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Medical Resilience in Developing Countries Joseph (Jay) McIsaac, MD, MS VP, Director, Partner, Integrated Anesthesia Associates, LLC Associate Clinical Professor, University of Connecticut Chief of Trauma Anesthesia, Hartford Hospital Supervisory Medical Officer, NDMS, US DHHS Disclaimer • I am an intermittent employee of the US National Disaster Medical System. Nothing in this talk should be construed to represent the policies of the US government. All opinions are entirely my own. Overview • Infectious Diseases • Hospital (Clinic and Medical Office) Resilience • Medical Supply Chain • Business Opportunities Maslow’s Hierarchy of Needs Healthy Population = More Productive Economy • “The economic effects of population health can be seen both at the individual and macroeconomic levels [GDP]. There is no real dispute about the presence of these effects on economic development…” -Bloom and Canning, Population Health and Economic Growth, WORKING PAPER NO. 24, The International Bank for Reconstruction and Development / The World Bank, 2008. Infrastructure Burden of Disease Infectious Disease and Trauma • Infectious Disease • Pediatric (Gastrointestinal (clean water; sanitation) + respiratory + vaccine preventable childhood diseases) • Vector borne infectious disease: • Acute- Zika, Chikungunya, dengue, yellow fever, malaria • Chronic (Chagas, helminths, onchocirciasis, schistosomiasis, malaria) • Trauma • Pediatrics- falls, burns, drowning • Adults- traffic accidents, work accidents, violence, disasters • Both are preventable or can be reduced substantially Zika Virus Disease • Mosquito transmitted • First identified in Africa • Mostly mild disease (fever, headache, and rash) • • • • Birth defects Encephalitis Guillain-Barre Disease (paralysis) Sexual transmission Neglected Tropical Disease Distribution Vectors Vector Control • Avoid (Good luck!) • Barriers (window screens, nets) • Repel (DEET) • Trap (mosquito magnet, etc) • Kill (insecticide) • Interfere with reproduction • Interfere with habitat (drain standing water) Medical System • Hospital, Clinic, and Office : • Staff (health and safety, family security, transportation, training) • Structural Integrity (Floods, winds, seismic) • Power and water infrastructure • -Filtration and purity, storage of water • -Alt. Power Sources: wind, solar, steam piston or turbine engine • Supplies • Medications (pharmacies and manufacturing) • Bandages, disposables, and equipment Safe Hospitals • PAHO (WHO) Safe Hospitals Initiative • • • • • • Resistance to earthquakes and floods Hospital Safety Index Baseline Assessment Tool Sustainable Design and Construction Guidelines Cost Benefit Analysis Model Policies Power and Water • Water storage and filtration • Alternate power generation • Solar • Wind • Steam • Fossil fuel Medical Supply Chain Resilience Business Development Focus Group [Business Plan] • Technical • • • • • • • Meteorologist/Climatologist Public Health/Epidemiologist Infectious Disease Physician Entomologist Architect Civil Engineer Logistician • Business • • • • • Economist Contracting Finance Insurance Country Specific Experts • Partnering • • • • PAHO/WHO Government Agencies (US and non-US) Institutional: Major Universities and University Hospitals (US and non-US) NGOs
