Removing global bottlenecks in medical training

by Jeffrey Burns on May 9, 2011

This post, final of a three-part series, is adapted from a talk by Jeffrey P. Burns, MD, MPH, Chief of the Division of Critical Care Medicine at Children’s Hospital Boston, at the IBM Impact 2011 Global Conference. (See posts one and two.)

We have a healthcare gap in the United States and around the globe: There aren’t enough doctors and nurses trained in how to take care of a critically ill child. Children are not little adults; you can’t just cut the doses.

So we need a solution. But the solution that we need in a resource-limited environment is not the same solution that we need in a resource-advantaged environment. We need to find a platform that addresses the needs of both.

Several years ago, one of my colleagues, Traci Wolbrink, went to a camp in sub-Saharan Africa, a hospital that was well supported by the local government. It was providing antiretroviral therapy for HIV, fully sponsored by international organizations.

The first night she got there, 12 children died. They died from bacterial pneumonia. They had streamed in from all over the country with their mothers to get an anti-HIV therapy that would give them a lifelong treatment benefit. Yet, ironically, they were dying of something that was treatable, and treatable in their own environment.

She said to the doctors there, “Do you have a generator?”And they said yes.

She said, “Do you have an oxygen tank?” They said yes.

And she showed them how to set up what’s called bubble CPAP. The resources were there in their own environment, but they didn’t know how to put them together. Traci had learned bubble CPAP in a camp in Cambodia. Just as my information for the surgeon in Guatemala was bottlenecked in Boston (see my earlier post), this knowledge in Cambodia was bottlenecked and had difficulty getting to sub-Saharan Africa.

This is the prototype built by IBM Interactive. We’ve trialed it in Beirut, the U.S., South America; it’s gone around the world.

The module, part of what we call the Pediatric Intensive Care Unit (PICU) Without Walls, is designed to exist in a connected and disconnected state. It’s designed to go on a thumb drive and plug into a simple CPU. Whenever that CPU connects to the web — like by dial-up modem every six weeks as it does in Cambodia — it can reach up into the “cloud” and pull down the most updated information.

It’s designed to provide information on demand, so you can connect no matter where you are in the world and know you’re getting reliable information on how to care for a critically ill child. Not information that comes in a long PDF file, but information that’s dosed in a way that’s effectively used by you. We can use the adult learning principles that my son is using in gaming to make this information transmittal more effective.

It’s designed to give curriculum maps so we can train people around the world. And it’s designed to create a social network so we can exchange ideas on what works. So experts in Boston and Hanoi and Bangalore can be on the web to explain how things work.

The information exchange is not just a one-way transfer.  I know very little about malaria, and I’ve never treated Chagas disease -  yet they afflict many children in the world.  To explain how to treat these children when they become dehydrated, what’s needed isn’t me out of Boston. It’s my colleagues in Bangalore who see 1,000 children a day. We need to put them on the web to explain, “This how you safely rehydrate a child.”

This platform is not a panacea, it’s not a universal solution for healthcare in children, but it is definitely a beginning. We can make this not only a smarter planet, but a better planet.

Jeffrey P. Burns, MD, MPH, is Chief of the Division of Critical Care Medicine at Children’s Hospital Boston. He established and is Executive Director of the Children’s Hospital Simulator Program, one of the first hospital-based pediatric simulator programs in the U.S., and also co-chairs the hospital’s Ethics Committee.

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