All right. Good morning, everyone. Welcome to Orlando. We'll do introductions in just a minute, but they've asked that I do some housekeeping reminders before we get started. So welcome to our session that Malik and I will be presenting on establishing onsite health centers in different locations across the globe, and it's our company's approach, so an oil and gas company approach. Please be sure to silence your cell phones and other devices. As a reminder, you can evaluate and claim credit by navigating to the session through the event app. If you haven't already done so, you're encouraged to download the AOHC event app located, and if you have any questions, you can see someone at the registration booth, and they'll walk you through that. So now that that's over, it's good to see a lot of people that I haven't seen in a while, so again, welcome. We'll go ahead and get the disclosure out of the way, maybe. This one? Nope, not that either. Sorry, our screen's not advancing like it should. Yeah, the clicker's still not working, but... Oh, well, we'll try to navigate through the technical difficulties, but neither Malik nor I have any financial disclosures or conflicts of interest to report. I'm just having to do it from the mouse pad, Malik. I wonder if we can get the tech guy to come fix the... We're going to see if our technology person can come get our clicker to work. I'll go ahead and start with introductions, and then Malik will introduce himself when he comes back. So I'm James Davis. I'm the Global Occupational Health Manager supporting ExxonMobil's upstream business. I started with ExxonMobil in 2001 in Beaumont, Texas, where we have a large manufacturing site with a refinery, chemical plant, lubes facility, and polyethylene facility. Since then, I've had a number of roles supporting pretty much every aspect of our business around the world. In my current role, supporting upstream, that translates to geographically Africa. We have operations in Angola, Equatorial Guinea, Nigeria, Mozambique. Of course, Guyana in South America is one of our newer growing affiliates. A number of countries in Asia Pacific, Papua New Guinea, Australia, Malaysia, Indonesia, and we also have upstream operations in Canada. We have upstream in the U.S., but that's not part of my portfolio. Our U.S. operations are managed by a team located in the U.S. We still can't advance our slides the way we should be able to, so just bear with us. As you can see, that's a varied geographic portfolio and certainly represents a wide array of health risks that we manage across the world. And that's what we want to share with you today is our approach to managing those health risks in varied locations across the world with different health risks. Before I hand it over to Malik for introduction, he asked that I share a fun fact, and I'm actually going to piggyback on his, because we share a similar passion in that we love food, and specifically we love to cook. The main difference between Malik and myself in that regard is he's an expert chef and can make a living at cooking, whereas I'm very amateur, so I would go broke if I attempted to make a living cooking. But my favorite way to cook is outdoors over an open flame in a Dutch oven, so I'm frequently called on to feed the masses at college football tailgates or Mardi Gras parades, holiday events, and I've been known to participate in jambalaya cook-offs and crawfish boil competitions, but I won't share my track record with that. So Malik is much more sophisticated with his cooking style than I am. So Malik. Good morning, everyone. Can you hear me well? Yes. Welcome to everyone, and I see lots of present former colleagues and partners, so I'm really glad to see you all here. If some of you remember, today is also my birthday, so I was born May 19th. And I'm really glad to be here and be able to share our experience. And among the audience, several people have participated in this topic, so it's certainly something where they can add comment and also illustrate more about what we have been doing together in this topic. So I've been with the company for 15 years, mainly as a public health manager, and I've been hired by one of the persons that is here 15 years ago, Dr. Dawkins, retired from our company. Yes, thank you. And before that, I worked for 20 years for different companies in public health, mainly companies funded by the European Union, French corporation, U.S. government, to implement community health programs. And during my experience with the company, I think my main accomplishments have been to establish an infectious disease unit and programs for the company, and then the culture of health. So, oh, excellent. Thank you very much. And lately, as we were starting our operations in Mozambique, I raised my hand to be the one overseeing our operations there, and that's what I'm doing now as my main activity. So, we'll share our experience in establishing these clinics, and please, I'll pass it back to Dr. Davis. Great. Thanks, Malik. So, what is it that we want you to gain from this session? And so, by the end of the session, we hope that you'll be able to describe our strategic with you to determine, first, to assess health risk and determine how to manage those risks to establish service delivery in various regions around the world. Hopefully, you'll have a better understanding of some of the tools that we use to assess risk, and then drive decisions related to how we're going to manage those risks. And finally, hopefully, you'll understand a little bit more about how we identify internal and external factors that drive and inform our decisions for establishing health centers and managing other health risk in locations where we operate. I'm going to start with kind of a high-level overview of our strategy, and then Malik will get into more of the details and specific examples. But before I get into kind of the health strategy, I want to share a little bit more information about ExxonMobil in general, just for some perspective. And so, we operate in 59 countries around the world. We have about 62,000 employees representing 160 nationalities. And as you can see from the graph, more than half of our workforce is located outside of the U.S. Our company has three primary value chains where the income is generated. And those are the upstream business product solution, which is traditionally the downstream business low-carbon solutions, which is the newer aspect of our company. And then we have three other corporate functions that support the three value chains. Malik and I are part of a global team of about 400 health professionals that work in 80 different health centers around the world. We're very fortunate to have the support of senior management that supports our mission of protecting and promoting worker health. And you can see a quote from Darren Woods, our CEO. Our efforts to protect the safety and health of our employees, contractors, and communities are at the heart of what we do every day. And so, that makes our job much easier, so we're not having to convince the company that this is important. But that's part of our culture, and that's visible around the world when we visit with our workforce. Maybe just, I wanted to do this a minute ago, and I got distracted with the technology difficulties. But just to get a flavor for who's in the audience, I know we have a number of oil and gas colleagues. Can I get a show of hands for who supports oil and gas? All right, a big portion of you. Manufacturing, military, I see quite a few of you guys. How many support remote healthcare, some aspects of remote healthcare? So, the majority of you. So, good. I know there are others of you. We won't go through the list exhaustively, but I wanted to just get a flavor of who was in the audience. So, a little bit more of our workforce in numbers. So, we are certainly a company of scientists and engineers. So, we have over 20,000 of these professionals that work for us around the world. Again, 64% of our workforce is actually outside of the U.S. About a third of our global workforce is made up of women. A third of our workforce in the U.S. is minority. And our company has a strong commitment to recruiting and hiring our U.S. veterans. I won't go into the details on the right-hand side of the slide. It's kind of small to see, but it really highlights the proportion of executives that we have in each of these demographics, which is improving. Probably 10 years ago, it was primarily white males that made up the executive population, but those demographics are certainly becoming more diverse. So, as we approach health risk in various locations around the world, not only in different geographies, but the health risks are certainly very different and varied. We try to have one global strategy that we use to manage those risks, or to assess and manage those risks. So, as we develop our health programs and determine service delivery models, this is kind of the premise of that strategy, and I'll share that with you. But a global strategy certainly doesn't mean we have a cookie-cutter approach. We don't have a one-size solution. The local solution is very much unique and individualized to the needs and the health risk in a particular location. This strategy always starts with assessment. Really, the context is for a new operation, a new location where we don't yet have a presence, but you could apply this to a location where you have an existing presence and you're wanting to continually assess the health risk and how you're managing those risks. But our assessment starts with data gathering, and this is boots on the ground. We go into these locations. Malik, recently in Mozambique, has visited a number of times to perform health risk assessments, understanding what the risks are in the area. We perform medical resource assessments to understand what's available in the community. What does the infrastructure look like? What's the specialty care look like? Access to emergency medical care. And then, most of this we do in-house. So we have the expertise through Malik and his colleagues that we are able to do most of these assessments internally, but we do leverage external relationships for some of these assessments as well. And, of course, when we can, we benchmark with our peers in industry who may already have a presence in a particular location, and that's certainly the case in Mozambique, where Total has had a presence there for a number of years. And so we've leveraged what they've already done, and so we try to not start from scratch if we can help it. Once we've completed our assessment, then we move on to the planning phase, and really what that is is we look at the data that we've gathered, what we think we need versus what's missing in country, and then we do a gap assessment and determine our approach to how we're going to mitigate or manage those gaps and what we need to put in place to manage the gaps if there are risks in country that can't be managed through local resources. So we'll develop a list of options that may help us manage those health risks, and we always allow for scale, for scalability, because typically in these projects we start very small with maybe just a couple of people in a particular location. And as the project grows, the population grows, and we have to be able to scale with that. And typically the largest population is during the project phase of the activity, where we may have 5,000 or 6,000 or 7,000 or 8,000 people in a particular location. And then as we move into operations, we get into a steady state where the workforce is typically a good bit smaller than it was in the project phase. From planning, we move on to execution. Our role primarily is to develop options to manage the health risk. We will usually come up with a preferred option or maybe a couple of preferred options. But it's key that we have senior management support in the service delivery model that we choose for any particular location. And so we will present options and our recommendations to senior management, but those have to align with what the business is trying to achieve. And so senior business management alignment is key for us to be successful in execution. To the extent we can, we certainly leverage local resources. So if we learn from our health risk assessments, well, our medical resource assessments, that access to care is adequate for various aspects of medical care, emergency medical response, primary care, urgent care, specialty care, we will leverage those resources in-country when we can. But that's certainly not always the case. And Malik, again, will get into some of the details there. Once we decide on a service delivery model, we go into implementation mode and then ultimately sustainability, where it's a continuous monitoring of the data, of metrics that we use to track our effectiveness, and then we make adjustments as we need to. And later on, I'm going to share an example of kind of a significant adjustment that we made in Nigeria recently as part of this ongoing assessment. My last slide. So in ExxonMobil, we use a bowtie to help us, or bowtie model, to help us think about how we assess and manage risk. And so I'll provide an example in a minute, but I'll just walk you through the structure first. So on the far left-hand side of the bowtie is the hazard that we're trying to manage. It could be a safety hazard, it could be a health hazard, or an environmental hazard. And so this is used broadly across the company, not just for health risk, but to manage all risk. In the middle of the bowtie is a hazard event. So it's an illness, it's an injury, it's an incident. And then on the far right-hand side of the bowtie is the potential consequence of that event. And so on the health side, it could be an illness, it could be a fatality. And then on either side of the bowtie are our safeguards. And on the left-hand side of the bowtie are our prevention safeguards. So what can we do to prevent a case from happening in the first place? But we recognize that we're not always successful at that, so we have to be able to mitigate situations when they do occur. And so on the prevention side, this involves understanding what the risk is we're trying to manage. On the health side, that means disease surveillance, understanding the potential for illness and injury risk in a particular operation. A lot of focus on awareness in our workforce and education so that our workforce understands the risk that they're faced with. Of course, exposure reduction through environmental controls or engineering controls, PPE. And then finally, on the health side, preventive medicines and vaccines when those are available. I would say we – I don't want to say we provide more of a focus on the left, but that's where we want to be most impactful is on the left-hand side of that bowtie to prevent any incident or illness from occurring. But, again, we recognize that despite our best efforts, we're still going to have incidents, we're still going to have injuries, and people are still going to get sick. So we have to be prepared to manage those cases when they come up. And so, again, that's the ability to treat and diagnose cases, providing medical care either on-site or through external providers, depending on the geographic location. We have a very strong infectious disease control program to manage infectious diseases and outbreaks. And, of course, anytime we have a case, there's a thorough investigation. I like to use malaria as an example because it's one of the more common risks that we're faced with in many of our locations around the world. So taking malaria as the example, malaria is the hazard or the risk that we're trying to manage. The event would be a malaria diagnosis, and on the far right-hand side, an illness or fatality potentially would be the ultimate consequence. But as it relates to malaria, again, we have to understand what the malaria risks are in a particular region. We certainly rely on published data through WHO, sources like TRAVX, but that's not our only data source. We also do kind of a boots-on-the-ground assessment of malaria risk, really talking with providers in the community to understand what the risk is in a particular area. And so that helps drive our decision-making related to malaria. Strong emphasis on educating our workforce about malaria risk. We have a malaria visa program that employees are required to go through. It's a training module to make sure that they understand the risk of malaria that they're faced with and our expectations for them to manage that risk. Again, exposure reduction through environmental controls, vector control, limiting water sources for mosquitoes, impregnated clothing, bed nets, and PPE. And then finally, for malaria, we thankfully have chemoprophylaxis available, and that's part of that left-hand side of the bowtie. And sometimes, depending on the location, we will either recommend malaria treatment or even require it. We just recently laid down a program where we would verify compliance through a field test. We've recently stopped that because we didn't feel like it was we felt that our workforce was in a position where they understood the risk. They could be trusted to take their chemoprophylaxis. And more importantly, I think we just weren't seeing malaria cases in our non-immune population. And so we did stand that program down. But again, despite our best efforts, we still have malaria cases, especially in the semi-immunes. But occasionally, we do see them in non-immunes. So we have to have the ability to diagnose early and to treat early when needed. And we have to be able to provide a higher level of care. So it's not just that we're able to initiate treatment, we also have to be able to manage a really sick patient if we have to. Almost always, that leverages other resources in the community or potentially results in a medevac. So I thought the malaria example would be good just to have a specific risk that we manage frequently. But you can apply this really with any health risk, any safety risk. And so we find it to be useful in how we look at risk and how we assess risk. So Malik, I think it's over to you. Anything else on the strategy that you'd want to think of? Davis really presented well the aspects related to our company in general. And I think the key points there are related to how spread we are globally. So the same picture will not be the same in the US, in Asia, or in Africa. The second part is related to our population of workers. So we don't have the same types of workers in all the places. Some places, we have very young workers in business centers, several thousand. And in some places, we can have 10,000 workers in the field for construction. So these are different, I would say, settings where you have to think about the clinical services we should deliver to that location and to our people. So thank you again for being here. Welcome in this session. My part is organized in three elements. The first part will be showing what type of parameters, factors to consider. The second will illustrate some scenarios where we define sets of services and type of clinic in these settings. And the last part will be the take-home message. So as you can see on the screen, there are several parameters to consider. And they have been already illustrated initially. And you might have been facing these aspects too. So the first is where do we work and what type of work we have. That can be a construction site, like I was just mentioning. That can be a manufacturing site. Or that can be an office site with several thousand people. And we will see some examples related to that. So worker population, what type of population. But will that population be stable? I will take the example of the platforms or the camps. You can have these sites where you have 20 different nationalities, people coming from all over the world. So you have a mix of population and type of health risk. And all of you might have seen that during COVID. If you stay in your office, it's like, OK, that's one level of risk. But if you have travelers coming in, mixing of populations, then that will lead to a different level of risk. That's the same for malaria, as illustrated by Dr. Davis. Or if you look at TB, how you have platforms or camps where people are living and working together, where it will be different than if you are just in an office or a manufacturing site with very large warehouses. The third part is related to the health risk of the location. As I was saying, if we are in Africa, Asia, or Australia, or Canada, or UK, the risk of infectious diseases is usually higher. But we've been all taught during the past five years that infectious diseases do not have borders. They cross borders. They go in. They go out. And it's really important to see, yes, what do we have locally, but what can come with the migration of workers, or the travel, and the mix of people within the location, if it's a congregate setting or if it's an open setting. Then it's important, as we look at all these aspects, what are the requirements to have a clinic in your work site? I know in France, for example, if you have a certain number, and other countries, you need to have a doctor, a nurse, and a clinic. Other places, they will be more open, more relaxed. But it's very important to look at what are the health requirements from a country perspective so you comply with that. Otherwise, your operations can be shut down, and then you can lose lots of time and investments. The other part is related to, will my site be in the city, or will that be outside the city? Will that be in a remote location? Because with all the money of the world you can have in your company, you are not able to tackle all the medical needs for your workforces. You have to relate with the local system for diagnostic capabilities, some treatment capabilities. And we also, too, with the vaccines during COVID, I think none of us was able to buy the vaccines when they were available. You have to work with the local health system so they can supply you with vaccines, or you can go to the sites where they provide the vaccines to access these means. And it's the same for medical emergency response. We can have a provider helping us to do all that, but there is a stage where you might have to put them in a hospital locally, where you have advanced care before they are being evacuated. You can maintain them on your site, and the more your site is remote, and the more you have to consider such level of capability at the location. And I will share some tools that have been developed by OGP IPCA. That's an association of all NCAS workers, really showing, OK, what level of care you need to consider for your location, depending on the type of operations and where it's located. Then fitness for work with occupational health services. Do you have workers that are exposed to important efforts? Will they have to do certain tasks that can be constrained if they have some health conditions? And the more you have workers that need to accomplish those things, and I can see several from the military. So in the military, if you are not, in my opinion, if you are not well, so you cannot be deployed for interventions, there are certainly some elements being looked at very carefully. And that's the same for us. If you are located like 1,000 miles from the capital city in a place where you have to do really construction work, or if you are in a platform, then you really have to be looked at carefully before being deployed. And it's a part of the occupational health evaluations before you are being deployed to these locations. And then depending on the type of population, location, you look also at the type of services you can provide on site, or have them provided outside the location. And again, that will depend on where you are located. Do you have the services outside? And it's always better to use what is in the communities rather than duplicating the services internally and not taking advantage of what can be done to be as effective and efficient as possible. Because as we look at our medical services, it's important to know, yes, health has no price, but the management also have to pay for our services to be deployed in addition to the people that will provide these services. Once you develop these clinics, services, it's to see, OK, who will have access to these clinics? Will that be everybody? Will that be the dependents? Will that be the contractors, only the employees? And again, that depends on what do you have at your location, what is available in the communities, and what type of services and operations are locally. And the last element, but not the least one, and at the beginning, Dr. Davis mentioned who is working or having telemedicine services at their site. It's a very, very important element, especially as it's very difficult to have all the capabilities on site. But if you develop some connections externally to really have the inputs and have a better management of your cases, it's really, really useful and important. And taking advantage of that as it becomes more developed and effective is really an important point. So I'll go now through a tool that was developed by colleagues as we were supporting the different projects. And if you look on your left, what you have are the different parameters that I've mentioned as I was commenting on the factors. The first one is the site accommodation. Do you have people living and working on the site? Or do you just have the office location, where it's located? Do you have only one site for one country? Or do you have four different sites and what to provide to these different locations? The worker size, the size of the workforce, if you have just five or 10 people in a given country, that will be different than if you have your 10,000 people in a remote camp. I'm sorry it's a little small. But I thought it's important to show the different parameters that we are looking at. Do you have a very good health system in country? Are you in UK? Are you in Australia? Or are you in Papua New Guinea or Malaysia? All depends. And we classify the different countries on those that are having the advanced quality of services steadily available or where you don't have much and you have to rely more on what you have locally and have some medevacs or referrals outside the country. The medical facility, how far is it? And it's an example of a project 12,000 miles from the capital city, advanced care. Or if you are just in the city, close to all the other specialties steadily available with good quality. So that's another element. Do you have infectious disease risk at the location? How to protect better the workers about that and even the dependents when you have the family members coming? Add the vector control aspects. And do we have community programs that are needed to also help improve the health of the communities? These are the different parameters. And there is a scoring system depending on for what parameter, how the needs for health are more apparent. And based on that, we define relatively what is the size of the health clinic, do we need a health clinic, and what type of services to consider in that clinic. So this is the first part, I think. No, I'll finish with this one, the first part. And I wanted also to share what OGP IPCA is doing. For those who don't know what is OGP IPCA, it's really a group. It's like a group of oil and gas companies that are producing very, very useful guidelines for different aspects. And this one is related for medical emergency and primary health care guide. They have many other services. You can access their site, look at their tools, and use them for your own practice. So I think it's a very good source of information. And the company likes to work with them to share our approaches so others can also adopt them. And here in this slide, the other part is what type of level, what level of care you need to anticipate at your clinic. And it's organized by tiers, tier 1, tier 2, 3, and 4. And that relates to what do you need to consider for your own location, depending on what is steadily accessible at site. Try to respond within 20 minutes. Within one hour, what do you need to have on site? And if you cannot have that, how to refer people to how to consider the referral to other sites to address the needs of the workers who would face a given injury or illness. And if you just Google IPCA, OGP IPCA, their health documents are really, really useful. And considering the approaches we've been implementing across the globe, not only for this topic, but for many others. So the second part of my presentation is related to the scenarios that we are using to illustrate the approach. This one is our main campus. We have about 10,000 people, only offices. It's in Houston. Houston is the home of the biggest, I would say, health center in the world. When I heard about that at the beginning, we were visiting it with Dr. Dawkins. Looking at that health center, you have, I believe, about 100,000 health care workers in that center. And really, five, 10 different companies or health care universities. So it's really, really advanced. For a site like this, what we have in the campus is more limited to helping people for travel health, having some occupational health exams. But most of the services are being done outside the campus. Here, the services are limited. We have to have a medical center, limited. We have to have a medical emergency response if there is an incident on the site. We do biometric screening. And it's about the wellness. It's very important, as you all know. And I attended a session just earlier this morning, very, very well done by somebody from Johns Hopkins. So we apply a number of the elements you recommended in terms of having well-being activities and support to our workers on site. So travel health, industrial hygienists, and industrial hygienists are part of our department. They represent maybe one third of our 400 people in the company. And they measure emissions. They help for emergency preparedness and response, health risk assessment, different aspects. So we have that. They monitor the air. I was looking at somebody who came here during the session. He had an infrared detector. And I think he was looking at, how is the ventilation in the room? And what's the temperature of the room? So we have industrial hygienists looking at that, looking at emissions. If you are in a work site where you have refineries and other aspects, but they are also part of our health project support team when we go to a given country to assess the risk and help us implement what is needed. And then we have a wellness center. It's gigantic. I don't remember how many. 100,000 square feet. 100,000 square feet. You can go there during the work hours. So that's really a unique location for 10,000 people. That's the first example of what we have. Large office, developed country, and really our head office now, where our CEO even moved from Dallas to come down to Houston and be a part of this site. The second scenario is Lagos. And we have our previous occupational health manager, Dr. Effiem, who is now at the global level. But this is really a unique situation for us, or has been a unique situation. We had a clinic at the time, about 2,000 workers, and there are some changes. Dr. Davis will illustrate on that. And the type of services that are provided there are indicated here, primary health care, lab. We even got a pharmacy, occupational health, fitness for work, medical emergency response, and all these other aspects. And this is the head office in Nigeria. But I'll let Dr. Davis mention it. No, really, just quickly, the only thing I wanted to point out about Lagos and Nigeria more broadly is I mentioned earlier that we continually assess and monitor our health programs. When our operations were started in Nigeria, we decided that we had needed the ability to provide primary care services not only for our employees, but for our dependents, because we felt that that was a service that was lacking in the community. And so we have operated a primary health care clinic, or multiple primary health care clinics, full service, lab, x-ray, pharmacy. And we also coordinate hospitalizations, referrals to outside providers. But due to our ongoing risk assessments and medical resource assessments, we felt that that risk had also changed. And so just earlier this year, we have transitioned away from a primary care model. And so now the company has transitioned to a traditional HMO. And so I just wanted to highlight that as part of the ongoing assessment that we do. And so you have to continually assess the health risk, continually look at the resources in the community. And I think we'll see that in Guyana as well. Resources in Guyana, when we first started operations, they were quite limited. We've seen really robust increase in their capacity to provide emergency response and some other specialties as well. So that's what I wanted to highlight about Nigeria. Thank you, Dr. Davis. Yes, and that's one of the factors that was mentioned, what exists in the community. So if you have very good providers, it's very important to take advantage of, not take advantage, but work with these providers so you continue to be effective and gain efficiencies if you have set up your own system internally. And in Nigeria, we have four sites. Some are offshore sites. Some are like office, like this one. And you have also a shore base where you have people coming and going to supply the offshore site. So very important to look at the full picture, how many sites, what is inside, what is outside, and what you can build inside. The third example is related to offshore. How many are supporting offshore locations here? At least 10 or 12. So really, it's a different setting than an office. You really have to have at least something inside. And this is just a picture of one of the operations site, but you can have 400 people there. They come from all over the world. They stay there for a number of weeks, depending on the type of facility you have or operations. And it's really a site where a risk that is not always seen is like the infectious disease risk where you have people that can have a norovirus. And when I just came on board, Dr. Dawkins said, oh, the president of the company is saying we need to be able to stop these outbreaks as they occurred. We got even a platform closed at a given point in time in a developed country and closed because of norovirus. And if you close a platform, it's like a lot of, I would say, money or resources that are being stopped for two, three, four days. And jointly, we were able to develop some approaches called infectious disease outbreak management, where you really put the system in place to prevent to the extent you can and mitigate as you go. We used it during the pandemic. And I've mentioned OGPI PICA. You can have the manual that was developed for that on the OGPI PICA site. But it's really a place where you have people coming from all over the world. You have that risk. But you also have the risk of well-being aspects. You have to look at all these elements. But at least you need to have primary health care, urgent care, and medevac. You have to look at, OK, what type of shoppers you need to have. Or if you can only use both, it's like, hmm, we need to have a little more services on site. And then screen the people before they come. It's like a fitness for duty, what type of people are allowed to come there. And I'm sure all the colleagues who raise their hand are doing the same. And maybe one of you would like to add something that is not on the slides from the offshore support or illustrate anything. Yes? I'm struggling with the aging workforce. I'm struggling finding people that are healthy. It's like it's tough right now with the labor market. I'm sticking out of comorbidities and stuff that 60 and 70-year-olds I send out to these maritime operations. Absolutely. I think all of us are facing this. And the key part is about the screening. How can they be screened and not assigned to these locations? And a good rationale you can use, and we've observed that too, is that the medical evacuation you do on these sites are more related to chronic illnesses or issues related to diabetics or high blood pressure rather than injuries in these offshore sites. I've had a handful of injuries, but most of it is medical complications in unhealthy 50-year-olds and up to just the amount of 70-year-olds I'm running around with some of these ships. It's just shocking to me how much of that. It's to explain what's the cost, how much the organization is ready to pay for the medevac of these individuals. It's really to find a balance on that, and at the same time, on the site, to have wellness and well-being activities. Either that or don't have staff. I think that's where we are right now. Then it's to be ready to have the medevac and have the care associated to it. But yes, we are all facing that. And the key is at the screening. Yes? Do you have hyperbaric medicine chambers on the offshore platforms? In my opinion, we don't have that. It's more external service that is being provided when there are needs. Yeah, we don't have any hyperbaric chambers on any of our vessels. But when we're doing a lot of subsea work that involves utilization of a lot of divers, then we'll sometimes have an expert come in to support that operation, who will identify a resource in the community if needed. It may not be in the community, but they will identify hyperbaric treatment options for those higher-risk operations, no doubt. Yes? Yeah, I'm Steve Frank with Baker Hughes. I wanted the group just to know, in this environment and remote operations of any kind, ISTM is doing work around mental health fitness screening. And that's a particular problem, I think, in this environment. And rotators come offshore, too. And ISTM is? The International Society for Travel Medicine. Yeah, thanks. Yes? Do you set your own fitness standards for deployment offshore? Or do you follow something like OG UK? We do have our own internal standards that parallel, I would say, that are very closely related to OG UK, or the Malaysian standard, the Canadian standard. We've recently gone through a very rigorous review of that process, because we've had a lot of challenges in this area, probably our biggest challenge offshore and in remote locations. We have not yet required an OG UK certification, necessarily, for all of our workforce in these locations. But we're trying to move to some equivalent for that. I have, I think, five more minutes, so 10. Yes? So when you're doing the site assessment and you're looking at the local capabilities, what sort of checklist or certification do you do, if you will? And what sort of standard are you trying to see that they meet to have more capabilities, like pharmacy, lab, accreditation? How do you decide they meet an acceptable standard? What is it? For the different facilities that we visit, we look at, we have like a checklist of elements. But within that, you look at what are the capabilities, what type of a license they have. You look at the physical environment. And you assess the type of training they have. And ideally, they are following a standard. So are they following some internationally accepted laboratory standard or pharmacy standard? And so that's really what we would like to see, is that they have some published standard that they are adhering to. So it's not necessarily like a J-PRO standard. It could be WHA. It could be something else. That's right. That's right. Yes, Rick, go on. I keep looking at you suspiciously. A specific question, a general question. On one of the sites we're looking after in Tanzania, we just have on the client, this employee is killed by a black mamba. Black mambas are in Mota B. I'm just wondering what your snake prevention program and what your attitude to anti-venom. The second question, more general, is you mentioned community health. I'm just interested to know what community health, public health programs you're perhaps thinking about rolling out when you're on site in Mozambique. I'll respond to the first one. The second, we'll have it on the site. The first one is for snakes. This is something that we see in different places. So there are some preventive measures and also from mitigation measures. And among the ones I've seen beyond our awareness is that people working in the field, usually they have some gaiters like to protect the higher level of your, or the lower level of your feet with some protection. And you should have the anti-venom serum on site. And then the referral and the medevac as appropriate. The community health will come to it. I believe we have just five minutes to conclude, if I remember correctly, for our session. About seven. And then we'll be here. We can respond to additional questions. So that was a scenario number three. And thank you very much for contributing to this presentation and sharing your perspectives. Because honestly, if we add up the number of years of experience in the room, we might go to a very high level. So we are presenting here. But it's like really experience from everyone here. The fourth one is manufacturing sites. We can have sites with 300 people or 1,000, 2,000 people. And most of the time, you have a clinic. Unless it's a small place, you have to follow the local regulations. And the services that are provided are listed here. And for the manufacturing sites, the very important one is industrial hygienist to be able to measure emissions, help for noise exposure, and other aspects. One more example. It's like a remote camp. We got that in. Even in the US, we have a remote camp. If you look at the Permian Basin, where we are operating, very far from everything. So it's to see, OK, what do you need on site? How you can use part of the local health system or develop the local health system? And that would come to the community interventions. It's important to develop what is locally so you can also help the communities, but also benefit from such services. And when you have congregate setting, you need to do a TB screening, have some well-being activities also done. And the more you are remote, if it's a large site, you need to have the labs, the x-rays, and the pharmacy. Not especially in the US, but other locations. So that's the last scenario. And I will end up with a take-home message. It's like a balance, where you look at a number of parameters. First, it's important to assess the local health risk. What are the regulations? And what are the local capabilities in the communities? Analyze the needs, considering the type of operations. Is it an office? Is it just a camp? Do you do drilling? And how many people will be there for how long? And what type of population you will have? Do you need only young people? Or will you also have more, I would say, elder workers? And how to better protect them as they come on site? Then you have your clinic. What do you put in place? How many people to work there? The type of services. And what type of specifications will be needed locally? Then provide your services. Implement the different types of what you need for clinical aspects, but also the management procedures. And the most important part, as we all have seen, is how you relate to the local health system to make the best of it, be compliant, and refer the people as appropriate to these services. So in a nutshell, that's our presentation. And your questions, comments, are welcome. Thank you. Yes? Other questions? Oh, sorry. Can I ask, when you are new in the country, how do you go about gathering the legislative requirements in terms of what you're going to do for an operation in that perspective, et cetera? Well, we have a lot of partners in regulatory compliance. And so we have a regulatory compliance group that would assist with that exercise. One of the first activities that we would do in country would be to have law assess the regulations and the health risk. But we would also leverage health experts, usually in country, to help us understand the unique health requirements. But I would say we rely heavily on our partners and other parts of the company to assess those risks. Well, one of the biggest challenges that we've had recently is related to national content. And it's been a real challenge in how we staff our clinics, especially if we don't feel that a particular location has the expertise locally, but we have the government telling us you have to have local expertise. That's been a struggle for us. And so that's an important part of our assessment is what the national content requirements are in a particular location. I'm from Indonesia. We have excellent science. I'm part of the government, too. Following that question, how do you manage to combine your regulation and just incorporate the local and local regulation? For example, in our country, it's obliged to have an annual medical checkup. While in Europe, the corporate is not really obliged to have it annually. How do you open to push to have it like annual examination? Because it's part of our regulation. Our first rule is always follow the local requirements. You follow the local regulations. Now, if our requirements are more, if our company requirements are more strict, then we'll follow our company requirements. However, if the local regulations are the stricter requirement, then we will always follow the local regulations, no doubt. We have Dr. Kumar, Nervin Kumar, who supports Indonesia. Anything else you would add to that, Nervin? Yeah, a lot more than Indonesia has. I think 100% compliance with the annual medical checkup. So I think these questions are very important. Other questions? Maxwell Chevron. Just thank you very much for the presentation. Very interesting. And I really appreciated you putting up your risk assessment matrix. That's very helpful. One of the questions I have is, when you're assessing the needs in a location, do you have internal guidance or trigger points where you say, OK, for personnel, say, for this level of population at this type of location, we need X number of paramedics, or we need a medical practitioner, or that kind of trigger point? Yeah. Thank you for your question. We have a range. You saw the matrix. There is a score. And then based on the score, we have a range of workforce size to consider and type of workers for that location. So it's not like A equals C, but we have, OK, we will use that range. Because it's a guidance, and you adapt based on the specificities of the location. But it's already a good way of starting. And then the next step is a discussion with the management. Because what we would put in place and recommend will depend on how much can be invested for that location while managing the risk at the optimal level. Thank you. Yes. Hi. My name is Alton Dorkin, and I'm with BL Tintoff. So we face a similar set of situations. And I just want to make a comment about populations getting sicker. And as we think about our role in the community, I don't think we went through fitness assessments to get our way out of that problem. Because eventually, you're going to have no workers that are fit. So when you think about your community health programs and your on-site services, you need to start catering for them. These are manageable conditions. So I can't see why a type 2 diabetic can't, as long as you manage that case. You've got a clinic on site, you know about the risk, and you know about assisting that employee. And so you can help to change your dynamic. And if you go into developing countries where no health services, a lot of mobility in those populations, if you just apply, you need a certain level of fitness, you will have no workers. So you have to think about how you manage community health risk. Part of that is putting in place chronic care and so on to keep people fit in work. But you kind of catch them at a part of the life cycle where you can't wish that problem away. Absolutely. Interestingly, we probably have a higher risk in the Gulf Coast of the United States than we do anywhere else in the world as it relates to comorbidities and chronic illness and disease. So if we had a workforce without hypertension, diabetes, and heart disease, we wouldn't have workers to work in our refineries in the Gulf Coast. So yes, you're absolutely right. So we do have a very robust culture of health program. But it's not usually enough. But no, that's certainly a good point. Yes. How do you manage data privacy, OHI, PHI, all over the world? Are you using one EMR or two EMRs? We have one. So that's a complicated question. We have an entire data privacy team, both within our health department, but the company has a data privacy team as well. So if we believe that there is potential for a data privacy risk, then we do a data privacy case that goes to that team for review. As it relates to EMR, we do have one EMR, but there are exceptions. Well, we have one EMR. The server is in Europe to manage that risk. And we do not have the EMR. We can't use in a couple of locations, France, Colombia, I believe. We're just starting to grow our business in China, and there are going to be some unique challenges there. And also we use GDPR, like it's what is being adopted for global data privacy regulations. So it's really something that is being looked at, applied, and there are trainings related to that for the different members of the medical team. That is definitely a very, very important point, because if you are caught not being compliant, it can be very costly for the individuals and for the company. Good. Well, we're beyond our time commitment, but thanks for the engagement and the questions. It was good to see you all. Thank you.

onsite health centers

oil and gas company

health risks assessment

local regulations

medical services

workforce health

data privacy laws compliance

chronic health conditions

fitness assessments

community-focused health programs