Transcript Developing Enduring Professional Relationships in a

Developing Enduring Professional
Relationships in a Changing
World Climate
By
Zina C. Munoz, R.N., B.S., C.E.N.
Director
The Renal-Tech Donation Project
Introduction
While healthcare workers in the developing world struggle on the
front lines of the world's most serious public health problems, their
efforts are severely hampered by a lack of information.
The inability to access and use medical information readily available
to those in the developed world remains one of the most serious
obstacles to better health in the developing world.
Building enduring professional relationships in the current climate of
political and social unrest depends upon bridging the gap between
developed and developing nations.
Communication
The key to developing enduring professional relationships
within the global medical community is COMMUNICATION.
Communication is the basis for all human interaction.
Technology has given us a variety of methods to communicate
efficiently over vast distances and in short amounts of time.
It is a fact that technology and access to it is not evenly distributed
among the peoples of the world.
Those who need technology the most, have the least access to it.
The Information Gap
Of the 52 million deaths worldwide during 1996, over 40
million of them were in the developing world. More than 12
million of them were children under the age of five, most of
which died from preventable causes. Many of these deaths
could be avoided and several of the problems faced by health
professionals could be overcome if the adequate information
was at hand when needed. But, information poverty is one of
the most serious obstacles facing health professionals in the
developing world.
For example, Africa is estimated to have only 4.15 million of
the 544 million estimated Internet users as of February 2002.
Barriers to Global Communication
Accessibility
Reliability
Cost
Language
Accessibility
Prerequisites for Internet use - telephone and electricity
There are three pre-conditions for using the Internet. First you
need a phone connection, second a computer and a modem and
third electricity.
One in three people globally lacks access to electricity.
80 % of world population doesn't have a telephone line.
Ownership or even access to a computer and modem is limited
to a relatively minute portion of the world’s population.
Reliability
A shortage of infrastructure, notably of telephone lines, is a major
obstacle to increasing Internet access in developing countries.
For example, the average waiting time for a telephone line ranges from
5.3 years in Zimbabwe, to 10.9 years in Tanzania, to 48 years in Nepal.
Even when telephones are available, they frequently malfunction.
In some African capitals, phone lines can be down up to 50 percent of
the time. Completion ratios for local and long-distance calls within the
Southern Africa Development Community average 30 percent--and are
far lower at peak calling periods.
Similar problems are faced with respect to electrical service. Such
service can cut out at any time with brownouts and power surges that
destroy computer equipment rather quickly.
Cost
The cost of a computer and modem in many developing nations can
be as much as 8 times the average personal yearly income.
Institutions in developing nations fare little better than individuals in
obtaining computers for use by their medical staff.
Even when technology is available, it becomes quickly obsolete in
comparison to the equipment used by developed nations.
Conditions in many developing nations put more stress on delicate
equipment and the availability of technical support and repair is
limited.
Language
It is not just a matter of the infrastructure not being readily
available, nor the costs being too high. Even if the
telecommunication resources were in place and affordable, most of
the world's poor would still be excluded from the benefits of global
communication due to illiteracy or the total lack of computer skills.
Further obstacles arise with four-fifths of web sites being published
in the English language, which although favorable to the West and
global patterns of commercial transactions, ultimately excludes the
majority of the people on the planet.
What Developing Nations Need
Training
Reference Material
Access to Journals and Professional
Publications
Clinical Support
Specialized Services
Training
Basic skills – IV certification, BCLS,
ACLS, PALS, etc.
Specialty training - dialysis nursing,
critical care, emergency/trauma, etc.
Continuing medical and nursing
education
IT training, PC repair and network
administration
Reference Material
Medical libraries in the medical schools of developing
nations are severely limited in size and content.
Often the texts that are available are outdated.
Most hospitals have no reference facilities at all.
The cost of one textbook is often more than the what
it takes the average family of four to survive for three
months.
The situation for nurses is even more acute and the
costs more prohibitive.
Access to Journals and
Professional Publications
The cost of just a one year subscription to a medical
journal is often as much as a physician’s yearly income
is some developing nations.
For nurses, the problem is more acute as their rate of
pay is substantially less.
Journals for other support services such as dialysis
technicians, dieticians and social workers are even less
readily available.
This problem keeps the medical staff of developing
nations from access to the latest medical information.
Clinical Support
In specialties such as Nephrology, there are often few physicians in
a given region with whom to consult.
In rural areas, specialty practitioners are basically on their own.
Access to laboratory facilities and pathology services is limited.
The cost of lab tests we take for granted are extremely high.
Because of delays in delivering and processing specimens, the
results may be unreliable or come too late to be of benefit to the
patient.
Complex patients often do not have the benefit of multi-specialty
referrals.
Specialized Services
Renal transplant services are not available in many developing
nations.
Physicians must refer patients who need such services to medical
facilities in other countries.
The communication between the referring physician and the
transplant physician is hampered by the general problems of the
particular nation’s communications infrastructure.
The absence of organ banks and coordinated donor programs has
given rise to the system of “Kidney Brokers”.
Even after transplant, patients do poorly because of inadequate
follow-up and the inability to obtain anti-rejections medications on
a consistent basis.
The Importance of E-mail
and E-Mail Discussion Groups
The web may be the part of the Internet that gets all the attention
but e-mail gets a lot of the work done. Users e-mail important
documents, discuss urgent issues, and make new contacts by using
this simple convenient and efficient part of the net.
The strategic importance of e-mail is particularly significant for
developing nations, where internet connections are still relatively
scarce and expensive. Reducing "bandwidth" waste is at a premium.
While many older computers can not be configured to provide
Internet access, they can be configured to send and receive e-mail.
Thus, e-mail discussion groups become critically important to many
professionals in developing nations as it is their only link to their
colleagues.
A List of Nephrology E-Mail
Discussion Groups
For Nephrology Professionals
1. NEPHROL* - general nephrology, all subjects including renal
pathology and transplantation
(In the body type: subscribe NEPHROL)
2. NEPHADMIN - for nephrology administrators
(In the body type: subscribe NEPHADMIN)
3. NEPHBSCI* - nephrology basic science discussion
(In the body type: subscribe NEPHBSCI)
4. NEPHCNPT* - discussions of individual clinical nephrology
cases
(In the body type: subscribe NEPHCNPT)
Nephrology E-Mail Discussion
Groups continued:
1. NEPHDEVEL* - discussion of humanitarian projects
and ISN Sister Centres Program
(In the body type: subscribe NEPHDEVEL)
2. NEPHINDIG* - discussion of renal disease in
indigenous peoples
(In the body type: subscribe NEPHINDIG)
3. NEPHJNL* - nephrology/transplantation journal club
(In the body type: subscribe NEPHJNL)
4. NEPHMIN - a stripped down version of NEPHROLDIGEST with all repetition and North American specific
content removed, designed for subscribers in
developing countries
(In the body type: subscribe NEPHMIN)
Nephrology E-Mail Discussion
Groups continued:
1. NEPHNPPT* - discussions of individual renal biopsy cases
(In the body type: subscribe NEPHNPPT)
2. NEPHRONOL* - Spanish - English discussion of
nephrology subjects
(In the body type: subscribe NEPHRONOL)
3. NEPHHIST* - history of renal medicine, ISN Video
Legacy Project interview transcripts
(In the body type: subscribe NEPHHIST)
4. KFINT-L* - discussion relating to the International
Federation of Kidney Foundations
(In the body type: subscribe KFINT-L)
5. MDDIALYSIS - for US dialysis unit directors
(In the body type: subscribe MDDIALYSIS)
Nephrology E-Mail Discussion
Groups continued:
1. PDIAL - peritoneal dialysis
(In the body type: subscribe your_email_address)
2. PedNeph - paediatric nephrology (for renal healthcare
professionals)
(In the body type: subscribe PedNeph)
3. RENALPRO - e-mail list for nephrology professionals - nurses,
technicians, dieticians, social workers, administrators,
physicians, engineers, etc.
(In the body type: subscribe RENALPRO)
4. RENALRD - a listserv primarily for those in renal nutrition.
(In the body type: subscribe RENALRD)
5. CNSW - member listserv social workers.
This complete list can be found at:
http://www.cybernephrology.org/communication/commProviders.htm
Nephrology E-Mail Discussion
Groups continued:
For Nephrology Patients
1. DIALYSIS - dialysis
(In the body type: subscribe DIALYSIS)
2. IGAN - IgA Nephropathy
(In the body type: subscribe IGAN)
3. KidneyDisease - for adult patients with renal disease
(In the body type: subscribe KIDNEYDISEASE)
4. NephKids - for parents of children with renal disease
(In the body type: subscribe NEPHKIDS)
5. PKD - a patient's email discussion group for polycystic kidney
diease
(In the body type: subscribe PKD)
6. TRNSPLNT - transplant patient discussion group
(In the body type: subscribe TRNSPLNT)
Guidelines for Developing Internet Sites
to be used in Developing Nations
Text and Graphics
Language
Photographs, Video and Audio
Links
Support
Text and Graphics
Text should be simple and easy to read. Fancy fonts
may look good but can make it more difficult for
someone with limited skills in English to read.
Graphics should be used only when necessary and be
limited to graphs and diagrams that enhance the
demonstration of a particular concept or skill. (Fancy
logos and other graphics that take a long time to load
should not be used.)
Web pages should be configured to be visually
appropriate to low resolution monitors.
Language
Most medical web sites are in English.
While some physicians in developing nations
speak english, most of the nursing and support
staff does not.
Use volunteers to translate the basic
information on your web site to other
languages.
Link to on-line and downloadable translation
programs.
Photographs, Video and Audio
Sometimes a picture is worth a thousand words and sometimes it is
not.
Photographs should be presented at the lowest possible resolution
for faster loading.
Many computers in developing nations are not equipped to handle
video or audio playback.
Provide links to free Internet programs that can be downloaded and
used to accept video and audio playback.
Make your more complex content available in Zipped File Format.
Offer to place complex video and audio portions of your page on
CD-ROM so it can be ordered to be sent by mail.
Links
While many of us are sophisticated enough users to be able to “surf
the net” for information we want, please bear in mind that physicians
and nurses in developing nations generally do not have that level of
expertise.
Provide as many links as possible to sites that will enhance the
information provided on your site.
Rank your links according to relevance and provide a short synopsis of
their content so that someone working with limited Internet access can
decide if going to the referral site is worth the time and cost.
Eliminate any banner ads or other pop-ups that are not directly related
to your content.
Provide a search engine referral on your site.
Support
Support is not readily available to persons using
computers and the Internet in developing nations.
Include a support page that addresses common
problems that may be encountered by someone
using your page.
Provide an e-mail address to someone in your
organization who can answer support questions.
Make available free programs that will benefit the
user of your site who has limited computer expertise.
The Renal-Tech Donation Project
www.renal-tech.org
Founded in 1998, this project is dedicated to providing computer
hardware, software and Internet access to physicians and nurses
in developing nations.
Much of the equipment we provide is donated used and
reconditioned by volunteers. These volunteers are high school
and college students who exchange their time for training we
provide in PC repair and networking.
More About Renal-Tech
All equipment we provide to developing nations comes with software
for word processing, spreadsheets, databases and communications.
We provide hands-on training during our visit to a country as well as
remote support via our support site.
During each of our visits, team members give lectures and clinical
demonstrations in their area of expertise.
How to Donate to Renal-Tech
We accept donations of computers (Pentium I or above), monitors, printers,
modems, digital cameras, fax machines, UPS units and software. Both
desktop and laptop units are needed.
We accept textbooks and journals for both physicians and nurses.
We also accept donations of medical supplies, equipment and medications.
Donations can be sent to:
Zina C. Munoz
The Renal Tech Donation Project
7661 Forest Hill Road
Burr Ridge, Illinois 60527
Nepal
Pilot Project - June, 1998
June, 2002 - Follow-up
On-Going Programs
Pilot Project – June, 1998
June, 2002 – Follow-up
On-Going Programs
Helping to build a new Kidney Center so that
the money currently used on rent can be
used to serve patients without sufficient
funds for treatment
Developing a monthly continuing education
program for nurses
Working to help Kidney Center to attract
dialysis patients from tourist population
Helping to develop a disaster plan with the
three major hospital Emergency Departments
in Kathmandu
Kosovo
Fact Finding Mission – December, 1999
June, 2000 – Connecting the Central
Pristina Medical Center Nephrology
Department to the Internet
September, 2002 – Setting Up a
Network at the Central Pristina Medical
Center Radiology Department
Fact Finding Mission
June, 2000
Connecting the Central
Pristina Medical Center
Nephrology Department
to the Internet
One networked computer and two
free standing units were placed in the
Nephrology Department. Medical software
was provided by Dr. Wendy Brown.
September, 2002
The Central Pristina
Medical Center
Equipment for a network
in the Radiology Department
(20 stations, three floors)
September, 2002
Consulting with nursing staff
about patients in the ICU
Working with physicians
from Radiology Department
regarding placement of
computer stations
Plans for the Future
Helping to build a Dialysis Center in Nepal
Coordinating an effort to update nurses training in
Kosovo
Traveling to other nations who need assistance in
entering the global medical community with
equipment and funding for Internet connections
Sponsoring a web site that will provided continuing
education programs for nurses in developing nations
Technology with a Human Face
Conclusion
Humanity looks to us, the healers, who minister to the sick and
comfort the dying, to provide sanity in a world gone mad with
conflict and hate.
Our differences in race, religious beliefs and political ideologies
are not important. It is our primary goal of giving our patients
the best possible care that unites us in a common cause.
If we can communicate and build enduring professional
relationships, we can help each other care for those precious
lives entrusted to us. And, maybe, we can provide an example
for the world to follow.