Global Health Initiatives

Summer travel incites excitement in some and dread in others — on one hand you have a shake up in the routine, new experiences, and potentially getting away from the blazing heat of your hometown; on the other hand you could be facing long lines at TSA, daunting credit card bills, and general jet lag. For Ruvos Partner and Founder Jeff Couch, summer travel has struck a slightly different chord the past few years. While some of us were revelling in our weekend getaways to Wild Adventures water park, Jeff was — almost literally — circumnavigating the globe in the name of public health. Let’s retrace his steps.

Saturday June 9th

Jeff departs from his home in Tallahassee in the morning and 30 hours later, makes it to Bangkok, Thailand by Sunday night. We can only imagine his trip was filled with a few episodes of Malcolm Gladwell’s Revisionist History podcast and several naps.

He preps for the week-long workshop ahead, paying special attention to Wednesday and Thursday, when he will present to a group including Medical Directors, Laboratory Directors, Directors of Public Health, Laboratory Information Systems (LIS) Managers, Doctors, Scientific Officers, Medical Specialists, Data Managers, and Medical Technologists on automation in data governance and security. Along the way he will guide his audience of clinicians and advise them as to what open source tools they should use based on each tool’s strengths and weaknesses.

The idea is to make the presentations high level, for his primary goal is to persuade these clinicians to understand the benefits of the tools we use for data exchange domestically and — if they are convinced — bring the materials back to their home countries to discuss individual feasibility with data engineers and changemakers. That’s right, Jeff isn’t the only weary traveller at this first week-long workshop, the 20 representatives in attendance hail from 10 different countries including Bangladesh, Bhutan, Cambodia, Indonesia, Kazakhstan, Malaysia, Pakistan, Thailand, and Vietnam.

The rest of the week’s agenda is purposefully sparse, leaving plenty of time for small-group collaboration and exploration of both 1) ideas and 2) the magical city of Bangkok.

Back in Florida

Sunday the 17th, Jeff only has a week to prepare his presentations for his next trip. By the 24th he lands in Nairobi, Kenya, drained again from globetrotting, but revitalized by the work that is yet to be done. Kenya played host to African countries of the GHSA including Côte d’Ivoire, Kenya, Ghana, Liberia, Nigeria, Sierra Leone, Mali, Senegal, Tanzania, and Uganda. Similar in structure but with a curriculum customized for the continent, the participants and facilitators enjoy the collaboration of public health improvement and problem-solving.

We sometimes take open healthcare data sharing for granted in developed countries like the United States; a handful of these workshops had attendees who’s home country’s data sharing networks depend on unreliable power grids, and others operate under governing bodies that have outlawed data sharing between provinces. For comparison’s sake, this would be like if the United States had a federal statute outlawing an Emergency Room doctor in Georgia from requesting medical records from a patient’s primary care facility in Tennessee. These great minds gather at these workshops to learn from successful Subject Matter Experts (SMEs) on the tools they use to connect hospitals and laboratories together and share data.

When we talk about tools in this context, we’re talking more about open-source and proprietary data integration tools than hammers and drills. For example, Mirth is an Integration Engine; we deal with Integration Engines daily at headquarters and at various client sites, for they are the tools that allow us to seamlessly and scalably integrate healthcare messages between disparate systems (2). An Integration Engineer — like one of the many on our team — will configure and deploy these things called channels, through which messages flow based on those configurations. [Side note: sometimes I ponder over the meaning behind these tools’ names. Denotatively, mirth is a noun meaning amusement, especially as expressed in laughter. I have never seen these folks express such outward joy during interface development, so do with that what you will.]

So what role does a data movement tool play with regards to Global Health?

Data movement is the backbone of data sharing. Without secure, fast, and reliable data movement, data sharing is a very nice pipe dream. These integration tools make the dream of patient Electronic Health Records (EHR) and Electronic Medical Records (EMR) a reality. For reference, EHRs have existed in some form since the 1960s; The United States signed their mandatory use into law via HIPAA & HITECH in 2004. As many may remember, before their inception all medical records were kept…on paper.

Enter: The Global Health Security Agenda (GHSA), which is a partnership between two of our partner organizations the Centers for Disease Control (CDC) and the Association of Public Health Laboratories (APHL). So far, 30 countries have benefitted from the work that the GHSA has done, 5 of which involved hands-on work from Ruvos team members. In 2016, we traveled to Vietnam to meet with their Ministry of Health and advise their leadership on cloud migration strategy. Discussed earlier, this is one of those countries that did not allow any open data sharing between provinces at the time we were asked to advise them on strategies for implementing open data sharing, so this was a tall task. Since 2016, meetings with the Ministry of Health, continued education, advisement, and proof of concept from Ruvos and the GHSA has dwindled barriers that long prevented a solution. Last month, Vietnam announced that all citizens will have an EHR by 2019 (4).

In 2017, we travelled to Tanzania and Mozambique for a similar purpose, explaining the costs and benefits associated with open data sharing and data integration tools to clinicians. A few months after those trips, the Ministry of Health of Tanzania sent Freddie, a data engineer and representative from their country, to the United State for us to host. Jeff made it his mission to take Freddie on the burger tour of Tallahassee — in true Jeff fashion — but the real tell of a successful mission was sending Freddie back to Tanzania fully trained and certified in Mirth. This summer’s trips to Thailand and Kenya close out another round of GHSA efforts.

In the US we both become aware of and crack down on rampant infectious diseases quite quickly thanks to technology like Advanced Molecular Detection (AMD) and reportable disease data tracking software. And conceptually, everyone understands the importance of systems put in place to protect the public from outbreaks of infectious diseases and promote general wellness; however, importance of cause doesn’t always dictate the order in which needs are satisfied. When I spoke to Jeff about his then upcoming trips, this seemed to interest him quite a bit, adding that he is “most excited to learn about how things work in other areas — our solutions may not work elsewhere due to political, cultural, or economic factors”

After 30 Years

Unfortunately, after 30 years of should-be advancements in medicine and healthcare technology, sub saharan African nations saw only a .3% improvement in average health metrics compared to a mean increase of 11.12% in the rest of the world. Further, Central and Eastern European block countries actually saw a decrease in life expectancy at birth (1). The World Health Organization contributes these trends to factors such as inequitable globalization, spread of superbug diseases like Ebola virus, a and lack of access to immunizations, sex education, and prenatal and maternity care. Further, time and time again these primary factors are not tended to due to secondary factors like selective or inappropriate health sector reform and a lack of sustainability in programs. What underlies all of these factors, however, spoke to me: a “lack of communication and competing interests between funder organizations”.

a “lack of communication and competing interests between funder organizations”.

In an age when people in developed countries are living longer than ever before, it is inexcusable that the underlying reasons for such staggering health crises have nothing to do with health. The Global Health Security Agenda is unique in that it is actively aware of these traditional shortcomings in international health aid, and works just as actively to combat those threats. GHSA has a publicly available roadmap that extends through 2024, which provisions Action Plans for prevention, detection, and response to several major threats faced in participant nations. GHSA also bolsters sustainability by not taking on more countries than it is capable of helping. We are overwhelmingly proud of the work we have done in the last few years with GHSA, and we look forward to the next success story.

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