Battling disease

The developing world suffers from many curable diseases. So, why aren’t we curing them?

Without drastic increases in funding and public awareness, the plight of people affected by the neglected tropical diseases is unlikely to lessen anytime soon.

Once upon a time, the world suffered.

In 1987, 20 million people across the world were plagued by a debilitating, painful and potentially blinding disease called river blindness. This parasitic infection caused pain, discomfort, severe itching, skin irritation and, ultimately, irreversible blindness, leaving men, women and children across Africa unable to work, care for their families and lead normal lives.

But the recent discovery of a drug called ivermectin was about to change it all. Not only was ivermectin cheap and easily synthesized, but it was also a powerful cure: With only one dose a year, it was possible to completely rid patients of disease and even halt the progression toward blindness. In short, ivermectin was a miracle drug – one whose discovery would lead to Satoshi Omura and William Campbell winning the Nobel Prize in medicine in 2015.

There was no time to be wasted. Recognizing that the populations most at risk of disease were those least able to afford treatment, Merck & Co pledged to join the fight to end river blindness. Thirty years ago this October, the pharmaceutical company vowed that it would immediately begin distributing the drug free of charge, to any country that requested it, “for as long as needed.” It was the final piece of the puzzle: an effective drug for a tragic and completely preventable disease. And we all lived happily ever after.

Only… we didn’t.

Merck’s generous offer should have been the final chapter of a brief story with an upbeat ending – the eradication of a tragic and preventable disease that had plagued humankind for centuries. But such was not the case: 30 years later, in 2017, river blindness rages on across the world, afflicting as many as 37 million people, 270,000 of whom have been left permanently blind.

Neglected tropical diseases like river blindness stand in stark contrast to those like tuberculosis, which is estimated to affect a third of the world’s population due to the increasing prevalence of highly antibiotic resistant strains.

In short, tuberculosis has stuck around because medicine has run out of drugs with which to treat it – which is why, as a molecular biologist, I am researching new ways we can finally defeat this stubborn disease.

But this only increases the urgency for river blindness and other widespread diseases for which, unlike tuberculosis, science does have effective cures – and inexpensive ones at that. Even with all the necessary tools, the world has failed to cure the curable.

Turning a blind eye

One-and-a-half billion people across the world suffer from neglected tropical diseases, a group of infectious diseases that prevail in tropical and subtropical countries lacking good health care infrastructure and medical resources. These diseases typically do not kill immediately but instead blind and disable, leading to terrible suffering, creating losses of capital, worker productivity and economic growth.

Thirteen diseases are universally recognized as neglected tropical diseases. At least eight of these diseases, including river blindness, already have inexpensive, safe and effective treatments or interventions.

For less than 50 cents per person, the United States could cure a fifth of the world’s population of these severely debilitating and unnecessary diseases. In spite of this, the United States allocates nearly as little to treating and preventing neglected tropical diseases around the world as it does to drugs for erectile dysfunction.

The forgotten fevers

Consider dracunculiasis, or Guinea worm infection, which occurs when people consume water contaminated with fleas carrying parasitic worms. The worms mature and mate inside the human body, where they can grow to be two to three feet long.

A girl in Juba, South Sudan, has a Guinea worm extracted from her leg. Photo credit: Skye Wheeler/Reuters
A girl in Juba, South Sudan, has a Guinea worm extracted from her leg. Photo credit: Skye Wheeler/Reuters

Adult females eventually emerge from painful blisters at the extremities to lay eggs in stagnant water, where offspring will infect water fleas and begin the cycle anew.

No drug exists that can cure Guinea worm, but because of a cohort of mostly privately funded public health efforts, the number of Guinea worm infections worldwide has dropped from 3.5 million in the 1980s to only 25 in 2016.

Funding from the U.S. and other countries could help in the final push to eradication, and some argue that funding from the individual countries themselves could help.

Another example, albeit more grim, is the group of soil-transmitted helminths, or worms. Roundworm, hookworm and whipworm collectively affect over a billion people across the world, all in the poorest areas of the poorest countries. All these worms infect the human intestines and can cause severe iron deficiency, leading to increased mortality in pregnant women, infants and children. Furthermore, hookworm infections in children retard growth and mental development, leading to absences from school and dramatically reduced labor productivity.

However, soil-transmitted helminths can be expelled from the body with a single pill, each of which costs only one penny. What’s more, preventing infection in the first place is completely achievable through increased awareness and sanitation.

The purse strings of nationalism

Without drastic increases in funding and public awareness, the plight of people affected by the neglected tropical diseases is unlikely to budge anytime soon.

The U.S. spends over $8,000 per person per year on health expenditures, compared to countries in Africa that spend around $10. While this opens the door to a critique on efficiency, it’s far more indicative of the disparities in health resources.

Less than 20 percent of the world’s population lives in some of the most developed and economically high-functioning countries, including the United States – and nearly 90 percent of the world’s total financial resources are devoted to the citizens of these nations. And yet, low-income countries bear the majority of the world’s infectious disease burden. In short, the rest of the world does not suffer the same diseases the United States does, and Americans are doing little to nothing about it.

At first glance, this is not so surprising. As a whole, the world suffers – but how many neglected tropical diseases currently penetrate American borders?

Some experts predict that eliminating or controlling the neglected tropical diseases in sub-Saharan Africa alone, which shoulders over 40 percent of the global burden of neglected tropical diseases, could save the world $52 billion and over 100 million years of life otherwise lost to disease.

Conversely, some global health experts estimate that for every dollar spent on neglected tropical disease control, we get back over $50 in increased economic productivity. By increasing awareness and funding of neglected tropical disease eradication, the United States will be making one of the best global investments possible. The rest of the world has waited long enough.

Katherine J. Wu, Ph.D. Candidate in Microbiology, Harvard University.

This article first appeared on The Conversation.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

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Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.