Delivering medical care to patients in rural regions around the globe can be a challenge. You might rightly guess at the need for more clinical resources in places like sub-Saharan Africa — but Harrington, Maine?
The small Down East town has been selected, along with villages in Haiti, Kenya, South Sudan and Uganda, as a pilot location for a project by the nonprofit Health eVillages. The point is to improve medicine by making knowledge more mobile. It’s a new take on the classic “black bag,” where the tools are slick apps, tablets and networking.
Washington County has not been devastated by an earthquake or torn apart by civil war. The region is stable and the water is drinkable, unlike some of the other areas in the pilot project. But clinics across rural America have their own set of challenges attracting good practioners to address diseases linked to poverty, lifestyle and age.
Physician Assistant Mary Boyd recently listened to the concerns of a patient whose arthritis is getting worse and who suffers painful episodes of gout. Boyd is holding what looks like an ordinary tablet, which she taps from time to time to access various references.
“You finished your colchicine, you’re on the prednisone. You know, I think at this point, you can’t take the indocin,” Boyd says. “I don’t want to you be in so much pain anymore.”
Eventually, Boyd decides to add a new drug to her patient’s treatment plan.
“A lot of our patients, their biggest concern is, ‘Is this new medication going to interact with what I’m already on?’” she says.
Boyd uses the tablet to double check her own knowledge about drug interections when prescribing something new. She can then share this with the patient. She can also take pictures and upload them into a medical chart, or pull up a library of photos to help a patient understand diabetic wound care.
The tablet comes with a whole library full of apps that takes the place of the standard medical texts and helps physicians on the spot.
“There’s just no way our brains can keep track of all of that information, all the time,” Boyd says. “Having a program where I can go and look things up quickly and efficiently is very helpful.”
And it’s especially helpful for someone like her, a PA fresh out of school with only seven months of experience. Many rural and community health care clinics in Maine rely on new nurse practioners and PAs as primary caregivers. That’s especially true for a remote area like Washington County, says Harrington Family Health CEO Lee Umphrey.
He says their practice can offer clinical experience and nice ocean vistas, but not the competitive salary that a more seasoned doctor might demand.
“We have a limited budget, so that hurts recruitment,” Umphrey says. “Hospitals recruit from us too, so sometimes we’ll have somebody here and next thing we know, the hospital’s offered them a job.”
Keeping up care standards can be challenging for a rural location, he says. That’s where the mobile medicine project comes in.
The nonprofit Health eVillages is testing a number of these mobile medical tablets in clinics around the world, cost-free, each one customized for that clinic’s special needs. But the project’s goal is much bigger.
“Article 25 of the Human Rights Declaration states health care is a basic right,” says Donato Tramuto, a health care executive and activist who founded the nonprofit and developed the tablets. “And I think everyone deserves to have, not just the basic right, but deserves to have the basic care that you and I and others have.”
Tramuto envisions a clinical practice where prescriptions, medical knowlege, electronic records and telemedicine all dovetail digitally in one place, and where patients can be part of the process with their own apps. At least 40 percent of consumers already use two or more medical apps to measure diet, pulse, stress, steps, sleep, UV rays and more.
“They’re already ahead of the medical practice,” Tramuto says.
The scope of the project is ambitious. The nonprofit has had to build Internet infrastructure and solar charging units to support the technology in remote locations. Another daunting task is to make the tablets work with the patchwork of programs, prescription software and electronic records systems clinics currently use.
It’s early yet for the project, but Tramuto says by 2020 the U.S. will start feeling a problem already seen elsewhere in the world: a shortfall in primary care doctors.
“They’re screaming today that they don’t have time to take care of all the patients that they have, and they’re going to be swelling from 10 to 12 patients to probably 25, 30,” he says. “You’ve got to give them the tools.”
The tools for a 21st century doctor, he says, don’t come in a classic black bag.