Clara Faria: Hello and welcome to the Mind the Kids podcast. I’m Clara Faria, a junior doctor and aspiring child and adolescent psychiatrist. This series in designed to inspire, educate, and foster a deeper understanding of the global landscape of mental health of children and young people. And on that note, it's a huge pleasure to have here today Professor Giovanni Salum. Professor Salum is the senior vice president of global programs at the Child Mind Institute, where he's making a global impact on mental health of children and young people worldwide. And he's also an academic, he's an associate professor at the Federal University of Rio Grande do Sul. And today we will be talking about his long and diverse research career that spans research, policy and global impact. So welcome Giovanni. It's a huge pleasure to have you here. Professor Giovanni Salum: Thank you so much for having me, Clara. It's really a pleasure to be here and an honour. Clara Faria: Thank you. So if we can start with the research, the first topic I wanted to talk about is you've led a huge research project with national and I would say even global importance called the Brazilian High Risk Cohort Study. And if you could talk a little bit more about it to our audience and when did it start and its relevance. Professor Giovanni Salum: Perfect. So the Brazilian High Risk Cohort Study really started in 2007, 2008, when the Brazilian government at that time wanted to make a change. And they created what call the National Institutes for Science. It was a government call that put together many research groups. And was at that time that some leaders in our field, like Euripides Jair and Luis Rodriguez, decided to get together the three major universities in the country, UNIVESP, USP, and URGIS at that time, and created a national institute of developmental psychiatry. So that was very important because that funded this cohort called the Brazilian High Risk Cohort. This study is truly remarkable, as you said. I'm very proud to be involved in that study. And I was doing that study when I was a research assistant. So I was, Luis was coordinating that study and I was the, he was the PI and I was the, like his right hand, let's say. And we were able to really design a study that was unlike any other studies at that time. A study that combined epidemiology, but also brain imaging, genetics, and like trying to integrate all the, you know, the scientific elements into into that work stream. That study really was one of a kind. And what we did in 2009, that we went to 57 schools in São Paulo and Porto Alegre, and we interviewed the family member, and they tell us about the whole family. So then what we did is we interviewed 10,000 people. And from those 10,000, 1,000 were selected randomly. And 1,500 were selected by high risk. And we followed them over time, every three years, with an assessment. This includes brain imaging, collecting blood, collecting information about their environment, their schools, geolocating, their voice, their hair to investigate drug use, for example. And we just finished the fourth wave of data collection of that study with 80 % retention. So this means we are able to investigate development in childhood from six years of age up until 32 years of age in multiple waves of data collection. That study allowed us to publish 120 papers, many PhD, many master's degrees. So it's a study that really was able to help so many careers out there. Clara Faria: That's fantastic. And one thing you just said that I find it's fascinating is that the study helped capacity building in our country. Well, Brazilian as well. not only capacity building, but I think it like filled a really important research void that we didn't have. Cause in epidemiology, when we talk about all these big cohort studies, they often come from high income countries. And there aren't that many, think, you know, there's the BHRC, there's the Pilatus birth cohort, but that aren't like, you can count on, you know, in the fingers of one hand, how many cohort studies we have from low and middle income countries. So it's really fantastic.

Professor Giovanni Salum: It is indeed like all the knowledge we have is really biased towards high income countries, right? And that goes into all the fields, genetics, imaging, like all the social terms of health. Really, we know a lot for high income countries, although 90 % of the children of the world live in low and middle income countries. So we really need to understand better what's going on. And it's for us to understand the biology, for example, there, as you said, there's very few studies. Some studies in India, some in South Africa, but very few number of studies investigating mental health. So the result of that is that our knowledge is really biased towards realities that are not represent most children of the world. Clara Faria: I know it was a huge study and it's 15 years in the making, but I wanted to ask you, do you have a favorite research finding from BHRC? And if yes, can you share it with us? Professor Giovanni Salum: So that's a good question. think I would say there are many, let's say. Can I pick three. Okay. So let's say epidemiology-wide, I would say the first one that I would like to discuss is that one study from Danielle Fattori that showed that 80 % of children with a diagnosis of a mental health condition do not get any treatment. Clara Faria: Yeah. Professor Giovanni Salum: So basically, most of children that are out there do not receive any type of care. And that, think, has an importance to policymakers saying that sometimes people think, there's over-treatment. We think that we are over-medicating. are over-treating children in our school environments. That might be the case for some high-income countries. That might be the case by high-income families in Brazil as well. But for the most of the population, we provide very little treatment. So that was the first one I would like to highlight. The second one, would say, like one paper published by Karola Zeebold and Sara Evans Lacow, they made an assessment of the terminance of incarceration in children. The one that was really standing out was poverty. So across everything we could investigate, poverty was the main social determinant for incarceration. And that means that I think those cash transfer programs that Brazil is so proudly off really have an important role here. We need to address social determinants really well and I'm very happy that our country has done so much for poverty and needs to continue to do so. The last one I would say is perhaps a more biological one. I think it's also important for us to understand the biology of the mental health conditions and I would say one study that was done by Louisa Axelrod. She's a was a research assistant, so she worked with me and she published, I think, five or six papers during her graduation. She looked into how risk for genetic risks are transmitted. And what we showed is that the behavior of the parent, the expression of the behavior of the parent carried by the genetic risk exerts part of the risk for their offspring. What that means is that when we are talking about genetic risk, there's also an environmental effect that is being done by the own expression of their parents' behavior. So just to say, to me, the nice thing is that the complexity as genes and environment interact to generate outcomes is something remarkable. And we still know little. We need to understand better how genes and environments really interact. so we can disentangle what's modifiable for people to get better for their problems. Clara Faria: Well, those are really three very interesting findings. As I have an epidemiology bias, I'm going to pick up on the first one because I think it's had something very interesting that, you know, it's often common to hear from colleagues and from even other doctors sometimes, we're over medicalizing children. And yet this study shows this is clearly not the case for the majority of the Brazilian population. And I think when we talk about the reality of the Brazilian public health system, which is fantastic. But we're talking about a population of over 200 million people. So it does not reach everyone. And it's actually interesting because know that there was a recent study done in the UK looking at the percentage of children with mental health problems that have had access to services and it's actually not a high percentage. It is actually quite a quite low number. And I think it matches with what we are seeing now. Our mental health services that we call CAMHS are heavily oversubscribed. Like we have waiting lists of up to three years in some time, plus of the country for ADHD assessments and autism assessments. And I will provoke you on another finding that I found super interesting. So in the recent paper you've published on the 15 years of the BHRC, you've also collected a few measures on educational health outcomes. And a finding I thought it was really fantastic is that you found that some traits, especially positive traits, they could mitigate the effect of mental health conditions on educational outcomes for children and people, which we know usually mental health conditions have a negative impact on educational health outcomes. And I wanted to know if you can talk a bit about that, because you were talking about what we can modify, right? And I think it's an interesting finding in that sense. Professor Giovanni Salum: Of yeah. think to the first point, I would just add that I think I'm concerned about both ends. I think, for example, in the school environment, I do feel that sometimes we are using too much clinical terminology in the school environment. Sometimes it's not about like everyone is ADHD, there's no inattention, everyone is depressed, there's no sadness. So there's this balance we need to take care of, which is understand what's the setting, right? In a health setting, that's one thing. An educational setting is a bit different, right? The second thing I would say though, that you are right, in I think when it comes to mental health, every country is a developing country, right? There is no mental health systems out there. And most countries are not equipped to deal with the needs of the young people over there. And going to the second point, I think that all our assessments and our measures are kind of biased towards to understand problems, right? And then sometimes we are not really capturing the strengths of people more generally. And so in that paper that was published by Mauricio Hoffman, my.. PhD student and now he's a faculty at Santa Maria. We showed that positive traits really mitigate the effects of the mental health conditions on educational outcomes and also on IQ. Positive is in track with IQ to also mitigate low IQ effects on educational outcomes. And I think to me that opens up to this whole field on for us to think what's the best strategy to help children? Is it better for us to help them with the difficulties they have, or is it better for us to invest in their strengths because that can perhaps mitigate their difficulties? So that's very fascinating because it might be another strategy to synergize, let's say, in terms of different types of approaches. Clara Faria: Yes, totally. And I think especially when we think about mental health service capacity, and we know that at the moment there is not enough capacity to see at the same time, every child that needs it. Thinking about synergizing strategies, it would be really interesting if there was like an evidence-based framework to really encourage children's strengths. And that could even be done in partnership with schools, maybe. And that could definitely maybe help migrating to mental health services, which is another topic that I know you're very, very experienced that. So Professor Giovanni was also the mental health state secretary of Porto Alegre. And just for context to our listeners, so Porto Alegre is a huge Brazilian city. It has over 1.5 million inhabitants and you are in charge of, if I understood correctly, you wrote of the whole mental health services in that region. And I think that's just like super interesting because you have like stakeholder experience and also the academic experience. And I wanted to ask you what led you to transition from one road to the other. Professor Giovanni Salum: Yes. So it's a funny story because I was in a psychiatric meeting called the ACNP, the American College of Neuroscience Pharmacology. And that year, Thomas Insel, the director of the NIH, was leaving NIH. And he gave a lecture about his life legacy. He told a story that he was in a room full of people telling about all the results of genetics and imaging to a group of parents. And then there's someone in the audience that said, Dr. Insel, it's very interesting that what you're describing there, but it seems that my house is on fire and you are worried about the chemical composition of the painting in the wall. And then that struck me a bit. think, there was truth there to me. And I was with that in my mind. And then I was leaving the concert of my favorite Brazilian singer called Caetano Veloso. And he was, I was with my wife and then I find a professor of mine called Erno Hamans. And he was leaving the same show and said Giovanni, it's time for us to give back to society. Would you like to be the mental health director of the city? And he was the secretary of health of the city of Porto Alegre. And he invited me to to coordinate them in the mental health sector. And I accepted, and it was the best, one of the best experience of my life. It really changed the way I saw things. I was in a very academic position at the beginning thinking that I was going to distill my knowledge to people. And that was not what happened. My knowledge was not very applicable to many of the challenges the system had. And I learned so much for people that have been there for their whole lives, right? We visited together, like all the service in the city, we were able to implement electronic health record, create new services, create an assessment mechanism for investigating quality of care. We closed really bad hospitals that were not serving children well. We were able to open new units in general hospitals that serve children. So that was amazing. I really enjoyed it. I had support from all over the administration and also we were able to construct a plan for the whole city on what should be treated in each unit of care. But after like two years, my wife said, it's either me or the city. So I chose her and I went back to the university. But when I went back to the university, I couldn't continue doing the same thing. So I diversified my research interests that I started doing work with the ministry about large-scale studies to investigate pathways for care. That's one study that's already ongoing to investigate the pathways for care in each community center in Brazil, it's called CAPIS, and also a national trial for interpersonal psychotherapy, cognitive behavioral therapy during the pandemic and single session interventions. That's another topic that I'm interested for the public health sector. So I really started being interested in things that are more like close to the needs of people. And that has been very rewarding to me, is to shift my attention to things that can promote change and help people more Clara Faria: That's a really fantastic story. When you said about the knowledge you've built during your academic career not being applicable to the reality of well coordinating a hugely complex mental health service, I think that applies a lot to the UK as well, because we are also at the moment in the middle of a national health service crisis, like we have an access of demand, the waiting lists are huge. You can have private assessments, but private assessments are very expensive and only limited, very similar to what we have in Brazil, only accessible for a very limited part of the population. And I wanted to ask you before we go into your fantastic work at Child Mind and impacting mental health globally, what are the main lessons you take from that period walking at a stakeholder level and if there was any major challenge you faced that stayed with you? Professor Giovanni Salum: The number of challenges are like daily, like it's just like so many challenges, but at the same time, the joy is that you find so many amazing people working in the system with very little. So that's the thing, for example, and you make really, you find people that are there. Sometimes I think in us in our academic lives become too much self-absorbed about like publications and our careers, which is...fine, but I think there is a lesson there to be giving to others that it really makes a difference. know, like people are thinking about, there's so many people thinking about making a better system to everyone. So it's really a genuine concern about others that I didn't find in other fields. The other thing I really was passionate about was getting to know the stories, like getting to know the places and how much the way you think about mental health really makes a change. So what I mean by that is that I made a very good friend called Sarah. Sarah Jan is her name. And we could not be more different from each other. know, like she's a very religious person. I'm not very religious. She lives in a Quilombo. I live in a big city. She was very oriented to community practices. I was all about evidence and science and et cetera. And this woman was the person that really taught me everything I know about mental health in the public sector, just because every time we visited a service, she was able to investigate where is the best interest of the people there. So like this whole...way of of asylum, you know, this view that everyone should be put in the asylums which is something that was very strong in Brazilian psychiatry many years ago, The idea of take out liberty from people and not be able for them to express their true selves. And Sarah was like, was completely, it was very easy for her to see and enter service and to whom we should also invest because it's not only about closing services because people need services. Where's the line between like a service, there's violation of human rights and where's the line between how do you work for them to improve and where is time for them to close because there's no one there you can help get them better. So I think that the major lesson lesson learned is that it's at the end of the day to me it's all about people and what you can learn from people and I think it's to be open to learn from people you never imagined you'll be able to learn because they're different from you because in general, they're the ones that are teaching you the most. Just let me tell you one another story about Sarah. When I was, the most difficult time of my life, when my young daughter was in ICU, she was born premature and then she spent one month in the ICU. And I am not, as I mentioned, not a religious person. I was like doing therapy at that time. But the thing that really helped me at that time, my therapist helped, but Sarah was the one helping me the most. Sarah is her whole community, right? So she has a community of 30 people living with her. In her community send me a song. They send me a song which is called like, Malu, which is my daughter's name, open your mind for the breath of life that we are singing your way, let's say, right? So, and I was so attached to that song and I sang that song every day. And that was able to carry me through this very difficult moment of my life. And I think I'm mentioning that just because I think that's all about, mental health is all about that as well. It is about the connections we make with people and the ability that other people are to help us. And I think this goes back also to the positive traits we are talking about. The strengths, they're not only about what they can do well. It's how well can I motivate other people to help me? And I think that type of thinking really got me thinking that, perhaps there are other places in the world that really have that. Clara Faria: That's really moving. And yes, I think what you're talking about a lot is about integrating different perspectives. Because as you said, in the UK, there was a similar transition from an inpatient-based model of care to a more community-based model of care. And we still have inpatient units, of course. But I feel like the bulk of the mental health care, the idea is to be done in the community. And I think as you said in Brazil, especially after the psychiatric reform that happened in early 2000s, there was a lot of clash. Here there's also clashes, but yeah, it's really fascinating that you said that like, you've became so close with your friend, Sara, that has like a totally different worldview from you. And yet like you could build something meaningful and contribute. Now back to research again, but this time at a global scale, because I know that currently you are the Senior Vice President for Global Projects at Child Mind. And if you could tell us a little bit more about what your work entails. And you said that after the experience as a mental health secretary in your city, you changed the way you see research Professor Giovanni Salum: I was working at the university with those national trials I mentioned. And then the Stavros Niarchos Foundation, is a Greek foundation, reached out to the Child Mind Institute to create a capacity building program in Greece. So they were investing almost a billion dollars in the Greek mental health sector. And they're truly remarkable. The Stavros Niarchos Foundation really invests into things that are transferred to the government. So their model is really together with the ministry understands something that's good for the Greek state. And they were building three hospitals, general hospitals, not psychiatric hospitals. They're building three hospitals in three different cities. And they said, it's not only about building hospitals. You need to build capacity for people to be able to have good systems. So they reached out to Child Might Institute at that time. And at that time, because of my scientific life, I had a partnership with Mike Milham. He was a neuroimaging researcher. And he said, I have a friend that from my science life that is doing public health work. You should talk with them. And then that was when I joined the Child Mind, exactly to help build the capacity building program there in Greece. And I think that next chapter, it was not different. I think, and the reason I say that, because the success of that project was also about people. It was first the connections with people at the SNF Global Health Initiative that already had that model of sustainability very strongly into their DNAs. And the second was about finding connections with Greek professionals that wanted to make a difference. And in that case, let's say it was Anastasia Kumula. She was retiring for her position in the public health sector for many, years. She was doing clinical training for the whole country for many, many years. And she is remarkable. And the reason the partnership in Greece worked was also about that trust. And the reason that I'm emphasizing trust is that there's in an international program, there's so many reasons for misunderstandings, language misunderstandings, cultural misunderstandings there is no trust out there, every misunderstanding is a possibility of a crisis, right? If there's trust out there, every misunderstanding, Yeah, he said that. Perhaps he's meaning other things that you gain the benefit of the doubt, right? So the program in Greece is really remarkable as well. We were able to create with the ministry and with professionals all over the country, a network of professionals to change mental health in the country. We were able to create training programs. We were able to do a landscape analysis reviewing all the papers ever published in Greece. Then a landscape analysis with 4,000 people understanding the needs of the country, review all the laws and policies, everything to make a plan. We were able to execute that plan around training. We are now training teachers about mental health literacy. We are training psychiatrists and psychologists on evidence-based protocols for the health sector. We are now training judges for mental health sector as well because there's a big need, judges make decisions about children's lives all the time. They need to be informed about mental health as well. We were able to create a website called chemi.gr that has psychoeducational information for the Greek population in a credible way. And we were able to create a YouTube and youth engagement groups all over the country. So really remarkable, a whole capacity building strategy for the country in a way that's very powerful. And just like to end, that was very successful that the funder decided to expand that model to other countries and create the SNF Global Center that's now expanding that capacity building model to Brazil and South Africa and also doing other projects in other countries. Clara Faria: Yeah, wow, that's really, really fantastic. About the Greek project, and about the expansion of it as well. I have two questions. So first related to the capacity building and training other professionals and training not only health professionals, but the school personnel and judges and like, how did you all develop that training? Did you use already evidence-based tools available? When we're talking about implementing interventions in other countries, there's usually the challenge of cultural sensitivity. How did you, you know, overcame this? Professor Giovanni Salum: So I think that's a very good question. First of all, we use a more principle-based approach. said, given there was trust, and the trust was built around that, the first thing we said is that it needs to be science-based. The second principle was it needs to be about the children. We are concerned about the children. The third principle needs to be free, because people cannot afford care sometimes and we need to be something for the public health sector. And the last one, we need to measure everything we do, right? If we agree on those things, then we can try to move forward and work with differences the way we are thinking about, right? For example, we didn't say it needs to be cognitive behavioral therapy. No, we said it needs to have evidence. If it's interpersonal therapy or... that's fine, it just needs to have evidence behind it. And that's important because otherwise, you go into, for example, there's so many schools of thought in Greece for psychology that if you go to one school of thought, it might exclude many people. So we needed to really do something that has some principle-based approach. The second thing is that when you're approaching any country or anyone that you're working on, you need to avoid a colonialistic approach. You're saying, I'm here to tell you how to do things. What a bad idea when if you are doing that, sometimes people in the place that you are training know better ways of doing than you. And the worst thing that can possibly happen is for you to be teaching something that's worse than is already established. So you need to position yourself in that's something we have you know, always knew, but it was was able to develop our model as a catalystic agent. The good thing is that sometimes is that there might be competition in the country or there might be not enough support and etc. So external people can help get people together. But it needs to have a catalystic approach, which is basically saying. I'm here to help you connect, to help you and we can do things together. And we can also inject evidence, inject international experience and things like that. So that was the way we did everything. Everything was very collaborative. Everything was a co-creation process. It was not really a cultural adaptation translation. We co-created everything we did with them. And all the short guides, all the manuals were created with Greek professionals, with Greek... input, was very strongly connected. It was difficult, but that's the only way. It's empowering local agents to make change, to help them make change. Clara Faria: I see. My second question was actually more of a curious question referring to Brazil, because I see that lots of the work you're doing is about, as you just said, empowering local communities. And if you can share a little bit, what are your plans for Brazil and South Africa? Both you and I know that there is a huge necessity for capacity building in chat and adolescent mental health in Brazil. Professor Giovanni Salum: So in all those countries, our approach are the same. It has always a data element, right? So we are in all those countries, always start with a systematic review of the literature and understanding everything that has been published about that reality. And we have done for Brazil and we have done for South Africa and we have done for Greece. The second element is we are doing epidemiological studies in all those three countries, the first ever epidemiological studies for mental health in children, know, like a nationally representative sample. So that's another element that's called part of the data element. The second is really about training, right? So it's about evidence-based types of trainings. And what we are doing in all those countries is, again, trying to use the protocols we have developed for Greece, but together with professionals in those countries, adapting them to make them freely available to the communities. We are also launching websites. So in Brazil, it's going to call Junto. Basically, like said, together, that would be the main thing. In South Africa, it's going to be Kemi, Kemi is called Child and Lesson Without Initiative. So we call Kemi in Greece and here in the US. going to be like a...campaigns about mental health, but also psychological information, credible information for parents and children and educators. Then we have a component in fellowships that is empowering like local leadership and we have gatherings, like that's the whole strategy, right? In Brazil, what we are doing is, again, connecting with the ministry. We have a strong partner called IEPS in Brazil that does a lot of public policy. We are also connecting with USP Ribeirão and USP São Paulo for the adaptation of the manuals. We are also connecting with other community organizations to mapping community organizations that are doing mental health work in the country. We are partnering with states, with state of Pernambuco and state of Rio Grande do Sul to do a mental health literacy strategy. So we are partnering with many, many, let's say pilot studies with the idea of informing a national policy, right? So that's the strategy there. And the same in South Africa. So in South Africa, we are doing more of those, community work because there's so much of the care that's provided in mental health for children that's done in the communities. It's called Waves for Change, School of Hard Knocks, Grassroots Soccer, Community Keepers. There's many institutions that are doing what they call task shifting approaches. So what means is that you, lay professionals provide the therapy under supervision of experienced professionals for young people. And they use a lot of this near to peer approach, which is ways that you can see near peers teaching therapeutic concepts, you know, or being there for people in therapeutic concepts for younger people. And that's the richness of this whole thing is that we are now thinking about ways that this near to peer approach could be also be transferred to Brazil, like grassroots soccer, for example, you know, like it's, having attention of people to mental health. So in grassroots soccer, for example, after soccer plays you use therapies to engage men, for example, into talking about their emotions. That's something that's not frequently seen in Brazil, right? Although there's so much being done. So we are also connecting and learning so much as we go along. But the whole, principle-based approach is the same. It is about catalyzing change, it is about trying to integrate science, measure what we're doing, and working with communities for that to become something that can inform national strategies and benefit as many people as we can. Clara Faria: Well, that's all fantastic. And just to wrap up our super interesting conversation today, I wanted to ask you, the common theme as you said is building trusting relationships with people and doing fantastic mental health research, but your career has spent many different areas and you've had so many unique experiences and we have a huge early career audience here at ACAMH and so I wanted to ask you to wrap up. If you could give an advice maybe to your younger self when you were completing your PhD at what would you say? Professor Giovanni Salum: That's a difficult one. I feel so privileged. I love the work I'm doing. I feel really so privileged to have those experiences. And I was only able to do that, I think, also because I had amazing mentors.I had, Luis was one of my mentors, Giseli was one of my mentors, and then I went to NIH and spent time with Danny Pine and Ellen Libeinluft that were my mentors. And then now Kathleen, Peter Szatmari are helping me. So I think... finding mentors, that you can trust and that they can act in your best interest. I think that's very important, right? Everyone, know, like one thing that I think, and I think, I think I like a lot, I will sound a bit childish, but in any case, I'll risk it. I'm very fan of Moana. And then, because I have a four-year-old, so that's my world right now, right? And there's one of the songs that they wrote for Moana is that they say that the people you know will change you, right? And I think that's true. We can only change by the people we know and love in a way. The other thing is the things you have learned will guide you. I agree. think things that we have learned not change you, right? But really can guide where you're going, right? And the last part is nothing on earth can silence the voice that is still inside you. And I think that's to listen to yourself, right? That's the part actually was harder for me. Therapy helped me a bit to listen to that voice. For example, if I had not listened to that voice, all the people in the scientific career always said, you need to focus, you need to focus, And I didn't listen to that. was like, I don't want to focus. I want to experience. Of course, it's risky if you want to be a researcher, right? So it depends on the voice inside you. would say that this is about that. It's about what do you want to do? You know, there's in my way of thinking, there's only one life, the only decision is about, and that Danny Pine helped me understand that, is that the only decision you have is how you want to spend your time, right? So I wanted to spend my time getting to learn, you know, to learn as much as I can about different things. And to me learning, it is not only about what I know, it is about connecting, it is about like, you know, creating a space that you have relationships that you love, that love you, because that's where you are able to say the things that you're not doing right and still learn to grow. So for example, if I know, you know, Louis, for example, is someone I have no doubt that really loves working with me, loves me and et cetera, he can be critical and say, you didn't do that well. That's not a good idea, right? And I can take it not as a personal criticism, I can take it, he wants me to grow and I can grow in that direction, right? So for me, learning was about that. That is where things grow. is when you are able to disagree and exchange experiences in a way that is, if you believe or you are certain that you share common goal, which is to do good for children, right? So I think I would say that. think that I would say Moana, which is basically those three things is, you know, what you learn can guide you. The people are going to spend your time are going to change you and you have to listen to yourself. Clara Faria: On that note, I'm going to end this really, really fantastic podcast. Thank you so, so much for taking the time to speak to me. next week, we're going to receive Tom Osborne, which actually, curious fact for the listeners, it was Professor Giovanni who introduced me to him and all his fantastic work he's been doing in Kenya at the Shamiri Institute. So yeah, see you next week. Professor Giovanni Salum: It's amazing. Please, listeners, see that. Tom, I'm a fan. I'm really a fan.