On May 16, the House International Relations Subcommittee on Africa, Global Human Rights and International Operations held a hearing entitled, “Medical Outreach: An Instrument of U.S. Diplomacy.”
Chair Christopher Smith (R-NJ) noted in his written statement that sub-Saharan Africa has “24 percent of the global burden of disease, but only 3 percent of the world’s health workers.” He described a recent meeting with the Ugandan Minister of Gender, Labor, and Social Development, Ms. Zoe Bakoko-Bakora: “She said that what Ugandan women really needed and wanted was basic pregnancy care assistance and help in giving birth safely, especially in rural areas where health clinics and doctors are hard to come by.” Calling the use of communications technology to assist medical personnel in remote areas “one of the best good news stories to come along in years,” Rep. Smith expressed his hope that the U.S. government will “creatively use medical outreach technologies and applications developed in the U.S. to spur new action to raise the profile of basic health outreach in our assistance efforts abroad.”
U.S. Agency for International Development (USAID) Office of Health, Infectious Diseases and Nutrition Bureau for Global Health Director Richard Greene outlined the new technologies supported by USAID, including a “pre-filled, single use syringe” called Uniject. He explained, “The Uniject device cannot be reused. Traditional birth attendants (TBAs) can use it to immunize hard-to-reach children and women in their communities. Multidose vial waste is eliminated, saving precious dollars. Indonesia now provides the birth dose of hepatitis B (HB) vaccine in the Uniject device to all infants born in the country. UNICEF has identified Uniject as an important tool in its efforts to eliminate maternal and neonatal tetanus in high-risk areas around the world. By allowing TBAs to deliver safe injections, Uniject is especially effective in reaching women who have not been immunized due to ethnic or religious barriers or limited health infrastructure.” The device may also be used to administer the hormone oxytocin to women in labor, Mr. Greene said, thereby reducing the risk of hemorrhage.
Mr. Greene identified three telemedicine initiatives that have been developed or are being developed with the support of USAID: the international internet video conferencing system, established by USAID through Medical Missions for Children; the telemedicine network for Latin America and the Caribbean, which has a network of almost 600 doctors; and a future public health education channel in South Africa, partly funded by USAID, which “aims to be in all 4,000 public healthcare sites in South Africa within 5 years, serving 97,000 nurses and 36 million South Africans.”
Dr. Karen Rheuban, medical director of the Office of Telemedicine at the University of Virginia (UVA), detailed the university’s telemedicine programs: “Our gynecologic oncologists supervise a nurse practitioner located six hours from Charlottesville as she performs cervical biopsies on patients at high risk for cervical cancer. We follow and treat chronically ill patients such as those with Hepatitis C, and HIV/AIDS and, as we are able, spare post operative patients or patients with devastating neurological impairments such as Huntington’s disease or spinal cord injuries the unnecessary burden of travel for care.” She highlighted specific programs for women: “We have recently procured a mobile digital mammography van configured to broadcast screening mammograms back to our radiologists for immediate interpretation and feedback to women in rural communities. We have tied this outreach program to a collaboration that will bring state-of-the-art screening for human papilloma virus, the cause of cervical cancer, and…remote access to clinical trials for women in Appalachia.” She also mentioned a telehealth initiative in Guyana called the “Remote Area Medical Cervical Cancer and Women’s Health project,” which provides “gynecologic care for hundreds of patients each year.”
Dr. Rheuban stated that UVA partners with the Infectious Disease Society of North America, as well as other universities, to support the Infectious Disease Institute and HIV/AIDS training and clinical center in Kampala, Uganda. “Through this initiative,” she said, “thousands of patients have been treated with antiretroviral therapies and receive careful monitoring for complications of both disease and drug treatment. Data from that project is transmitted via satellite facilitated broadband to Bethesda daily.” Asserting that “we have only begun to explore the role of telehealth in this process,” Dr. Rheuban proposed the establishment of a “federally funded international telehealth partnership and resource center” to link the international health care outreach initiatives of U.S. government agencies, the United Nations, and the World Health Organization.
