Technology is not a silver bullet but harnessing the digital age and the Fourth Industrial Revolution could help in reaching the United Nations (U.N.) Sustainable Development Goals by 2030.
As part of the Global Health Equity Week ’22, several HIMSS members inspired the students at Trinity School in Bronx, New York by speaking to them about using technology in bold new ways to solve global health problems for a more equitable and sustainable future for all. Speakers included Dr. Alex Morozov, physician-scientist; Dr. David C. Rhew, global chief medical officer at Microsoft; and from GlobalRise, John Casillas, executive director and Karen Salazar, global nutritionist.
When Mr. Jason Ford, middle school principal at Trinity School, learned about the many health crises in Uganda, he pulled out all the stops to organize a day of educational activities. In fact, two of his students, along with eight HIMSS members, had visited the East African country during the summer. The educational classes included two lunch-and-learn sessions that were filled to capacity, and a session in the main auditorium for all students.
The HIMSS member panel shared two cases about bold uses of technology that have the power to improve nutritional health, and to expand access to surgical care: drones to improve livelihoods of remote mountain communities, and augmented reality to provide high quality surgical care in a rural setting.
Uganda is a landlocked, low-resourced country with a population of 47 million living in the geographical equivalent of Oregon. If all the people from California moved to Oregon, then you can imagine the density of Uganda. This tropical country on the equator is lined by the Rwenzori Mountain glacier range on the west, but due to climate change in eastern and northeastern Uganda, the rainy season is unpredictable, and droughts are more common and severe.
The Rwenzori Mountains offer majestic, sacred spaces for indigenous populations yet the Bakonzo tribe who live there battle a lifetime of health inequities. Despite rich soil and climate conducive to growing crops most of the year, the main dietary staples consist of carbohydrate-rich, nutritionally poor foods such as plantains and corn, with no protein of vegetables.
Following a five-month mission in Africa and India, the GlobalRise team arrived in New York just a day before their presentation at Trinity School. They started the panel discussion by providing context around stunting, a developmental delay caused by chronic malnutrition from birth. Stunting is a scourge affecting millions of children worldwide. Then they shared with students a story of a young child homesteading in the glacier mountain range. The child is one of countless others who live off the land without quality nutrition, schooling, or healthcare and, as a result, are often diagnosed as stunted, or with severe acute malnutrition (SAM).
The challenge in this unique steep mountainous terrain, with no accessibility to various public services, is about harnessing the power of culture, good nutrition, technology and food systems to transform the lives of these families and communities.
Owed to the nutritionally deficient diets in the Rwenzori Mountains, the rates of stunting are staggeringly high – up to 50%. GlobalRise’s multi-disciplinary team is tackling this issue by building a “digital food system.” The system tethers crop transport drones, saving the people hours of walking to markets for income; and creates a contextualized nutrition regime monitored with digital health tools. The program could help 300 million mountainous people improve their nutrition and income.
There are 17 U.N. Sustainable Development goals designed to connect and support one another. For example, GlobalRise is shepherding healthy diets and good nutrition habits (Goal 2: Zero Hunger) to mountain dwellers, which will help prevent disease and illness (Goal 3: Good Health and Well-being) like childhood stunting. The nonprofit’s community nutrition program includes producing clean water by teaching dwellers proper filtration practices and lessons in soap making for personal hygiene (Goal 6). They work to address the inequity of smallholder farmers in the mountains who are disproportionately women, yet they are often not in control of their lands (Goal 5: Gender Equality). Lastly, healthy children have better learning outcomes (Goal 4).
Good nutrition is a force multiplier for good health. GlobalRise graciously hosted HIMSS members for two weeks in Kasese, Uganda. The team assessed the feasibility of connecting smallholder farmers in the mountains to local markets through cargo drones, a mobile commerce app, and a data-rich geospatial mapping system. The team also explored with hospital leaders on various ways to transport digital health solutions through the cargo-drone system and improve access to health services for mountain dwellers with these technologies.
Back in Trinity School in New York, these stories fully engaged the students and they asked thoughtful questions:
"How many drones will it take to do this? It seems like it might take a lot!"
Answer: We think seven to 10 drones on a rotating schedule to different areas of the mountains would be sufficient, but that needs to be engineered and modeled. We would be transporting to mountain centers and not directly to their homes. The local people would still need to walk a short distance, but it's much closer than the three-hour walk into town.
"How many drones do you need right now?"
Answer: One; and we are looking to rent, not buy, so we can prototype the system, and isolate metrics for scaling.
"If they eat like that today, isn't that healthy?"
Answer: (We showed students what a healthy meal looks like with locally produced foods that are balanced on the plate.) Unfortunately, that's not how they are eating today. The local diet mostly consists of matoke, known as plantains, and other starches without greens or fruits, which can lead to stunted growth.
Architecting systems to exchange food, commerce, and care in highly populated, remote mountain areas is possible through innovation, and has the transformative power to raise families from poverty, eradicate childhood stunting and provide access to health care.
More than 5 billion people worldwide, predominately in low-resourced countries, cannot access simple, affordable, and safe surgical operations and procedures, and as a result, millions die each year. This staggering statistic demonstrates a global shortage of surgical talent and resources, which alludes to the complexity of removing barriers to access. Dr. Michael L. Marin, surgeon-in-chief of Mount Sinai Health System in New York, is threading the needle through the complexity to bring a pragmatic vision to provide surgical care to underserved populations.
To that end, the Kyabirwa Surgical Center was founded in 2019 near the source of the Nile in Eastern Uganda. Through philanthropic efforts, the center was founded to disprove the misperception that surgery is too complex and too expensive for rural communities. The collaboration between Mount Sinai and the Kyabirwa Center spans over 7,000 miles, but with technology, solar power, a dedicated internet trunk line, and assistance from doctors in New York, the local physicians and clinicians are fully equipped to perform safe and affordable surgical care to rural patients.
Doctors across the continents collaborate in real time using a combination of technologies in Microsoft Teams, Dynamics 365 Remote Assist, and HoloLens 2. Surgeons at the Kyabirwa Surgical Center consult with colleagues in New York on cases and even share real time views from their respective operating rooms. For example, Mount Sinai surgeons can see exactly what a doctor at the Ugandan center sees through their mixed reality headset and make visual notes to offer suggestions during a procedure.
At Trinity School, Dr. Rhew demonstrated HoloLens 2 technology to students who navigated a human skeleton, interacting virtually with bones and organs. The students were excited by the virtual experience, amazed by how it worked, and inspired by how technology could improve lives and potentially save millions.
The success of using technology in bold new ways has far-reaching implications, and the power in convening those who have, with those who have-not, is truly a model that can shift global health with yet-unimagined outcomes to save and improve lives. Using technology in innovative ways has the potential to connect those with resources to those without. Change like this can shift the global health ecosystem in positive ways that we have yet to realize.
The HIMSS vision is to realize the full health potential of every human everywhere; its mission is to reform the global health ecosystem through the power of information and technology. The global impacts of population growth, married with climate change, will require that we use technology in bold new ways to improve access to, and quality of, health services and preventive care.
There are 17 U.N. Sustainable Development Goals, and technology plays a crucial role in making progress toward all of them. Making progress requires keeping pace with global changes, and will span generations.
That is why it’s important to engage youths in these real-world challenges, inspire their curiosity through the power of technology and empower their creativity now. It may give us a greater chance to make the much-needed life-changing progress.
(Learn more about GlobalRise and meet Executive Director John Casillas, who is harnessing information and technology to pioneer a digital food system in the world's most remote areas with the highest rates of childhood stunting.)