private
time.

Charlie: Yep. Oh totally.

John: There is this expression there “There is always more happening at the toubab’s house” the
toubab is a term for “generic foreigner” and I said, “Sometimes I just need my private time to read

my books,” sit there and sometimes the Malians would come up and they’d say, “John are you sad?
Why are you not out with us with the tea and playing checkers and chatting?” Professionally, I said
that this is sort of the environment that I would like to be working in which set me up for the next
step which was moving on to life after the Peace Corps. I had two choices. The one that I took was I
went back to — what I found is I could not, practically speaking, pre-internet, apply to medical
school from the edge of the Sahara desert.

Charlie: Probably branch off.

John: Interviews, resumes, transcripts so I needed something to do for a year. So I went back to
Johns Hopkins and I got a master’s degree in public health in the International Health Group,
studying biostatistics and epidemiology. The other option which would have been a very different
life is I had the chance to go on a USAID project to spend a year on a riverboat in the Gambia River
doing assessments of flora and fauna because they were thinking about building hydroelectric dams,
they wanted to do an environmental impact study. I was very excited about that possibility. I
decided not to because a year later I would’ve been back in the same situation, applying to medical
school, needing something to do for a year, but it could have been a very different future for me so I
ended doing a public health degree.

Charlie: Oh great and obviously that turned out pretty remarkably because you developed a
software. Can you describe that software? What the technology is? And how do you pronounce it –
— WHONET — by any chance?

John: Yes, WHONET.

Charlie: Yeah, let’s talk about WHONET for a little bit.

John: So my Master in Public Health was in Baltimore so this was before the software. I studied
statistics, epidemiology. I’d always loved math for fun, for puzzles. I had a wonderful teacher in high
school, Mr. Breeze, who just made math odd and for me exciting. We learned that if you have seven
dwarves, you can make thirty-five different three dwarf potato-peeling committees. So this whole
idea about fun with numbers I loved, and in Mali I taught and we taught the French curriculum so I
learned a lot of new things there, but I didn’t see it really as a professional career. When I studied
my public health degree, I studied probability statistics epidemiology and then I realized about the
power of numbers, not just for fun — at least for me — but how numbers can be used a lot in a very
practical way for understanding the world, the research, quantifying things, what are risk factors,
what was the impact of this intervention. You know some interventions are so obvious you don’t
need the numbers. These people live, these people die. You don’t really need a statistician to tell
you that this is a good thing to do, but in today’s modern complex society, it’s often not so obvious
so this is where the numbers really come into play to say, “Yes, given these considerations and these
risk factors and these adjustments. This with a good numerical understanding this is clearly the
better approach, the better solution.” So I studied that for the one year. This whole idea about the
quantifying uncertainty like, “Are you certain?” “No, I am not certain, but I am certain that with 95%
confidence that the statement I just made is true under certain assumptions that might not hold but
something which points to a useful future.” Then I came to Boston and then I went to medical
school, I needed something to do to pay for medical school and then I applied for a job that I got as a
statistician in the department of anaesthesia. Did that for a year and a half and then I moved over to
microbiology and I’ve been with this project ever since. I only in my life took one computer class.
This was a studied basic for one year in 1980.

Charlie: Computer science coding? Is that what you’re talking about?

John: I was a high school student. I studied basic for one year pre-DOS and pre-windows obviously,
pre-hard drives. At least I had the advantage over my older brother who didn’t even have a monitor.
You typed everything onto paper, it gets sent off to Brookhaven National Lab, you wait for your
results, and what we do in 1976 is we played computer games. We played Star trek, I Smell a
Rumpus. At least I had a monitor to work with. We had one cassette for the software, one cassette
for the basic so you know it was a different time. I never imagined I’d end up in computers. The
public health degree gave me an appreciation of numbers and database management. I worked for
anaesthesia. He hired me as a statistician, but I ended up programming. Like other people in my
situation who were not trained as programmers, I have been trained in basic so I said, “Yeah, she did
basic. She had a similar background,” so I said, “I can do this.” Did that for a while and then moved
to microbiology because my passion, my interest was international. I started with Dr. Thomas
O’Brien. People listening to this probably will not know Dr. O’Brien from his own wonderful work in
antimicrobial resistance over many years, more people would be familiar with the work of his son.
Well, he has six children. One of them is Conan O’Brien so one of his sons is well-known in the field
of late night entertainment. So he hired me to work in epidemiology, data management, the
WHONET software did not yet have a name, but he had been working since the 1960s on database
management. He has some of the very first, earliest publications of health applications of
databases. We collaborated with — there are military computers here in the city, naval computers,
graphics, so he was really a pioneer in health database management. He shepherd it from
mainframes to personal computers, we have now brought it to DOS to Windows to internet web-
based now moving to cloud applications. So I started doing it just to pay for medical school. Initially,
he didn’t have the funds so I worked for two months for food. I taught Margaret, the secretary,
programming and she fed me for two months and then they got money and they brought me on.
My plan was to stay with Dr. O’Brien until I graduate in 1991. I loved the work so I said, “Let me see
if I can do this for one more year.” I could not find a reasonable one-year funding opportunity.
Somebody recommended me in the student office. “Why don’t you try this new two-year fellowship
called the Echoing Green Fellowship?” And I said, “Two years? Oh, that seems like a long time,” I
was thinking one more year with this project not two years, well that was nearly thirty years ago. So
that’s how I got started, he hired me as an epidemiologist, but he really needed a programmer. That
time, we worked with around 10 countries so I rewrote the software to make it more generic,
configurable, user-friendly, and customizable so we went from use of the software in 10 countries to
30 countries to 60 countries. The software, we estimate, is now used in about 120 countries.
Directly or indirectly, we support probably about 4,000 laboratories around the world mostly
hospital labs, also public health, food and veterinary laboratories, reference laboratories, research
laboratories. Software is available in 24 languages so we really try to go out of our way to meet the
local, national, regional, and global needs for data management to support containment efforts for
antimicrobial resistance.

Charlie: Wow. That’s amazing. Now that first conversation we have with Dr. O’Brien, was the
software already developed or were you there from ground zero to its current stage?

John: Ground zero was approximately 1964. I existed at that time. I knew exactly what I was doing
that day. I think I was pooping, sleeping, and crying. Lots of people wonder “Where were you when
John F. Kennedy died, what were you doing?” I knew exactly what I was doing. I was pooping and
sleeping and crying and just been born a few months prior. Some of the leaders in our field of
antimicrobial resistance Kirby, and Bauer, and Sherris. He trained under them in 1962 and he
started using their method for standardized susceptibility testing in 1964 and then when he saw
that, when he saw the accumulation of patient reports about bacteria, he said, “Well, yes. This
information is very valuable for patient care. That’s why we do it.” But the information is also

valuable for understanding emerging microbial threats. Emerging threats in your own community, in
your country, around the world and he said, “Well, there must be something here about databases
and computers.” I enjoy very much the movie Desk Set with Spencer Tracy and Katherine Hepburn
with EMERAC and it’s all about the idea about how computers can transform the ability to manage
data. So he had this publication, I think the first was around 1969 on this subject about computer
databases from managing infectious disease data so now let’s go back to the very beginning;
mainframes, 4 train cars, optical skin sheets. Early 90s, he had a series of programmers. Early 90s,
leach out, transformed it at least to the PC world, personal computers, brand new at the time. I
inherited the project from these previous programmers in 1989 so no, I was not there from ground
zero. I inherited it and the people who had done wonderful work for our own hospital and for a
number of projects and collaborators around the world, but we always had to adapt and customize
the software. One of the first things I did is I made a global data structure, universal data structure a
configuration ability so we can focus on the software development and let people run with it in
terms of what they did with it. So I would train one person in each of several countries and then
they would take that and fly with it and use it within their country. Argentina now it’s about 90 labs
in the country in the national network. China I believe is over a thousand. So there’s a European
regional project called EARS-Net with 30 countries. 20 of those 30 countries use the WHONET
software for national data management. There’s also actually an American network. Our next
regional meeting will be at the end of November, at the end of this month, and most of those
countries also use WHONET for national data management. At the beginning of this project — early
1990s — we collected the data ourselves in Boston, but it was just overwhelming for our very small
group so we really become much more active in software tool development that other people can
use and strategic and technical guidance on how to setup these local and national and regional and
global surveillance collaborations.

Charlie: Wow. That’s amazing. What do you do to get countries on board? Do you ever find that
some countries or hospitals say, “No, we don’t need this?” If that does happen, what do you do to
change their mind and say, “Hey listen, and this is useful software.”

John: Sure. A number of strategies. Well, first of all, it’s a free software so the price is right. It’s not
much of a sell and there’s really no other question that people don’t want it, the question is do they
have the time, the interest, the ability to get things up and running? I find that in life you have three
groups of people or three groups, in my case, healthcare facilities, and hospitals. The one end of
hospitals will succeed and things will work wonderfully no matter what you do, and the other
extreme, the country or the facility will not work no matter what you do. But in the middle, you
have a very large group where they have the desire and they do need the ongoing hand-holding,
training, support, touching base to help them through their obstacles. In the 1990s, a lot of the
obstacles were very basic computer skills. I was giving a training course in Mongolia for a lot of
people who had never sat down at a computer. I was trying to teach them how to double click. You
would take it for granted you just said “double-click.”

Charlie: Yeah. Yeah, you’re starting it basic.

John: So they would do click… click… and I said, “Okay, please double-click a little bit faster.” So
they would do click, click and I said, “Okay, double-click again but try not to move the mouse
between the first and the second click.” So there’ve been many different kinds of administrative,
political, technical obstacles and a lot of it is just time. Until recently, antimicrobial resistance was
not identified as a public health major priority. This has always identified a party at the hospital level
for the facilities on patients, but it wasn’t until the late 90s and early 2000s that countries started to
become aware of the challenges of antimicrobial resistance, and then more recently, in the last ten

years, federal governments. Not only the ministries of health, but departments of finance,
economics. There a lot of food and trade issues you know, the Department of Agriculture. The
majority of antibiotics used in the world, and people are often surprised to hear this, do not go to
humans. In the United States, between 80 and 90% of antibiotics do not go to people. They go to
animals. For purposes of food production and part because the animals might be sick that’s called
therapeutic use, or prophylactically because they are at a high risk of becoming sick. But one of the
most common uses, the biggest use, is growth promotion. If you want to have a bigger animal, you
have few choices. One, give the animal more to eat? Nah, too expensive. Two, take better care of
the animal? No, too expensive. There is better hygiene and measures for raising the animals. Or,
let’s give the animal a little bit of antibiotics to make a bigger animal. So this is a very contentious
issue of use of antibiotics, its done for economic benefit in growth promotion, but with these
concerns about the impact on human medicine as well as of course also an animal medicine.

Charlie: Wow. And how do you keep the software free? What goes into the funding? How do you
do that?

John: We have a variety of grants. We’ve been lucky, but it’s always a challenge. The primary
sources of funding over these last several years have been the CDC, NIH, the US National Institute of
Health. We currently have projects with one of the state health departments so it’s a variety of
short-term and long-term projects. Antimicrobial resistance is now recognized not only by the WHO
as a public health threat, but also by the United Nations meaning that it’s not only a health issue, it’s
also an economic, patient safety, human welfare trade issue. So their first meeting on antimicrobial
resistance was a year ago with a general assembly in New York City so our hopes for sustainable
funding are I think better than in the past. When in the past, it was a sell to convince them we have
an important project and an important subject. That’s no longer a hard sell now we need to see how
to align ourselves with. The WHO has this new initiative called GLASS, the Global Antimicrobial
Resistance Surveillance System, and the idea there is they have a website for capturing national
statistics, but the idea is that many other countries will need WHONET to prepare the data for
submission to WHO. I mentioned earlier the European Initiative, the Latin-American Initiative,
GLASS is the first WHO-affiliated global initiative of this type. So between potential governmental,
non-governmental different funders, we hope to align ourselves with their funding priorities and
directions.

Charlie: Great, and what countries have found the most help from this software?

John: We do find the software’s underutilized. Many times people say, “John, I love WHONET. It’s
great. It saves me so much time and effort and work.” And I feel good and then I say, “Well, what
do you do with the data?” And they say, “Well, once a year, we prepare our annual statistics.” I say,
“Great. You could’ve done that with Excel.” So people are very grateful for the software, but what
we are really trying to promote is automated daily alerts. You have a potential outbreak, you have a
laboratory error, you have a patient who needs further investigation and maybe isolation so what
we’re really trying to do is push these projects for automated daily flagging and alerts of important
new threats when containment efforts are actually possible. It doesn’t help a year later to know
that you had an outbreak the previous year.

Charlie: Right, you want to know as its happening or before it happens.

John: Yes, so we have a number of new projects for automated daily alerts. One of these projects is
CDC funded called Cluster for 84 United States hospitals, for automatic daily outbreak detection of
healthcare or hospital associated outbreaks with response, investigation, molecular confirmation

where the isolates are available by whole genome sequencing. That’s one project. We have another
project with the Philippines, India, Columbia, and Nigeria to do the same kind of work. We have
another project with Argentina. So in each of the countries that I just mentioned, the goal of these
immediate projects that we do have is automated daily use and feedback and response.

Charlie: And is there a balance between too little data and too much data? Is there a fine line or are
you just like “Hey, let’s collect everything and see what we get”?

John: For some people, this would be a debatable point. From mine, no. Get all the data you can for
a few reasons. We work with two kinds of facilities around the world: facilities that already have a
computer and facilities that do not. For facilities that already have a computer system, it’s just much
easier to download everything than to download a subset of everything. By downloading
everything, there are always target highlighted party pathogens. The problem is if you focus only on
the priority pathogens, you’ll know about issues happening in those priority pathogens that you
might miss important changes and trends and other pathogens that are below the radar. There are
certain key organisms. MRSA — I won’t describe the acronyms, it’s not important for this group —
CRE, VRE , EspL, these are different kinds of party pathogens that people try to keep close
monitoring, but there are other pathogens that just nobody is paying attention to. For example, the
European project is looking at blood and cerebral spinal fluid pathogens from eight species. That’s
useful to get into the general idea overtime about the problems that are changing at the very high
level that in southern Europe resistance there tends more resistance and in northern Europe there
tends to be less resistance because of differences in antimicrobial use patterns and hygiene
measures in the hospital setting. So this kind of much targeted approach I think is the greatest value
for advocacy, education, awareness, and fundraising. Yes, resistance is a problem. It’s getting
worse. It’s different from country to country and it needs to be monitored, but in terms of
containment efforts, you need to know we have an outbreak in this community, in this pathogen
which might be a problem only here. It might be an outbreak of a susceptible strain, outbreaks of
resistance strains you’re weirder about, but at the same time if it’s an outbreak of a susceptible
strain you don’t want those either because they can also kill people. So in terms of feedback on
local, national wide variety of emerging issues, I would recommend capturing everything and that’s
what we try to do. So facilities that already have a computer system, just download everything, it’s
easier. On their other hand, for places that do not have a computer system, we’re in a different
scenario here that everything they do is based on paper meaning they don’t actually have long term
medical archives. I visit these laboratories and they show me their notebooks and so if they for
example — one facility I visited recently in the South pacific — they said yes. If the doctor wants to
know the result from their patient in this month, we will look at that patient for them, but if the
doctor wants to know any of the patient results for 3-4 months ago, they’ll point the doctor at this
huge stack of notebooks and they say, “Here you go. You’re on your own.” So they can’t even
retrieve the patient local medical records so this is a different need so they have the same needs in
terms of daily outbreak detection and alerts, but they also have a basic need for medical archives
and clinical reporting on printouts rather than on pieces of paper.

Charlie: Right and what are your plans for the future for WHONET?

John: So we have a new grant from NIH for big data management so part of this is involving — we
had three what are called NIH’s specific aims. One is modernizing and advancing the software and
database platform to be cloud-based, multi-level synchronized, automated data transfers. For
example, one could imagine in terms of patient confidentiality issues that maybe the hospital would
want a comprehensive copy of their data including patient names and all of those details. Maybe
there will be a national database hosted for example on a national server without the patient

names, but will all of the other details, and one could also imagine a cloud-based version with the
identified data that might be available to the world for public access. So this one is sort of
modernizing the automation and security features to take advantage of the new cloud-based and
other new technologies, that’s one area. Another aspect about the big data is about increasing the
sophistication of our algorithms that’s one objective of these cluster projects to find first time ever,
first time in the country, first time for your facility, first time in this patient niche population or
second time or maybe the facility next to you had it but you don’t so increasing the automation and
sophistication of the algorithms for finding new threats before they become a problem. The third
component of this grant is to link with whole genome sequencing these new technologies. I enjoy
very much the televises program CSI — sorry, it’s off the air — but somehow with CSI, somebody
gets murdered Saturday night and Monday morning the have the genome sequences for everybody.
We’re not quite there yet. Maybe in ten years the technologies are improving, it’s the technology,
the cost of the technology, the availability of the technology, as well as the ability to interpret it, the
bioinformatics. How do you interpret a genome sequence? If I just give you a long sequence of A’s,
T’s, C’s, and G’s, you don’t know what to do with that so there’s a laboratory aspect about getting
the genomes and there’s an analytic aspect about understanding them so the question here is they
can sequence technically everything, but the funds and resources and ability aren’t there. So in
some of these projects the main idea is to flag these isolates should be sequenced to help us to
understand their evolution, their spread. This one plastic example based on partial genome
sequencing because the technology was not fully — I take that back, no. This was done on the basis
of all genome sequencing. They had a bunch of isolates of MRSA from Denmark and one of the
isolates had the same whole genome sequence that was very typical in Thailand. That particular
person was actually a patient from Thailand so the specificity is really there to say from where did
this patient get it. The leaders in a lot of the whole genome sequencing are in food-borne disease. If
you have a hospital lab outbreak with five people, you kind of try to figure out the local connection.
But with food-borne disease, there are these examples of like alfalfa sprouts or strawberries that a
few people might get sick in Los Angeles, a few people in Boston, a few people in Finland, and with
some of these whole genome sequence studies, you are able to figure out which factory, which food
product. So the food-borne people are in the lead on bringing in whole genome sequencing into
daily practice, but, of course, it’s now moving into daily practice into hospitals and elsewhere
especially when you suspect a problem, but you only do the genome sequencing when you suspect a
problem. I think all of the WHONET software is to tell them, “You have a problem, please do a
molecular confirmation and please do an epidemiological investigation.”

Charlie: That’s unbelievable, and your personal plans for the future? Not necessarily personal but
your business or whatever? What are your plans for the future?

John: Well, for the professional plans, it basically to hopefully get long-term sustainable funding,
predictable funding, implement the changes that I’ve already described. This antimicrobial
resistance is not really taking off in terms of national priorities. In the last two years, I’ve actually
been to every country and territory in the Caribbean except for Cuba and Haiti that I’ll get to next
year. So countries that had never done anything before are now saying, “We need to get something
off the ground.” Africa is big priority for here. So professionally, it’s try to reach out to these places
that want to initiate activities and get them started. Personally, I can mention I met Dave Santulli,
founder of United Planet, because of our common issues in travel. He’s chapter leader of the
Traveller Centre Club and they’re about 225 countries or territories and one goal is to try visit all of
them. It may not be realistic to do all of them, but little by little. I have something else I’d like to
read briefly. This is a book called Fishing in the Sky by was a college friend of mine who was also in
the Peace Corps in Mali — Fishing in the Sky: The Education of Namory Keita. He went to the Peace

Corps. When he was about 64 years old, he died in Mali. He died about 20 years later so he made
his life there so I just want to read this about places to go.

Charlie: Yeah, absolutely. Go for it.

John: It’s also a wonderful book for people interested in what I had described so far. He was a
professor of English. He taught teachers in mail how to teach pedagogy, et cetera, but he was also a
poet. This is a section from his book: “I told the group that he was with I write poetry and was
planning a book in pros about my journey to Timbuktu” — which is in Mali. “One final evening under
the stars, they ask me to read to them one poem ‘The Wild Bird’ they liked especially and maybe
read it a second time.” So here’s the poem: “‘Woe to him who has found the wild bird and has no
searching more. Sorrow to her who has filled the inn as the child waits at the front door. Beware
the full cup for swear the final word. Keep ever in an empty room in the inn, find another wild bird.’
And then Hellen commented, ‘Maybe the idea of your book should be that Timbuktu is like the wild
bird, a place you never get to.’” So I incurred to that, there will be places that I won’t get to so it’s
sort of that mystery. There’s always somewhere else to go, there’s something more to learn. So this
was also one of the things that drive me. Sometimes I go to places for not the best reason. I go to
places sometimes because they’re on the list. That’s not the best reason. There are better reasons
for visiting these places, but some of these places I went to have been some of the most fascinating
and interesting because you learn the reason they are on the list has to do with their identity. They
are proud of being from this place that nobody has ever heard of. They’re different in some way. So
by going to a number of these places, it’s really been an eye opener and you appreciate that as
Americans are proud of being American, but as any other nationality, you are proud of where you
are, your traditions, your history, and you want to preserve that and you want other people to
appreciate that as well so that’s also one of the things driving me.

Charlie: Absolutely. Well, thank you so much, Dr. Stelling. Thanks for coming by and if you got
anything else to say, this is your time.

John: No, just thank you so much for this opportunity. I haven’t done something like this before so I
thank you for your time.

Charlie: Thank you so much.

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