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Healthcare is a complex issue in the South Pacific, home to just 1% of the world’s population but covering 30% of its surface. Health resources are scarce, transport is often a long and arduous boat journey to the nearest tertiary hospital, while health literacy and access to trusted information (particularly digital access) remains low.
Healthcare is administered by individual Governments and delivered through a public healthcare system at little or no cost to patients for clinical care. Health systems are supported by multiple donors and UN agencies, including the World Health Organisation’s Division of Pacific Technical Support. WHO provides particular support to the Healthy Islands framework and host regular meetings of health ministers from the Pacific. Three themes have emerged at all six meetings of the Ministers of Health:
1. The predominant and growing burden of noncommunicable diseases.
2. The lingering burden of infectious diseases and the dangers of their re-emergence.
3. The need to support health systems so that they can cope with this double burden of communicable and noncommunicable disease.
All solutions proposed in the Hackathon should take one or more of these three themes into account in their design.
Case Study 1: Limited Health Resources Shared Between Many Islands
Challenge Statement: Through innovative technology, social measures, or other methods, how can healthcare in the Pacific be improved using limited resources?
A broken leg, a heart problem, infections, pregnancy, diabetes, blood tests and cancer – just to name a few common ailments or medical issues occurring in our everyday life and experienced by people all around the world! How would you feel if you were told you needed to travel for 30 hours at sea on a freighter and then maybe you need to take a flight to get the medical help and diagnosis you needed? This is what the people of Tokelau face daily!
Tokelau, a dependent but self-governed territory of New Zealand, is comprised of three atolls, each of which are approximately 100 kilometers apart from each other. There is no airport and all inter-atoll transport is via boat. Each atoll has a population of approximately 450 people. Each atoll has a small hospital or “clinic”, and there are between 1 and 2 doctors on each island. At times in the past there have been no doctors on some of the islands. There are between three and five trained nurses at each hospital. Each hospital is equipped to provide basic care – to prepare a patient for travel by sea to the nearest hospital in Samoa.
Tokelau will soon be gaining access to high speed submarine fibre optic cable services, facilitating abundant and reliable telecommunications access.
The people of Tokelau face complex health risks; not only do they face high rates of pneumonia, cancer, influenza and skin infections, but an increased reliance on imported foods (such as sugar, flour, and noodles) and high levels of smoking have increased incidence rates of diabetes, gout and poor dental health, to name a few. According to the Tokelau Department of Health non-communicable diseases (NCDs) have worsened over a generation to the point of urgently needing to be addressed.
Patients can be transferred to Samoa for care or onwards to New Zealand.
Due to isolation and small population, solutions for improving healthcare are restricted by funding levels, and must be implementable at the lowest cost possible, with sharable resources valued highly.
Case Study 2: Response to Unique Challenges of Covid-19
Challenge Statement: The threat of Covid-19 is heightened in the Pacific by misinformation, certain and cultural practices and a lack of adequate facilities and resources. How can this threat be minimised using innovative technology, social change, traditional engineering or other methods?
Covid-19 has forced upon the world a unique set of challenges and health risks and dealing with these in remote pacific communities is even more difficult. Close proximity of living quarters, inadequate clean water and sanitation, public misinformation and a lack of health resources mean that methods for containing an outbreak, such as self-isolation and wide-spread testing, are difficult to achieve.
This is especially true on in Vanuatu, where Cyclone Harold destroyed homes and left thousands homeless in early 2020. An outbreak here would have devastating consequences. Luckily, most pacific nations responded quickly to the threat by shutting down borders to international travel, however just one case in a country like Vanuatu would likely spark an outbreak.
Vanuatu is an archipelago that consists of nearly 300,000 people living across 80 islands. It is one of the few countries that remains without a single case of Covid-19 (most of the other countries without a case are also in the Pacific), however as Covid-19 will likely remain in the world for a significant period of time, a health mitigation strategy must be found in order to reopen the country, including the industry that makes up 40% of Vanuatu’s GDP: Tourism. Moreover, all inter-island travel has also been restricted, limiting people to their individual small islands.
Even if the Government of Vanuatu were to be conservative on border security and inter-island travel, there is still a chance of the virus reaching the country through transport of necessary services, such as food and medical supply delivery, so an effective Covid-19 response is necessary.
Many people in Vanuatu do not have access to clean water, especially for the sanitation required to combat Covid-19, and often are living in cramped conditions, such as cyclone shelters after the destruction of homes, while lifestyle aspects such as Kava Bars and a very much communal living style makes stopping the spread extremely difficult. Misinformation, such as that extreme hot/cold temperatures, drinking alcohol, etc. etc. stop or kill the virus also spread very easily, as the Government imposed a ban on news outlets printing Covid-19 stories unless authorised, internet access is somewhat limited and there are a lot of medical words that are very difficult to translate into Bislama (the most commonly spoken of the 3 official languages).
While the Chinese Government has committed to building ventilators in order to convert the tuberculosis ward in Vanuatu’s main hospital into a Covid-19 ward, there are still only 20 COVID-19 beds in the whole hospital. Many health professionals who work in Vanuatu are hired from other PICs due to a lack of Vanuatuan graduates.
Case study 3: Improving disease surveillance in the Pacific Islands
Challenge Statement: Fast and accurate disease tracking is an essential step in improving healthcare across the Pacific. Faced with many challenges including low internet access and limited healthcare resources, how can a solution for disease surveillance be implemented that is intuitive, fast and effective?
Disease surveillance is a mainstay of public health – being able to quickly and accurately detect and verify infectious disease outbreaks is a prerequisite for mounting satisfactory responses across all countries. Weak disease surveillance mechanisms can have catastrophic effects for even basic conditions – diarrhoea remains the second highest cause of death in Under-5’s across the Pacific but outbreaks are often not detected or not acted on quickly enough.
Disease surveillance can take many forms – primary healthcare facilities can report when they spot particular symptoms of disease without knowing the actual diagnosis (syndromic surveillance), doctors and laboratories can be required to report specific diagnoses via both passive and active case detection (notifiable diseases and laboratory surveillance) and crowd-based syndromic surveillance has been successfully used in several countries around the world (e.g. Flutracking.net in Australia). Other proxy surveillance measures (such as vector surveillance) can look for likely markers of disease, such as higher rates of mosquitoes in a given population or area.
Disease surveillance in the Pacific is particularly difficult, however. Limited internet access and low rates of digital literacy make conventional means of disease surveillance more difficult and weak laboratory systems mean that infectious diseases are not always diagnosed.
The World Health Organisation and the Pacific Community (SPC) support surveillance through a mechanism called the Pacific Public Health Surveillance Network (PPHSN). PPHSN is dedicated to the promotion of public health and improving public health surveillance and response to health emergencies in the Pacific. Its main priority is communicable diseases, especially ones prone to outbreak. Target diseases include: dengue fever, measles, rubella, influenza, leptospirosis, typhoid fever, SARS and HIV/STIs.
Crowd-based syndromic surveillance and novel data sources have worked in other settings to augment existing surveillance systems but in the unique setting of the Pacific, there are challenges to implementation. Mobile phone ownership and network coverage tends to be urban-skewed and social media participation is not as strong as other countries with higher populations.
There are also challenges with quickly communicating information about known and suspected disease outbreaks between villages, health facilities, central health authorities and regional bodies.
Click below to discover more case studies under different challenges
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