Optimizing health through nutrition and lifestyle management needs to take the predominant role. The Cleveland Clinic is leading the charge in this field. They have created the Center for Functional Medicine. It is a patient-centered approach using a multidisciplinary team including a physician, physician assistant or nurse practitioner, registered dietitian, health coach, and/or behavioral health therapist.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.
In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.
As a part of this series, I had the pleasure to interview Dr. Sheila Kilbane.
Sheila Kilbane, MD, is a board-certified pediatrician with nearly two decades of practice. After completing the fellowship in Integrative Medicine with Andrew Weil, she developed the Healthy Kids Happy Moms Program which helps improve recurrent and chronic childhood illnesses.
Dr. Kilbane and her team see patients in her private practice in Charlotte, North Carolina. She has an online companion course to this book, and she also consults with healthcare practitioners who are learning to incorporate integrative medicine into their pediatric practices. To learn more visit www.sheilakilbane.com.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you share the most interesting story that happened to you since you began your career?
Early on in my medical career, I saw one of my partner’s patients, “Javier,” because new doctors in a practice typically have more room in our schedules to accommodate last-minute sick visits. This nine-year-old boy was having terrible stomach pains and missing a lot of school. His chart was about two inches thick (yes, I practiced when we still used paper charts), and while my schedule didn’t permit me to read the whole thing before his visit, I spent two hours over the next two evenings going through his records.
It was eye-opening. Javier had been on seven rounds of antibiotics in just two and a half years. Four of those were for Strep throat, one for pneumonia, and two were for sinusitis. He had also been to the clinic twice for viral gastroenteritis (diarrhea). He was now having these terrible stomach aches and was constipated on top of all of these recurrent illnesses.
My question became: how do I figure out what is causing not only the constipation and stomach aches, but also his recurrent illnesses?
So, I dipped my toes into the world of allergies and nutrition with Javier and ordered food and environmental allergy blood panels. Most of the foods we tested were positive, as were the environmental allergens. These results both surprised and didn’t surprise me. The surprising part was that he did not have what we think of as classic environmental allergy-type symptoms — runny nose, watery itchy eyes, and a cough. Instead, he had constipation, abdominal pain, and recurrent strep throat.
I asked his mother to take him off all the foods he tested positive for. I had no idea at the time how difficult it would be for the family to radically change Javier’s diet. But Javier’s symptoms were so severe and chronic that his mother was willing to try it.
Within a week, Javier’s symptoms began to improve. I couldn’t believe what I was seeing, but I also knew it was not a coincidence. His symptoms were directly related to the food he was eating. His abdominal pain resolved very quickly, and his bowel movements became easier and easier. Eventually, he was having an easy daily bowel movement, and we were able to wean him off the laxative he’d been on.
I remember his case so well, not only because it was the first time I had to fill out a school dietary form but also because he began to improve so quickly off of those foods. All of a sudden, a family I was seeing almost monthly, was not coming in as much.
I was able to stay in touch with his case because of that school dietary form. His mother had to be vigilant with the school so they would honor the changes in his diet that we were implementing, so I had to get very precise on the form, giving the cafeteria examples of what foods might contain dairy, for example. His mother had seen such profound improvements in his health, and she was highly motivated to maintain the right nutrition for him at home and at school.
A month later when Javier came in for a check-in visit. I couldn’t believe the change in him. His mother and I talked about the fact that some foods that are marketed as healthy were actually making him sick, and that removing them from his diet could restore his health. He continued to do great and didn’t need a single round of antibiotics that ensuing year.
Javier’s case helped me correctly deduce two things. First, his immune system could function more efficiently once his systemic inflammation was in the right balance. Second, by decreasing the processed food he had been eating, the oppressive hold sugar had on his immune system lifted, and he was able to move out of the sick cycle.
Javier’s turnaround was one of the initial cases that led me into integrative medicine. And integrative medicine helped me fall in love with my profession again after feeling disheartened and burned out shortly after I started practicing medicine.
Can you please give us your favorite “Life Lesson Quote”?
Patch Adams: “You treat a disease you win, you lose. You treat a person you win every time, no matter what the outcome.”
Medicine is important, but the connection between the practitioner and patient is most important.
Can you share how that was relevant to you in your life?
The way I speak to a child and their family in my clinic plays an important role in the healing process, as does my state of being. My interactions, tangible and intangible, impact the child’s immune system positively or negatively. It is my job to be present, to listen, and to be kind to the family. It is equally important for parents to feel heard and seen in the realm of pediatrics and important for parents to know that I am doing everything I can to help their child get well.
Are you working on any exciting new projects now?
Yes! I just published a book called Healthy Kids, Happy Moms: 7 Steps to Heal and Prevent Common Childhood Illnesses. I’m more excited about this book than anything I’ve done in my career thus far!
The program I write about was born from cases such as Javier’s, which I mentioned earlier. Breaking down and absorbing food is the first step toward good health. Once I realized how profoundly nutrition and stress affect a child’s health, I began implementing nutrition and some strategic supplements into my general pediatric practice.
I began to see the common chronic and recurrent childhood illnesses either melting away or improving significantly, and I wanted to scream it from a mountain top. Eventually, I went on to complete the two-year Andrew Weil Integrative Medicine Fellowship through the University of Arizona. I studied the science behind what I was seeing in the clinic and how important mind-body therapies (tools for managing stress) and nutrition are in our health. Believe it or not, when I went to medical school, I received almost no nutritional training.
The changes I saw in my patients and entire families, was a powerful force that inspired me to leave general pediatrics and open my own integrative clinic in 2012. I was able to articulate how important it was for families to eat well, exercise, sleep, manage stress, be outside, and spend time with loved ones to maintain that feeling of connectedness. I wasn’t using expensive tests, rather, I was listening to parents, asking about nutrition, and uncovering the child’s main triggers of inflammation and illness.
The five main triggers of inflammation are food, environmental allergies, environmental toxins, infectious diseases, and stress (emotional and physical). Once we began decreasing the child’s main triggers of inflammation, we saw long-lasting improvements in their health. Kids who had been on antibiotics three and four times per year were going years without needing even one of them. When the kids did get exposed to a virus or bacteria, their systems were much more resilient and able to recover quickly, often no longer needing strong antibiotics, steroids, or other anti-inflammatory medications to get them through the illnesses.
In writing my book, I condensed all of what I learned from my integrative and conventional medical training along with almost 20 years of clinical experience. I continued to refine my 7-step process and worked closely with an integrative pharmacist, Deb Allen, who played a big part in how we were able to strategically use supplements to enhance digestion. Today, our team consists of a naturopathic doctor, a pediatric nurse practitioner, a health coach, and a patient care coordinator. Similar to functional medicine, we work as a team to support the families in our practice as they make the much needed — but not always easy — lifestyle changes to support the health of the children in our care.
As a bonus, we usually see the health and well-being of everyone in the family improve along with that of our patients.
Soon, our families began referring their loved ones living around the globe to us. We also receive calls from doctors asking how they could use our program in their practices. There are very few pediatricians trained in integrative and functional medicine so the book was my way to fill this gap until more in-depth integrative medical training makes its way to the hallowed halls of medical schools.
How do you think that will help people?
Both families and practitioners will learn about the common triggers of inflammation and illness, and learn how to use my seven-step program for restoring health and well-being for the child and the entire family.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider is one who is open-minded and remains authentic to themself at work. He or she may not have all of life figured out, but they are committed to doing the best they can to keep themselves healthy both physically and emotionally, while staying up to date in their field of medicine.
When patients feel seen and heard (whether it is with a surgeon, an oncologist, or a primary care doctor), that is where deep, and long-lasting healing begins, and that doesn’t always mean the patient is cured. There is a difference between curing and healing. Practitioners may not always be able to cure their patients’ illnesses, but they can play a significant role in helping them to feel peace with where they are with their condition. I devoted an entire chapter of my book to this topic, called Healing vs Curing.
Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?
The pandemic has brought to light many things about the U.S. healthcare system, including glaring disparities in access to high quality food, education, healthcare, and our baseline high level of chronic disease. When you couple this with the poor communication and data tracking among hospital systems across the country, the consequences of the coronavirus were compounded.
Our healthcare system was blindsided by a virus that causes the highest morality for individuals with obesity and the underlying chronic diseases that accompany obesity, such as diabetes and heart disease. One-third of the adult U.S. population is obese. When COVID hit, it was too late to implement widespread preventive programs to improve the health of patient’s struggling with these chronic diseases. The old adage never rang more true, an ounce of prevention is worth a pound of cure…especially when a cure has yet to be found.
When baseline health is optimized the immune system has better resiliency once we are exposed to a virus or bacteria that can cause illness. The immune system of someone who is obese is not going to work as effectively and efficiently as someone who is of more normal weight, but since our healthcare system predominantly functions as a “sick care system”, obesity goes unchecked until there are 2 or more additional chronic issues. We are drowning in patients who have chronic medical conditions and despite the fact that we know beyond a shadow of a doubt that lifestyle factors play the biggest role in our health, we still don’t have the time and resources or personnel devoted to helping our patients be more proactive in their health, especially those who live below the poverty line.
The coronavirus was simply the spark that ignited the smoldering problem. The fire grew and moved rapidly throughout populations living in close quarters, working on the front lines, and living with underlying illnesses that were poorly controlled. Yes, healthy individuals are also at risk for developing COVID-19 complications, they are less acute. Infectious diseases used to be the great equalizers, meaning, a society could only be as healthy as the poorest among us. But place an infectious disease in our modern era where the wealthy can sequester themselves on the backs of those who deliver everything from toothpaste to toilet paper to the front door, it is the less advantage who suffer the gravest consequences.
Hospitals in densely populated areas were overflowing, while hospitals miles away were sitting with empty beds. The healthcare workers at every level were doing the best they could, risking their lives and that of their families every day. Yet they continued to show up, to gown up with whatever safety equipment was available, to field questions they did not have answers for, and to take care of those with and without COVID-19 related illnesses.
If we had a centralized system for collecting and disseminating healthcare data, how many lives could have been saved? If all hospital systems across the country used one database for electronic medical records, hospital censuses, tracking statistics about which treatments were working and which were not, as well as the ability for medical professionals to receive the latest information without a significant lag in time, this pandemic may have played out very differently. Information about which hospitals had beds and equipment available would have been much more accessible and ambulances and patients could have been routed in real time to a hospital that was adequately staffed and prepared. One emergency medicine doctor in my city said at one point she had to call 8 hospitals to find an open bed for a patient to be transferred. Don’t you think there may be more efficient uses of a physician’s time during a pandemic?
I actually think given the state of our healthcare system, the healthcare workers did a phenomenal job adapting as quickly as possible to what was needed. The U.S. healthcare system typically shines when it comes to acute illness. It’s the prevention of chronic disease where we fall short. It is much more difficult to take care of a sick patient who shows up at the hospital with obesity, and poorly controlled diabetes and heart disease. It is a set up for a poor outcome and is more stressful and difficult for healthcare workers to overcome these obstacles when treating patients.
Our healthcare system is optimized around deciding which prescription medicine to recommend. That’s not to say doctors don’t try their best within the constraints of the system, but I can tell you from my own experience in primary pediatrics that doctors who don’t see a targeted number of patients in a day are not viewed as “team players.” The only way I was able to provide the kind of care I felt good about was to work long after the clinic was closed reviewing medical records and doing research on how to best keep my patients from returning again and again with the same complaints that were not being resolved by a pharmaceutical approach.
During the height of this pandemic, practitioners barely had time to go to the bathroom, let alone take steps to mitigate chronic illness for their patients. Moving forward, my suggestion is that we use public health strategies to begin chipping away at our high rates of obesity. That step alone will go a long way to improve our country’s overall health crisis. And if we could take a second step to develop a more centralized way of collecting, organizing, and disseminating health information, we would be taking two giant leaps toward a better healthcare system.
Of course, the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
Despite the inadequacies of our healthcare system, I would not have wanted to live in any other country than the U.S. when this pandemic hit. As I stated earlier, our system is designed to be a “sick care system”, and that is what we did…we took care of the acutely ill patients.
Our healthcare workers did an incredible job of shifting and taking care of people. They pivoted when new information became available. They created online forums to disseminate information. The infectious disease doctors in our hospitals held video conferences to keep us updated, despite the fact that they were working around the clock to figure out how to best handle the situation. We have two main hospital systems in Charlotte, and they actually came together to support the community. Normally they appear to be in competition with one another.
Our medical system, which is notorious for how difficult it can be to navigate, started making things just a little bit easier for patients. Physician practices began doing virtual visits and going outside to talk to patients or swab noses. The hospitals did everything they could to staff up and accommodate a higher volume of patients. I felt the medical system in Charlotte handled the pandemic as best they could. And when the vaccine did become available, I actually cried because I felt so grateful to live in this country and this city, where I was able to drive up in my car, in a very orderly, organized line, get the vaccine at no cost, in a timely fashion, and continue on with my day.
Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
As an integrative pediatrician, I’m trained to look beyond the immediate complaint of, for example, an ear infection. I’m going to take that same approach to answer this question.
1. Optimizing health through nutrition and lifestyle management needs to take the predominant role. The Cleveland Clinic is leading the charge in this field. They have created the Center for Functional Medicine. It is a patient-centered approach using a multidisciplinary team including a physician, physician assistant or nurse practitioner, registered dietitian, health coach, and/or behavioral health therapist.
In my current practice, which operates largely outside the insurance system, we have a team similar to what they use at the Cleveland Clinic. Together, we spend at least one hour before meeting the patient, discussing the child’s medical history and the best strategies to optimize the child’s health. We devised our own medical history intake process around our integrative approach. It goes beyond the one I used in general pediatrics (where an average visit was anywhere from 10 to 20 minutes) to include a detailed dietary history, psychosocial influences on the child (including the parent’s relationship with one another), questions about exercise, screen time, and so on. We work as a team with the family to educate and support them on making healthy eating, physical activity, and the daily implementation of stress management tools a priority.
One example is the kids we see in my practice who have asthma. They will often come to us because every time the child is exposed to a virus, they end up hospitalized or spending hours in the emergency room. We work with the families to identify the child’s main triggers of inflammation and illness and work diligently to decrease the exposure to these while optimizing nutrition, and medications. After five or six months, these kids are typically able to withstand an exposure to a virus (or another trigger such as environmental allergens). They may have a mild asthma exacerbation, but do not end up in the emergency room or the hospital. Of course, these families still had some stress when the pandemic hit; my patients were better equipped to handle the stress if in fact they did come into contact with the coronavirus. Imagine if our healthcare system offered the resources and personal for kids and adults to have this level of care. Can we begin implementing what many integrative and functional medical doctors are doing and what the Cleveland Clinic is modeling? Extrapolating from what the Cleveland Clinic has been able to do, Americans would enjoy better health at a more cost-effective model.
2. Our current “sick care system” offers higher financial reimbursement for procedures and surgeries than it does for preventive care, such as education guidance on diet, exercise, and stress management. Even though we know 80% of chronic disease is caused by our diet and lifestyle, we have minimal resources allocated to this. If we had programs similar to what the Cleveland Clinic is doing, we might be able to make some significant inroads toward better health for our citizens. Another non-profit group working to shift the system is the True Health Initiative. Some of the giants in the field of nutrition, including David Katz, MD (founder of the prevention research center at Yale) and Walter Willet, MD, DrPH, of Harvard (one of the most cited researchers in the field of nutrition) have joined together to work toward a common goal of improving the health of our country by promoting “lifestyle as medicine.”
3. Healthcare reform needs to include the impact nutrition plays in our health, which means everything under the purview of the U.S. Department of Agriculture. (I address this topic further in the last question.)
4. The insurance industry currently dictates a significant amount of the way doctors practice medicine. Much of what we do on a daily basis is to check off boxes and fill in diagnosis codes for illnesses in order to optimize insurance reimbursement. The pendulum needs to swing more toward a multidisciplinary preventive system, as I have discussed above.
5. We need more education in our medical schools around nutrition and lifestyle if we are going to expect a change. We also need support for our healthcare workers so they have the resources to lead by example when it comes to a healthy lifestyle. Fresh, healthy food available in hospital cafeterias, green space to walk outside and/or gym memberships, yoga and meditation classes, counselors, and fostering a positive, healthy working environment for the practitioners and patients alike.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
Our children and adults are living with more chronic health issues than ever before. Fifty percent of children now have a chronic illness. Within the span of my career, I have seen my patient base change from predominantly healthy kids to those who need more and more medications to help their systems function optimally. We regularly give kids medications to help them have daily bowel movements, keep their reflux at bay, control eczema, help them stay focused, help them sleep at night, and keep their anxiety at bay. The stress and toll it takes on physicians to care for a small number of chronically ill patients are manageable. But today, when fifty percent of children have a chronic illness and 33% of the adult population is overweight and taking multiple medications, it is stressful for patients and healthcare practitioners.
While there are certainly areas where we need more physicians, it’s my experience from working both inside and outside the insurance reimbursement model. We need more patient-centered, multidisciplinary teams. Similar to what I use in my practice and what the Cleveland Clinic does in their Center for Functional Medicine.
How do you think we can address the issue of physician diversity?
Education, education, education. Equal access to high-quality education and childcare from birth is critical. A child whose developing brain is not being read to below the age of five and lives in a stressful household has very little chance of catching up with their peers. If we don’t begin to improve the quality of our schools and daycares in every neighborhood of our cities, physician diversity will not improve.
How do you think we can address the issue of physician burnout?
Physicians today are serving a much sicker population than ever before. We are staring at a computer screen for hours each day, and we are spending a significant portion of the day charting. I know many physicians who stay up until well after midnight just to get all of their charting done. Burnout is not just a function of the work environment and short staffing but of the litigious nature of our society. We all live in fear that if we don’t have everything documented fully, we may have legal issues down the line.
Patients have 24/7 access to physicians now via email. In the world of Dr. Google, we not only have to answer questions about a patient’s treatment, but we also have to respond to a long list of questions the family has come up with after searching the internet. This is not a complaint about well-informed parents; it’s just a fact that patients would like more contact with their medical professionals than what the system allows.
I left the conventional pediatric practice where I worked to start my own clinic because I reached the level of burnout fairly quickly after residency. I was running from room to room prescribing two, three, and sometimes even four different medications to control kids’ symptoms. Over the ensuing two weeks, the kids would get better, we would stop the medications, and they would get sick again and be back in my office two weeks later. I was not getting to the root of the illness because I didn’t have the time, or the training to do so. I was putting a Band-Aid on the symptoms.
When my practice switched to electronic medical records, I knew it would send me over the edge to look at a computer screen all day, while trying to connect with families and take care of these kids. So in 2012, I opened my own clinic with a new model of healthcare outside of the insurance reimbursement system. The first thing I did was hire a scribe who could take notes into the electronic medical record system so I could be present with families during the visit and not have to focus completely on the computer screen the entire time.
I spend an hour with each patient, and I have a team to help with all the lifestyle aspects, including a pharmacist, nurse practitioner, and health coach. I work with families to resolve or improve the child’s chronic underlying issues to attain a better baseline of health. Education on the importance of diet and lifestyle are critical factors in my practice, and this is where my book comes into play. It is a step-by-step guide to help families through the process I use in my clinic.
What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
When individuals understand the profound effect good nutrition, exercise, and stress management have on their health, they can start demanding healthier food choices at restaurants, schools, daycare settings, and hospitals. Corporations can enhance flexible spending accounts to their employees, enabling them to find modalities that work for them. Modalities may include integrative physicians like myself, exercise programs such as yoga or a gym membership, nutrition counseling, dietary supplements, massage therapy, and stress-management programs such as counseling coupled with meditation and breathing exercises. This could also evolve into community type support within companies. Those who are further along in their health journey could partner with a new employee to share their experience, best practices, etc.
Leaders of companies and healthcare organizations are starting to offer a wider range of healing modalities than ever before. Again, they are constrained by the for-profit environment in which they operate (even if they are a nonprofit organization). I would like to see these leaders speak out more publicly and forcefully about the benefits they have seen in their populations and push insurers, communities, and regulators to look beyond the pharmaceutical and medical device sectors for lasting approaches to health and well-being.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I will forever remember the first day of my Integrative Medicine Fellowship like it was yesterday. I had been incorporating nutrition and more natural therapies in my pediatric practice for years and seeing incredible results, but I felt like I was on an isolated island. One of my partners said to me one day, “Sheila, what is that Voodoo medicine you’re practicing?” I just grinned and took it, and then a year later, that same partner asked me how to dose probiotics.
It was a long and lonely road. I felt like I was living two lives. I had one type of conversation with my conventional doctor friends and an altogether different discussion with my integrative doctor friends (and there were very few of these).
When I arrived in Arizona to start my Integrative Fellowship, I was with 65 other Healthcare practitioners who felt the same way I did. We were all recommending nutrition changes for our patients and seeing significant improvements. The opportunity to get together as a group and gain a deeper understanding of the science behind nutrition was extraordinary. I was able to progress even more rapidly in helping the children in my practice to achieve and maintain good health.
I started to have visions of the book that I just finished writing as well as the online education courses I eventually developed for families and other Healthcare practitioners around the globe who didn’t have access to an integrative pediatrician.
Things have progressed so much since then and what I envision now is similar to what Andrew Weil, M.D. envisions: that integrative medicine is good medicine. It incorporates both conventional medicine with natural and nutritional healing strategies so the body’s innate healing capabilities can work optimally. Understanding nutrition and its impact on health should be part and parcel to medical training, not a separate field.
We can never achieve optimal health for our citizens if we cannot figure out how to provide high-quality food to everyone.
Physicians, the government, and the private sector should band together (similar to the True Health Initiative) to hold the food industry accountable for its role in the poor health of our country. According to Harvard School of Public Health, “If current U.S. trends continue, more than 57 percent of today’s youth will be obese at age 35.” These numbers are unacceptable. I would venture to bet the CEOs of the companies who peddle sugar drinks and highly processed candies and fast foods to children do not feed their own children the same foods they are marketing to other people’s kids.
Why are we not holding the food industry to the same accountability we held the tobacco industry to for the negative health consequences highly processed food has on the health of our citizens. We all have only so much willpower, and if the only thing available for a child to eat in the school cafeteria is a box of sugar cereal, of course, they will not choose fresh fruit or vegetables. The controlling centers of our brain light up with sugar, and very few people can override that signal, especially a young child.
Furthermore, we need to take a closer look at the U.S. Department of Agriculture and what type of crops are subsidized. Can we move more money into growing vegetables and fruits to feed the kids in the school cafeteria and to fill the shelves of grocery stores in areas considered to be food deserts? The inequality in our food system is egregious. In Mecklenburg County, where I live, 72,793 individuals live in a food desert, and 35% of all households are food insecure.
In the U.S. in 2018, 14.2 million households experienced food insecurity due to a lack of resources, and this number has swelled since the pandemic. The available foods are often processed and filled with sugar, fat, and preservatives, all of which contribute to obesity. Counties with poverty rates of >35% have obesity rates 145% greater than wealthy counties.
We have a large and diverse population in the U.S. We are also at a point in our history where we are particularly motivated to get healthy. Let us use this momentum, come together, clearly outline the problem, and work step-by-step to resolve it.
How can our readers further follow your work online?
Facebook — Sheila Kilbane, MD
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Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.