Welcome back everyone to the SuperCloud 22. I'm John Furrier, host of theCUBE. This is the Clouderati panel. The distinguished experts who have been there from day one watching the cloud grow up and building clouds and all open source stuff as well. Just great stuff, good friends of theCUBE and great to introduce back on theCUBE, Adrienne Cockroft, formerly with Netflix, formerly AWS retired, now commentating here in theCUBE as well as other events. Great to see you back out there, Adrienne. Lori McVidi, Cloud Evangelist with F5, also wrote a great blog post on SuperCloud as well as Dave Vellante as well. Kind of setting up the SuperCloud conversation which we're going to get into. And Chris Hoff, who's the CTO and CSO of LastPass who's been building clouds and we know him from theCUBE before with security and Cloud commentary. Welcome all back to theCUBE and SuperCloud. Thanks John. All right. Lori, we'll start with you to get things going. I want to try to sit back as you guys are awesome experts and involved from building and in the trenches on the front lines and Adrienne's coming out of retirement. But Lori, you wrote the post kind of setting the table on SuperCloud. Let's start with you. What is SuperCloud? What is evolving into? What is the North Star from your perspective? Well, I don't think there's a North Star yet. I think that's one of the reasons I wrote it because I had a clear picture of this in my mind. But over the past, I don't know, three, four years, I keep seeing in research my own and others, right? Complexity, multi-cloud, we can't manage it. They're all different. We have trouble, what's going on? We can't do anything, right? And so digging into it, you know, you start looking into, well, what do you mean by complexity? Well, security, right? Migration, visibility, performance, right? The same old problems we've always had. And so SuperCloud is a concept that is supposed to overlay all of the clouds and normalize it, right? That's really what we're talking about is yet another abstraction layer that would provide some consistency that would allow you to do the same security and monitor things correctly, right? Cornell University actually put out a definition way back in 2016. And they said it's an architecture, right? That enables migration across different zones or providers. And I think that's important and provides interfaces to everything, makes it consistent and normalizes the network, basically brings it all together but it also extends to private clouds. Sometimes we forget about that piece of it and I think that's important in this so that all your clouds look the same. So SuperCloud, big layer on top makes everything wonderful, it's unicorns again. It's interesting, we had multiple perspectives. C comes like Snowflake who built on top of AWS. Jerry Chen who we heard from earlier today, Greylock Penn, this castle's on the cloud saying, hey, you know, you can have a moat, you can build an advantage and have differentiation. So startups are starting to build on clouds. That's kind of the native cloud view. And then of course they get success and they go to all the other clouds because they got customers in the ecosystem. But it seems that all the cloud players, Chris, you kind of commented before we came on today is that they're all fighting for the customer's workloads on their infrastructure, you know. Come bring your stuff over to here and we'll make it run better. And all your developers are going to be good. Is there a problem? I mean, or is this something else happening here? Is there a real problem? Well, I think the North Star's over there, by the way, Lori. Oh, there it is. The SuperCloud North Star. So indeed, I think there are opportunities whether you call them problems or not, John, I think it's to be determined. Most companies have, especially if they're a large enterprise, whether or not they've got an investment in private cloud or not, have spent time really trying to optimize their engineering and workload placement on a single cloud. And that regardless of your choice, as we take the big three, whether it's Amazon, Google or Microsoft, each of them have their pros and cons for various types of workloads. And so you'll see a lot of folks optimizing for a particular cloud. And it takes a huge effort up and down the stack to just get a single cloud right. That doesn't take into consideration integrations with software as a service instantiated, oftentimes on top of infrastructure service that you need to sort of supplement where the abstraction layer ends in infrastructure as a service, right? I'm providing, you've seen most IAS players starting to now move up chain as we sort of predicted years ago. To platform as a service, but platforms of various types. So I definitely see it as an opportunity. Previous employers have had multiple clouds, but they were very specifically optimized for the types of workloads. For example, in let's say AWS versus GCP based on the need for different types and optimized compute platforms that each of those providers ran. We never in that particular case thought about actually running the same workloads across both clouds because they had different pricing models, different security models, et cetera. And so the challenge is really coming down to the fact that what is the cost benefit analysis of thinking about multi-cloud when you can potentially engineer the resiliency redundancy all the in season illities that you might need to factor into your deployments on a single cloud if they are investing at the pace of which they are. So I think it's an opportunity and it's one that continues to evolve. But this just reminds me, your comments remind me of when we were talking about OpenStack versus AWS. Oh, if there were only APIs that existed that everybody could use and you saw how that went, right? So I think that the challenge there is what is the impetus for a singular cloud provider any of the big three deciding that they're going to abstract to a single abstraction layer and not be able to differentiate from the competitors. Yeah, that differentiation is going to be big. I mean, assume that the clouds aren't going to stay still like AWS and just not start innovating. We see the devs are doing great, Adrian. Open source is bigger and better than ever. But now that's been commercialized into enterprise it's an ops problem. So to Chris's point, the cost benefit analysis is interesting because do companies have to spin up multiple operations teams each with specialized training and tooling for the clouds that they're using and does that open up a can of worms? Or is that a good thing? I mean, can you design for this? I mean, is there an architecture or taxonomy that makes it work? Or is it just the cart before the horse, the solution before the problem? Yeah, well, I think that if you look at any large vendor sorry, large customer, they've got a bit of everything already, right? If you're big enough, you've bought something from everybody at some point. So then you're trying to rationalize that trying to make it make sense. And I think there's two ways of looking at what multicloud or super cloud. And one is that impractically people go best of breed. They buy, they say, okay, I'm gonna get my email from Google or Microsoft. I'm gonna run my applications on AWS. Maybe I'm gonna do some AI machine learning on Google because those are the strengths of the platforms. So people tend to go where the strength is. So that's multicloud because you're using multiple clouds and you still have to move data and make sure they're all working together. But then what Lori's talking about is trying to make them all look the same and trying to get all the security architectures to be the same and put this magical layer, this unicorn magical layer that let's make them all look the same. And this is something that the CIOs have wanted for years and they keep trying to buy it and you can sell it but the trouble is it's really hard to deliver. And I think I want to go back to some old friends of ours at Instradius who had, and they were back in the early days of clouds, well, we'll just do an API that abstracts all the cloud APIs into one layer. And Stradius ended up being sold to Dell a few years ago. And the problem they had was that they didn't have any problem selling it. The problem they had was a year later when it came up for renewal, the developers all done end runs around it were ignoring it and the CIOs weren't seeing usage. So you can sell it, but can you actually implement it and make it work well enough that it actually becomes part of your core architecture without, you know, from an operations point of view without having the developers going directly to their favorite APIs around it. And I'm not sure that you can really lock an organization down enough to get them onto a layer like that. So that's the way I say it. You just defined shadow, shadow IT. That's pretty good. Yeah, shadow IT, yeah, yeah. I mean, this brings up the question. I mean, is there a real problem? I mean, I guess we'll just jump to it. What is super cloud? If you can have the magic outcome, what is, what is it? Stradius kind of rendered in with automation, the security issues, Kubernetes is hot. What is the super cloud dream? I guess that's the question. I think it's got easier than it was, you know, five, 10 years ago.  There are SaaS-based services which are across multiple clouds from vendors that you've kind of picked. So it's easier to build things which are more portable, but I still don't think it's easy to build this sort of magic API that makes them all look the same. And I think that you're going to have sort of leaky abstractions and security being, getting the security right, it's going to be really much more complex than people think. What about specialty super clouds? Chris, what's your view on that? Yeah, I think what Adrian was alluding to, those leaky abstractions are interesting, especially from the security perspective. Because I think what you see is if you were to happen to be able to thin slice across a set of specific types of workloads, there was a high probability given today that at least on two of the three major clouds, you could get SaaS providers that sit on those same infrastructure, the service clouds for you, string them together and have a service that technically is abstracted enough from the things you care about to work on one, two, or three. Maybe not all of them, right? But most SaaS providers in the security space are identity space, data space, for example, co-exist on at least Microsoft and AWS, if not all three with Google. And so you could technically abstract a service to the point that you let that level of abstract, like Lori said, no computer science problem could not be, you can't, so no computer science problem can't be so more layers of abstraction or misdirection, right? So the redirection.  But then what that really talks about is then, if you built your seven layer dip model, then you really have specialty super clouds spanning across infrastructure service clouds, right? One for, you know, your identity apps, one for data and data layers to normalize that, one for security. But at what cost? Because you're going to be charged not for that service as a whole, but based on sort of compute resources based on how these vendors charge across each cloud. So again, that cost-benefit ratio might start being something that is rather imposing from a budgetary perspective. Lori, weigh in on this because, you know, the enterprise people love to solve complexity with more complexity. Here, we need to go the other way, right? It's a commodity. So, you know, it has to be a better way. I think I'm hearing two fundamental assumptions. One, that a super cloud would force the existing big three to implement some sort of equal API. Don't agree with that. There's no business case for that. There's no reason that could compel them to do that. Otherwise, we would have convinced them to do that, what, 10, 15 years ago, and we said we need to be interoperable. So it's not going to happen there. They don't have a good reason to do that. There's no business justification for that. The other presumption, I think, is that it's more about the services, the differentiated services, right? That are offered by all of these particular providers as opposed to treating the core IAS as the commodity it is. It's compute, it's some storage, it's some networking. Look at that piece. Now, pull those together and it's not open stack. That's not the answer. It wasn't the answer. It's not the answer now. But something that can actually pull those together and abstract it at a different layer. So five providers don't have to change because they're not going to change. But if someone else were to build that architecture to say, all right, I'm going to treat all of this compute so you can run your workloads, as Chris pointed out, in the best place possible. And we'll help you do that by being able to provide those kind of cost benefit analysis. What's the best performance? What are you doing? And then provide that as a layer. So I think that's really where SuperCloud is going because I think that's what a lot of the market actually wants in terms of where they want to run their workloads because we're seeing that they want to run workloads at the edge, right? A lot closer to me, which is yet another factor that we have to consider. And how are you going to be moving individual workloads around, right? That's the holy grail. Let's move individual workloads to where they're the best performance, the security, cost optimized, and then one layer up. Yeah, I think so. John Considine, who ultimately ran CloudSwitch that sold to Verizon, as well as Tom Gillis who built Bracket, right? Are both rolling in their graves because what you just described was exactly that. Well, they're not even dead yet. So I can't say they're rolling in their graves. Sorry, Tom. Sorry, Jim. Well, how do hyperscale keep their advantage with all this? I mean, to that point. Native services and managed services on top of it. Look how many flavors of managed Kubernetes you have, right? So you have a choice, roll your own or go with a managed service and then differentiate based on the ability take away and simplify some of that complexity. Doesn't mean it's more secure necessarily, but I do think we're seeing opportunities where those guys are fighting tooth and nail to keep you on a singular cloud, even though to Lori's point, I agree. I don't think it's about standardized APIs because I think that's never going to happen. I do think though that sort of sassy super cloud model that we were talking about. Layering SaaS that happens to span all the three infrastructure services are probably more in line with what Lori was talking about. But I do think that portability of workload is given to you today within lots of ways. But again, how much do you manage and how much performance do you give up by running additional extraction layers? How much security do you give up by having to roll your own and manage that? Because the whole point was in many cases, right? We are cloud is using other people's computers. So in many cases, I want to manage as little of it as I possibly can.  You're born in the cloud, just like that's generation of startups. Great. Now when you have this super pass layer as Dave Vellante was riffing on his analysis and Lori, you were getting into this kind of pass layer that's kind of like sassy. What's the SaaS equation looked like? Because that to me sounds like a super cloud versus saying, I have a workload that runs on all the clouds equally. I just don't think that's ever going to happen. I agree with you, Chris, on that one. But I do see that, you know, you can have an abstraction that says, hey, I don't really want to get in the weeds and I want to spend a lot of ops time on this. I just want it to run effectively and magic happens, or as you said, some layer there. How does that work? How did you see this super pass layer, if anything, enabling a different SaaS game? I think you kind of hit on it there, right? The last like 10 or so years, we've been all focused on developers and developer productivity and it's all about the developer experience and it's got to be good for them because they're the kings. And I think the next 10 years are going to be very focused on operations because once you start scaling out, it's not about developers. They can deliver fast or slow. It doesn't matter, but if you can't scale it out, then you've got a real problem, right? So I think that's an important part of it is really, now what is the ops experience and what is the best way to get those costs down? And this would serve that purpose if it was done right, which we can argue about whether that's possible or not, but I don't have to implement it, so I can say it's possible. Well, are we going to be getting into infrastructure as code moves into everything as code, security, data, applications as code? I mean, blank as code, fill in the blank. Yeah, we're seeing more of that with things like CDK and Pulumi, where you're actually coding up using a real language rather than the death by YAML or whatever you... How much YAML can you take, right? But actually having a real language so you're not trying to do things in parsing languages, right? So I think that's an interesting trend. You're getting some interesting templates and I like what... I mean, the sort of the counter example is that if you just go deep on one vendor, then maybe you can go faster and it is simpler. And one of my favorite vendor, favorite customers right now that I've been talking to is Liberty Mutual. Very deep, serverless first on AWS, they're just doing everything there and they're using CDK patterns to do it and they're going extremely fast. There's a book coming out called the Value Flywheel by Dave Anderson, it's coming out in a few months to sort of just detail what they're doing. But that's sort of the counter argument. If you can pick one vendor, you can go faster, you can get that vendor to do more for you and maybe you get a bigger discount. So you're not splitting your discounts across vendors. So that's one aspect of it. But I think fundamentally you're going to find that the CIOs and the ops people generally don't like sitting on one vendor. And if that vendor, if that single vendor is a horizontal platform that's trying to make all the clouds look the same, now you're locked into whatever that platform was, right? You've still got a platform there, there's still something. So I think there's, that's always going to be something that the CIOs want, but the developers are always going to just pick whatever the best tool for building the thing is. And a sort of analogy here is that the developers are sort of dating and getting married and then the operations people are running the family and getting divorced, right? And all the bad parts of that cycle are in the divorce end of it, right?  It's all about yourself. Well, you know, that's why ops people don't like locking because they're the ones trying to unlock, right? They aren't the ones doing the lock-in, they're the ones unlocking when developers, if you separate the two, they're the ones who are going picking, having the fun part of it, going trying a new thing, right? So they're chasing a shiny object and then the ops people are trying to untangle themselves from that remains of that shiny object a few years later. So one way of fixing that is to push it all together and make it more DevOps-y, right? But that's sort of trying to put all the responsibilities in one place, like more continuous improvement. Chris, what's your reaction to that? Because you're- No, I was, that's exactly what I was going to bring up. Yeah, John, and because we keep saying devs, dev and ops and I've heard somewhere you can glue those two things together. Heck, you can even include sec in the middle of it and dev sec ops. So what's interesting about what Adrienne's saying though too is I think this has a lot to do with how you structure your engineering teams and how you think about development versus operations and security. So I'm building out a team now that very much makes use of thanks to my brilliant VP of engineering, a team topologies approach, which is very streamlined and product oriented way of thinking about, for example, an engineering, if you think about team structures you might have people that build the front end with the middle tier in the back end and then you have a product that needs to make use of all three components in some form. So just from getting stuff done, their ability then has to tie to three different groups versus building a team that's streamlined that ends up having front end, middleware, and back end folks that understand and share standards but are able to uncork the velocity that's required to do that. So if you think about that not just from an engineering development perspective, but then you couple in operations as a foundational layer that services them with embedded capabilities, we're putting engineers and operations teams embedded in those streamlined teams so that they can run at the velocity that they need to. They can do continuous integration. They can do continuous deployment. And then we added CS, which is continuously secure and continuous security. So instead of having giant centralized teams, we're thinking there's a core team, for example, a foundational team that services platform make sure all the trains are running on time that we're doing what we need to do foundationally to make the environment for the dev and operator and security people functional. But then ultimately, we don't have these big monolithic teams that get into turf war. So the Adrian's point about the operators don't like to be panned in. Well, they actually have a say ultimately in how they architect, deploy, manage, plan to operate those systems. But at the same point in time, we're all looking at that problem across those teams and go like, if one streamlined team says, I really want to go run on Azure because I like their services better. The reality is the foundational team has a larger vote versus opinion on whether or not functionally we can, we can satisfy all of the requirements of the other team. Now they may make a fantastic business case when we play rock, paper, scissors and we do that. Right now that hasn't really happened, right? We look at the balance of AWS. We are picking sassy super cloud vendors that will by the way happen to run on three platforms if we so choose to expand there. So we have a similar interface, similar capability, similar processes, but we've made the choice at last best to go all in on AWS currently with respect to how we deliver our products for all the reasons we just talked about. But I do think that operations model and how you build your teams is extremely important. Yeah, and to that point, the vendors themselves need optionality to the customer, what you're saying. So I'm going to go fast, but I need to have that optionality. I guess the question I have for you guys is what is today's trade off? So if the decision point today is first of all, I love to go fast model on one cloud. I think that's my favorite when I look at all this. And then with the option knowing that I'm going to have the option to go multiple clouds, but everybody wants to lock in on the vendor side. Is that scale? Is that data advantage? I mean, so the lock in is a good question. And then also the trade offs. What do people have to do today to go on a super cloud journey to have an ideal architecture and taxonomy? And what's the right trade offs today? I think that there's, sorry, just to put a comment and then that Laurie get a word in, but there's a lot of the market here is you're building a product and that product is a SaaS product and it needs to run somewhere, right? And the customers that you're going to, if to get the full market, you need to go across multiple suppliers. Most people doing AWS and Azure and then Google occasionally for some people, but that I think has become kind of the pattern that most of the large SaaS platforms that you'd want to build out of, because that's the fast way of getting something that's going to be stable at scale. It's got functionality. You don't have to go invest in building it and running it. Those platforms are just multi cloud platforms. They're running across them. So Snowflake, for example, has to figure out how to make their stuff work on more than one cloud. I mean, they started on one, but they're going across clouds. And I think that that is, that's just the way it's going to be because you're not going to get a broad enough view into the market because there isn't a single, you know, AWS doesn't have 100% of the market, right? It's maybe a bit more than then, but Azure has got a pretty solid set of markets where it is strong and it's sort of market by market, right? So in some areas, different people, some part places in the world and different vertical markets, you'll find different preferences. And if you want to be across all of them with your data product or whatever, whatever your SaaS product is, you're just going to have to figure this out. So in some sense, the super cloud story plays best with those SaaS providers, like there's no flakes of this world, I think. Lori? Yeah, I think the SaaS, right? The SaaS product, right? Kind of identity, you know, whatever, right? You're going to have specialized, right? SaaS, super cloud, we already see that emerging, right? Identity is kind of becoming like this big SaaS play that crosses all clouds, right? It's not just for one. So you get that kind of an evolution going on where, yes, I mean, every vendor who provides some kind of specific functionality is going to have to build out and be multi-cloud as it were. It's got to work equally across them. And the challenge then for them is to make it simple for both operators and if required, right, dev. And maybe that's the other lesson moving forward, right? You can build something that is heaven for ops, but if the developers won't use it, well, then you're not going to get it adopted. But if you make it heaven for the developers, right? The Hops team may not be able to keep it secure or keep everything. So, right, maybe we have to start focusing on both. Make it friendly for both at least. Maybe it won't be the perfect experience, but gee, at least make it usable for both sides of the equation so that everyone can actually work in concert, like Chris was saying, right? A more comprehensive, cohesive approach to delivery and deployment, so. All right, well, wrapping up here, I want to just get one final comment from you guys, if you don't mind. What does SuperCloud look like in five years? Is it, what's the Nirvana? What's the state? What's the steady state of SuperCloud in five to 10 years? Or say 10 years, make it easier. What's the process? Five to 10 years. Chris, we'll start with you. Wow. SuperCloud, what's it look like? A magic plain, a single pane of glass? Yeah, I think. Single glass of pain. Yeah, a single glass of pain, thank you. You stole my line. Well, not mine, but that's the one I was going to use. Yeah, I think what is really fascinating is ultimately, to answer that question, I would reflect on market consolidation and market dynamics that happens even in the SaaS space. So we will see SaaS companies combining in focal areas to be able to leverage the positions that, let's say, in the identity space that somebody has built to provide a set of compelling services that help abstract that identity problem or that security problem or that instrumentation and observability problem. So take your favorite vendors today. I think what we'll end up seeing is more consolidation in SaaS offerings that run on top of infrastructure to service offerings to where a SuperCloud might look like something I described before. You have the combination of your favorite interoperable identity, observability, security, orchestration platforms that run across them and they're sold as a stack, whether it be co-branded by another, by an enterprise vendor that sells all of that and manages it for you or not. But I do think that, you talked about is this, I think you said, is this an innovator's dilemma? No, I think it's an integrator's dilemma as it has always ultimately been. As soon as you get from sort of, genesis to bespoke build to product to then commoditization, the cycle starts anew. And I think we've gotten past commoditization and we're looking at niche areas. So I see just the evolution, not necessarily a revolution of what we're dealing with today as we see more consolidation in the marketplace. Laurie, what's your take? Five years, 10 years. What does SuperCloud look like? Part of me wants to take the high in the sky unicorn approach. No, it will be beautiful and one button and things will happen. But seen this cycle many times before and that's not going to happen. And I think Chris has got it pretty close to what I see already evolving, right?  And that's really what we're talking about. We call them SaaS, but they're, right? X as a service, everything is a service. And it's really a SuperCloud that can run anywhere, but it presents a different interface because well, it's easier. And I think that's where we're going to go and that's just going to get more refined. And yes, a lot of consolidation, especially on the observability side, but that's also starting to consume the security side, which is really interesting to watch. So that could be a little different SuperCloud coming out in there that's really focused on specific types of security, at least, that we'll layer across and then we'll just hook them all together. It's an API-first world. And it seems like that's going to be our standard for the next while of how we integrate everything. So SuperClouds are APIs. Adrienne, take us home. Yeah. What's your- Sure, I think, and just picking up on Lori's point there, these are web services, meaning that you can just call them from anyway, that you don't have to run everything in one place. You can stitch it together. And that's really meant it's somewhat composable.  Kind of compose their applications on multiple platforms. But I think the interesting thing here is what the vendors do. And what I'm seeing is vendors running software on other vendors. So you have Google building platforms that then they will support on AWS and Azure and vice versa. You've got AWS's distro of Kubernetes, which they now give you as a distro so you can run it on another platform. So I think that trend's going to continue and it's going to be possibly pick, say, an AWS or a Google software stack, but you don't run it all on AWS. You run it in multiple places. Yeah. And then the other thing is the sort of third tier, second, third tier vendors like, I mean, what's IBM doing? I think in five years time, IBM is going to be a SaaS vendor running on the other clouds. I mean, they're already sort of halfway there to be a bit more controversial. It's always fun to kick like, I don't work for corporate entity now. No one tells me what I can say. Bring it on. How long can Google keep losing a billion dollars a quarter? Right? They've either got to figure out how to make money out of this thing or they'll end up basically being a software stack on another cloud platform. Is there like the actual way they can make money on it? Because you've got to, and maybe Oracle, is that a viable cloud platform that you've got to get to some level of viability and I think the second, third tier vendors are going in five, 10 years are going to be running on the primary platform. And I think just the other final sort of thing that's really driving this right now, if you try and place an order right now for a piece of equipment for your data center, key pieces of equipment are a year out. Right? It's like trying to buy a new fridge from like Sub-Zero or something like that. And it's like, it's a year. You got to wait for these things. Right? Any high quality piece of equipment. So you go to deploy in your data center and it's like, I can't get stuff in my data center. Like the key pieces I need, I can't deploy a whole system, we can get bits and pieces of it. So people are going to be cobbling together. This is going to cloud because the cloud vendors have a much stronger supply chain to just be able to give you the system you need, right? They've got the capacity. So I think we're going to see some sort of pandemic and supply chain induced sort of forced cloud migrations just because you can't build stuff anymore outside the cloud because they have the supply. They are the chain. That's super smart. That's what, that's the benefit of going last. So I'm going to scoop and real quick. I can't believe we didn't call this web three super cloud because none of us said web three. Don't forget DAO, blockchain, blockchain super clouds. We have, I mean, there's, there's, there's a very interesting distributed computing stuff here, but we'll call that the cube version. The cube version. The cube version. All right. In the metaverse, cube verse soon. Super cloud, perhaps. But anyway, three points, Adrienne and Laurie. Chris, great to see you, Adrienne and Laurie. Thanks for coming on. We've known each other for a long time. You guys are part of the Cloud Erotic, the group that has been in there from day one and, and watch it evolve and you get the scar tissue to prove it and the experience. So thank you so much for sharing your commentary. We'll roll this up and make it open to everybody. And as additional content, we'll call this the outtakes, the longer version, but really appreciate your time. Thank you. Thank you. Thanks so much. Okay. We'll be back with more super cloud 22 right after this.


It is now time for Member Statements, and I recognize the member for Oakville. Thank you. Good morning, Speaker, on our last day of the legislature before the summer session. In between Toronto and Hamilton, Oakville is a hidden gem, rich in history, vibrant with natural beauty and bursting with adventure. As summer approaches, I rise in this house to highlight some exciting events taking place in my community over the summer. Every Friday is Jazz Night in the summer from 7 to 9 p.m. in Town Square in downtown Oakville. This Sunday, June 11th, the Canadian Caribbean Association of Halton annual spring concert is being held at the Queen Elizabeth Community Cultural Centre. After four long years, the annual Mayor's Picnic is back, taking place on Sunday, June 11th from 12 p.m. to 4.30 p.m. at Lakeside Park. It will be an afternoon filled with lots of family fun, things to do including face painting, children's games, balloons, and new this year model train setup. The 2023 Oakville Film Festival is running from June 21st to 27th, celebrating a decade of diverse cinema. The festival has showcased hundreds of films of all genres appealing to a wide range of audiences. Canada Day returns to Bronte Heritage Waterfront Park on July 1st. Enjoy an evening of free performances, family fun, and, of course, fireworks. And be sure to mark your calendars for the last weekend in July. On July 28th to 30th, the Oakville's largest outdoor event comes back with the Oakville Annual Family Rib Fest at beautiful Sheridan College. Speaker, I invite everyone to bring their families and for a staycation in beautiful Oakville this summer. I wish everyone all the best for a great summer. Thank you, Speaker. Thank you very much. Member Statements, the Member for London Fanshawn. Speaker, as the school year comes to close, I'd like to reflect on a recurring issue in my office. Has heard from parents, teachers, school board staff that issue, staffing and resource shortages in our schools.  Jacob is a first grader and is facing problems with another first grader. The mother has tried various avenues for resolution but the crux of the issue appears to be lack of support in the classroom and a systemic EA shortage. Jacob is hurt physically and emotionally. He is confused and afraid. I can't speak for the other child in this case but I would assume he also feels forgotten and in need of support. I have also heard from representatives of our local school board and they have identified the same issues with staffing shortages. The Thames Valley District School Board reported a 5.4 million increase in expenses for special education for the coming year, leaving them with a 3.4 million deficit for special education expenses alone. And there are all other deficits across the board for operating costs. The independent financial accountability officer recently revealed that the government withheld 844 million earmarked for education at a time when school boards are facing significant funding deficits. The government needs to provide proper funding now and ensure appropriate staff levels at schools across the province so children like Jacob are not left behind. Thank you very much. Member Statements, the Member for Kitchener, South Hespeler. Thank you, Speaker. When it comes to Member Statements, I generally wait for the spirit to move me about what I'm going to talk about. Yesterday I was in Estimates and the Attorney General was speaking about bail vetters and intensive bail supervision and it had me thinking about being a Crown Attorney, being a Crown Prosecutor. And to be honest, it made me feel rather sad and modlin. When I was a Crown, I viewed it very much as almost a calling, an honour. And I thought we haven't had a shout out for Crown Attorneys in this chamber recently. And when it comes to the legal profession and the profession of being a Crown, there really is nobody else that deserves it to the extent that Crown Attorneys do. I've described Crowns as being the first responders of the legal world. When we talk about fire, police, paramedics, there's a lot of conversation about the trauma they see, PTSD, but the Crowns don't get that. Crowns have to see terrible images. They have to deal with human suffering every single day. They deal with it in a very personal and direct fashion. They are some of the hardest working people I know. It's a job that never ends. I say with doctors, at least nobody expects you to operate at home on your kitchen table at 2 o'clock in the morning, but with Crowns they do. And increasingly in today's justice system, we're the ones that are having to explain to people why justice doesn't look the way they thought, why being a victim doesn't feel the way they thought, and the pressure that that puts on you is incredible. So I want to thank all of the Crown prosecutors out there that are doing an incredible job. Member statements. Member for Parkdale High Park. Thank you, Speaker. Minden's local hospital closed on June 1 due to staffing shortage, and despite overwhelming opposition from the local community. Minden is far from alone. Lanark County, Guelph, Hamilton, Perth, Grand River, Windsor, Alexandria, Wingham, Thessalon, Campdville, Seaforth, Ottawa, Bowmanville, Clinton, Orangeville, Carleton Place, Essex County, Kingston, Waterloo, Credit Valley, Smith Falls, London, Chesley, Fort Erie, Port Colborne, all communities that have seen either no ambulances available or the closure of hospital services in the last year due to staffing shortages. The staffing crisis continues in our health care system and the government still refuses to repeal bill 124 that suppresses the wages of health care workers. At the same time, staffing agencies like the Canadian Health Labs are convincing hundreds of health care workers to leave their workplaces by offering them double the salaries they normally earn. The company made $154 million from just 500 nurses and PSWs they hired out of our public health systems. Their plan is to hire as many as 5,000 people. These agencies take health care workers out from the public system and sell them back at huge profits. This is systemic destruction of our public health care system and we the public and paying way more for declining services. Speaker, I can only think this is happening due to the conservative agenda to undermine public health care system because no one can be so incompetent to not see the damages these policies are creating. Thank you, Member Statements. The Member for Windsor to come see. Last month I had the sincere privilege of joining the Association of Consulting Engineering Companies who hosted the Ontario Engineering Project Awards, the 20th holding of that event. I'm very proud to recognize a winner from my riding of Windsor to come see. It was the Surincosal Flooding Protection Master Plan. I was certainly privileged to join Stacy McGuire, Ryan Langlois and Laura Hurley, he of Dillon Consulting and the City of Windsor as they accepted the award and also recognized where BBA's Great Adventure on Boarding Program, Tollic Engineering's Hockey Night in Huntsville, Dillon's Collins Creek Wildlife Mitigation Project, Lee Consulting's Water Management Plan by site 46X0176BO, Hatch's Process Gas Project, the Particulate Emissions Project, Sudbury Smelter, and this one was led by my former classmate from UODWA Benoit Payet for its Port Lands Bridges Project, Irrimosa Engineering for its Minor Mediation Cloud Skate Integration, Jail Richards for its Manitake Water Main Link Phase 1 in North Island Water Main Link, Hatch for the Kingston 3rd Crossing, Irrimosa Engineering's Electrical Power Studies and Arc Flash Models for Multiple Wastewater Facilities, Macintosh Parity for the Ducks Unlimited Project Inspections for 250 sites in Ontario, RV Anderson for Central Bridge Placement and Additional Works, and RJ Burnside for the Godi Water Supply Project and ACOM Canada for the Ontario Line Immersive Sound Studio. To all my engineering colleagues who are awardees this year, thank you. You've made our profession proud. Thank you very much. Member's statements. The Member for Toronto, St. Paul. Good morning, Speaker. It feels really good to be here in the legislature today. My mother has been hospitalized for almost two months and I've been able to be right by her side. I promised I wouldn't cry. As her primary caregiver, thanks to the support of the leader of the official opposition and my Ontario NDP colleagues, thank you. I want to thank my staff for their support as well as other staff who have reached out. I want to thank other members including government members who also shared their concern. I won't ever forget it. Over the last several weeks, my mother has been cared for by dozens of hardworking doctors, specialists, nurses, OTPT and PSWs. I can't thank them enough. Only about ten days ago, after hundreds of vows of blood work, tests, consultations, two biopsies, we got a diagnosis. Neurosarcardosis. A rare autoimmune-related multi-systemic disease that involves inflammation of the brain, spinal cord and ingus, cranial and peripheral nerves. It attacks the central nervous system. This disease has no cure, but remission might be possible. Speaker, I have seen it ravage my mother's body and brain and mind and strip her of her independence. But she is a fighter. They're forgiving me a few extra moments. The treatment for this disease is incredibly difficult on the body with its own laundry list of complications, some of which can be life-threatening. I want to thank countless constituents in my community of St. Paul's across party lines for their love and support, phone calls and text messages. I especially want to show gratitude to our local faith leaders and many congregation members at St. Michael and All Angel, St. Matthew's Holy Blossom Verity Center for Better Living, previous pastors from MCC Toronto and right here at the legislature, Charlie the Chaplin, for their consistent shoulder and faith when I've had none. To my chosen family, family members, dear former caucus members and education colleagues and friends, my mom's friends, thank you. To my partner Aisha, thank you for being my rock. Speaker, to all of the members in the House, I don't know what our future holds, but my mom and I are so lucky to have experienced all this compassion during this unbearable time and I cannot thank you all enough. Thank you. Member Statements, the member for Elgin Middlesex London. Thank you, Speaker, and obviously our hearts and our best wishes go out to the member of Toronto St. Paul's for her and her family and we wish her all the very best. It's a pleasure to rise and share a wonderful local event in my riding with the legislature this morning. Speaker, the Rosie Rubarb Festival begins this weekend in the lovely town of Sheddon, Ontario. The Rosie Rubarb Festival was founded over 25 years ago to promote the small town community of Sheddon and raise money for new community centre. The festival is always held the second weekend of June when the rhubarb ripens and is ready to become tasty treats for all to enjoy. Speaker, to date, the festival has raised over $1.2 million to help support local community initiatives including a local community centre. These funds have been used to construct a picnic pavilion, purchase playground equipment and build a new library in the village. It is enjoyable to see Sheddon come together for some good old-fashioned country fun at the start of every summer. Vendors, artisans, food trucks and businesses fill the fairgrounds all have fun. Rhubarb baking contests, country music dancing, face painting, petting zoos and a Sunday car show are all part of the festivities. However, Speaker, the best part is obviously tasting the renowned rhubarb pies and rhubarb sauce with ice cream. I invite all members of this house along with your families to attend the festival this weekend and enjoy the sight, sounds and taste of southwestern Ontario. Member statements? The Member for Kingston and the Islands. Critical metals like cobalt, lithium and nickel go into batteries. Rare earths like dysprosium, myodymium or prosodymium go into electric vehicle motors and wind turbines. Recycling these critical materials is a strategy which would give Ontario workers a shortcut into the value chain between the mine and EV. Right now, rare earths mining and processing is led by China which also dominates in other critical minerals such as graphite. Australia and South America are leading sources of lithium. Indonesia leads in nickel but much of this is controlled by Chinese companies as well. In the future, for economic, environmental and security reasons, a circular economy must develop for critical materials. Today, production of critical metals and rare earths involves value added work in chemical processing and it is performed offshore. However, Ontario is amongst the global leaders in technology to recycle critical metals and minerals. To maximize the economic benefit to you and me of EV and battery production in Ontario, production for which the federal and Ontario governments have agreed to pay dearly, I believe we must be a first mover and leader in the cyclic economy for critical materials. This means supporting the ecosystem around critical minerals, processing and recycling before other regions in North America begin to dominate. Thank you very much. Member statements? The Member for Lanark Frontenac, Kingston. Thank you, Speaker. Speaker, as the 43rd Parliament rises for the summer, I'd like to acknowledge my fellow MPPs on both sides of the House for your continued dedication to your constituents and connecting with them over the summer months. Mr. Speaker, as we look forward to a season full of family gatherings, graduations, vacations and day trips to some of the most beautiful destinations in Ontario, I invite you to visit my writing of Lanark Frontenac, Kingston. From hiking the trails to taking the live music at one of the world famous festivals, there is something for all ages. Enjoy cultural events like the spirit of the drum powwow this Saturday and Sunday in Smith Falls. Experience one of our festivals like the world-renowned Stewart Park Festival in Perth, Puppets Up in Elmont, the Sydenham Lakes and Trails Festival and the Blue Skies Music Festival in Clarendon. Just to name a few. Families will enjoy our many fairs in Lombardy, Carleton Place, Packingham, Mississippi Mills, Smith Falls, Perth and many others. Experience canoeing or kayaking along the natural waterways in Lanark and Frontenac counties and take in pristine protected wilderness or travel the UNESCO World Heritage Site, the Rideau Canal, which passes through Perth, Smith Falls and many other towns from Ottawa to Kingston. Mr. Speaker, I wish everyone a safe, happy and healthy summer and if you're thinking about a day trip or a multi-day adventure, remember there is much to do and see in Lanark, Frontenac, Kingston. Just one more member statement. Member statements, the member for Durham. Thank you, Mr. Speaker. It is my pleasure to inform this House that in my riding of Durham, the entrepreneurial spirit is alive and thriving. I've had the pleasure to attend some grand openings and reopenings for small businesses over the past few months. Before Perry, I had the opportunity to meet with Stacey Burns and her team for the grand reopening of Ocala Winery. In Bowmanville, I proudly joined Amanda Green in cutting the red ribbon to open her dream business, Exquisite Lashing Company. Amanda acknowledged that our government's cutting of red tape and regulations helped make her business dream a reality. To block west of my office in downtown Bowmanville, Carmella and George Mangus just opened sugar dust, sweets and cafe, delighting their customers with elegant cakes, sweet treats and delicious lunches. Earlier this month, Mr. Speaker, one of the youngest franchisees for Firehouse Subs, Jasmine Nellis, opened her second franchise in West Curtis to a sellout crowd. With many successful entrepreneurs across Ontario, my constituents are expanding their businesses, creating jobs, because our government is getting it done by reducing red tape, regulation and creating an environment for growth and prosperity. Mr. Speaker, on behalf of all members of this House, I want to congratulate all the small businesses of Durham. Keep up the great work. Let's grow together. Let's make Ontario strong. Thank you very much. That concludes our member's statements for this morning.


Ladies and gentlemen, the President and the Vice President of the United States. Ladies and gentlemen, I almost get the impression you see someone you like. Ladies and gentlemen, I would like at this time to start the festivities here today. This is a family festival day. By introducing someone who is eminently familiar to all of Texas, but who will be more familiar to all of the nation in the near future. Someone who has proven common sense. Someone with tremendous courage and conviction. Our congressman from the sixth district soon to be Texas Senator Phil Graham. Thank you. Thank you. Well let me say that it does my eggy heart good to come over here and see so many people that support Ronald Reagan and George Bush. Four years ago the economy was in catastrophic shape. The inflation rate had reached 13%. Prime interest rates were 21.5%. The nations were seeing productivity decline and unemployment rise. And in the best tradition of the democratic process, the American people sent in a new team. And that team was the Reagan-Bush team. And under the leadership of Ronald Reagan and George Bush, we brought the inflation rate down from the highest levels in American history to the lowest levels in 20 years. We've dug out from under a recession that started four months before our program did and 7 million Americans have gone to work in permanent productive tax-paying jobs for the future for them and for their children. That's more permanent productive tax-paying jobs with a real future that we've created under the Reagan program than all the government jobs programs put together since 1946 have created in the way of Ducaman, who for 25 years and a quarter of a century has stood for Texas in the United States Senate. Under his leadership in the last four years, we've provided our citizens soldiers with the weapons they need to deter aggression and to keep the peace. And the peace is more secure today than it was four years ago because America is stronger today than it was four years ago. And more than any other member of the United States Congress, our senior Senator John Tower is responsible for that. Senator Tower. Mr. President, Mr. Vice President, my distinguished colleague in the Congress and soon to be my successor, Phil Graham, distinguished governors, party and campaign leaders, my fellow Texans, it's a great privilege to be here today to see this marvelous crowd here in Austin, Texas, the capital of our sovereign state. And to say that from Periton to Brownsville, from Texarkana to El Paso, we rejoice that our great president has elected to open his great campaign for reelection right here in Texas. We take even greater pride that his running mate is a proven, outstanding national leader, a great Texan, George Bush, a man that we know, love and respect. And so may I simply say, ladies and gentlemen, it is my high honor and privilege to present the Vice President of the United States of America. Thank you, ladies and gentlemen. Thank you very much. Thank you. Thank you very, very much. Thank you so much. It is really great to be back in Texas. The only regret I've got in this wonderful homecoming is that the man I was sitting next to, my dear friend, our great former governor, isn't still governor of Texas. Bill Clements did a wonderful job. Now I must start this few remarks with a confession. I watched the Democratic Convention on Television. Not all of it. No, wait a minute, not all of it. Just a little.  I'm surprised they didn't name the Moscone Center the Temple of Doom. Mr. Mondale says that our present strong economic growth makes him nervous. Well, then he's got a lot to be nervous about because right now, this country is in the midst of nothing less than the strongest sustained economic expansion since 1949. And one other thing they didn't mention out of that Temple of Doom is there are more Americans working today than at any time in the history of the United States of America. But I think Texans, perhaps more than others, know that in San Francisco the delegates lost touch, it seems, to us at least with the roots of their own party. The great names of the Democratic past, Roosevelt, Truman, Kennedy, Johnson, I don't believe would have been comfortable, felt at home there in San Francisco. I don't believe that Franklin Roosevelt would have condoned the weakness in the face of totalitarian aggression. And I don't believe that Harry Truman would have been silent. I believe he would have spoken out against Marxist-Lenis regimes in Nicaragua. And John Kennedy never would have embraced Fidel Castro, by the way. And Lyndon Johnson would have seen our action to save American lives and give democracy a chance in Grenada as a proud moment in the history of the United States of America. And very candidly, very candidly, I'm proud to serve with the President who stands up for our country and doesn't apologize for the United States of America. At that convention with all its oratorical style, Walter Mondale asked all those special interest groups, do you want Ronald Reagan to appoint the next Supreme Court? And there was a deafening no out of there. But I believe the American people will answer very differently in November. They want a Supreme Court that will interpret the law, not legislate. And frankly, they overwhelmingly support the appointment, the one appointment that President Reagan has made, namely the appointment of Sandra Day O'Connor to the Supreme Court. I think they're on the wrong side of that one. Since the days of Dwight Eisenhower, under whom this country was, I think history will show, a miracle of peace and stability and security, prosperity, no American president has served out two full terms. And we need that stability and constancy again. We need that consistent, purposeful presidential leadership that we've had for the last three and a half years. And all I can say is one good term deserves another. And ladies and gentlemen, it is my great honor to introduce to you the President of the United States, Ronald Reagan. Thank you very much. Thank you very much. And I want to thank you for always reminding me that if you want to see where America's dreams reach toward wide open sky, where her spirit of progress is as strong as her heart is big, then come to the Southwest and come to the great state of Texas. Take up where the Vice President left off on one point at their convention, the leadership of the Democratic Party gave Texas the back of their hand. Well, we've come to give you a message from our heart. We care about Texas. We care about your citizens and the values that you all live for. But rather than saying you're, maybe I should be saying our for you've made me feel at least like an adopted son. And you've also given me and the country one of your finest. Believe me, Texas has no more loyal son than my partner, George Bush. And I use that term partner advisedly. With all due respect to those who have served in that office before, I don't believe there has ever been a Vice President that has been so involved at the very top level in all that is going on in our country and in the decisions that are being made. He is untiring, totally faithful, and I am so grateful for what he brings on the basis of his experience as a congressman, his experience as the director of the CIA, as our ambassador to the United Nations and as our representative to the Republic of China. I just happen to think he's the best Vice President that we've ever had. Now, I'm also thankful for the friendship and the support of great Texans like John Connolly, Bill Clemets, John Tower, and Phil Graham. They have worked with courage and common sense for growth, for stable prices, and for a strong America. But you know when Phil Graham tried to help us control government spending and taxing, he infuriated the national democratic leadership. So, he did the honorable thing. He left his party. He joined ours, but then, they didn't need to do this. Having just been returned to office, he went back to the voters of his district to give them a chance to register approval or disapproval on the action he'd taken. And thank heaven they registered approval. They stuck with him then, and I'm confident that Texas will stick with him now. I'm confident that Republicans, Democrats, and independents will join together to elect Phil Graham, your next United States Senator. With his talk about switching parties, I remember when I cast my first vote. I was a Democrat, and I cast it for Franklin Delano Roosevelt in 1932. He ran on a platform to reduce the federal budget by 25 percent to eliminate useless boards, commissions, agencies, and bureaus, and restore the autonomy of state and local governments that he said had been unjustly seized by the federal government. Ask yourselves which party could run on that platform today? Certainly not those we heard and saw in San Francisco. But then, with all respect to millions of fine patriotic citizens who are Democrats in this country today, where those people in San Francisco truly representative of those millions of rank-and-file Democrats across this land. To those of you who are still Democrats, and I know there must be many here, and who might share my belief that government should not plunder more of our earnings, should not seize greater power over our lives, but should work to ensure the ultimate and individual freedom consistent with an orderly society, then I extend an invitation to you and to millions of others, come where you will be welcome and appreciated. Join George Bush and Phil Graham and me and together we'll make history on November 6, 1984. You know, when I heard some of the things that were being said last week in San Francisco, and I didn't watch all the convention, there are some punishments you just don't deserve. But, from what I did here and then maybe the next day read about, I couldn't help but think that maybe the fog is so thick out there that it was getting inside their heads, but maybe there's another explanation. The National Democratic Leadership is going so far left, they've left America. I'm sorry, I'm sorry they seem to see only misery and feel only fear and never stop pining for their days of tax and tax and spend and spend. They offer a three-point program, fear the future, ignore the present, and forget the past. And one promise, one promise that was made at that convention by one of them made me think of a suggestion I got for the income tax. It was a plan we will not adopt. It was a sample form. One line you put down how much you'd earned and on the other line it said send it. But, they offer a three-point program as I said, forget the future, ignore the present, forget the past. I've found a way to put their pessimism to constructive use. It's a sure-fire diet that you can use to lose weight and there's only one rule. You only eat on the days the pessimists say something good about America. Permit me to make three small points of my own. Point one, those responsible for punishing America with record inflation, record interest rates, record tax increases, credit controls, farm embargoes, gas lines, no growth at home, weakness abroad, and phony excuses about malaise are the last people who should give sermonettes about misery, unfairness, and compassion. Point two, today they offer new realism. Well, forgive me, but their new realism seems to begin right where their old ideas left off. Billions in new spending, higher taxes on small business, family farms, and every other working family, and we must answer with a firm unequivocal, no. Point point three, a little barometer of discomfort that Jimmy Carter and his vice president used in 1976. They created the misery index by adding the inflation and unemployment rates. In 76, that came to 12 and a half percent. And they said our candidate had no right to seek re-election with a misery rate as big as 12 and a half. Well, since the Democratic leadership devoted hours in San Francisco to talk of misery, I hope I'll be pardoned for taking 10 seconds to say we cut their misery index almost in half from the 19 and a half it was in 1980 to 10.3 today. And we'll bring it down even more if they'll just get out of the way. We'll campaign on our record. And yes, on theirs as well. And for ideas we believe will bring new hope to all Americans. We intend to represent only one special interest group. You, the people. Let me pose the question they never got around to in San Francisco. Which major industrial nation today has the strongest currency? The strongest economic growth. Seven and a half percent for the last quarter. Inflation of only three, well it's only been 3.3 percent in the last few months. Labor force participation at an all time high. Fastest rate of job creation as you've just been told. There are 7 million more people employed in the United States today than we're working in 1980. Last year there were a record 600,000 business incorporations. It's fastest growth in business investment in 30 years. The largest increase in real after tax personal income since 1973 and leadership in developing jobs and markets for the future in science and high technology both on earth and in outer space. Well I think you know which nation fits all of those and the initials are USA. I'm sorry the other side still of this but then they never have understood the economy. They still think that GNP stands for Gross National Promises. They've never understood that incentives are the driving force of growth and human progress. That if we work or save more than before our reward will be greater than it was and will be challenged to lead more productive, worthy lives. They don't understand but America does believe that challenge will be the choice of a new generation. Incentives Incentives, initiative and innovation are sparking a revolution in America. We see it here in Austin with your great shrink the world will beat a pat or and no one will be able to hold America back. So please don't let them bury the American dream in their graveyard of gloom and envy. Endless tax increases deeper dependency planned protectionism certain sacrifices and veiled quotas. We don't need that kind of progress do we? I've always been told that if you want to make a Texan's neck swell you tell him where to line up and what to think. Well this election offers the sharpest most important choice in modern times greater freedom or coercion. Right, I asked the leadership of the Democratic Party to support six key measures for our future.  For example they seek to reduce deficits but the futile way by raising taxes on America's families. Right I'm asking why not do it the right way the fair way the effective way why not insist that governments spend no more than government takes in. Why not insist a speaker O'Neill a speaker O'Neill permit a vote on the I hope they're listening in Washington but why shouldn't he permit a vote on the constitutional amendment mandating a balanced federal budget. Fairness for families means a spouse working in the home should enjoy the same individual retirement rights IRAs as a spouse working outside the home. Each should be able to save and exclude from taxation up to $2,000 a year. We'd like that bill passed now. Tuition tax credits would help low and middle income parents paying to send their children to parochial or independent schools while also paying their full share of taxes to support public schools. You know it's fine to get way out there in the nether region out in the abstract someplace and talk about our great national family but how about a little help for the real families who sustain our neighborhoods our churches and our schools the forgotten Americans in all those years of their domination have been those parents who sit around a table at night deciding how to pay their bills and put the kids through school how about a little compassion for them. Then there's our bill offering incentives for investment in 75 enterprise zones that would bring jobs and growth and hope for people in inner cities and in other distressed regions but here's the rub again enterprise zones have been blocked for two years by the same people who gave those fine speeches about opportunity and fairness well do they want to end the welfare bondage or they just want to fill a buster forever and they'll do someday somewhere somehow for somebody we think it's not asking too much that Americans be able to take a walk after dark without having to cringe in fear we we have a strong anti-crime proposal that would provide new restrictions on bail tougher sentencing and stricter enforcement of drug trafficking laws lives are at stake so if we still can't get a vote on that maybe it's time to move some politicians out of office to get the criminals off the streets and finally last night I asked the house to pass the equal access bill it would permit religious student groups the same freedom that other student groups now have to meet in public school high schools in their vacant rooms during off hours this is let me repeat this is in non-school hours I believe the God who blessed this land of ours never deserved to be expelled from our schools in the first place well I'm pleased to give you some good news and just receive take out your pins members of the press today I have just been informed the house of representatives finally passed despite stubborn resistance by its liberal leaders the equal access bill 337 to 77 but let's make one thing plain while this long overdue action is welcome it's certainly not sufficient they should put their new realism to work and take action on each of those other five requests that they've bottled up for so long and together we will make America great and let me let me just suggest to you the steps that we've taken the steps we've taken to reverse years of neglecting our military security shameful neglect have not made America less secure the steps we've taken have made us more secure if the sons and daughters of this nation can risk their lives to protect our freedom in a dangerous world we have a moral obligation to give them in the way of protection the finest we can in weaponry in machinery I want to tell you something when you see when you see one of those young men or women out on the street in uniform if you haven't done it already give them a smile and maybe ask them where they're from and tell them maybe you're a little grateful for what they're doing but let me tell you that nothing in this job has made me more proud than the young men and women who are representing our country in uniform they have the highest level of intelligence and education of any who have ever represented our country in the past in uniform they are the best trained they have an esprit de corps that just won't stop and I I was an officer once I was supposed to salute but I also know that if I'm commander in chief and when they started throwing those high balls at me I'm going to salute them back thank you thank you for your wonderful Texas welcome today and for being with us here and sharing your joy and spirit and before I go I do want to ask you a question that you may have heard before tell me are you better off today than you were four years ago ask another is America better off than she was four years ago then I'm going to assume I won't even ask this one I'm just going to assume that you don't want to go back to the days of America being second best let's keep going forward together thank you and God bless you all President Reagan if you would please sir if you would come forward Vice President Bush two lovely ladies in the wings here in the best tradition of Texas have a presentation for you


Our next speaker is Preston Reynolds. Dr. Reynolds is the Professor of General Medicine, geriatrics and palliative care, and a core faculty member of the Center for Biomedical Ethics and Humanities at the University of Virginia. Dr. Reynolds received her MD and her PhD in history from Duke University and then completed residency in internal medicines at Johns Hopkins University. Dr. Reynolds served as a member of the American College of Physicians Board of Regents and the ACP Health and Public Health Policy Committee. Chair of the Human Rights and Education Subcommittees of the Society of General Internal Medicine, and member of the Board of Directors of Physicians for Human Rights. Dr. Reynolds led a national campaign in the early 1990s to reform medical education and the medical licensing system. Dr. Reynolds' research has focused on the history of race discrimination in healthcare and medical education. Dr. Reynolds has also been involved in the effort to bring genetics into generalist clinical practice and national policy efforts to reform healthcare in this country. Today, she's going to be talking, taking the four box model to Nepal. Welcome, Dr. Reynolds. Well, I will have to say that it's an amazing process to come to the McLean Center, be part of this group, and find yourself taking the things that you learned here really to a very remote part of the world. I first went to Nepal in 1994 and I've been back there numerous times since then and I was invited to be on the International Advisory Board of a newly established medical school there. It's a Patan Academy of Health Sciences. It is in Kathmandu. It's a 13th medical school created in the country and I believe it really is a model of innovation. It has tapped into the creative energy of people around the world and these are some of the International Advisory Board members at our meeting in 2011. This is an invitation to come back in 2012 but you can see that these are really master educators from just about every continent here around the globe and it's really been a privilege to work with them to bring what we believe as a vision of social justice, clinical excellence, best practice in medical education to shape a new generation of health professionals in that country. Patan Hospital was Nepal's mission hospital for 40 years and it attracted to this institution missionaries from, again, all over the world and so it always had a philosophy of caring for the disadvantaged and when Arjun Kharky, he was the founding vice chancellor, decided he wanted to create a new medical school in this country, he decided that Patan Hospital had already the values that he was looking for in dedicating a school to addressing health disparities and the needs of the urban underserved and particularly the rural, very underserved population in this country. The first matriculating class was 2010 and 2015 we enrolled our fifth class. Here you see at the top Rajaj Gangal who was the founding dean. Arjun Kharky was the founding vice chancellor and here in the bottom is our new dean who succeeded Rajesh. It follows the British model which is six years and I'm gonna focus on the preclinical and the clinical years and to say that this is the first medical school in Nepal that has created a longitudinal ethics and professionalism curriculum and I was invited to serve on the International Advisory Board to in fact create this program with some of the faculty who were there. What makes Patan Academy of Health Sciences different but one it's mission and vision that it really is absolutely dedicated to training health professionals to take care of the poor and vulnerable and to meet the needs of the rural population. We have a very, very innovative selection process that takes preference from people from disadvantaged and rural backgrounds. Everyone has to successfully pass an entrance exam but then there is social preference and inclusion preference to take those students from disadvantaged and rural backgrounds as I just said. It strongly is weighted toward a community based curriculum with a law with a six month placement in the district hospital in year four and then teaching methodologies it's the first medical school in Nepal to implement problem based learning as well as case presentations as a way to teach the basic sciences. They get exposure very early to a patient and they longitudinally follow patient with a chronic illness, a patient who is palliative and dying and then a disabled child. And as I said, this is the first medical school to institute a longitudinal ethics and professionalism curriculum. They have an electronic portfolio so all of the things we're gonna talk about and ethics goes into their portfolio. They have frequent formative evaluations and feedback and there is very, very close and intensive mentoring. I should also say that in terms of the inclusion process and we'll see that we have enrolled students from all over, all over the country and as you can see, 77% of them have a rural background. What's also important to recognize is that even in the first class in 2010, we admitted students from the delete class which are the untouchables so that we have really committed ourselves to be inclusive economically, geographically, ethnically and culturally. 60% of the students are on scholarship. We were able to arrange with the Nepali government that they will not get their license until after they have fulfilled a period of service in exchange for the scholarship. So if they're on a two-year scholarship, it's two years of service, it's a four-year scholarship, four years of service, well they will go back and practice in a rural area and help meet the needs of the disadvantaged population who live in the very remote mountainous and district areas. So I'm gonna now focus on the ethics piece because that's what we're here to talk about and I'm gonna focus on the preclinical years and this is the material that I've been engaged in helping the faculty develop. In the first block, the introductory block, the students are really immersed in the mission of Patan Academy of Health Sciences with this commitment to social justice, the social determinants of health, community-based practice and care of the poor and vulnerable. We then move into two years of their preclinical clerkship and as I said, it's primarily problem-based learning and what we've been able to do is create four problem-based learning cases that they work on as well as they get an introduction to these ethical topics as part of lectures and case discussions and we would all consider these really core to an ethics education. Then we move into the clinical sciences years and this is where I'm really amazed at what they have dedicated themselves to accomplish. As you can see here, there's 18 months of the junior clerkships, which we would consider our core clinical clerkships. Then there's a six-month rule placement which just launched this year. Those students, so I was there a couple weeks ago and went out into the rural districts and met with the students that are in the first rural placement. And then once that period is finished, then they will come back for what we would consider senior electives. The six-month rule placement, 17 of those weeks are done in a hospital and seven weeks are done in the district public health department learning about community sciences and the social determinants of health. Now we're gonna talk about the clinical activities. The students rotate in all of the core clinical areas that we would consider relevant in this country. And as you can see, there is a NICU, a PICU, an ICU, as well as specialty wards. There's OBGYN as well as surgery. The OBGYN dropped off the slide. In the 24 months, the 18 months, ethic clinical rotations, they get seven lectures to start off with. And then every other week, all of the students that are in their clinical rotations come together for two hours and a half discussions using the four box model to analyze ethical dilemmas that they've observed on the wards. Every student is required to write up a case with a PowerPoint presentation before they come to this two hour discussion. These are the seven lectures that start off with that 18 month core clinical block. And as you can see, it's informed consent, confidentiality and circuit decision making, end of life and truth telling, human rights and social justice, the hidden curriculum and role modeling, and then the four box model and reasoning through ethical dilemmas. As I said, every other week, all of the students, whether they're on surgery, OB, pediatrics, intramus, and they all come together. And this is actually led by now, the former dean, Dr. Rajesh Gangal, leads these ethics discussions really as what we would consider in a sense, safe space. What stays in that, what's discussed in that room generally stays in that room. And also the chair of pediatrics, the head of the NICU, and now a general practice faculty member help facilitate these discussions with Dean Gangal. The first 45 minutes are spent in small groups where the students discuss the cases that they have seen and worked up using the four box model. And then each group chooses one that they want to present to the whole group of 60. And then the last 75 minutes are generally spent in discussing these cases per group in terms and a large group discussion facilitated by the senior faculty. And they use the four box model mark. I have case write ups where they actually have this four box model in their Neporaly e-portfolios that we printed out. I've given them copies of Mark's book and it's really amazing to see this as a framework for helping students and now faculty begin to look at ethical dilemmas that they see in clinical medicine in this country. What are the type of topics? Confidentiality, truth telling, informed consent. Who in the family is making the decision? Medical error and how it was handled. Autonomy, disclosure, issues of paternalism, futility. And importantly, issues of social justice and the limitations of resources, primarily financial disparities and social inequities. They have now moved, as I said, into their six month clinical rotations and what we have introduced is a requirement for all students to do two cases that they see in the rural areas and to load those onto their portfolios and in a virtual classroom discuss those at least twice during that six month placement. So then we'll begin to get an idea of the ethical dilemmas that the students are observing now in the rural district hospital area. And this is a typical hospital. I was there several weeks ago when we drove 10 hours out to the Terai, viewed the hospital, met with the students, talked about their experiences, challenges, what they loved about it, what they wanted to improve, and then went back and fed that back information to the medical school leadership. So we're in the transitions of leadership. I really had the privilege of working with Dr. Bruce Hayes who was a missionary from Australia. He was actually working at Patan Hospital for 25 years. He just returned to Australia. And Katrina Butterworth is also a physician. She's from the UK and she is a missionary, has been there for about 22 years and her daughter is about ready to start college. So she and her husband have decided to go back to the UK. We've transitioned it now. The Nepali faculty of the medical school are doing this full time and all aspects of it from the lectures to the case discussions and the clinical awards. And I've been asked to stay on board and help develop this curriculum as part of the senior clerkship and the internship which is required as part of that six-year model. So we're also now building out an ethics curriculum for a to be established school of nursing and a to be established school of public health. Lessons learned, we have found that in fact the four box model is a very, very useful framework for beginning the conversation and beginning skills development and how you work through ethical challenges. But it is very Western, they would argue it is Western relevant and that we need to expand the four box model with the more attention to cultural nuances and particularly how it can be applied in a very resource limited setting. What we've also learned is that the students are seeing that their faculty are not meeting these ethical ideas. And the challenges, what do they do when they see their faculty perhaps not telling the patient that they have cancer, making mistakes when it comes to how they're handling medical errors, not doing proper informed consent. And so the last conversation with the faculty at PAWS was how can the students now become the moral agents of ethical change in this environment and empowering them and strengthening them to really be the transformative change agents not only at this incredible institution but when they get out of the district levels more into rural practice. We found that the curriculum itself is building ethics and teaching competence of the PAWS faculty. The general practice faculty member who's now leading these discussions emailed me and wanted to do online education in ethics. I sent him to a website that actually is very comprehensive. He says, whoa, I think I'm gonna start not so intensively with probably a two year curriculum. So he went to the World Health Organization's website and began to start reading and developing some knowledge in this area. Also the challenge articulated by the ethics faculty is how do we ensure the students model these ethical and professional behaviors when they are in practice and when they are in teaching roles themselves. So this idea of taking the virtual classroom out into the rural areas, developing a CME program for the graduates to continue to enrich and strengthen their own ethics competence once they finish and move on. Next steps are developing a method of formative feedback on professional behaviors, continuing the ethics curriculum and case discussions into the senior clerkships and into the internship year, analyzing the cases that the students bring from the rural district postings, creating an online educational research on ethics and professionalism by use by other medical educators in Nepal and hopefully hosting a conference on ethics and professionalism education with medical schools in Nepal and India since many of the medical schools in Nepal rely on India as their model for educational material. So as I showed you earlier, the students think that this ethics case discussion in their clinical years is the best thing they do. As Rajesh told me several weeks ago, he loves leading it. The students love coming together and they find that this interactive format to be very helpful for them also addressing moral distress issues that they experience on the wards. And since the senior faculty are involved in facilitating the discussions, it gives them a very good hands-on idea on how to mentor and shape their professional development. So the International Advisory Board comes together every year for several days and Nepal is now becoming a model for what we would like to have happen in medical schools not only in Nepal but also in the United States and around the world. So the neat thing is that the Nepali faculty are now becoming a model of what we would like to take out from Nepal to other parts of the world through the members of the IAB. And as I just wanna finish, Mark, thank you for giving us something that is so useful in parts of the world that I'm not sure I would have ever expected taking this when I was a fellow. So with that, I just wanna thank you again. That was a very nice presentation. Thanks for sharing that experience. One question I have has to do with the comment you made about the way the students saw the four box model as being too westernized. And so I wondered what insights they gave you outside of the ones that you mentioned focusing on distribution issues because I think that that could be embodied in that four box model as well. Did they give you any insights as to how that model might be expanded or contracted to fit their practice in their area? And also how did the students relate to the traditional four principles that we use in the West? Did they put a primacy on one principle over another or did they suggest introducing other principles for that context? So Bruce, Dr. Bruce Hayes, who started off the curriculum in the preclinical years did teach about principle-based ethics. And when the students are required to write up their cases, they're actually required to talk about what the effect of this ethical dilemma was on the patient, on the healthcare team, and on them to use a four box model to analyze the ethical dilemma and also to address what principle, in terms of autonomy of beneficence, non-maleficence, and justice is illustrated in this case. So they're using what we would consider Western framework to look through, to look at ethical challenges. One thing that is very apparent in a resource poor country like this is that families make decisions because they have to pay the full cost of healthcare. And that drives a decision making process that is very different than what we would experience here. So a child may need to be in the NICU, but it costs $500 a day and that family may have no money and may have to withdraw care. Or they may have a week's worth of money, but after a week, if that baby is not able to survive in a pediatric ward, they will have to take that baby out of the NICU and move to palliative end of life decisions. And a number of the cases that the students raise are around these financial limitations. Also around decision making by families. And I know Bill, when I was an ethics fellow, really emphasized in terms of end of life care, often does, we have to respect that family decision making process. But in this culture, it's a family decision making process. And I think our emphasis on autonomy in this country, they can recognize the need for that more in Nepal, but they also understand culturally, contextually, it's still a family decision making process. So how that process works, case by case, context to context is a very unique set of discussions. Last question. This is on, yeah, just as a related question Preston, I think it is terrific work, but in terms of trying to adapt it to the local situation, I wondered if you could tell us a little bit about the religious composition of the population, of the faculty and the staff, and whether you've considered working with religious leaders as a source of both of what counts as a case and for modifications of the four box model to Nepal. So Bruce and Katrina since they are missionaries are Christian and a number of the physicians there still at Potten Hospital are missionaries usually from a Christian base faith. The Nepali faculty are Hindu and Buddhist. And I think that the combination of Christian Hindu and Buddhism has really enriched the ability for conversations to happen. Addressing various aspects of religious belief. It's interesting though when reading through these cases, the religion of patients does not come through. I think transitioning this teaching from Bruce and Katrina to the Nepali faculty will absolutely ensure that when those issues arise they will be addressed because they are familiar with the religious beliefs of the people in that country. However, it's interesting that religion really does not play a dominant role versus the financial issues and versus the ability of the medical system to respond to whatever the medical needs are of that patient at that time. So since you have a resource challenged environment you may not have an ICU bed even though you have a patient that you may want to admit to an ICU. They have six dialysis machines. So if you have need dialysis but you don't have a machine that's gonna frame the conversation around the ethical dilemma about resource utilization and resource limitation. But I've been fascinated that religion has not come through as the ethical challenge that the students are observing in the case itself. And maybe that's because we haven't delved down enough and what they're looking at is what we would consider traditional ethics. Thank you. Thank you very much.