Raj Panjabi was nine years old when his family fled the Libyan civil war. Nearly three decades later, Harvard University’s medical professor strives to improve access to health care in his home and other developing countries as CEO and founder of the NGO. Last Mile Health.
The success of his approach, focused on community health, catapulted him to the list of the most influential 100 people in the world, according to the magazine Time in 2016. This year, he was a leading physician against the pandemic. Although COVID-19 vaccines are designed to end the tunnel, they can take years to reach millions of vulnerable people around the world.
Question: How does coronavirus affect rural communities in low- and middle-income countries?
Answer: Rural communities have already faced such challenges. If we look at every pandemic in human history, we know that the poor and marginalized are the last to have access to laboratory tests, treatments and vaccines. This has been the history of every pandemic historically. And, unfortunately, the Covid-19 pandemic strengthens a viral apartheid, in which only the rich have access to the right services and treatments. For example, access to Test it is lower in rural areas than in cities. Treatment is delayed because oxygen therapy or dexamethasone are not available. Also, rural areas are the last to receive some of the new drugs.
Raj Panjabi, professor of medicine at Harvard.
In terms of vaccinations, the experience of previous campaigns shows that poor and rural areas are the last to receive them.
Regarding vaccines, the experience of previous immunization campaigns shows that poor and rural areas are the last to receive them. From current information on global immunization, we know that 13 million children under the age of one do not receive a single dose of vaccine. We are talking about measles, polio and other vaccines that are already known and used, but which are not accessible in remote rural areas and sometimes in urban areas where the limitation is not geographical, but poverty and lack of health services. Health. I think that, however, the communities are not well prepared at the moment.
P: He notes that some rural communities have already faced similar challenges to covid-19. What lessons do these experiences teach?
A: One of the keys is the incorporation of community health workers and the coordination of their action with teams of doctors and nurses. Countries that bet on community health before the pandemic are relatively better today. A good example is Liberia, where it was founded Last Mile Health.
Years ago, I had Ebola epidemic which caused a lot of pain and suffering in our country. About 11,000 people lost their lives in the region and almost 30,000 were infected. But it could have been much worse.
At one point, it was predicted that one million people could be infected, half or more of whom could die. So when Ebola broke out in humanity and Liberia, the role that community health workers played was enormous. They were the ones who, in a team with nurses, examined the patients.
In one district, we examined 10,000 people; only 42 door-to-door workers paid attention to the symptoms. The same workers also tracked contacts and connected patients with health system services. The same workers, who serve about 80% of Liberia’s rural population, are now being trained to identify coronavirus cases and identify contacts to ensure that the health system does not collapse completely.
P: You insist a lot on the importance community health, with community workers proactively addressing families in low-income countries. Do you think that this model deserves to be consolidated in high-income countries, such as Spain?
A: I think so. For example, in Brazil, community health workers have helped with chronic diseases that affect many rich countries and rich areas in poor countries, such as hypertension and diabetes; diseases that end up causing heart attacks or strokes that severely disable patients and even lead to death. In fact, the Brazilian family health program has contributed to a 15-20% reduction in mortality from heart attacks and heart attacks. We could achieve similar results in rich countries, but we did not dedicate the necessary resources. For example, the Bureau of Labor Statistics reports that here in the United States, there are only 56,000 health workers in the community. We need at least 300,000. Sometimes people think that the cost of labor for health care is an expense, not an investment.
Raj Panjabi, professor of medicine at Harvard.
Half of the world’s population, 3.7 billion people, do not have access to essential health services. Within this group, the worst are the one billion who live in the most remote communities.
P: Beyond the covid-19 pandemic, what do you think are the challenges for access to universal health care worldwide, including in rural areas?
A: As long as there is a patient who is not at hand, it means that we have not done enough. Unfortunately, there are many patients who are out of reach. For me, this is the biggest problem that, in addition to the fact that they are generally neglected, the information we have about him is insufficient.
We often talk about the lack of care for specific diseases. People do not have enough access to treatment for HIV, tuberculosis, high blood pressure, safe births … But if you cut all these diseases and wonder which population is most at risk of acquiring them and not receiving medical care, we will find rural populations and removed in the forehead.
Half of the world’s population, 3.7 billion people, do not have access to essential health services. Within this group, the worst are the one billion who live in the most remote communities. So let’s build a primary health care system that is available to every child and every family.
P: How can technology, including artificial intelligence and telemedicine, help increase access to health services in poor social settings?
A: Building a robust health system requires four pillars: staff; medical supplies and medicines; a space for service delivery and, finally, technology.
When we watch shows around the world, the most successful invest in these four areas. Technology can improve training with virtual tools, help with diagnosis, improve follow-up and facilitate access to health services, as is the case with telemedicine. However, there is a painful paradox: there are many places in the world where technology can make a big difference, such as in rural areas, but there is no infrastructure to take advantage of technology. Therefore, among other things, we need better infrastructure models that reduce energy demand.
On artificial intelligence (AI): I think there’s a lot of hype around it. But for a community health worker who has to diagnose 20 different pathologies, AI is only relevant when one of these 20 things is very rare and AI can identify it. If not, it is not so relevant.
In my opinion, you should start by guaranteeing the technological infrastructure, taking advantage of telemedicine and providing teleeducation. AI only makes sense if you accompany the other areas of health care technology.
P: Beyond technology, do you think primary care and community health should include mental health?
A: It certainly seems crucial to me. One of the studies I did in Liberia was after the civil war that lasted 15 years and caused a lot of trauma. We studied 1,600 households in 2008 with the Government of Liberia. Between 40 and 44% of the adult population had symptoms that were classified as severe depression or post-traumatic stress.
It is inconceivable that community health can ignore a problem of this magnitude. Community health is underfunded. Because the mental health of the community also.