I spoke of Peru earlier. Haiti has been on the agenda for, now, 20... more than 20 years, and what was a single hospital, a single clinic in Haiti three years ago when I first visited there, when money became available from the global fund to fight AIDS, TB and malaria, from the President's fund for AIDS and from a foundation, that program grew. The year I was there we, we saw - again note the lapse into the first person plural - my colleagues there saw 100,000 patient visits. This year past, it was 1.2 million patient visits, not in one hospital but now in four hospitals and in seven clinics at widely dispersed areas on the central plateau.

The program has, has spread elsewhere. Early on we discovered an epidemic, or we were told about an epidemic, of drug-resistant tuberculosis in Russia and were asked to consult at a prison on Tomsk in Siberia. Paul and Jim and our colleagues began working there then, there... they found the, the prison overrun with MDR-TB. If one goes into a prison in that setting or any other where there is no opportunity to... to separate people with disease like tuberculosis, the spread is guaranteed. Paul and others refer to tuberculosis as 'ebola with wings' and it is a problem that is one that I think the world will confront in greater and greater fashion in the time ahead.

Let me... since I brought that up let me just mention that the problem of, of what was MDR-TB, multi-drug resistant tuberculosis, has evolved into something now called XDR-TB. That's a form of tuberculosis that's resistant to virtually all drugs, and in the absence of new drugs, in the absence of new ways to deal with... with this problem, we really confront the possibility of a worldwide epidemic of a disease that, in very, very many situations is lethal in a matter of very few weeks.

We began in, in Siberia to help train Russian physicians, brought Russian... some Russian physicians here to the Brigham and the School of Public Health at Harvard for the Clinical Effectiveness program, and there's now a movement to set up a Clinical Effectiveness program in Moscow just as some of our younger students in the early... earlier students in the Clinical Effectiveness program have set up a program in Buenos Aires for Argentina and for other Latin American States.