Raj Panjabi was nine years old when his family fled the civil war in Liberia. Nearly three decades later, the Harvard University medical instructor strives to improve access to health care in his native and other developing countries, as the NGO’s CEO and founder. Last Mile Health.
The success of his community health approach catapulted him to the list of the world’s 100 most influential people according to the magazine Time in 2016. This year he served as a primary care physician against the pandemic. While COVID-19 vaccines target the end of the tunnel, it could take years to reach millions of people in vulnerable populations around the world.
Ask: How does the coronavirus affect rural communities in low- and low-middle-income countries?
Answer: Rural communities have already faced these kinds of challenges. Looking 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. Historically, that’s the story of every pandemic. And unfortunately, the Covid-19 pandemic is amplifying one apartheid viral, in which only the wealthy 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 is not available. Also, rural areas are the last to receive some of the new drugs.
Raj Panjabi, a medical professor at Harvard.
As far as vaccinations are concerned, experience from previous campaigns tells us that poor and rural regions are the last to receive them.
As for vaccines, experience from previous vaccination campaigns shows that poor and rural regions are the last to receive them. From current information on immunization around the world, we know that 13 million children under one year of age do not receive any dose of vaccine. We are talking about measles, polio and other vaccines that are already known and used, but are out of reach in remote rural areas and sometimes in urban areas where the limitation is not geography but poverty and lack of health services. Health. I think the communities are not well prepared for all this at the moment.
P: He mentions that some rural communities have already faced challenges similar to covid-19. What lessons do these experiences teach?
R: One of the keys is to include health professionals in the community and coordinate their actions with teams of doctors and nurses. The countries that bet on public health before the pandemic are relatively better off today. A good example is Liberia, where it was founded Last Mile Health.
Years ago we had the Ebola epidemic that caused a lot of pain and suffering in our country. About 11,000 people died in the region and nearly 30,000 were infected. But it could have been much worse.
At one point, forecasts were that one million people could be infected, half or more of whom would have died. So when Ebola broke through humanity and Liberia, the role health workers played in the community was huge. It was they who, in a team of nurses, examined patients.
In one district we examined 10,000 people; only 42 door-to-door workers watch for the symptoms. Those same workers also followed up contacts and put the sick in contact with the services of the health system. Those same workers, who serve about 80% of Liberia’s rural population, are now being trained in identifying coronavirus cases and tracing contacts to ensure the health system doesn’t collapse completely.
P: You stress the importance of a lot community health, with community workers proactively reaching out to families in low-income countries. Do you think this model deserves to be strengthened in high-income countries such as Spain?
R: I think so. In Brazil, for example, health workers have helped with chronic diseases that plague many rich countries and rich areas of poor countries, such as hypertension and diabetes; diseases that eventually cause heart attacks or strokes that severely incapacitate patients and even cause death. In fact, Brazil’s family health program has contributed to a 15-20% reduction in deaths from strokes and heart attacks. We were able to achieve similar results in rich countries, but we have not spent 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 health care labor costs are an expense, not an investment.
Raj Panjabi, a medical professor at Harvard.
Half of the world’s population, 3.7 billion people, has no access to essential health services. Within that group, the billion people who live in the most remote communities are the worst off.
P: In addition to the COVID-19 pandemic, what do you think are the challenges for accessing universal healthcare around the world, including rural areas?
R: As long as a patient is out of reach, it means we haven’t done enough. Unfortunately, many patients are out of reach. For me, the main problem is that the information we have about him is not only generally neglected, but insufficient.
We often talk about the lack of care for specific diseases. People don’t have enough access to treatment for HIV, tuberculosis, hypertension, safe deliveries … But if you cut through all of these diseases and ask yourself which population is most at risk of getting them and not receiving medical care, we find nationwide and remote population groups in the lead.
Half of the world’s population, 3.7 billion people, has no access to essential health services. Within that group, the billion people who live in the most remote communities are the worst off. So let’s create a basic health care system that is available to every child and family.
P: How can technology, including artificial intelligence and telemedicine, help improve access to health services in a poor social context?
R: Building a robust health system requires four pillars: personnel; medical supplies and medicines; a space to provide the service and, finally, technology.
When we look at shows around the world, the most successful shows invest in those four areas. Technology can improve training, with virtual tools, aid in 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 the countryside, but precisely there there is no infrastructure to take advantage of technology. That is why we need, among other things, better infrastructure models that reduce energy demand.
About artificial intelligence (AI): I think there is a lot of hype around it. But for a community health worker who needs to diagnose 20 different pathologies, AI is only relevant if one of those 20 things is very rare and AI can identify it. If not, it is not that relevant.
In my opinion, you should start by guaranteeing the technological infrastructure, the use of telemedicine and the provision of tele-education. AI only makes sense if you guide the other technology areas for healthcare.
P: Do you think that in addition to technologies, primary care and community health should include mental health?
R: It certainly seems crucial to me. One of the studies we did in Liberia was after the civil war that lasted 15 years and caused a lot of trauma. In 2008, we surveyed 1,600 households together with the Liberian government. Between 40 and 44% of the adult population had symptoms classified as major depression or post-traumatic stress.
It is inconceivable that public health can ignore a problem of this magnitude. Community health is underfunded. Therefore, the community mental health also.