Closing Gaps for Moms and Teens

What does it take to reach a pregnant mother in rural Kenya, and a teenager in America who's been told not to trust vaccines? In this second episode recorded at the Clinton Global Initiative, two innovators share how they are working to close two very different but equally urgent gaps in children's health.

Dr. Lorraine Muluka, obstetrician and founder of Malaika, describes how her maternal health platform is bringing comprehensive, end-to-end pregnancy care to women in Kenya, using WhatsApp as the front door, AI to fill the gaps between clinical visits, and community cohorts to address the loneliness of pregnancy that even trained gynecologists often fail to see. Malaika supports mothers from pregnancy through their baby's first six months, building care that is continuous rather than fragmented, and accessible rather than aspirational.

Judy Klein, founder of Unity Consortium, shares how a personal loss to cervical cancer (a disease the HPV vaccine now prevents) drove her to spend a decade fighting vaccine misinformation. Her organization's latest initiative: a national program training 10,000 teen health ambassadors who can carry science-based, empathy-driven conversations about vaccines into their own communities, one trusted relationship at a time.

Together, they make the case that the future of global health runs through trust, community, and meeting people where they already are.

Episode Resources:

Clinton Global Initiative

Connect with Dr. Lorraine Muluka:

Dr. Lorraine Muluka LinkedIn

Malaica Website

Malaica LinkedIn

Malaica Instagram

Connect with Judy Klein:

Judy Klein LinkedIn

Unity Consortium Website

Unity Consortium LinkedIn

Unity Consortium Instagram

Connect with us:

KidsX Website

KidsX LinkedIn

Children's Hospital L.A. Website

Children's Hospital L.A. Instagram

Children's Hospital L.A. LinkedIn

Transcript

SPEAKER_01 0:00

I'm Ashley Ambrose, and I serve as Deputy Director of Health Equity at the Clinton Global Initiative.

SPEAKER_00 0:06

I'm Francisca Luciana, and I serve as Managing Director of Health Equity at the Clinton Global Initiative.

SPEAKER_01 0:12

Thank you so much, Amcar, for taking us up on this opportunity. It's been great.

SPEAKER_04 0:17

Francisca, what do you look for when you're evaluating and selecting potential commitments to support?

SPEAKER_00 0:23

Thanks so much. That's a great question. So we look for a few things, but there are three in particular that separate the most successful projects from others. One, that it the project addresses a specific need. So being really clear about the problem it's trying to solve for. Two, that it's designed with the patient in mind. And three, that it demonstrates potential to improve access and quality of care. In addition to these, I would say we also look for projects that offer something new. So it could be expanding a proven model to a new geographic area or population, designing new tools, products, and ways of delivering care, or innovative models of financing and partnership, that it has a strong project design, so clear roadmap for implementation that is backed by early funding and necessary resources, that there is a risk mitigation plan, and that it shows potential for lasting impact in sustained services. And then that it's measurable. We really like to track concrete outcomes like numbers of mothers, children, and young people who have gained access to quality health care. So our health impact area is named in honor of Dr. Paul Farmer, a longtime partner of CGI. In every aspect of our programming and commitment development for health, CGI aims to uphold Dr. Farmer's work and teachings, directing efforts and commitment development to vulnerable communities where we can have the greatest impact on daily lives and health. And again, these efforts are really centered around making quality healthcare more available, accessible, affordable, and most importantly, equitable.

SPEAKER_04 2:09

Welcome to the Dose of Optimism, where I talk to the optimists in healthcare. My name is Omkar Kulkarni, and I work at one of the world's best children's hospitals where I lead innovation. I started KidsX, which is a premier international startup accelerator for pediatric innovation. And over the years, I've met thousands of startups, investors, and innovators. Every one of them has a story, and every one of them is optimistic about the problems they're solving. On this podcast, you'll meet amazing people who will share their stories and what makes them optimistic about the future of healthcare. A little note before we get into this episode. Please talk to your own physician about your health or the health of your children. All right, let's get started. I was really excited to talk to Lorraine about what she's doing with Malaika. Tell me more about the problem you're seeing there and how their solution can really create an impact.

SPEAKER_01 3:13

So, Malaika, they are rethinking how moms experience pregnancy and care across Kenya. Malaika is a maternal health platform that provides this comprehensive pregnancy care in areas in Kenya where that quality of care piece is really lacking. So they're pairing in-person antenatal visits and skilled birth attendance with online support communities and resources. And as part of their commitment, they've developed this new innovation lab where new product versions are co-created and rolled out with pregnant women so that their experiences are continually at the center of Malaika's version improvements. So their care is really centered around the individual and their own needs. What's especially powerful is how the adaptation adaptations that Malaika is making to their platform is making the program more and more accessible for low-income populations without compromising that quality piece. So their cost was originally$10 per month per mother, which is significantly lower than other platforms already, but they are bringing that number down even further, recognizing that they need to do so to reach the mothers that have been impacted most greatly by health inequities.

SPEAKER_03 4:46

Happy to study more about Malaika. We are a maternal health company that is based in Kenya. And what we are doing is providing comprehensive end-to-end care support for pregnant women. Our goal is really to improve the outcomes for pregnant moms. We have a maternal mortality ratio that's a hundred times higher in sub-Saharan Africa than what it is in Europe. So what we do is we combine clinical care with community and technology to ensure that these mothers have continuous support throughout the pregnancy journey and we have better outcomes for them and their babies.

SPEAKER_04 5:20

What are examples of different ways that you incorporate technology and new care models into the pregnancy?

SPEAKER_03 5:26

One of the things that we've been able to do is first of all build for the women continuous support in terms of an AI bot whereby they are able to directly send in any questions at any point in time and get direct answers. This bot is also sending out daily messages to the moms because you realize that the gaps that exist in pregnancy occur because sometimes it's women do not know that there's actually a risk in their pregnancy. So being able to give them education, but not only that, allowing them to engage with this AI bot that can then escalate to a human in cases of higher risk for the pregnancy. That is one of the things that we've been able to utilize. But beyond that, we are now also able to utilize technology in terms of the clinical care team. So we have community, as I've mentioned, which our front end is WhatsApp. And in there, we have women who are connected to other women in the same cohort of pregnancy. So they're delivering at the same time. And they have access to the AI bot, they have access to a nurse midwife. And when they come to the clinic, our clinical care team, our doctors, our nurses are actually able to engage holistically with this lady. It's not just I saw you one month ago, but we're able to pull all this data, which this lady has been having different data points in her pregnancy, and so really have comprehensive care for the mothers.

SPEAKER_04 6:46

So tell me about WhatsApp and how you made the decision to make that the front door.

SPEAKER_03 6:52

It was really a question of when we asked ourselves, what is it that every day you are engaging? Because the first idea was should we build an app? And we asked ourselves, what would be different in this app and what do we actually want to achieve? And our goal was to be really present with the pregnant women through our pregnancy. And when we look at most women, and right now we actually see in Kenya that smartphone penetration is actually above 60% and it is growing. So we saw that WhatsApp is something that they're engaging with. Daily, you have the groups where you talk to your friends, to your old classmates. And so we wanted it to be something that felt familiar and actually natural for the moms. And we've really seen that it does make a lot of sense for them to engage with WhatsApp, especially from the element of community as well as the educational content and direct contact with the nurse midwife.

SPEAKER_04 7:43

They're speaking with the nurse midwife. Are they also engaging with other moms?

SPEAKER_03 7:48

Yes. I think this actually is a lesson that we have learned along the way. But I also personally remember when one of my first friends ever got pregnant and we went for the baby shower and we were all young and excited. And she was talking about her journey. And we're like, How is it? How has it been? And she's very lonely. And for me, that was the first time I was hearing that. I'm a trained gynecologist, right? But I have never had any mom actually tell me that was her experience. But it was a friend of mine. And when we started off supporting women with a nurse midwife, we realized that they wanted this kind of care, whereby, yes, you may have even a partner, you may have family, but it's really important to walk the journey with other people who are going through it almost at the same time. It brings some sort of omradery. There are actually lots of peer-to-peer learnings. So I think it's something that we see that maybe it used to be there back in the day when communities lived together. But you see, now more and more we have a lot of urbanization, right? And so women are actually quite lonely. And so we really see it as something quite critical because they engage with each other, but we also bring in learning sessions for them. We have weekly webinars on topics that are of interest to them. We have community in person for them where they come together and actually are able to engage. And we really see this making a difference for them.

SPEAKER_04 9:05

Now, the questions that they're asking the nurse-midwife, are there any that surprise you?

SPEAKER_03 9:11

It's literally the basic stuff, right? And I guess being on this other end as a gynecologist or as a doctor, a mom would always ask herself, is this something important enough to ask the doctor? If I were to text, because they know that you are one to a ratio of hundreds of women. But now that they have a nurse who is just on standby, they don't have to Google their symptoms. There's simple things like, can I eat this? Or, you know, I had if I eat this, the gender will be different. So there's day-to-day things, but there's also real important stuff like, hey, I'm actually having this headache that is not going away, right? I've taken water, should I take a painkiller? And we have been able actually, through that closeness, trusted relationship that they build with the NAS midwife to pick up on risks in pregnancies and advise them, something that probably would have taken time, right? Before they thought to ask the gynaecologist or go to the doctor, that would have taken some time.

SPEAKER_04 10:09

Help me connect the dots between what you said at the beginning, which is the high rate of maternal mortality in sub-Saharan Africa with this intervention. Where are the touch points where you think that this could really help reduce the risk of a negative outcome, including mortality for these moms?

SPEAKER_03 10:28

It comes down to the gaps that we see that actually cause the high maternal mortality rates, right? So the first gap is in terms of decision making. So the time that it takes a lady to take a decision to actually seek care. So we have reduced that gap by bringing the care right to her phone. So accessibility in terms of just being able to speak to a healthcare giver, have an emergency line, we have that for the lady. So basically 24-7 care. And then the next one is in terms of them being able to reach a facility. Now, this comes in two ways because one, you can go to the closest facility, but is it the right facility for you? So dependent on the risk that you have in your pregnancy, then you may need a different kind of care. So we have actually incorporated emergency ambulance services whereby we are actually able to help the moms get to emergency care in a timely manner. And then the last gap usually is in terms of the quality of care that they're receiving, right? Do they actually have caregivers who are well trained to identify what they need to do in that situation? And for that, we now actually have a team of clinicians who we work with who are continuously being trained. And so we really see that in terms of this intervention, we are now able to bridge these gaps in this journey by really being present and ensuring that women have continuity of care. Because maybe just to throw it on the other side, what the norm is, you find that often the journey is very fragmented. So one lady may visit like three or four different facilities during her pregnancy journey. The data is fragmented, they're not speaking to each other, and just being able to have an intervention that gives end-to-end care, we really see that making a difference in terms of the maternal mortalities here.

SPEAKER_04 12:12

And once the baby's born, does the solution continue? Does the app or the experience for them continue into early days of parenthood?

SPEAKER_03 12:21

Yes, it does. Initially, we started off supporting up until the first eight weeks because that's when the official post-patem period ends. But now we are actually supporting the moms and the babies up until they are six months. And this is the age whereby they are winning the babies. It's still always hard to say goodbye, but we are very also focused on making this pregnancy journey really safe for them. So we feel that at least being able to walk the journey with them up till the babies are six months and handing them over to pediatric care, then that's really also making a difference also in the outcomes for the babies as well.

SPEAKER_04 12:57

I imagine this may have an impact on infant mortality or newborn mortality as well.

SPEAKER_03 13:02

Yeah, it definitely does. And yeah, the emergency line, there's lots of times that we've had calls, moms not knowing what to do, maybe a baby is choking. So we also have courses for them in community after the baby has come. Just what do you need to do in these different situations? We have someone on standby who can support, we have lactation experts. So it's really looking at this journey for the mom and also preparing her for her reproductive health journey. What are the, because this is a very critical point where you also come in touch with these ladies. And so just giving them health education about different interventions for their health screening for different cancers is also an important thing that we are able to do during this time.

SPEAKER_04 13:44

Is there anything unique you've done for the population you're serving in the region of the world you're serving?

SPEAKER_03 13:51

We have been able to adapt our solution to the different moms that we have served in Kenya. So most of the population is in Nairobi, but we have also served women in very rural areas and also in lower-income informal settlement areas. And you're then able to see that, okay, the needs of these women, for example, in the informal settlement, you'd find that there are many women who actually have HIV in pregnancy, right? So that was unique to them. And so we did adapt our teachings, we did adapt just debunking the needs around that. When we were in Garissa, we were then also serving a population that could not speak English. So we needed to switch the language to adapt to them. But it was also a very patriarchal community. So we also needed to adapt to ensure that the husband, the head of the home, actually believes that this is the solution. He now became the champion for it. So I think that's what I would say in terms of what we've been able to do. It's really being led by the clients that we are serving to be able to ensure that this is something that is of use for them.

SPEAKER_04 14:58

So, how much does the husband or the father of the baby need to be involved, or are they involved in the app?

SPEAKER_03 15:05

It's a very significant role. On the digital end, we do include them in the educational sessions that we have online. We've even had some meetups for the fathers themselves. And this also came because they are really now present and you realize that what has happened traditionally is that they've been left out of this journey. So making room for them. And you know, in the digital space, you could have your camera off. So you initially they were listening behind the camera, and then they're asking the questions. They're like, okay, so they really want to be involved in this journey. In the physical space, we actually make room for them. And it's very surprising. I must say, I've been practicing maternal health for over 15 years in Kenya, and I've never seen as many fathers present in these journeys as I see now. And it's really about giving them the space to feel that they are part of the journey. They want to know how I can support. They want to know what they should do after the baby comes. Another important factor is when it comes to the finances, right? Because they are, in a large number of cases, the decision maker as to where we will actually get this gender. And they're very focused on, okay, so I like this, but I need to plan. So you know, even how we approach them and now include them in the journey is also based on that. And I really think it makes a difference. It makes a difference in the support that the women are receiving. And it's the same in rural Kenya, in urban Kenya, we've seen that support from the partners is something that's lacking. And when it's included, it really does make a difference.

SPEAKER_04 16:31

As you think two, three years from now, what is your biggest hope? Where do you want to see this evolve into?

SPEAKER_03 16:37

I would love to see this evolve to a space whereby we are supporting women all across Kenya and potentially have now moved into a second country because access to quality, affordable maternal health care is a right for all women and fathers as well. So I'd really love to see that we are able to grow our solution, scale our solution in a way that we are supporting women throughout Kenya, all income segments, and then also get into another country.

SPEAKER_04 17:09

Lorraine, thank you so much for joining us on the episode and excited to see your solution continue to impact moms and babies and fathers all across Kenya and hopefully broader parts of Africa. It's hard to talk about pediatrics these days without talking about the vaccines. And the work Judy and our team are doing at Unity is really important in that conversation. Tell us more about your commitment with that group.

SPEAKER_01 17:38

Unity Consortium, in partnership with Voices for Vaccines, has launched a commitment to build a national network of 10,000 teen leaders who are trained and supported to serve as trusted health ambassadors in their own communities. Through education, mentorship, and communication tools, these young leaders are equipped to share science-based health information to counter misinformation and promote preventive care, particularly around vaccines. Collectively, the network is designed to reach millions of young people every year, leveraging the fact that young people often trust their peers, families, and close networks most when making health decisions. I think the timing of this commitment is everything. There is more disinformation surrounding vaccination than ever before. And we need to focus on rebuilding trust from the ground up. Unity Consortium is helping young people become those trusted voices on vaccines using peer-to-peer approaches that feel more authentic and can really shift how health information is shared and received.

SPEAKER_02 19:15

She had two young children. We got together. And sadly, she was diagnosed with cervical cancer. But the first time she was diagnosed, she beat that. She had another child, and the cancer came back. And this time it took Roseanne from us and was just one of the most devastating things for a young family to live through. And unfortunately, when Roseanne and I were in college, the HPV vaccine did not exist, which does exist now and protects young people against cancers, including cervical and head and neck cancer. So one of the reasons I am so passionate about vaccines is because of the personal cost. It drove me to start Unity and to focus specifically on adolescents and young adults, because that's a group of people that don't get a lot of healthcare attention.

SPEAKER_04 20:09

And we hear a lot about vaccine hesitancy and the growth of it in the last many years for a lot of factors. But this has been a problem for a long time. There's always this small but somewhat loud group of people who will talk about and perhaps create hesitancy amongst those who should be vaccinated or could be vaccinated, and that creates confusion.

SPEAKER_02 20:34

You're absolutely right. This really misinformation as we know it has existed since vaccines started and smallpox. There was pictures of cows getting pox, and it really has been a continuous issue from the time that, again, those first vaccines came into being. However, as you correctly said, that was a very small group. There was like two to three percent of people in the US who what I would call would be anti-vaccines. There would be more, a larger percent, who correctly so had questions about vaccines and the risks and benefits, as most parents do want to protect their child and make the best decisions. But over the last couple of years, especially it was kicked into fast gear during COVID, that percent has really, I would say, increased dramatically. And along with that, and probably fueling that is just the rampant bad information and lies that exists on platforms that didn't exist many years ago, social media that are just so accessible to everybody. And because of this rampant bad information circulating at people's fingertips, it's really undermined families' confidence in vaccines and sown mistrust, not just in vaccines, but in our healthcare leaders, our institutions, and more. So parents and young people, they're just confused and they're scared.

SPEAKER_04 22:23

So tell me what Unity does.

SPEAKER_02 22:25

First, I will just say that we are a data-driven organization. So we look at these statistics, and I'm gonna share, if you don't mind, a couple statistics that really are the backdrop for the decision that we made to launch the Trusted Teen Community program. Just to build on what we just talked about, four in 10 young adults today are favoring health advice from friends and family. And almost as much, say, social media is where they're going for advice. And this really is a surge in kind of a trend that was increasing but has really gone up dramatically. And it's not that people don't trust their physicians or their healthcare providers, they are still the most trusted source. But the issue is that they're trusting uncredentialed voices, people who are not experts, their families, their friends, almost as much. So uh one particular statistic is that they trust their doctors about 85% versus 72% trusting their family and friends.

SPEAKER_04 23:38

Social media is part of it, and there's a algorithm and perhaps addictive nature to the information that's coming through. But you can argue that it's the internet in general, right? People are getting information, I imagine, particularly young people, from yes, social media and the internet. And the internet has a lot of uncredentialed voices that are putting information out there, which then social media perhaps even further fuels. So I think the underlying challenge is that there's a lot more information available because of the internet, a lot of which is really accurate and true, but a lot of it, because it's largely ungoverned, is uncredentialed. So I think that's one issue. The other interesting thing that I would love your thoughts on. So historically, people in general of all ages had long-standing relationships with their primary care providers, pediatricians, but also for adults, primary care providers. I feel like that's deteriorated over the last decade as well. There are more people that don't have a doctor, they just go see somebody when they need some help, whether it's an urgent care center or an online resource. And there's a lot of benefits of that, don't get me wrong. But that trusted relationship with your doctor, somebody you've seen for 20 years, and you believe in what they tell you, that I believe is shifting just because we don't have those same relationships with those same doctors. And I wonder if that also plays a role in some of the issues around eroding trust.

SPEAKER_02 25:02

Oh, absolutely. You're absolutely right. It's broader than just social media. It's really the digital environment we're in. So people are asked where they go when they need health advice. The websites are the first. AI, a third of people are going to AI for health advice. And then social media as well.

SPEAKER_04 25:24

And a lot of AI pulls from Reddit, right? So a lot of these generated answers are pulling from comments and uncredentialed sources. Now, if you're savvy, you can definitely look and figure out where the credentialed sources are. But if you're not, or if you're not careful about where you're getting your information about any topic, but in this case vaccines, you could be looking at a generated summary or generated answer to your questions on any one of these tools that include sources that are uncredentialed or unvalidated or verified. And that adds to the challenge of the social media problem you talked about, but also this AI digital problem you're talking about too.

SPEAKER_02 26:02

Right. So the bad information and the good information are side by side and they're not differentiated. Yeah, that's absolutely right. And then you brought up relationships, and that is again a key kind of underlying reason why we are starting the trusted team community. People, again, still trust their healthcare providers, but that trust is going down, according to the polls. And there's a huge divide, a partisan divide between Democrats and Republicans in trust in their healthcare provider. 85% of Democrats are still trusting their healthcare provider, 64% of Republicans. And similarly, difference when we ask about CDC. Surprisingly, Republicans are trusting kind of public health departments or local public health departments in the CDC less than Democrats as well. And also age, to your point about access to digital and social media, the younger adults, the kind of 18 to 34-year-olds, have a much bigger trust issue with these institutions and don't have those relationships with healthcare providers. As we talked about earlier, they aren't as closely linked into the health system. And even if you are, how often are you going to your doctor versus going online or talking to your families and friends? So there's this communications thing that is carrying influence. So you have who you trust over here, but there are factors and the top three reasons people are actually going to these uncredential voices and have them influence them is because they say they have direct experience with my issue, they have empathy for my situation, and they're convenient.

SPEAKER_04 27:55

So tell me about the collaborative you've built and how you're addressing all these specific issues through the work you're doing.

SPEAKER_02 28:01

Yes, we are considering what's gonna win the battle of influence because that's what it comes down to in the end. And we looked at how can we build on relationships and these new modes of communications, especially with communities that are very vaccine hesitant. And we wanted to identify and empower people in the community who are trusted across these ideological divides. We want to treat people with respect and empathy and understanding. So we put forth this solution, and I am thrilled to launch the Trusted Teen Community Program. It's about enabling young people to own their health, shape their future, and be trusted voices in their community. And we have this audacious goal to educate 10,000 young people alongside 1,500 adult mentors in communities across the country. We intend to use kind of science-based information, proven communication skills, all delivered by experts, and do it in an interactive and engaging way.

SPEAKER_04 29:16

Love it. Someone's got to start with big goals and the framework you have is, I think, the an interesting one as you think about how you're going to create lasting impact because ideally you create these mentors and then they have an impact on the teens.

SPEAKER_02 29:33

Absolutely. We start with education, right? And we have a teen advisory council, and we said, what would you want to learn if you were in this program? One quote I remember specifically is if people understood what vaccines do, then that maybe they would embrace them. And so there's this lack of understanding that kind of allows this misinformation to flourish and take seed. So by sharing information, helping people to do some critical thinking, we hope this knowledge will be helpful. But the thing they were really excited about is help us to communicate with people who don't have the same views or perspectives in a way that's empathetic, that is not defensive, and that is listening and respectful of different positions. So we will also communicate those skills because, as you said, it's not good enough just to educate a couple teens, right? The hope is that we will give them the skills and the passion to become leaders in their community and share this information. And we will support that. But we want them to do that on their own once they're educated. We want to empower them to be these kind of trusted ambassadors in their community.

SPEAKER_04 30:56

I love it. And I think there's a huge need for it. I think I just saw it's around three-quarters, right? Around three 75% of teens are fully vaccinated with HPV.

SPEAKER_02 31:07

Even less. It's like closer to six in 10 fully vaccinated. And we just uh heard a survey back that only six in ten parents of young kids intend to vaccinate their kids.

SPEAKER_04 31:20

That's getting worse.

SPEAKER_02 31:21

Yeah.

SPEAKER_04 31:22

The impact that it could have if you even impact 10,000 lives is tremendous, and hopefully it can prevent terrible things happening like you've experienced another's experience as well. So thank you, Judy, for the work you're doing and appreciate you coming on the show.

SPEAKER_02 31:38

My pleasure. Thank you for all your work.

SPEAKER_04 31:41

All right, thank you for joining us for your dose of optimism. Make sure to check out our show notes to get more information about our guests and the work they're doing. Visit our podcast page on the Kids X website to join our podcast community and to learn more about pediatric innovation. Thank you to our sponsors and to our presenting partner, Kids X. Please subscribe wherever you get your podcasts. And remember, it takes a village to make sure our kids grow into healthy adults. So volunteer at your local library, help out at the community center, and if you're so inspired, donate to your local children's hospital. Alright, see you next time. The content, views, opinions, and information presented on this podcast do not reflect the views of Children's Hospital Los Angeles or of the sponsors of the podcast.