EPISODE 54: MITCHELL PARRISH, PRESIDENT AT H CLINICAL

Mitchell is the President of H Clinical, the leader in decentralized trial and home health services for clinical trials across Latin America. With a 15-year passion for enabling clinical research, supporting life sciences, and transforming organizations, Mitchell is responsible for H Clinical’s strategy, business activities, and operations. Prior to H Clinical, Mitchell served as Managing Director, Everglade Rx, Executive VP & General Counsel, Advarra, and Associate Attorney, K&L Gates. Mitchell is on the Board of Directors for Life Science Washington, Faculty for RAPS, and a former Steering Committee Member for Harvard MRCT. He is a published author on FDA regulations and a frequent speaker on technology in clinical research. 

Episode’s transcript

Julio Martinez: 0:00

<silence> Welcome to the Latin MedTech Leaders podcast, a conversation with MedTech leaders who have succeeded or plan to succeed in Latin America. Please subscribe on your favorite podcasting platform. Apple Podcast, Spotify, Google Podcast. Amazon Music is teacher Tune in iHeart Radio, Pandora or leisure er . Welcome to the La MedTech Leaders Podcast today, our guest is Mitchell Perish . President of H Clinical H Clinical helps sponsors, CROs and sites reach and retain more patients through the most complete home trial service offering in Latin America. An exciting field with a 15-year-old passion for enabling human subject research, supporting life sciences, and transforming organizations. Mitchell is responsible for age , clinical strategy, business, activities, and operations prior to age clinical. Mitchell serve as managing director at Everglade Rx, executive VP and general counsel at Adv Vera , an associate attorney at k and l Gates Mitchell is on the board of Directors for Life Science, Washington faculty for regulatory affairs , professional society reps , and former steering committee member for Harvard's MR ct. He's a published author and frequent public speaker. So Mitchell is truly an honor to have you here in the show. Thank you so much for accepting our invitation. Welcome,

Mitchell Parrish: 1:32

Julio . Thank you very much. Excited to be here.

Julio Martinez: 1:34

Awesome. All right , Mitchell, let's get started with how you got involved with Latin America. You lived in Washington, right? Yep . State , uh, you are a gringo, <laugh> <laugh> , but you're very, very much involved with Latin America. So what's the story behind that on a personal and professional level?

Mitchell Parrish: 1:53

Yeah , yeah. It's interesting, right, how life works. And so my journey to being able to work in Latin America started I think about 12 years ago. So the clinical research industry, while it's a big industry, ultimately it can be a small one. Um, so I met a group when I was speaking at a conference in North Carolina , um, of all places, and that is where the first time I met , uh, my current partner and the CEO of H Clinical Dr. Ulysses Franco . So I actually met him at a conference 12 years ago. And that is the first time I really started to, I think, pay attention to research, not just the US and Europe, but also in Latin America. The other introduction I had to working in Latin America was in my first job that I started in the clinical research industry. It had a international fellows program, and that program was, they had regulatory leaders and other research leaders from around the globe come and live in, at the time where I was working in Olympia, Washington would come live there , um, watch how we work, we would learn from them, they would learn from us. And because of that, we had a number of people come from Latin America, from Peru, from Chile and other places. So I got additional exposure that way. And I've always been interested in, in terms of a global focus. And one of the things that as I've kind of seen and met individuals working in Latin America, one of the things really I think heightened the , the interest is the fact that especially in the us you , you don't always get the most positive news. But the thing is, it's like, why is that happening? Because in Latin America, right, people are incredibly bright. You have this growing infrastructure, you have a participant population that , you know, seems more engaged. You have a lot of bright minds coming up with new technology, and it's just this area where you have so much potential that I think hasn't reached its potential 'cause there hasn't really been a focus on it. And all of those things drew me to be like, this really seems like a good spot , uh, for me to work in because of my, my interest there 'cause of the people I've met, but also the, the opportunity that I , I know you're continuing to work on to grow. And I know age clinical is too, and we're seeing a fantastic traction in Latin America. And that's really why, why I'm there to make sure to continue to see that growth and traction for, for research in the region.

Julio Martinez: 4:12

Very good. Mitchell, I'm so happy to hear that story because it's , um, fascinating that , um, somebody of your caliber is , uh, involved in contributing to promote a clinical research and investment in the region, which is badly needed. So let's , um, talk about trends in the region. Mitchell, what do you see happening in Latin America? Let's talk about , uh, everything related to economy, politics, social trends. What do you see happening that is conducive to , uh, more research in the region?

Mitchell Parrish: 4:47

Yeah, I think there's a lot of trends, right? That , so that's a big, definitely a big open-ended question. I think there's a lot of trends that are largely pointed in the right direction. So I think globally, you know, the majority of research is still done in, in the US and, and in Europe and , and you have , uh, Japan. Not that there hasn't been research done , um, in Latin America. There, there has been, but it's interesting because there hasn't been a particular, it , it felt like there wasn't as much of a focus on that as other regions, even as they started to look outside of the, theoretically us , Europe, Japan, you know, it started to seem like research was focused on Southeast Asia or, you know, for a while India was, was a big piece. But I think what's happened is that , uh, a number of things. The first one is I think organizations have started to recognize that, again, kinda like I mentioned when we started off talking, is there are incredibly bright people that can effectively execute research in the region . But two, enrollment is a very competitive and hard to do and especially hard to do , um, for trials, pediatric trials, for rare disease trials, for all these different pieces. And in Latin America, you have a large population center. You also have what feels like more of an interest in engaging in, in research from participants. So there's more individuals I think, willing to participate who can see the benefit of research. And yes, I mean, you certainly have to consider the fact that there are based on resources. Some people do see clinical research as a care option in, in Latin America, where that wouldn't necessarily be the case. But , um, you know, that's something certainly considered from an ethics perspective. So because of the participant base, because you have the resources there to perform research, and because we know enrollment is one of the biggest challenges to clinical research, quick enrollment, also hitting your numbers, I think there's starting to see, okay, we have run trials Latin American, look, we're, we're getting quality data and we're actually getting our numbers and we're doing it much quicker than we would elsewhere, which is ultimately allowing products that can change people's lives, getting to market quicker, and you're allowing to do it more cost effectively . So I think pharmaceutical companies, CROs are starting to see that. Now, the other piece though, that goes along with that, that's only one piece. The other, another important factor is the governmental intervention. Regulatory bodies, ethics review committees in Latin America. And one of the biggest hurdles that we've seen when organizations approach us and say, okay, I wanna do clinical research in this country, that country, they're concerned about the regulatory timelines to actually get the approvals. And we have seen a focus through various countries to try to reduce that time, the time to actually get your approvals. And I think organizations have taken notice that, look, there has been a focus on a number of countries of Latin America to try to get those times down. And if you couple that with quicker enrollment, then all of a sudden we're not starting to see companies to see this as a hurdle, but as, oh, no, wait, now we've got quicker regulatory times, but we're also in enrollment faster. So now it's really starting to make sense, but that is the government starting to support and be a bit more focused on clinical research. So I think that's another trend we're seeing. And that brings me to the final piece. You have to think about the pandemic. I mean, we are in a, a pandemic still, if Brazil's in the news a lot other places are in the news, places in Latin America are not in the news , uh, like , uh, Iquitos and the Peruvian, Amazon, there's a lot of places that are these hotbeds. But because of that, that we've seen a big push to have COVID-19 trials performed in Latin America because of the numbers there. But we're also starting to see more research in general there, especially for a company like Age Clinical who does home visits. We're starting to see more interest because there's more restrictions. And so to continue to do clinical research, you have to have home visits. But the pandemic, I think, has started to really drive even more interest because , um, there's been great success in terms of just the , the volume of data that companies have been able to achieve in a short amount of time , um, due to the, again, patient populations and how much Covid-19 is prevalent in Latin America.

Julio Martinez: 9:03

Hmm , good answer. So , um, a , a few comments. Um, one is, I just read a paper considerably , uh, last week. It's an academic piece of work. I don't recall the source of it, but , um, it's , uh, about the argument of the paper is that traditionally people think about doing trials in Latin America or , or the perception is that companies go to Latin America because it's cheaper. But the argument in the study and the conclusion of the study, Mitchell, is that companies really, really go to Latin America for patient enrollment because that physician patient relationship is so strong. You have , uh, patients who are are clinical trial naive yet, and as you correctly said, they see trials as a way to get medical care that the system doesn't always provide at the quality that they want or they need. So I think you are right in that point. Totally. Latin Americas , uh, patients are very much eager to participate in trials. And there's a funny anecdote here. My brother is a interventional cardiologist from Harvard and everything, I think you know that. And , uh, he has a large medical practice in the Miami area. And , uh, we're talking about patients being extremely educated nowadays in the US and he's like, pages now come with 200 pages of Google searches, <laugh> for a consult, <laugh> . So they don't wanna listen to what I'm <laugh> what I have to tell them to advise them. They just wanna argue about their case with me. I mean, I spent so many years in school in training my fellowship, everything. And these patients think that they know better, they can reason better than a doctor. So in the US you have that happening. And also you have, and this is coming from very high rank physician here in the US and we are working with for a trial. He told me, Julio , um, in the US you have so many options as a patient, there are so many alternatives for care. Uh, there are so many FDA approved products here. That patient doesn't need to be subject to an implantable device that is risky if they can buy 10 more years with some conservative alternatives that are already out in the market, FDA approved. Whereas in Latin America, I mean, by the time a product is approved in the US will probably be about 10, 15 years before it gets to Latin America, because companies do not immediately think about Latin America as their first market. They think about Europe, China, Japan, right. Europe. So , uh, you have that happening too. So, and , and the other point that you made, which is correct, countries like Panama, Argentina, Paraguay , Peru, I mean, they have all enacted new regulations that are actually laws and then regulations to make it easier friendlier for companies to do clinical research. Columbia has done a little bit here and there, but not enough yet, eventually will. So, and Covid, as you said, it's also a driving force for clinical research because I guess these big pharma companies are doing vaccines need to , uh, diversify their patient population. So Latin America is just perfect for that. So moving along here , um, Mitchell, tell us about age , clinical. I mean, what exactly is your need ? Who is your perfect client? What the scope of the services that you guys offer in Latin America? Sure.

Mitchell Parrish: 12:47

So age clinical is a clinical trial support organization. We are in 22 countries in Latin America. We have our GCP trained staff dispersed , uh, throughout those countries. And then we have seven depots that support our logistics operations to enable clinical research as well as procure supplies and distribute supplies to also facilitate clinical research in terms of the support that we offer. The predominant service we provide is support to make home visits happen. So the other thing that's happened during Covid, we've seen this as a slow trend that's increased in terms of decentralized trials or , you know, a hybrid version. Some visits done at a site, some visits done at a patient's home, you know, virtual, where they're truly trying to do it entirely at a home. But you still have to have, you know, a nurse available in case something happens or there's specific blood draws, things of that nature. So our predominant focus is on home trials or home health for clinical research. So to facilitate that, we provide the staffing that does the home visits. So no matter where you are, whether it's in a big city, whether it's in a remote location, we provide the trained staff that goes to the house to perform that particular protocol visit at the home. Then to facilitate that, we do the logistics. So procure the supplies, have the kits ready , uh, coordinate to make sure that everything's gonna happen for the visit. That if there's a , a blood draw that happens, then needs a portable centrifuge done during the visit, is picked up within the amount of time to make sure the ST sample stays viable. And then we get that to the central laboratory or back to the site . So there's a big logistics depot component that goes along with these home visits. And then the final piece for that is also the , just the project management to execute the operation to be able to perform home visits. And that gets into working with the sites that are having this service perform, working with the sponsors, dealing with, you know, it's still a relatively new thing in Latin America. So there are regulatory ethics based questions, things like that, that we handle. So that's really the predominant service when we say we're a clinical trial support organization. But then we also do clinical trial staffing. So CRAs, our clinical research associates are in high demand right now. So we certainly provide CRA staffing for a number of trials. And then also I'd say the third category is bespoke services. So just based on our infrastructure, our knowledge being in Latin America, we do things dealing with being able to, after a clinical trial, individual participants need compassionate use care to continue their, to get the product after the trials . And so facilitate compassionate use studies as well as deal with the one-off things like , uh, procurement of, of genetic samples based on specific needs, again, for, for various companies. So it , it really is there to support CROs and sponsors and other companies to execute what they need done in Latin America with our predominant focus on home trials.

Julio Martinez: 15:43

Okay. All right . All right . So that's , uh, I mean, hum trials or home care in , in the context of clinical trials are really your specialty. And I've seen a trend in that , um, sector, Mitchell, we were approached , um, a couple years ago by a company called Global Care Clinical Trials. And that's how I got in contact with this sector. I didn't know he was out there. So , uh, I, I met with a representative, the person travel to Columbia . We met, we spoke about possibilities together, and then recently , uh, in September, October last year, they got acquired by Coves , by Coves . It was a big purchase because , uh, coves definitely saw the opportunity. They wanna capture that piece of that growing trend. So

Mitchell Parrish: 16:39

It certainly is a growing trend. I mean, the future, there's all sorts of buzz right now around decentralized trials. And even the FDA has come out with specific guidance saying we need to think a little bit more creatively about how we actually can get more people involved, diversity in clinical research and just, it , it really does seem like the future. So, and COVID-19 is only just ramped up the adoption of, of home trials due to lockdowns, but also as an organization, you know, we supported the Johnson Johnson COVID-19 trial, vaccine trial in five countries in Latin America. Um, with the, one of the main concerns being, you know, the sites can't handle this many people. They're trying to enroll, so they need overflow. That could have visits done at the home. But also, you know, if people have signs and symptoms of covid, right, you don't want them traveling on a bus to, you know, come into the site not , so it's , it's gonna make more sense for people to stay at home. And so because of COVID-19 , we really have seen a huge uptick in , uh, the adoption of decentralized or essentially hybrid trials.

Julio Martinez: 17:44

Very good. Alright , so what countries are most active for you guys? Um , right now, Mitchell? Yeah,

Mitchell Parrish: 17:52

Really it's still the largest country , the largest populations. Um, so Brazil, Argentina, Mexico, those still seem to be the major focus areas where we've seen more interest recently, Columbia , Peru, Chile. So we've definitely seen an uptick in the work in those particular countries, but we have started to see interest in other places too. So, you know, Uruguay , we usually don't think about any research being done in Uruguay .

Julio Martinez: 18:20

Uruguay, yeah.

Mitchell Parrish: 18:22

So, you know, Panama, like you mentioned Costa Rica. So we have seen diversification too, in terms of the number of countries that are having clinical research, but really it's still those main , uh, the largest population centers that have still seen the bulk of the research in Latin America.

Julio Martinez: 18:38

Okay. Alright . Um, I'm gonna ask you a question that I should have asked you before <laugh> , but it just came to my mind. The EU MDRI mean, you and I were before, and during the conversation here during the recording, we've been speaking about the trends that we are seeing in our own businesses , uh, in the uptake of , uh, activity for , uh, or interests , uh, in Latin America for clinical research. And , uh, I wrote an article two years ago when the E-U-M-D-R was gonna be active or effective in May, 2020, I mean, before that, about a year or so before that. And then it was postponed because of the pandemic, and then it's gonna become active or effective , uh, on May, 2021, right. This year. So my question to you is, do you see any benefit to Latin America because of what's happening in Europe? Uh, everybody needs to do trials now, even for a syringe, you have to do trials . So,

Mitchell Parrish: 19:41

You know, I, I think any of , any of those pieces, no , no matter where they are globally , um, you know, 'cause we haven't even, you know, we're starting to see Chinese-based companies, right? E even more focused on, on Latin America. But yeah, you know, any, anytime there is, I think, you know, requirements or legislation passed in other areas, we're certainly as a company looking at and saying, you know, who do we currently have as clients that, that may, you know, need to see additional research or , or where, where are there additional opportunities? And so, you know, I think when you have those types of things, there's always the potential to, to recognize maybe even more research, you know, again , uh, depending on more stringent requirements, like you said, syringes, things of that nature. So in terms of what we're, you know, I don't know if there's gonna be a huge , uh, say boon to Latin America from that still. What, what we're seeing is, okay, a lot of, and I know right, you're in the clinical research space, but you know, there's, there's the whole medical device component, which is this whole , whole , whole other, other component for us, we're still saying , okay, it's a lot of COVID-19 vaccine trials, it's a lot of infectious disease. It's, it's all those things that already would've required clinical research. And then it's also those therapeutic areas where you tend to see a higher instance of Latin America. So of course there's been a lot of nash, a lot of diabetes trials , um, you know, in Mexico and other places. So where the really the focus, I mean , um, so I'm not so sure how much additional could could come of that. We're still really seeing it being the major therapeutic areas that are being , um, pushed to Latin America for the trials.

Julio Martinez: 21:17

Okay. All right . Fair enough. Alright , Mitchell, let's talk about , uh, regulations, but not necessarily regulation in terms of getting a , a study approved at the national level or at the local level. IRB at this committee, but , uh, home care specifically. And the only , um, research that I've done in the sector is in Columbia because of the , uh, anecdote I just told you, the opportunity that was presented to us here as a company by , uh, Covance now Global Care clinical trials. And I started digging into how it works in Columbia and I found out that , uh, this is heavy , heavily regulated, at least in Columbia . I don't know about the other countries. I like to get your take on on this because , uh, in Columbia you have in essence two type of clinics or healthcare service providers. I mean, for the purpose of the conversation, to make it simple, two types of , uh, service providers, the typical hospital, you know, the brick and mortar building where patients come in to you, to your facility and you see them inside your facility in the walls. And I'm translating to , uh, uh, from Spanish because , uh, in Spanish they call it intraoral , intraoral inside the walls a morale is a wall, a big wall. So the other category that you can get licensed by the local government as a healthcare service provider is extra morale outside of the walls. So you are only allowed to provide healthcare services at somebody's house or another place, not your office, right? Not your building. And some hospitals have both licenses. So what do you think about this? I mean, how are you guys doing in Columbia , for example, in the concept of this regulation and how does it work in other countries?

Mitchell Parrish: 23:12

That's a very good question, and it's very important here to distinguish what we're doing as opposed to healthcare, for example, like outside of the wall inside. So I think the, the first thing when we're approaching, 'cause we do, I mean we get these questions, we've actually had to work within Columbia to address these questions. So the first thing that's so important for what we do is to distinguish the fact that what we're doing is beholden to a protocol that's approved by vema. So you're doing it according to a protocol and you're doing it under the oversight of a research site that's in Vema certified. So really when we do a home visit, we are, each clinical is an extension of the site, following the protocol, following the oversight and guidance of the principal investigator. And you have to stay within that very narrow window, otherwise you are getting into an area that's regulated in a whole different context that that brings in a lot of different , uh, requirements and approvals and challenges. So we're heavily regulated, it's just we're heavily regulated within the clinical research specific sector. So that's, so that's everything we do with our nurses. Yes, they have to have appropriate licensure, for example, in Columbia. But, but at that level. But you know, they're being reviewed by the ethics committees. Um, you know, they're their CCBs , um, they're looking at their GCP certificate, they're looking at their dangerous goods training or yata training, and they're having all those things. They're being added to the delegation of authority log at the site. So it's really, that's how we need to be able to operate. And Columbia actually, of all the countries tends to be more stringent than other countries. We still, as an organization, operate in the same manner that we do in Columbia elsewhere. And that's very important for us to make sure we stay compliant and that we're acting within that clinical research construct. But actually it is Columbia , uh, that does tend to have more requirements and like, you know, it can be very challenging operating Latin America Times. 'cause a lot of the times those requirements that aren't written, it's not in a regulation, it's not in a guidance, it's just that's what the requirement is. And you're like, well , I don't, you know , that's okay. Well we'll agree to that. I don't understand where it's coming from, but that's fine if that's what you're requiring. So

Julio Martinez: 25:25

I'm sure you guys did your research, <laugh> you have to operate within the law and , and everything that's perfect that , uh, you guys are free to operate under that little windows you said of clinical research. Fantastic. I mean, that's great news <laugh>. So this is actually easier to promote this type of , uh, services , uh, to the benefit of patients. Um, and I love this

Mitchell Parrish: 25:46

One thing there because it , it's interesting when we start to see other companies operating in , in Latin America, and I don't know if you've seen this too, but you know, I think people sometimes think, you know, you come to Latin America and it's gonna be the, like a US term, right? The Wild West, like anything goes and it's , that's a big misnomer. It's like, no, you know, there are specific things that have to happen in, in Latin America. And you know, another piece that we're seeing in terms of providing services, you know, you also have to be appropriately incorporated within the country, right? You have your licensure, you know, what's your lifestar ? Are you a CRO ? And so it's just interesting that we start to see more interest in Latin America. We're also starting to see with , you know , are you even allowed to be, you know, without, you know, do you have your Brazilian tax site ? You know, those types of things. So it is interesting as we've seen a growth to, for, for people to understand, look, there are requirements laws in each country, and a lot of them

Julio Martinez: 26:36

<laugh> . Yes. And a lot of them are Yeah. Can be very bureaucratic and very rigid. Yeah. I mean, these are not Banana Republics anymore. I mean, the US is not invading countries like Panama to get Noriega who was giving speeches with a machee . Remember that <laugh>? Yeah .

Mitchell Parrish: 26:51

I I do actually, I was a bit younger, but yes, I do. Yeah, yeah .

Julio Martinez: 26:56

Well , the invasion of gran the island because , uh, the communist regime of Cuba wanted to get inside and then the US invaded. I mean, so yeah, that's a thing of the past. And Latin America has really, really evolved and uh , it is , it's impressive. Countries like Columbia , like Mexico , uh, Argentina, Brazil, I mean, these countries are , uh, comparable to many of the countries in Europe. I just had , um, a company , uh, visit , uh, Columbia . We're visiting , uh, like five different sites all over the country for a , a study, a medical device study. And we went to Cali to a facility clinica in Bacco in Cali, one of the top facilities in Latin America. But for them, I mean, these are Harvard people. I mean, top credentials from the US is a publicly traded company. So first time they go to South America and everything was new to them. But when they got to, when we got out of the car and they saw the building, the in Acko building, they were like, wow, this is like Cleveland Clinic in the us . I mean, I don't see every day a place like this in the us This is unique <laugh>.

Mitchell Parrish: 28:07

It's true. I mean, you have some incredible professionals with state-of-the-art facilities, homegrown software to manage the complexity that's beyond even, you know, software being developed, you know, in the us . And so, but that's just like us, right? Some places are gonna be more sophisticated than others, but yeah, it's definitely, I've had that same experience. Like we were showing a group in Columbia to a research site there, and they're just like, oh, wow. Like, okay. Yeah, no, absolutely. We wanna send a lot of research here because you have everything.

Julio Martinez: 28:37

That's exactly what they said. I mean , gonna record the trials here, <laugh> . Yeah , that's what they said. <laugh> . Anyway, Mitchell, so do you travel a lot, by the way?

Mitchell Parrish: 28:46

Used to, yeah.

Julio Martinez: 28:47

Used to, of course. Yeah . Now

Mitchell Parrish: 28:49

The pandemic definitely slowed that down. I think the last trip I had actually was to Bogota. Yeah,

Julio Martinez: 28:53

Bogota. Oh yeah . Okay, good. So is it fun to do business in Latin America and your opinion ? I mean, what would you say to the CEO of a company that is just exploring the region as a place to do trials on basic

Mitchell Parrish: 29:06

Whatever? Yeah . You know, first I think the business opportunity is fantastic. Again, the resource component. You have really sophisticated, highly educated individuals that are eager to perform the work, and then you have their participants. So it's just a great opportunity for clinical research. But then in general, I mean, it's nice to get exposure and I, I love Latin American culture. It , it is this very warm, inviting, inclusive culture. And so on that nature, yeah, I mean, I love to travel to, to all the different places in Latin America because it's fun to be exposed to that. But that was one of the first things when I met, when I was talking about, you know, meeting fellows coming from Peru and from Chile, and when I met Dr. Franco, I mean, there is this sort of inclusiveness and, you know, friendliness that the really

Julio Martinez: 29:48

Yes. Friendliness. Yeah , it's very warm.

Mitchell Parrish: 29:51

Yeah. And that gets imparted into the work, which makes, you know, work is stressful just at a baseline, but you don't need to make it more stressful than it is. So it's really nice to be able to build those relationships and that rapport and know that you have very hard workers that also understand, you know, the balance and what's important. And I really like that component. And I love the family component too, of, of

Julio Martinez: 30:10

Being America . Yes . And they invite you to their houses and everything. If you go in business, they, they're like, that's happening to me. I've , I've been living in the , for 25 years and sometimes I travel in business and they're like, Hey Julio, so are you by yourself? What are you gonna do tonight? I don't want you to get stuck in your hotel without anything to do. So come over to my house, let's have dinner with my family. It's

Mitchell Parrish: 30:31

Really nice . Exactly. I love that piece. I have a meals in people's homes for that exact reason. And, and that's fantastic. And we're actually continually trying to even educate our clients on what it means to do specifically home visits. Because when we do a home visit, you are going into a family home. It's not just there to see a participant. And if you don't allot time to say hi, you know, address the family, it, it becomes very, we've had visits where, you know, someone doesn't want a nurse to come back because they didn't spend the time to, you know, make sure they're oriented to the family and that they're, you know, that they're heard. And so it is very important to recognize it is different culturally. It's not just like, okay , 30 minutes in and out. You have to make sure to build the trust with not just the participant, but the participant's family when they're there. So that component is definitely important and interesting.

Julio Martinez: 31:24

Excellent. Mitchell, I know you're a busy person. Thank you so much for accepting my invitation again, to be, I guess in our show. I really, really enjoy my time with you and I look forward to being in touch. And , uh, how can listeners get in touch with you with H Clinical?

Mitchell Parrish: 31:40

Yeah, definitely Lio , thank you for having us and for being able to talk about Latin America and H Clinical. Really appreciate your podcast and continuing to, you know, shed light on the value of doing research, all types of research in Latin America. So h Clinical, you can look us up@hclinical.com, my email mitchell dot parish@hclinical.com . So we're right there. You can contact us via the website, form, field , email, phone, it's all right there. So definitely happy to continue to work with a number of clients throughout the region.

Julio Martinez: 32:10

Beautiful, Mitchell . Take care all . Bye .

Mitchell Parrish: 32:13

Thank you . Take care .