This week we asked forum attendees to go on globalcitizen.org and read the article Mobile Health Messages are Helping Parents and Saving Lives. The article outlines an initiative by various health organizations to send health related information to individual’s phones via text in remote regions. The initiative has thus far been very successful in breaking down barriers to healthcare. Please give it a read!
This Week’s Conversation
This week’s forum focused on innovations in healthcare, especially in remote regions. Access to effective healthcare can drastically improve quality of life, life expectancy, employment opportunities, and the performance of local economies. However, many remote populations lack access to effective healthcare because of limited funding, resources, and important technologies. Many remote regions also do not benefit from educational outreach programs, leaving isolated populations with less quality information on which to base their healthcare decisions. It is important to note that limited access to healthcare in remote regions happens all over the world, including Canada where we have “universally covered health care.” This week’s forum asked participants to consider some of the limitations to delivering healthcare to remote regions and develop solutions accordingly.
Participants divided themselves into four groups to develop solutions to the problems presented in the four case studies relating to telehealth, vaccine innovations, mental health outreach, and the growing anti-vaccine movement in Canada.
Case 1: Telehealth
Many remote populations suffer from a lack of access to regular health services, specialists, and hospitals; 11,000 people in Canada’s northern communities are more than 100 kilometres from a doctor. Lack of access to regular, effective health care results in worse health outcomes for these communities. It is difficult to entice medical professionals to work in “undesirable locations”, so the Canadian government have had to get creative in designing a Telehealth program, which aims to provide healthcare to remote communities using communication technologies. Telehealth has proven to be cost-effective and reduced the need for emergency care in remote regions by allowing healthcare providers to diagnose, treat, and consult with patients remotely.
India is also currently struggling with providing adequate access to effective healthcare. It is estimated that nearly 600 million people are not receiving the health care that they need. This is mostly due to a growing private healthcare system that is funneling money away from the public healthcare system, on which the 276 million Indians living on less than $1.25 a day depend. How can India incorporate a system of remote healthcare services to ensure that those living in rural and remote regions receive adequate healthcare services?
Solution: The group concluded that India would benefit from a similar system of remote healthcare services (telephone, skype, etc.) that remote regions of Canada have introduced. The group also acknowledged, however, that an equal part of India’s poor access to healthcare lies in a generally underfunded public healthcare system that fails to provide the same incentives to doctors, resulting in less talented professionals in the public system, and therefore worse treatment.
Case 2: Vaccine Innovation
Nearly 20 children remain unvaccinated against diphtheria, pertussis, and tetanus (DTP3), diseases for which we have had effective vaccinations for decades now. There are two subsets of the global population that remain seemingly out of reach of modern vaccination campaigns: children in rural, isolated populations and children in informal urban settlements (often referred to as slums). These two groups remain under-vaccinated because vaccines must be kept at a strictly regulated, cool temperature of 2 to 8 degrees Celsius (depending on the vaccine). Remote populations remain disconnected from the complex networks of power sources required to effectively transport vaccines to isolated regions. Urban populations, by contrast, remain difficult to vaccinate because governments have difficulty collecting census data about them, while the communities themselves are often skeptical of the benefits associated with vaccination.
Solution: A major factor limiting effective vaccination for remote and impoverished urban communities is the fact that the DTP vaccines must be administered three times. Given the rate of development in the rest of the pharmaceutical industry, the group concluded that with enough resources dedicated to research and development, it would be possible to develop a vaccination for DTP that would only need to be administered once. In the meantime, the group concluded that governments would benefit from developing a trusted network of community leaders in urban settlements capable of communicating the benefits of vaccination and potentially administering the vaccines themselves.
Case 3: Mental Health Outreach
Nearly 1 in 4 people in Zimbabwe suffer from some form of mental health condition, while the country only employs 13 psychiatrists and 12 clinical psychologists. The Friendship Bench Project aims to reduce the treatment gap by using a cognitive behavioural therapy based approach on primary care level to address depression. Patients visiting the primary care clinics are being screened with a locally validated tool called the Shona Symptom Questionnaire (SSQ). When scoring above the cut-off score, they are referred to the friendship bench where they receive individual problem-solving therapy from a specifically trained lay health worker. The lay health workers are often local grandmothers who are trained to give this kind of help. They are required to stay for short shifts on the benches, but the work is not high commitment. The lay health workers are employed by the city health authorities of Zimbabwe’s capital Harare and therefore represent a sustainable option to provide this task-shifting treatment approach. A recently carried out randomized control trial (4) showed that the Friendship Bench can deliver a successful, culturally acceptable and reliable treatment program for depression on a primary care level.
Solution: Because of the success of the Friendship Bench Project in Zimbabwe, the group concluded that this program should continue to operate and other developing countries/remote regions should consider developing and implementing similar programs, whereby trusted community members can meet with other community members suffering from mental health problems and provide them with “individual problem-solving therapy.”
Case 4: Anti-vaccination Movement in Canada
The Canadian Public Health Association describes immunization as being among “the safest tools of modern medicine”, while noting their effectiveness and small associated risks. Despite these facts, the anti-vaccination movement in Canada continues to grow. Canada has seen vaccination levels go down, while vaccine-preventable infections have increased by 30% since 2005.
Based on polling 1,013 Canadian parents with unvaccinated kids, the pollsters learned that:
- 40 per cent come from households with over $100,000 in income
- 38 per cent hold a university degree while 66 per cent have completed post-secondary education
- 65 per cent cite health reasons for not vaccinating
- 19 per cent say religious reasons are what make them refuse vaccines
- Another seven per cent said philosophical reasons stood in the way of vaccination
Solution: The group concluded that the solution was to be found in increased education about the risks associated with vaccines, especially the long-discredited link with autism. Implementation of state penalties for failure to vaccinate remains contentious, so absent a political climate that would tolerate mandatory vaccinations, state and society should combat vaccine skepticism with engaging educational materials.
Healthcare is an important part of development, and lack of access may disproportionately affect certain groups within communities, both locally and abroad. Innovation and creative, culturally aware, solutions are important in helping to remedy these problems.
If you want to get more involved check out these campus organizations:
- QBiT: The Queen’s Biomedical Innovation Team focuses on innovative healthcare solutions. Look out for their initiatives and events!
- Queen’s Global Health Outreach attempts to increase healthcare access in Canada and abroad, follow them on social media and attend their fundraisers – or apply to intern next year!
FORUM: TUESDAYS @ 5:30 / JOHN ORR, JDUC
“Our goal with forum is to provide a safe, informative, judgement free space to discuss a variety of issues within development. We want everyone who comes to forum to feel comfortable expressing themselves in whatever way they see most fit. No question is too simple or too complex and you will never be judged for trying to grow in your understanding. While it is important to recognize that words carry with them a certain weight, it is also crucial that we remember everyone here is coming from vastly different backgrounds with varying degrees of development knowledge but that we all share a common desire to learn, grow, and make a difference.”