Interview: A One-Stop Healthcare Shop
By CHRISTINE DELL’AMORE
Solving global health crises such as HIV/AIDS and tuberculosis calls for some serious innovation. So by thinking outside the box, Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, came up with a solution inside the box.
Garrett dreamed up Doc-in-the-Box, a pioneering primary care clinic constructed from industrial shipping containers. The inexpensive clinics would provide on-the-spot health testing and treatment to people in the developing world. Garrett talked to United Press International about her model for translating donor dollars into tangible results.
Q. What was the impetus behind Doc-in-a-Box?
A. A couple years ago, I was getting rather distressed about the problem of rolling out anti-retroviral treatment for HIV/AIDS. Prevention was fading into the distance as pressure to provide treatment took front and center. I had a real fear we’d see a net increase in mortality — especially child mortality — in lots of poor countries.
We’re doing something we’ve never done before in the history of humanity — a massive chronic care program in which the taxpayers in one part of world are paying to keep people alive in another part of the world. This is a profoundly exciting thing — it indicates people in the wealthy world have come to understand how desperate poverty is.
But is it sustainable? As the baby boomers age and our healthcare costs rise, are we still going to be altruistic? It seems such a profound risk, I thought, We’ve got to come up with another way to do this.
Q. You’ve mentioned the dire deficiency of healthcare workers in the world. How would the Doc-in-a-Box help?
A. Doc-in-a-Box would not have to be staffed by a doctor or a nurse. Its design from the get-go is to be user-friendly for a paramedic or a community health worker. Ideally, you’d want it staffed by people already highly respected in the community, who would take pride in it and not strip it down to bare bones. You’ve got to realize that you’re going into such acute poverty, everything looks like something the average person would want. That’s why the Rensselaer (Polytechnic Institute) has made a container using recycled goods found in any Third World seaport.
Q. Would this box be at a fixed location in the community, or would it move?
A. One could make it transportable, but that’s rather inefficient. Our concept would be permanent structures that operate like franchises, (similar to) Starbucks. You’d have a whole central system of monitoring and accounting, all maintaining high standards of operation … in the center, you’d have a small group of doctors and nurses for consulting, if community health workers ran into something beyond their training.
Q. Can you briefly explain how it would work economically?
A. We’re still trying to flesh out all the details. There’s no reason why an organization like Medicins Sans Frontieres wouldn’t want to purchase a network of franchises. In some countries, there’s an entrepreneurial spirit, the idea of I’ve saved up and I want to have a Doc-in-a-Box franchise.
Q. How would it be integrated into current healthcare systems? What if people are wary of it?
A. If these were perceived as competition, they would not be viewed kindly. The (Doc-in-the-Boxes) have to be seen as relieving the government of burden. Today, in a lot of sub-Saharan African hospitals, there is row upon row of HIV patients. It’s unbelievably demoralizing to healthcare workers who are (essentially) running hospices. If you had a way to disseminate TB treatment, anti-HIV treatment, basic treatment for malaria and vaccinations for kids that is separate from the hospital systems, the hospitals can get down to business of saving lives.
Q. When will it be a reality?
A. Right now, our big effort is a conceptual one — we’re trying to push both the donor and recipient community and all the funding mechanisms in between to stop thinking in these rigid old ways where they’re shoving money down ancient stovepipes, and start thinking in more imaginative ways about how we can save lives.
For more information, visit: http://www.cfr.org/project/405/
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