“When you work in global health, it never feels like you’re doing enough — it’s never big enough, it’s never fast enough. People are dying for reasons they shouldn’t be for reasons that should’ve disappeared from the world 90 years ago,” says Mark Arnoldy, CEO at Possible.
As healthcare continues to be a hot topic of debate here in the United States, Arnoldy is providing an integrative system that delivers care to the poor across the globe.
Nepal is a rich environment… To try and prove that a healthcare system involving government hospitals, clinics and community health works can be successful. The country has enormous demand: 30 million people, of which 80 percent live in rural areas. After enduring a decade-long civil war [from 1996 to 2006], there’s a fair amount of political will and a lot of interest in building a system of universal health care.
Digital connectivity… Is one of the most exciting, new developments in healthcare. Five years ago, in some of these really rural, isolated areas, you couldn’t use a cell phone. Now, we’re running an integrated, electronic health system between our hospital and community health workers using an Android device.
A major, global challenge that people don’t really hear about … In a place like Nepal, there is no registration system for births or deaths. If you’re trying to understand whether some sort of intervention is effective, you don’t know who is living or who is dying. Complicating matters further is that there’s often no national identification system either.
Previously, for instance, a person would go to India for a serious operation. They would be given pamphlets and an x-ray and be expected to keep them and take them to other medical facilities as needed. When people are responsible for paper records, it’s very hard to provide quality healthcare; you can do harm to patients when you don’t have the proper history. Advancements in biometric devices — essentially machines that turn a fingerprint into a secure, digital code — enable us to rethink how we design a healthcare system. With them, we can track patients longitudinally.
It’s almost cliché at this point… But the book “Mountains Beyond Mountains” by Tracy Kidder had a profound effect on me. It’s about Dr. Paul Farmer, the cofounder of Partners In Health. It presents a very compelling narrative and challenges people around the question, What does it mean to live a moral life in the 21st century?
Reporting by Chris Peak
Tag: healthcare
The Jobs Robots Won’t Take
In April 2017, the U.S. unemployment rate dropped to the lowest level in a decade. And while there are many factors to consider, there’s evidence that automation and the rise of robots may not eliminate as many jobs as projected. Here are some of the sectors offering long-term job security for decades to come.
CLEAN ENERGY
The fastest growing profession in the country: wind turbine technicians.
Solar energy is also a bright spot for the unemployed and underemployed, “growing at a rate 12 times faster than the rest of the U.S. economy,” according a 2017 report published by Environmental Defense Fund. The majority of this growth consists of installation jobs. Robots can’t climb onto rooftops to mount photovoltaic panels (or repair them), which means there’s an ever-growing number of positions for living, breathing workers.
EDUCATION, HEALTHCARE AND CUSTOMER RELATIONS
“Where humanity matters there will be humans,” says business advisor and technology consultant Shelly Palmer.
Schools, hospitals and businesses continue to need workers to do “people things” since robots can only react to predictive behaviors or conduct menial tasks. “Robots do not yet have the ability to perform complex tasks like negotiation or persuading, and they are not as proficient in generating new ideas as they are at solving problems,” says Mynul Khan, chief executive officer of Field Nation in an op-ed for Tech Crunch.
To learn how education could adapt in an automated world, check out this additional reading:
How to Prepare for an Automated Future
ENGINEERING AND ARCHITECTURE
The number of architectural and engineering jobs has more than tripled from last year’s average of 2,000 each month to 7,000, according to the Bureau of Labor Statistics. But the industry isn’t just having a moment. It’s estimated by 2022, biomedical engineering will experience 23 percent growth, environmental engineering 12 percent and civil engineering (the field with the most positions) 8.4 percent.
Fueling the demand for this non-automated workforce? An aging population and crumbling infrastructure.
MAINTENANCE
Call it “Rise of the Maintenance Workforce.” While robots are clearly putting pressure on the American labor force, when they break, humans are needed to fix them. The demand for people who can repair hardware and software, as well as code new programs, is expected to steadily increase. By 2022, there may be more than half a million new jobs in robotic and machine learning maintenance, installation and repair. Some labor experts project that modern technologies will ultimately create more jobs than they destroy.
This gradual shift can best be witnessed in U.S. manufacturing, which has shed almost 5 million jobs since 2000. The auto industry has introduced around 52,000 robots during the past seven years, helping to spur the creation of nearly 260,000 jobs. A 2013 study done by the International Federation of Robots (which despite its name is not made up of robots; rather it’s a group of tech industry leaders) estimated that 10 to 15 percent of jobs in the auto sector were created because robots and machines were introduced to assembly lines.
To learn more about how robotics is affecting manufacturing, check out this additional reading:
The New Hire: How a New Generation of Robots Is Transforming Manufacturing
How Artificial Intelligence and Robots Will Radically Transform the Economy
Fashion’s Sustainability Moment, the Ridiculously Cheap Device That Could Save Lives and More
The Future of Fashion Is Mushroom Leather, Bloomberg
When you think about how high-end fashion items are manufactured, you might conjure up images of factory pollution, mistreatment of animals and poor labor conditions (and you’d be right). But François-Henri Pinault, CEO of Kering — the luxury group behind Yves Saint Laurent, Gucci and others — is taking major strides to fix the supply chain. In the last four years, his company has invested in alternatives to leather, embraced the use of recycled textiles, worked to reduce plastic use and even links CEO bonuses to sustainability achievements. “It’s the new moon,” says Pinault. “The new frontier is the sustainability frontier.”
The Paperfuge: A 20-Cent Device That Could Transform Health Care, Wired
A team of Stanford bioengineers has developed a device that costs less than a quarter to make and can help save lives around the world. Dubbed the Paperfuge, it operates like a traditional centrifuge to spin bio samples and help diagnose diseases like malaria, but it requires no electricity and fits inside a doctor’s pocket. The device embodies “frugal science” — the idea that affordable yet powerful tools can transform global medicine.
New Court Aims to Redefine Young Adult Justice in Chicago, Christian Science Monitor
For young people charged with nonviolent crimes, a criminal record can mean diminished job prospects, continued poverty and a seemingly inescapable life of repeat offenses. But a pilot program in Chicago aims to break this cycle by letting perpetrators make amends to those they’ve wronged and contribute positively to their community instead of serving time. Ultimately, if the offender completes the program successfully, his or her record can be wiped clean.
Meet the Couple Caring for Uninsured Families
New York City has long been the final destination for incoming immigrant families. Today, that population totals over 3 million people, and nearly 35 percent of them lack access to health insurance. Now one married couple is aiming to provide these families with the pediatric care they otherwise can’t afford.
Dynasty Pediatrics is a private practice with an office in Brooklyn’s Kensington neighborhood. Its founders, Dr. Marina Klotsman and her husband, Schmeil, provide affordable healthcare services for the borough’s newly settled immigrants, many of whom lack health insurance. As a result, the Klotsmans often end up waiving co-pays and other medical fees for those families struggling to make ends meet.
“We put a lot of effort, a lot of time, a lot of our own energy into this place,” says Marina. “It’s not even for business; it’s for the feelings we have. We want to help everybody.”
Schmeil agrees, adding, “The money’s not the main subject in this office.”
Dynasty Pediatrics is open Sunday through Friday, with hours late into the evening. The goal is to make it easier for working-class parents — many of whom support family members living outside the US — to bring in their children without disrupting their work schedules. The Klotsmans also help families explore insurance plans as well as local services like NYC’s universal pre-K program.
That sense of duty goes back to the husband-and-wife team’s own journey to the US from Kyrgyzstan. Schmeil left his home country in 1989 during the dissolution of the USSR, a period he remembers as marred by “chaos.” Marina left eight years later, in 1997, to further her medical career. They would eventually meet in Brooklyn through Marina’s uncle and marry soon after.
Learn more about the Klotsmans’ passion for helping others in the video above.
This Anti-Poverty Initiative Was Born in a Hospital Waiting Room
Dr. Michael Hole, a senior resident in pediatrics at Boston Medical Center (BMC), was used to hearing unusual questions from patients, but this mother’s was truly a first: “Can the clinic help me get my taxes done?”
Lacking an accountant’s expertise, Hole referred her to a free tax preparer. But when she returned for her newborn’s next appointment, the mom told Hole she’d taken two buses and a train across town, only to find the place closed. She tried once more the following week, but this time, she didn’t bring the right documents. Fed up, she forked over $400 to a local H&R Block — a huge chunk of her negligible four-digit annual earnings.
The woman’s experience wasn’t an aberration either, says Dr. Lucy Marcil, another BMC pediatric resident. “There were 27 free tax sites in Boston at the time, but they were rarely accessible to families. It might be in a church basement or be open from only 4 to 7 p.m. on a Tuesday. Others have a five-hour-long line of people,” she says.
Frustrated by the situation low-income families confront, Hole and Marcil cofounded StreetCred in 2015 to help working parents complete their annual tax filing. Their unique solution? Set up free prep stations at a place where parents show up regularly: In their case, the waiting room. While the doctor’s doing a check-up, a volunteer is using a W-2 and other records to fill out the parents’ Form 1040. (Often, the volunteers are employees elsewhere in the hospital, like a pharmacist or IT staff member, who receive tax-prep training from local partners.) Last year, StreetCred’s service returned more than $400,000 to approximately 200 Boston families.
Most of those savings come from applying the Earned Income Tax Credit (EITC), the federal government’s largest and arguably most effective anti-poverty initiative. Started by a Republican president in 1975 and given its current shape by Bill Clinton in 1993, the EITC is one of the few programs in Washington to enjoy bipartisan support. Essentially, working families making less than $53,500 can file a “negative tax return,” drawing a check from the IRS worth up to $6,242.
Unlike other entitlements that limit what a recipient can buy (think: WIC and SNAP’s restrictions to certain food items), the EITC’s payback is up to parents’ discretion. “A lot of what they spend money on is major expenses hanging over their head: credit card debt, a roof falling in or a car repair,” Marcil says. “Conceptually, the idea is that you take away financial insecurity and poverty and instability. Those things take up a ton of mental space, and removing some of that frees them up to be more actively engaged: reading to their kids or providing consistent schedules, rather than having to run off to a third job.” With what’s left over, Marcil adds, “they can buy fruits and vegetables for the baby, a winter coat or a high chair — all the things that we think of as necessities to raise a child that are really luxuries to them.”
There’s just one problem: One in five eligible low-income Americans isn’t actually taking the credit. By situating the refund in a medical context, StreetCred has the chance to significantly boost participation rates. For one, 92.4 percent of kids see a pediatrician at least once a year, giving the doctor — a professional that commands parental trust — a chance to ask whether they know about the credit, just like they ask about guns, swimming pools and low windows. (Not that the EITC isn’t within their purview too: It’s been shown to improve maternal and infant health by, for instance, upping birth weight and decreasing maternal smoking.)
Next tax season, which runs from January 23 through April 18, StreetCred will test out their model at three new locations: Boston Children’s Hospital, South End Community Health Center and a homeless shelter. They’ll be looking to see how many families they can reach, the error rates on returns, the refund’s impact on the family and, finally, the way the service changes the family’s relationship with their healthcare provider. And they’ll be piloting another set of services: With their tax form filled out, the volunteer can check whether the family qualifies for other social services they might be missing out on, like Medicaid or a Section 8 housing voucher.
Beginning with Boston, doctors’ checkups are getting much more comprehensive, and families are clearly benefiting from it.
Homepage photo of Lucy Marcil by Matthew Morris/Boston Medical Center
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Correction: An earlier version of this story stated that StreetCred helps parents fill out their Form 1099; they actually assist with filling out Form 1040. NationSwell regrets the error.
The Surprising, Eco-Friendly Place to Store Data Servers, Safer Ways to Care for the Sick and More
Why Data Farms Are Heading Underwater, CityLab
According to an animated Walt Disney classic, everything’s better, down where it’s wetter. That’s exactly what computer giant Microsoft learned when it submerged a data farm under the sea. Cold ocean temperatures eliminates the need for massive, energy-sucking cooling systems, which land-based servers require.
Hospitals Focus on Doing No Harm, The New York Times
When one hears that an estimated 98,000 and 440,000 people die because of preventable errors at hospitals, it’s easy to think that doctors are breaking their promise to do no harm. In response, healthcare facilities nationwide are implementing new procedures — from the somewhat common sense (practicing consistent hand washing) to the more complex, like immediate monitoring for symptoms of sepsis and changing hospital culture.
Here’s How Houston Boosted Mass Transit Ridership by Improving Service Without Spending a Dime, Vox
Thanks to overcrowding, late arrivals and seemingly constant price hikes, it’s no wonder that subways and buses get a bad rap. In the highway-riddled city of Houston, transit officials found a way to boost ridership: by emphasizing frequency over geographic scope. More importantly, however, was their discovery of a mass transit strategy that can be replicated coast to coast, at no cost.
The New Devices That Make It Easier to Follow the Doctor’s Orders
Ever forgotten to take a prescription medication before leaving for work in the morning? Maybe even accidentally skipped a whole day of antibiotics once you started feeling better? Of course you have. No harm done, right? Don’t be so sure.
Aside from the obvious dangers of someone forgetting to take medicine they need, the Atlantic estimates that the U.S. hemorrhages $100 to $300 billion dollars from medication non-adherence, or “taking too many pills, not taking enough pills, taking the wrong pills at the wrong times.” Between wasted pills, unnecessary doctor’s visits and hospitalizations, even premature deaths, this mistake is all too common.
For decades, the answer has been those plastic pill organizers with a little box for each day of the week. No more. Companies like Vitality and PillPack are invoking a 21st century consciousness to bypass the dangers — both medical and financial — posed by medication non-adherence. And with 20 percent of American adults taking five or more prescriptions, the market is poised for an easy solution.
From Vitality comes GlowCap, a device that fits over most prescription bottles and “that lights up when it’s time to take a pill, then chirps, and finally sends a text reminder,” reports the Atlantic. Soon, Vitality also plans to release the GlowPack, which will monitor adherence for sirups, inhalers, ointments and blisters packs as well.
And PillPack wants to get rid of the current script bottle entirely. Instead of providing each medication separately, PillPack is a full-service pharmacy that arranges and mails all of your medications in single-use packets labeled for the specific time they should be taken, eliminating virtually any risk of taking too much or too little of your meds. PillPack’s CEO, T.J. Parker, isn’t shy about his product’s appeal: “We have the opportunity to make everyday tasks delightful. Even something as unsexy as taking pills,” he says.
MORE: These Pharmacists Are Making Affordable Medication for All a Reality
From Farm to Patient: How One Medical Facility is Rethinking Hospital Food
The words “hospital food” usually inspire thoughts of rubbery jello and syrupy fruit cups. But the St. Luke’s University Health Network in Easton, Pa. is doing its best to change that.
In the fall of 2013, it teamed up with the Rodale Institute, a nonprofit dedicated to establishing organic farms and spreading organic practices, to establish a produce farm serving the hospital network. The farm’s harvest quota for this season (its first) was set at 44,000 pounds from five acres of tilled land; as of this writing, it’s is on track to exceed that amount.
The excess land used for the farm is part of the St. Luke’s Anderson Campus, the newest addition to the St. Luke’s hospital network. Opening its doors three years ago, the hospital itself covers about 40 acres – but in total, it owns 500 acres of land. The additional land was acquired, according to Anderson Campus hospital president Edward Nawrocki, as part of a long-term expansion strategy.
Last year, however, Nawrocki began looking for creative ways to use the extra real estate. Some employees suggested an organic farm, an idea that Nawrocki jumped on.
He contacted the Rodale Institute and spoke with executive director Mark “Coach” Smallwood. Coach started looking for a farm manager and quickly decided upon Lynn Trizna, a young woman involved in organic farming that Coach identified as “a farmer without a farm.”
Nawrocki, “Farmer Lynn”, and Coach picked a site for the farm and a smaller, five-acre parcel for the first season. Following organic practices, 12 types of produce— from tomatoes to kale to beets — were planted.
Often, ripe produce is picked in the morning, transported, prepared and served the same day.
“Health care in the past was about sick care. We got paid when people got sick.” says Nawrocki. “In the next decade, it’s going to be about keeping people well.”
But this change doesn’t come without challenges. The existing food vendor, Sodexo, has had to modify its food acquisition practices to incorporate the local produce since many of the items it sources already come prepared. Farmer Lynn and Nawrocki have taken a hands-on approach to working with Sodexo on menu modifications, something that the vendor’s staff is excited and proud of.
Currently, the Rodale Farm organic produce is served in the cafeteria, plus it’s also gradually being incorporated into the patients’ meals, as many are on restricted diets.
As the farm grows, Nawrocki and Farmer Lynn and Nawrocki are working to expand patient options. Both hope that other hospitals with land investments will adopt this idea, revolutionizing how food is prepared for those who need good nutrition the most. Who knows? Maybe in the future jello cups and prepackaged food will be seen in the same light as bloodletting today – an anachronism of a less sophisticated time.
The Innovative Blood-Drawing Technique That’s Pain-Free and Saves Money
Most 19 year olds spend their days hanging out with friends, not revolutionizing American healthcare. But that’s not the case with Elizabeth Holmes who dropped out of Stanford to start the company, Theranos.
During her freshman year in college, Holmes took chemical engineering professor Channing Robertson’s seminar on advanced drug-delivery devices (aka, things like patches and pills). After completing a summer internship at the Genome Institute in Singapore, she hit upon her first idea: a patch that simultaneously delivered medication and collected data about the patient to inform their doctors with.
Holmes dropped out of school to work on a patent for that product and to launch her company using the rest of her college savings.
That invention was the first of many that the now 30-year-old CEO would develop. According to Fortune, Holmes is listed as a co-inventor on 82 U.S. and 189 foreign patent applications. Eighteen in the U.S. have been granted.
When Holmes first told Robertson about her plan to drop out, Robertson told Fortune, “I said, ‘Why do you want to do this?’ And she said, ‘Because systems like this could completely revolutionize how effective health care is delivered. And this is what I want to do. I don’t want to make an incremental change in some technology in my life. I want to create a whole new technology, and one that is aimed at helping humanity at all levels regardless of geography or ethnicity or age or gender.'”
As Holmes set to work on her company, she shifted from her initial idea to one about developing a revolutionary way to run diagnostic tests on very small amounts of blood — just a drop — instead of the full vials most labs need.
She came up with a technique that not only minimizes the discomfort, but also enables doctors to run dozens of tests on just one sample — and it delivers the results efficiently and inexpensively. They’re so affordable, in fact, that no test costs more than half of the allowed Medicare reimbursement for it. Fortune writer Roger Parloff says, “with widespread adoption [this] could save the nation billions.”
And that’s just part of Holmes’s next plan for Theranos. The company is partnering with Walgreens, whose stores currently host 21 patented Theranos blood-drawing facilities. They’re all in Phoenix and Palo Alto for now, but the drug-store chain plans to gradually add them nationwide. Holmes’s eventual goal? For just about every American to have a Theranos facility within five miles.
In addition to the cost savings and the minimized discomfort, Holmes’ technique allows for more frequent blood draws in people with conditions that require it, so that doctors can better monitor the fluctuations in their health.
Holmes said, “Anywhere from 40 percent to 60 percent of people, when they’re given a requisition by a doctor to go get tested, don’t, because they’re scared of needles or the locations are inconvenient or the cost is too high. And if you’re not even getting tested, how is it possible that we’re going to move toward an era of preventive medicine?”
MORE: This California City is Staffing A Firehouse with A Different Kind of Lifesaver
Would You See a Doctor Who Never Completed His Residency?
For most of us, going to the doctor can be as simple as making an appointment. But for some, especially those in living in rural areas, getting medical care can be much more difficult.
This is the case for those living in desolate locals of Missouri where 40 percent of the population reside, but only 25 percent of the doctors statewide practice.
However, that’s scheduled to change, due to a new law signed by Gov. Jay Nixon earlier this month. Under it, medical school graduates will be allowed to practice in underserved areas without completing their residency.
In every state, medical school graduates can’t apply for their license until they have completed a residency that lasts at least a year. That is, in every state except for Missouri. For those graduating in the Show Me state, they can begin to practice immediately upon completion of their licensing exams — even if the residency still isn’t finished.
Instead, the grad will work as an “assistant physician” alongside a “collaborating physician” who agrees to be responsible for the assistant. After a month, the assistant physician will be allowed to work independently, but still under the watchful eye of the collaborating physician.
The new law is dividing medical professionals. Proponents express its need considering how few doctors there are to serve underserved areas, which are defined as a place where there is a low ratio of primary-care doctors per 1,000 residents, a high rate of infant mortality or where many senior citizens and others live below the poverty line.
Opponents, however, are not so sure that this is the best solution for Missouri residents. Since many those living in underserved areas may need more medical attention, a recent grad with little experience might not be the best option.
Rosemary Gibson of the Accreditation Council for Graduate Medical Education is one such person wary of the law. “Primary care is not simple,” Gibson told Governing. “If you have a lot of older people living in rural areas, they have a lot of co-morbidities [such as diabetes combined with heart disease].”
Jeff Howell, a lobbyist for the Missouri State Medical Association, sees the law as a viable and helpful solution and believes that the critics’ concerns about the qualifications of the grads aren’t warranted. “They’ll still be in collaboration with a licensed physician,” Howell told Governing. “That collaborative practice never disappears.”
While those in the medical field continues to squabble over whether or not this is a good idea, for those in rural Missouri, this law could make a doctor a stone’s throw away.
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