Panjabi opan sax
So those are, I would say at a clinical level, the major challenges. Obviously there are some rapid diagnostic tests, they must have transformed the ability to do this. Without the advent of rapid diagnostic tests for HIV, for instance, we would not have been able to understand the true burden of HIV disease in that rural setting. Being able to train community health workers to use this 15-minute test, that’s almost as simple as a pregnancy test over the counter, has allowed us to make malaria testing available right at the home level, going door-to-door. Certainly those are parts of what I call the extrinsic motivation for these workers.Of course we’ve had to invest at Last Mile Health along with our partners, the Ministry of Health, tremendously in a decentralized healthcare model that involves nurses and community health workers. What I’ve learned more recently is that there’s an intrinsic motivation that’s not unfamiliar to any of us that are physicians, which is simply the desire to learn.And, at that stage, we launched what ended up becoming called Last Mile Health with about 00 from our wedding.
So we started the first rural HIV treatment with the government in 2007, and a few months later we had about 60 patients with HIV disease, many of whom needed strong social and community-based support.
These are places where forest is dense, roads are sparse, and health workers are sparse. And there are almost 3000 of these workers across the country serving hundreds of thousands of people who are all in remote rural communities. So imagine being able to now truly understand the burden of disease and then being able to treat it. What do you think motivates your community health workers to join your program?
So that then introduces, as you can imagine as a clinician, significant delays in diagnosing disease and then also starting treatment, and then continuing treatment. There’s a big burden of falciparum malaria, which is the major killer of children under 5 in that region. You would think one component is career progression and the chance to earn an income and the chance to be recognized by your community and have a job.
[Laughter] So once you got started, you must run up the challenges all the time, this is not easy work. I think the challenges of poverty and inequality are particularly pronounced for patients who live in we say “most remote” communities.
These are primarily hunting communities and may have up to a couple hundred people, but the distances then, they have walked to get to the nearest township are quite far.