In Brazil, one of the biggest challenges to dealing with the Zika crisis is logistics.
The South American country has bad infrastructure, unequal access to health care — and it's huge. It's difficult for a mom with a microcephalic baby who lives in the countryside, hours away from specialists, to get the help she needs.
But one doctor has developed a system that could revolutionize medicine in Brazil — and has already helped tens of thousands of babies.
Dr. Sandra Mattos, a pediatric cardiologist, checks in with her tiny patients from her laptop. Her screen is split, showing various hospital rooms around Brazil's northern Paraiba state. Mattos is practicing telemedicine, which allows doctors like her to diagnose and treat patients at a distance. The rational is pretty straightforward — it gives people in remote communities access to specialist care.
"Training a specialist takes a very long time, it's too much effort, too much time," Mattos says. "Using telemedicine, you can concentrate the expertise in some areas and spread it to much bigger areas, and more people will benefit from it."
Telemedicine is not new. But what's different here is the scale and scope of what Mattos has created. It all started a few years ago. The state of Paraiba was having a lot of problems getting infants born with congenital heart defects the care they needed. Mattos had worked with telemedicine before outside Brazil, and had been thinking long and hard for decades about how to deal with the problems of the health care system here.
So she set up what she calls the Heart Network. There are 22 regional hospitals and more than 100 doctors involved — around the clock care. The linchpin to all this are what she calls the echo taxis: basically, cars that deliver specialized equipment to facilities in remote rural communities.
"They run around every week, three echo taxis go to three villages in the countryside, the medical equipment stays in that maternity for that whole week, during which we run pediatric cardiology clinics. And all of them are supervised via telemedicine," Mattos says.
The local staff is trained to operate the equipment while specialist doctors are on hand to look over the data. That way, they can check which babies need to be seen in person and which ones don't.
"It's a way of running clinics and not having to overload the big centers, which are really very, very few and far apart from each other," she says. "We try to bring to the large centers the patients that really need care."
In the few years the system has been in place, they've looked at the hearts of 127,000 infants in the state. This would be successful by any measure.
But, then, Zika happened. The minister of health was all of a sudden having to deal with a surge in cases of microcephaly. The government was looking for a way to treat and properly diagnose the infants with suspected brain damage. Mattos's program was easily adaptable.
"As we had the network and access in those remote areas, we just said should we not use the model of the network and try both managing and diagnosing these children," she recalls.
The echo taxis were sent out with equipment that would look at babies' brains instead of their hearts. On the other end of the computer, there were now neurosurgeons instead of heart surgeons. And that huge database of information on babies born in the state proved pivotal in trying to figure out what was going on regarding Zika-related birth defects in Paraiba.
"I think, perhaps, that is what is so unique about our situation here in Paraiba and in Brazil. We don't have very large databases in Brazil as a whole, its not very common, especially rural communities — we don't get data from them," she says.
Ultimately, it has allowed the state to far more efficiently deal with the Zika crisis, says Erin Staples who lead the Centers for Disease Control study in Paraiba.
"I think it's a way forward," she says. "We saw children in places where it took our teams, you know, over a day to get to. And just imagining, if they had to come to here, they might not have the means or the time. So having a system set up to help spread the knowledge and expertise is important."
And, she says, it shouldn't only be adopted in other parts of Brazil.
"I think it's a good model for Brazil, I think it's a good model for even rural places in the United States, [where] there isn't always the right care."
Dr. Mattos says its an example of local solutions being applied to local problems.
"So rather than coming in with a globalized solution," she says, "we lead people by empowering them here. "
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