Rebooting Global Health: Changing How We Approach Health Technology

By Alcir Santos Neto

In a world devastated by war, cyber-attacks, disease, and natural disasters, over half the global population cannot obtain essential health services. The most vulnerable among us are often pushed into poverty by out-of-pocket medical costs, or left to die from preventable diseases.

• Language: English
• Publisher: New Degree Press
• Release date: May 3, 2021
• ISBN: 9781637301661

Book preview

Rebooting Global Health

Changing How We Approach Health Technology

Alcir Santos Neto

New Degree Press

Copyright © 2021 Alcir Santos Neto

All rights reserved.

Rebooting Global Health

Changing How We Approach Health Technology

ISBN

978-1-63676-703-1 Paperback

978-1-63730-064-0 Kindle Ebook

978-1-63730-166-1 Ebook

Contents

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Introduction

PART I

Where We Are Today

A Brief History of Health Innovation

Global Health System: What Are the Challenges?

Can Access to Care Be the Solution?

When We Don’t Collaborate

How to Overcome Global Health Threats

PART II

Approaching Health Technology

Forging Alliances

Turning Problems into Solutions

Don’t Try to Solve the Whole Problem

PART III

Changing the Status Quo

Enterprise

Thought Leaders

The Future of Global Health Technology

Author’s Letter to Learners

Acknowledgments

Appendix

Introduction

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Is that a warplane over us? 

A young health worker in blue scrubs hid her face behind a surgical mask and fearfully awaited confirmation.¹

Startled by the familiar sound, another health worker quickly turned her head. The panic in her eyes betrayed her attempts to calm her frightened colleague.

Don’t look so frightened; it will be all right.

This was the new normal in Syria. In what used to be the quiet green pastures of southwestern Syria, where mountains embraced the countryside of eastern Ghouta, thick, unsettled dust and agonizing cries echoed against piles of rubble and blood. Sixty-five feet deep underground, a twenty-eight-year-old pediatrician, Dr. Amani Ballour, courageously and steadily fought death. She miraculously saved thousands of casualties in a cramped and dark hidden cave hospital. 

I am not a hero. I am just human.

Over the six years she led her medical team, it is estimated Assad forces purposefully attempted to bombard the hospital at least twenty times. They bombed the hospitals a lot, recalled Dr. Ballour as she explained that bombs and artillery rounds targeted surface hospitals. 

At times, the doctor and her hundred-member staff could not safely leave the hospital to get some rest, leaving them no choice but to share sleeping quarters with wounded dead. Her hospital is one of many underground cave hospitals serving as a safe haven for Syrian civilians.  

By some measures, the Syrian Civil War is considered the greatest humanitarian disaster in the twenty-first century. Millions of refugees with critical and chronic medical conditions are not only overflowing refugee camps but also introduce new challenges to the already precarious public health system of neighboring countries. Problems like these are not going to go away because of the socioeconomic, political, and environmental factors at their root. The strain on public health systems in conflict zones will remain an incurable illness until global leaders simultaneously treat the comorbidities of conflict: diseased socioeconomic, political, and environmental policy. Unfortunately, the disease is spreading.

The Global Status Quo

Within the last twenty years, studies have shown an increase in conflict, an exponential rise in economic damage caused by highly destructive natural disasters, a rapid explosion in technological innovation, and a widening of health and economic disparities in certain countries.² With changes to the way the international community addresses these challenges, problems like these are not going to go away anytime soon.

Global health problems are often politicized and are hostage to leadership opinions, reliant on the economic environment, restricted by political decisions, and haunted by inequity. As researchers and practitioners work around these barriers, they often face an imbalance of cooperation to solve global health problems—either an overcompensation or deficiency in collaboration. To better understand this situation, researchers would require data measuring or explaining this imbalance of multidisciplinary and cross-sector collaboration. Few to none are found in academia, and as a result, there is a global data gap in this space. 

How is the global health community responding to this?

We are witnessing the rising support for establishing local partnerships and finding local solutions, also known as localization and contextualization. On the other hand, some tend to revert back to traditional thinking—using top-down decision-making and implementing solutions as they see fit.

This traditional thinking can lead many to believe these global health problems could be fixed only by improving accessibility to pharmaceuticals or increasing the number of trained doctors. Such measures would require either heavy government intervention or reliability on international health organizations. However, there is no single approach, ideology, policy, or intervention that solves all global health problems. 

The Stanford Social Innovation Review, in their piece The Need for Cross-Sector Collaboration, recognized the pressing need for collaboration:

Think, for example, of the challenge that is most pressing to you, and consider the various individuals affected and the systems at play. Can a single policy, however finely crafted, or a social program, however well run, or a new technology, however innovative, by itself solve that problem?... Yet all too often we approach these issues with piecemeal and even siloed solutions, and with efforts (however passionate, intense, and even exhausting) that aren’t sufficient to address the problems at the scale at which they exist.³

There is no checklist, formula, model, or one-size-fits-all approach to solve complex global health problems. We cannot just specialize in one solution and hope it will solve all similar health problems around the world. Specializing in specific critical areas does have its merits in solving symptoms, but it will take a bigger picture convergence to solve the problem. Solving complex problems will require changing our approach.

I had expected to see this type of change in the health system of my hometown during a trip to Brazil in 2019. Upon traveling back to my hometown of São Paulo, eighteen years after I left for the States, I was excited to revisit my elementary school and reunite with my extended family. At least that was the mindset I had before the trip. That was all about to change.

An Eighteen-Year Gap

On the outskirts of the metropolitan city of São Paulo lies the small town of Jandira. Every Sunday morning, the city square transforms into a traditional Brazilian street market. It was in this same city square my dad used to help my grandmother sell clothes in her makeshift tent. 

On our recent visit, my family drove through the city center on our way to visit my grandmother. The smell of the crispy pastel especial being deep-fried and the sounds the hardworking vendors shouting special promotions brought back memories. From the passenger seat of the car, my father pointed to a cramped clinic at the corner of a busy street that was sprayed with graffiti, with a line of about fifteen people waiting outside impatiently.

Small children cried out in hunger. Young men complained about the long wait. Senior citizens, unable to access the facilities in their wheelchairs, struggled to stand in line. At last, the door of the rundown, unairconditioned facility opened, and a health worker emerged—clipboard in hand—in blue scrubs, saturated with perspiration. His finger was pointing to his clipboard, ready to call the next person in line. 

Long lines and minimal services are not uncommon in public hospitals in Brazil. It is unfortunate but typical to hear stories of patients dying in waiting rooms in a public health system short on staff and beds.

It’s no coincidence, then, approximately fourteen people die per day in the state of Rio de Janeiro without access to hospital beds.⁴ In addition, 819 people die a day due to preventable issues.⁵  By World Bank estimations, Brazil spent approximately 9.5 percent of its 2018 Gross Domestic Product (GDP) in a free and universal healthcare system, more than many European and Asian countries that have better healthcare, yet it is not efficient enough to address the growing health disparity.⁶

The clinic’s image was imprinted in my head because it represented what should not happen in a system that spends so much on healthcare.

. . .

One of my aunts in Brazil has been fighting cancer for some time now. During our visit to São Paulo, we accompanied her to medical appointments at a private hospital specializing in oncology and neurosurgery. The hospital’s twelve-story, monumental building stood in stark contrast to the rundown, unairconditioned clinic we’d seen in nearby Jandira just the day before. The contrast grew even more dramatic when we went inside. 

The hospital’s lobby had the ambiance of a five-star hotel—waxed marble floors, modern abstract art, and a pleasant chamomile aroma. Heavenly music accompanied our elevator lift to the third floor. There, right next to the check-in area, I spotted a coffee shop. 

Coffee shops are commonplace in hospitals in the US, but to find a coffee shop like this in Brazil was like discovering an oasis of indulgence. Mesmerized by the three-layer triple chocolate cake and roasted aroma of dark caramel lattes, I decided to partake. There, a few feet away, sat several patients’ family members, nattily dressed in Ted Baker blazers and Armani suits, sipping their iced mocha lattes. 

Meanwhile, hospital staff warmly greeted patients and escorted them to the air-conditioned waiting room, where citrus-berry ice water and plasma TVs made the wait more enjoyable. 

Within a single, twenty-four-hour window, I witnessed what twenty years had done to the development of the health and economic opportunities of my hometown. The disparity gap had grown more significant than before, especially when it came to accessing quality medical care. While universal healthcare is a constitutional right in Brazil, the quality of care is a continuous problem. I imagined how much more problematic healthcare is for people who live in countries that lack access to care. To add on top of this deeply moving experience, I was working at that time in a primary healthcare clinic in Fort Bragg. I was responsible for contacting vendors to modernize our medical equipment inventory. This included purchasing a new one-touch activation Wi-Fi-enabled spot vision screening that conducts vision screening tests and auto-refraction applications. 

After hanging up the phone with a sales representative, I thought to myself, We live in the twenty-first century, and health disparities should not be a global issue, especially with the current level of technology, scientific knowledge and global economic capabilities. Unfortunately, we do not live in a perfect world.

I acknowledge my thought could be portrayed as naïve. Yet, it made me wonder why there is not only a lack of effective cooperation in solving complex problems, but a lack in the implementation of emerging health technologies that could provide lifesaving care to the most vulnerable populations.

This is where I noticed how I could draw from my own experience to help make a difference. Having spent my life working in international marketing, translation, education, military, and global health, I took a step back to envision how these different disciplines could offer valuable insight. Then I stepped forward to begin a journey that has changed the way I see innovation in global health. Threats from different sectors impact global health problems. Through improved collaboration among different disciplines and sectors, we can solve them.

Tools to Help Solve Global Health Problems

What tools help solve these multisector problems?

While there are many we can go over, this book focuses specifically on health-related issues. Health technology has many crosscutting benefits to not only decrease the gap of access to health, but to also lead to improvements in retrofitting technology and growth in economic development, resulting in saving more lives. Technology has pushed the boundaries of imagination, and it can also bring revolutionary solutions to global health.⁷

Employing my own direct and professional experience, along with other expert opinions, the information presented will introduce innovative concepts and cross-disciplinary insight. Every bit of detail to the global problems will lead to the crucial understanding of how anyone can become a force of change.

This can all be accomplished, and people can be mobilized to improve access to health services around world without forcing it through government entities or infringing upon personal liberties. We need to encourage people who have resources to be part of the change without being forced. The others, who have the energy and passion, we need them to mobilize without force until we are all working together to achieve the same goal.

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1 Feras Fayyad, The Cave, produced by National Geographic Society, video, 60:46.

2 United Nations, A New Era of Conflict and Violence, accessed December 18, 2020. 

3 Jeanine Becker and David B. Smith, The Need for Cross-Sector Collaboration, Stanford Social Innovation Review, accessed December 18, 2020. 

4 Stella Arengheri, Morrem Nos Hospitais Brasileiros 819 Pacientes Por Dia, Jornal Da Universidade de São Paulo, accessed December 18, 2020. 

5 Globo Notícias, Por dia, 14 pessoas morrem por falta de leitos em hospitais do RJ, diz Defensoria, Globo Comunicação e Participações, accessed December 18, 2020. 

6 World Bank, Current health expenditure (% of GDP) - Brazil, East Asia & Pacific, Central Europe and the Baltics, accessed December 18, 2020. 

7 Venkat Atluro, Aamer Baig, and Satya Rao, Accelerating the Impact from a Tech-Enabled Transformation, McKinsey & Company, accessed December 18, 2020. 

PART I

Where We Are Today

  Chapter 1

A Brief History of Health Innovation

In the Mediterranean coastal cities of classical Greece, a young  man had a revolutionary idea that would spark health innovation throughout history. This man was Hippocrates, the father of medicine. 

As Plato theorized and debated the pillars of justice, Hippocrates traveled and built the pillars of modern healthcare. A disease was not a mystical curse of the Greek gods, Hippocrates taught his students. Rather, disease occurs naturally.

Of his many contributions to the development of medicine, I believe his most significant health innovation was simply adding hands to the list of medical aids. The Greeks already used their hands as tools with which to clap, wield a sword, and grab a spoon. But Hippocrates looked at the end of his arm and saw a thermometer.

Hippocrates was one of the earliest, if not the first, recorded in history to recommend using hands to judge if a fever was present in a patient.⁸

Traveling forward in time, almost two thousand years into war-raging medieval Europe and the Age of the Enlightenment, various remarkable minds advanced the technology of the thermometer. 

As kingdoms fought valiantly for territory and riches, inventors and scientists Galileo Galilei, Isaac Newton, Anders Celsius, William Thomson Kelvin, Gerard van Swieten, Gabriel Daniel Fahrenheit, and the creator of the medical thermometer Thomas Allbut all fought tirelessly for progress and innovation.⁹,¹⁰,¹¹,¹²,¹³,¹⁴ So, where did this temperature-measuring journey of 2,100 years get us, in the broad scheme of innovative technologies?

Medical Importance of Measuring Temperature

While Brazilians flooded the streets joyfully chanting and celebrating their first World Cup victory in Rio de Janeiro in 1958, distress overwhelmed a meager wooden house, hidden in a remote, destitute community in Presidente Prudente. Young Solange cried in panic as she lit a metal kerosene lamp, calming her four children while attempting to save her newborn baby’s life. With her husband nowhere to be found, she rushed to cool down eight-month-old Alcilan as he battled an unknown fever. 

It was almost one hundred years after the invention of the personal medical thermometer, and Solange had never heard of or had access to one. She used the palm of her hands to monitor the fever and attempted to use cool water to keep the temperature down, as Alcilan experienced multiple febrile seizures. She waited until the break of dawn to seek help.

At sunrise, Solange grabbed her baby and four children, hopped on a bus, and traveled almost ten miles to the nearest hospital—Santa Casa de Misericordia. She presented her child to a nurse, who immediately admitted him and diagnosed with meningitis.