Improving Access to Healthcare for Impoverished Communities
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The document discusses the efforts of Bridge to Health Medical and Dental to improve healthcare access in low-resource communities in Uganda and Kenya. It outlines the challenges of healthcare provision in rural areas, the organization's mission to provide sustainable services, and innovations like portable ultrasounds to enhance maternal health. Through partnerships and programs, they aim to educate local populations and healthcare practitioners while addressing significant health disparities.
Improving Access to Healthcare for Impoverished Communities
- 1. IMPROVING ACCESS TO HEALTHCARE FOR LOW-RESOURCE COMMUNITIES Rotary International, June 25th 2018 Dr. William Cherniak MD, MPD - Executive Director, Bridge to Health Medical and Dental Ms. Tina Papacosmas RDS – Dental Director, Bridge to Health Medical and Dental @WilliamCherniak
- 2. WHO AM I? • Dr. William Cherniak (Bill) • Family and Emergency Medicine Physician • Lecturer, DFCM, UofT, Division of Emergency Medicine in Toronto, Canada • CoFounder and Executive Director of Bridge to Health Medical and Dental www.bridgetohealth.ca • Clinical Assistant Professor, USC Keck School of Medicine
- 3. TINA WHO AM I SLIDE
- 4. OUTLINE • What is Global Health • Journey to Entrepreneurship • Bridge to Health Medical and Dental – Brigades and Education • Break • Bridge to Health Medical and Dental – Programs and Moving Forward • Course Outline (and why you should come!) • Grading/Projects
- 7. UGANDA
- 8. UGANDAN HEALTHCARE • Healthcare provision is a mix of public and private sources1 • Public Healthcare: • Provided on a district health system, with level one to four health centers (four being the most advanced) • Private Healthcare • Delivered predominantly by faith-based organizations such as the Uganda Catholic Medical Bureau (UCMB) and others 1. World Health Organization. Health System Profile for Uganda. 2005. Accessed online on February 22nd, 2016 at https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0ahUKEwjI- 4y91IvLAhWKWh4KHfneA0IQFgg3MAM&url=http%3A%2F%2Fwww.afro.who.int%2Findex.php%3Foption%3Dcom_docman%26task%3Ddoc_download%26gid%3D2835&usg=AFQjCNFFP8HT_nk97BWpJLNuHy pX1hIh9Q&sig2=BXpgMRSr1yIGdZG_RbYLmw&cad=rja
- 9. WHERE IN THE WORLD IS…
- 10. • Population of ~600,000 • Rural region of Uganda • Serviced by only a handful of healthcare providers • Mountainous topography KABALE DISTRICT
- 11. THE REALITY • Healthcare workers flock to urban centers • Communities isolated from main town • Limited or no access to care in rural communities • Minimal access at main referral centers
- 13. LOCAL PARTNERSHIP: • Kigezi Healthcare Foundation, southwest Uganda • Not for profit, non governmental community development organization • HIV/AIDS • Maternal health • Malnutrition • Microfinance • Disease, ignorance and poverty
- 14. BACKGROUND ON TINA AND HOW SHE GOT INVOLVED WITH GLOBAL HEALTH WORK
- 16. OUTLINE • What is Global Health • Journey to Entrepreneurship • Bridge to Health Medical and Dental – Brigades and Education • Break • Bridge to Health Medical and Dental – Programs and Moving Forward • Course Outline (and why you should come!) • Grading/Projects
- 17. Our aim is to provide sustainable healthcare in a cost effective manner, having a lasting impact on the communities we serve. MISSION STATEMENT
- 18. Bridge to Health aspires to: 1) Build partnerships with not-for-profit healthcare organizations in under-serviced regions of the world 2) Provide high quality medical and dental services 3) Educate local populations and healthcare practitioners 4) Develop sustainable healthcare infrastructure through innovative models MISSION STATEMENT
- 19. OUR MODEL
- 20. Untitled
- 21. OUR MODEL
- 22. UGANDA • Nearly 30,000 patients seen over the last six years • Partnered with KIHEFO • Working with local government and Academia
- 23. KENYA • Launched new partnership with Africa Cancer Foundation and Kisumu County Government in February, 2018 • Began discussions with Dr. James Alaro at NIH/NCI, Center for Global Health in March, 2017 • Developed collaborative arrangements over 12 months • Treated nearly 3,000 patients in first year
- 26. SOME STATS ON KISUMU • Population of 1,031,485 as of 2012 vital statistics, 20% under 5 years old • >50% rural, 60% in absolutely poverty (<$2/day) • Infant mortality rate 54/1000 • Canada, by comparison, is 5/1000; still one of the highest in the developed world • Maternal mortality rate is 495/100,000 • Canada is 11/100,000 • Doctor to population ratio 0.02/1000 • Canada is 2.2/1000 or 110X greater https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&uact=8&ved=0ahUKEwjvrKmNiIHaAhVL94MKHfm3BGcQFghkMAY&url=http%3A%2F%2Finf otrakresearch.com%2Fwp-content%2Fuploads%2F2017%2F04%2FKisumu-Countytrak-April-release.pdf&usg=AOvVaw2ffDcfs7wRbkZ-CVhgedQJ
- 29. Banner
- 32. OUR MODEL
- 39. BANANAS!
- 46. After
- 47. Prostho
- 48. OUR MODEL
- 49. Only ~54% percent of women ever see a health care provider during pregnancy1 Only ~30% of these women actually deliver with a health care provider2 High rates of HIV in women ◦ 1.4 million in Uganda HIV+ (prevalence rate of 6.5%)3 ◦ Women aged 15-49 estimated prevalence of 7.2%-8.3%3 Major lack of infrastructure and services 1. Data obtained from White Ribbon Foundation 2. Unpublished data obtained from Kigezi Healthcare Foundation/Bridge to Health Medical and Dental 3. Obtained online from UNAIDS, Dec 9th, 2017: http://aidsinfo.unaids.org/ MATERNAL HEALTH
- 50. • Old idea! • The WHO (2003) recognizes ultrasound technology • Effective in rural East African settings • Simple and non-invasive procedure • Reduces fear ULTRASOUND IN PREGNANCY
- 51. THE QUESTION Can offering a free obstetric ultrasound, through use of a portable ultrasound, increase the rates of women presenting for antenatal care? • Is advertising via word of mouth enough, or do you need to use radio? • Will women who have previously seen a traditional healer be more likely to come when ultrasound is advertised?
- 52. RESULTS • Purchased two portable ultrasound machines • Designed health clinics on WHO PMTCT guidelines • Enrolled 159 women in study, rate 11.1/1,000 pregnant women on control days and 65.1/1,000 on internvetion days. • 4% HIV+, 2% syphillis+ • Ultrasounds left with KIHEFO, in use today
- 53. Prostho
- 54. CTV VIDEO
- 55. CERVICAL CANCER Entirely preventable cancer, kills very few in wealthy countries • highest cause of cancer death in women in Uganda • Need high quality screening and treatment programs Developed first ever educational program for screening and treatment • Taught 15 Ugandan healthcare workers • Screened more than 600 women • Treated dozens for pre-cancerous lesions • Road to sustainability
- 59. PUBLICATIONS • New England Journal of Medicine • Syphilitic Gumma • The Lancet • Pathology in Low and Middle Income Countries • Annals of Global Health • Host Perspectives of International Electives • Presented at CUGH in Washington, DC • PLOS One • Presented at American Public Health Association Meeting in Chicago, IL • Presented at Canadian Conference for Global Health in Ottawa, ON • Article in New York Times • Numerous Student presentations and publications
Editor's Notes
- #20: https://youtu.be/-V1OufUd9gs – BTH video #2
- #51: -ideally suited to low and middle income countries, as it is relatively low-cost, low input, and easily maintained and transported
- #53: http://london.ctvnews.ca/mobile/video?clipId=1109564
- #55: http://london.ctvnews.ca/mobile/video?clipId=1109564