Keeping it Simple in the Developing World

Did you know that three-quarters of the 40 million sightless people in the world don’t have to be blind? According to ORBIS International, a global nonprofit organization, most of the world’s blind population owes its lack of sight to a lack of access to care.

ORBIS’ mission is to eliminate avoidable blindness by "strengthening the capacity of local eye health partners in their efforts to prevent and treat blindness." Through a process that ORBIS calls capacity building, local partners gain "self-sufficiency in eye health care and residents enjoy quality eye health services that are affordable, accessible and sustainable."

As part of ORBIS’s broad-based capacity building program, the organization works with carefully selected local partners on projects typically lasting at least three years. ORBIS has about 100 of these active partners, which include hospitals, health centers, universities and training centers, local non-governmental organizations (NGOs), eye banks and government health departments.

Currently, ORBIS' long-term capacity building projects are taking place in Bangladesh, China, Ethiopia, India, Vietnam, Peru and Jamaica; the group relies on an active pool of roughly 500 volunteer faculty members to provide clinical and technical expertise at local hospitals.  In addition, ORBIS' Flying Eye Hospital — a ophthalmic surgical and training center located onboard a DC-10 aircraft--uses volunteer pilots from FedEx and United Airlines to transport the Flying Eye Hospital from one destination to the next.

Consider the case study of Ethiopia to get a sense of what ORBIS does on the ground. Ethiopia is burdened with one of the world’s highest levels of avoidable blindness. An estimated 1.6% of the population is blind, with approximately 12% of this blindness caused by trachoma — a highly infectious eye disease that is entirely preventable.

ORBIS explains that “trachoma is spread through contact with an infected person’s hands or clothing, or by flies that have come in contact with the discharge from an infected eye or nose. When left untreated, repeated infections lead to trichiasis, an agonizing condition in which the eyelid turns inward, causing the eyelashes to painfully ‘rake’ across the surface of the eye, scarring the cornea and eventually leading to blindness.”

How to fight trachoma? ORBIS’ “strategy includes a national effort to build latrines, educate community members on trachoma prevention, and train rural eye care workers to distribute antibiotics and perform sight-preserving eyelid surgeries. These interventions cost very little but contribute immeasurably to an individual’s quality of life.”

The action plan above isn’t as simple to implement as it may sound, but it is straight-forward and relatively cheap. It’s also very necessary: as Maggie noted back in October, “developing nations spend $500 million to educate health care workers who leave to work in North America, Western Europe and South Asia,” a trend that leaves countries like Ethiopia with a shortage of medical experts. As one JAMA article put it, “unchecked flows of health workers leave regions with the greatest health care needs with the fewest workers…37% of the world’s health care workers live in the Americas, predominantly in the United States and Canada, yet these countries carry only 10% of the global disease burden. In contrast, Africa is home to only 3% of the world’s healthcare workers, yet it has 24% of the global burden of disease.”

The sort of work that ORBIS does—community-based education and prevention—is extraordinarily important because it is operating in a context of much disease and few medical workers. The work of ORBIS also casts an exceptionally unflattering spotlight on some of the other health care issues in the developing world that we’ve discussed here on Health Beat. Recall that:

• In November, Maggie pointed out how Big Pharma bribes doctors in developing countries in order to encouraging the selling and prescribing of their products: “In Kashmiri, a physician confides, ‘representatives of pharmaceutical companies offer cash, refrigerators, color televisions, laptops, PCs, mobile phones, ovens, phone bills, [and even to pay school] tuition [for your] children.'
     
  “In India, a doctor from Mumbai reports:  ‘On sale of 1,000 samples of the drug, you get a Motorola handset. On sale of 5,000 samples you get an air cooler. On sale of 10,000 samples get a motor bike.’”
     
   
• In March, Maggie wrote about how pharmaceutical manufacturers are “up in arms” because countries like Thailand are importing “less expensive generic versions of drugs for which these companies hold a patent monopoly”—including anti-AIDS and cardiovascular drugs.
     
   
• Just last week, I penned a post on medical tourism and pointed out that the practice of traveling to countries like India, Thailand, or Malaysia in order to receive medical care ends up creating a two-tiered health care system which leaves poorer citizens out in the cold. In India, for example, the WHO worries that “medical tourism could worsen the internal brain drain and lure professionals from the public sector and rural areas to take jobs in urban centres” and notes that medical tourism “does not augur well for the health care of patients who depend largely on the public sector for their services.”

Bribery, monopoly, and the creation of a two-tiered health care system—these are the scourges of global healthcare. Organizations like ORBIS help show us another way to approach health care improvement in developing countries. Be sure to check them out.

Comments

[Maggie Mahar]

Vadim--

Thank you-- information about effots to create
sustainable health care in developing countries is always welcome.

[Vadim]

Another organization that works to establish sustainable health care in West Africa is GlobeMed.

You can read more about them and support them here: http://tinyurl.com/6k8uj3