How to reach people in remote places-COVID-19
Social media, newspapers, and various communication channels have us covered with data about COVID — 19, but what happens with those people living in remote places? What about those who don’t have access to information or health care? To answer these questions, some MIT-HMS Alumni discuss possible solutions.
One of the lessons that I liked the most in the Bootcamp was creativity and problem solving using binary numbers. In my creativity exercise, I found that an old fashion solution may be recording educational videos on CD, DVD or pen drive, talking about how to protect yourself from the pandemic. Create a communication bridge with community leaders and facilitate the information, and medical equipment through them. Other possible solutions are an ambulant hospital, and communications stations to establish a connection between doctors and patients.
In Puerto Rico, local newspapers reach the most remote places in the country so we try to maintain a presence through the media with educational articles. Many health professionals maintain a presence through television and radio where they educate about steps to stay safe.
On the other hand, the most important lesson is to understand the problem. How it happens, who is around, whom it affects, who is the victim, and what side effects and collateral damage has. (Joel Acevedo)
As a clinician in private practice, I want to continue to provide care for my patients, but minimize the risk of acquiring the COVID-19 infection. We have seen countries like Italy, with a distinguished health care system, having health care workers make up approximately 9–10% of the total amount of COVID-19 cases. In other countries such as Spain, 13–14% of the health care workers have been infected. In the USA it is estimated that approximately 5400 health care workers have acquired the COVID-19, with 65 cases in Puerto Rico being reported among healthcare workers.
Healthcare workers falling ill with the virus puts additional unnecessary pressure on already short-staffed health care systems. Many countries are bringing back health care providers from retirement to meet the increased demand.
We must become more aware of how to minimize the spread of the virus among healthcare workers. Every government and the health care system should provide the necessary personal protective equipment (PPE) to defend their front line, healthcare workers. If PPE is not readily accessible because of excessive demand, limited availability or high prices, then health care organizations should consider partnering with different companies to strategize the manufacturing of PPE equipment in a quick and affordable method. Also, testing should be readily available to health care providers even if they don’t present the typical symptoms to prevent asymptomatic carriers from transmitting the disease to coworkers and patients.
Other measures that can be considered by doctors to curb the propagation of the disease is to offer telemedicine consults. These remote consults can be done for various health care illnesses. This will minimize the unnecessary exposure of patients to other people who could be transmitting the disease. It also allows doctors to limit their office appointments to the truly urgent visit. The Center for Medicare and Medicaid Services has expanded telehealth provisions under the Coronavirus Preparedness and Response Supplement Appropriations Act which will allow providers to use a multitude of audio/video modalities including those that are not HIPAA compliant such as apps like Facebook messenger, Skype, and Google Hangouts. If there is one thing that this pandemic has shown us, it’s that at this moment it is critical that patients receive the right medical information through any available channel. Patients and doctors are learning that medical care can continue to be provided even if medical offices are closed.
I am hopeful we can come up with other creative measures to help us continue providing medical care while reducing the risk of infection. If you have any thoughts please feel free to share with us in this discussion. (Amogh Sahai)
On a practical note, I believe isolation (region-wide in this case) is the answer to many of the questions we are raising these days. As evangelized by design thinking, the involvement of those affected in the solution process is key to producing a quality solution. Insights into their lifestyles will be key to developing strategies to reach out and ensure they have the resources needed; we need to understand their regular means of acquiring knowledge and medical care. If community leaders are currently providing these, they may be the best avenue through which to act — however they may become super-spreaders, which would be catastrophic. Also, these individuals may not logistically be able to keep up with all the information needed.
From an optimistic perspective, there could be enough resources (communication technology to ensure they are aware, sanitary equipment to help them mitigate risks, and medical equipment to help those affected, etc.) for all. However, I ultimately believe we will not be able to offer the same level of information dissemination and care to those in remote areas and it is therefore absolutely critical that substantial efforts be placed into inhibiting the introduction of cases to these extremely-hard-to-treat areas. (Jacob Lavigne)
I think of this problem in two ways. One is access to accurate and high-quality information on the situation around the world and the best practices to stay protected. The other one is access to a medical professional if there is suspicion of infection or presentation of symptoms. For the first one, I think science communication plays a critical role. We need professionals and students to step in and help educate the general public, and people who do not speak English. In the past few weeks, I have observed an enormous amount of initiatives of this sort. For example, students have created youtube videos interviewing experts who explain the biology of the virus, best practices to minimize infection, and how tests are being conducted. I have also seen professionals creating animations and infographics with clear guidelines on preventative measures. Scientists are turning on the regular media (radio, TV, etc.) to answer questions about the pandemic, and some are creating chatbots that host databases of questions and answers about COVID-19 (examples here and here). Those who speak other languages are also translating messages and news to share with the world. One example is the group led by the New England Complex Systems Institute, which has over 4,500 volunteers around the world and maintains translation of its website and related resources in 17 languages. A second example is the New Voices in Science, Engineering and Medicine chatbot, offering answers in Spanish and Mandarin.
Regarding access to medical care, remote screening and telemedicine are offering potential solutions. These range from web-based and mobile applications that offer self-assessment and symptom checking options, to services that connect potential COVID-19 patients in great need of treatment with healthcare organizations in their local communities, so that they can receive the right attention and treatment based on their condition. Some of these tools also have integrated e-schedules, which is useful when the capacity of human resources and systems are limited, and as a way to avoid crowds of potentially infected patients in waiting rooms if they have to be seen. The rapid growth of the software as a service (SaaS) tools will soon provide the opportunity to integrate medical digital devices with these telehealth solutions, as well as to enable collaboration of a multi-healthcare provider network, allowing all network participants to allocate resources where they are likely to save the most lives. (Patricia Silveyra)
Living in a developing country makes you think about the challenges of getting health information to the communities. Guatemala has a unique characteristic — we have 22 different languages, including Spanish. One of the most accurate strategies to get the information to rural areas and indigenous groups is by using images showing the basic health sanitation measures (eg. using a mask, hand-washing, social distancing, etc). Each village in rural communities has its health community leaders, who are the responsibility of translating health information in their own language. Community radios are a valuable tool because they are used to inform the population in their language.
Even though the lack of internet access will make it difficult to inform the population through social media, it is a good opportunity to disseminate information that could be easy to understand and most importantly, to share with the community.
Technology has given us the opportunity to offer health services in new channels. Telemedicine is one of the newest channels to bring health to patients. Right now it is one of the most useful options because patients don’t have to be in contact with physicians.
Lastly, the use of SMS is one of the most successful methods to inform people, with a delivery of 95% to all the cellphone lines in the country. (Rodrigo Arevalo)
Authors
MIT-HMS Healthcare Innovation Bootcamp Alumni
Jacob Lavigne, Ph.D., Researcher from Canada
Patricia Silveyra, Ph.D., Lung Researcher from Argentina
Rodrigo Arevalo, M.D. from Guatemala
Joel Acevedo, Ph.D., Health Tech Innovator from Puerto Rico
Amogh Sahai, M.D. from Puerto Rico
