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Dr Monique Nugent: Prescription For Admission-A Doctor's Guide to Navigating the Hospital

Ellington Brown & Rita Burke

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A hospital can be the place that saves your life and the place that makes you feel the least in control. We sit down with Dr. Monique Nugent, a hospitalist and author of *Prescription For Admission*, to name the exact moments when patients and families get lost and what to do about it, even when you’re exhausted, in pain, or scared. 

We get practical about navigating a hospital stay: how to understand the plan for the day when schedules are fluid, why a paper-and-pencil checklist can sharpen your questions, and what “success” really looks like after discharge. Dr Nugent explains why discharge planning is often harder than people expect, from equipment and medication access to insurance limitations and the real-world logistics that can trigger avoidable readmissions. 

We also unpack healthcare equity in plain language. Equity isn’t about giving everyone the same thing; it’s about giving each patient what they need based on their body, abilities, language, and lived experience. And we end with a challenge you can act on today: have the uncomfortable advance care planning conversation with your loved ones, so no one is forced to guess under pressure later. 

If you found this helpful, subscribe, share this episode with a caregiver or patient advocate in your life, and leave us a review. What’s the one question you wish you’d asked sooner during a hospital visit?

Contect to Dr. Monique Nugent using the following platforms:


Website: https://drmoniquenugent.com/

YouTube:  https://www.youtube.com/@Dr.MoniqueS.Nugent

Instagram:  https://www.instagram.com/the_happiest_hospitalist/

LinkedIn:  https://linkedin.com/in/moniquenugent-mdmph/


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[00:00:00] Ellington Brown: Welcome to SpeakUP! International with Rita Burke and Elton Brown! Today we have Clifford Brown, who is going to read an excerpt from his book inside USAID an Odyssey for foreign Assistance. Clifford Brown? The virtual floor is yours! 

[00:00:21] Clifford Brown: Well, thank you. This book was inspired in large part in response to the sudden wholesale destruction of the United States Agency for International Development, otherwise known as USAID.

The primary vehicle for delivering Nonmilitary US assistance to countries for well over 60 years. In 1992, six years after I raised my hand in a partner's meeting and resigned from my law firm, I found myself in Asmara the capital of the not quite yet independent Eritrea, trying to give away $20 million. A local driver, a successful hunter I saw when I visited his home, decorated with, uh, deer antelope and warthog heads met me at the airport and he drove me to the government office complex.

In some leftover US army barracks built to house a World War II era. Listening post the site was easy to find, thanks to a huge ROIC antennas that were still in place. But finding somebody to take the free $20 million was impossible. I roamed the halls looking for someone to talk to. One door, had a piece of typewriter paper type to it with a handwritten note reading, Ministry of Education.

I knocked and was allowed in the entire ministry, consisted of for armed uniformed soldiers, and they were all there. I introduced myself, explained what USAID was, and made my pitch, the fact that one of the uniforms was worn by a truly gorgeous Eritrean woman may have helped my delivery. They listened politely and patiently, and then they said no.

They explained that if they took American money, it would seem like America was bribing them to adopt us friendly policies. I could understand their concern, but in this case, the priorities could be theirs and theirs alone. Literally all they had to do was to give us a shopping list and some sensible proposed uses.

I did this for over a month, knocking on door after door ministry after ministry, and I failed utterly. I'll stop there.

[00:02:30] Rita Burke: The voice you have just heard is none other than Mr. Clifford Brown. And as you know on SpeakUP! International, we have conversations with people we consider to be community builders. Now, Mr. Brown gave up his career in a Beverly Hills law firm to pursue 27 year adventure in foreign aid. His new career took Mr. Brown across the globe as a foreign aid expert. Mr. Brown speaks several languages and held many titles as he traversed the world. There's so much more from his bio that I can tell you about Clifford Brown this morning. But as we say and SpeakUP! International are preferences that people tell their own stories.

Mr. Clifford Brown, I welcome you to SpeakUP! International! 

[00:03:27] Clifford Brown: Well, thank you so much, Rita. It's an honor to be with you. I've, I've looked forward to our conversation. Um. Your show distributes ideas, and I learned long ago that ideas are the most powerful thing in the world. And, uh, I'm happy to be able to participate in your program.

[00:03:48] Ellington Brown: Uh, we're glad that you are here with us too. Uh, Mr. Brown, I don't know, for some reason, I just like your last name! It just has such a ring to it! 

[00:03:57] Clifford Brown: Yeah, I like yours too. It's, it's, it's, 

[00:04:00] Ellington Brown: You had a really lucrative job in Beverly Hills as a lawyer. What made you decide to move into foreign aid work?

[00:04:14] Clifford Brown: Well, you know, I, I never really liked business law. It, it, I enjoyed learning what I was learning. I was involved directly in capital markets doing securities work. It was very hard work. Um, and I guess I was young enough to be foolish enough to think, well, I've got enough money now I can go do something that's gonna be more fun.

Uh, but it was quite a coincidence when I, a big case ended, I was a, a bankruptcy attorney, commercial bankruptcy, and it was the Continental Airlines bankruptcy where I represented a, a, a group of a, a, a committee of the little people. They were the, the flight, not the flight attendants, they were the baggage handlers and the ticket sellers and whatnot.

And this case got on for almost three years. And I, it was a creditor's committee. I was counsel to the creditor's committee when the case ended. It, it had been so all consuming. I took one year, I took 32 trips to Houston from LA to work on that case. And so when the case was over, I had a lot of time on my hands and I was reading the newspaper and I saw an ad, the USAID, I didn't know what USAID was, but they wanted attorneys who had another language and I already had Spanish and how I got, it's a long story, but I had been, I lived in Latin America before law school, so I flew back to DC I saw a big map on the wall and he had little red pins all over the world.

And I said, what are those pins? He says, that's where our attorneys are. And something in me turned. I said, I gotta have this job. I didn't care about the money at that point. I gotta have it. So I went back to la I had to explain to my wife what I wanted to do. She was an attorney too. Um, she said, well, you go try it.

See if you like it, and if you do. Maybe we and the kids will come later. So they did and we ended up, uh, oh, it's a long story part of it's in the book, but we ended up in Nairobi. And even though we were making a lot less money, we had a nice house, the government paid for.

[00:06:09] Rita Burke: I wanna go back a little bit and ask the question, what led you into law in the first place?

[00:06:15] Clifford Brown: You know, that was, uh, um. The result of a conversation I had with one fellow in San Francisco. He was in Stanford Law School, but he'd been in my fraternity in in college.

And a friend of mine who, who happens to have been the, the US ambassador, the youngest US ambassador, ever appointed Ryan Crocker, you've probably heard the name 'cause he, he was quite well known and is, he is retired now, but he and I were buddies in college and Ryan and I hitchhiked down to Mexico one, one winter.

We've said, let's go south for the winter. So we literally hitchhiked down to, to Ensenada, Mexico. But we stopped in Stanford. We talked to our friend who was a senior classmate, he was in law school. He said, well, the reason I did it, it was socially acceptable and it gave me a lot more options to do later.

And I said, well, that makes sense. And um, so after college I was, and actually had won a fellowship to travel in Latin America for a year. And I was, I was down there in um. Applied to law school at UCLA and uh, and got in. So that's the only, that was the only game plan I had, was to go back to la I had a girlfriend there and I followed her to, to la but that's why I chose UCLA and, uh, you know, I, I, I can't explain it any better than that.

Once I got to law school, I loved it! I thought it was, unlike most law students who hate it, I loved it. I thought it was cool to learn the rules and that, you know, then I, I did, well, first year I was, uh, enough, high enough in the class to get invited to the law review. So I, I continued to, to push it out into a career in, in commercial law.

But as I say, when, when the opportunity came to, to work for the government, I, I took it in part because I had seen what some of the, the State Department and USA people down in Central America were doing. Uh, when I was knocking around there on my fellowship, I, I attended some of their conferences and I thought that that looks like a cool job.

So, later when I had the chance, uh, I also wanted to use my Spanish overseas, uh, or somewhere in a job, and I couldn't use it in the commercial law firm. So, um, it's just one of my, uh, favorite topics that when you, when you learn a language, you, you, you really, it's like you've grown a new soul. And I wanted to use my Spanish in my work, so that, that was another reason I joined the government.

[00:08:46] Ellington Brown: Interesting story. Okay, so now you've worked doing a little bit of everything like farms, tugboats, research. You know, your fingers have been everywhere. So when you finally land this USAID, uh, position, what changed for you, , emotionally or practically for this position abroad? 

[00:09:22] Clifford Brown: You know, and I, I talk about this in the book, it, I got to think about stuff that I wanted to think about.

Uh, as a lawyer, you, in a sense, I use the phrase, you're a mental prostitute. You must think about somebody else's problem. You've sold your mind. And even if they're paying you well for it, you're not thinking about what you wanna think about. Now. You said, I wrote an earlier book called Dilettante, and that title came to me because in a way that's, that's what I felt I had become, even though I was specializing in foreign aid law and, and bureaucracy.

And, and foreign aid law really is a specialty. It's it, you can, because once you learn it, you can't do it anywhere else except right there in that agency. Nobody else does it. So I felt very lucky to, um, to be part of the general counsel's office in USAID. For the first 12 years I was with the agency, but we got to dabble in thousands of other topics because USAID worked in so many different areas and, and the lawyers were called in when the managers themselves had a problem.

So we were necessarily involved in, in deciding issues. Involving say, we're prohibited from assisting a, a, a military force or police force. Well, what is a force if we're assisting the customs agents to reform their procedures for collecting tariffs? Is that a, are we violating the law because they're a force, because they have the ability to arrest people if locusts fly from Ethiopia into Kenya or, or vice versa.

And we're prohibited from assisting Ethiopia because they're a military dictatorship. And our law says we will not give assistance to military dictatorships. Well, how are we gonna prevent the, the corn from being eaten in Kenya if we can't spray those locusts in, in, uh, Ethiopia? And so the lawyers were consulted by that, about that.

And, and I could go on and on with the thousands of different areas where we worked, but the lawyers got to dabble in all of these things. So to me, that was the most, uh, interesting. Mental and emotional experiences, I got to learn about, um, not only the countries and the peoples that I, I was working around, but topics that, you know, I wouldn't normally not have thought about in, in private commercial practice.

So that was what made it fun, especially as that's what made it fun for me. 

[00:11:55] Rita Burke: Sounds as if it was really an exciting responsibility, but there were, I correct ?

[00:12:08] Clifford Brown: It, it was always, it was never boring. It was, it was always fascinating work. Uh, the downside was. I didn't put down roots, like, and I envy people who have roots in any given place, and that, that was certainly the downside.

My roots are the people I met in that agency, but they're scattered around the world. And my first family, I mean, I've got a, a boy who's working in Bogota, Columbia. I rarely see him. I've got a daughter who's living in Switzerland. I rarely see her or my two grandsons over there. So that's the downside. I, and I'm, I haven't, I, I remarried, uh, in 2005 and I have three kids from my second marriage.

And, uh, I'm telling those kids, you can go to school anywhere you want, as long as I can drive there in an hour and don't even think about the Peace Corps because I want you to stay home. You know, that's, that's the trade off. But what I did, I did for, for 27 years and it was, it was fun. 

[00:13:05] Ellington Brown: You are most fortunate because a lot of people can't say that.

They just go to go to work. Get the money, go home. They, hate their job. And here you have a job that you absolutely love, even though it paid a little less than what you are or were normally used to receiving. Once you arrived, what moment did you find you felt that you had evolved? And when I say evolved, you can take that any way you want. And while you're at it, you can also, uh, talk about maybe some of the things that USAID does that changed you? 

[00:13:50] Clifford Brown: Sure. Well, you know, I, I talk about this moment in the book. That was one of the most, uh, memorable events.

I, the, the agency sent me to, to listen in on an an interagency meeting. Uh, the various agencies in Washington will, will have these interagency meetings. So I went over to, I think it was the Department of Agriculture, and I sat in on a meeting with the, with the State Department and with people from USAID and with, from agriculture, and there may have been some other agencies there too.

I think OMB may have been there. And the first thing they did was they, they, they pulled a map down and they started talking about the weather systems all around the world. And I thought, this is something out of a James Bond movie! Why am I sitting, why do they think I need to know what the weather is doing in Bangladesh or South Africa or Malawi, or, you know, Peru?

Uh, I said this, this is so amazing that they, they think that I need to know about the weather all around the world and what I was realizing is that these people are, are in charge of events and, and, um, activities that could affect anybody anywhere in the world. And that to me, uh, it was very cool. I thought, well, wow, this is, this is so different from worrying about whether Mark Sara's used car dealership in Palm Springs can sell used cars on the street and, and have the ugliest car lot in the city.

Uh, this is way more fun. That was part of it. Um, and I, I remember that event especially. Um, but as I say, all of the things I got to think about were, were fun to think about. And, and it was, to me, the purpose of that agency. And let me, let me just spend a minute on this. People know what the military does and people know what, what diplomacy is.

For the most part. It's, it's passing information back and forth. The position of our government and vice versa, getting the position of the, of the host government. But what Youse did was everything in the middle. And it wasn't just the humanitarian work, for instance, when, um, when the Soviet Union fell apart, they needed help reforming their commercial codes.

So USAID got the task of hiring experts to go over there and teach them about modern accounting and modern commercial codes so that the private sector could function. When the governments in Central America all wanted to reform their, their legal systems to train lawyers and judges on how to do jury trials, we got the job to, to hire the experts to go down there and teach them.

We created entire industries in Central America. Uh, for instance, we, we had an experiment in Honduras to see if onions could be growing up in the mountains. And so we had, Chemonics is one of the beltway consulting firms that came in and they. They paid some farmers to grow some onions. They shipped a container over to Miami, and, and we found out, yeah, you can, you can grow onions here and they can, you can sell 'em in the states at a time when the onions are not being harvested up here.

And half, uh, you know, 10 years later, half a million people are making their living, uh, growing onions in Honduras. And we repeated that. We did it with shrimp farms in El Salvador. We did it with melons, with cantaloupe, with snow peas, with, uh, strawberries in Guatemala, flowers in Costa Rica, flowers in in Columbia.

Uh, when environmentalists up here wanted to set up a, a corridor in, in Central America so that the animals could run back and forth from Panama all the way up to Mexico without, uh, being impeded. We were given the task of bringing, uh, the ministries together to negotiate the boundaries of their various national parks, and we made that happen.

Um. When teachers in Peru asked for assistance in, uh, reforming the ways they teach kids how to read, we got that job. Uh, when the various countries in Central Asia that were, when the Soviet Union fell apart, you know, the, the energy systems there were not built to respect borders. They had transmission lines and irrigation ditches that just went all over the place with no, no metering to know what they were really selling to the, to the country next door.

So we got that job to try and bring the governments together to negotiate appropriate arrangements so that we could fight corruption in the energy se sector. There were a lot of smuggling goes on through the wires of electricity. So when smoke came, I could go on and on and on about the types of things we did.

But, um, that was the tool that the US used, the primary tool that the US used to do anything. In between, between military and diplomacy, and that tool's gone. And that's a real tragedy. 

[00:18:57] Rita Burke: Well, your stories are fascinating! On SpeakUP! International, we seek to inspire, educate, and inform, and there's no question that is happening here to hear about a connection between USAID and shrimps and onions.

I'm very surprised, but I'm happy to hear those stories. But at the top of the show, you spoke about meeting people from the Ministry of Education, and could you tell us any other stories about meeting people and how they responded to your advances? 

[00:19:42] Clifford Brown: Certainly, um, you know, one of the. We were always encountering government officials that had, uh, their own positions on different matters.

We were there, there was one event I recall in Guatemala where there was a, a barge loaded with corn that the US was bringing down to, um, distribute to very poor communities in Guatemala. We had a, we have a large surplus. We, or at least we had, I, I think we still do because the, the farm program still exists and the government will periodically buy corn from farmers.

And so part of what we used it for was to respond to humanitarian needs overseas. Well, this particular barge had had somehow, uh, the corn had gotten wet with seawater on the top of the barge when they brought it down to Guatemala. So the Ministry of Guatemala would not allow it to be offloaded. So we had this crew sitting on an American tugboat, uh.

In front of a barge, it was just parked out there and we had to figure out what to do with this corn. So we went down there and tried to get the ministry to give us permission to unload it, and they would not do it unless we ensured that it was buried. And we had chicken farmers down here that wanted it.

Uh, we knew that it would be useful. Even they said it, it wasn't gonna be healthy when they, because of the seawater on top. So we tried to, um, to get permission to just give it to the farmers and they said, no, you're gonna have to bury it. So we, we brought in trucks and we, we took the corn off the barges and we, we arranged for it to bear it be buried.

And about a week later we found out that it all, somebody dug it up. We think it was the same chicken farmers that dug it up, but, uh. I had a, one of the topics I was hoping we might get to was, um, our interaction with, uh, faith-based organizations in, in Kenya. I remember one time we had a program that we had guys on motorcycles that were driving around giving measles vaccines to people and they had their, their, uh, hypodermic needles in the medicines on one in one saddlebag.

And on the other side they had bibles. And before you got a shot, they would get out a Bible and they would, they would read a passage and you had to say a prayer with them before you got your measles shot. And, um. Uh, I thought that is, that, that's no problem. I mean, that's, that's, we're not there trying to sell religion.

We're, but we, we are using this faith-based group to distribute, do something that we think is quite useful to the community. Um, unfortunately my my boss said, no, no, no. We can't do it. If they're gonna start saying prayers before we give them the hypodermic meals, we're not gonna, we're not gonna let that happen.

And I, I fought that battle for 20 years. Uh, it, it, it's, uh, as I say, I could go on and on with, with particular stories. That's why I call the book an odyssey because there's so many different events that, and, and fields and whatnot that we worked in. It's, it's a, it's a real hodgepodge, and, and my stories are just mine.

And every USAID officer could probably give you a list of stories also about his, his or her own experiences. It, it's, as I say, it's, it was never boring. 

[00:23:02] Ellington Brown: So you mentioned a little bit about you enjoying the rules or learning about the rules. So how did you personally reconcile rules with that were written in Washington, and how did you use them, let's say, when you were in Africa? Were they applicable? Tell, tell us about that. 

[00:23:27] Clifford Brown: They, they, they were, we, well, first of all, most of our projects are, are implemented by other organizations.

In other words, what we do is we com we put these proposals out on the street. And by the way, the, the proposals were not cooked up by say it alone, every. Proposal we ever had was always fully vetted with Congress, with, with the executive branch, with the State Department, and it was a, whatever it was we were doing, it was an objective of the US government.

So it wasn't just USAID that was figuring these things out, but to, but to give money to anybody, whether it's a contract or a grant. There's a, there's an elaborate competition process that you have to go through and, and, and there are also exceptions to those competition rules. So just to do it, uh, in that sense, part of what I was working with were the, the common procurement rules and regulations that apply across the board to the Department of Defense and any, and every government has their pro procurement rules.

These are ways to make sure that there's a fair playing field because there's a lot of different organizations that want the money. So we would give grants and we would give contracts to other organizations and that you have to. That the, that the, uh, publication of the request for applications is properly done.

You put it on the street, you receive applications and, and those, if applications are evaluated by a committee, the committee operates under its own rules and it, it must, uh, come up with a memorandum. They present that to the contracts officer. The mission director is not involved in that. They, they, in fact, they're prohibited from being involved in that.

And yet, at times, if you can justify the need to do it in a non-competitive manner, it's the lawyers that have to decide, did you write a good enough justification? So, and I, I talk about this. In, in the book too, that we were not just lawyers writing rules. We were quite often the judges because then our own people would come to us and say, have I written a waiver that's that's appropriate?

Have I convinced you that this is the only organization in the country that has the capability of doing it? And we would say yes or no. And of course there were many other times when judgments had to be made because of rules. Uh, at one point there was a coup in Guatemala where President Serrano surrounded his Congress and his Supreme Court with soldiers and arrested the, the congressmen and the, and the judges and the US said, well, we're terminating all assistance to government organizations.

And you might think that's an easy decision, just go through the list and see who's government and who isn't. And, um, but it's not, there are things like parastatals that happen to be, for instance, the human rights ombudsman in Guatemala. So if we are helping him, the government said that all of the stuff that we use is gonna be turned over to you. Well, the Ute stopped existing because the government fell apart and the same thing happened in Somalia. So the lawyers had to decide, well, what are we gonna do with this stuff now?

Can we ship, send it across a border to another country and use it in a different project? I mean, there was always, always rules, uh, coming up. The example I gave earlier about locusts, uh, spraying for locusts in Ethiopia, we had the same thing with HIV AIDS when we wanted to combat HIV AIDS. And yet we're prohibited from, uh, assisting the military or the police.

Well, the police and the military are some of the primary vectors for spreading this disease if they're visiting lady friends in different cities. So we need to work with them to prevent this disease, but that's not assisting the military that is preventing disease. And they would come to the lawyers and ask us questions like that.

So yeah, there were always rules and they applied. And the reason they came out of Washington, and here, I I, you ask a good question because that was one of the most difficult things I, I coped with early in my career. Uh, my boss came to me ringing his hands and he said, you know, the auditors said that you didn't follow your own rules.

And this was in Peru. We had built, um, well, we were given money to help recover from heavy rains in Peru. The El Nino, the current that comes up the west coast of South America had, had, uh, gone in a different direction that year. So they had incredibly heavy rains, and we used some of the disaster assistance money to build streetlights in a poor, uh, uh, neighborhood that had been destroyed by, by these rains.

And the auditor said, that's not disaster assistance, that's recovery assistance. And so you haven't followed your own rules. And my first reaction was, well, so what? We wrote those rules. We thought, we thought that, you know, building streetlights is something that they needed because of this disaster.

There was a lot of looting going on and whatnot, and the auditors said, no, you can't do it. And I, I had, I had trouble understanding why our agency was so. Upset by this audit report that said nothing other than you didn't follow your own rules. And, uh, wiser people than me said, well, Cliff, look, when we write the rules, you know, the people that come after us are gonna have to follow 'em period.

Even though they're with the same agency. And it's the agency's own rule. It wasn't a, a law or a statute, it was an internal regulation that we had cooked up. But it was always a dance of sorts to decide when you winked at it or when you didn't. I don't know if I've answered your your question fully, but that's that's my .....

[00:29:07] Ellington Brown: You've answered that, that question fully. You talked a little bit about, uh, working in South Africa. And I'm just, I'm wondering how was your interaction with the people that supported you in South Africa? Can you talk a little bit about those individuals? I'm talking about natives 

[00:29:32] Clifford Brown: Certainly! Um, we had a major program in the nineties to support the anti-apartheid movement. So there were a lot of NGOs. Those are non local, non-governmental organizations. And they were primarily the, from the black community in South Africa. And they were, they were fighting against the apartheid regime.

And I have a good friend, Aaron Williams, who was the head of the Peace Corps, uh, at one point. But in when I, he would, he and I worked together in USAID. He was with USAID before he joined, um, the Peace Corps. And he was actually the mission director in South Africa when Nelson Mandela got out of jail. And it was.

His mission and, and it preceded his own tenure there. But they had been helping the apartheid movement, which succeeded in, in no small part because of some of the assistance that we gave them. I mean, obviously it was a, it was a cause that was going to succeed. Um, and those people were incredibly grateful for the, for the help.

Um, we had human rights defenders. If the government, at the time it was the white government of South Africa, if they were fighting back against some of these NGOs and they didn't appreciate what they were doing, they people would be charged with violations of their own laws. And we had, we were financing a program that supported the human rights defenders and we had a network of human rights defenders that would to fight to get these people out of jail and, and fight to let them continue their work.

Um, and. You know, we can't claim a credit for the entire event, the success of that movement, but we certainly played a big part in it. And tho the locals in South Africa were quite grateful. For me, it was an interesting experience. I was not directly working on those programs, but I passed through South Africa a few years later.

Uh, I was on my way to Namibia for the, the anniversary of their independence. That's a country that used to be German, Southwest Africa. It's to the west of South Africa. Um, and uh, when I came back through Johannesburg, and by the way, Johannesburg just blew my mind when I first saw it from the aircraft.

It looks like Chicago. I mean, it's a, it's a huge modern city, but I deliberately took a day there to try and get a tour of the city because on my way to wind hook the capital of Namibia, I didn't have time the first time. So on the way back, I. I, I found a woman, I, I think she was a Jewish woman who, who was giving tours and she took me around it personally and was showing me the sights in the city.

And we were, we spent the day talking about it. And I, I happened to believe that the, the religious side of the white community there, and I'm basically parroting back what she said. They knew that what they were doing was wrong, and they were the ones that eventually decided, look, we've gotta give this up.

This is not right for us to be controlling this place. And it was, it was very much a, a, a phenomenon of the, uh, not only was the lobbying coming from the, the, the NGOs that, that were largely from the black community, but it was also the part of the religious community of these people are descended from Dutch and English settlers and the religion.

Both the Christian and the Jewish faith are very, very, uh, well represented in the, in the white population there. And that had a major role, I think, in, in why apart that was finally abolished. So that was one of the more gratifying trips that I took, and it was edifying to know that, you know, our assistance did what it did.

And it, and it ties into the recent termination of USAID because Aaron thinks that Elon Musk was there when it was happening, and he had a bone to pick with USAID, you know, and he was, he was the guy that Trump allowed to dismantle our agency. Uh, that's just a theory. We don't know that for sure, but he certainly took a chainsaw to the agency and, and bragged about it.

[00:33:40] Rita Burke: It sounds to me as if you are super passionate about USAID and obviously you were involved with it through. Over 27 years. And it also sounds to me as if you could write a book on each country that you were involved in, because there's so much father there to write about. So here's my question to you then. How would you respond to the question if I had my way as it relates to USAID? How would you respond to that question? 

[00:34:17] Clifford Brown: Well, I've thought about this a lot. Um, what we did allowed us to see people and situations and countries in so much, so many different contexts that I came away believing that the entire experience made our nation wiser.

What I've come to believe now is that national borders in the very presence of a nation state. It's an historical anachronism. And if you think about it, how did, how did borders get established? They were established because some people in a particular area wanted to keep the others out so that, that it was only they that could use that land.

It was essentially selfishness, which started it. And then after a given kingdom got established, they might, they might have discovered that, well, if we control the kingdom next door, we can make them pay us tribute. And that process continued and different empires grew. And what you've got now are very large nation states.

If you didn't have such large nation states, neither would you have such large militaries. Which as we've recently seen, can take their direction from a single person. So we wouldn't have a guy like Putin in charge of the Russian military. We wouldn't have Trump doing what he's doing right now with the, with the US military.

None of that would happen if these big nation states didn't exist. So if I were omni, omnipotent and able to make anything I wanted happen in the world, it would be do away with these national borders because they do more harm than good now. They have allowed these, these vast militaries to exist. They keep people from understanding each other, from even seeing each other.

They restrict immigration, they restrict trade, they facilitate, uh, corruption at the border. Uh, they do all kinds of things that, that, and they are an historical anachronism that grew out of selfishness at the beginning. So that's, that's what I've come away with in my, in my old age. I wish those borders weren't there.

And it's the same reaction I had when I was 13 and my family traveled down to Mexico. I had never been out of the US but we drove down into Mexico on the way to visit my, my paternal grandmother in Texas. And I stood there at the border between, I think it was El Paso and Juarez, and I, for the first time in my life, I was looking at an international border.

I said, why is that fence there? Because people on one side were so poor, and people on the other side were so rich, I didn't understand it. And you know, it's, it's some 63 years later, I still don't understand it. I wish it weren't there. 

[00:37:16] Ellington Brown: Well, you know, I think a lot of people don't, don't, don't understand it.

And we know that millions of Americans did not, uh, respond favorably to the idea of cutting USAID to millions of people that have been supported by it. And, and yes, it, it, it did help, um, the US gain favor with a lot of these countries because they were, they were supporting them. So in some ways, yeah, it was a probably a good thing.

And so I have two questions. One, you talked about the fact that they, you, you guys buried that corn and then it was dug out by the farmers. So talk about the attempts that were used to persuade farmers to grow, uh, cocoa, uh, or should I say coca as opposed to cocoa? And how did you, how did that struggle end?

[00:38:25] Clifford Brown: Well that's, that's one area where I think our foreign assistants has not really been successful. I was the deputy director in Columbia for, for two and a half years during the height of Plan Columbia, which at the time was the third biggest program we had in the world. And the state Department was there with, with an army of spray planes, and they were spraying the coco fields.

And then USAID's job was to go train the same farmers to grow it. It's cacao. Cacao is the, is the material that the, the, the bean that you make chocolate out of. And so we were, and you can grow it in the same kind of land where they used to grow coca, which is the raw product for cocaine. And we were training farmers to grow cacao to make chocolate.

And we do that in Peru and I think they're still doing it in, in Ecuador and Bolivia. And at the time. We were successful in reducing a lot of the coca production, but what the farmers, we couldn't possibly compete with the drug industry because a farmer that's way off in the mountains in, in Columbia, if he is growing coca, you know, the, the drug dealers will come and provide him with the seeds and the fertilizer and the inputs and give him all the material they need.

He doesn't have to go to town and buy it. And then when his harvest is over, they'll show up at his farm and pay him cash and a good price for that coka so he doesn't have to try and market it. Well, we can do all the teaching in the world, um, to, to teach him to grow whatever, whether it's cacao or palm oil or anything that eat that might take the place of the coca.

But we're never gonna compete with the drug dealers. So the only real solution is either legalize it or, you know, if you wanna spend a lot more money on enforcement. Okay. But, uh, my, I came away believing that it was a waste of time and 20 years later. Uh, the proof is in the pudding. The Columbia is back up there at one of the, perhaps the biggest produ producer of cocaine in the world.

And the same thing happened in the poppy business in Afghanistan, and it happened in the cocaine business. We would fly out of Lima, for instance. I spent three years there, three and a half, and we would get on a plane in, in Lima, we'd fly for a couple of hours. We'd land in a, in a small airport in the, in the west, the eastern side of the Andes, where the jungle is.

We'd get in a car, we'd drive for half an hour or an hour. We'd walk another 20 or 30 minutes up into the hills and we'd see a nursery that we were supporting. Well, I just flew over probably a million times the territory that that nursery involves. Do you think that's gonna change per we could do this?

Thousand times and the coca is still gonna get grown somewhere. And if they can't grow it there, they're gonna move over next door into Brazil and they'll grow it there. If they couldn't grow it in Columbia, but they can, they would go to Venezuela. I mean, we're never gonna control that. So that's that.

That was a waste of money. That's my take. 

[00:41:24] Rita Burke: So then you as a young man went to law school in the States and became a lawyer. And obviously there were career related content that you learned, and then you started to travel around the world, and I'm sure that education was much more extensive, intense than what you learned in law school.

So was there anything that surprised you as you traversed the world in your role as a person working for USAID? 

[00:42:06] Clifford Brown: Well, I guess surprised, I, I was surprised to see that we are so much alike, uh, you know, back here in the us you, you, you just don't appreciate how, how alike we are. But when you, you get out there and you start working with people, especially if you've try to learn their language, and I, I did because I enjoyed that process.

I, I, I, I, and it was a, it was a bridge that allowed me to communicate with pe, with pe, with the local people a lot more than I would've without it. So at, at the bottom of the human experience we're all alike. And that, that is not. It wasn't so much a surprise as, as it was a deep impression that I remain convinced of.

We are not that different. And, um, it, it becomes apparent when you work with anybody for any length of time that you have. You're both humans and you need the same, the same thing. The other thing that, I guess I will say that the whole, the whole world's still learning how to govern itself. Governments are still figuring it out.

They haven't gotten it right yet, and they haven't, they especially haven't learned how to avoid the negative impact of the, of the money. And, you know, we see it in the states now and it's, it's certainly a dominant figure overseas, but I think that. When I first interviewed with USAID, I, my biggest question was always, does, does it do any good?

And, uh, the the one response that I still remember was, well, I don't know, but at least it keeps us in contact with the good people. We get to know 'em, we know who they are, and we know who to work with. So, um, that remains, I think the, uh, the biggest positive benefit from engagement overseas is that you, you know, those people, uh, and you don't know 'em if you don't engage.

So that's what I think is, is probably our biggest loss right now, is that we're no longer working with them. 

[00:44:25] Ellington Brown: Yeah. That is a very sad thing. But speaking of sad things, bride kidnapping or human trafficking. 

[00:44:35] Clifford Brown: Yeah. 

[00:44:35] Ellington Brown: You may have witnessed that. Can you talk a little bit about that horrible situation? 

[00:44:42] Clifford Brown: Sure. Um, when I got to Kyrgyzstan, I was surprised in, in Central Asia, it's, it was a tradition stemming back thousands of years. The young men are actually literally encouraged to go out and take a bride.

Take a bride, and so we, it was illegal during the Soviet times, but the, the, since it fell apart, that practice has seen a resurgence. And so my own wife, my, I married a kgi woman, she was my Russian tutor and she still is, and she's the one I, I have three kids with. But her older sister was kidnapped. And yet they're still married and they have a family.

We, we hired a film crew out of, uh, Eastern Europe from the, um, Vienna. It was a University of Eastern Europe, and they brought their crew out to Kyrgyzstan. They interviewed families and they, they asked them permission to, to film the entire process. So in the first scene, you see a young man, he is getting dressed up and his grandma is next to him and she's saying, don't get a pretty one.

I want one that's gonna work. And then he and his friends, his male friends of his same age, they go out in a, in a car and they, they grab a girl that's standing in line to board a school bus and they drag her back into the car kicking and screaming, protesting, she's gotta go to school. And they tell her, honey, your school days are over.

And they take her back to the groom's home. And the groom's, female relatives, his grandmother, his aunt. His aunts and they all surround this girl and they try to convince her to put the scarf on. And once she puts the scarf on, they consider the deed done. She is now his wife. And the same film crew went back a year later to interview these couples and there were four of 'em.

And in three of 'em, the ladies are still there. And they, some of 'em, they have, they have kids now and they're saying, yes, I love my husband. And the fourth one, they went back a year later and the, the woman had committed suicide. I have personally sat in classrooms with young women dressed like westerners who have told me, uh, this was at the American University of Central Asia, these, so they speak English and in their classes there.

And these ladies told me, this is how we do it. If we didn't do this, we don't date. So this is how we're going to get married and, and this is our tradition. And I would always respond, well, slavery used to be tradition two out here, and you think that makes it right? The other phenomenon I encountered in West Africa, that of human trafficking, and it's not just human trafficking, it's body parts trafficking.

There are freighters from, uh, the major shipping lines that are crude mainly by men from Southeast Asia. They're, they're from Indonesia, the Philippines from Thailand. And W one, one of my colleagues met two women who had been smuggled aboard one of those freighters into conakry one evening during some, some chaos in, in downtown Conakry.

Um, and they approached him. They didn't speak, uh, they didn't speak French or Susu, which was the local dialect, but they spoke enough English to, to tell him their, tell him their problem. They had been lured onto the ship with the promise it was going to America or, or to Europe. And instead they're brought to, um, the, the, uh, west coast of Africa.

And they're installed in a, in a, in a home there. And then on at night, they're forced to go out in boats and as sex slaves to, so the sailors, they're, the sailors are afraid to come ashore because of the HIV AIDS. So they take the ladies out to the boats, and when those ladies object, this is where it gets worse.

And, uh, this part is not for children, but the, uh. There's so much, uh, charter, there are so many charter flights going back and forth from Africa now to China because of the Chinese projects in Africa that the crewmen on the, the planes and perhaps the workers that go back and forth, they've discovered that they can take body parts back to the, to Asia to be used in medicine.

So if these ladies object to what's happening, they become involuntary organ donors. And it's, when I learned about this phenomenon, it was after I had already retired from usaid, but the same fellow who was the defense outta shape showed me a video. I will not bother to describe. I was so convinced that, you know, the, the stars were aligning about the same time he showed me that video and told me what he had learned.

I was offered a job with the American Bar Association Rule of Law Program in their Africa Bureau, and I went back to work for a year so that I could at least make other donors and appropriate parts of the State Department, DRL, some of the various divisions that might deal with this sort of thing, aware of it.

And I spent a year talking to them about it. It's still out there. It's still real, and it's one of the most horrendous. Uh, practices that I've ever learned of that's, it's not just bringing these ladies and trapping them, and it goes both ways. They also are trapping African women and taking them up to say, Ukraine or Odessa and other places, the, uh, the Middle East, and they become sex slaves there.

So they're, it's, it's this, it's human trafficking and both directions. But the bo body part trafficking part to me was just over the top. Unbelievable!

[00:50:14] Rita Burke: You have lots of stories, you have intriguing stories, you have profound stories, you have exciting stories, you have sad stories to tell. And you said at the top of the show, one of the questions that you asked was, does it do any good? And so my question to you, Mr. Clifford Brown, is what good did you do as an agent of the USAID?

[00:50:40] Clifford Brown: I was part of the. The program. I won't say that without me, it wouldn't have functioned, but we all made it function and the program itself did a lot of good. There is a, a website now that's tracking the deaths that, uh, there's a certain group that, that is monitoring the deaths of children that we would've, that our programs could have avoided. Um, I was part of the agency that made those programs happen. So when you ask what did I do, um, my role was as important. I won't say it's more important or or less important than that of every other bureaucrat that was making those programs function. But we made those programs function and they did a lot of good, um.

My own individual effort. Where I probably came closest was in speaking about ethics in government. I, I, that was one of my gigs, was to train our own staff on some ethical rules that applied across the board. And at one point I was asked to speak to a group of Central American bureaucrats and, and when I started to explain to them the rules that we had, you could see throughout the audience sort of a sense of shame that they did not have.

Ethical rules anywhere near the, to the level of detail that we did. So that was, and, and now 20 years later, all of Central America does have rules preventing government officials from taking gifts, requiring government officials to file reports of their assets and liabilities and stuff. And I claim, uh, you know, a significant part of the, the consciousness raising will you if, if you will, uh, in that particular effort.

But, um, you know, the, the, the implementers themselves were the ones that were running those programs. We just put them in place. So I'm not gonna try and claim credit for saving a life here or there. I, I did have an experience later, after I got out of the agency setting up a shelter for homeless teenagers in, in Washington state.

I mean, we have a lot of issues right here in the states that need, need help too. So, um. I consider myself honored to have been part of that program, but I can't claim individual credit for any particular event. 

[00:53:07] Ellington Brown: You, talked about USAID being dismantled and how you feel behind it's being removed.

Can you tell us what some of the individuals who need USAID and they know they're not getting it anymore? How are they taking the news? 

[00:53:34] Clifford Brown: You know, it's, it's, it's very sad. I have so many. I was lucky to have already been retired when the, the agency was destroyed. But I have, I have a lot of friends that were still with it, some of whom were just years away from vest.

Their pensions, vesting, uh, I mean, imagine how you'd feel you worked for 18, 19 years and you got one more year to go before your pension vests, and all of a sudden you're out on the street. It's a, it's a real tragedy and, and everybody's dealing with it in their own way. I, there was a, a woman I know, a widow who brought her three adult, well, she had one adult boy and two minor children, but fortunately they're, they're fairly old. And, uh, she worked for us for 20 years in Kyrgyzstan and we have a, a law that says if you are a local citizen of another country and you work for the US government for 20 years, you can get your green card and you can come here. She brought her family here and I said, at the time, you're not gonna have any problem getting a job.

You speak Uzbek and kgi and Russian and you're gonna get a job. And she did, but all of a sudden, but she got a job with a USAID contractor. Now, now she's working at a local grocery store putting cheese in bags and she's. Taking care of an autistic boy on the side just to make ends meet because, uh, and her story is one of tens of thousands of stories of career people who were very dedicated, wanted to work in this area, and now the whole field has been destroyed.

So the, it's not just the usage staff, it's all the staff of those implementers I mentioned, they're out on the street. Some people decided to, to start driving food trucks. Other people are, their careers have changed completely. Uh, so they're all doing the best they can. It's like a big bankruptcy case in that sense.

It had harked back to my prior career before usaid. It's a mess!

[00:55:21] Rita Burke: Uh, is there anything, is there anything that we have not asked you that you wanna share with your listeners? 

[00:55:33] Clifford Brown: No, I think you've given me, uh, a quite a, an open forum here to, to, to say what was on my mind, and I thank you for it. It's, uh, it's, it's been a, a, a, a gratifying opportunity to really get into a, a whole lot of aspects to it.

The, uh, I try to tell my stories in, in, in, in my books, but again, they're just my stories and there, there's so many others out there that need to be told that, uh, I hope people will be curious to hear. Um, I, uh, as I said at the beginning, ideas are the most important thing that's out there and, um, I, I can only hope that at some point.

Our either the agency itself will be revived or something similar will be created to take its place. And you know, it's the other Western donors have have their own programs and they're still out there and a lot of the slack will be taken up by them. So on that point, I think it's not, it's not a completely hopeless, uh, uh, situation.

I think the, the, the impulse that humans have to help each other is still universal and it's, it's out there and it's not going to disappear just because of what happened in USAID. And I, it's my hope that, that our programs can be revived at some point. So anything I can do to sort of stimulate interest in the field and in the, in what the agency did, I'm, I'm very grateful to, to be able to do that via your program or others like it.

[00:57:16] Ellington Brown: Boy! So now you've lived this very, I'm gonna call it chaotic, life. Very exciting life. So now that you've, left, South Africa, I'm gonna use that as an example. You back in the States, what do you think was the most important thing that you learned from that experience?

[00:57:46] Clifford Brown: As I said before, I think it's the, it's the common humanity that we all have. I, I learned that we're just not so different and I, I will continue to try to. I'm studying Chinese right now. It's, it's, it's, it's, it's a fun experience. I, I get on the phone with a lady and, and don't Guan China most mornings, and she, she's trying to learn English.

I'm trying to learn Chinese and we we're gonna continue that. And while my health holds up, I'm gonna, I'm gonna do what I can to stay involved with, uh, um, people of the same ilk as it were. Um, that's what I learned is, is that people everywhere are pretty much the same deep down. 

[00:58:33] Ellington Brown: I think people who, who travel outside of the US understand that, that concept.

[00:58:44] Clifford Brown: !Mm-hmm. 

[00:58:44] Ellington Brown: And I know that I didn't understand that because, well, let's face it, uh, propaganda comes in many forms and when you're listening to the news in the states. You think that the sun rises and sets, behind the United States, and when you go to another country and you listen to the news, you realize that the United States is just an integral part of everything else.

It's not the, uh, be all that end all. Even though it looks as if the people in Washington are trying to move in that, in that direction. I am so happy that you, uh, came on and we got a chance to, uh, talk to you about how all of this got started for you, your first encounter with, uh, individuals, organizations that need, uh, USAID bureaucracy and that all of the impossible things that well, at least you thought were impossible, that were coming your way as lawyers.

You guys found a way to work around, and I think you proved that when you talked about that corn. And you, you know, they showed you to bury it and, well, it's still gotten to the hands of the people who, who need, who need it, and fighting for, you know, drug, drug trade and making sure that drugs that are necessary for people to live, um, a fruitful life that they did get them.

Um, even though it may took some fast dancing to get those things done, we talked about the brutal reality of living, uh, in that, in that culture and what it can bring to the individuals who are a part of it. So, I thank you for today. Uh, I, I wanna know, uh, one thing. Before I forget. And you talked about another book that you wrote.

So I have the cover of the USAID book, and it would be great if you can send me a copy or a cover of that book, um, because I'd like to use that when, when as the..... 

sure! Well, this is it. I'll send it, I'll send you the whole ebook. Um, and the, the other one is called Dilettante. It came out about four or five years ago, and it's, it's not, it's, it, there's a bit of overlap between them, but no, the other book tells about my, my fellowship down in Latin America.

Some time I spent on an oceanographic ship and, and got me down there and some of my early childhood experiences. But it, it's the to, I wrote it for the sake of my kids. Uh, and, and yet it, I thought, well, well, now it's written. I might as well put it out there. It's, it's available on, on Amazon and they both are, but I'll be happy to say to you again, thank you.

Uh, please, please. Thank, uh, please, uh, uh, uh, send me that, send me that, uh, ebook. Is the ebook, uh, uh, free. I know some people write books and they're basically, they don't charge for the book. Are you charging for your book? 

[01:02:03] Clifford Brown: Well, it is being sold. Uh, it's, uh, I think it's might be five bucks for the Dante. I think this one's on sale right now for $3 on Amazon, the ebook.

Um, it, uh, but I'm not in control of the, the price of this one. This, this one I think will go up to $8 in a month or so. But, um, uh, yeah, it, it, uh, but I'm happy to share both of them with you. 

[01:02:26] Ellington Brown: Oh, great. Rita, do you have anything you wanna add to this? 

[01:02:30] Rita Burke: Uh, I just want to thank Mr. Clifford Brown for joining us on SpeakUP! International and to let him know that that many of what he, many of the things he mentioned I was intrigued with.

But the three things that will tattoo themselves on my soul and my heart and my mind, because I so agree with them, is the fact that, uh, you said "impulse to the impulse to help each other is universal." I concur. I agree. Next, you said something about, um, "we're more alike than we're different." I so agree.

And the question that I will pursue further is hunger. Borders established in the first place. I despise them, and it's, they're human out, selfish. But that's another discussion. Another conversation. So I thank you being with us on SpeakUP! International! 

[01:03:34] Clifford Brown: Thank you so much!