Archive for the ‘international’ Category

Patients With Passports

May23

Four years ago, Maggi Ann Grace’s partner, a building contractor, learned that he had a defective heart valve. The uninsured 50-something American did not have $200,000 for heart surgery, but the state medical system, with its strange logic, would let him deteriorate before it did anything for him. Grace’s son, a medical student, told them of quality healthcare facilities in India.

Soon, the proactive North Carolina couple were at the Escorts Heart Institute in New Delhi. A team of doctors performed pre-op tests and then surgery-initially to repair the mitral valve, and then, when that didn’t work, replaced it. The fee for the successful surgery as well as the postoperative care and stay was less than $10,000. The hospital staff won the couple’s hearts with the quality of care they provided over an entire month.

Grace, author of State of the Heart: A Medical Tourist’s True Story of Lifesaving Surgery in India spoke of her experience at the Harvard Medical School’s Division of Medical Ethics last Wednesday. She was on a four-member panel to discuss medical tourism, the emerging trend of flying to developing countries for health care. While such travel is not a new phenomenon, its scope is new. Last year, some 150,000 Americans went abroad to receive medical care at a fraction of the cost they would have paid at home.

Global health care advocates say that services in at least 15 countries are equal or better to those offered in the United States. Josef Woodman, author of Patients Beyond Borders: Everybody’s Guide to Affordable, World-Class Medical Tourism, said that these countries are not just in Asia, but in South America as well. Health travel organizations now link U.S. patients with out-of-country providers; the practice is a major revenue-earner for some developing countries.

“Call me ill-informed, call me a snob, but I did not really think that the quality of medical care in developing countries could be equal to what’s offered here in the United States,” said David Boucher, Assistant Vice President of Blue Cross Blue Shield South Carolina. He seemed to echo the sentiments of some in the audience, but fortunately Boucher had the opportunity to revise his opinion. After he traveled to verify the global healthcare researchers’ assertions, he became managing director of Companion Global Healthcare, a company that helps patients get treatment overseas.

But while medical tourism brings down health care costs for middle-class patients, who have the means to consider such an option, it does little for those at the very bottom of the system. More importantly, by skimming off the middle layer, medical tourism could take away some of the pressure that must be brought to bear on a morally bankrupt health care system, which an audience member said, is not above leaving its sick uncared for.

Indeed, medical tourism is rife with ethical questions. Harvard Law School Assistant Professor Glenn Cohen brought up some of these issues. This trend, for instance, could affect the quality of care offered to the poor in developing countries because the best physicians may end up catering exclusively to well-heeled foreign clientele. In certain countries, the medical “brain drain” could be exacerbated as U.S-trained physicians from the richer developing nations like India and Malaysia choose to go back home.

The panel raised a number of questions: Is it ethically appropriate for American insurance companies to provide international health care options and incentives to their customers? What are health care providers’ and insurers’ obligations to patients when they return to the United States and need follow-up care? How do American patients reconcile with the “so, sue me,” attitude of hospitals abroad when things do go wrong?

For me, a foreign national from the Third World, another question was foremost. How do we ensure that America doesn’t end up exporting its mucked-up medical system to these nations that now offer quality healthcare at affordable prices to a sizeable part of their population? In an era of globalization, we have to answer these questions collectively. Refreshingly, we are addressing the vital issue before the juggernaut of healthcare economics relegates all ethical considerations to the wayside.

Story by Vijaysree Venkatraman.

Posted by Joseph, under international  |  Date: May 23, 2008
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Harvard Students Win Grant to Light up Africa

May19

Team Lebônê

David Sengeh (Sierre Leone), Hugo Van Vuuren (South Africa), and Stephen Lwendo (Tanzania) of Lebônê Solutions,

When Harvard Professor David Edwards assigned students in his “Idea Translation” course the task of designing an attractive light display for the London Olympics, one group opted to light Africa instead.

With Dr. Edwards’ encouragement, the students looked for ways to address the need for low-cost energy in Africa. Nearly three-quarters of the continent is without electricity, so they needed a device that could be easily available and cheap. They found the answer down the street in the lab of Harvard biologist Peter Girguis. He developed microbial fuel cells, which harvest energy released by microbes as they break down food. The students proposed that the clean and cheap technology could be applied to African soil.

“Essentially all you do is dig a hole, layer an anode, some soil, sand and a cathode — and connect the anode and cathode to a circuit board to charge a battery that can power an LED light, run a radio or charge a mobile phone,” said Hugo Van Vuuren, a recent Harvard graduate, in an interview with allAfrica.com.

Nine months later, the students were on their way to the capital of Ghana to present their idea in the World Bank Group Development Marketplace Competition. What started as an undergraduate student mid-term presentation was selected from 52 finalists as one of 16 winners to receive $200,000 in grant money earlier this month. The group is now a social enterprise that goes by the name Lebônê Solutions, Inc., which means “light stick” in Northen Sotho, a language spoken in South Africa.

According to Van Vuuren, the concept is already tested and works. Over the summer, members of the Lebônê team will travel to Tanzania to run field tests. If successful, they will bring the technology to entrepreneurs in Namibia for local distribution.

“It will be interesting to see how this works scientifically and culturally,” says Van Vuuren. “Scientifically, we want to use materials already in Africa, such as graphite, chicken wire or whatever else is freely available. Culturally, we want to test how people use the devices, adapt to the technology and benefit from the harvested energy.”

Van Vuuren is one of four students in the group from Africa, and as a recent economics graduate, he recognizes the value of innovation.

“As Africans privileged to study in Cambridge, we feel very fortunate for the opportunity to use technology to potentially affect society, culture, and local socio-economic circumstances,” says Van Vuuren. “We are grateful for the support of Harvard, our professors, and of course the World Bank. It is not often that students get to work on a project that might one day change conditions back home in Africa.”

For more information, visit the Lebônê Solutions, Inc. Website.

Posted by Joseph, under international  |  Date: May 19, 2008
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Lecture Notes: South Africa and HIV

Feb06

Every Wednesday, Boston University’s School of Public Health hosts the Public Health Forum, an opportunity for students, staff and members of the community to hear the latest research straight from scientists. Today’s forum brought Dr. Francois Venter, a South African clinician and leader in HIV/AIDS treatment. His talk titled, “South Africa & HIV: Crisis – What Crisis?” focused on the failures of prevention and politics to contain the epidemic in his country. Venter, (No relation to artificial-genome synthesizer Craig), described the current state of HIV treatment as depressing. Scientists are feeling defeated as rates of new infections increase worldwide and trials for vaccines, microbicides and diaphragms fail.

In South Africa, which holds 5 million people living with HIV in its borders, the most of any country, the numbers are rising despite increased condom use and widespread education campaigns.New data reveals up to 91% of new infections in Uganda and South Africa are not the prostitutes or drug users normally associated with HIV, but married women and widows. Dr. Venter doesn’t know why this is the case, but it is clear we don’t understand the transmission dynamics or sexual behaviors. He describes South African culture as very conservative compared to bare-it-all America. The majority of the country’s population is Catholic so no one claims to be homosexual and married couples say they are faithful. This image does not support the data, however, and research to find out more on how HIV is being transmitted in South Africa may be prevented by social acceptability.

Once people are infected, doctors in South Africa are facing what Dr. Venter calls “The Treatment Gap,” thanks in part to their health minister. She needed to be in the hospital and unable to work before they could pass a 5 year plan that would improve the number of drugs reaching pregnant women, nurses and adult patients.

What’s even more shocking is the bureaucracy is being difficult when it is projected 1 in 2 South Africans will be HIV+ within a decade, the projected number of AIDS orphans will reach 2 million and 1 million of its citizens have AIDS with only 20% receiving treatment. Despite South Africa’s status as a middle income country, life expectancy there will soon drop to 50.

“We will never treat our way out of this epidemic – but we need to treat,” said Dr. Venter. What he suggests for now is providing access to drugs and testing to people in South Africa, which unfortunately, requires a restructuring of the health system. Although the media tries to hype the good news about HIV/AIDS, the reality is, things could be better.

Posted by Joseph, under international, lecture notes  |  Date: February 6, 2008
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