Craig Lehmann, Dean/Professor, Stony Brook University
Stony Brook University is in the early stages of creating a community- and school-based health model entitled “Health Care at My Fingertips” (HCAMF) which will improve health care access for 150,000-200,000 women, newborns and young children in Illeret, Turkwel and Meru, Kenya. The project will empower communities from these underserved and remote rural and urban regions to adopt a new health care model that combines electronic medical records (EMR), hand held portable ultrasound diagnostics, e-health technology and community health workers (CHWs). Maternal women, infants and children will be linked to primary and specialty care at distant hospitals using wireless e-health units operated by CHWs that will be recruited from and trained within each community. The CHWs will conduct health screenings and provide community based health promotion targeting women and children. This combination of two proven models (e-health and CHW) represents a new paradigm for providing access to existing health promotion, disease prevention and treatment strategies that may be replicated in many parts of the world. Kenya’s 2005 Millennium Development Goal status report indicates that the country needs to adopt greater control measures to meet many of its MDGs, including those for child survival and maternal health. The infant mortality rate in Illeret and Turkwel are estimated to be much higher than their district rates of 76/1000 and 66/1000 respectively. This compares to a country rate of 64/1000. Immunization coverage in pastoralist areas has improved but lags far behind the rest of the country. In Illeret, for example, a needs assessment report conducted by The Turkana Basin Institute estimates that only 29-55% of children had an immunization card. Meru’s student population of 100,000 is at risk from a lack of HIV, TB, malaria, vaccination and other health data. An epidemic is possible, as demonstrated by a recent polio outbreak. A woman in Africa has a 1-in-26 risk of maternal death, compared to 1 in 7,300 in more developed areas. The major source of maternal mortality in sub-Saharan Africa is hemorrhage associated with childbirth. The region has the lowest rates for caesarean interventions (3.5%), indicating a high risk of death and/or mutilation. Mt. Meru Hospital receives many patients referred from neighboring institutions and is in dire need of assistive technology such as ultrasounds. However, residents have limited access to health care facilities. The nearest hospital to Illeret is 136 miles. The only clinic is served by two nurses who are unable to diagnose even the most basic diseases, yet it serves 13,000-15,000 residents from 18 scattered and distant villages. The only health clinic in Turkwel lost funding years ago. Health care in Meru is more available but costs and distance are major barriers. HCAMF will use wireless technology to link remote, low resource hospitals and clinics to competent clinicians that would not otherwise be available. Technology deployed within a community based health model will provide basic diagnostics including new portable hand held ultrasounds, e-health technologies, point-of-care testing (POCT), electronic medical records (EMRs), and health education as never before possible.
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