I’ll admit, it’s a compelling image — a doctor in a lone clinic working tirelessly to meet the surging demand of people who come long distances with hope of cure and comfort. Or a tent in the middle of a conflict zone, a surgeon armed with a sterile scalpel helping who she can. But peer deeper into these images and step into the scenes for a week or a month, perhaps even stay a few years. With a closer look at the mechanics, these heroic scenes become even more impressive when we explore how even the briefest mission is made possible. Where does the supply of gauze, medicines, stitches or knowledge of life-threatening eclampsia come from? In order to find out, we’ll have to zoom out a bit to understand the context of these globally scattered efforts. In the process, we’ll begin to unravel a crucial question for regional development: When do programs that survive uncertain commitment transform into systems that stably thrive? I co-founded Community Lab with a growing group of colleagues that I hope will include you to make this question the basis for action.
Think for a moment about a major academic hospital that I’ve been affiliated with in New York City, New York Presbyterian (NYP) Hospital-Weill Cornell Campus. This hospital system has 2,000+ beds, 17,000+ employees, 1.5 million outpatient visits and revenues amounting to about $3.2 billion per year. Each member of the patient care team is supported by an elaborate infrastructure that contains a mix of old skills and new technology, linked together by machine-like processes charged by the spark of human compassion. Not to mention a large trail of money and documentation that makes the Minotaur’s labyrinth look like a straight line to freedom. This center has worked hard over the past few years to partner with a hospital in the Mwanza Region of Tanzania to train new generations of doctors while also providing an opportunity for NYC students, residents and faculty to gain medical experience in the setting of a developing country. What seems to amaze everyone who goes to this relatively well supported hospital in Tanzania is just how difficult it is to practice medicine without all of the tests, technology and perceived certainty that the NYC outpost offers. Even with familiar conditions like heart disease, diabetes and hypertension — not unlike what we’d see in any county in America — the Tanzanian patient is a relative mystery, only displaying physical signs of health and illness that many have long lost the ability to interpret, replaced by an easier CT scan request.
The basic unit of medicine is the individual receiving care, yet the means to procure the materials and learning for such treatment require much larger and more integrated structures. And the further a treatment center is from a network of resources, the more pronounced these structures must be. In a perfect world, the Mwanza hospital would be financially self-sufficient — much as Weill Cornell/NYP is — serving as a regional pacemaker pulsing waves of skills and expertise across an interconnected health system. But even though Weill Cornell/NYP appears to be self-sufficient, we can’t forget that the entire tri-state region is the enabling engine of supplies, workers, finances and demand that allows such a density of activity to take place in a few city blocks. And it’s important to consider that while this hospital is one of the nation’s best, it’s really one ship in an ocean of many more. Thinking along these lines, to make an effort like the Mwanza hospital work in a low-resource region, we’d need to coordinate and focus the collective resources of a much larger area simply to get the right inputs. In the developing world, we’re essentially talking about national and multinational coordination. Countries like the U.S. prove that simply having enough isn’t enough — it’s the coordination and effective application of inputs that make systems responsive and sustainable. And although our current U.S. health system is indeed sustainable, I think the recent health care debate has elucidated that it is not entirely responsive.
I co-founded Community Lab with an ever-growing group of colleagues who believe that demand driven development requires broad skill sets from public and private sectors alike. In order to create a network of hospitals that lower the overall cost of bringing in supplies, training skilled health workers and reaching dense and distantly populated lands, medicine and public health need help. We believe that an integrated approach to regional development requires a sound foundation of economic planning and appropriate integration between health, food and educational systems. In order to do this, we have strong relationships with academic institutions (i.e. The Earth Institute at Columbia University), U.N. organizations (Millennium Villages Project, UNICEF), national governments (i.e. Nigeria, Timor Leste, India), private sector companies (i.e. Yahoo, Hewlett-Packard, Skadden) and an array of civil society organizations. As we work with people ranging from students to professors, young professionals to seasoned experts, ordinary citizens to heads of ministries, Community Lab is becoming synonymous with cohesive community development that leads to coordinated national results.
It’s dizzying to think about how simple it is to give a dangerously dehydrated person life-saving rehydration therapy. Diarrhea alone accounts for almost 20 percent of global child deaths. But imagine the complex challenge of making sure that there are systems in place that can reliably identify, assess and intervene in the illness of any of the six billion people on Earth who may need care. To do this, individual clinics and hospitals are the courageous and necessary starting points to establishing coordinated health systems that utilize and extend regional economic networks. Over the past five decades, the global community has accrued the experience and expertise to take small innovations and rapidly expand them to meet a broader need. We’ve slowly reached a critical point of understanding that this technique of scaling-up crucial services is a methodical, applied process. Community lab strongly believes in our collective ability to bring clarity and focus to globally scattered experiences in order to make the development of health systems reliable and sustainable. And that’s the key to the question I posed in the first paragraph: It takes a community of systematic and reflective practitioners across industries and disciplines to transform programs that survive into systems that thrive.
We’re looking forward to hearing from talented, optimistic and hard-working Cornell students interested in working with Community Lab.
Prabhjot Singh is in his last year of the Tri-Institutional MD/PhD program. He can be contacted at firstname.lastname@example.org. What’s Up, Doc? appears alternate Fridays this semester.