Linking Health in the Americas
Advances in computer and telecommunications technology are expanding the promise of medical knowledge, interventions and prevention to the most remote and impoverished regions of our hemisphere.
In Peru, public computing centers are linking poor residents without telephones to distant medical facilities and sources of medical information. In Brazil, an airline now has the capacity to hook emergency patients up to equipment that can transmit critical medical information to physicians on the ground. And in Costa Rica, the Ministry of Health and other partners are setting up a national telemedicine network linking medical and research facilities.
These are but a few examples of the technological developments that are revolutionizing medicine in the Americas — developments that according to Dr. David Brandling-Bennett, deputy director of the Pan American Health Organization (PAHO), are as significant as the sequencing of the human genome.
“Certainly, the computer and the Internet have extended tremendously our ability to collect, analyze, and transmit data and to share information,” says Brandling-Bennett, a graduate of Harvard Medical School. “This greater computational and communications capacity enhances our ability to study and understand health dynamics and to plan and evaluate interventions. Perhaps more importantly, it will allow us to transmit and share more information, potentially empowering people and communities to improve their own health. A great deal has been achieved with powerful computers and the Internet, and the promise for the future seems far greater.”
Nevertheless, while technological developments beginning at the end of the 19th century and continuing through the 20th century have led to tremendous improvements in health, Brandling-Bennett notes that they have not led to a reduction in disparities. “Will we do any better? Will the new technological developments of the late 20th century serve to reduce or eliminate inequities, or will they merely serve to widen existing gaps and perhaps create new ones? The challenge is to ensure that our newest technologies serve those who need them most.”
PAHO, founded in 1902, has long been an advocate for using health technology to improve public health and eliminate disparities in access to care. The organization succeeded in putting health technology on the agenda of the Summit of the Americas when the hemisphere’s leaders met in Santiago, Chile, in April 1998. PAHO noted in a “Health Technology Linking the Americas” initiative that health technology has enormous potential to reduce today’s social inequities and will help governments achieve through partnerships what they cannot achieve alone.
The initiative noted that by sharing technologies and information networks, countries can:
better prepare themselves for disease outbreaks or natural disasters;
share groundbreaking news on emerging health issues and discoveries in vaccines research and development; and
empower public health workers at all levels to make timely, well-formed decisions by providing them with access to the crucial data and knowledge they need.
Dr. George A.O. Alleyne, director of PAHO, agrees that sharing technologies and information networks is critical for healthcare decision-makers. “Most activities designed to improve the operation and management of the health services or to address such public health issues as sanitation, nutrition, maternal and child care, and lifestyle changes are highly dependent on information. Consequently, the health sector must harness these new information tools if it is to fulfill its goals in the best and most efficient way possible.”
Alleyne says PAHO and other organizations have already engaged in initiatives to take advantage of the current information revolution. “These efforts emphasize the importance of garnering telecommunications support as the health sector seeks improvements in health service delivery, health promotion, consumer education, and environmental protection and pursues equity, quality, and efficiency.”
Dr. Roberto J. Rodrigues, PAHO’s coordinator of the Health Services Information Systems Program, predicts healthcare practice will change dramatically in the coming years, thanks to information technology. “Dramatic gains have been made in the application of space communications and interactive information technologies to aid development efforts in education, health promotion, remote medical services, economic improvement, and a broad range of information services via Internet Web sites,” he notes.
Brandling-Bennett observes that universities can help ensure that the benefits of health technology are distributed evenly. “I think we will all agree that we must make special efforts to bring disadvantaged countries and people the benefits of computerization, the Internet, and an understanding of the human genome, though it is likely that these benefits will first accrue to wealthier nations and people,” he says. “It is precisely here that universities can and must play a key role. The fundamental purpose of the university is the generation of information, the creation of knowledge, and the sharing of that information and knowledge to influence action. What better institution than one dedicated to research, learning, and understanding could take new technologies that can improve health and direct them to meet the needs of the poor and those who suffer the most ill health.”
In a recent report, a group of World Health Organization (WHO) experts describe information and telecommunications technology as the main driving forces in the current globalization of trade, economics and politics, with equally important implications for health. The experts say that investment in health telematics can help ensure that the gap between developed and developing countries does not grow even wider.
While the idea of using telecommunications to improve medical practice may look new, it dates back more than three decades. The space program was the first pioneer in telemedicine, using telecommunications to monitor the physical conditions of astronauts in orbit. Today, this space-age technology is available even in remote or impoverished areas.
Success stories in telemedicine abound in Latin America.
In Peru, for example, the Peruvian Scientific Network “Red Cientifica Peruana” has found a way to make low-cost Internet service, with links to medical services, available to low-income users in underdeveloped areas. Cabinas públicas, or public computer centers, are now installed in more than 27 locations throughout Peru. The centers typically contain 20 computers with dedicated Internet lines. A computer and Internet hookup can be rented for as little as $ 1 an hour. The Peruvian network has direct links to clinics and hospitals, conference proceedings, and information on such topics as child health and mental health, so that anyone in Peru, for a modest fee, can access information globally. The centers are popular with people who don’t have a phone line or a computer at home — more than 95 percent of all Peruvians. Plans are underway to finance 1,000 more centers in Peru with help from the Inter-American Development Bank.
Varig Airlines of Brazil recently became one of a growing number of commercial air carriers to purchase onboard medical equipment, including defibrillators and monitoring devices, that will allow crew members to manage serious medical emergencies in flight under the direction of doctors receiving electronic data on the patient via airphone.
In some areas, prison inmates with conditions that warrant examination by specialists no longer get to venture out for a trip to the doctor. Instead, prison physicians transmit data via telemedicine networks to specialists who can examine X-rays, see videos, and look over EKGs to render a diagnosis and prescribe treatment.
In more everyday situations, medical professionals working in some of the most challenging areas of the Americas are gaining access to medical libraries and databases around the world, and are consulting remotely with specialists on difficult cases.
In Costa Rica, the Ministry of Health, the Costa Rican Social Security Agency, and other partners currently are implementing a nationwide telemedicine network linking hospitals, clinics, and research and learning centers. In Brazil, the Oswaldo Cruz Foundation and many others disseminate technical information.
Telemedicine also allows new technologies to reach beyond clinical settings into the medical classroom. In Barbados, for example, the University of the West Indies leaped into the information age back in 1982 when its Distance Teaching Enterprise linked five Caribbean islands with teleconferencing sites. UWI now offers full degrees at home using communications technology.
The Caribbean is a pioneer in distance education, and as the Internet expands, other parts of the Americas are fast becoming a virtual hemisphere in which people can share information no matter where they live.
In Mexico, “The rapid growth of information networks, which started during the early years of (the 1990s), has been astounding,” says Dr. Gladys Faba, director of the National Health Information and Documentation Center. The National Autonomous University of Mexico, which had 7,000 user stations in 1990, today has more than 40,000 computers connected to its UNAM network. “The development of Bitnet and Internet and the appearance of domestic networks in the country have played a decisive role in stimulating the expansion of information services in educational and healthcare institutions,” she says.
The University of Buenos Aires in Argentina has connected its academic units to the national and international Internet community, integrating that network with 33 national universities and foreign institutions. “The increase of computer communications in our country and the development of medical informatics in the last few years in Argentina has been very significant, with a greater number of physicians and paramedics using computers for self-teaching,” says Dr.Daniel Jares of the Medical Informatics Foundation.
What does the future hold? “It is certain that technological developments, including those in computers and communications, will have a major impact on health throughout this century,” says Brandling-Bennett.
“We also know, given the nature of the new technologies, that the benefits won?t be equitable. They might not reach the 5-year-old indigenous child in Guatemala, the sugarcane cutter in Guyana, or the rural school teacher in Bolivia. As we become more reliant on these technologies, the health status of the poor, those in rural areas and minorities may stagnate if they do not have access to or cannot use the new means of communication or find the information they need. We must ensure that the neediest do benefit from the new technologies.”
What brings you in to see me today?” This is the typical question asked of new patients during a psychiatric evaluation in a Boston clinic. When asked of a Latino patient, however, the answer…
At no time have I felt more vital than in serving at Partners In Health (PIH), and seldom more needed than in places like Haiti. In the Haitian people, as well as in every other country that PIH serves, we find an…
A waiting room in a charity clinic in rural Haiti. It is a humid afternoon, and huge drops of warm rain are starting to fall. A young woman is watching as her ten-year-old son, Dominique, clutches…