Global Health: Making a Difference Robert Malkin Director, Global Public Service Academies
Global Health: Making a Difference Robert Malkin Director, Global Public Service Academies.
Mar 29, 2015
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Global Health: Making a Difference
Robert MalkinDirector, Global Public Service Academies
Instructions
During our call
• To mute #5
• To unmute press #5 again
• Press #0 for technical assistance
First:
What is Global Health?
$29 billion
Global Health
$29 billion
$31 billion
Global Health
$29 billion
$31 billion
Global Health
What are they all talking about?
What is Global Health?
What is global?
Dry, ice and green on earth
What is Global?
Earth at Night
What is Global?
Population Density
(Millions per square mile)
% Without safe water
What is Global Health?
What is Global Health?
% Stunting
What is Global Health?
% HIV Positive
What is Global Health?
Life Expectancy
What is Global Health?
UN Human Development Index Low Human Development (least, third)
High Human Development (most, first)
Medium Human Development
So, what can we
do?
Conclusion:Send $$
Least Most Developed Nations
Not so fast!
Not so fast!
Conclusion:Send Equipment
Just Sending Money Won’t Work
Savannah Carson, EWH volunteer with new friends in Tanzania
CorruptionBrain DrainInfrastructure
80%of hospital equipment in least developed nations
is donated
WHO Guidelines for Medical Equipment DonationsWHO Essential Health Care Technology: http://www.who.int/medical_devices/en/index.html
At the end of the day, this girl was waiting
My Experience at Kissy Eye Clinic
Freetown,Sierra Leone
Arrival with cataract surgeon
Where Sierra Leone?
UN Human Development Index Low Human Development (least, third)
High Human Development (most, first)
Medium Human Development
Sierra Leone
Sierra Leone
• Life Expectancy - 38 years
• Safe Drinking Water - 54%
• Infant Mortality - 170/1000
• Under Five Mortality - 286/1000
Ingrid
BB
Adolfo
Cindy
Something Was Wrong
•It was late at night•Cataract patients waiting•Phaco and XYZ = 20 minutes
Got to Work
•In 30 minutes•Fixed the XYZ•All Patients Treated
Training Paul to work on XYZ Scope
Needed •Spare parts•Tools•Knowledge
70%of all donated medical equipment does not work*+
Hypotheses
Spare Parts
Consumables
Too Complicated
*WHO Guidelines for Medical Equipment Donations+ Malkin, Annual Review of Biomedical Engineering, 2007
O2 sensorNeeds replacement
Tracy Lipps with donated Siemens VentilatorsWorked for 4 months, then stopped
Jinotepe, Nicaragua
Sidelined due to consumables
Electrodes
Sensors
Test strips
Reaction Cartridges
Blood Pressure Cuffs
Printing Paper
Sterilization Check strips
IV Pump Cartridges
Reagent Packs
Bovie Pens
Tubing
Canulae Consumables
Malignant neoplasm, % of population
Inappropriate Donations
Leading Causes of Mortality
WHO data 2003 (COPD= chronic obstructive pulmonary disease)
Most Developed Nations Least Developed Nations
Leading Causes of Morbidity(loss of quality of life - DALY)
5 Most Developed Nations % DALY loss
5 Least Developed Nations % DALY loss
1 Malignant neoplasms 16 1 Lower respiratory infections 142 Unipolar depressive disorders 9 2 Malaria 83 Ischaemic heart disease 7 3 HIV/AIDS 84 COPD 4 4 Diarrhoeal diseases 8
All Causes of MorbidityAll SignificantCauses of Morbidity 5 Most Developed Nations 5 Least Developed Nations
1 Lower respiratory infections 0.9 14.12 Malaria 0.0 8.43 HIV/AIDS 0.2 8.34 Diarrhoeal diseases 0.2 8.15 Birth asphyxia and birth trauma 0.4 3.66 Maternal conditions 0.4 3.57 Nutritional deficiencies 0.7 3.48 Perinatal Low birth weight 0.3 3.29 Other unintentional injuries 1.8 2.8
10 Measles 0.0 2.611 Road traffic accidents 1.9 2.212 Tuberculosis 0.0 2.0
13 Malignant neoplasms 15.9 1.014 Unipolar depressive disorders 9.2 0.915 Ischaemic heart disease 7.1 0.716 Chronic obstructive pulmonary disease 4.5 0.217 Cerebrovascular disease 4.3 0.818 Alzheimer and other dementias 4.1 0.119 Alcohol use disorders 4.0 0.120 Hearing loss, adult onset 3.6 0.421 Osteoarthritis 2.4 0.222 Diabetes mellitus 2.2 0.223 Self-inflicted injuries 2.1 0.2
Significant (>=2%)Insignificant (<=1%)
% of Total DALY's
What is Everyone Talking About?• Global Health ≠ us
– archetype = Africa
• Sending money is NOT the answer– Only medium human development
• Sending equipment is NOT the answer– Consumables– Lack of trained staff– Spare parts
• Our equipment is NOT appropriate– Solves the wrong problems– There is no silver bullet
What are we doing?Duke-EWH Summer InstituteGlobal Public Service Academies (GPSA)Duke Research: Capacity Building Duke CUREs
What can you do?
Duke-EWHSummer Institute
56 Participants in 2009
1 Month Training in Costa Rica/Tanzania
1 Month in a poor HospitalNicaragua, Honduras, Tanzania
www.ewh.org
Analysis FailuresRepairing Equipment
29% Spare Parts for the Power Supply
InventoryWhat do they have?
Training24% training including user error and installation
Identifying Technical Needs“The Long Interview”
Health Impact
• 2003-2009: >2000 pieces into service
• >$4 million worth
Trip Profile: Stephanie Patnode University of Southern California, UC Berkeley“I’d go back tomorrow. I … for once, felt like an engineer.”
Training100’s Global Engineers
Students Making a Difference
www.gpsa.us
Academic Summer Programs for High School Students
Global Public Service Academies
Students Making a Difference
• High School Students•Sophomores/Juniors•Interested in health careers
• 4 weeks in a developing world clinic/hospital•Mornings in training
•educational collaborator MIT, FLGCU•language
Pediatric WardJacmel, Haiti
Students Making a Difference
Afternoons working in the clinic•Health Screening (vision, BP, temperature, weight, etc)•Shadowing physicians, pharmacists, nurses•Traditional volunteer roles•Research with MIT faculty, undergrads, grads•Needs Finding – Disabilities FGCU faculty, undergrads
www.gpsa.us
Students Making a Difference
•Expecting it to be very competitive•Will cost, scholarships available•Applications available Oct 1 @www.gpsa.us
•First summer in 2010
www.gpsa.usMen’s Ward, Sierra Leone
A few pictures fromCalhuitz, Guatemala
What can you do?Design for the Developing World
• Web Site: www.ewh.org/youth• Lists about 20 Identified Needs• Anyone can design solutions
– EWH will pay for prototyping– May enter distribution system
High School, Middle School, Clubs, EWH Chaptersand individuals purchase kits and build equipment
High School in Nashville
Science Club In Memphis
Summer Camp in Durham
LA Tech
Kits available
Sudan
Nicaragua
• >1000 pieces delivered• >$1 Million (replacement value)
El Salvador
Philippines Indonesia
EWH Chapters
Cambridge and Oxford, England, … and others
EWH Chapters•Meet Weekly or Bi-Weekly•10-15 Students per meeting
Chapter guidelines available from [email protected]
UNC/NC State/Duke EWH Chapters building phototherapy devices
Congressman Price, the Mayor of Durham, Chuck Messer
Duke/EWH: Succeeds Through Generous
Support of our Partners
Duke UniversityHamilton RoddisFOUNDATION
Gift of Life
Leonard M. Foundation
You Have Unique RoleYou must make that Role a Reality
www.gpsa.us
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