Clara Faria: Hello and welcome to the Mind the Kids podcast. I'm Clara Faria. I am a child and adolescent psychiatrist in training based here at the University of Cambridge and also a research scientist. And today I have the honor of receiving in our podcast, Tom Osborn. Tom is a community mobilizer, entrepreneur, and also a research scientist. He is the founder and CEO of the Shamiria Institute, which is a grassroots pioneer mental health organization in Kenya, where he is leading some really, really important changes in the local mental health. So welcome, Tom. Thank you so much for being here with us. Tom Osborn: Thank you so much for having me, Clara, and I'm really excited for this conversation with you today. Clara Faria: Yes, me too. So I think I wanted to start by the beginning of your academic journey. So I know you did your undergraduate at Harvard. And from then, you basically went on this fantastic journey of founding Shamiri and having a real concrete impact in mental health of children and people in Kenya. So I think I suppose I wanted to ask you, how did you have that idea? Is it something that was brewing since your undergraduate in Harvard? And whatever else you want to share with us as well. Tom Osborn: Yes, that's kind of precisely where it all began, was during my undergrad at Harvard. But just to give some background context, I was born and raised in Kenya. You know went through the you know public school system here until I graduated from high school so fun fact you know when I was in high school I actually didn't want to go to University, know, I saw myself, you know as an entrepreneur working with local communities Etc. And so actually my first venture was in the climate change space, you know, so growing up in rural Kenya. We were using a lot of like firewood and charcoal to cook which was not only just but for the environment but also for people's lungs. So like my mom had this really bad respiratory tract infection as a consequence of this. I wanted to do something in the space. And so for three years after high school, I ran this company which basically was converting sugarcane waste into clean burning fuel for rural communities. And then I was pretty lucky at the end of that to get a full ride to go to Harvard for undergrad. And initially I thought I was going to study something around energy systems and economics. And in fact, that's what I was studying until my second year where I had to take a inter psychology class as a required class. And this class, you know, kind of had this really life-changing experience for me, you know, because for the first time I was able to see a lot of experiences that I had had from a mental health and wellbeing, you know, perspective, you know, kind of realizing that but not just myself, but all those people close to me were either struggling with depression or anxiety. And so that really sparked this curiosity about psychology and mental health in particular that led me to switch my major to psychology, but to also join a laboratory called the Youth Mental Health Laboratory at Harvard. And it was at this laboratory where my future career path and the work we are doing and Shamiri will eventually end up being formed. to be more detailed, the crux of the work that they're doing in this laboratory was trying to develop interventions for youth mental health and folks like Dr. Jessica Schleider at that time was a graduate student of the lab and there's so many other folks like her who are kind of doing all of this intervention stuff and then they're also doing all of meta-analysis work and trying to really figure this out. Then the curiosity for me was both on the scientific part, but more importantly, what I did see as an opportunity was that a lot of this really cool interventions were in my opinion dying in academic journals. So like every year they published two or three big RCTs in these big journals. And then I was like, okay, why are the researchers then kind of moving on to do the next research project? Why is no one really thinking about how can we take this research and try to build infrastructure that will help us to scale it? And so that allowed me to really find my path at the intersection of working with researchers who are developing these new cutting-edge interventions, but also taking advantage of my community mobilizing skills and my passion for social entrepreneurship and social innovation to try and tackle these from a scaling perspective. So that then informed the work that we do at Shamiri. So Shamiri is a Kiswahili word for thrive. And so basically our mission is to bring at scale this type of brief evidence-based interventions that have been shown to be effective, but to be able to then deploy them at communities and especially low resource communities at scale in a really data-driven and data-informed way. Clara Faria: Yeah, that's really amazing. Before moving to conversation, my God, I just have to say this is so cool that Jessica Schleider was a graduate student at the time because I was actually like when I was reading to do this podcast, this interview with you and when I was reading about, you know, all about Shamiri and the Shamiri layperson intervention and all of that, I was like, my God, so much of this like relates to Jessica Schleider's work. I mean, the efforts of like, obviously it's all your original fantastic work, but like all the efforts of, you know, like a simple intervention that can be scalable. Cause now she's doing a lot of around single session interventions in think Northwestern. And it's so cool that it worked together at some point. And it's really cool to see like how those trajectories intersect and kind of like, yeah, that's really amazing. So, well, to move on with the conversation. As you said, you see, you saw that lots of people around you were struggling with depression, anxiety and other mental health conditions. And as we know, well, I think there is sufficient evidence at least here in the UK to point out to the fact that the prevalence of mental health conditions in children and young people is increasing. And not only like clinical level diagnosis, but also what we call sub-threshold difficulty young people are struggling more. And at least here, one of the major barriers that we have, and our health service at the moment is super-stretched. And whenever we talk about expanding capacity, a problem that people point out often is the cost of therapy and how it's expensive to train psychologists. All of this context is to say that I thought it was a really fantastic and genius is way that you came up with in Shamiri of doing the peer to peer intervention and how you were able to scale that up. So I was going to ask you more about that. Like, how did you come up with this model? Like the model that is the base of the Shamiri, like person intervention. And was it something that you had seen working before? Tom Osborn: Yeah, I think there's a coming together of a few different ideas which were intertwined from my previous experience. So when I was in this lab, you know, what became pretty clear pretty quickly was that there were these brief interventions that could have large effects, right? So the work of Jessica Schleider and Joan Wise, who was the PI, who is still the PI in the lab was really trying to document that you could get similar effects with simple interventions like growth mindset, gratitude, et cetera, but then also that you didn't need more than four or five sessions of just one on one therapy, right? So that was one school of thought that I was really impressed upon by Joan Wise, Jessica, and many other great people who had the love at this time trying to really pioneer this work. The second came from my experience growing up in Kenya. And growing up in Kenya, we had really experienced a of success with this folks called community health workers. And the idea of community health workers from the primary health perspective was that these were lay people who will go door to door across mostly rural homes and be able to do basic screenings for things like malaria, et cetera, basic administration of vaccines and basic meds for malaria helped improve health outcomes quite significantly. So at least in a similar context in healthcare where we still had a posse of expert providers, this community health worker model had proven really inspirational in terms of being the last mile health delivery. And at that time, Professor Vikram Patel, I he was still based in India at that point, was also trying to experiment with of this for mental health, right? But I was convinced, you know, kind of pretty quickly that, okay, like if they were able to have all of a success in primary health, you know, we could also be able to do it with the mental health space. And the third idea was the idea of like community. And so basically that came from... starting in a kind of some of the pioneers of more formal mental health in Kenya, including one guy who would highly recommend for the listeners to check out. It's a guy called Thomas Lambo. And he was the first psychiatrist in Nigeria, I think in 1950s. He was only one psychiatrist for the whole country. And he pretty much realized that a lot of this...in traditional methods that had been taught, could really meet the needs. And so what he did is he built a village hospital model where he basically turned resources within the village, like schools, churches, even just like trees into centers where people could do group work et cetera. And so basically the thesis of Shamiri was was there a way to marry all of these three ideas, you know, from this effective, simple, single sessions that could be destigmatizing and less stigmatizing to task shifting to the equivalent of community health workers to then embedding, you know, all of this work within communities. So what ended up being our model was that we combined really three single session interventions into a much more longer four-week intervention that start growth mindset, gratitude and value affirmations. We combined them into, you know, kind of like a protocol and we decided to train recent high school graduates, 18 to 22 year old as lay providers or version of community health workers in this context. And then we decided to make this work be embedded within schools as a group based model where people go through this content together. Clara Faria: That's so cool. Because like, just out of anecdotal experience as well, like, so in in Brazil, like, have you been to Brazil? I think you were in IACAPAP? Yeah, that's so cool. So, well, I'm not sure if you've seen that, because that like, it's it's a bit segregated. But like, sadly, Brazil, we have like lots of social inequality. So we will have these communities called favelas, which are like embedded within the city and, and like the most successful health intervention that our primary care system has implemented in favelas are the community healthcare workers, which will be someone in the community who has received some basic health skills training, but they're gonna do precisely what the community healthcare workers in rural Kenya, you were telling, did like, they're gonna go to people's houses, they're gonna check for vaccinations, they're gonna check, they're gonna do like basic screenings to see if, you taking your medications for, know, like hyper pressure and that kind of thing. And they will be much more accepted than like, I worked in one of those communities for like a year and...And they would be much more, obviously, if it was something that required more medical attention, we would go and if the patient couldn't move out of their homes, we would go there and we would do like a home visit. But they were much more accepted than us. It would often be that they would be the first point of contact and they would go in first and then they would report because it's just, like community health, community health focus is just something so fantastic and so amazing. And as you said, it's a way that we can scale and reach much more people. So it's really fantastic that you combined those really three great ideas to create the Shamiri lay person intervention. I will link in the podcast because the Shamiri lay person intervention was already tested and published in JAMA and in the BMJ. And there are several articles that I know you've published around it. We will make sure that they are linked for people who want to to check them out as well. But it is really fantastic. also, as you said, like lots of countries in Brazil, there is also a shortage, but lots of countries have even less personnel. And as you said, there is a huge mental health need to be filled. And on that note, what I wanted to ask you is that, I think Shamiri has, you know, in a certain way helped a lot fill this gap for mental health care in Kenya, in youth in Kenya, and looking at all that you've achieved in the past years, what do you think are the main challenges that Kenyan mental health youth still faces? what are the challenges that you're still looking to conquer? Tom Osborn: Yeah, thanks, also for sharing the story you shared. think that also just points out to what I've been trying to emphasize, and I think there's a lot of momentum around more like South-South collaboration, right? Because a lot of these challenges we're facing are similar, at least at an abstract level. And I think a lot of these solutions and ideas can be quite easily cross-planted across these different settings. With regards to the...challenges that the young people in Kenya are facing. You know, obviously it's evolving, you so when we started doing this work in 2018, 2019 and actually prior to COVID, most of the issues were around just societal, you know, pressure, which was a really big risk factor for a lot of mental health problems, just to paint a picture for most kids in Kenya, education is always seen as the only pathway out of poverty. And so you have your parents, your siblings, your community are all really kind of like invested in the education of one person, right? And so you're kind of almost seen to some extent as like a get out of poverty card, if I may use that phrase. And then so this really puts a lot of like pressure on young people the boarding school. So we have a public boarding school system for the majority so 80 % of adolescents go into these public schools. There's also like you know pretty crowded, it's pretty intense and so that you know kind of pressure cook environment was pretty you know it was a really big issue when you're know you're starting to do this right and so we realized actually as we were doing this work initially that even interventions around you know, social skills, life skills, study skills are also quite important and relevant, you kind of in this context. And of course, the, you know, the environmental factors associated, you know, with things like low resources that kind of come into play. But since COVID-19, in addition to that, there has been an evolution in the mental health needs and associated, know, kind of like triggers around them, think. A few things with gene merging, for example, is just digital spaces, know, social media, you know, is kind of starting to become a thing. In the context of Kenya, we've also had issues around... political instability, pharma, and emerging stresses which are increasingly becoming an issue and which are increasingly making it difficult for young people as they're trying to navigate this. We're having all of these emerging stresses which are contributing to mental health. And finally, from the perspective of the work that we have done at Shamiri, we are facing two challenges as we're trying to scale. So the first is who is going to pay for this at scale, right? I'm going to get the government to pay, but governments are generally broken over the computing health priorities. And can get parents to pay, parents are generally broken over the priorities. Because we can't be able to scale through philanthropy alone at some point find ways to scale this bigger and better with a more sustainable pair. And similarly, as Shamiri, we can't scale across the whole country. So at some point, we need to be able to bring on board other players, like local organizations, to also replicate homeowner. Clara Faria: That sounds like a big challenge I had, I have all my fingers crossed and I think you're 100 % right. I think in a very different scale and again, a very different setting and as you also said, I the South faces unique challenges that usually the more developed nations do face but facing different, like in a different measure with different resources. So like, so here in the UK, here we also are in the middle of a mental health crisis so our services are super stretched. Like, for example, we have a two to three year waiting list for like, CAMHS appointments, which is the had and child and adolescent psychiatry services. And obviously, I know that in lots of places, there isn't even a waiting list because there isn't organized service. So given those, you know, considering those proportions, but then I see a similar scenario that of you, the one you described where like, we have lots of mental health charities here that are doing a fantastic job. And lots of them are very serious, like ACAMH, and have like evidence based work and all that. But there comes a point where you know, as you said, from a certain point onwards, you need either government or private money, but like the money needs to come from somewhere. Philanthropy alone cannot do it. So, yeah, it's really interesting to see the challenges you're facing at the moment. And I do hope that you guys are able to kind of scale more and more and get that. I also think it's interesting. So you've mentioned South-South collaborations and and something I've been observing as well is like the role of like global philanthropic institutions. What do you think? Because I know that you've been in both places, right? You've been in the US, you're now based in Kenya. How do you see those relationships and collaborations? Tom Osborn: Yes, my belief is eventually those who are closest to the problem are closest to the solution, in as much as we need to and we must facilitate collaboration throughout the board, I think this has to be done in a way that really empowers and centers the solution around those who are actually, you know, closest to the problem, right? So like in this perspective, you know, it will be great to collaborate with organizations, for example in Brazil we're doing similar work, right? And so my belief, especially when it comes to North-South collaboration is, often what happens is folks who write the checks sometimes confuse that or conflict that with knowing what works best for everyone and in every context. And that is very erroneous in my kind of like opinion, right? And so the perspective that I am taking is that in this type of like collaborations that work should be geared towards really amplifying and empowering proximate solutions. And I think increasingly we're starting to see, hopefully doesn't, you we've had some, this 2025 has been a really difficult challenge for those of us who work in the mental health space from a funding perspective, but immediately post COVID, I think one of the silver linings from the pandemic was it really brought mental health to the core of everyone's thinking and really, you know, unlocked a lot of like funding around this. And this has been really instrumental for organizations like Shamiri to really pick up and to really scale. But now we're starting to see, at least from multilateral funders, for example, USAID is now dead. Other development agencies like the UK, Nordic countries, France, et cetera, are slowly scaling down their portfolios, and the amount of funding that they're giving. And so there's a big impetus now for more locally sustainable revenue sources. And so how I see it is funding unlocks the initial innovation and unlocks the initial experiment and creates an environment that allows us to be able to take risks and build off those risks. But eventually we will need to find ways to get, in my context, the Kenyan government, Kenyan school districts, individual schools in different parts, to also see the value proposition of what we're doing and really be able to support that, right? So those are really key and crucial for me, right? But collaboration remains key. And I think what we can do now is share best knowledge and best ideas. Like we have been training lay providers, and if Fox wants to do that in Brazil, there is no need of reinventing the wheel. They can build off the work that we do, refine it and modify it to make sense in the context, and vice versa. So I do think that is worth a...crux of a super strong collaboration that can turbo-check this movement is going to be creating, moving away from silos and creating learning communities that can empower us to build these systems in approximate way that works for the context that we work with, but is built on years of evidence and best practices and shared learnings. Clara Faria: 100%. And as you said, like context is everything, right? Like, and I think it needs to be context specific. and one of the points you made, which, which I agree a lot with is that oftentimes like the funding agency or the group who's bringing in the funding, especially when we think about North-South collaborations definitely can happen the Oh, but we are implementing our intervention in your setting, and then it's an intervention that comes pre-made and then it doesn't work because there are several challenges that are context-specific. And speaking of challenges, you've mentioned the COVID pandemic and one of the effects the COVID pandemic had globally was really putting youth mental health in the agenda. But I think we were affected differently. when I say we, mean, each country had its unique challenges and likewise, youth mental health organizations had their unique challenges. So I wanted to ask you about...How was that for Shamiri? And is this a more challenges question? What was the biggest challenge the organization faced so far aside from funding? Tom Osborn: Yes, I took them in a few different buckets, So I think the first bucket is translating research into practice. And so what I mean by this is a lot of research that we were building on, a lot of the research that we were...building on was really done in super controlled environments, where you're really trying to maximize for internal validity within the study design that you did. And so a lot of variables are controlled, et cetera. But once you move outside of that context, and especially as you're beginning to scale and you're operating in implementation real-world context, you do not have the ability to pretty much be able to have as much control. So things like fidelity becomes super crucial and super important. And how do you translate and maintain that fidelity as you're that comes with issues of quality control, et cetera. So the first big challenge is just from a technical perspective, how do you simplify evidence-based protocol into a model that can be replicated at scale with as close to similar impact, et cetera. So that becomes one fast and you're kind of a big challenge that we face. Then the second one which a lot of people also face is with regards to basically just how you then build a team that is very complementary. And so for example in our context at Shamiri we had to be able to do three things effectively. So one is implementation, so like on the clinical side, know, be able to technically implement the protocols and the models at scale. Then the second part of it is you also have to be able to collect data and be able to do research and to be able to allow this research to inform, you know, like the work that we are, you know, doing, you know, kind of effectively, you know. And then the third is from a product perspective. So how do you put the, how do you time the research and implementation into a product that users can't interact with. Like how do people sign up? How do they book sessions? How do they follow up? How do they connect to their data? And what we realize is often this requires different people with different skill sets who often don't work together. And so then you need to the team, kind of build that equal know, system, you know, kind of around that to make sure that it works. And that, you know, is a pretty big part, you know, like just building, you kind of that team. And then finally, the other challenge you face is how to sell this. And this becomes especially important in this context where you realize that the different stakeholders you're trying to serve to who often want different things. In the context of Kenya, where we work, most of our work is school based. We're working with students, you know. Yes, a student might be depressed, but the outcome that they're interested in is different from what the parent is interested in or the school is interested in. The school, for example, cares about school climate, want them to stay in school and to graduate and to get better grades. And the student maybe just cares about belonging and interpersonal relationships and maybe not as much about staying in school as the school may want to care. And what we realized, which was for us shocking was, at least in Kenya, for all of of these constituents, they didn't really care about reductions in depression and anxiety, at least as measured by DSM-5-based tools like the PHQ and the GAD, because they just didn't really understand it. They're like, okay, so if I had elevated symptoms, then I don't have elevated symptoms. What does that really mean? What is the consequence of that? And so finding ways to articulate the consequence became very important for us because from a research perspective, what we really cared about was effect sizes, reduction in depressions and effect sizes, how long it lasts. And it makes a lot of sense from the perspective of a researcher or a clinician, but from the perspective of a client what the effect size of D equal to point three really mean. Yeah, like. They don't really, can't really conceptualize that, right? They want us to be able to find ways to take like this and ways that reason and make sense to what they're actually really going through. And so what we ended up doing in our context in this regard was being able to, we call it like a thrive index. So basically we're tapping into things which matter to all of these constituents, from mental health, reduction outcomes, to school climate, interpersonal relationship academic outcomes and achievement and livelihood, which also all make sense because they're all in different parts of the story of mental health. And so moving away from just a purely clean call outlook and presentation to a more thriving and flourishing presentation took us like a couple of years to get to. But it was really crucial because once we figured it out in 2021, we were able to rapidly scale from working with about only 3,000 youth per year to 25,000, 100,000 just in two years because now it was pretty easy for us to get this buy-in and do it. Clara Faria: Wow. Yeah, it's really interesting. You mentioned the last challenge, the challenge about oftentimes clinicians and researchers using metrics that are not like, as you said, like we care about the effect size. So we want to see, you know, the reduction in anxiety, depression, the school doesn't necessarily care for that. And the buy-in of the stakeholders is so important, right? So it is really amazing that like you're able to scale up this much just by looking at like different metrics and by looking at like and I suppose like here, sometimes we do lots of like PPI, we do lots of public and participant involvement groups. And oftentimes, yes, like when we ask when you ask the kids, what is important for you, they're not going to say, my GAD score, they're going to say, if I'm doing well in school, if I have friends, if I am going to get into the university I want to get, and all that. And likewise, the school cares about school, like retainment and all that, the couldn’t care less about the metrics we look at. That's super interesting. I suppose the other thing I wanted to ask you as well is that I know, so it's interesting that in the beginning you mentioned you had some experience with energy systems and that's deemed from your experience in Kenya, growing up in Kenya and using, you saw lots of people using coal and other things like to cook and all that. And that had an impact on you and that made you look into how to optimize energy systems and all that. And then from that, you went to mental health. But now we also have this whole, it's not exactly my area, but I know it's a very pressing and important area in mental health research, which is eco-CAMHS and people looking at the impact climate change is having on youth mental health. And I was just wondering if this is something you're also interested in, because I read you have projects on that as well. And if you can tell us a little bit more about it. Tom Osborn: Yeah, so we've actually done some very preliminary work just trying to understand the association of like mental health as an emerging stressor. mean, like climate change as an emerging stressor to mental health and findings are a little bit interesting in that they are different from the in that they're different from, you kind of some of those that has been coming from the so what we found in Kenya is people are mostly anxious about the more immediate weather pattern changes. Like last year, for example, we had this intense one month flooding, which came up and affected a lot of people in livelihoods and close schools. And the year prior, we had, I think, a small period of drought. So what we found is this more immediate weather pattern changes are at the top of focus minds in Kenya more than the long term warming temperatures and future challenges around mental health. That's kind of the main difference we found. And then I think also the...traditional, unquote, eco and anxiety eco camhs is still also not emerging from the data that we are having here. think part of that also is informed to some extent by the history of the relationship that people have with nature in Kenya. So for example, one story I like telling my Euro-American friends is I didn't meet a climate change denial until I went to school in the US because in Kenya we grew up with environment being a big part of people's culture and the idea of the interconnection between people in nature and need to preserve and take care of the environment. And so I think people are connected to niche in a way that is, at least up to now, buffering some of these issues. But what is starting to emerge a lot is how short-term weather changes are affecting people's mental health. But once again, this is an emerging stress and emerging factor. And obviously, as more data continues to come, we may see how this unfolds. But that's something that we're interested in, and we've been exploring it with a couple of professors in some universities here, University of Nairobi, and Aga Khan University and excited to see kind of where this research unfolds. Clara Faria: I'm really curious to see how it unfolds and what do you find in the success of is is? Well, Tom, to wrap up, I just wanted to ask you, considering all the enormous work you're doing and all you've achieved so far, what are you most looking forward to achieving with Chimera Institute? What is like if you had to, I mean, I you've worked in very...in many different work streams, but if you had to choose one, your most important work stream for the rest of this year and for next year, what would it be? Tom Osborn: Yeah, so our goal at Shamiri is to scale, right? So we want to be able to make sure that we can get our intervention or model to as many young people as possible. And our goal is to serve a million youths per year by 2028, right? And so that is what's in where we're putting most of our energy because basically we are hoping to show not just locally, but also folks in the West that it is possible to deliver evidence-based care at scale at a fraction of the cost, right, if you are oriented on communities, if you mobilize all the resources that you have, including lay providers, know, if you expand the repertoire of interventions that you use to also include a brief, simple, know, stigma-free interventions in addition to the more traditional, know, cognitive-based therapy, for example. So our goal is to be able to to scale up to a million youth per year. We are at 135,000 now. We are hoping to get this to 200,000 by the end of the year and then just like build off from there. Clara Faria: Well, that's really, really fantastic. And I mean, I'm sure you're going to do it because like your passion and your determination for it, it is really, really impressive. I suppose, but again, feel totally free to not answer that. Like I know you did your undergrad in the US and then you moved back to Kenya to kind of initiated this fantastic grassroots movement that is impacting the lives of so, many people. And I suppose there's always, for us that went to do our education somewhere else, but were born somewhere else, there is always a question and a duality of, should I go back? And I was just, I just wanted to ask you like, was that an easy decision for you? And for all the young people out there who are wanting to make an impact in mental health and facing that duality, like, yeah, do you have any advice? Tom Osborn: Well, it's not a simple question. I get asked this question a lot, especially when I travel and meet young people who like you are either in Europe or in America, you know, kind of for their studies or other careers. And I think it eventually becomes to, in my opinion, an intersection of three things. I think the first is where you feel most comfortable, like where and I think there's genius for people, know, as you grow, as life happens, etc. The second is the type of work that you want to do, right? So do you want to...be a researcher, and if you to be a researcher, maybe it makes sense to be domiciled in an institution that has access to more like research funding, right? And then the third is the type of impact that you want to see, right? So for me, it became pretty crucial, you know, to, when I was kind of like doing all of these things, you kind of what came to me was that I felt that Kenya was, you know, kind of where home was. I felt that I didn't really want to be a researcher in the traditional context of working email and just publishing you know kind of like papers where I wanted to do was to work with folks like that and to be able to you know, translate them what they're doing into the real world and at scale. And the type of impact that I was desiring was really being able to build something which could not just scale pretty rapidly, but be also stable and sustainable in the long run. And so when I put all of these three things together, it led me to concluding that the best and the easiest way to do this, you know, will be kind of like moving back to Kenya. But if I was maybe, you know, kind of trying to go the academia route, kind of my decision making framework might have been different from before trying to go the entrepreneurial building route. So my short answer is of course it depends kind of with everyone, but at least for me a good guide is where do I find home slash feel comfortable in, what type of work do you want to do and what is the impact that I desire to actualize in the world. Clara Faria: That's really good advice and thank you for sharing that with us. And I think just to add to our listeners who they will probably know anyway, but I think like in a certain way you have best of both words in the sense that like, obviously, your work in Kenya is hugely impactful, like you also, but your work is also respected within the research. Tom Osborn: Yeah, so I am based in Kenya, Kenya is home, but we do work closely. have collaborators around the world, so like CMI, which you've mentioned, different folks in America, in the UK, even Austria, India, et cetera. So we're always willing to collaborate with people. Our models and methods are open source, open access. We do help folks who want to experiment and try this around the world, people to do it separately. I'm excited to collaborate and talk to folks from around the world. Clara Faria: On that note thank you so much for sharing your research and so many precious insights with us today. For more details you can visit the ACAMH website which is www.acamh.org