April 6, 2012

Good Friday Señor Nerlens Noel’s High Top Fade. Did you mean to say “Commodore Perry” instead of “Commode Perry”?  Interesting slip, considering how technologically advanced the toilets are in Japan.  Some of them even have a volume control for the loudness of the flushing sound. 

In Kyoto, we toured Nijō Castle, the place where the Tokugawa shogun signed over power to the Emperor: the Meiji Restoration. I think the tutorial went well.  I was happy with the experience, both putting the presentation together and delivering it at ICASSP.  Exclusively for the readers of the blog, here are the slides from the tutorial.

After coming back from Japan, I took the Westchester Express up to Ossining with a gregarious Jamaican driver.  Among the many topics we talked about, one, related to your “food binge,” was about tasty food, healthy food, and getting ‘sugar.’  He recalled once during his bucolic childhood getting invited to a wealthier girl’s house for dinner, being served lots of vegetables, and being miffed at why these rich people weren’t eating tasty food like fried chicken and rice.  Now that he is obese and diabetic, he is starting to change his diet to include more vegetables.  If there could be someone who does to dually healthy and tasty food what Lender did to bagels (cheap and accessible everywhere), I think he or she could disrupt the world populace and economy even more than potatoes did.

But in its absence, let us turn to diabetes.  In February, Chacha (a physician and proprietor of Navjeevan Hospital in Aligarh) and I had a discussion on using technology to better serve his rural patients who are being treated for chronic diseases such as diabetes and hypertension.  Primarily due to his reputation and quality, some patients travel more than fifty kilometers from rural outposts to consult with him.  He is overloaded with patients and has no time to sit in peace.

By his estimate, approximately 80% of his time is spent in patient consultations and 60% of those consultations are regarding those two chronic conditions. He also says that once such a patient is in a holding pattern, in-person consultations are overkill; treatment dose adjustments can be made by the physician just based on numerical values from test results remotely with very little or no degradation in patient outcome.  If technologically implemented in a good way, the physician can crank out such adjustments in less than a minute per patient as opposed to four or five minutes required per patient for an in-person consultation. If done remotely, the patient saves the significant time and monetary expenditure of traveling to Aligarh and the physician saves time, allowing him to serve more patients.  Doing so could be disruptive just like Lender’s Bagels.

For any human system to work, everyone involved needs to have some incentive.  Let’s start with the patients. 

  • Another topic of conversation with my Jamaican driver was when he was growing up there was no television, listening to the radio was a big thing, and hearing stories from someone who had just returned from the big city was an even bigger thing.
  • Clearly, not traveling to Aligarh saves the patient a day or two of lost earnings and also the travel expense.
  • As written by Bhaduri in the most recent issue of OR/MS Today, “According to WHO regional advisor Kathleen A. Halloway, a majority of Indians spend about 70 percent of their income on medicines and healthcare.” “More than 40 percent of low-income families in India have to borrow money from outside the family to meet their healthcare costs. Almost 16 percent of families had been pushed below the poverty line by this trend.”
  • The physician can offer a reduced fee for remote dosage adjustment as compared to in-person consultation.

Now the physician: Chacha’s objective is to serve more patients at more-or-less current levels of outcomes, stay sane, not decrease bottom line monetary profit, and not decrease his reputation.  Other physicians may have differing motivations, but some fraction will share Chacha’s.

There’s a third type of individual involved in the system as well: the medical laboratory technician.  When Chacha’s rural patients come to him, they bring paper reports with the results of blood tests administered close to their homes.  Sites for medical tests are much more ubiquitous than physicians of repute.  For remote dosage adjustment to work, especially if many patients are illiterate, the medical technician will have to transmit the results to the physician.  If there is very little effort involved for the technician, then simple monetary compensation should suffice.

I’m going to continue with this later.  In the meantime, I encourage readers to donate to Global Health Bridge by going here, just as you did earlier this week.


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