The Doctor Who Quit Medicine to Fix Healthcare | Dr. Yacoub Hachine's Vigilant Living Story

"I am the master of my fate, I am the captain of my soul."

One of my favorite poems is "Invictus," famous for being read by Nelson Mandela during his stay at Robben Island. However, it was written by William Ernest Henley, who had to lose a leg to tuberculosis as a child and was told he needed to lose his other leg. He refused and traveled the world. That was also when he wrote this poem, as "Invictus" is Latin for "Unconquerable." This is the story of my journey in this ocean with my start-up, Vigilant Living.

Believe it or not, that was me just five years ago. I dealt with weight and health challenges, including issues with my self-esteem and mental health. You may think it's because of HIV. I was born with a genetic condition which leads to weight gain. When I looked for help from a health worker, I learned something is wrong with the system—as a medical student, no less. I took it upon myself to lose all that weight using lifestyle interventions. That was when I decided to leave medical practice, become a health and wellness coach to inspire others struggling with health and wellbeing, and co-found Vigilant Living, a start-up with a vision of promoting longevity, productivity, and meaning for individuals and the public. I have learned two main lessons from the years I spent on this journey.

The First Lesson: From Reductionist to Systems Biology

The first is that current medical practice is based on biology, which we describe as atomic or reductionist biology, because it looks at a person as parts and not as a whole. This is why we have cardiologists, nephrologists, brain surgeons, gynecologists, and even proctologists—if you know what that means. This leads to expensive care, overspecialization, overprescription, side effects, unnecessarily risky operations, lack of empathy, and burnout of health workers.

However, recent discoveries in biology and medicine are shifting this paradigm to systems or holistic biology, because everything—from genes to bacteria living in us, environment, and lifestyle—has a role to play in our health and diseases. Only then can we achieve precision medicine, which is preventative, personalized, predictive, and participatory medicine (P4).

The Second Lesson: Systems Thinking in Healthcare

The second lesson is that we have the same challenge in healthcare. Unlike the interaction being only between the patient and doctor, healthcare has a vast amount of stakeholders and systems, including politics, infrastructure, behaviors, technology, economy, security, ethics, laws, education, culture, and more.

This forces us to shift from the narrative of design thinking for innovation—which I also call the M-Pesa innovation—to systems thinking for innovation, as every small cog on the wheel has an impact on the rest, and any alteration should keep in mind the impact it has on the rest of the machine. This is why WHO created the Building Blocks of Health, including service delivery, health financing, drugs and technologies, health information systems, health workforce, leadership and governance, and lastly, the people and communities who consume these services.

At Vigilant Living, we have learned the value of all these blocks and had to innovate for them or lose the impact and the vision we are aiming for—especially for non-communicable diseases, which are killing more than a third of Ugandans and leading to disabilities, loss of productivity, and medical debt.

The Call for Philosophical Leadership

In the current world, there are many forces at play, including ICT (AI), biotech (designer babies), environment (antimicrobial resistance), governance (corruption), and medical humanities (sedentarism). That's why we need leaders who are not only aware of these forces but are actively meditating on them. We need leaders who are philosophers and storytellers in the world of precision health.

In Conclusion

As a griot, I would not miss this chance to end my speech with a reflection on the wisdom we carry:

We are the ones whose minds have the answers we need, not just the questions.