Let's begin reading at verse 46. I'll read verses 46 and 47, get into our study. John chapter 8, beginning at verse 46, reading to verse 47. Jesus says, which of you convicts me of sin? And if I tell the truth, why do you not believe me? He who is of God hears God's words. Therefore, you do not hear because you are not of God. And so in our last study, I mentioned to you that I was going to pick up at this place here, and let me remind you of a few things. Jesus has been confronting some who have been listening to him. And I pointed out to you, if you look at verse 31, I point out that John had identified them as Jews who believed him. And that's an interesting way to put it. Jesus said to those Jews who believed him. And so that's basically who the conversation is as Jesus is speaking. That's who he is speaking with. So by saying that, John was pointing out that they'd shown an interest in him. It isn't that they were actually his disciples. They were people who had curiosity. And that's why Jesus made it clear that his disciples were those who remain or abide in his word. So that makes it obvious that curiosity alone doesn't constitute saving faith. There's a lot of people who have an interest in God. They have an interest in the Bible. You know, you can go to some colleges and you can actually take the Bible as literature. And there will be people there who will go and take that class because they see it as an interesting book. And there are those who want to know about God. There are those who speak and say, I'd like to know more about them. But that doesn't mean that they're willing to drop everything, pick up a cross and follow him. And that's basically what is taking place here. So John is making it clear that these whom he is speaking to right now are those who have shown an interest in him. They're not his disciples. They have curiosity. And again, that's why Jesus said his disciples are those who abide in or remain in his word. And as this is taking place in this chapter here, he went on to expose their lack of genuine faith by saying this to him.  Remember how they responded when Jesus made that statement? They got really upset at him. They responded immediately by saying, we've never been in bondage to anyone. And so Jesus was speaking to them about that because indeed, even as they were saying, we have never been in bondage to anyone, they were in bondage to Rome. And so the self deception is what's being dealt with as Jesus is speaking to them. And so Jesus went on to say to them in verse 32, that he's the one who makes people completely free. Now, all of this is serving to reveal that these are not genuine disciples. You see, when Jesus spoke of complete freedom, true believers would have rejoiced. How did you respond when you actually grasped that message? How did you respond when you heard that you could be free completely, that all of your sins would be completely washed away by the blood of Jesus Christ? I don't know what you responded like. I can tell you how I responded. I responded with amazement. I responded with this and it's like, you're kidding me. I was only 20 years old.  You know, I reserve that for John Mata. I wasn't the worst sinner in the world, but I certainly was a sinful young man and laden with so much guilt and so much depression over the things that I'd done, just heavy. And so when the gospel is preached to me and I am told that the blood of Jesus Christ, God's Son, cleanses you from all sin, not just some sin or a few sins or particular sins, all sins, every single one. I was amazed. What were you like? I was amazed. It can this be so? Can this be true? See, if the Son makes you free, you are free indeed. And there should be a response in the heart of a person, a response that you spend a lifetime just glorifying God for what he's done. You know, why do you serve God? Why do you serve God? I serve God because he set me free to do so. I serve God because he loved me. He gave his Son for me. And the gratitude of my heart is overwhelming. I'm overwhelmed with gratitude for what Jesus did on the cross for me.  No, there are my moments where I sometimes seem to forget what he's done. But the overwhelming reality is what Jesus is saying is, listen, the Son will set you free. And the one who set free is free completely is free indeed. And again, those who are hearing this message should have rejoiced that the knowledge that they were no longer in bondage to sin ought to produce this great joy. The freedom given to us in our Savior brings such relief that we are overwhelmed by it. Remember when the angel was speaking to the shepherds who were approaching the Christmas season, you'll be hearing about this real soon. But remember how the angel told the shepherds on the night that Jesus was born, how the angel in Luke 2, 1st 10 said to them, do not be afraid, for behold, I bring you good tidings of great joy, which will be to all people. I bring you good tidings of great joy, mega-carous in the Greek, great unbelievably great joy, because that's what happens, guys, when you get right with the Lord, there's this joy. And so that's the response of somebody who's been totally forgiven, this amazing joy. Like it says in Romans 4, verse 7, blessed are those whose lawless deeds are forgiven, whose sins are covered. The word blessed speaks of joy, rejoicing. The one who knows these things has joy in their heart. And if you're not walking in the joy of the Spirit, remembering that the joy of the Lord is your strength, maybe you need to just rehearse in your mind what God has forgiven you from and how grateful you can be. It has a way of restoring joy. It has a way of reminding you, look at God has done. We live in such a society that is so dissatisfied with what they have. We always want a little bit more, just a little bit more. Like that millionaire who was asked, how much is enough? And he says just a little more. We're that way as a people. I want just a little bit more, more satisfaction, more whatever. You know what, God has already given to you more than you can even handle. We just don't realize it yet. And as you begin to walk in his Spirit and you begin to see what God does and when you begin to count your blessings and you begin to think about what the Lord has done, you're just amazed. I can't help. I'm looking at my wife for a moment here and I'm thinking it was in a November. She may not even remember this. It was a November that she gave her heart to Jesus Christ.  Yeah. And I remember that. I remember that because she came to my Bible study hunting a husband and got me. No, she didn't. Okay, these people should have had great joy, but instead notice how they responded, anger and indignation. Verse 33, they claimed that they'd never been in bondage to anyone. So as we have seen, Jesus made it clear that even at that moment they were in bondage. They were in bondage to sin.  Now they had claimed to send from Abraham, but Jesus makes it really clear. You're really children of the devil.  Notice verse 43 where he said, why do you not understand my speech? Because you are not able to listen to my word.  He was a murderer from the beginning and does not stand in the truth because there is no truth in him. When he speaks a lie, he speaks from his own resources.  This is coming from the mouth of sweet and gentle Jesus. There's so many people that don't have the full concept of Jesus in terms of his teachings.  How come they can point out sin sometimes? Isn't that cruel? Isn't that judgmental? Look at the words of Christ here. Look how strongly he's speaking to these people. It isn't a lightweight thing that he's saying at all. He's telling them, you are children of Satan. That's what he's saying. And that's a pretty heavy thing. You're revealing your rejection by rejecting my word. And the real desire is not to follow me, Jesus is saying.   And he says, and you're like your father. He lied to Eve. He lied to Eve. When he said something related to the fruit in the garden, she speaks to him and she says, God has said to us that we shouldn't eat of this. Neither should we touch it, lest we should die.   And it was Satan who provoked and encouraged Cain to rise up and to kill his brother Abel.  In 1 John 3, 11 and 12, John says it like this. He said, this is the message that you heard from the beginning, that we should love one another. Not as Cain, who was of the wicked one and murdered his brother. And why did he murder him? Because his works were evil and his brother's righteous.  And why do they refuse to believe him?  As I've mentioned to you before, I say this fairly often enough to try and make that point indelible in our souls. The fact is, when you tell someone the truth, they don't always love you for doing so, do they? They don't always love you for doing so. One of the first things you hear today is, why are you judging me? Why are you judging me? You know, they don't always thank you for pointing something out, even if you do it with tears and a broken heart. And you can actually alienate them for telling them the truth. And that's, that's, that was the case with Jesus. And that's the, that's something that the Lord taught me as a minister of the gospel a long time ago. As a matter of fact, Galatians 416 became a very important scripture to me very early in my walk with the Lord, where Paul said to the church of Galatia, have I therefore become your enemy because I tell you the truth?  Because people would prefer a lie over the truth very often, and that's just a fact. And so as that goes on, verse 46, he asks the question, which of you convicts me of sin? Well, they couldn't convict him of sin, but they still rejected him. Now think about that for a moment when Jesus asks the question, which of you convicts me of sin? If, if you said that in your home, if you were just sitting there in thanksgiving and, you know, could you pass the mashed potatoes, got to have some corn, please? And oh, by the way, which of you can convict me of sin? Forget about it. That's the end of thanksgiving meal for you. Where do you want me to begin? You know, this, this, this, all of us are that way. But think about it. Think about Jesus. I mean, Jesus is raised. I mean, he must have been an unusual brother to have anyway, because the Scripture tells us he had brothers and sisters. He must have been unusual. Think about it. How would you like to be raised in the home with a perfect kid? I mean, Mary never even had to tell him make your bed. He just couldn't know. Mary, he never lied. He never did anything, never got a lecture, never got in trouble. Really. You know, he did get one lecture. Now that I recall when, and he had remained behind in Jerusalem during the feast and, and Mary and Joseph had gone and they had to turn around and come back and then Mary was upset with him. And she said to him, your father and I, you know, looking for you. And then Jesus rebuked her for that because he had done nothing wrong. I'm about my father's business. When you speak of my father, it's not Joseph, my father's God. And so Jesus even rebuked his mother in a mile away, but it was a rebuk nonetheless, because she tried to lecture him once it's in Scripture. And well, a second time, I know I'm thinking about Mary. I didn't prepare this, but I'm thinking about it again. You know, when John do they have no wine. Woman, what's that got to do with me? You know, thank you, Jesus. Teach me to disrespect. No. He's saying you are not the one who gives me the timetable of my activity. My father is. I'm not under your orders. I'm under his. And so you'll see those rebukes even to his mother because she tries sometimes to insinuate herself into his life. But even so, who could, who could say Jesus sinned? And he could say that in front of everybody. Imagine that everybody, everybody. And you know, he was without sin, let him be the first to cast stone at this woman. He had said he's the only one who could have done that. And he didn't because Jesus Christ is perfect. And so we ask that question in verse 46, which of you convicts me of sin? Verse 47, he who is of God hears God's words. That word here in the original language, the New Testament was written in the Greek language. It's called Coine Greek. Coine Greek speaks of the language of the average person at that time. It was just the language that they spoke common Greek. And it says he who is of God hears. So I looked up that word here. I wanted to know what word was used for that translation. And that word that is used speaks of understands. When Jesus said he who is of God hears God's words, the literal word would be understands or gives heed to. And so a person who knows the Lord values what God has to say. And when that person values what God has to say, they're listening with an inclination to obey. It's like what it says in Jeremiah 1516, where Jeremiah the prophet said, your words were found and I ate them. Your word was to me the joy and rejoicing of my heart. For I am called by your name, O Lord, God of hosts, your words were found and I ate them. They were sweet to the taste, pleasant to me. I desire them greatly. I hunger for your word. I desire your word. And that's what Jeremiah was saying.  And it's our desire to do those things that are pleasing to the Lord, to desire like Job said his word more than our daily food. And so if you have a relationship with God, you don't avoid his word. You desire his word. And when you read his word, you don't argue with it. There are quite a number of believers I encounter on a regular basis who like to argue with God. They say, I never argue with God. But we do. We do when we're reading the Scripture and begin to debate whether or not we'll do that, whether or not we're willing to do that. Sometimes I'll read your Bible and say, well, that's very convicting. I'm reading the wrong, you know, that's really not to me. That's my wife. I wish she was in here right now so I could show her what God is saying to her. You know, we have this tendency of wanting to kind of like push it off on other people. The things that he says that are pleasant to us to hear are the things that we will grab hold of and want to hear. The things that cut to our heart are convictions of sin are the ones we're uncomfortable with. And so one of the ways for us to discover if we really have a relationship with the Lord is how hungry are we for him and how hungry are we for his word. And Jesus is making it very clear that the one who was of God hears God's word. He says in verse 47, you do not hear because you're not of God. Now that is a very strong statement. I use various commentators when I prepare my studies in one of the commentators named as Alakot. And he said this. He said rabbis and priests, teachers of the law, judges of truth, offerers of sacrifice, keepers of feasts, worshipers in synagogues and the temple. They were all these things. But Jesus made it clear they weren't of God. They were very religious, went to temple, made their sacrifices, did all of these things. Is it possible for a person to do all these religious things and not have a relationship with God and some in this room would say absolutely because you did that, because you went to your catechism classes, because you went to church regularly, because you received whatever kinds of of identifications of your church. I did. I can speak as a Catholic. I can say that I received baptism. I can say that I had the sacrament of confession and penance and first communion and confirmation. And all of those things, if you were to look at it on paper, I would have been regarded as a good Catholic boy. But none of those things made me any different. My mom took me to a small church. Many of you are aware of this church. It's in Alvera streets. It's a little church there in Alvera Street. When I was in December, I would have been four months old at the time. My mom told me the story. She said I went to the little church there in Alvera Street. She says I found a priest and there's a little alcove. I've been in the church, perhaps some of you. It's an old church in LA.  And that's where my mom at the age of 20 took me and had me baptized in that little place. So my heritage religiously started when I was four months old. And my family, I have an uncle who's long been dead, who was I believe if he was an Archdeacon or a Bishop. He was very high in the Catholic church in Jalisco. And he actually came from Jalisco to California to baptize my eldest aunt because she was born in Mexico and he would have been a great uncle to me. So our religious history was steeped in Catholicism. That was my background. So I was baptized. I received communion. I received confirmation and all of that. I did those things. And had you argued with me or discussed with me religion because I'd gone to Catechism and I knew the rudiments of my own quote and quote faith. I was able to argue those points because I memorized them at the age of seven or eight years old. But I didn't want to hear God's word. I wasn't hungry for them. I didn't want to hear people preach to me about how to live or what to do. I refuse those things because that's what a person who professes religion is all about. They don't have a real relationship. They just hide themselves in regulations and hope that those things are going to make them good in the day that they stand before God. Jesus is speaking to people who have all of those things who've done so many things. Again, the rabbis are priests, the teachers of the law, judges of truth, their authors of sacrifice, keepers of feasts, worshipers and synagogues, worshipers in the temple. They were all of those things and yet Jesus is saying you are not of God. They could hear but they refused to act upon. They heard but they failed to give heed to his words.   No, Jesus answered, I do not have a demon but I honor my father. You dishonor me.  This is the only place that this is actually found. This statement here, but it was common knowledge at that time that that is what they were saying. So they call him first a Samaritan.  You need to remember something we've already looked at and I'll touch on it lightly. The Samaritans and Jews had nothing to do with one another because the Samaritans were what would have been referred to as a hybrid race, meaning that the Assyrians had brought in people who had been conquered by Assyrians and brought them into the area of Samaria. When you think of the map of Israel, think of the map of California because Israel is a west coast kind of country. So picture it is similar in configuration to California. So you have northern California, central California and you have southern California. Well, the north of California, the north of Israel is called the Galilee, the center which would be central California for us. The center is Samaria and then the southern would be Judah. And so what they did is they brought people from foreign lands and populated the area that is referred to as Samaria with people who brought in their false gods. And so over time what happened is the false gods that they had brought in with them, their faith in and practice of worship of these false gods began to be intermingled with the Jewish faith. And the Jews very early began to regard Samaritans as pagans and had no dealings with them. And that's why when a Jew would travel from the south to the north or from the north to the south they would normally cross over the Jordan to their east and would travel south or go north but first traveling across the Jordan then go up bypassing Samaria and then coming back in and going to whatever destination they were going to. The Jews had no dealings with Samaritans. So it would be referred to as a Samaritan was a very terrible kind of a slam if you will, it was a slur. So it's interesting in spite of this I wanted to touch on a couple of things that I didn't touch on last time. It's worthy of note that the Samaritans are mentioned a few times in the Gospels. We've seen them already in John's Gospel for example the Samaritan when we looked at the woman at the well which was we were told that this woman was a woman of Samaria. So the Samaritans have already been introduced to us. When you look into the Gospel of Luke, Luke records how Jesus went through a village and was approached by 10 lepers. We're all used to call them lepers. 10 lepers and remember how these lepers had approached it and asked for mercy and Jesus had cleansed them of their leprosy. It's recorded in Luke 17 because it says in Luke 17 verses 15 and 16 after they had been cleansed one of them when he saw that he was healed returned and with a loud voice glorified God and fell down on his face at his feet giving him thanks and then Luke adds these words and he was a Samaritan. There were 10. Nine of them were Jews. One was a Samaritan and yet Jesus says were there not 10 of you cleansed and yet only one came back to give thanks and praise and they're pointing out one the Samaritan woman at the well two you have this cleansed leper who was Samaritan. It's given us an insight into some things about the Samaritans and then once again all of us know the story of the good Samaritan and so it's a that good Samaritan is recorded in Luke chapter 10 but in the midst of all of this where somebody falls among thieves and they beat him left him on the side of the road and a priest and a Levite came by Jesus made sure to point out that they stepped across the street walked around him and then here comes a Samaritan and the Samaritan ministers to him and all so this compassion that he had was pointed out by Jesus so what he was doing was exposing the religious hypocrisy of the Jewish religious leaders so when they're saying to Jesus are we not speaking the truth when we call you a Samaritan it's interesting to see how the Samaritans really show up in the New Testament as not being as evil as these people here are claiming them to be what they were is people in need of the gospel and so Jesus ministered to them they also say that he's in league with and empowered by Satan do we not say rightly that you're a Samaritan and have a demon a demon well this is an accusation they had casted him Luke 11 18 says if Satan is divided against himself how will his kingdom stand because you say I cast out demons by Beelzebub the prince of demons so once again what they're doing here is they're not dealing and this is an important point I want to make this very clear as I say this this is a very important point I want to make here I want you to notice something in all of this they are not arguing against Lord Jesus Christ's message what they choose to do is attack him as a person and that's called an ad hominem argument if you can't beat a person on the strength of your arguments in contrast to theirs just attack them just call them a name try and make them look as bad as possible tie some very negative thing that has occurred tie it into their character and people will stop stop taking into consideration the strength of argument and what they will do is just attack the person that is so common is one of the things I learned about ad hominem arguments when I was in elementary school it is a very common thing to not deal with the argument just attack the person and that's what they're doing here they're attacking him they're not listening to the words he's saying he said you can't hear them they're ignoring the things he's saying because they are so bent on destroying him they can't hear a word that he's saying so he says in verse 49 I do not have a demon I honor my father and you dishonor me so Jesus ignores the charge that he's a Samaritan denies that he's demonized he's being attacked and his response is to give his response actually gives us insight into how we should respond he dealt with the attack clearly and he rebunded their unjust statements over the years it depends on how long you live you're going to have this happen more than once you will have people who will attack you I guess everyone of us in this room have had that more than once in a lifetime maybe many times you know if you're in ministry that's a very common thing for people to you know to attack you and that you become aware of those things I was speaking to my pastor Chuck Smith one time a long time ago now and I said to Chuck something like pastor I said you you've been around for a long time and God has used you in great ways um but I have to ask you a question I said to Chuck I said do you uh were you born with a naturally thick skin or did you develop one over time I wanted to know because he received so many attacks I mean I can still remember there's so many I mean he introduced a Maranatha Christian music the music that we're used to hear was unheard of some of you may be old enough to remember that you didn't have guitars on an altar or a stage occult at the altar you you didn't have guitars you didn't have drums as I mentioned recently there were there were articles that were written about Calvary Chapel introducing what they called voodoo music voodoo music that's so crazy you can't believe it but that's the truth you know these hippies who have come in and have introduced pagan rites that was resurrected when Chuck died sad to say somebody that I admire very much man by the name of John MacArthur resurrected that when Chuck died and said that we were offering an unholy profane fire and that that it was the hippies through the Calvary Chapel that has been the reason that the church is is is in a bad place now John said something to that effect and I felt sorry that he had done that because I've admired him for many years I respect him highly and for him to take that route but that that was common we've heard that many times many times Chuck Smith is a simple minded preacher and he just gives simple sermons to simple minded students you know Haster Chuck had a photographic memory I have a photographic memory problem is the film never develops but he had he had a photo he had a photographic memory you know and he could read something one time I've been with him many times where he would hold this Bible I'm thinking right now when we were in the Sermon on the Mount and I was sitting there with him and my dad as he was giving a message he had his Bible and he always held it closed on his lap and he quoted verse by verse word for word chapters five six and seven out of the gospel of Matthew he was not a simple minded man by any means he's a man who was going to be a doctor and he had the brains for it and he loved science but God called him to minister and he took that magnificent mind of his and put it into the word and that's why we today to this day I am blessed by his ministry for what he did and yet the accusation was against him and then later on it's been against us people like myself and Raul and so many guys you guys are simple minded guys give simple Bible studies but Chuck said I would rather speak a few words that are easy to understand than 10,000 words that people can't understand and I remember when my dad first got saved how I was sitting inside a Bible study in in 1973 my dad was one of the people sitting in the Bible study just a handful of people and I still remember using a word I still remember the word I used as I was teaching tetragrammaton and I was speaking I said you know that's the tetragrammaton the tetragrammaton is is the name of Jehovah J H V H and the tetragrammaton and my dad just looked at me and he was beaming with this big smile in his face when I said tetragrammaton and I was using my college vocabulary and the spirit of the Lord spoke to my heart I've never forgotten this and he said your father is so proud of you but doesn't understand a word you're saying I've never forgotten that it was true because I was using words my dad had an eighth grade education he was proud of his son he wasn't a stupid man my dad was very intelligent but at the age of 13 during his day he had to quit school so he could go out to the fields and work that's what my dad and all my uncles did that was common at that time they didn't all graduate my dad didn't he read the readers digest every night that was his book but dad didn't know big words and there he is smiling at me as I'm using them and I'm thinking yeah this college vocabulary comes in handy and the spirit says he doesn't understand what you're saying and that's what I began to learn not that like not like I'm so superior forgive me if it sounds that way that that's when I began to learn that you can have many words that are not understandable so for you who are teachers always remember that a child in the room should understand what you're saying they should be able to grab what you're saying it has to be that plane not because you're less or greater not because that's how it is and people have a tendency of of attacking and Chuck was attacked and they're attacking Jesus here and it's because they won't hear his words they refuse to listen as plainly as he's speaking they will not listen to him and so what he does is he rebuts their unjust statements in first Peter 2 23 the apostle said this when they hurled their insults at him he did not retaliate when he suffered he made no threats instead he entrusted himself to him who judges justly so he said I honor my father in what I say and all that I do but you verse 49 but you dishonor me now on a certain level the things that they're saying they do have the capacity of wounding and their unbelief and their attacks and accusations have a wounding effect Psalm 69 verses 7 through 9 reads it like this reads like this because for your sake I have borne reproach shame has covered my face I've become a stranger to my brothers and an alien to my mother's children because zeal for your house has eaten me up and the reproaches of those who reproach you have fallen on me and that's what it's taking place here and he's saying in your dishonoring of me the fact is you're dishonoring my father in John 5 23 he had said all should honor the son just as they honor the father and he who does not honor the son does not honor the father who sent him he says in verse 50 I do not seek my own glory there is one who seeks in judges so Jesus didn't come to seek his own glory but to bring glory to his father and the glory he brought to his father was related to redemption you see in yielding himself up as a sacrifice he satisfied his father's righteous commands he also paid the ultimate price he appeased his father's wrath and he provided salvation for those who would follow him so when I say you do not honor me he's saying ultimately I'm not seeking glory from you you see my father's the judge and my father is the one who will glorify me one of the things again that we remember as believers in Christ and as followers of him is as we don't seek glory from man if you do if you're seeking glory from man that's the wrong thing to seek what you want to hear is the well done from the Lord because when you seek glory from man you'll have a tendency of changing things to make it more appealing to people you might modify what you're saying and Jesus didn't do that he spoke and we've seen this he spoke very up front and and so did his apostles you know the people didn't want to hear it they wanted you know him to stop speaking the way that he did I was sharing with somebody just the other day when God called Jeremiah he said do not be afraid of their faces and it's not because they were so ugly he was saying because when you speak to people especially in groups because you can be intimidated by them you can be intimidated by the way they look at you and their body language and the things that they may even whisper to one another you can see it you know you're looking at one person right now but I look at a group of people and sometimes there'll be people on over in one place or over in another and I'm telling you you know you're sharing something you know and and they're not responding with a smile you know they're they're scowling at you angrily and and I tell Marie honey don't do that in church people are watching you it makes me look bad I mean I told you it wasn't that long ago that somebody from church uh yelled out and called me a liar while I was teaching they do that I had some I I can't even tell you some of the things that have happened in the church I was going to tell you something and I thought probably shouldn't tell you well I'll tell you it in a delicate way I had somebody get up and give me the California Howdy while I was teaching yeah I I if you know what that is if you don't ask your mom okay you know I this sounds self-serving I'm trying to make a point forgive me but I I know I've given over 8000 Bible studies that's a lot of Bible studies to stand up at least 8000 times it's a lot of Bible studies and there's a lot of faces and a lot of responses that I've seen over the years and if you're afraid of how they're going to respond you have no place in ministry because you have to think the one that you want to respond is in heaven Jesus and you want to hear the well done and the most important thing guys always remember this speak the truth speak it in love but again have I therefore become your enemy because I tell you the truth I memorized that one over 40 years ago because I was raised by a mother who was very plain speaking you always knew where you sit with my mom anybody here who knows my mom or remember sir she was a plain speaking woman she raised me and so I'm a plain speaker I don't know that it's insulting sometimes I don't honestly don't I don't know that sometimes it may be harsh I don't realize that I just think it's true right so over the years God gave me a beautiful woman who said be nice and it's helped me because I thought I was I thought the best thing I could do is tell you the truth I thought the church wants to hear truth doesn't it I did I didn't want to hear some evangelists tell me how nice I am and I'm going to have the greatest day I've ever had I didn't need that I already knew I was a miserable lying thief I only knew I was a doper and a drunk that I was everything evil I knew that already so some guy coming up and telling me no you're you're wonderful just the way you are that guy's nuts he doesn't know me and I really felt that so when they said you're a sinner you're lost you're going to go to hell but Jesus Christ loved you and died on the cross for you and he'll change your life and forgive you of your sins that's the gospel I needed to hear that message not that I'm good but that he's good and that's how it works and don't be afraid I'm not I'm really not one of these guys who's afraid why because my fear is of the Lord not men and that's why Jeremiah said God said don't be afraid of their faces tell them what I told you and they're not going to like it and you're going to get kind of tired of it after a while and you're going to go through some things that you wish it didn't go through but I called you to this because they need to hear truth do it with love love for God and love for people but always tell the truth and what happened here is they were not responding well to it and so he said I'm not I'm not seeking glory from you in verse 51 most assuredly I say to you if anyone keeps my word he shall never see death what do you mean he shall never see death well believers in Jesus presently possess spiritual life because we're born again and because we have new life in Christ we live in fellowship with his father we know that God is the author of life and though our body will perish our spirit never does so in this way for the believer there cannot be death that lasts forever or eternally and John 11 we'll see this in a while verses 25 and 26 where Jesus is speaking he says I am the resurrection in the life the one who believes in me will live even though they die whoever lives by believing in me will never die and then the question is asked do you believe this now what we think of as death in scripture is really portrayed as sleep it's not that our soul sleeps there's no such thing as soul sleep but it's that our body appears to be asleep you see that in chapter 11 of John how Jesus speaks of the death of Lazarus when Lazarus died Jesus spoke of him as being asleep in John 11 verse 11 he said our friend Lazarus sleeps but I go that I may wake him up well when Jesus said this his men said well Lord if he's sleeping he'll get well they thought Lazarus was resting recovering but Jesus cracks him in John 11 14 he said to them plainly Lazarus is dead now sometimes people think of death as a friend Bible doesn't call death a friend the Bible says it's an enemy in 1st Corinthians 1526 the last enemy that will be destroyed is death so in Christ believers live and death has no victory over us in 1st Corinthians 15 55 through 57 oh death where is your sting oh Hades where's your victory the sting of death is sin the strength of sin is the law but thanks be to God who gives us the victory through our Lord Jesus Christ and in 1st Corinthians 15 54 when this corruptible has put on incorruption this mortal has put on immortality then shall be brought to pass the same that is written death is swallowed up in victory so death has been swallowed up in life physical death is thought of in its true sense as entering into life and life comes by abiding in the word that Jesus gives and hits his word that preserves us from judgment in John 5 24 most assuredly I say to you he who hears my word and believes in him who sent me has everlasting life has everlasting life shall not come into judgment but has passed from death into life and that's the kind of stuff that I like to read to you when I first got saved I would tell my friends oh I hope I go to heaven I hope I go to heaven I because I've been raised to believe that you can't know that that only self-righteous people would ever say they're going to heaven and it took a long time in the first several weeks of my walk with the Lord for my friends to finally show me enough scripture to say no you passed from death into life your name is written in the Lamb's book of life it's not something you try to get by earning and working for is something you receive by faith through Jesus Christ and Jesus forgave you of all of your sins and cleanse you from all unrighteousness and his holy spirit dwells within you and your name is written in the Lamb's book of life and one day he's going to call you and say come up here and you're going to leave this place and be in his presence immediately where there is no and no death there's no fear there's no tears there's no sorrow there's nothing but joy that's what you have through Jesus Christ you see and that was what really changed my life is the knowledge that it's not works of righteousness which I've done but according to his mercy he saved me by the washing of regeneration the renewing of the holy spirit and so that's what Jesus is speaking about and so that's powerful what he just said so how do they respond well verse 52 now we know you have a demon and that's sweet Abraham's dead and the prophets and you say if anyone keeps my word he shall never taste death are you greater than our father Abraham who's dead and the prophets are dead who do you make yourself out to be so that's pretty direct isn't it now again remember who's saying this those Jews who believed him but they're being exposed right now for the real lack of faith not true faith now Abraham they're saying Abraham and the prophets heard the word of God yet they're dead if God's word keeps you from dying then how is it that they died you've got to be crazy and then in verse 53 are you greater than our father Abraham who's dead prophets are also dead in other words death comes to all men no matter what they believe even the greatest men die Psalm 89 48 says what man can live and not see death can he deliver his life in the power of the grave so who do you think you are anyway and so Jesus responds in verse 54 if I honor myself my honor is nothing it is my father who honors me of whom you say that he's your god yet you have not known him but I know him and if I say I do not know him I shall be a liar like you but I do know him and keep his word your father Abraham rejoiced to see my day and he saw it and was glad did you said you're not yet 50 years old and have you seen Abraham Jesus said to them most assuredly I say to you before Abraham was I am and they took up stones to throw at him but Jesus hid himself and went out of the temple going through the midst of them and so passed by verse 54 it's my father who honors me and it's his honor that matters most and and my father is the one by the way that you call your god and this is because he is the god of Israel so you automatically call him your god but he's not your god because your actions are canceling out your words in verse 55 he says you have not known him but I know him they don't know god on the basis of their rejection of his word and in his proof that he knows god is that he says I know him and keep his word which is by the way proof that you know him also in 1st John 2 4 and 5 he who says I know him and does not keep his commandments as a liar the truth is not in him whoever keeps his word truly the love of god is perfected in him by this we know that we're in him he says in verse 56 your father Abraham rejoiced to see my day he saw it was glad it may mean that Abraham looked forward earnestly to the messiah and his appearing he may have had a spiritual revelation by the way when he was about to sacrifice his son Isaac remember how he'd gone to the mountain and was about to sacrifice his son Genesis 228 reads Abraham said my son god will provide himself a lamp for a burnt offering and so it may be that he got a revelation at that time well in verse 57 the Jews said to him you're not yet 50 years old now that's interesting we know that Luke 3 23 tells us that Jesus began his ministry at around 30 why did they use the number 50 you're not yet 50 because that would be the age where maturity began to blossom um when you read your bible uh the uh like when with Timothy when Paul's writing to Timothy he says though he says to them that uh him that he needs to live as an example to the believer why because people did not receive deep knowledge from the young and Timothy was a young man when Paul was writing to him so he said be that one example to the believer in word and faith in conduct and gives to him a variety of things we were in Israel and um Chuck Smith we were with Pastor Chuck and his son Chuck Jr we were at a place called Shiloh and when we were at Shiloh junior opened up the book of Jeremiah junior is around my age and I was in my 30s at this time and I was standing next to some of the Jewish bus drivers and I heard one of them when he turned and he said that young man what right does he have to open up the prophets because in the Jewish religion the youth do not touch the prophets until they're of a certain age so that 2000 years ago is still today that's still mentality is still in Israel to this day and so that's why they say you're not yet 50 years old they're saying you don't have the maturity even speak in the way that you are because we know that your ministry started earlier and what this is is simply a contrast of your lifespan with the centuries that have passed since Abraham but here's where I want to close with you because this is very important and I'm going to do it anyway because I didn't take you here last time I can't stop again verse 58 very important verses and I'm going to run through them Jesus said to them most assuredly I say to you notice before Abraham was I am this is what is called the third I am statement there are seven I am statements in the gospel of John the first I am statement was John 635 when he said I'm the bread of life the second we saw in John 812 when he said I am the light of the world but he is saying here before Abraham was I am now I want to point this out and and develop it a bit with you I want you to notice he is saying I am he is not saying I have been and he is not saying I was he is saying I am this is very important theology for you if you ever speak to somebody who denies the Trinity they will tell you that Jesus Christ is not God in the flesh they will tell you that the Jehovah's Witness organization which I think all of us are familiar with I'm certain we are will come to your door and we'll tell you that I have had those conversations with them I've had the discussions concerning the deity of Christ they have what is called the watchtower of the new world translation rather the new world translation of scripture and they will use what is called the new world translation they bring it they used to use the king James so when they've come in the early days of my ministry when they would come to my door I would say you guys use the king James before you had the new world translation they said yes so I said good you recognized it and honor did it one time yes we did okay then I'm going to use the king James and why did I do that I this this is something I could take a long time to talk to but I'm trying to jowl it down to something very quick they translate they created a Greek tense that does not exist and in the new world translation translate this I have been not I am there is a version of the Old Testament called the Septuagint version the word the Septuagint version is related to the Greek translation of the Hebrew scriptures it's called the Septuagint I went to the library got out a Septuagint open it up to John 8 58 in John 8 58 in the Greek when he says I am the word is Ego Emi E-G-O-E-I-M-I Ego Emi you open up the Septuagint version of the Old Testament and you go to Exodus chapter 3 verses 13 through 15 and when the Lord is speaking to Moses God said to Moses I am who I am you shall tell the children of Israel I am has sent you you open that up in the Septuagint Ego Emi the Old Testament repeated in the New Testament people will say Jesus never claimed to be God he just did he just did before Abraham was I am taking right out of Exodus chapter 3 verses 13 through 15 and saying I am the all existing ever existing one in scripture Jesus is revealed as God in the flesh we've seen it in John John 1 1 in the beginning was the word the word was with God the word was God John 1 14 in the beginning was the word the word was with God the word was God John 5 18 this was why the Jews were seeking all the more to kill him because not only was he breaking the Sabbath he was even calling God his own father making himself equal with God John 10 30 the father and I are one that's not they'll tell you oh one in agreement no that word one in the original language speaks of one of in essence not of purpose but in essence he is saying we are of the same essence he's claiming to be God in the flesh in John 20 27 and 28 Jesus said to Thomas put your finger here see my hands reach out your hand put in my side stop doubting and believe and Thomas said to him my Lord and what my God well I spoke to a jovis witness I pointed this out to him I said Thomas called him my Lord and my God well that's because he was surprised that's their answer well that there's he was shocked oh my God I said no no wait a minute I said you know would you say that Jesus is a rabbi and they said well of course he's a rabbi okay if Jesus is a rabbi what does a rabbi do when someone theologically is incorrect they correct them but what does Jesus go on to say you guys know what he's he went on to say you believe because you see blessed it is he who doesn't see and yet believes I said instead of bringing a rebuke he gave him a blessing and he gave us that same blessing does the Bible say that Jesus Christ is God in the flesh absolutely absolutely Philippians chapter 2 verses 5 and 6 you must have the same attitude that Christ Jesus had though he was God he did not think of equality with God as something to cling to Colossians 2 9 and 10 in him the whole fullness of deity dwells bodily and in Christ you have been brought to fullness Hebrews 1 verse 3 who being every existing who being the brightness of his glory in the express image of his person upholding all things by the word of his power when he had himself purged our sins sat down at the right hand of the majesty on high they understood what he was saying and it became the charge that led to his death in John 19 7 the Jews answered him we have a law according to our law he ought to die because he made himself the son of God their response verse 59 they took up stones to throw at him that Jesus hit himself and went out they immediately desired to enact capital punishment for the sin of blasphemy under Jewish law capital punishment was enacted against adultery murder incest sodomy rape witchcraft disobedience to parents preaching false doctrine blasphemy they understood what Jesus was saying they desired to kill him he stated he's God in John 10 33 the Jews answered him saying for a good work we do not stone you but for blasphemy because you being a man make yourself God did Jesus ever say he's God in the flesh yes did it lead to the charge that had him place on a cross absolutely yes he claimed to be God so they're collecting their stones and Jesus blends in with the crowd and he leaves that reminds me of what he did in the city of Nazareth by the way he had spoken in their synagogue and they didn't like what he said and they took him to the brow of a cliff and they wanted to push him off but Luke 4 30 says passing through the midst of them he went his way why because it was not his time to die


Hello and welcome to another installment of Issues and Answers, a production of the Government Information Service. My name is Jessie Leigh-Anne, and for the next half hour or so, I will be engaging performance based financing coordinator within the St. Lucia Health System Strengthening Project Implementation Unit. Quite a mouthful, but a pleasure nonetheless to have him in studio. Good day, Mr. Neyamjeevatist. Thank you. Thank you for having me. Thank you for being here. I want to start with you providing for the benefit of our viewers a definition, a succinct definition of this project to the St. Lucia Health System Strengthening Project and the brushstroke that is performance based financing in this masterpiece. Yes. So the St. Lucia Health System Strengthening Project is a project which is funded by the World Bank, but it's a very, very strong collaboration between the World Bank and the Ministry of Health. What this project aims to do is to strengthen health systems, all of the health systems in the country. You would appreciate first to achieve health, it's not just to prevent disease, there are other systems around which other systems around the achievement of health that we also have to ensure that it's working and ensure that you get a positive outcome from it. So the project itself, there are four components. The first one is to design and implement a package of services. The second one has to do with seeking to strengthen the efficiency of that package of service in the implementation. The third one has to do with the management of the whole project itself and the fourth one has to do with Billings and Lucia's resilience with respect to getting prepared for disasters and that type of thing. So these are the four main components. The PBF component is part of the second component which seeks to strengthen the efficiency of the health service and the PBF component focuses more on the primary healthcare setting and dealing with non-communicable diseases, specifically diabetes and hypertension. Okay, speak to performance-based financing as a precursor to universal healthcare and also national health insurance for St. Lucia. So universal healthcare, there are two main components of universal healthcare. One is the package of services that, and you would recall that I just mentioned, that part of the project is to design that package of services and the second component of universal healthcare is the financing of the implementation of that package of services and that's where the national health insurance comes in. So you develop a package of services and then you finance the package of services. And so the PBF component is part, of course, obviously of the development and implementation of the package of services. And what is unique about this PBF is that it's going to encroach or impinge on all of what that we need to do for universal healthcare. So it's like a pilot, it's a pilot universal healthcare, so to speak. So it looks at the development of the package of services and of course it's this time we're focusing on diabetes and hypertension, but you could have other services or the chronic diseases based on your analysis and what you see is looking in terms of efficiencies, it's looking in terms of data collection, it's looking in terms of analysis, it's looking in terms of accountability and governance and all of those other issues that ministries of health have been grappling with in terms of not only providing universal healthcare, but also in terms of providing a much more efficient service for people. Okay, let's get into the essential package of health services. What is being taken into consideration for the design of it and what will it constitute? Clearly, one of the things that have to come into consideration is what we call the epidemiological profile. So how does it affect the country? What's the burden of disease? How many people get sick? How many people die from it and so on? How many people are incapacitated from it? Another, of course, would be the cost. We cannot not also include the cost. So you would want to ensure that, yes, you're delivering these services. It has to be quality services as well. You have to take into consideration the cost. You also have to take into consideration your capacity to implement that. And so you would have to do a lot of reform of your services. A lot of the things that we're doing now in the absence of universal healthcare, common universal healthcare, the health sector will have to be a lot more efficient in terms of its data, in terms of its use of data, in terms of how it governs things, in terms of how it procures and how it provides services. So in a nutshell, that is what universal healthcare and what the PBF program pilot is trying to do. Okay, so for the pilot, you'll be focusing on the two non-communicable diseases as you mentioned, diabetes and hypertension. Exactly. Getting to what prompted this decision. Okay, so first is the epidemiological profile. So diabetes and hypertension has been consistently among the top 10 causes of death in St. Lucia for many years, as I could remember. And in addition to that, they account for about, if you really do the analysis, they account for about 75% of the mortality burden in St. Lucia. And so even in the absence of any analysis, we knew at the Ministry of Health that diabetes and hypertension has to make that list. And so even if we don't have a finalized list, we know that diabetes and hypertension is going to be on that list. And then with the advice from the World Bank and some of the other experts that work with them, they have decided, well, okay, we're going to be focusing, we're going to focus the pilot on diabetes and hypertension. The pilot is very, very important in terms of introducing us to these reforms, but also letting us get wet our feet, so to speak, in terms of when we have to come around to do the universal health care. So these were some of the things that had gone. And of course, we always have the issues of the provision of services. We're always talking about quality, quality of services, the coverage, how many people are we reaching, are we reaching the correct people? So that is what we are currently working on to try to put those reforms in place so that when we begin to implement, we still will not be perfect, but at least we would have taken into consideration some of the existing circumstances that we have and then trying to move forward with the assistance from the bank and some of the other experts that's working with us right now. Okay, let's get into some of the activities to be financed under the improvement of service delivery through performance-based financing. Right. Okay, so there are four main activities, well, two main activities. So screening, definitely screening for diabetes and hypertension and treatment for diabetes and hypertension. But we're also going to be looking at reforming or improving the existing data collection. We have to be working with the health management information unit to calibrate whatever systems that they have in place that will enable us to do the performance-based financing. We have to also work with some of the quality of care issues in terms of the delivery and the diabetes and hypertension. So over the last couple of months, we've been looking at all of the guidelines, all of the protocols, all of the different strategies that has been used in the Caribbean and internationally and to see how we could come up with, calibrate some of the procedures and some of the guidelines and protocols that will enable us to begin to implement performance-based financing. We are talking performance-based financing under the St. Lucia Health System Strengthening Project. Are we going to stick a pin in that, Mr. Jabati? So when we come back, we get into funding, a critical aspect of that. Stay with us. Pamela, I noticed that you built your retaining wall on my property. You will have to give me my land back or compensate me for that. My contractor isn't dumb. I trust that he will not build anything on your property. Where is your proof? Let's go to court. This situation does not require you to go to court. Looks like we have to go through mediation here. Mediation is a way people resolve conflicts like this. Someone, a third party, comes to speak to both parties. This person is called the mediator. The mediator is impartial. He or she makes sure that communication between both parties is effective and efficient. So, the mediator is a judge? No, the mediator is not a judge. Mediators, unlike judges, do not decide cases or impose settlements. Let me get a mediator to handle this retaining wall and that kitchen. Kitchen? Yes, your kitchen also falls on my land. Let me call the mediator. Thank you so much for staying with us. This is an edition of Issues and Answers on NTN. We're talking about performance-based financing as part of the St. Lucia Health System Strengthening Project. We're speaking to the Performance-Based Financing Coordinator, Mr. Nahum Shibatist. And we came off of the break speaking on the essential package of health services for the pilot program and the focus on diabetes and hypertension. Tell us how will this package be funded? Okay, so the entire project is $20 million, $20 million U.S. dollars, but for the diabetes, for the performance-based- Can I just see Lucia Health System Strengthening Project? The entire project is about $20 million, but for the diabetes and hypertension component, the PBF component, is $4 million U.S. dollars. And it's over, so we have about 30 months, so to speak, to use that money and to implement performance-based financing. Okay, so PBF, put this into context for us in terms of other countries that would have already implemented this program. Right, so there are a few countries who have been in the Caribbean. We don't have much data in terms of for the Caribbean region, but definitely for Latin America. In fact, the external consultants are from Latin America. But the difference between them and ours is that most of their PBF approaches has been with maternal and child health. So this is kind of the first in the few that's going to be looking at chronic diseases and specifically diabetes and hypertension. So again, we see Saint Lucia being used as a pilot. Some people like to say guinea pig, but I prefer to say pilot, you know, and it's because I think that the international thing, the international agency, see something peculiar about Saint Lucia. One of the things that's going for us is that we do have a health information system already in place, and that was coming from another project from the World Bank. And so what was done was to build on what exists. So in terms of the information system, in terms of what's happening even right now in the primary care setting, that's the other thing. It's all going to be happening in the primary care setting. And so rather than focus, because most of, when people talk about health, most people focus on hospitals, but in the case of the PBF, it's on prevention. So in other words, if you can get the prevention right, then you'll have a less burden and a much more complex issues to deal with at the hospital. So that is the whole approach. And then if you ever have to achieve universal health care, which if you want to see as the ultimate goal of this PBF, then now what WHO has recommended is that you start in the primary care. And so in terms of all what is recommended, this is the approach that the bank and the expose had advised the country to take. And so for me it's very exciting, and because this is the first time that we do have diabetes and hypertensive services, yes we do, but I can say here that we do not really know how whether or not we're making progress, so to speak. We know, I mean we can see, but we still have a lot of amputations for a lot of amputations. We still have, we don't know for example, if you take a particular community or a particular population in the country, what is the prevalence of diabetes and hypertension there? So hopefully over the next, when we start to implement this, this is the information we have on our fingertips, and so we'll be able to plan a lot better for the strategically, for the health of the country, at least from the perspective of diabetes and hypertension, but of course we could always extend those lessons and learn to some of the other things that will be in the package. Okay, I want to segue a little bit. The project itself is in full swing. So tell us what are you guys learning in terms of where you started from at the beginning of the project, but now you're beginning to assess what's happening on the ground. Right, so we are not there yet. We are not yet in full swing. It has taken us about nine months to think about. But the project is fully fledged. Fully fledged, so we're going to be starting, we're going to be actually starting in July. We are launching in June, so next month we're going to be launching and we are trying to get all of the deliverables that we need to have in place for launching right now. Let me just say that the support that I've received from the nurses has been tremendous. The support from some of the key staff that's going to be implementing that PBF has been tremendous and even the support from the bank and the external consultants has really been tremendous. They have given us a lot of flexibility in defining this, although PBF is relatively new, we had to learn about PBF and had to be consistent with some of the recommendations of the bank, but it's a very important, I think, and a crucial learning process for us. And so hopefully we would be able to answer your question a lot more in terms of the figures tell you what's the prevalence in this community or in that community. And so with that type of information, I believe we can have, we can do a lot better for the persons living with diabetes. More effective execution. A lot more effective execution. And I'm looking forward to reducing the number of amputees. A lot of, we're going to be have, we'll have, if you want a frame for doing a lot more research and evaluation. And so not only informing the non-communicable disease, but some of the other programs that we may have where we can take some of the lessons learned from the PBF and bring it across and apply it to some of the other conditions that we're looking at under health. Okay, so not yet in full swing, but fully fledged. Fledged. Flaming to get into the swing of things in July. In July. Just give us a status update, a progress report of sorts for this period. Okay, so up to now, so when I first came, we, yes, as I said, we did have, we knew the health, so we knew the health centers that we were going to focus on. Those were selected at the design phase. So now we had to work with all of the health center. We did a quick assessment of the health centers to try and find out what's their capacity. And I could report that in 16 of the 17, because we're going to be implementing in 16 facilities during the two and a half years. But a goal, of course, would be to get everybody because when you start to see progress, and normally PBF, wherever PBF has been implemented, there has been progress. So we're going to be implementing, we're going to be starting with eight facilities in the first six months. And then we're going to be bringing on the other nine, the other nine from January of 2022. That would be phase two. That would be phase two. Currently, what we are doing, we are developing with the assistance of the, we are hiring some staff. We're going to be hiring some staff to do some supportive supervision with the health centers. You will appreciate it's going to be a few, some new procedures. And so that staff itself hiring will be trained by the external consultants. And so they will be working with the facilities to ensure throughout the implementation of the pilot. And then we also will be hiring some IT, some IT staff as well, to work with the health management information unit. So my job really is to coordinate all of those units. There's about four or five units within the Ministry of Health. So that by the end of the pilot, we would have had build capacity in those units to allow the bank to phase out, so to speak, and then us to continue. But also will be at the end of the day, we want to have capacity also to be able to implement the universal healthcare. So just have always in the back of your mind that these are two, four services, really is diabetes screening, hypertension screening, diabetes treatment, hypertension treatment. But there will be a lot, there will be a few more services to be added on in the package of services. But we would have gotten lessons learned from the PBF so that by the time we're ready to implement the universal healthcare, we would be in a much better place than if we're starting from scratch. Wonderful. We argue for our final break when we come back, we're talking projected outcomes, key deliverables under this project. Stay with us. Everyone say counseling, counseling, counseling. How do you know about each other? They feel my fate, PS1, but I show my counseling. Maniglasia, just yesterday, you asked me advice about your husband and we spent over an hour on the cell. So say counseling, what does that mean? Just think about it, Maniglasia. When you have a difficulty with someone, you ask your friends for advice to help you to deal with your problems. But wouldn't you prefer getting advice from a professional counselor? I hope we're not one of those who think counseling is for crazy people. Mm. When your situation can be weird, I'm going to use professional counseling, but Maniglasia, each share a condition of doctor's visit. Eh, eh. Don't you know the Ministry of the Public Service has an employee assistance program, they call it EAP, which is offering six pre-counseling sessions for government employees. Eh, Glasia, why don't you take advantage of it? Really? It's free? Let me have one, let me call the EAP unit ASAP, because I want professional, did you say free? Free counseling. Boy, Glasia, wow. Who is the counseling, sir? Call the EAP unit at 468-2269. EAP works, let it work for you. Thank you so much for staying with us, we're talking performance-based financing under the Health Assistance Strengthening Project of St. Lucia. I have in studio for the past two segments, we've been speaking to Mr. Neham Jabatist, who is the performance-based financing coordinator out of the implementation unit. We've come across the plans, the activities that are scheduled for the next few months in terms of the rollout of this project and more specifically performance-based financing aspect. Speak to us about the projected outcomes. What are the key deliverables of this project that is hoped to come out after all is said and done? Okay, so first and foremost, I would go start with the impacts. We would want to see first a reduction in mortality, then we would also want to see a reduction also in mobility. So in other words, to prevent as many people as from getting the disease and prevent those people from dying. In addition to that, there are other, if you want to call it low-hanging fruit. So for example, much better quality services, much better quality services, that also would be a significant outcome. Also the use, using the key data that we have to make decisions. So evidence-based decisions as well. We also going to have service delivery, a much, much better service delivery, quality service delivery. We are also going to be and ultimately, what we would want to do is to provide lessons as well so that when we come across to implementing universal healthcare, we also would have had these outcomes that would help us to deliver a much more effective package for universal healthcare. So this is the one that comes to mind, but obviously there are others like improving the existing services, building the capacity of the Ministry of Health, even while we are doing, the chance to evaluation, evaluation of different programs. So it's PBF, but we will, during the implementation of the PBF, we also will be building capacity so that the Ministry can evaluate its programs on a more ongoing and regular basis. So these are some of the key outcomes and impacts that I think that we have. And of course, not forgetting all the amputations and all of the things that's happening in the hospital. And ultimately also reducing the burden of diabetes and hypertension now, but non-communicable diseases on the hospitals. These are some of the key outcomes that I envisage that we would be able to achieve from this PBF pilot. The pilot. Okay, let's speak to the overall goal. After the pilot, we know that there are plans to engage the private sector. Speak to us, give us a glimpse into what that will look like. Right, so universal healthcare, what universal healthcare really does is, there is, because right now, most of the provision of healthcare in the country is with the government. Yes. The government funds most of it. So universal healthcare would seek to engage the private sector. But what's gonna be very crucial is that both the private, the standards, the procedures of the public sector would also be applicable to the private sector. So it doesn't matter if you're a public or private provider. You would still have to, for example, go through the contracts. You would still need to generate the data that you need. And so, automatically, you would have an improvement in the delivery of service, in the public sector, as well as in the private sector. And you would have a much more standardized delivery of services with universal healthcare, you know? And of course, you are always underpinned with that in health. We always be the quality of services. So continuous quality improvement as well. So you're looking at the performance. First of all, you have to reach people, but you're also looking at quality, you know? You cannot just reach everybody. The quality of services that you, and then how you do things. So apart from the outcome, you have to look at the efficiency as well as the effectiveness. So it's gonna be very, it's not very easy. It's not very easy. We have a lot of reform to do. But at the end of the day, we will be in a much better place in terms of health in the country. And one important outcome that I didn't mention in the PBF is that we will, for example, in the PBF we will be providing free tests. So for those persons found with diabetes and hypertension, they will get free tests. One of the objectives of universal healthcare is to prevent out-of-pocket spending. And so that's why I think that this PBF is like a mini universal healthcare. Everything, almost everything that is to be offered under universal healthcare. We can see that happening in the PBF over the next couple of months. For diabetes and hypertension. For diabetes and hypertension, yes, you got it. That's right. Yeah, so just, you have your work cut out for you for the next few months. Tell us about the team that you have behind you in the rule out of this project. Yes, so my team, because my office really coordinates everything. So the team is the team of the Ministry of Health. But I can mention the key departments. So the first key department, it wouldn't happen if we do not have the primary care, the primary care services. And that's the community nursing service. They manage the primary care services. So all of the nurses in the health centers, I want to, as you say, big them up. Because if, without them, it wouldn't happen. So this would be one of the key. The other one is the health management information unit. And that's the people working the data for the primary care. They are key because the basis, all of this, the data will be automated. So we have to be building modules so that it can capture the data that we need. And so we have been working with them over the last eight or nine months, understanding the system, and then making recommendations, and then you soap it, or you soap it, I don't know what's the word, remember the word. But it was affecting their work, their day-to-day work, and they have been very, very, very helpful. I want to mention the planning unit of the Ministry of Health for conceptualizing this and for giving it priority, and for so that we now can do that. There is a focal, there is the office of the chief medical officer. There is a focal point for non-communicable diseases in there, as well, who has been very, very key because diabetes and hypertension is her focus. And so she has been very, very instrumental in moving forward, and of course, the epidemiology unit of the Ministry of Health. And one other thing that has happened, I kind of, we have formed an executive team within the Ministry of Health between these key departments and the project implementation unit that we are already starting to have oversight over this piece. So I'm not alone in this. We have been brainstorming, working with the bank and the external consultants to ensure that we could deliver a package of services for diabetes and hypertension that is cost-effective, but also very, very of a high quality and could have high impact in the relatively short time that we have to implement. Wonderful. I'd like to thank you so much for your time, Mr. Nahum Javatist, speaking to us on the performance-based financing aspect of the St. Lucia Health System Strengthening Project. Like I said, a mouthful, but definitely something that is welcomed by the people of St. Lucia. Thank you. You agree? Thank you, I agree. I totally, totally agree. Thank you, and it's been my pleasure. Wonderful. My name is Jesse Leon, signing off for now. This has been another installment of Issues and Answers, a production of the Government Information Service. Do enjoy the rest of it. Chairs, stay tuned to NTN for more programming. Goodbye. Let's go.


OK, thank you very much, Edward. Thank you, everyone, for coming. As Edward mentioned, I'm working at Cedar on this Marie Curie Enterprise Ireland Career Fit Fellowship. So my interest is in natural language processing and text analysis as applied to data from social science and humanities. That means things like historical texts, political texts, social media text, and legal text. And as my partner project in Cedar, I work with a company called Coralytics who work on analyzing financial regulations and regulatory documents. But today I'm going to talk to you about natural language processing in general, and then look at some examples taken from social media text and some ways of kind of quickly developing prototypes and dashboards for analyzing texts like that. OK, so I've kind of just said that there. The packaging we're going to talk about at the end to do visualization is a component of the R programming language called Shiny, which allows you to develop very quickly dashboards and interfaces that include sliders, radio buttons, dropdown boxes, text areas, hook in the machine learning components to them without writing any JavaScript. So I'm sure a lot of people here work in Python. Python is excellent for natural language processing. In the social sciences, R is very widely used, so people might not know JavaScript or Python. But now there are really good tools in the R programming which we're doing this. So if you know R but don't know Python, it's not as necessary as it once was to switch. If you put NLP into Google, the first results you get are often about neurolinguistic programming, which is a kind of business psychology concept. It's nothing to do with the academic area that I'm talking about here. So this is natural language processing. That's the automated or computational processing of natural language. And the slight distinction, you know, natural language as in English or other human languages, like the language I'm speaking now, but it's the analysis of that and not things like computer languages or other types of information encoded in text, like there's a lot of work on doing analysis of genetic data in text form. So it is text analysis, but it's not natural language processing, so that's the distinction there. And there are lots and lots and lots of applications for this, a huge pipeline, you know, going from when you first speak into a system, such as your phone, down to the responses and the interaction you get with that. So voice recognition, automatic translation, parsing, recognizing entities, these are all, you know, really, really dense research areas on their own. If you look in Google Scholar for any one of these areas, there's hundreds of new papers every year, so I'll show you some quick examples of those and then I'm going to focus a little bit in on classification in particular, and then exploring word meanings, a new area called distributional semantics. And just those packages I mentioned before, if you're working R, two text packages commonly used are Quantita and Tidy Text, and in Python, NLTK used to be very widely used. It's kind of been, I think, taken over from a little bit by these other two packages, Spacey, and the Stanford Core NLP Toolkit. So the Stanford Toolkit is actually a Java Toolkit, but it has Python bindings, too. This is an example of the output from Spacey's syntactic parsers. This is an automated parse of a sentence. If you read down from the top there on the left, the sentence is we are building a better health service and providing more care. And then you can see in this table all the structured information that a modern NLP system is able to extract. So the second column there, the lemma, is a process, sometimes very similar to a process like stemming, where the inflected form of the word, like providing or building, is reduced to its root form, goes morpheme or its lemma, so build or provide. So stemming just cuts the end, cuts the inflection of the words, basically. Lematization is a little bit more clever. You can see the second line there, it converts the verb R to its root form B. So whether it's R or was or is, it gets converted to the root B. And then the final three columns encode the syntactic information about the sentence. So you've got the part of speech of the word detected, and then the last two is easier to understand or if you see it as a tree. But basically for each word, it tells you the type of syntactic relation it's in with another word in the sentence. So we is the noun subject of the verb build. And that's really useful for extracting propositions, you know, predicates, logical expressions from texts when they can be actually realized in surface language in many, many different ways. Okay, so you're probably fairly familiar with the idea of classification, even as it's applied to documents or texts. So email spam detection is a type of classification. You want to say whether a document in your inbox is spam or not spam. We might want to do a kind of hierarchical classification by placing a document into taxonomy. So for example, if we want to say that a comment on a social media website is spam or it might be unwanted in a different way like being too toxic or abusive. So this is just kind of the same problem as classification but in a hierarchical way. And this task can also be a continuous task. So there's very a difference in practice in the way you implement this. Your output function can be something that converts a toxicity score into a binary yes, no decision for spam or not spam, abusive or not abusive. Sentiment you've probably heard of means like a positive or a negative emotional content in a comment or a review of a product or something. So whatever the specific outcome in terms of classification or placing on a scale, the method is fairly similar. We're looking to extract information from the text like words, phrases, syntactic relations and use these as features in a model to get an output. And then there's an unsupervised version of this where we can just extract features from the text, again like word frequencies, phrases like bigrams or trigrams or syntactic properties and without any particular classes in mind, simply scale the documents on a map 2D or 3D map and see which documents naturally are similar or close to one another. And this in the supervised classification case, this has all of the usual evaluation metrics of a classification task. So you have to consider, as always your business case here, if you're a social media company, it's not just the accuracy of your kind of abusiveness detector you need to worry about. You need to worry about which kind of error is worse for your business. Is it worse to, you know, delete a comment that actually wasn't abusive or is it worse to allow through a comment that was abusive so they can both have bad consequences. So accuracy alone is not always the best score. Okay, so any of you familiar with NLP in the last few years might have heard of topic modeling. So topic modeling is a way of discovering topics or issues from a group of texts in an unsupervised way without having pre-specified classes in mind. So topic modeling exploits the way that words are distributed differently across different documents to extract groups or clusters of words that represent a particular topics. So this kind of, these rows of words here are output from a model trained on British newspapers. Each row corresponds to a particular topic and you can see that there are some topics that seem to correspond to healthcare, others that correspond to the media, others to court and the police. And this isn't, nobody puts this information into the model, you tell it how many topics you want and these kind of related groups of words emerge from the way that words vary across documents. There's good packages for doing these in Python and are off the shelf. Okay and then an area that I'm personally interested in is one that's got maybe a bit more attention in recent years, which is distribution of semantics or trying to learn about the meanings of words, the semantics of words based on statistics of how they occur in text. So this has got a lot of attention recently because of progress with word embeddings and word to VEC, but it's not a new idea as such. There's a history in linguistics and the philosophy of language that says, words don't have some kind of completely objective meaning handed down from the sky. The meaning of a word comes from how it's used in society, it's used in ordinary language and we can model what a word means in a particular linguistic community by looking at how speakers use the word and the way the word is used is the definition of what its meaning is. So as I said, this is not a new idea in these references I have at the bottom of the slide there. Some of these predate word embeddings, but there was even older techniques in the 80s and 90s called late and semantic analysis, in semantic indexing. It's just that the availability of very, very large text corpora and much more processing power has kind of made these methods more successful and more accessible. Depending on what you count as a word, the English language, most people have about 50,000 words in their vocabulary. The wide range around that, like I said, depends on what you call a word. But if you think that you want to look at the occurrence of each word in the vocabulary with every other word in the vocabulary, you're already starting to fill up a matrix that's 50,000 by 50,000 and you need a lot of text to get examples of, for you to run across examples of many core occurrences. Until recently there were sort of data and computational issues. But now everyone's using word vectors and word embeddings, which are like the previous techniques, they just use a different method, either a neural network or SVD to reduce the space of the word co-occurrence matrix. And you might be thinking of everything I've said so far, I haven't mentioned deep learning. So where does it fit in in the context of all these things? Well, word vectors, word embeddings are not a deep learning technique. They do use a shallow neural network to reduce the dimensionality of the co-occurrence matrix. But where deep learning really is applied, a lot of these days is in the previous tasks I showed you, like translation, speech recognition, dialogue systems. A lot of these things now are the best performing systems are systems that just take in very, very low level features like words or even characters. And you have a deep learning system that goes completely end to end to do translation or question answering or something like that. But for the applications I'm interested in, like social science, law, humanities, interpretability is very important and people in these areas are used to using interpretable regressions. And while there are definitely, there is progress being made on interpreting deep learning models, it's still not as straightforward as looking at the value of a parameter in a regression or some kind of linear or near linear method. So if the, and often in these cases, the regression or naive Bayes or something like that, linear SVM on a bag of words or a bag of trigrams gives very, very close to as good performance as the deep learning method. So it's at least worth trying the kind of more traditional statistical learning approach before going to deep learning. So yeah, this is an example of, I'm gonna show you now an example of one application of distributional semantics, which is to look at how word meanings changed over time and what meanings of particular words were in the past. This is a tool that's been developed years ago in the UK called the sketch engine. And the idea is to, from a corpus, produce a sketch of what a word means. This is from a corpus in the 18th century, which is why you have these funny long S's in some of the spellings. And the idea is to get an overall idea for what the word liberty meant in this time period by looking at how it occurred in syntactic relations with other words. So liberty and property, liberty and privilege, liberty and rights. These were common associations in the time and then other types of syntactic relationships like the preposition friend of liberty, cause of liberty, blessings of liberty. And you can use slightly different association scores other than just word frequency to control for the background frequency of words and in different ways play around with the word association scores to see what the corpus suggests the word means. That tool is called the sketch engine if you'd like to look up online. Okay, so I'm gonna show you an example and hopefully a demo of working with some modern political text from social media from Reddit. Reddit is a very good source of text data. It has a lot of problems too. So there's a lot of kind of really terrible content on Reddit, terrible communities, a lot of abusive content. And it's not a random sample of the population, 70% of Reddit users are men and it's demographically skewed younger as well. But a really nice property of the text from Reddit is that it's very neatly divided into subsections. So you have lots and lots of specific communities. There's a community for Manchester United, a community for vacuum cleaners and a community for every political affiliation you can think of. And these are good test grounds for political text because the rules of the, you can see the rules for each subreddit and they clearly say what's allowed. And these places tend to suggest that they're places where people who consider themselves to be socialists, for example, come to talk about socialism among themselves. So it's not really an argument that involves lots of different things mixed together. They're kind of clean examples of people with this ideology using the language. And then I also have a demo. I don't have time to show you both, but I'll put the URL up for both of them. There's a corpus in one of the R packages as it comes with a corpus of speeches from US presidential primary debates for the Republican Party. So there's this kind of data, at least in the modern context, there's a lot of it out there. Yeah, this is an example of some of the discussion from the Reddit socialism community, just to show you that this is an anonymous online community talking about politics. So you might expect it's gonna be pretty terrible, but a lot of them are fairly well-moderated and the text often does contain good political discussion, at least as close as you get access to online among ordinary people talking about politics. It's not all terrible and abusive. And there's a lot of metadata with it, so you can get the content of the comments and you can get their score and their time of creation so you can kind of filter the data in different ways. So what I did with this data was to extract co-occurrence relations from the words by looking at how often one word co-occurred in the same comment as another word. And then you can use the co-occurrence frequencies to build a score. You can do that by just using the frequency score, but if you do that, it tends to be that the words with the highest score are simply the words that are most generally frequent in language. If you know the measure of mutual information, point-wise mutual information, something like that is a way to control for the background frequency of the word and then extract for every pair of words, you'll have a score for in the corpus overall, how often do they tend to co-occur together. And you can use that score between each pair of words to build a network. So if the score is above a certain threshold, then we'll draw an edge between the two words. Then you've got a semantic network or a word co-occurrence network and you can use all the tools of network science on that. So this is an example of a list of the terms with the highest centrality in the networks extracted from the libertarian and socialism communities using two different network centrality measures. And you can see that at least for face validity, it really clearly reflects the most important terms that you would think would be most important to those communities. Now you might get something like this out of topic modeling, but it's a different approach and it also allows for a kind of flexible exploration, as I said, with all the tools of network science. Okay, and then you can also build a dashboard with all the packages that R provides to explore this. I'm going to hopefully show you a demo of this now. So as I said at the start of the talk, Shiny is an R package that allows you to build dashboards with panels, input boxes, sliders, for exploring data quickly. Now if you've got a huge customer-facing product, you probably have designers to do this kind of thing in JavaScript and Python for you, but for an academic researcher or for someone prototyping internal tools, being able to develop these kind of interfaces quickly without having to use JavaScript is really great. And also there's a lot of really cool visualization packages in R. So the network visualization and all the different data packages R provides I think is richer than what Python does. And it's also really responsive. So the data visualization components are hooked into the input components and will respond to new input really quickly. So you can immediately enter in new terms and see how the network spreads out. And there's 2D and 3D visualization packages. And you can use the things that I-graph offer you. So if you have things like shortest path, we'll detect the shortest path between the two nodes and make that into a network.  And then there's also a classification example if it loads. So this is the data from the Republican primary debates. So the Quantita package comes with these speeches preloaded. So I don't know if you can see. I trained two regression models on this text. So just to say a bit about how this task works, if you're trying to train a model to predict the political party and the speaker based on the words in the speeches, okay? So as I said, the vocabulary might have 50,000 words. So then if you include two word phrases, two diagrams in this, because you've got a huge, huge number of dimensions. But it's not hard to find ways to reduce these dimensions. You can exclude the most common words, stop words, and you can exclude words that occur less than a certain amount of times in the text overall. And then depending on how many observations, how many documents you have, you can do an ordinary linear regression even or you can do a penalized regression like ridge or lasso, which will do some feature selection for you and discard the features that aren't needed. So again, these type of models are really responsive. The reason it starts off with the Republican prediction higher is just because there's more Republican text in the corpus. So the kind of the prior or the intercept is higher for Republican. But if you start to type in text here, this will change live as you type, okay? So I typed in, we need to help the poorest people in society and it kind of balanced up a little bit more. I think Clinton's bar came up a bit. So this is really simple to do. This is the code for this classifier. So this is the UI code. It's literally 10 lines of code that reads two bar plot outputs. And then the equivalent of the backend, although they all sit in the same place on the server, is less than 30 lines of codes to split the input text into words and then pass that to the predict method of the trained model. And even if your data overall is less than a certain size, you can host your app for free. The site is called shinyapps.io. I think it's linked to RStudio. I saw they just stand out there. And there's a button in RStudio where you can click publish and it will immediately send this to a URL that you can try right away. So it's a great system. Okay, so I'll leave you just with those links and I think that's it. Thank you.