Health/vision
Visioning for OLPC Health Initiatives
The Importance of OLPC to Health
The OLPC project is an important and innovative initiative in the area of education. In large part this is because the project is so much more than just a new gadget; rather it is grounded in sound philosophy and theory, and presents a vision for a radical transformation of access to education.
OLPC's approach to education is predicated upon three basic tenets (from the Learning Vision page):
- Learning and high-quality education for all is essential to provide a fair, equitable, economically and socially viable society;
- Access to mobile laptops on a sufficient scale provide real benefits for learning and dramatic improvement of education on a national scale;
- So long as computers remain unnecessarily expensive such potential gains remain a privilege for a select few.
Health initiatives must be similarly grounded, and direct analogues to these tenets can be drawn from, and adapted for, the health care field.
Further, health challenges are fundamental barriers to education; one cannot take part in learning or teaching efforts while struggling to have basic needs met, while sick or injured.
The Importance of Health to OLPC
It is also easy to imagine that XOs, even while distributed under the auspices of an educational program, will be used by children and families to tackle whatever problems they may be dealing with in their lives and communities.
This means that whether or not thought is put into it, kids with XOs, and their families, are going to try to use them in the event of a medical calamity or accident.
In the absence of community health infrastructure, this will mean reaching out to whomever they have access, be it peers or educational staff, the Internet at large, fact or fiction, strangers, etc... At the very least, educational staff taking part in a community XO initiative need to consider involving social workers and folks able to provide referral to whatever health resources do exist.
Principles
Our health initiatives must be about how we can support health promotion and public health efforts in resource-poor settings. The model put forward by OLPC suggests that this can be facilitated with ready access to these technologies, coupled with technical and social infrastructure development.
- Good health and high-quality health care for all is essential to provide a fair, equitable, economically and socially viable society.
- Access to mobile laptops on a sufficient scale can provide real benefits for health care, and could dramatically improve the quality and quantity of life for the most underprivileged.
- Health initiatives must value local knowledge and expertise, while making free and ready access to an international wealth of health learning and evidence-based medical knowledge.
- The initiatives, like the rest of the OLPC project, must incorporate a collaborative approach into every aspect of their implementation.
- Children, youth and family members in affected communities must be viewed as potential experts, as self-healers, as self-directed learners, and OLPC health initiatives must increase direct involvement in healthy living rather than increase dependencies on outside support.
- OLPC's approach to education in the community should be mirrored by a "care in the community" approach which seeks to value community members who are already serving in caring and supportive roles (community leaders, teachers, health workers, mothers, elders, etc...), build their capacity, and support them with infrastructural development and integration with networks of more advanced resources.
- "OLPC is not, at heart, a technology program."[1] As with education, local health projects incorporating XOs will need to pay great attention to infrastructure by addressing long-term concerns and sustainability. Locally based institutional structures should be supported rather than forming dependencies on outside agencies, and these efforts are made in parallel to, rather than instead of, traditional community infrastructure development which must continue.
Integrated Approach to Health Care
In the context of poor, isolated, rural communities, those health resources that do exist are invariably thinly-stretched. A low-cost, multi-purpose, and as ubiquitous as possible, communications and information processing device has the potential to play a role in helping to build healthy lives and communities. But to do so, it should take a broad view of health, and take into account an integrated view of health care and the many potential sites of therapeutic interactions.
Areas of health care:
- Training (see HSO, for example)
- Primary care
- Including pre-hospital, emergency, First Aid
- Clinical setting or bedside
- Secondary care
- Specialists, ongoing investigation, laboratory
- Tertiary care, chronic care, home care
- Follow-up, support, physiotherapy, occupational therapy
- Complementary medicine
- Patient education
- Prevention
- Around all of these, we have prevention as ongoing education strategy
Activities
Health care is therefore about doing, about activities that promote better health, increase quality & quantity of life (increasing longevity, decreasing mortality rates).
Health care can be broadly categorized into three (sometimes overlapping) Activities:
- Prevention → Assessment → Intervention
These sit on a spectrum of increasing
- Technical knowledge required,
- Sophistication of tools required & cost of those, access to materials, training time required,
- Size of infrastructure required to support, &
- Barriers to access, in most places;
but decreasing desirability in terms of where to begin addressing a problem, if possible. (An ounce of prevention being worth an pound of cure. —Benjamin Franklin)
Prevention & Training
This primarily consists in education to generate healthy behaviors, often by enabling the recognition of hazards or of health-promoting activities, or in health care training. Educating people is very much the core of the OLPC project, but it needs new health content (e.g., Hesperian foundation, HSO and also Wikipedia, etc.)
Prevention includes educational efforts directed at individuals and families, but also preventive work done by health promoters, paramedicals, public health initiatives, etc.
Assessment
Requires some training & tools, but these can often be pretty basic.
Assessment can be done by paramedical personnel in many cases, or even health promoters.
Individuals and family members can also be trained to monitor ongoing or chronic conditions and report back to health workers and doctors, or record them in a graphing/monitoring tool, e.g., blood sugar monitoring for diabetics or blood pressure for hypertensives.
One principle to consider here is the need to value, wherever equally accessible, the lower-technology choice of two alternative tools. An example would be when gathering basic vital signs, comparing the use/cost/feasibility of a) telemetry peripherals capable of measuring any combination of pulse rate, blood pressure, breathing rate, pulse oxymetry, blood glucometry, etc..., versus b) someone in the community with a bit of training and having access to a watch, a stethoscope, a blood pressure cuff, a pulse oxymeter, glucometer, etc...
This area would also include assessments, such as imaging & laboratory work, that can only be performed by trained experts, and require progressively larger and more complicated devices, e.g. sonography, x-ray, CT, MRI, etc...
Interventions
Often require a higher level of education and experience to engage in, but this can be distributed through the use of informal training (particularly for do-it-yourself and do-no-harm type information), more formal training and certification for more challenging activities, and delegated acts (for things that are of low to moderate, but not non-existent, risk).
Medical interventions that have complex needs and are of moderate to high risk of harm if miss-performed, or that require specialized equipment or techniques, will need professionals of sufficient training, certification and resources to perform. However, networked communications can still facilitate the consultation processes required to prescribe and plan such interventions. And as Emergency Medical Dispatchers have shown, amazing things can be taught (via telephone, let alone the potential of videoconference!) when there is great need.
- Therapies
- Home remedies, the good & the bad
- Physical & Occupational Therapy
- Many others
- Medicines
- Prescription, use & misuse
- Herbal, diet, etc...
- Procedures
- First Aid, CPR, Public Access Defibrillation programs
- Symptom-relief program
- Vaccination programs
- Invasive, surgical, etc...
- Dental
- Veterinary
People
- Individual (community member, child) ↔ Health Promoters ↔ Paramedicals ↔ Doctors ↔ Specialists
There may be enormous barriers between the different people involved in health care. As you move to the right in the list above we find
- Increasingly city-based services and greater physical distance,
- A decreasing availability of human resources,
- An increasing level of education, time, & money that must be invested, and
- More language barriers.
Breaking down barriers
How can an integrated approach to health care break down barriers?
- Barriers can be reduced by educating all parties, improving health information, its understanding, and its communication between all.
Between people in the list, some information flows to the right: from Individuals → Health Promoters → Paramedicals → Doctors → Specialists as traditional, health consultations are pursued.
Training, delegation, or standing orders often flows from the right: to Individuals ← Health Promoters ← Paramedicals ← Doctors ← Specialists.
There are also public health activities where information is collected and analyzed for populations by looking for significant trends within geographic areas, socio-political & socio-economic sectors among broad populations.
The Base Hospital and Health Promoters sections below describe a vision of integrated health care that may be advanced by organizations supported by learning from OLPC technology.
Base Hospital model
Expand the reach of doctors & specialists.
Conduct and propagate health-related training.
Base Hospitals certify teams of paramedicals, who in turn oversee networks of Health Promoters.
Create standing orders and delegate activities that can be performed by trained personnel when certain conditions are met.
Oversee documentation and review, analyze statistics, etc.
Advance availability of health network resources (paramedicals, doctor, & specialists) for consultation, telehealth, and emergency response.
Health Promoters model
Builds the capabilities, training, and networking of community members.
Recognizes and affirms the value of by supporting community members who are already in caring positions, such as moms, elders, community health workers, teachers, leaders of community institutions, healers, etc.
Case Study
Mancora: Example Health/Education hybrid project
Extending an OLPC educational roll-out into the health field
or
How I would use the XOs in a hypothetical dream project --JHehner 11:07, 30 January 2008 (EST)
The setting is las Comunidades Campsinas de Fernandez y Barrancos, located between a half-hour and two hour drive up the river valley, inland from Mancora, on Peru's north coast. Spread out among dry, rolling hills are a number of families living in shacks, peasants and farmers, their dusty fields and goat pens. There is a two-room schoolhouse, a church, and a small outpost of the Ministry of Health. Water is collected from a communal spigot, or the river itself when its riverbed is not dry. There are no phone lines, electricity comes only to a water pumping station nearby, not to any homes in the village.
Distribution
The dream goes like this:
OLPC rolls out broad distribution of XOs to every school-aged child in the region. This is supported by supplementary XOs being distributed to local teachers and those required to tie them in to a larger educational and support network.
In the health project they are also distributed to those identified as potential Health Promoters: community health workers, moms, elders, healers, leaders within community institutions, those who may already be serving in informal health caring rolls, who want to participate in supporting the health of their community and who are attracted by the opportunity to learn more.
XOs also go to an interdisciplinary health team which is formed, consisting of paramedicals (more advanced First Aiders, Paramedics, nurses, midwives, etc...) along with a small team of regionally-based doctors and specialists (they get XOs too if they lack their own computer technology that's adequate enough to participate).
Training
A training program consisting of workshops, help sessions and ongoing training is developed specifically for the health team. They meet for didactic sessions but also work on a number of practice scenarios. Plans are made for Continuing Medical Education. Training topics include both the technical aspects of using the XO, as well as capacity building for Health Promoters & paramedicals.
Infrastructure
We put in the support infrastructure required to help the project survive and grow. This includes institutional partnerships and commitments from community groups, our NGO as well as the Ministry of Health. They commit resources and personnel, agree to schedules, make themselves available on-call for the medical system as well as for overseeing Base Hospital certification programs.
The physical infrastructure to enable connectivity to the OLPC project is put in place, perhaps cheap repeaters on the hilltops or IP over power lines. These link us to our Base Hospital group in Mancora on the coast (located on the PanAmerican highway, and therefor accessible to Peru's network backbone) and to the Internet at large.
Training & technical support structures are put in place, equipment is tested, backup equipment stocks maintained.
Activities
Scenarios depicting the possibilities in a variety of areas:
Prevention
Materials are distributed via the network and worked into educational curriculum on important relevant topics such as sanitation & hygiene, dehydration, Dengue fever & mosquito control, etc...
Health Promoters are also able to circulate with patient education materials, in the form of multimedia presentations in accessible language and images, working directly with families and community members teaching and discussing these topics.
Children and youth using their XOs find materials on healthy living, diet, exercise, lifestyle choices, sexual health, First Aid, CPR, etc..., perhaps materials that engage them in activities rather than simply presenting static information.
Assessment
Juanita's little brother has developed a stomach ache and seems to have little appetite. She logs on to her XO, and though she looked through some of the self-diagnostic health materials, she's been taught to recognize times when medical assistance might be necessary. With her XO, she is able to identify and contact the current on-call Health Promoter, who this evening happens to be Sñr. Caballo, primary school teacher. Via videoconference, she is able to explain what is going on, and to answer some questions about her brother's recent symptoms. Sñr. Caballo is able to determine that her brother's symptoms aren't grave, and works through the Rehydration Fluid educational materials with Juanita and her mom. He tells them to call back if anything worsens, and stops by in the morning to check on them.
Pilar the obstetrician circulates to visit several expectant mothers in her area. She enters documentation about her home visits into her XO and works with the midwife so that she can be summoned when labour begins. She also uses the device for presenting healthy mom & new baby educational materials, and for reviewing childbirth standing orders with the midwife.
Chico and his mother have been caring for Chico's grandfather who is diabetic. One evening his grandfather gets back after trucking sacks of yucca out to the coast and seems especially lethargic. The family decides to contact one of the town Health Promoters, who immediately notifies the on-call paramedics. They arrive at Chico's house and follow standing orders to test abuelito's blood sugar and provide symptom relief (cookies and juice). They leave behind a glucometry peripheral, teach monitoring, and point the family towards the diabetic patient education materials, which include signs & symptoms, diet & exercise info., and a blood-sugar logging activity (shared to the health network).
Intervention
Jorge buries a machete in his thigh while felling an algarroba tree. His eldest daughter, Maria Gracia, hears his cries from the campo next to their hut, and runs for her XO. She contacts Emergency Medical Dispatch, and within seconds is communicating with the on-call Paramedic. She is shown via videoconference how to control the bleeding, while a tuktuk cum ambulance is dispatched. The regional doctor is also brought online to assess the damage, but is able to determine that cleaning and a line of stitches are all that are required. The emergency team arrives and a nurse dresses the injury. They also order antibiotics through the medical network, which automatically notifies the pharmacy and tasks a health promoter with bringing them by that evening.
While using the Distance activity to measure the rising water level in their flood plain / river valley, Jordano's friend Antony is swept from the edge and falls in. By the time he is pulled out he is not breathing. Jordano uses his XO to videoconference with the on-call Emergency Medical Dispatcher. While engaging First Responders, the EMD coaches Jordano in CPR, watching and encouraging his efforts, popping helpful graphics up on the screen when an instruction is not clear. Their efforts keep Antony viable until a health promoter can bring the town's Public Access Defibrillator over, and Antony is revived. Using Jordano's XO's GPS function, the response team rapidly finds them and begins transporting Antony out to the Ministry of Health Outpost on the coast. Via teleconference while en-route, the on-call Doctor works with the emergency medical team, reading vital signs via telemetry and providing patch medical orders.
Base hospital
Fernando participates in his family's annual check-up this year, and for once they don't have to spend a week's wages transporting the family to the regional health outpost; Fernando is also interested in being trained as a Health Promoter once he turns twelve next year. The community's nurse helps assess the family, while directed by the attending (conferenced) physician, and they enter the family's medical details in the secure database.
Community health volunteer Yolanda is completing her servicio rural during her last year of medical school, and is doing home visits in the community. She provides relevant patient education materials, and arranges consultations with her colleagues at the Base Hospital. While visiting the Lama family, some of the family members complain about nagging coughs. A family member has recently returned to the village after working in a poor neighborhood in the capital. The base hospital Doctors are able to assess the family using Yolanda's help and telemetry equipment. They schedule an appointment for teleconsultation with the local TB specialist, and order lab tests which a paramedical swings by to administer. A course of therapy is established, medication distributed and its consumption directly observed (DOTS-Plus) via videoconference.
Public health
Edith circulates from house to house as part of the Ministry of Health's mosquito eradication and Dengue control program. She uses her XO to document what she finds including being able to photograph the state of water storage, basins and collective spigots. A small microscope peripheral catalogues larvae presence and type. Presentations running on her XO and shared with the family's machines help her explain the government program, Dengue's vector and the need for larvicide packets and well-covered cisterns. She is also able to geotag her findings, localizing them despite an absence of landmarks, street names or numbers, and plot public health findings on a map. Later that summer when there is a Dengue outbreak, the data gathered reveals a cluster centered on an abandoned well, and the problem is quickly dealt with.