Global Health: Making a Difference

1. Global Health: Making a Difference Robert Malkin Director, Global Public Service Academies

2. Instructions During our call • To mute #5 • To unmute press #5 again • Press #0 for technical assistance

3. First:What is Global Health?

4. Global Health $29 billion

5. Global Health $29 billion $31 billion

6. Global Health $29 billion $31 billion

7. What are they all talking about?What is Global Health?

8. What is global? Dry, ice and green on earth

9. What is Global? Earth at Night

10. What is Global? (Millions per square mile) Population Density

11. What is Global Health? % Without safe water

12. What is Global Health? % Stunting

13. What is Global Health? % HIV Positive

14. What is Global Health? Life Expectancy

15. Medium Human Development High Human Development (most, first) What is Global Health? Low Human Development (least, third) UN Human Development Index

16. Most Developed Nations Least So, what can we do? Conclusion: Send $$

17. Not so fast!

18. Not so fast!

19. Just Sending Money Won’t Work Conclusion: Send Equipment Corruption Brain Drain Infrastructure Savannah Carson, EWH volunteer with new friends in Tanzania

20. of hospital equipment in least developed nations is donated 80% WHO Guidelines for Medical Equipment Donations WHO Essential Health Care Technology: http://www.who.int/medical_devices/en/index.html

21. My Experience at Kissy Eye ClinicFreetown,Sierra Leone Arrival with cataract surgeon At the end of the day, this girl was waiting

22. Medium Human Development High Human Development (most, first) Where Sierra Leone? Sierra Leone Low Human Development (least, third) UN Human Development Index

23. Sierra Leone • Life Expectancy - 38 years • Safe Drinking Water - 54% • Infant Mortality - 170/1000 • Under Five Mortality - 286/1000 Ingrid BB Cindy Adolfo

24. Something Was Wrong • It was late at night • Cataract patients waiting • Phaco and XYZ = 20 minutes

25. Got to Work • In 30 minutes • Fixed the XYZ • All Patients Treated • Needed • Spare parts • Tools • Knowledge Training Paul to work on XYZ Scope

26. of all donated medical equipment does not work*+ Hypotheses Spare Parts Consumables Too Complicated 70% *WHO Guidelines for Medical Equipment Donations + Malkin, Annual Review of Biomedical Engineering, 2007

27. O2 sensor Needs replacement Tracy Lipps with donated Siemens Ventilators Worked for 4 months, then stopped

28. Jinotepe, Nicaragua Sidelined due to consumables

29. Electrodes Sensors Test strips Reaction Cartridges Blood Pressure Cuffs Printing Paper Sterilization Check strips IV Pump Cartridges Reagent Packs Bovie Pens Tubing Canulae Consumables

30. Malignant neoplasm, % of population Inappropriate Donations

31. Leading Causes of Mortality Most Developed Nations Least Developed Nations WHO data 2003 (COPD= chronic obstructive pulmonary disease)

32. Leading Causes of Morbidity(loss of quality of life - DALY)

33. All Causes of Morbidity

34. 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

35. What are we doing? • Duke-EWH Summer Institute • Global Public Service Academies (GPSA) • Duke Research: Capacity Building • Duke CUREs What can you do?

36. Duke-EWHSummer Institute www.ewh.org 56 Participants in 2009 1 Month Training in Costa Rica/Tanzania 1 Month in a poor Hospital Nicaragua, Honduras, Tanzania

37. Analysis Failures Repairing Equipment 29% Spare Parts for the Power Supply

38. InventoryWhat do they have? Training 24% training including user error and installation

39. Identifying Technical Needs“The Long Interview”

40. Health Impact • 2003-2009: >2000 pieces into service • >$4 million worth

41. Training100’s Global Engineers Trip Profile: Stephanie Patnode University of Southern California, UC Berkeley “I’d go back tomorrow. I … for once, felt like an engineer.”

42. Students Making a Difference www.gpsa.us Global Public Service Academies Academic Summer Programs for High School Students

43. Students Making a Difference Pediatric Ward Jacmel, Haiti • 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

44. Students Making a Difference www.gpsa.us • 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

45. Students Making a Difference www.gpsa.us Men’s Ward, Sierra Leone • Expecting it to be very competitive • Will cost, scholarships available • Applications available Oct 1 @www.gpsa.us • First summer in 2010

46. A few pictures fromCalhuitz, Guatemala

50. 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