Revitalizing%20Informal%20Healthcare:%20Solutions%20and%20Strategies

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Revitalizing Informal Healthcare Solutions and
Strategies

• Rakesh Biswas
• Professor of Medicine,
• LNMCH, Bhopal, India

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Perspectives in Informal healthcare

• ... he noticed a pea-sized lump on the roof of
  his mouth. A local GP dismissed it as a reaction
  to a fish-bone, but having borrowed textbooks
  from a medical student in the next room, he
  self-diagnosed a squamous-cell carcinoma. 

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Perspectives in Informal healthcare

• ... it took him months to arrange a biopsy at
  Chittaranjan Cancer Hospital the pathology
  confirmed his diagnosis. Knowing he had received
  a death sentence, Sen and his family pushed for
  what was then, in India, a new form of treatment
  radiotherapy. 
• Quoted from Paul Farmer http//www.lrb.co.uk/v37/
  n03/paul-farmer/who-lives-and-who-dies

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What is Informal healthcare?

• Self-Care?
• Care provided by a relative?
• Care provided by a medical student?
• Care provided by unlicensed-healers/generalists/ex
  perts?

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Perspectives in Informal healthcare? Definitional
Criteria

• No training?
• No salary (Entrepreneur)?
• No registration?
• No professional association?
• Sudhinaraset M, Ingram M, Lofthouse HK, Montagu
  D (2013) What Is the Role of Informal Healthcare
  Providers in Developing Countries? A Systematic
  Review. PLoS ONE 8(2) e54978. doi10.1371/journal
  .pone.0054978

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Informal vs. Formal healthcare

• Generalist vs. Expert
• Approachable vs. Ivory tower
• Unique Exploratory vs. Usual Evidence based
• Accommodator vs. Assimilator (learning style)

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Informal to Formal transition?

• A medical students journey
• Quest for knowledge and power
• Accommodator to Assimilator cyclical Learning
  style (Kolbs)
• Informal formal duality ( experts also need to
  think informally anew when confronting the
  unknown)?

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Perspectives in Informal healthcare?

• Todays Formal was yesterdays informal?
• Todays standard treatment was yesterdays
  experimental and tomorrows junk?
• Nature of scientific revolutions and shifts?
• Learn to live with and optimize constant change ?

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Informal healthcare Strengths?

• Effective error and power check? (Sen first
  slide?)
• Informally negotiate the jungle of evidence that
  naturally keeps changing
• Potential window to better current day formal
  healthcare?

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Who is an informal healthcare provider?

• Everyone

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Can we involve everyone in healthcare?

• Everyone has been involved informally since time
  immemorial by virtue of their being a patient at
  some point in their lifetime?
• The Informal healthcare movement has run in
  parallel over the ages since the birth of human
  healthcare?

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Can we optimize everyones participation in
healthcare toward achieving better health
outcomes?
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Can we do this in an open, transparent,
accountable, ethical and legal manner?
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How?
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Informal healthcare lessons for Indian healthcare?

• Current healthcare needs of India are to a large
  extent met by unlicensed healthcare
  practitioners.
• Current crop of unlicensed-healers in India tend
  to copy 'formal-healthcare,' and this is often
  done poorly resulting in low quality health-care.

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Unlicensed healthcare to Informal but
open-accountable healthcare?

• Create a different group of 'informal-health-care
  ' workers such as 'patient-information-communicati
  on-managers. PICMs
• Not to provide medicines or care but to create
  informational awareness in the community both
  among patients and doctors
• Serve as effective 'clinical-auditors' and
  instil error-check mechanisms to benefit both
  doctors and patients.

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Informal participatory learning ecosystem?

• Pilot project currently serves both urban and
  rural-remote areas in two locations in India
• Patients receive access to a local and global
  network of 1000 health-professionals through
  their information communication managers PICMs.

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Village healer unlicenced
Patients Wife and family
Experienced Global physician
Patient
Primary doctor at the PHC
Community health worker CHW and Patient
information communication manager PICM

• Physicians and medical students in Urban India

ANM at the village PHC
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Informal healthcare as Informational healthcare?

• Patients information requirements are gathered
  by a community based informal intermediary PICM
• Shared (after obtaining informed patient consent
  and de-identification) with an online global
  network
• Eventually an evidence based resolution of
  patient requirements achieved with a lag time in
  days

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An Informal social media driven participatory
learning ecosystem
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Informal social media driven participatory
learning ecosystem
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Publications as a formal by-product of an
informal learning ecosystem?
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So what?

• Strengths
• Weaknesses
• Opportunities
• Threats

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Strengths and Opportunities

• Generation of new employment in the community.
• Transition of workload from over-tasked
  physicians to community based Patient information
  communication Managers PICMs
• Exposure for students and professionals to
  unique cases and innovative, interdisciplinary
  health solutions.

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Strengths and Opportunities

• Expansion of this ecosystem to other sites in
  India and globally.
• Engagement of students and physicians globally
• Vibrant global online community and open-access
  learning platform, interfacing society with
  science as well as delivering improved care to
  more patients in real time.

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Weaknesses and Threats!

• No takers in formal medical curriculum
• Threat of usurping the formal medical curriculum
• Patient privacy and confidentiality ethics
  optimization

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Q and A Brutally honest feedback please!

• Did they catch the chimp who made your
  slides?---Dilbert
• rakesh7biswas_at_gmail.com
• Next slide for QA

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QA Lets begin?

• First step toward collaborating to develop a
  global participatory learning ecosystem?
• Scale from a grassroots village-sub-center level
  by training their local potential PICMs?
• Formalize training initiation, assessment and
  participatory deployment or just let it continue
  informally?