Wait … a local charity has ties to a Central American country’s new national health strategy?
When Eric Peterson sold his Waterloo, Ontario-based health systems company in 2001, he and his wife – and business partner – Christina Munck had no idea what they wanted to do next, but they had three simple requirements for whatever it would be.
“First, it had to be something socially useful,” he says over the rim of his coffee at a small cafe in downtown Campbell River.
“Second, it had to be something we were good at. And third, it had to be something we enjoyed – which would just sort of naturally follow from the first two requirements. I think it was just understood that we were going to enjoy doing something that was socially useful that we were also good at.”
Around that time, Peterson says, “there was a huge focus on international health,” but that focus was mainly on developing drugs and vaccines for specific diseases.
“It was all about finding the perfect drug to combat aids or a vaccine for malaria,” he says. “While those things are tremendously valuable, I thought at the time – and I still think today – that having health systems is equally, if not more important. How can you deliver drugs, how can you deliver treatment, how can you fight disease if you don’t have doctors and nurses and some kind of organized structure in a system that can deliver it?”
He says he watched that very issue develop with the Ebola outbreak in Africa.
“The countries that had reasonably strong health systems, like Nigeria, did quite well,” he says. “The places like Sierra Leone, like Liberia, that had poor health systems … all the drugs and all the treatments and all the interventions don’t make much sense if you don’t have the capacity to deliver them.”
So how could Peterson and Munck help? After all, they knew health systems.
They’d been helping make them for years before an offer “too good to pass up” came along and sent them off looking for something else to do.
Fast forward to May 15, 2015. Guatemala City, Guatemala. The Guatemalan Ministry of Public Health and Social Assistance (MSPAS) announces its new national strategy for strengthening primary health care. There will be a renewed focus, the department says, on maternal and infant health and nutrition and the challenges faced by rural and remote communities.
The roots of this initiative, strangely enough, go back in time and across the globe to a registered charity – a Canadian Non-Governmental Organization (NGO) based in Heriot Bay on Quadra Island. That organization is called the Tula Foundation – Peterson and Munch’s post-corporate-buyout project.
The Tula Foundation arrived in Guatemala in 2003, knowing about the dire state of their medical system, especially in rural areas, and brought with them Peterson and Munck’s expertise in health systems and the technology utilized within those systems.
Over the first few years Tula was in Guatemala, they were examining the issue of a lack of medical practitioners in the country, and were working with a nursing school in Alta Verapaz – one of the poorest regions in Guatemala – and Canadian partners from the Centre for Nursing Studies (based in Newfoundland) along with the Canadian International Development Agency (CIDA) to train nurses by distance education to remedy that situation.
“You can’t do without nurses,” Peterson says. “If you’ve got a health system that’s depleted in nurses, you’ve got a real problem. So that seemed like a good place to start.”
Thanks largely to the dedication and strength of the local nursing school, Peterson says, they were able to make huge strides in training locals in remote communities to become medical caregivers within those communities.
By 2007, the other partners had left, and Tula had taken over full responsibility of the program, founding TulaSalud (Salud meaning “health” in Spanish) as a Guatemalan subsidiary, at which point they also began work on a tele-health network to increase and improve communications, training and medical data storage within the country.
That tele-health network eventually became an Android App called Kawok.
Kawok is a case management system for Community Health Workers (CHWs) – many of which are trained by distance through the TulaSalud distance education initiative – which allows them to track public health issues, focusing on maternal and infant health within their communities and into rural areas.
They do this by implementing a Community Facilitator (FC in Spanish) who attends to the healthcare of their community and others nearby using Kawok. The FC receives ongoing training through audio conferences and carries out health promotion and prevention activities within their community, both tracking and entering health information into the system to increase communication between populations.
It’s essentially a mobile healthcare database, storage system for medical records and teaching tool.
According to a recent report released by the Innovation and Technology for Human Development Centre at the Technical University of Madrid (itdUPM), a 2011 study of the population and health of the Alta Verapaz region of Guatemala showed that of the 1.18 million people in that region, 89.6 per cent lived below the poverty line with 46.7 per cent living in what would be considered “extreme poverty.” It also cited the infant mortality rate as 20 deaths per 1,000 live births and the proportion of births attended by health workers at approximately 39 per cent.
One of the main issues causing these numbers was due to a communication gap between community health workers in rural locations, the organization and transmission of medical information between them, and the midwives and traditional healers within rural and remote communities.
There are 23 different indigenous languages used as the first language in various rural communities, adding an additional complication to remote medical care.
Kawok helps bridge that communication and language gap, in an attempt to address some of these numbers, and now covers 810 communities in Alta Verapaz.
Since Kawok’s implementation in Alta Verapaz, maternal mortality has declined in the area of intervention from 309 deaths per 100,000 live births in 2008 to only 254 in 2012 (an approximate 25 per cent decrease) according to the itdUPM study, so when the MSPAS was looking to create a national health strategy, possibly shutting down the systems currently in place and replacing them with one overarching system, Peterson and TulaSalud went to talk them out of it.
“We had an emergency call from our friends in Alta Verapaz in about December (2014), saying ‘Something terrible is happening. They’re talking about having a national policy for information technology and health, and it looks as though they might be shutting down our program.'”
They managed to get a meeting with Guatemala’s Minister of Heath, and were preparing to fight against the cancellation of their program in Alta Verapaz.
What ended up happening, however, was much, much more than that.
After about an hour of listening to the group pitch their program’s benefits, the minister had given in, Peterson says, “and he told us ‘your program is safe.’ Not only that, but he also said, ‘if this program is so good, why are we only doing it in Alta Verapaz?'”
A Guatemalan worker installs some wireless network infrastucture in Alta Verapaz to help with connectivity and communications between Community Health Workers, hospitals, instructors and databases.
It was a good thing they had already been considering ways to expand the program – and had a grant application in with the Canadian government to do so – because they were about to be developing a national “Technology in Healthcare” strategy for an entire Central American country.
On Canada Day, 2015, the Tula Foundation received word that they had received that grant.
The Department of Foreign Affairs, Trade and Development Canada awarded the Tula Foundation a $7.6-million Partnership for Strengthening Maternal, Newborn and Child Health (PSMNCH) grant, which are “aimed at reducing maternal and child mortality and improving women’s and children’s health in developing countries.”
That money will help them expand their program into three neighbouring states, hopefully to cover the entire country in the not-too-distant future, saving more lives and increasing the health of women and children in an area having real difficulty with that.
Their distance education nurse training program also continues to this day, having trained over 1,300 nurses and many more CHWs to this point.
And Peterson and Munck have found their “thing to do” that fulfills their three requirements.
They have also found their little piece of paradise, away from big city life, over on Quadra Island.