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Archive for the ‘Access to healthcare’ Category

By Charlotte Vystavel

In today’s society, technology has grown in dominance into an entity that the majority of the world heavily depends on. Though there are negative implications of the human attachment to electronic devices, these devices have the ability to do far more than we are aware of. In this case, they have the power to make health care more accessible worldwide. This is illustrated with the invention of Peek, a smartphone application that tests eyesight and empowers healthcare workers, especially in developing countries.

In 2014, there were an estimated 39 million blind people on our planet, according to Dr. Andrew Bastawrous, ophthalmologist from London U.K. In a TED talk, filmed March 2014, Bastawrous explained that 80% of these people live in low-income countries and are blind from diseases that are “either completely curable or preventable.”

One disease we have discussed in class is a disease called Onchocerciasis, or River Blindness, which is caused by a parasitic worm. When a disease renders a person blind in a developing country where there is limited access to health care, there are few options or actions to take. Yet, Bastawrous and a team of healthcare workers created an innovation that could lessen the burden of such diseases.

PEEK is a “portable eye examination kit” that uses an application and simple adaptors to mobilise an eye clinic, making eye care accessible regardless of a person’s proximity to a clinic. People who live far from a city with healthcare are usually the people who are the most in need of it. Therefore, mobilising healthcare is a fundamental step in improving health situations for such populations.

The test starts with a ‘Visual Acuity Test’ that quickly evaluates a person’s sight, and is followed by a closer inspection through using the ‘Retina Adaptor’, which looks at the back of the eye.

Having lived in the south of Spain, where eye care is of top quality, I have personally had my eyes checked, which consisted of a process where I was able to see the back of my eye. The process was long and my optometrist used many fancy devices. Essentially, I could have done the same test using my iPhone and this application.

Bastawrous mentions in the Ted talk, “more people in Kenya, and in sub-Saharan Africa, have access to a mobile phone than they do to clean running water.” Though this is a startling assertion, it may not be far from true. Having visited Kenya and spent substantial amount of time in Uganda multiple times, clean water is truly scarce, yet the accessibility of a mobile phone is surprisingly high. Therefore, I could not be able to debunk his statement.

By using a mobile telephone, a device that is so commonly acquired and used, we are able to improve the access to healthcare in developing countries. Though I would usually be skeptical over the true accuracy of technology as opposed to traditional methods, this Ted talk has changed my view on the power of technology as a tool for improving healthcare.

 

PEEK follows the principle of going to the patient rather than the patient struggling to find healthcare. Bastawrous claims they are able to “give [the patients] the most comprehensive, high-tech, accurate examination, which can be delivered by anyone with minimal training.” Though I find this innovation successful, there is a substantial lack of explanation as to what happens next.

 

According to Bastawrous, after the evaluation that the person needs treatment, PEEK is able to “use text messaging services to explain that [they’re] coming to arrange a treatment.” However, there is no mention of where this treatment will take place and the cost. Cost, as we have learned in class, is a hugely limiting factor to receiving appropriate healthcare. The cost also includes the opportunity cost, of the person leaving to attend to health matters and perhaps missing work or caring for children.

 

Although I believe this innovation is a great success, it fails to address the difficulties of providing actual treatment to the people. Cost is a dominant factor in healthcare treatment. The device costs $500, which would be an investment on a durable good, but the subsequent treatment will likely be sufficiently more expensive.

 

PEEK successfully addresses the lack of access to eye care facilities in rural, developing areas, and therefore is a productive innovation that makes healthcare mobile and accessible. Yet, there are many questions regarding the treatment that must be addressed and answered in order to complete the care and successfully treat a patient. It is a great start to battling the issue of blindness and visual impairment, but it is only a start.

 

 

 

References:

Bastawrous. 2015. 24 February 2016 <http://www.peekvision.org&gt;.

 

Get Your Next Eye Exam on a Smartphone. By Andrew Bastawrous.

London. 2014.

 

Onchocerciasis. 2016. 24 February 2016

<http://www.cdc.gov/parasites/onchocerciasis/&gt;.

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By Cassandra Sunga

In December 2015, the Philippines announced that it would be the first country to launch Sanofi Pasteur’s brand new dengue vaccine Dengvaxia. As dengue infects 200,000 Philippine citizens per year and treatment for the disease costs about 18,000 pesos per patient, this intervention has the potential to save hundreds of thousands of dollars and several lives across the equator. Although this medical feat is one that should be celebrated, one fundamental question remains on its delivery however: who will ultimately be able to obtain this vaccine in the Philippines?

According to a report made by the Philippine Statistics Authority in 2013, poor households are 18.2% less likely than non-poor households to obtain their mandatory first dose of the Hepatitis B vaccine. Furthermore, the World Health Organization (WHO) in 2011 reported that only 55.5% of households in the lowest income bracket were able to obtain a full round of mandatory, WHO EPI vaccines in comparison to 83% of households in the highest income bracket. While the cyclical nature of income disparity and health is a constant in most countries across the globe, the poor in the Philippines are especially susceptible to the consequences as there is essentially no public safety net to ensure that they receive quality health care when needed. Although current President Benigno Aquino has overseen a number of positive reforms in healthcare policy since assuming office in 2010 (e.g. the expansion of their national health insurance program Phil Health and the appropriation of birth control to the public), differential access to quality health care amongst various income groups is still a major issue.

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Even though the country’s situation seems bleak for the poor and geographically isolated, one NGO has risen above the rest to find a valid solution to the problem. Gawad Kalinga (GK), which means, “to give care” in English, aims to “end the poverty of 5 million poor families by 2024”. The organization started by building quality housing structures and communities for poor families in the early 1990’s, and has since launched about 2,000 different communities across the country. To make each community economically sustainable, GK also partners with business schools and entrepreneurs around the world to empower Philippine citizens with viable livelihoods based on their working skills and what’s naturally available in the environment around them.

In 2010, Center for Disease Control (CDC) head Dr. Thomas Frieden published an article in the American Journal of Public Health on his 5-tier intervention pyramid. The pyramid creates a framework for understanding how impactful public health interventions will be depending on what factors they target. The idea is that if you have an intervention that targets broader segments closer to the bottom of the pyramid (i.e. socioeconomic factors), you will thereby have a broader impact on society. Although simple on the surface, the idea does come with a catch; targets listed towards the bottom are often times the most difficult areas to address or change in public health. Thus, the obstacles and difficulties that ultimately lie in changing the bottom of the pyramid are what largely deter interventions from aiming to make socioeconomic factors a main target.

As Dr. Frieden elaborates within his article, previous models and current interventions often times fail to address infrastructure in health systems. However, this framework is exactly what makes GK’s model so fascinating and exciting! Rather than using interventions that are too focused on the individual or are largely non-preventative, GK is trying to solve health disparity in the country by attacking the root of the problem: income disparity. While GK will most likely be unable to provide all of the people living in its communities with the dengue vaccine, they are providing them with something that is arguably just as essential for community health: hope. By finally creating the quality, sustainable infrastructure this country has needed for the poor, GK has laid down the groundwork for improved population health in the country. They took a leap of faith and started at the bottom of Dr. Frieden’s pyramid. Now, all they simply have to do is continue climbing upwards.

Citations:

 

  1. Frieden, Thomas R. “A Framework for Public Health Action: The Health Impact Pyramid.” American Journal of Public Health 100.4 (2010): 590–595. PMC. Web. 26 Feb. 2016.
  2. “Breastfeeding, Immunization, and Child Mortality.” Philippine Statistics Authority. Philippine Statistics Authority, Oct. 2013. Web. 26 Feb. 2016.
  3. “World’s First Dengue Vaccine Now Available in PH.” CNN Philippines. CNN, 12 Feb. 2016. Web. 26 Feb. 2016.
  4. “Welcome to Gawad Kalinga.” Welcome to Gawad Kalinga. Gawad Kalinga, n.d. Web. 26 Feb. 2016.

 

Image Citation:

 

  1. In the Philippines. Digital image. Gawad Kalinga. Gawad Kalinga, n.d. Web. 26 Feb. 2016.

 

 

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By Annalee Mueller

The Syrian refugee crisis is not a new problem. Turkey alone has approximately 2.5 million refugees, and while the political implementations are consistently a media focus, the health issues are less obvious to the rest of the world. Efforts are being made to deal with health needs, though improvements still need to be made. I am naturally drawn to examine Turkey in this case, as it is the bridge that so many have chosen in order to enter other European countries.

Syria Refugee Population

 

Syrian Refugee Population in Turkey – Human Rights Watch 2015

 

The Current State

The majority of Syrian refugees, approximately 300,000, reside in refugee camps near the Turkish/Syrian border. In response to the lack of available health care, several international health organizations pushed and successfully established field hospitals within these camps. Data shows that these health facilities are quite efficient, serving 90 percent of those staying there. On the domestic side, the Turkish government provides refugees free primary care if registered and free emergency care regardless of registration status.[1]

 

However, there are two major problems with this current solution. First, while those within the camps are served well, those who are scattered throughout Turkey face challenges accessing the current community centered health care system. In response to this issue, the Turkish government agreed to assist the construction of ten additional outpatient clinics, despite their initial reluctance to work alongside international aid organizations.[2] Evaluations of this response show that only 60 percent of refugees actually use these outpatient clinics, leaving 880,000 out of a total of 2.2 million Syrian refugees in Turkey without adequate care.[3]

 

The issue is that continuous arrivals of refugees in 2015 have widened the gap between the demand for services and the capacity of the health infrastructure to respond, resulting in a decrease in quality. The WHO has helped, providing training to Syrian doctors working in Turkey, technical support for outbreak response and immunization campaigns, equipment and medications, and information materials.[4] These have been helpful, but health care workers have continued to face many challenges, including a language barrier and shortage of resources.

 

The Response Plan

The most recent information, published by the Office of the United Nations Commissioner for Refugees (UNHCR) and the United Nations Development Program, outlines where resources are currently going to improve the health situation.[5] There are five main points to the response plan, highlighting the need for mental health services, medication for chronic diseases, and improved disease surveillance. It also discusses strengthening health promotion and streamlining decision-making on behalf of the various players involved in these efforts.

 

In addition to examining overall themes of interest, the report also discusses specific issues affecting Turkey. The first examines the fact that vaccine-preventable diseases are a major concern to those living in communities. Another important reality is that 25 percent of Syrian refugees in Turkey are women of child-bearing age. 15 percent of child-deliveries are high-risk, highlighting the need for improved women’s health services. Thirdly, it addresses the concern of increased mental health issues shown by those coming from high conflict areas.[6] These, along with other health issues, are the driving force behind the plan’s objectives.

 

Relevance to a Global Health Student

As a student, it is easy to look at this information and be overwhelmed at the amount of work that needs to be done to solve such a long list of issues. However, there is much to be learned from the way the Turkish government is handling the crisis. As implementers of policy, it has provided a framework for other organizations to build off of. WHO and the UN Refugee Agency have taken the lead while also partnering with others to provide solutions for ongoing problems. The cooperation amongst these organizations is vital for providing both effective and efficient health care. Though the response has by no means been perfect, it has been largely successful, likely due to a burden shared amongst several organizations.

 

 

[1] “Regional Refugee and Resilience Plan 2015-2016: Turkey, in Response to the Syria Crisis.” 3RP. http://reliefweb.int

[2] Samari, Goleen. “The Response to Syrian Refugee Women’s Health Needs in Lebanon, Turkey and Jordan and Recommendations for Improved Practice.” Humanity in Action. http://www.humanityinaction.org/

[3] “Regional Refugee and Resilience Plan 2015-2016: Turkey, in Response to the Syria Crisis.” 3RP.  http://reliefweb.int

[4] “Syrian Refugees in Turkey.” Word Health Organization. http://www.euro.who.int

[5] “Regional Refugee and Resilience Plan 2016-2017: Turkey, in Response to the Syria Crisis” 3RP.

http://www.3rpsyriacrisis.org/

[6] “Regional Refugee and Resilience Plan 2016-2017: Turkey, in Response to the Syria Crisis” 3RP.

http://www.3rpsyriacrisis.org/

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-By Sawyer Deitz

The rising cost of health care is rearing its ugly head once again, only this time its not only on American soil. China may soon be facing the issue of high health care costs, the same problem that confronts the United States currently According to a report from BioSpectrum, Chinese expenditure on health care exceeded 10% of their GDP in 2013; by the year 2020 China will up their healthcare spending to $1 trillion annually.[1] According to the BioSpectrum report China is doubling the total number of drugs in its national reimbursement program from 205 to 520. The purpose of doubling the available drugs is murky at best China has a mixed relationship with pharmaceuticals, as they currently ban representatives from entering hospitals, but this has not stopped a massive increase in the use of drugs. (more…)

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By Sherylle Estrellas

Across the world, many developed countries supply universal health care, allowing everyone the health coverage and service he or she needs at no or little cost to the consumer. Meanwhile, America, among the most developed and richest countries in the world, still has yet to implement an equitable and efficient health care coverage system. Although the Affordable Care Act means to improve the system, one can only wonder why it has taken so long for America to change its ways. Economist Victor Fuchs suggests a few reasons why.

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-By Selin Thomas

For more than two years, the Syrian conflict has been intensely growing in historic scale and scope, with the United Nations estimating more than 100,000 dead and millions displaced. In the last two weeks, the U.N. Security Council has been urged to act on humanitarian aid to Syria because the only achievement to come out of peace talks has been a cease fire in Homs, leaving many aid workers still risking their lives daily. Today, more than two million have fled the country, an estimated 4.25 million have been displaced within the country. (more…)

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-By Samantha Zito

Harm reduction strategies used to address drug addiction are hotly debated. Harm reduction focuses on keeping people alive and as healthy as possible instead of focusing on complete rehabilitation or “cures” for the addiction. The public health field is moving more and more towards harm minimization strategies to address problems such as addiction, especially in urban areas. While some countries are turning towards a public health approach to drug addiction, others such as Australia, Germany, Switzerland, and Spain, the United States continues to push drug addiction into a legal debate including the criminalization of drugs even with the devastating effects of overdoses and escalating addiction rates. One of the strongest examples of harm reduction strategies in drug addiction are medically supervised injecting centers. Although many cities in the United States would greatly benefit from these centers, many obstacles stand in the way of the possibility of these radical harm minimization strategies. (more…)

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