Unite for Sight Conference 2007
April 14th and 15th, two members of our organization flew out to Palo Alto, CA to attend Unite for Sight’s 4th Annual International Health Conference. There were over 300 speakers and 1,500 attendees for a full weekend of learning, brainstorming and networking. The following is a brief synopsis of all of the sessions that we attended over the weekend. A full list of speakers and the titles of their presentations can be found here.
Saturday
Technology and Telemedicine
- Paul Weiss, Stanford Pediatrician, on Health and Governance
Dr. Weiss reviewed the evolution of global health solutions from technical goals, such as GOBI (growth monitoring, oral rehydration, breastfeeding, and immunization), to a human rights approach. Stanford’s Initiative on Health and Governance, in particular, examines the relationship between democratization and health. The 3×5 initiative by the World Health Organization which had the intention of treating 3 million people affected by HIV before 2005. While only half of the goal was attained, the shortfall was not due to funding but a lack of infrastructure and relationships with governments.
- Sonesh Surana – UC Berkeley - “Developing a Low Cost, Long Distance WiFi-based Teleophthalmology Network in Rural India: The Aravind Experience” - sonesh(at)cs(dot)berkeley(dot)edu
15 million people in India are blind, with over 70% of which is preventable. The Aravind Experience hopes to treat those in the rural areas primarily by ad hoc eye camps and permanent vision centers. An average of 327 patients are treated per eye camp, and for 2005, 1,335 camps were set up. One drawback to this approach is that there is no increase in the utilization of the staff doctors, and advertising is limited to the word of mouth for each particular day. On the other hand, vision centers are a permanent residence for local nurses and trained staff to examine eye conditions in the area, with the remote aid of specialists in the main hospital. The problem: high resolution images of eye exams needed to be transmitted to the hospital. CorDECT, a local wireless loop was originally investigated as a solution, but found to be too expensive. Instead, directed WiFi was used at a cost of $600-$800 per link and $2,000 per tower. For areas with limited bandwidth, a tiered system of use and functionality regarding the transfer of images was implemented. With an average of 1868 patients per month at these centers, this was found to be a sustainable solution to reaching rural areas with opthalmologic care.
-Sanjeev Arora – University of New Mexico - “Project ECHO: Using “Knowledge Networks” For Complex Disease Care to Under Served Populations” - Sarora(at)salud(dot)unm(dot)edu
Less than 5% of 32,000 diagnosed cases of hepatitis C are treated within New Mexico, even though reporting and treatment is required by the government. This is because primary care doctors have the opinion that weekly interferon injections and a drug regime with the effects of mild chemotherapy are too advanced for their skill set. The ECHO project set up primary physicians with specialists at the University of New Mexico to co-manage patients with HCV. They used Pareto’s principle and estimated that this approach could be used for the 10-15 most common diseases in any particular area. Eventually primary care doctors became competent enough to be the destination for referrals in their immediate region. In India, Infosys technologies is duplicating this project requiring only a web browser.
-Eliott Grigg – George Washington University - “RICE: Remote Interaction, Consultation, and Epidemiology – A New Use For Cell”
Medical projects are most effective when they are developed to be self-contained and sustainable within a particular country. All too often, organizations will drop off advanced technologies without developing a framework to support it. For example, a hospital may have the capability to perform CT scans, but do not have the dyes necessary, paper to print on, or the ability to store digital images for future visits. For many developing countries, there is a huge gap in the literature base to be drawn from. This was a $50k grant funded by Microsoft to create a platform for which to share charts, consult specialists, and track the progress of epidemics all through existing cell phone networks within Vietnam. Once on the ground, the project evolved to become a web-based system, rather than a platform on the phone. Bringing such technology to the rural areas could lead to a large amount of information from which data could be mined. A sustainable business model for the implementation of such technology is currently being investigated.
Public Health in the 21st Century
- Susan Blumenthal – Former US Assistant Surgeon General - “Critical Health Issues in the 21st Century”
Since the 1960’s when the fight against infectious diseases was declared to be won, the state of public health systems has deteriorated, as was illustrated by the anthrax and avian influenza scares. Now we are facing “double jeopardy” in having to deal with both chronic and infectious diseases. Globalization, urbanization, and zoonoses are changing the landscape of public health initiatives, and while prevention efforts could minimize the impact of many of these forces, they only make up 3-5% of expenditures.
-David Heymann - Former Executive Director for Communicable Diseases, WHO - “Challenges in Public Health: From Smallpox and Polio Eradication to SARS and Avian Influenza”
One of the main problems in efforts to eradicate smallpox was access to the vaccine. Thankfully, efforts to eradicate smallpox were successful just in the nick of time. Only after the fact was it found that the smallpox vaccine would not have been able to be used in those infected with the HIV virus. Polio eradication efforts mainly face the problem of seeking out asymptomatic cases in the population, and over $5 billion has been spent by Rotary, UNICEF, CDC and the WHO.
Brain Drain and Restricted Access to Resources
-Tom Hall - UCSF - “Globalization and the Health Workforce: Historical Perspectives, Future Challenges”
Health workers are the most expensive component of the healthcare system and human resource changes take decades to influence. The Joint Learning Initiative was created to address the problem of brain drain particularly in the high-end workforce. Rural regions, which generally required the largest breadth of knowledge, are sent the least qualified doctors. Additionally, approximately 1 of 5 doctors in developing nations are being exported to industrialized nations.
-Gavin Yamey - Senior Editor PLoS Medicine - “Restricted Access to the Medical Literature: A Global Health Crisis” - gyamey(at)plos(dot)org
Restricted access to medical literature is a huge impediment to treatment and surveillance of populations in low-income nations. This was recognized as early as 1969 in a report by the United Nations. Since journals cater to the interests of their readership, articles that concern developing nations are less likely to appear western journals and therefore have active areas of research. PLoS Neglected Tropical Diseases hopes to change all that with a journal that caters to the needs of those in low and middle income countries.
Social Entrepreneurship:Correcting Market Failures
- The speaker for this session did not show, but a few members of the audience discussed a few different types of products that are liable to fail in the marketplace, namely last-line antibiotics, vaccines, and generics. Solutions ranged from shared payoffs for collaborative efforts for R&D investments and the Global Alliance for Vaccines and Immunization price system.
The Health of Refugees and Communities in Africa
- Kathryn Azevedo - ATRIC - “Community Based Rehabilitation: Setting the Foundations for Peacebuilding”
Dr. Azevedo spoke of her personal experiences in South America, and the importance of teaching lay people in areas with violence to rehabilitate others in the community.
- Cornelius Pratt - Temple University - “Mobilizing War-Torn African Communities to Improve Public Health”
Dr. Pratt explained how the mobilization model for public health is a process, rather than an event, that transforms communities and builds positive interaction between warring groups. Conflicts are commonplace in Africa, historically have been underreported in the media, and face extraordinary human resource problems. Public health initiatives should not only be concerned with clinical outcomes, but should also consider ways to reduce fear and improve security for health workers. Unfortunately, many times bureaucracy weighs down the effectiveness of many of these initiatives.
Sunday
Engaging Universities, Students, and Communities in International Health
- Robert David Siegel - Stanford - “Engaging Students in International Health: A Case Study”
Robert emphasized the importance of students relating to needs when working in the international health field.
- Thomas Novotny - UCSF - “Innovations in Global Health Education”
Tom highlighted how educational systems should seek to encourage students who are motivated to student international health, rather than beating their original passion out of them by the educational process.
- Seth Wanye - Unite for Sight Ophthalmologist - “The Role of Student Volunteerism to Eliminate Blindness in Ghana”
Dr. Wanye talked about his experiences as an ophthalmologist in Ghana and the dire need for student volunteers in an area where he is the only opthalmologist available to care for over 2 million people. Here is a video of one of the panels he participated in.
- David Tozer - Child Family Health International - “Changing Latitudes and Attitudes: Measuring the Impact of Global Health Immersion”
Mr. Tozer spoke on particular projects that Child Family Health International is working on.
Social Activism and Creating Change Through Nonprofit Organizations
- Anne Firth Murray - Founding President of the Global Fund for Women - “Social Activism: An Informal Discussion About Creating Change Through NonProfit Organizations”
Anne Murray led a stimulating discussion on the creation and new trends in Nonprofits. Anyone looking in to creating a nonprofit themselves should pick up a copy of Paradigm Found, which relates her experiences in creating the Global Fund for Women. She also stressed the importance of collaboration among NGOs, and the plans for a Center for Service which would facilitate communication between NGOs. Another resource mentioned was the Tides Center which focuses mainly on social work.
Sustainable Disease Control Strategies in the Developing World
- Brian Blackburn - Stanford - “Insecticide-Treated Bednets in Mass Disease Control and Elimination Campaigns”
Mr. Blackburn spoke on the community effects of delivering insecticide treated bednets to certain locales. The community effect is theorized to be due to lower vector density or less parasitic hosts for insects to feed upon.
- Sam Abbenyi - Director of Program Planning and Analysis for the International Trachoma Initiative - “Logistics of Mass Drug Administration, The Case of Azithromycin For Trachoma Control”
Mr. Abbenyi discussed the SAFE method and the Logistics Management Information System as they pertain to the control of trachoma.
Health As A Human Right
- Daniel Bausch - Tulane - “Infectious Disease and Human Rights: Making Research Matter” - Doctors for Global Health
Talked about the Mano River Union Lassa Fever Network and the problem of getting important diagnostic blood work done in a timely manner.
- Kari Stoever - Global Network for Neglected Tropical Disease Control - “The Neglected Tropical Diseases: New Promise for Their Control”
Inspiring presentation on the importance of combating Neglected Tropical Diseases. While there are many pharmaceutical donations, there is an inadequate amount of funding and general awareness of these issues to meet important goals.
-Satyajit Sinha - Opthamologist for the AB Eye Institute - “Continental Diversities in Community Ophthalmology”
Dr. Sinha compared and contrasted his experiences in impoverished communities in South America and India.
Entrepreneurial Social Innovation
-Zachary Kaufman - Yale University - “Atrocities and Social Entrepreneurship” - zachary(dot)kaufman(at)aya(dot)yale(dot)edu
Talked about inefficiencies inherent in NGOs that are based upon traditional hierarchal business systems, and how the success of NGOs is typically built on personal connections.
- Lorena Guille-Laris - Cinepolis - “A Company’s Vision for Social Responsibility: The Case of Cinepolis in Mexico”
Discussed how Cinepolis has made social responsibility a priority in its business structure, by holding eye clinics for rural Mexican communities.
