Partners in Health has been improving chronic care in rural communities in Rwanda through an innovative model of care inspired by Paul Farmer. The regional hospital sees its mission as training community members to extend care into the community and monitor patients at home in order to prevent disease complications and the need for hospitalization. The hospital tracks symptoms and medications using electronic medical record (EMR) systems based on open source technologies. Meanwhile, the United States continues to neglect reforming our crisis-oriented health system because “we can’t afford it”, and the cost of chronic care continues to explode as the population ages. With far fewer resources, but with more creativity and courage, innovative leaders in Rwanda are creating new models of care based on prevention because they can’t afford not to. Maybe we can learn something from Rwanda.
High Tech and Personal Touch in Chronic Care: Finding a More Sustainable Model
Last week I spoke at the On Lok Lifeways Conference on October 22, 2008 in San Francisco, entitled “Sustainable Long Term Care: Ethics, Technology and International Perspectives.” The organizers asked me to draw insights from my experience in developing new models for chronic care as the founder and former CEO of Health Hero Network, and to compare that to what I had learned while traveling in Rwanda with Partners in Health last year. Here is my presentation.
In the most innovative models of care on both continents, health care providers have discovered that delivering better care with fewer resources can be possible with a proactive approach to supporting and monitoring patients at home rather than waiting for the inevitable complications of neglect. On both continents, healthcare providers have discovered that technology can be a useful tool to improve the effectiveness of care providers and to increase rather than replace personal touch.
In the United States, our healthcare system too often still penalizes rather than rewards prevention, especially in the largest fee-for-service system, Medicare. When it comes to innovation in disease management and prevention, we claim that we “can’t afford it,” while in a much poorer country in the heart of Africa, the government and the health system are working together to embrace innovation in home and community-based care because they can’t afford not to do it.
We have something to learn from innovations arising in places like Rwanda, where necessity truly is the mother of invention. Learning from such innovations can help us expose some of our own false dichotomies that too often have become an excuse to stifle innovation.