2016 Articles
By Reza Ghadimi
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12-29-2016 - Learning From the Past, Encouraging the Future
We covered many issues in the past year about the need for and use of telehealth, telemedicine and tele-education and how these tools can help with the plight of the under-served and the poor in our rural and urban areas here at home or internationally. From all the changes that have occurred in the last year, it must be appreciated that many of those concerns have been addressed by our legislators, universities, healthcare providers, managed care organizations and the insurance companies.
Some of our weekly notes and editorials attracted more attention than others. We thought that you may want to revisit some of them:
Our articles on "The Physics Girl" posted on January 28, "Adopt a clinic" posted on August 11 and 18 received the most attention.
Two articles on immigrants posted on March 17 (the UN article) and July 7 (a mother and her baby), were read many times. The September 1st article on Mother Theresa and the March 24th one about a woman with asthma in NYC, woke the emotion of many.
It is clear that we are reaching many of our readers and actions taken by telehealth organizations such as; "NM Telehealth Alliance", "American Telemedicine Association (ATA)", and "UNM's Project Echo" are having positive, constructive, productive and beneficial results.
Still the coming new year will bring us challenges that need addressing and concerns to keep in perspective and attend to. The new administration, in it's zeal to make drastic changes in budgetary issues, may cut areas important to us healthcare providers. It will be important to point out that Americans can be most productive and resourceful when they are healthy! And that the healthcare industry is one of the largest employers of our population and one that has exported almost non of it's jobs overseas. Thus it needs to be stimulated, nourished, cultivated and not cut or downgraded.
New Mexico Telehealth Alliance wishes you, your family and your organizations a very happy and resourceful new year.
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12-15-2016 -
With the people of the Middle East it was the custom of the great families to send their children into the desert, to spend part of their childhood amongst one of the Bedouin tribes. It was for the children to breath the desert's fresh air, their bodies to feel the desert wind, sand and sun. And their souls to drink the bounty of the desert. In the desert, one is conscious of the immortality of space, and in virtue of that realization escape the domination of time. By striking camp one can slough off the yesterdays, and tomorrow seems less of a fatality. Is it any wonder then, that all God’s prophets were born and lived in the desert?To fully understand God’s true nature, maybe we too should spend part of our childhood in the desert, and discover why Abraham, Moses, Jesus and Mohammad spent their early life in the wilderness. Perhaps then, we can appreciate the kindness that God wants us to have toward each other. Maybe then, we too can look out and see the light of God. For now let us celebrate and thank the Lord and count our blessings for all that He has given us and for this great nation of ours. Let us pray and resolve to share our blessings with those less fortunate around the world through the gift of our profession.
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12-89-2016 - Bubbles
"Bubbles!" The little girl shouted with excitement swiping at the soap bubbles in front of her. But as other bubbles rose out of her reach, she became upset watching them float away. Her disabled body made it difficult reaching far. Soon she lost interest and pushed the hand holding the soap bottle away.
Her mother tried calming her; "Honey they are just playing with you."
"I don't want to play with something I can't hold or catch," she said tearfully.
She had MS (Multiple Sclerosis) and with the limited treatment options of the time, she was confined to bed or wheelchair. Many debilitating diseases had no treatment and the little knowledge available on their care were out of the reach of most healthcare providers.
Several years later, while serving in the US Air Force, I was a member of our unit's ATH (Air Transportable Hospital – Air Force's equivalent to Army's MASH unit). We were deployed to Amman, Jordan after the Jordanian Civil War in 1970. We treated many casualties of that war. But one young girl of about ten left a lasting memory. She had lost a leg in the bombing. We were trying to evaluate her, but her incessant screaming and crying made it difficult. At one point, I lost my temper and snapped at her that we were just trying to help her."You want to help me" she shouted back, "take your bombs away and give me my leg back."
I was taken back and felt terrible. Over the next couple of months, after many surgeries and skin grafts, we were able to save a short stump. I made friends with her and made her happy when I built her a prosthesis with a broom handle, before leaving Jordan.
Diseases and wars have kept our profession very busy in the last hundred years. Today stories coming out of Iraq, Syria and Afghanistan bring back many unpleasant memories to people like myself. I am sure the medics of our armed forces have their hands full with all kinds of problems today. But if there is anything to be thankful about is that advances in communication technologies such as Telehealth, Telemedicine and Tele-education make it possible to bring help to our healthcare providers and patients in a timely fashion and allow sharing of ideas and treatment options with experts all around the world. I hope and pray that with these wonderful tools in our hand, we maybe able to bring some sanity to our troubled world and find a peaceful way to live with each other.
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12-1-2016 - Where the Time Goes
As we finish the age old celebration of Thanksgiving and prepare ourselves for Christmas and the coming New Year, I cannot help to wonder on the immortality of Time itself. For whatever time is, its hold on us is dictatorial and constant. And nowhere is this demand more critical than in medicine. Despite its hold on everyone of us individually, everyone wishes, demands and does everything to control it, and when it seems that time is running out, many turn to medicine to borrow, buy, squeeze or even steal more of it. But do we, as practitioners have any of it to give, sell or bestow upon our patients? There are many who think we do.
I had a famous singer as a patient once and at another time a champion golfer. On both occasions, they became ill before a scheduled performance and wanted me to cure them immediately. "I don't have TIME to be sick", was the mutual statement. And how about the mother with a sick child who says; "I don't have the time to stay home with him." or someone with a sick parent asking; "can't you put her in the hospital, I don't have the time to watch her." Are we truly the merchants or bankers of time?
Then there are times when we ourselves are stretched for time, well beyond the given hours of the day. When we are late for surgery, or it is the end of the day and there are still ten patients waiting to be seen.
How many times have we said; "Only if there were more hours in the day!" But there isn't even one minute more in the God given day. Time has no prejudices of our race or creed, does not understand war or peace, and cares not for our wealth or lack of it. Despite all our rushing, sleep or food deprivation, and all of our multi-tasking, it moves on a steady and uninterrupted rhythm. Then one day we look in the mirror and say, “Where did the time go?”Fortunately for us, technology has given us tools to manage our time for the benefit of our patients and ourselves. Telehealth, telemedicine and tele-education, cut short the time we spend between our patients and the way we care for them. But only if we use it and use it properly. Tomorrow, the sun will rise, the wind will blow, the tides come and go, and the moon and stars wander about us, as time marches on. But hopefully we will have time for a good night sleep. So as a lullaby I will leave you with this song by Sandy Denny and sang by Nina Simone; "who knows where the time goes"
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11-17-2016 - World Antibiotic Awareness Week
This is World Antibiotic Awareness Week. It is amazing that antibiotics are not even a hundred years old and yet we have developed, expanded and used them to such levels that many diseases are now resistant to them. Since my article on this subject last year, I have been following this matter with interest – as have many of our colleagues. As is evident by the two articles I have linked below, awareness is catching on. Fortunately many of us are heeding the warnings and are more cognizant of the way we practice. But it is not enough to educate ourselves to the proper use of these drugs. It becomes even more important to educate our patients and overcome their suspicion of our change in treating them. Particularly in established, older patients who for many years have been receiving antibiotics from us for even minor colds and flues. Especially since they can still get these drugs from some of our other colleagues, who are either too tired to fight these patients, too ignorant or just financially motivated. As practitioners, our judgments are our own. Unless some harm shows itself, no one really questions our rational. The problem here is that harm may show itself years later and no one will go back to see who was the culprit. Maybe we should be our colleagues keepers and educators. But that packs in its own set of ramifications and ethical questions.I was working in a resort town in Northern New Mexico a while back. Many of my patients and even residents of the town had a permanent address elsewhere. So, although I was their regular provider there, they considered their doctors back home as their primary care physician.
One such patient was the wife of a local merchant. She brought her young baby to see me once. The baby had been running a low grade fever and pulling on her ears. The mother stated that the baby had another ear infection and that her doctor back home usually prescribed antibiotics. I examined the baby and found no evidence of any kind of infection. I told her so and suggested that we should treat her symptomatically. She became argumentative and said that her doctor back home always gives her an antibiotic. I tried to reason with her but she left disappointed.
Our town pharmacy was next door and later that afternoon I saw her in there filling a prescription. Later I asked our pharmacist and was told that a prescription for antibiotics was called in from an out of town doctor for her baby.
Today there is more awareness of these types of problems and technology provide us with tools that can be used to overcome some of these misunderstandings. Telehealth, telemedicine and tele-education make it possible to educate, examine and treat people in places near and far. Proper use of these tools can reduce or even eliminate many ambiguities and help us make accurate diagnosis, even when our patients are away. There really is no excuse for practices such as the one told above.
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11-3-2016 - Leprosy
India reports that their health department has checked 320 million people for leprosy.
The medical school I attended was in the US Public Health Hospital on Staten Island, NY. It was the early 1970s and the Vietnam War was still on. Due to the need for healthcare providers in the military, there was a shortage of medical personnel in the private sector. This was particularly acute in such places as public hospitals and clinics like our Hospital. As a result, many foreign doctors were employed in these places to fill the need. This brought with it numerous challenges but just as many opportunities as well. Several of these doctors, for example, were from Latin America and the Far East; like China, Korea or the Philippines. Besides their Western education, many had Eastern medical experiences which came in handy at the time.
Our hospital for example, was the only one on the East Coast that treated Hansen's Disease (Leprosy). Two of our oriental and a Colombian provider had good experiences in the treatment of this disease from their home country and thus were put in charge of that clinic. With the advances in the treatment of this disease, the number of cases were small. Many of our patients were from the Caribbean, Central and South America. They stayed with relatives in the NY area and were treated by us. Often, the biggest challenge in treating these patients, was not their health problem, but rather the economical and financial hardship their care in NY created. They were being seen every few months, which made it necessary to stay in NY till their treatment was completed. They were usually from indigent families and going back and forth to their home countries was not a realistic option. Some did go back and we usually lost them and never saw them again.
Today, with the advent of telehealth and telemedicine, we can treat many of them in their own countries and at home. If we could overcome the many political and bureaucratic obstacles.
In our last February' Interstate Telehealth Discussion Group conference call, Doctor Bob Haws, a Pediatrics-Nephrologist from Marshfield Clinic told us about his work with Bardet-Biedl Syndrome (BBS). He told us that; "there are only 2500 patients in the United States that have this disease and Marshfield Clinic is the specializing center in the treatment of it. Since these patients live all over the United States and the world, it makes it more challenging to provide care for them. If they could use telehealth, in their work, the burden, cost and hardship on the patients and the providers would be reduced dramatically. Yet unreasonable licensing requirements make such logical means of care unavailable."
There are many other diseases such as BBS, and Hansen that could effectively be treated through telehealth, telemedicine and tele-education, if we could set aside, our prejudices and unreasonable need for turf control. This week we learned that Pennsylvania became the eighteenth state to enact the FSMBs Compact. If we could universally sign up to the Compact, advances can be made on many of these rare disease and universal healthcare become a true reality.
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10-27-2016 - Bob Hoover
News comes to us that the legendary pilot R.A. "Bob" Hoover, has died. He was 94. With his Tennessee drawl and trademark straw panama hat, Hoover was an icon of American aviation.
Many of us in aviation held him as a hero in many ways. His love and devotion was second to non, as he was an avid promoter of it. He flew in more than 2,500 civilian and military air shows in the U.S. and around the world, thrilling those on the ground with his trademark routine: shutting off the engines on his Aero-Commander, while performing loops and dives. He flew with such precision that he was able to pour iced tea into a glass in the middle of a barrel roll. After every air show, Hoover would take time to talk to the young people and promote flying. Bob Hoover attended an air show in Santa Fe in 1998. I took my son there and met the legendary flier. He was more interested in talking to my then seven years old son than me.
Hoover's achievements are too numerous to list here, but what he did for aviation could be a great lesson for all of us in medicine. For while he flew for more than seventy years of his life, his focus was always on promoting aviation and helping to make it safer and more resourceful.
Every pilot faces a potential emergency requiring a forced landing off an airport on every flight. Calamities happen when the pilot panics and stops flying the plane, becoming a passenger himself. Bob use to say; "When faced with a forced landing, fly the airplane as far through the crash as possible!" A lesson I have carried throughout many aspects of my life.
In healthcare too, we face the potential of errors, but should never forget our primary role of serving the ill and the injured. And serving them wherever they are in rural as well as urban areas. Fortunately for us telehealth, telemedicine and tele-education make this very easy today, just as GPS makes navigating the skies a lot easier than guessing where in God's sky are we. Rest in peace Bob, you will not be forgotten.
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10-20-2016 - Understanding Each Other
The topic of today's issues is something I have been very concerned about in all my medical practice years. That is to make sure that we practitioners and our patients totally understand one another. For us, to understand what the patient's real problem is and our patients, to fully comprehend our diagnosis, prognosis and instructions we are giving them.
When I was serving on the NM Medical Board, the number one reason patients complained about their providers, was lack of proper communication between them. And when I sit on the NM Medical Review Commission hearings, the number one reason for law suits is misunderstandings between patients and providers. No where is this more dangerous than when dealing with non- English speaking patients, or an average patient who will not understand our medical jargon. So I am pleased about the two reports from AAMC and The PEW Charitable Trusts, I have linked to in this week's "In The News" section bellow.
Our patient population come from many national backgrounds and cultures. They bring with them; their traditions, customs and rituals that most of us are unfamiliar with. Grasping their problems and needs are not always clear or simple. Consider this story told to me by a colleague who was a Vietnam veteran, working in a local urgent care:
He was at work one day when he noticed a commotion across the clinic in another provider's section. There were shouts and angry exchanges so he went to investigate. There were police officers and others not from his clinic standing by.
"What is going on?" He asked a nurse.
"We called child protective services, because Doctor R. felt his young patient was abused. They are Vietnamese and don't speak English well."
It was early 1970s and the Vietnam war had just ended. Many Vietnamese were immigrating here. Since he had spend a couple of tours in Vietnam and knew a little of the language, he volunteered to intervene. Soon the problem became clear. The treating doctor of a young child had noticed several bruises on the child's body and had suspected abuse so he called the social services, who called the child protective services, who called the police and they all ganged up on the poor family.
A Vietnamese folk remedy for many diseases is to use suction cups to suck out increased ill pressures in the body – especially in the lungs - to eliminate the sickness. The cups thus leave marks on the skin, which were interpreted as abuse marks by the doctor. By his intervention, my colleague cleared the confusion, got the child proper treatment and the relieved family went home together.Such confusions exist in many of our intertwining, mixing and confused world, such as our executive director; Terry Boulanger mentions in his news summery. "Sometimes the way the IT industry names things drives me crazy and I can only imagine what it does to you who are not in the field."
Here are the links to his news blogs for those of you who do not receive his e-mail;
Navigating the Buzz Words of Telehealth, Expert system - A definition, Understanding the evolution of the internet of things, IoT for healthcare brings potential coupled with concerns, IoT security from the outside in and inside out.
Thus it behooves us all to be cognizant of our environment as it has never been more dynamic than it is today. And in no place is the confusion of miss-communication more dangerous than in medicine. Telehealth and tele-education can help us overcome these barriers. Especially in the rural areas of our country with limited access to language translators.
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10-13-2016 - Interstate DG Annual
A year ago, this week, we held the first meeting of Interstate Telehealth Discussion Group. Since then our meetings have been attended by many interested parties. Many organizations and university groups have shown considerable interest in telehealth – which is great. However, young providers are still missing from our discussions. Yet they may be the most affected by this technology and the future of it.
Since I am attending my daughter's wedding this weekend and have been too busy to write a proper article for this week's newsletter, I will reiterate my concerns from my last year's article as they are still pertinent today:
When I first entered the world of medicine at the ripe age of fourteen in the middle of the last century, we had nothing that could be called technological to today's standards. We had reusable needles and glass syringes, plaster of Paris came in powder form in a bucket, and x-ray machines stood in the corner of a room. We carried an alcohol lamp and sterilized the needles and syringes by boiling them in water before each use. When a patient was being x-rayed, usually his or her family members were in the room with them, including their children. Antibiotics were new and looked at with skepticism and vaccination considered witchcraft. We have come a long way in the past half a century. Today we consider all of the above; archaic, old and even barbaric. Yet in their own time, they were state of the art medicine.
Much of what we use today was considered science fiction at the turn of the last century. The rate at which our world is progressing will put us decades ahead in the next generation. By involving themselves, our young practitioners could benefit immensely in understanding, forecasting and developing the next generation of medical devices, medications and technologies. I - for one - would love to see younger people at our meetings, conferences and organizations. The future belongs to them and the better they understand the present, the better they could shape and direct what is coming their way. Encourage young practitioners in your organization to join us.
What would they say of today, sixty years from now, I wonder.
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10-6-2016 - Albuquerque Balloon Fiesta
We met about 5 AM in the parking lot. There were four of us, but soon a couple more trucks showed up. Jeff handed me a broom and pointed to an area behind his salvaged bread delivery truck. "We are going to spread the balloon there, make sure there are no sharp objects or anything that can damage it."
In the early light of the day, I swept the ground as best I could and returned to the truck to help unload the balloon parts. Jeff connected the tanks to the burners and tested them. The canopy, called envelope in balloon jargon, carefully unfolded and spread out. A powerful gas operated fan was placed at the opening. Several of us held the mouth open as Jeff started the fan and blew air into the envelope. It gyrated, rolled and began to inflate. Despite of the early hours of the morning, several bystanders showed up, smiles exchanged, salutation made – balloon people are friendly folk, for one never knows whose help maybe needed. We stood up taller and pretended to know what we were doing.Jeff turned the burners on, pointing it into the expanding envelope. The heat soon warmed the air inside and it started to rise. Jeff jumped in and instructed us to hold it down. Burners belching flames made the balloon struggle to break free from the ground. Myself and another passenger jumped into the basket, as others let go of it and we left the earth and shot up into the cool air of the morning. We rose to meet the first rays of the sun, clearing the top of the Sandia Mountain. In the air, we were joined by several other balloons that had taken off from other places around town. An exhilarating feeling overwhelmed me as a light wind got a hold of us and blew us across the landscape bellow. Sleepy Albuquerque slipped silently under us. We looked shamelessly into many backyards while people slept. Occasional blast of the propane torch broke the silence and kept us aloft. Lost in the thrill of the moment, I panned the world around me in silence.
The year was 1977, and we had just attended the fourth Albuquerque Balloon Fiesta. Years later, while working at Lovelace, we established a First Aid and Medical Tent at the newly opened Balloon Fiesta Park. Most of what we cared for there were scrapes and scratches due to people falling or running into something, while looking up at the many colorful balloons ascending into the blue skies of New Mexico. Among the thousands of visitors, there were occasional people who had forgotten their medicine. We checked them and refilled their medications. A few times, it became necessary to refer or shipped them to our ER. On those occasions, the primary provider of the patient back in their home town was consulted. The contact was established by a long distance phone call which usually required us leaving a message and then waiting to hear back from them. Back home, charts had to be found, and studied to refresh the particular patient's problem before calling back. All this, took time and effort, for which the primary provider was not compensated.
Today, Telehealth and telemedicine make these efforts easier, faster and to the benefit of all. Parity laws, further help providers get paid for their consultation, no matter where the patient maybe. We have come a long ways from lunching a handful of balloons from shopping mall parking lots, long distance phone calls to far away clinics and guessing on how to properly treat a traveling patient that we would never see gain. Telehealth, telemedicine, and tele-education make it possible for patients to be informed and stay in touch with their providers throughout their travels and thus reduce or eliminate the need for an ER visit away from home. Lets work together to fully develop this system and make all our lives easier in this mobile society.
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9-29-2016 - Marco Polo
Sept 23, 1215 was the birthday of Kublai Khan, the Chinese ruler whose empire stretched across modern day China and Mongolia. He founded the Yuan Dynasty. He is also known to be the first to institute paper money.
Despite his popularity and tremendous achievements, he would have been unknown to us, was it not for the writings of Marco Polo, who visited China during this time. It took Marco Polo three years to travel there. He was a teenager when he started the journey with his father and uncle. He spent seventeen years in China and another three years to return to Europe.
Marco Polo praised Kublai as a great leader but gave conflicting reports on the emperor's life in his writings. Considering his seventeen years of experience there, it is understandable to see how witnessing the running of such an empire could leave varying impressions on a young mind.
One of the emperor's excesses that impressed Marco Polo was his summer palace. The place was called Shang-tu, a word that became known as Xanadu in English. Shang-tu however just meant "Upper Capital," distinguishing it from the main capital he founded to the south. The place had mystical powers and was the subject of many writings by Marco Polo, Samuel Coleridge and others. Today, Kublai's main establishment is known as Beijing and all that remains of Shang-tu, is several grassy knolls on a vast plain.
Interesting, how empires change, rulers die, palaces become ruins and history paints diverging pictures of events. It is also fascinating to note that the entire human history occurred in a tiny period of geological time on this small planet of ours. Marco Polo's adventures took twenty three years of his life. Today we can traverse the same distance that took Polo three years, in a few short hours. Write about it, publish it and send it to millions of readers by internet. These technological advances have made us aware of how small our planet really is.
Just before Voyager 1 spacecraft left our solar system in 1990, Carl Sagan convinced NASA to turn it around and take a last family picture of our solar system. The picture showed earth as a blue dot in the darkness of universe. Later, at a lecture, Sagan reflected that "on that dot, every human being who ever lived, whether prince or pauper, rich or poor, smart or simple lived out their lives".
The picture clearly reveals how small we really are, yet our ego and our audacity made taking that picture possible. Though many credit a few scientists for making that picture possible, was it not for humanity as a whole, the existence of those few would not have happened. So we owe our achievements to the entire human race and should not take our humanity for granted nor subject it to peculiar prejudices. As Alexis Tsipras, the Greek Prime Minister in his address to the UN General Assembly last week elegantly stated; "Humanity should not be conditional".
Many challenges face us all on this blue dot today. Not the least is the challenge of healthcare for our people. Fortunately, the same technology that made taking the selfie of earth from four billion miles possible, gives us the ability to see and care for each other right here on earth. Telehealth, telemedicine, and tele-education give us all the tools we need to provide healthcare for every human being on earth. We just need the wherewithal to use it.
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9-22-2016 - Memory
Seat 4A placed me by the window on my way back from Florida. The early flight was half full and as we flew west, I watched the rivalry between day and night in the country bellow. Almost all my fellow travelers, were sleeping. I, was glued to the window, watching the lights of the towns flickering and going out with the arriving day. I recall thinking; "they have all heard of Elvis and know who the Beatles are. But I wonder how many know the name of their doctor?" Mementos of sand and sea safely stored in the archives of my mind, I reflected on the gift of memory.
When my children were in high school, I drove them to school every morning. Occasionally, another student would carpool with us. Once, an exchange student from Scandinavia was with us. She was a charming young lady who spoke with a strong accent. A junior who was staying with a neighbor of ours. The radio was on the morning show and played a variety of songs. The next song caught her attention and she announced; "Oh Louie Armstrong."
I was surprised that she knew the jazz master and asked if he was popular in Sweden. "Oh yes, my father owns many of his albums. He often plays a song or two on the radio when he takes us to school in the morning. This song makes me homesick."
It is a strange thing; memory! How simple things in passing can awaken deep emotions or echoes of past events. There are things that we will remember for ever and then those that are erased as dust by the passing wind. The fact that we have the ability to file them in our long term or short term memories is not in itself surprising. But what we choose to store, is. Why so many of us recall such menial things as certain musicians, bands, actors or characters, yet cannot remember who the governor of our state or our senator is, or our doctor's instruction regarding diet and exercise. In remembering selectively, do we make our lives better or just easier to cope with? I suppose the tsunami of irrelevant daily data bombarding us makes this selective remembrance a necessity.
As practitioners we face this dilemma daily. How do we make our patients follow our instructions and not forget them as soon as they get into their car and turn the radio on. Perhaps having the ability to remind our patients of our instructions would be beneficial. Fortunately today's technology provides us this ability. Tele-education and telehealth are two instruments in our medical-bag that we can use. But we must first care enough for our patients to make this extra effort. The hectic life, we ourselves live however makes this ever more challenging and the organizations we work for often make such efforts prohibitive. If we want to make lasting impression on our patients, it behooves us to remind them of us and our concern for them. Otherwise the memory of their visit will be erased as footsteps in the sand by the passing wave.
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9-15-2016 - Citizenship Day
Saturday; September 17, is Citizenship day (observed tomorrow Sept. 16.) With the movement of all the migrants, refugees, and seekers of a better life, the world is being remade and the ramification of all the changes are profound and will be long lasting. Politics aside, we all have to appreciate the fact that seeking a better life is a fundamental and natural desire of all creatures of God. Just watching the ants and spiders wanting to migrate to the warmth of my house, this time of the year is proof of this desire.
Although our birthplace may determine our race and certain minor anatomical differences, it should not bind us to a permanent geographical region. After all, if not for man's desire to migrate in search of betterment, we all would still be living in Africa.
We should remember that much of the scientific, technological, and medical advancement, we are so proud of, was brought here or invented by immigrants. There is an old saying that; "Every man is born twice. First to the parents and family that bore him and second to the people and society he/she chooses to live with." We the people of this planet must share it's resources equally and evenly. Only then, man's true potential for advancement and achievement will propel him forward to new accomplishments.
Today we have the technological means to share our knowledge and abilities with one another. Tele-education, telemedicine and telehealth are just three tools that can help us reach humanity in need everywhere. Sharing ideology, knowledge, and discoveries with one another will be to the betterment of all. For, we are all citizens of this small planet.
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9-8-2016 - Eastern New Mexico
We spent the last weekend in Carlsbad, NM getting our son married to a wonderful young lady from there. It was a joyful occasion and the happy couple are honeymooning on an Alaskan cruise. We appreciate the good wishes from many of you. Whenever I travel this incredible state of ours, I think and study the demographics of it and how it affects the healthcare of our people.
I don't know how many of you have traveled to Southeastern New Mexico. To Roswell, Hobbs or Carlsbad - to see the Carlsbad Caverns perhaps. It is hundreds of miles of open country. With antelope, deer, coyotes, eagles, hawks, badgers and rabbits adorning the beautiful landscape. It is also home to some of our largest dairy and cattle industry with many of their cows grazing peacefully throughout. This time of the year, the many wild plants and cactus are blooming and displaying their pallet of colors to the tapestry of nature for as far as the eye can see. The cumulus clouds against the blue New Mexican sky add yet another level of beauty to this land of enchantment. Strewn among this majesty are many small towns, like Encino, Vaughn, Ft Sumner, Mountainair, and Clunch. Roswell with it's alien museum and Hobbs with a jungle of oil wells are in the distance. Eastern New Mexico (61,967 mi²) is an area almost as large as all of New England combined (71,992 mi²), yet sparsely populated. The citizens of this area are hard working people who raise cattle for our food and grow maze and sorghum for our livestock. Out of the ground, they pump the oil that provides us with our energy needs and pays billions in taxes that help our state government function. Regardless of what or how we feel for these industries, their working people are the backbone of our economy. Yet when it comes to their healthcare, we neglect them grossly. The small clinics and hospitals in these rural areas are dangerously understaffed and sadly under budgeted. We owe these people a lot more.
There is no secret that healthcare in our country is mismanaged. No place is this more evident and revealing than the rural counties. But this being the twenty first century, certain technological advances give us the tools we need to overcome this disparity. Organizations such as NM Telehealth Alliance, UNM Center for Telehealth, and Project ECHO, have been working very hard to incorporate this technology into the daily task of a healthcare delivery system. But many of our practitioners have been slow in adopting it. This is in part, due to their lack of appreciation of this need. Fall is the best season to see the desert southwest. You should all take a weekend drive through this country and see for yourselves. Take the kids or a loved one and start at the Blue Hole in Santa Rosa and take highway 54 south through Vaughn, Gallinas, Ancho, Carrizozo, and spend the night in the historic Capitan or Ruidoso. Or better yet in the mountain coolness of the Inn of the Mountain Gods on the Mescalero Apache Reservation. Next day head on north toward Mountainair and stop at the Quivira and Abo Missions and see the Spanish Missionaries of the past's contribution to our state. I guarantee that you will be impressed and return with a good appreciation of the need in these areas. Then consider setting a few hours a week aside to help the folks there through telehealth. We can show you how, and remember that this will not be voluntary work. NM telehealth laws allow you to charge for your consultation and services and the patient insurance will pay you for it. See you on the range – either in person or virtually.
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9-1-2016 - Volunteers
Among the stack of mail was a card from The Salvation Army, thanking me for a donation I had made earlier. It gave me time to pause. What an easy way to feel gratified; put a check in an envelope, mail it and go on about your business. Your money would – supposedly – help those in need. But is it really that easy. Do we really feel satisfied. Could we do more? How about …
It was interesting that the above card arrived last week on August 26, on the birthday of a young girl born in 1910 in Skopje, Albania (today's Macedonia). Her name was Anjeze Gonxhe Bojaxhiu. Her father died when she was eight and the family's poor status worsened. Her strong mother's faith however, helped the family cope and developed a sense of obligation and devotion in the young Gonxhe. So much so that at the age of eighteen she left home and joined the Sisters of Loreto at Loreto Abbey in Rathfarnham, Ireland. There she learned English, geography, catechism, and history. In 1931, at the age of twenty, she took her first religious vows as a nun. Soon after she was sent to Calcutta, India to serve at a convent there.
In Calcutta, the terrible poverty around her disturbed her so much that she felt compelled to leave the sanctuary of the convent and live among the poor. She exchanged her traditional habit for a simple white cotton sari with a blue border that became her signature garment for the rest of her life. Although she had no income and had to beg for food and supplies, she persevered, and soon after, the Vatican recognized her work and helped her start a congregation there. She gave her services wholeheartedly to the poorest of the poor and got to be recognized by much of humanity. So that by the time of her death in 1997, her relentless devotion to serving the poor had gotten the attention of the world and her Missionaries of Charity grew to be an international institution in 133 countries. She opened orphanages, homes for people with tuberculosis and leprosy, health clinics, and schools. She even opened shelters in Harlem and Greenwich Village in the United States.
She was awarded the Nobel Peace Prize in 1979. When asked how she found time to do all her charity work, she said, "I work all day. That is the only way. By blood, I am an Albanian. By citizenship, I am Indian. By faith, I am a Catholic nun. As to my calling, I belong to the world. As to my heart, I belong entirely to the Heart of Jesus."
When she was at the convent in Ireland she changed her name after Thérèse de Lisieux, the patron saint of missionaries but opted for the Spanish spelling of Teresa. We know her better as "Mother Teresa."
Remembering that it was her birthday and all that she had done for our world, I felt shame for feeling satisfaction in sending a check to The Salvation Army. We can do so much better. Fortunately for us the technology of telehealth, telemedicine and tele-education enable us to contribute to these needs with our talents and expertise without having to leave home. Just a few short hours a week could make a world of difference.
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8-25-2016 - Dualities
The early morning light cleared the mountain ridge to slit through the curtains and welcome itself into my day. It was exhilarating to be waken such. My wife had the radio on in the kitchen and Edvard Grieg's Peer Gynt Suite was playing softly. A perfect accompaniment for such a morning. I peeled the covers off and stood with sunshine in my face. Such blessing and beauty sent my way – overwhelming!The morning news though, was anything but pleasant. It portrayed a world in chaos, pain and despair. The contrast between my world and that, minutes or hours away was so profound that no amount of rationalization, philosophizing, or finger pointing for that matter, justified it.
I dressed and headed to town and our monthly telehealth meeting. On the long drive there, I repeatedly changed the channels on the radio in the hope of hearing any news to compliment the sunshine of my morning. But it was not to be, even the traffic report was depressing. Finally I settled on listening to the classical channel's music interrupted by screaming salesmen, peddling their goods.
Our meeting discussed the many requests for assistance, our financial shortcomings and the many ideas we had on how to move telehealth forward and help our fellow men near and far. It gives me a glimmer of hope that at least we are making a difference in bringing healthcare to some rural parts of our world by pointing a few of our colleagues in the right direction.
The meeting concluded, errands done, chores accomplished, I headed home at the end of the day. The late afternoon clouds over the Sandia Mountain were ablaze in golden sunset. I kept the radio on classical and ignored the commercials. My wife handed me a cup of hot tea on my arrival. Sitting on the porch, I watched the last rays of the light draining from the cloud tops and the crickets announcing the coming of the night. With tears in my eyes, I counted my blessings and wished for a better tomorrow for all. For, this Escher(ian) duality of our world is, at the least, confusing. But while some stab at the fabrics of our society with daggers and spears, many more of us are at hand with simple needles and thread sewing it back up.
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8-11-2016 - Adopt a Rural Hospital/Clinic
"One sometimes finds what one is not looking for." said Sir Alexander Fleming who was born on August 6th, 1881. He became a bacteriologist who discovered penicillin in 1928.
I am on the road to see my son who is getting married in two weeks and as I was preparing for this week's notes – on the road – I again noticed the "Adopt a highway" signs that ask organizations and community groups to adopt and care for a section of that highway and keep it clean. It reminded me once again that it would be a great idea to have major medical centers, hospitals and schools to adopt a rural hospital or clinic, in similar fashion. Bring them under their umbrella and see to their care and success. Many university medical centers send interns and residents to rural community clinics on rotational basis. Although this is great, it benefits the rural communities, minimally.
Our rural clinics and hospitals deserve more than just receiving students. They deserve a full fledged support system. If every major medical institution adopt a rural health center, state of the art healthcare could be brought to these areas to the benefit of everyone.
At the last ATA meeting, many rural communities were presenting on how they used telehealth to improve healthcare delivery system to their area. It would be even a better idea, if major medical centers in each states create a "Department of Rural Hospitals and Clinics" in their organizations and take responsibility of assuring the patients at small town healthcare centers receive the same quality care. The technology of telehealth, telemedicine and tele-education makes such adoption idea not only possible but profitable. It could bring revenue to the majors through this support system, and in the process, real, timely, and proper care is provided to our rural communities. Lets adopt our rural hospitals and clinics and provide them the support system they deserve. Telehealth can help us do exactly that!
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8-4-2016 - Clinics and Walmart
News comes to us that Mescalero hospital joins UNM's telehealth services. They join Zuni Comprehensive Community Health Center, Gila Regional Hospital in Silver City, Sierra Vista Hospital in T or C, Union County Hospital in Clayton, and Sandoval Regional Medical Center in Rio Rancho (Alamogordo Daily News). This, of course is wonderful news and the kind of telehealth communication NM Telehealth Alliance strives for.
In a parallel story, Walmart is pushing forward with it's “a medical clinic in every store” concept, as Walgreen talks about expanding their pharmacy services to provide family healthcare to their customers. All, of course are planning to depend heavily on telehealth.
Although the use of telehealth and telemedicine is most appropriate and welcomed, one must question the commercialization of the concept. It is no secret that these organizations are very much “for profit” establishments. Thus it is a given that they will fully exploit these clinics for profit. How they perform their task needs close scrutiny. Medicine is one art where close provider/ patient relationship is of paramount importance in good healthcare delivery. If these stores offer their healthcare services much like they do their bakery goods – roast the chicken and place it in the middle of an aisle for people to serve themselves – there will be problems. Providers at many of these businesses are routinely changed or rotated between branches. It seems, for example, that every time I go to my pharmacy at the local one of these stores, I find a new pharmacist working there. Often, I am told that the previous pharmacist is working at another store today. This practice makes it difficult to establish any rapport with ones provider. Harming the very basic concept of practicing good medicine. And what about the medication prescribed? Will the patient receive the proper drug or one that the store has special contracts with. I can go on about many of such scenarios but I think that the message is clear.
On the other hand, the proper use of the concept as it is done at the establishments mentioned at the beginning of this article would be most welcomed and maybe the answer to the healthcare provider shortages of the twenty first century, especially for our rural areas. We will just have to wait and see, but we must be ready to step in and correct things before they get away from us. After all the last thing we need is a Volkswagen type discovery of a system abused and gone wrong and no one noticed till it was too late.
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7-28-2016 - Magicians Need Help Too
The magician had no hands. As a matter of fact he had just a semblance of a limb on the right and upper stump of an arm on the left. Yet he expertly shuffled the cards and spread them on the table, as he continued to delight, fascinate and mesmerize the audience. As he finished his spellbinding show, he stepped down from the platform, he was standing on and struggled to carry his four feet dwarfed body off the stage. The audience, enthralled and impressed, cheering and roaring enthusiastically. At that moment he was king, smiling ear to ear and bowing happily. His handicapped body did not enter into the equation at all. The show was not about his physical ability, rather it was about his magical prowess. The audience, shook their heads and asked each other how the magic was done rather than how he could have done the magic.
Years ago, while standing on a street corner in New Delhi, India, I watched a young man with a badly deformed body twist, rotate and contort himself into unbelievable positions. But unlike our magician on stage, the Indian audiences of our street magician watched with indifference and only a few threw coins his way. As a healthcare provider, I not only watched the magician on stage with gaiety, but wondered about all the health and medical issues he has to deal with on daily basis. He, however seemed well nourished and otherwise healthy, despite his handicap. The poor wretch of a young man I witnessed in India, though was anything but healthy. Many bruises, cuts and skin lesions were a testament to his destitute existence. The contrast between these examples reveals the many disparities among citizens of this world. Though both were physically handicapped, the comparison ended there.
It is easy to blame their circumstances on socio-political aspects of their respective societies, it does not however alleviate the unjust and insufferable condition of one over the other.
The fact that many such circumstances exist in our world is saddening. But it is even more heartbreaking to know that it really does not take much to bring help and relief of pain to many of our fellow men. Especially today with the magnificent technology available to us, we really could make a difference. And we don't have to go to the other side of the world to find people in need. Many in our own rural and under-served communities need our help. Telehealth, telemedicine and tele-education could bring much needed relief to many, right here in our country. But if we find the wherewithal to help those far away as well, so much the better.
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7-21-2016 - The New School of Osteopathy
A year ago the New Mexico TeleHealth Alliance Board members met with President Garrey Carruthers of New Mexico State University and Dr. Oliver Hayes, director of Burrell College of Osteopathic Medicine, to address the use of telemedicine at the new Burrell College. It is heartwarming to see that this school is established, first class students chosen, faculty and staff hired, and awaiting the start of the first day in August. Our congratulations to Burrell and NMSU on this historic achievement.
One issue of concern however is that although no public money was used for the development of the new osteopathic school at NMSU, the fact that the school is affiliated with and built on state owned university property gives the impression that it is a state sponsored program, and thus has the same requirements for acceptance as all other state colleges. But in fact it is a private medical school with a hefty tuition that makes it hard for many of our young interested native New Mexicans to afford it. Yet the medical students of this school will be using our medical centers in New Mexico for their studies and internship, and our patient population for their practice and learning.
Our visit with Dr Hayes and President Carruthers was very encouraging as both were excited about the healthcare programs at NMSU and the future of healthcare, use of telehealth, telemedicine, and prospects of increasing the role of mid-level providers in NM. We hope that considerations are in the works to allow more New Mexicans the opportunity to apply to the Burrell program. Perhaps it should be a requirement that a certain number of students at Burrell College be New Mexicans and a scholarship program established to pay for their way.
Our state is in dire need of primary care providers, our young people, especially our Native American and Hispanic students should be encouraged and given the opportunity to get into a carrier in healthcare at NMSU and the many other fine schools of higher education in our state. Since they are most likely to remain in New Mexico and care for us.
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7-14-2016 - Jobs in Healthcare
The Albuquerque Business Journal reports that of the ten fastest growing jobs in New Mexico for the next eight years, 70% are in the healthcare field.
Well that is nothing new to us. We in the healthcare arena have known for a long time that the provider shortage we face in caring for our patients has been the single most detrimental hurdle. This is especially so in the rural areas of our state. The problem however, is not unique to New Mexico. Almost the entire country faces similar shortfalls and there lies the real problem. With such great demand for the limited number of providers, competition becomes severe and recruiters will do anything to attract potential job seekers to their corner of the country. This leaves states such as New Mexico, large in size but with a relatively small population, at a disadvantage. Small population brings limited revenue. Limited resources make for small incentives to offer potential candidates. The freshly graduated with extensive debt to satisfy go to the richer states with better benefits. Quality of life? Disregarded!
Add to this conundrum, is the fact that many of the baby boomers are retiring and moving here with better finances and healthcare insurance. Typically these newbies move to urban areas of our state with larger hospitals and specialists. So the dominoes start falling for the rural and under-served population.
We at New Mexico Telehealth Alliance have been trying to get our urban providers to use telehealth and take their specialty out of the cities but with little success. This is partially due to the fact that these providers are so busy caring for the local patients that they really can't find any time to devote to the outside. The other problem is that the rural populations typically don't have the finances to compete with their urban brethren.
Programs through our medical schools and universities, such as UNM Project Echo help educate and bring attention to the need but little more happens. Perhaps a new way of thinking is needed to resolve the problem. Maybe big businesses should start supporting their local health organizations instead of just providing health insurance to their employees. Gas and oil companies in the Southeast and Northwest of our state for example could provide perks to attract providers to their local area. Likewise, the mining industry in the Southwest and large dairy and ranching companies can do the same in the Northeast.
An area often unfairly overlooked is the thousands of foreign healthcare providers seeking asylum from war torn and impoverished parts of the world. Among the millions of refugees are many doctors, nurses, and other highly educated and trained scientists and medical professionals. They could be identified and their applications expedited. Telehealth could be used at many levels to educate them, help them pass our exams and get licensed. Telemedicine, telehealth and tele-education can ease the pain for everyone – yes pun intended.
We covered many issues in the past year about the need for and use of telehealth, telemedicine and tele-education and how these tools can help with the plight of the under-served and the poor in our rural and urban areas here at home or internationally. From all the changes that have occurred in the last year, it must be appreciated that many of those concerns have been addressed by our legislators, universities, healthcare providers, managed care organizations and the insurance companies.
Some of our weekly notes and editorials attracted more attention than others. We thought that you may want to revisit some of them:
Our articles on "The Physics Girl" posted on January 28, "Adopt a clinic" posted on August 11 and 18 received the most attention.
Two articles on immigrants posted on March 17 (the UN article) and July 7 (a mother and her baby), were read many times. The September 1st article on Mother Theresa and the March 24th one about a woman with asthma in NYC, woke the emotion of many.
It is clear that we are reaching many of our readers and actions taken by telehealth organizations such as; "NM Telehealth Alliance", "American Telemedicine Association (ATA)", and "UNM's Project Echo" are having positive, constructive, productive and beneficial results.
Still the coming new year will bring us challenges that need addressing and concerns to keep in perspective and attend to. The new administration, in it's zeal to make drastic changes in budgetary issues, may cut areas important to us healthcare providers. It will be important to point out that Americans can be most productive and resourceful when they are healthy! And that the healthcare industry is one of the largest employers of our population and one that has exported almost non of it's jobs overseas. Thus it needs to be stimulated, nourished, cultivated and not cut or downgraded.
New Mexico Telehealth Alliance wishes you, your family and your organizations a very happy and resourceful new year.
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12-15-2016 -
With the people of the Middle East it was the custom of the great families to send their children into the desert, to spend part of their childhood amongst one of the Bedouin tribes. It was for the children to breath the desert's fresh air, their bodies to feel the desert wind, sand and sun. And their souls to drink the bounty of the desert. In the desert, one is conscious of the immortality of space, and in virtue of that realization escape the domination of time. By striking camp one can slough off the yesterdays, and tomorrow seems less of a fatality. Is it any wonder then, that all God’s prophets were born and lived in the desert?To fully understand God’s true nature, maybe we too should spend part of our childhood in the desert, and discover why Abraham, Moses, Jesus and Mohammad spent their early life in the wilderness. Perhaps then, we can appreciate the kindness that God wants us to have toward each other. Maybe then, we too can look out and see the light of God. For now let us celebrate and thank the Lord and count our blessings for all that He has given us and for this great nation of ours. Let us pray and resolve to share our blessings with those less fortunate around the world through the gift of our profession.
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12-89-2016 - Bubbles
"Bubbles!" The little girl shouted with excitement swiping at the soap bubbles in front of her. But as other bubbles rose out of her reach, she became upset watching them float away. Her disabled body made it difficult reaching far. Soon she lost interest and pushed the hand holding the soap bottle away.
Her mother tried calming her; "Honey they are just playing with you."
"I don't want to play with something I can't hold or catch," she said tearfully.
She had MS (Multiple Sclerosis) and with the limited treatment options of the time, she was confined to bed or wheelchair. Many debilitating diseases had no treatment and the little knowledge available on their care were out of the reach of most healthcare providers.
Several years later, while serving in the US Air Force, I was a member of our unit's ATH (Air Transportable Hospital – Air Force's equivalent to Army's MASH unit). We were deployed to Amman, Jordan after the Jordanian Civil War in 1970. We treated many casualties of that war. But one young girl of about ten left a lasting memory. She had lost a leg in the bombing. We were trying to evaluate her, but her incessant screaming and crying made it difficult. At one point, I lost my temper and snapped at her that we were just trying to help her."You want to help me" she shouted back, "take your bombs away and give me my leg back."
I was taken back and felt terrible. Over the next couple of months, after many surgeries and skin grafts, we were able to save a short stump. I made friends with her and made her happy when I built her a prosthesis with a broom handle, before leaving Jordan.
Diseases and wars have kept our profession very busy in the last hundred years. Today stories coming out of Iraq, Syria and Afghanistan bring back many unpleasant memories to people like myself. I am sure the medics of our armed forces have their hands full with all kinds of problems today. But if there is anything to be thankful about is that advances in communication technologies such as Telehealth, Telemedicine and Tele-education make it possible to bring help to our healthcare providers and patients in a timely fashion and allow sharing of ideas and treatment options with experts all around the world. I hope and pray that with these wonderful tools in our hand, we maybe able to bring some sanity to our troubled world and find a peaceful way to live with each other.
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12-1-2016 - Where the Time Goes
As we finish the age old celebration of Thanksgiving and prepare ourselves for Christmas and the coming New Year, I cannot help to wonder on the immortality of Time itself. For whatever time is, its hold on us is dictatorial and constant. And nowhere is this demand more critical than in medicine. Despite its hold on everyone of us individually, everyone wishes, demands and does everything to control it, and when it seems that time is running out, many turn to medicine to borrow, buy, squeeze or even steal more of it. But do we, as practitioners have any of it to give, sell or bestow upon our patients? There are many who think we do.
I had a famous singer as a patient once and at another time a champion golfer. On both occasions, they became ill before a scheduled performance and wanted me to cure them immediately. "I don't have TIME to be sick", was the mutual statement. And how about the mother with a sick child who says; "I don't have the time to stay home with him." or someone with a sick parent asking; "can't you put her in the hospital, I don't have the time to watch her." Are we truly the merchants or bankers of time?
Then there are times when we ourselves are stretched for time, well beyond the given hours of the day. When we are late for surgery, or it is the end of the day and there are still ten patients waiting to be seen.
How many times have we said; "Only if there were more hours in the day!" But there isn't even one minute more in the God given day. Time has no prejudices of our race or creed, does not understand war or peace, and cares not for our wealth or lack of it. Despite all our rushing, sleep or food deprivation, and all of our multi-tasking, it moves on a steady and uninterrupted rhythm. Then one day we look in the mirror and say, “Where did the time go?”Fortunately for us, technology has given us tools to manage our time for the benefit of our patients and ourselves. Telehealth, telemedicine and tele-education, cut short the time we spend between our patients and the way we care for them. But only if we use it and use it properly. Tomorrow, the sun will rise, the wind will blow, the tides come and go, and the moon and stars wander about us, as time marches on. But hopefully we will have time for a good night sleep. So as a lullaby I will leave you with this song by Sandy Denny and sang by Nina Simone; "who knows where the time goes"
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11-17-2016 - World Antibiotic Awareness Week
This is World Antibiotic Awareness Week. It is amazing that antibiotics are not even a hundred years old and yet we have developed, expanded and used them to such levels that many diseases are now resistant to them. Since my article on this subject last year, I have been following this matter with interest – as have many of our colleagues. As is evident by the two articles I have linked below, awareness is catching on. Fortunately many of us are heeding the warnings and are more cognizant of the way we practice. But it is not enough to educate ourselves to the proper use of these drugs. It becomes even more important to educate our patients and overcome their suspicion of our change in treating them. Particularly in established, older patients who for many years have been receiving antibiotics from us for even minor colds and flues. Especially since they can still get these drugs from some of our other colleagues, who are either too tired to fight these patients, too ignorant or just financially motivated. As practitioners, our judgments are our own. Unless some harm shows itself, no one really questions our rational. The problem here is that harm may show itself years later and no one will go back to see who was the culprit. Maybe we should be our colleagues keepers and educators. But that packs in its own set of ramifications and ethical questions.I was working in a resort town in Northern New Mexico a while back. Many of my patients and even residents of the town had a permanent address elsewhere. So, although I was their regular provider there, they considered their doctors back home as their primary care physician.
One such patient was the wife of a local merchant. She brought her young baby to see me once. The baby had been running a low grade fever and pulling on her ears. The mother stated that the baby had another ear infection and that her doctor back home usually prescribed antibiotics. I examined the baby and found no evidence of any kind of infection. I told her so and suggested that we should treat her symptomatically. She became argumentative and said that her doctor back home always gives her an antibiotic. I tried to reason with her but she left disappointed.
Our town pharmacy was next door and later that afternoon I saw her in there filling a prescription. Later I asked our pharmacist and was told that a prescription for antibiotics was called in from an out of town doctor for her baby.
Today there is more awareness of these types of problems and technology provide us with tools that can be used to overcome some of these misunderstandings. Telehealth, telemedicine and tele-education make it possible to educate, examine and treat people in places near and far. Proper use of these tools can reduce or even eliminate many ambiguities and help us make accurate diagnosis, even when our patients are away. There really is no excuse for practices such as the one told above.
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11-3-2016 - Leprosy
India reports that their health department has checked 320 million people for leprosy.
The medical school I attended was in the US Public Health Hospital on Staten Island, NY. It was the early 1970s and the Vietnam War was still on. Due to the need for healthcare providers in the military, there was a shortage of medical personnel in the private sector. This was particularly acute in such places as public hospitals and clinics like our Hospital. As a result, many foreign doctors were employed in these places to fill the need. This brought with it numerous challenges but just as many opportunities as well. Several of these doctors, for example, were from Latin America and the Far East; like China, Korea or the Philippines. Besides their Western education, many had Eastern medical experiences which came in handy at the time.
Our hospital for example, was the only one on the East Coast that treated Hansen's Disease (Leprosy). Two of our oriental and a Colombian provider had good experiences in the treatment of this disease from their home country and thus were put in charge of that clinic. With the advances in the treatment of this disease, the number of cases were small. Many of our patients were from the Caribbean, Central and South America. They stayed with relatives in the NY area and were treated by us. Often, the biggest challenge in treating these patients, was not their health problem, but rather the economical and financial hardship their care in NY created. They were being seen every few months, which made it necessary to stay in NY till their treatment was completed. They were usually from indigent families and going back and forth to their home countries was not a realistic option. Some did go back and we usually lost them and never saw them again.
Today, with the advent of telehealth and telemedicine, we can treat many of them in their own countries and at home. If we could overcome the many political and bureaucratic obstacles.
In our last February' Interstate Telehealth Discussion Group conference call, Doctor Bob Haws, a Pediatrics-Nephrologist from Marshfield Clinic told us about his work with Bardet-Biedl Syndrome (BBS). He told us that; "there are only 2500 patients in the United States that have this disease and Marshfield Clinic is the specializing center in the treatment of it. Since these patients live all over the United States and the world, it makes it more challenging to provide care for them. If they could use telehealth, in their work, the burden, cost and hardship on the patients and the providers would be reduced dramatically. Yet unreasonable licensing requirements make such logical means of care unavailable."
There are many other diseases such as BBS, and Hansen that could effectively be treated through telehealth, telemedicine and tele-education, if we could set aside, our prejudices and unreasonable need for turf control. This week we learned that Pennsylvania became the eighteenth state to enact the FSMBs Compact. If we could universally sign up to the Compact, advances can be made on many of these rare disease and universal healthcare become a true reality.
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10-27-2016 - Bob Hoover
News comes to us that the legendary pilot R.A. "Bob" Hoover, has died. He was 94. With his Tennessee drawl and trademark straw panama hat, Hoover was an icon of American aviation.
Many of us in aviation held him as a hero in many ways. His love and devotion was second to non, as he was an avid promoter of it. He flew in more than 2,500 civilian and military air shows in the U.S. and around the world, thrilling those on the ground with his trademark routine: shutting off the engines on his Aero-Commander, while performing loops and dives. He flew with such precision that he was able to pour iced tea into a glass in the middle of a barrel roll. After every air show, Hoover would take time to talk to the young people and promote flying. Bob Hoover attended an air show in Santa Fe in 1998. I took my son there and met the legendary flier. He was more interested in talking to my then seven years old son than me.
Hoover's achievements are too numerous to list here, but what he did for aviation could be a great lesson for all of us in medicine. For while he flew for more than seventy years of his life, his focus was always on promoting aviation and helping to make it safer and more resourceful.
Every pilot faces a potential emergency requiring a forced landing off an airport on every flight. Calamities happen when the pilot panics and stops flying the plane, becoming a passenger himself. Bob use to say; "When faced with a forced landing, fly the airplane as far through the crash as possible!" A lesson I have carried throughout many aspects of my life.
In healthcare too, we face the potential of errors, but should never forget our primary role of serving the ill and the injured. And serving them wherever they are in rural as well as urban areas. Fortunately for us telehealth, telemedicine and tele-education make this very easy today, just as GPS makes navigating the skies a lot easier than guessing where in God's sky are we. Rest in peace Bob, you will not be forgotten.
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10-20-2016 - Understanding Each Other
The topic of today's issues is something I have been very concerned about in all my medical practice years. That is to make sure that we practitioners and our patients totally understand one another. For us, to understand what the patient's real problem is and our patients, to fully comprehend our diagnosis, prognosis and instructions we are giving them.
When I was serving on the NM Medical Board, the number one reason patients complained about their providers, was lack of proper communication between them. And when I sit on the NM Medical Review Commission hearings, the number one reason for law suits is misunderstandings between patients and providers. No where is this more dangerous than when dealing with non- English speaking patients, or an average patient who will not understand our medical jargon. So I am pleased about the two reports from AAMC and The PEW Charitable Trusts, I have linked to in this week's "In The News" section bellow.
Our patient population come from many national backgrounds and cultures. They bring with them; their traditions, customs and rituals that most of us are unfamiliar with. Grasping their problems and needs are not always clear or simple. Consider this story told to me by a colleague who was a Vietnam veteran, working in a local urgent care:
He was at work one day when he noticed a commotion across the clinic in another provider's section. There were shouts and angry exchanges so he went to investigate. There were police officers and others not from his clinic standing by.
"What is going on?" He asked a nurse.
"We called child protective services, because Doctor R. felt his young patient was abused. They are Vietnamese and don't speak English well."
It was early 1970s and the Vietnam war had just ended. Many Vietnamese were immigrating here. Since he had spend a couple of tours in Vietnam and knew a little of the language, he volunteered to intervene. Soon the problem became clear. The treating doctor of a young child had noticed several bruises on the child's body and had suspected abuse so he called the social services, who called the child protective services, who called the police and they all ganged up on the poor family.
A Vietnamese folk remedy for many diseases is to use suction cups to suck out increased ill pressures in the body – especially in the lungs - to eliminate the sickness. The cups thus leave marks on the skin, which were interpreted as abuse marks by the doctor. By his intervention, my colleague cleared the confusion, got the child proper treatment and the relieved family went home together.Such confusions exist in many of our intertwining, mixing and confused world, such as our executive director; Terry Boulanger mentions in his news summery. "Sometimes the way the IT industry names things drives me crazy and I can only imagine what it does to you who are not in the field."
Here are the links to his news blogs for those of you who do not receive his e-mail;
Navigating the Buzz Words of Telehealth, Expert system - A definition, Understanding the evolution of the internet of things, IoT for healthcare brings potential coupled with concerns, IoT security from the outside in and inside out.
Thus it behooves us all to be cognizant of our environment as it has never been more dynamic than it is today. And in no place is the confusion of miss-communication more dangerous than in medicine. Telehealth and tele-education can help us overcome these barriers. Especially in the rural areas of our country with limited access to language translators.
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10-13-2016 - Interstate DG Annual
A year ago, this week, we held the first meeting of Interstate Telehealth Discussion Group. Since then our meetings have been attended by many interested parties. Many organizations and university groups have shown considerable interest in telehealth – which is great. However, young providers are still missing from our discussions. Yet they may be the most affected by this technology and the future of it.
Since I am attending my daughter's wedding this weekend and have been too busy to write a proper article for this week's newsletter, I will reiterate my concerns from my last year's article as they are still pertinent today:
When I first entered the world of medicine at the ripe age of fourteen in the middle of the last century, we had nothing that could be called technological to today's standards. We had reusable needles and glass syringes, plaster of Paris came in powder form in a bucket, and x-ray machines stood in the corner of a room. We carried an alcohol lamp and sterilized the needles and syringes by boiling them in water before each use. When a patient was being x-rayed, usually his or her family members were in the room with them, including their children. Antibiotics were new and looked at with skepticism and vaccination considered witchcraft. We have come a long way in the past half a century. Today we consider all of the above; archaic, old and even barbaric. Yet in their own time, they were state of the art medicine.
Much of what we use today was considered science fiction at the turn of the last century. The rate at which our world is progressing will put us decades ahead in the next generation. By involving themselves, our young practitioners could benefit immensely in understanding, forecasting and developing the next generation of medical devices, medications and technologies. I - for one - would love to see younger people at our meetings, conferences and organizations. The future belongs to them and the better they understand the present, the better they could shape and direct what is coming their way. Encourage young practitioners in your organization to join us.
What would they say of today, sixty years from now, I wonder.
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10-6-2016 - Albuquerque Balloon Fiesta
We met about 5 AM in the parking lot. There were four of us, but soon a couple more trucks showed up. Jeff handed me a broom and pointed to an area behind his salvaged bread delivery truck. "We are going to spread the balloon there, make sure there are no sharp objects or anything that can damage it."
In the early light of the day, I swept the ground as best I could and returned to the truck to help unload the balloon parts. Jeff connected the tanks to the burners and tested them. The canopy, called envelope in balloon jargon, carefully unfolded and spread out. A powerful gas operated fan was placed at the opening. Several of us held the mouth open as Jeff started the fan and blew air into the envelope. It gyrated, rolled and began to inflate. Despite of the early hours of the morning, several bystanders showed up, smiles exchanged, salutation made – balloon people are friendly folk, for one never knows whose help maybe needed. We stood up taller and pretended to know what we were doing.Jeff turned the burners on, pointing it into the expanding envelope. The heat soon warmed the air inside and it started to rise. Jeff jumped in and instructed us to hold it down. Burners belching flames made the balloon struggle to break free from the ground. Myself and another passenger jumped into the basket, as others let go of it and we left the earth and shot up into the cool air of the morning. We rose to meet the first rays of the sun, clearing the top of the Sandia Mountain. In the air, we were joined by several other balloons that had taken off from other places around town. An exhilarating feeling overwhelmed me as a light wind got a hold of us and blew us across the landscape bellow. Sleepy Albuquerque slipped silently under us. We looked shamelessly into many backyards while people slept. Occasional blast of the propane torch broke the silence and kept us aloft. Lost in the thrill of the moment, I panned the world around me in silence.
The year was 1977, and we had just attended the fourth Albuquerque Balloon Fiesta. Years later, while working at Lovelace, we established a First Aid and Medical Tent at the newly opened Balloon Fiesta Park. Most of what we cared for there were scrapes and scratches due to people falling or running into something, while looking up at the many colorful balloons ascending into the blue skies of New Mexico. Among the thousands of visitors, there were occasional people who had forgotten their medicine. We checked them and refilled their medications. A few times, it became necessary to refer or shipped them to our ER. On those occasions, the primary provider of the patient back in their home town was consulted. The contact was established by a long distance phone call which usually required us leaving a message and then waiting to hear back from them. Back home, charts had to be found, and studied to refresh the particular patient's problem before calling back. All this, took time and effort, for which the primary provider was not compensated.
Today, Telehealth and telemedicine make these efforts easier, faster and to the benefit of all. Parity laws, further help providers get paid for their consultation, no matter where the patient maybe. We have come a long ways from lunching a handful of balloons from shopping mall parking lots, long distance phone calls to far away clinics and guessing on how to properly treat a traveling patient that we would never see gain. Telehealth, telemedicine, and tele-education make it possible for patients to be informed and stay in touch with their providers throughout their travels and thus reduce or eliminate the need for an ER visit away from home. Lets work together to fully develop this system and make all our lives easier in this mobile society.
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9-29-2016 - Marco Polo
Sept 23, 1215 was the birthday of Kublai Khan, the Chinese ruler whose empire stretched across modern day China and Mongolia. He founded the Yuan Dynasty. He is also known to be the first to institute paper money.
Despite his popularity and tremendous achievements, he would have been unknown to us, was it not for the writings of Marco Polo, who visited China during this time. It took Marco Polo three years to travel there. He was a teenager when he started the journey with his father and uncle. He spent seventeen years in China and another three years to return to Europe.
Marco Polo praised Kublai as a great leader but gave conflicting reports on the emperor's life in his writings. Considering his seventeen years of experience there, it is understandable to see how witnessing the running of such an empire could leave varying impressions on a young mind.
One of the emperor's excesses that impressed Marco Polo was his summer palace. The place was called Shang-tu, a word that became known as Xanadu in English. Shang-tu however just meant "Upper Capital," distinguishing it from the main capital he founded to the south. The place had mystical powers and was the subject of many writings by Marco Polo, Samuel Coleridge and others. Today, Kublai's main establishment is known as Beijing and all that remains of Shang-tu, is several grassy knolls on a vast plain.
Interesting, how empires change, rulers die, palaces become ruins and history paints diverging pictures of events. It is also fascinating to note that the entire human history occurred in a tiny period of geological time on this small planet of ours. Marco Polo's adventures took twenty three years of his life. Today we can traverse the same distance that took Polo three years, in a few short hours. Write about it, publish it and send it to millions of readers by internet. These technological advances have made us aware of how small our planet really is.
Just before Voyager 1 spacecraft left our solar system in 1990, Carl Sagan convinced NASA to turn it around and take a last family picture of our solar system. The picture showed earth as a blue dot in the darkness of universe. Later, at a lecture, Sagan reflected that "on that dot, every human being who ever lived, whether prince or pauper, rich or poor, smart or simple lived out their lives".
The picture clearly reveals how small we really are, yet our ego and our audacity made taking that picture possible. Though many credit a few scientists for making that picture possible, was it not for humanity as a whole, the existence of those few would not have happened. So we owe our achievements to the entire human race and should not take our humanity for granted nor subject it to peculiar prejudices. As Alexis Tsipras, the Greek Prime Minister in his address to the UN General Assembly last week elegantly stated; "Humanity should not be conditional".
Many challenges face us all on this blue dot today. Not the least is the challenge of healthcare for our people. Fortunately, the same technology that made taking the selfie of earth from four billion miles possible, gives us the ability to see and care for each other right here on earth. Telehealth, telemedicine, and tele-education give us all the tools we need to provide healthcare for every human being on earth. We just need the wherewithal to use it.
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9-22-2016 - Memory
Seat 4A placed me by the window on my way back from Florida. The early flight was half full and as we flew west, I watched the rivalry between day and night in the country bellow. Almost all my fellow travelers, were sleeping. I, was glued to the window, watching the lights of the towns flickering and going out with the arriving day. I recall thinking; "they have all heard of Elvis and know who the Beatles are. But I wonder how many know the name of their doctor?" Mementos of sand and sea safely stored in the archives of my mind, I reflected on the gift of memory.
When my children were in high school, I drove them to school every morning. Occasionally, another student would carpool with us. Once, an exchange student from Scandinavia was with us. She was a charming young lady who spoke with a strong accent. A junior who was staying with a neighbor of ours. The radio was on the morning show and played a variety of songs. The next song caught her attention and she announced; "Oh Louie Armstrong."
I was surprised that she knew the jazz master and asked if he was popular in Sweden. "Oh yes, my father owns many of his albums. He often plays a song or two on the radio when he takes us to school in the morning. This song makes me homesick."
It is a strange thing; memory! How simple things in passing can awaken deep emotions or echoes of past events. There are things that we will remember for ever and then those that are erased as dust by the passing wind. The fact that we have the ability to file them in our long term or short term memories is not in itself surprising. But what we choose to store, is. Why so many of us recall such menial things as certain musicians, bands, actors or characters, yet cannot remember who the governor of our state or our senator is, or our doctor's instruction regarding diet and exercise. In remembering selectively, do we make our lives better or just easier to cope with? I suppose the tsunami of irrelevant daily data bombarding us makes this selective remembrance a necessity.
As practitioners we face this dilemma daily. How do we make our patients follow our instructions and not forget them as soon as they get into their car and turn the radio on. Perhaps having the ability to remind our patients of our instructions would be beneficial. Fortunately today's technology provides us this ability. Tele-education and telehealth are two instruments in our medical-bag that we can use. But we must first care enough for our patients to make this extra effort. The hectic life, we ourselves live however makes this ever more challenging and the organizations we work for often make such efforts prohibitive. If we want to make lasting impression on our patients, it behooves us to remind them of us and our concern for them. Otherwise the memory of their visit will be erased as footsteps in the sand by the passing wave.
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9-15-2016 - Citizenship Day
Saturday; September 17, is Citizenship day (observed tomorrow Sept. 16.) With the movement of all the migrants, refugees, and seekers of a better life, the world is being remade and the ramification of all the changes are profound and will be long lasting. Politics aside, we all have to appreciate the fact that seeking a better life is a fundamental and natural desire of all creatures of God. Just watching the ants and spiders wanting to migrate to the warmth of my house, this time of the year is proof of this desire.
Although our birthplace may determine our race and certain minor anatomical differences, it should not bind us to a permanent geographical region. After all, if not for man's desire to migrate in search of betterment, we all would still be living in Africa.
We should remember that much of the scientific, technological, and medical advancement, we are so proud of, was brought here or invented by immigrants. There is an old saying that; "Every man is born twice. First to the parents and family that bore him and second to the people and society he/she chooses to live with." We the people of this planet must share it's resources equally and evenly. Only then, man's true potential for advancement and achievement will propel him forward to new accomplishments.
Today we have the technological means to share our knowledge and abilities with one another. Tele-education, telemedicine and telehealth are just three tools that can help us reach humanity in need everywhere. Sharing ideology, knowledge, and discoveries with one another will be to the betterment of all. For, we are all citizens of this small planet.
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9-8-2016 - Eastern New Mexico
We spent the last weekend in Carlsbad, NM getting our son married to a wonderful young lady from there. It was a joyful occasion and the happy couple are honeymooning on an Alaskan cruise. We appreciate the good wishes from many of you. Whenever I travel this incredible state of ours, I think and study the demographics of it and how it affects the healthcare of our people.
I don't know how many of you have traveled to Southeastern New Mexico. To Roswell, Hobbs or Carlsbad - to see the Carlsbad Caverns perhaps. It is hundreds of miles of open country. With antelope, deer, coyotes, eagles, hawks, badgers and rabbits adorning the beautiful landscape. It is also home to some of our largest dairy and cattle industry with many of their cows grazing peacefully throughout. This time of the year, the many wild plants and cactus are blooming and displaying their pallet of colors to the tapestry of nature for as far as the eye can see. The cumulus clouds against the blue New Mexican sky add yet another level of beauty to this land of enchantment. Strewn among this majesty are many small towns, like Encino, Vaughn, Ft Sumner, Mountainair, and Clunch. Roswell with it's alien museum and Hobbs with a jungle of oil wells are in the distance. Eastern New Mexico (61,967 mi²) is an area almost as large as all of New England combined (71,992 mi²), yet sparsely populated. The citizens of this area are hard working people who raise cattle for our food and grow maze and sorghum for our livestock. Out of the ground, they pump the oil that provides us with our energy needs and pays billions in taxes that help our state government function. Regardless of what or how we feel for these industries, their working people are the backbone of our economy. Yet when it comes to their healthcare, we neglect them grossly. The small clinics and hospitals in these rural areas are dangerously understaffed and sadly under budgeted. We owe these people a lot more.
There is no secret that healthcare in our country is mismanaged. No place is this more evident and revealing than the rural counties. But this being the twenty first century, certain technological advances give us the tools we need to overcome this disparity. Organizations such as NM Telehealth Alliance, UNM Center for Telehealth, and Project ECHO, have been working very hard to incorporate this technology into the daily task of a healthcare delivery system. But many of our practitioners have been slow in adopting it. This is in part, due to their lack of appreciation of this need. Fall is the best season to see the desert southwest. You should all take a weekend drive through this country and see for yourselves. Take the kids or a loved one and start at the Blue Hole in Santa Rosa and take highway 54 south through Vaughn, Gallinas, Ancho, Carrizozo, and spend the night in the historic Capitan or Ruidoso. Or better yet in the mountain coolness of the Inn of the Mountain Gods on the Mescalero Apache Reservation. Next day head on north toward Mountainair and stop at the Quivira and Abo Missions and see the Spanish Missionaries of the past's contribution to our state. I guarantee that you will be impressed and return with a good appreciation of the need in these areas. Then consider setting a few hours a week aside to help the folks there through telehealth. We can show you how, and remember that this will not be voluntary work. NM telehealth laws allow you to charge for your consultation and services and the patient insurance will pay you for it. See you on the range – either in person or virtually.
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9-1-2016 - Volunteers
Among the stack of mail was a card from The Salvation Army, thanking me for a donation I had made earlier. It gave me time to pause. What an easy way to feel gratified; put a check in an envelope, mail it and go on about your business. Your money would – supposedly – help those in need. But is it really that easy. Do we really feel satisfied. Could we do more? How about …
It was interesting that the above card arrived last week on August 26, on the birthday of a young girl born in 1910 in Skopje, Albania (today's Macedonia). Her name was Anjeze Gonxhe Bojaxhiu. Her father died when she was eight and the family's poor status worsened. Her strong mother's faith however, helped the family cope and developed a sense of obligation and devotion in the young Gonxhe. So much so that at the age of eighteen she left home and joined the Sisters of Loreto at Loreto Abbey in Rathfarnham, Ireland. There she learned English, geography, catechism, and history. In 1931, at the age of twenty, she took her first religious vows as a nun. Soon after she was sent to Calcutta, India to serve at a convent there.
In Calcutta, the terrible poverty around her disturbed her so much that she felt compelled to leave the sanctuary of the convent and live among the poor. She exchanged her traditional habit for a simple white cotton sari with a blue border that became her signature garment for the rest of her life. Although she had no income and had to beg for food and supplies, she persevered, and soon after, the Vatican recognized her work and helped her start a congregation there. She gave her services wholeheartedly to the poorest of the poor and got to be recognized by much of humanity. So that by the time of her death in 1997, her relentless devotion to serving the poor had gotten the attention of the world and her Missionaries of Charity grew to be an international institution in 133 countries. She opened orphanages, homes for people with tuberculosis and leprosy, health clinics, and schools. She even opened shelters in Harlem and Greenwich Village in the United States.
She was awarded the Nobel Peace Prize in 1979. When asked how she found time to do all her charity work, she said, "I work all day. That is the only way. By blood, I am an Albanian. By citizenship, I am Indian. By faith, I am a Catholic nun. As to my calling, I belong to the world. As to my heart, I belong entirely to the Heart of Jesus."
When she was at the convent in Ireland she changed her name after Thérèse de Lisieux, the patron saint of missionaries but opted for the Spanish spelling of Teresa. We know her better as "Mother Teresa."
Remembering that it was her birthday and all that she had done for our world, I felt shame for feeling satisfaction in sending a check to The Salvation Army. We can do so much better. Fortunately for us the technology of telehealth, telemedicine and tele-education enable us to contribute to these needs with our talents and expertise without having to leave home. Just a few short hours a week could make a world of difference.
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8-25-2016 - Dualities
The early morning light cleared the mountain ridge to slit through the curtains and welcome itself into my day. It was exhilarating to be waken such. My wife had the radio on in the kitchen and Edvard Grieg's Peer Gynt Suite was playing softly. A perfect accompaniment for such a morning. I peeled the covers off and stood with sunshine in my face. Such blessing and beauty sent my way – overwhelming!The morning news though, was anything but pleasant. It portrayed a world in chaos, pain and despair. The contrast between my world and that, minutes or hours away was so profound that no amount of rationalization, philosophizing, or finger pointing for that matter, justified it.
I dressed and headed to town and our monthly telehealth meeting. On the long drive there, I repeatedly changed the channels on the radio in the hope of hearing any news to compliment the sunshine of my morning. But it was not to be, even the traffic report was depressing. Finally I settled on listening to the classical channel's music interrupted by screaming salesmen, peddling their goods.
Our meeting discussed the many requests for assistance, our financial shortcomings and the many ideas we had on how to move telehealth forward and help our fellow men near and far. It gives me a glimmer of hope that at least we are making a difference in bringing healthcare to some rural parts of our world by pointing a few of our colleagues in the right direction.
The meeting concluded, errands done, chores accomplished, I headed home at the end of the day. The late afternoon clouds over the Sandia Mountain were ablaze in golden sunset. I kept the radio on classical and ignored the commercials. My wife handed me a cup of hot tea on my arrival. Sitting on the porch, I watched the last rays of the light draining from the cloud tops and the crickets announcing the coming of the night. With tears in my eyes, I counted my blessings and wished for a better tomorrow for all. For, this Escher(ian) duality of our world is, at the least, confusing. But while some stab at the fabrics of our society with daggers and spears, many more of us are at hand with simple needles and thread sewing it back up.
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8-11-2016 - Adopt a Rural Hospital/Clinic
"One sometimes finds what one is not looking for." said Sir Alexander Fleming who was born on August 6th, 1881. He became a bacteriologist who discovered penicillin in 1928.
I am on the road to see my son who is getting married in two weeks and as I was preparing for this week's notes – on the road – I again noticed the "Adopt a highway" signs that ask organizations and community groups to adopt and care for a section of that highway and keep it clean. It reminded me once again that it would be a great idea to have major medical centers, hospitals and schools to adopt a rural hospital or clinic, in similar fashion. Bring them under their umbrella and see to their care and success. Many university medical centers send interns and residents to rural community clinics on rotational basis. Although this is great, it benefits the rural communities, minimally.
Our rural clinics and hospitals deserve more than just receiving students. They deserve a full fledged support system. If every major medical institution adopt a rural health center, state of the art healthcare could be brought to these areas to the benefit of everyone.
At the last ATA meeting, many rural communities were presenting on how they used telehealth to improve healthcare delivery system to their area. It would be even a better idea, if major medical centers in each states create a "Department of Rural Hospitals and Clinics" in their organizations and take responsibility of assuring the patients at small town healthcare centers receive the same quality care. The technology of telehealth, telemedicine and tele-education makes such adoption idea not only possible but profitable. It could bring revenue to the majors through this support system, and in the process, real, timely, and proper care is provided to our rural communities. Lets adopt our rural hospitals and clinics and provide them the support system they deserve. Telehealth can help us do exactly that!
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8-4-2016 - Clinics and Walmart
News comes to us that Mescalero hospital joins UNM's telehealth services. They join Zuni Comprehensive Community Health Center, Gila Regional Hospital in Silver City, Sierra Vista Hospital in T or C, Union County Hospital in Clayton, and Sandoval Regional Medical Center in Rio Rancho (Alamogordo Daily News). This, of course is wonderful news and the kind of telehealth communication NM Telehealth Alliance strives for.
In a parallel story, Walmart is pushing forward with it's “a medical clinic in every store” concept, as Walgreen talks about expanding their pharmacy services to provide family healthcare to their customers. All, of course are planning to depend heavily on telehealth.
Although the use of telehealth and telemedicine is most appropriate and welcomed, one must question the commercialization of the concept. It is no secret that these organizations are very much “for profit” establishments. Thus it is a given that they will fully exploit these clinics for profit. How they perform their task needs close scrutiny. Medicine is one art where close provider/ patient relationship is of paramount importance in good healthcare delivery. If these stores offer their healthcare services much like they do their bakery goods – roast the chicken and place it in the middle of an aisle for people to serve themselves – there will be problems. Providers at many of these businesses are routinely changed or rotated between branches. It seems, for example, that every time I go to my pharmacy at the local one of these stores, I find a new pharmacist working there. Often, I am told that the previous pharmacist is working at another store today. This practice makes it difficult to establish any rapport with ones provider. Harming the very basic concept of practicing good medicine. And what about the medication prescribed? Will the patient receive the proper drug or one that the store has special contracts with. I can go on about many of such scenarios but I think that the message is clear.
On the other hand, the proper use of the concept as it is done at the establishments mentioned at the beginning of this article would be most welcomed and maybe the answer to the healthcare provider shortages of the twenty first century, especially for our rural areas. We will just have to wait and see, but we must be ready to step in and correct things before they get away from us. After all the last thing we need is a Volkswagen type discovery of a system abused and gone wrong and no one noticed till it was too late.
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7-28-2016 - Magicians Need Help Too
The magician had no hands. As a matter of fact he had just a semblance of a limb on the right and upper stump of an arm on the left. Yet he expertly shuffled the cards and spread them on the table, as he continued to delight, fascinate and mesmerize the audience. As he finished his spellbinding show, he stepped down from the platform, he was standing on and struggled to carry his four feet dwarfed body off the stage. The audience, enthralled and impressed, cheering and roaring enthusiastically. At that moment he was king, smiling ear to ear and bowing happily. His handicapped body did not enter into the equation at all. The show was not about his physical ability, rather it was about his magical prowess. The audience, shook their heads and asked each other how the magic was done rather than how he could have done the magic.
Years ago, while standing on a street corner in New Delhi, India, I watched a young man with a badly deformed body twist, rotate and contort himself into unbelievable positions. But unlike our magician on stage, the Indian audiences of our street magician watched with indifference and only a few threw coins his way. As a healthcare provider, I not only watched the magician on stage with gaiety, but wondered about all the health and medical issues he has to deal with on daily basis. He, however seemed well nourished and otherwise healthy, despite his handicap. The poor wretch of a young man I witnessed in India, though was anything but healthy. Many bruises, cuts and skin lesions were a testament to his destitute existence. The contrast between these examples reveals the many disparities among citizens of this world. Though both were physically handicapped, the comparison ended there.
It is easy to blame their circumstances on socio-political aspects of their respective societies, it does not however alleviate the unjust and insufferable condition of one over the other.
The fact that many such circumstances exist in our world is saddening. But it is even more heartbreaking to know that it really does not take much to bring help and relief of pain to many of our fellow men. Especially today with the magnificent technology available to us, we really could make a difference. And we don't have to go to the other side of the world to find people in need. Many in our own rural and under-served communities need our help. Telehealth, telemedicine and tele-education could bring much needed relief to many, right here in our country. But if we find the wherewithal to help those far away as well, so much the better.
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7-21-2016 - The New School of Osteopathy
A year ago the New Mexico TeleHealth Alliance Board members met with President Garrey Carruthers of New Mexico State University and Dr. Oliver Hayes, director of Burrell College of Osteopathic Medicine, to address the use of telemedicine at the new Burrell College. It is heartwarming to see that this school is established, first class students chosen, faculty and staff hired, and awaiting the start of the first day in August. Our congratulations to Burrell and NMSU on this historic achievement.
One issue of concern however is that although no public money was used for the development of the new osteopathic school at NMSU, the fact that the school is affiliated with and built on state owned university property gives the impression that it is a state sponsored program, and thus has the same requirements for acceptance as all other state colleges. But in fact it is a private medical school with a hefty tuition that makes it hard for many of our young interested native New Mexicans to afford it. Yet the medical students of this school will be using our medical centers in New Mexico for their studies and internship, and our patient population for their practice and learning.
Our visit with Dr Hayes and President Carruthers was very encouraging as both were excited about the healthcare programs at NMSU and the future of healthcare, use of telehealth, telemedicine, and prospects of increasing the role of mid-level providers in NM. We hope that considerations are in the works to allow more New Mexicans the opportunity to apply to the Burrell program. Perhaps it should be a requirement that a certain number of students at Burrell College be New Mexicans and a scholarship program established to pay for their way.
Our state is in dire need of primary care providers, our young people, especially our Native American and Hispanic students should be encouraged and given the opportunity to get into a carrier in healthcare at NMSU and the many other fine schools of higher education in our state. Since they are most likely to remain in New Mexico and care for us.
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7-14-2016 - Jobs in Healthcare
The Albuquerque Business Journal reports that of the ten fastest growing jobs in New Mexico for the next eight years, 70% are in the healthcare field.
Well that is nothing new to us. We in the healthcare arena have known for a long time that the provider shortage we face in caring for our patients has been the single most detrimental hurdle. This is especially so in the rural areas of our state. The problem however, is not unique to New Mexico. Almost the entire country faces similar shortfalls and there lies the real problem. With such great demand for the limited number of providers, competition becomes severe and recruiters will do anything to attract potential job seekers to their corner of the country. This leaves states such as New Mexico, large in size but with a relatively small population, at a disadvantage. Small population brings limited revenue. Limited resources make for small incentives to offer potential candidates. The freshly graduated with extensive debt to satisfy go to the richer states with better benefits. Quality of life? Disregarded!
Add to this conundrum, is the fact that many of the baby boomers are retiring and moving here with better finances and healthcare insurance. Typically these newbies move to urban areas of our state with larger hospitals and specialists. So the dominoes start falling for the rural and under-served population.
We at New Mexico Telehealth Alliance have been trying to get our urban providers to use telehealth and take their specialty out of the cities but with little success. This is partially due to the fact that these providers are so busy caring for the local patients that they really can't find any time to devote to the outside. The other problem is that the rural populations typically don't have the finances to compete with their urban brethren.
Programs through our medical schools and universities, such as UNM Project Echo help educate and bring attention to the need but little more happens. Perhaps a new way of thinking is needed to resolve the problem. Maybe big businesses should start supporting their local health organizations instead of just providing health insurance to their employees. Gas and oil companies in the Southeast and Northwest of our state for example could provide perks to attract providers to their local area. Likewise, the mining industry in the Southwest and large dairy and ranching companies can do the same in the Northeast.
An area often unfairly overlooked is the thousands of foreign healthcare providers seeking asylum from war torn and impoverished parts of the world. Among the millions of refugees are many doctors, nurses, and other highly educated and trained scientists and medical professionals. They could be identified and their applications expedited. Telehealth could be used at many levels to educate them, help them pass our exams and get licensed. Telemedicine, telehealth and tele-education can ease the pain for everyone – yes pun intended.
7-7-2016 - Immigrants Plight
"There is a baby with a rash outside in a car," the nurse informed me one day long ago "will you go and check it out?"
It was our policy to keep children with a rash out of the urgent care to prevent spreading it to others. Warning placards, in Spanish and English, were placed at the entrance to alert patients that we would come out and see the patient and not to bring them in.
"Buenos Dias" I said in my accented and limited Spanish, and continued to inquire about the nature of the rash covering a very young infant's body. It turned out to be a garden variety of children's viral diseases and not one of the dreaded ones like measles that was coming across the border. What makes me remember the case was not the baby's illness, but rather the distraught state of the mother. She was visibly scarred, looking around at every car passing by. I looked at my interpreter questioningly.
"She is illegal and worried about the cops." she hushed in my ear. There was a big raid the night before and many illegal migrants were arrested by the INS. Apparently some of her family members were among the arrested. I prescribed the usual treatment for the baby and they left in a hurry.
I could not get the mother out of my mind for a long time that day. For despite the great danger she felt in being discovered, she sought help for her sick baby. We prevented the baby from spreading his infection to others in our waiting area but was sure that the cramped and poor conditions of the residences of these migrants did not prevent the spread to others in their community. After all, that was probably how her baby contacted the infection. Although I did ask about others being sick, her alarmed reaction to my inquiry about others made it clear that no proper response would be coming as she was ready to bolt out of there.
The incident happened many years ago, yet today we are further from resolving this problem than ever before. We just celebrated our independence day. Two hundred forty years ago, we said no to tyranny, control and prejudice. Our very motto of freedom became; "Give me your tired, your poor, your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed, to me: I lift my lamp beside the golden door."
But the anti immigrant fervor today, is doing the opposite and closing all doors to these very people. Argument on the legality or right or wrongness of the issues aside, what do we do when as healthcare professionals, we are asked to care for these people. In medicine, we are thought to give care to all who need it. Despite any racial, geopolitical, or other discriminating or prejudicial status. But how do you treat fear, uncertainty, despondency, need, etc.
Fortunately, today we do have tools like telemedicine, tele-education and telehealth to help many of our fellow men, near and far. But the use of these tools themselves, have become controversial and contentious. Turf control, financial consideration and political misunderstandings are limiting the use of these wonderful tools. Maybe these technologies are advancing too fast, but so are the plight and need of millions of hungry, poor refugees all around the world. Lets put our racial, geopolitical, discriminating prejudices aside and help our fellow men. Lets live up to our motto. Even if we don't want these masses to come here, we can take help to them through our technology.
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6-30-2016 - Roadside Café
The howling wind outside the roadside restaurant, kept us inside. There was a warning that the police may close the road. Looking around, about twenty or so travelers and locals were scattered throughout the establishment. The hour was late and the nearest town, sixty miles away. Weary eyes, scan the sky for a break but none was coming. An old farmhand across the counter informed us that he had never seen it this bad, talking persistently and asking;
"Where are you from?, What is there that is new?, Where are you going to?, Tell me so that I can learn., And maybe I'll go there too!"
Though he was inquisitive, no one seemed to care. The empty conversation was strangely welcomed. Once he learned that I was in healthcare, he first told me of his numerous aches and pains, then asked for advise and finally complained about not getting any help out here in the country.
"What was I doing here?" I asked myself.
I was on my way to a clinic in the northeast part of our state, when I got caught in a spring storm. The clinic's only provider had to leave on a family emergency, and I was asked to cover for him.
"Why can't I say no?" I admonished myself.
But I knew why! The cost is high for the people of this region. With no regular income or job, most depend on others. The local farms need the part time workers. Without their help, they could not manage and people like me wouldn't get the produce we need.
"Where are you going to?, And maybe I'll go there too!" The Old farmer went on asking another, as the light of the day faded and customers' uneasiness increased. The proprietor wanted to go home but himself was stuck by the storm.
Then just as suddenly as it had come, the wind stopped and the dust settled. Everyone dashed to their cars and as I was pulling away, I noticed the lights going out at the cafe as the owner left to go home.
The rest of my journey that evening was uneventful, but I could not help thinking of the last two hours of my life, and wondered where did the old farmer go?
Looking back, telehealth would have eliminated the need for my travel there. Yet that clinic miles from the nearest hospital and city, today, still struggles to get providers to help them out. Telehealth is helping but support is shortcoming. My old eyes have seen much, over the past three quarter of a century and it bothers me that at this day and age with all the wonderful technologies available, we still do not provide for those who provide for us.
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6-16 & 23-2016 - Children’s Grief Center
Our world is becoming evermore dangerous and challenging. Conflicts of all kind are affecting us all in many ways. This is hardest on our children and young members of our society. Often they feel totally confused and have no idea how to deal with their loss or calamity. Their family members, themselves maybe in too much pain to help the children. If not properly addressed, the psychological affect could become a lifelong painful scar. Thus NM Telehealth Alliance would like to inform our members of this important NM program that helps these young people;
"Since 2001, the Children’s Grief Center of New Mexico has been providing free support groups for young people ages 5-25 who’ve had a loved one die. To answer that need, CGC provides a free 3-day, 2-night camp, called Camp Corazon, for kids ages 7-senior in high school who are grieving the death of someone important to them.
Camp Corazon offers traditional camp activities such as a challenge course, bonfire, songs and games. But it also provides a unique opportunity for kids who have lost a loved one to share feelings and memories with other kids who’ve been through something similar. Camp Corazon provides grieving children with age-appropriate coping skills that will help them manage grief in their day-to-day lives, even after they leave."
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6-9-2016 - Music and Healthcare
If Music is the universal language, Medicine is the universal vocation. Just as one can strap a guitar to his shoulder and travel the world and be listened to, a medical vocation of any kind would be welcomed all over the world. I have sat next to company CEOs on an airplane whom upon learning of my vocation, were eager to share with me their medical issues and ask for advise. And I have been to small villages without running water or electricity, on Mexican mountain tops, or a hard to get to island in the middle of the ocean to be equally welcomed. The need for healthcare is universal. We do not hurt in Spanish or Chinese. Diabetes does not have shades of French or Indian. Our children don't cry in Swahili or Portuguese. We are welcomed and our services sought after because there is a need. Just as Brahms, Beethoven or Rodriguez sooth the senses equally in Europe, Asia or Africa, our medical ability eases the discomfort of many everywhere. Even musicians occasionally need medical help.
So it is indeed a pleasure to see new medical schools open and students graduate from dental, medical, or nursing schools. The Burrell College of Osteopathic Medicine is a new addition to the New Mexico medical scene. First classes start in August and that is overwhelmingly good news. Our sincerest congratulations to NM State University and the Burrell family for bringing to fruit such a great endeavor. Now we need a Dental School and a college of Veterinary Medicine to compliment our medical schools (wink, wink, nudge, nudge!).
In all of this telehealth plays an ever more important role.
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6-2-2016 - Halley's Comet
In May of the year 240 B.C.E., Chinese astronomers; Shih Chi and Wen Hsien Thung Khao's chronicles noted the earliest recorded sighting of a comet that came to be known as Halley's comet. In the 18th century, the English astronomer Edmond Halley speculated that the comets seen in 1531, 1607, and 1682 were actually the same comet, returning at regular intervals. He predicted its return on Christmas Day of 1758. It did, but he didn't live to see it.
The Babylonian clay tablets recorded it in 164 B.C.E. and 87 B.C.E. It appeared in 1835, the year Mark Twain was born. In 1909, he said: "I came in with Halley's comet in 1835. It is coming again next year, and I expect to go out with it." He died on April 21, 1910, one day after the comet reached perihelion.
Halley's comet has appeared in regular successions throughout history. It has been associated with good and bad luck. It's appearance reveal the cycle routine of many things in nature. Though we have learned to accept and realize these heavenly cycles, we do not readily accept the cycle of many other occurrences in our own world; the cycles of poverty, war, famine, natural calamities, diseases, etc. Fortunately we now have the technology to help us deal with these cycles. Telehealth, telemedicine, and tele-education can meet and solve many of our immediate problems. No prediction of the recurrence of these problems are needed, they never left us.
We at NM Telehealth Alliance strive to help our state deal with some of these cycles. New Mexico was one of the first states to recognize the need and use of telemedicine. We predicted that it would be an important tool of future medicine. We are here to assist you in anyway we can to promote and advance telemedicine in your organization and your community. But we first must know what it is that you need. We have made our website an interactive tool. Please use it and ask us your questions, tell us your concerns, enlighten us with your suggestions and make recommendations on how to improve telehealth and telemedicine in our state. This is your Alliance, your website, and we are your telehealth team. Please let us know your thoughts and your views. Our team can help your people find ways to implement, incorporate, use and improve telehealth in your establishment. We can change the cycle of problems in your workplace to a resourceful and amiable solution.
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5-26-2016+ - Stories we heard at ATA
Stories always add a level of understanding, expectation and intrigue to a conversation or presentation. They also substantiate the presenter's point of view or dire need for help. At the recent ATA meeting in Minneapolis, we heard many stories of cases that were helped by telehealth in situations large and small. A woman, who was helped by telemedicine for her mental condition, presented at one of the plenary sessions. At another session, Dr. David Shulkin, Under Secretary for Veterans Administration reported the many ways telemedicine was used to treat veterans in the system. Dr. John Noseworthy, President and CEO of Mayo Clinic told of how Mayo uses telemedicine. David B. Hoyt, Executive Director of American College of Surgeons, and Jack Resneck, of American Medical Association and many others all had their own stories.
But the stories that mattered the most, intriguing, heart warming, or even depressing were those heard at dinner tables or individual encounters. On the way to or from the different sessions or just waiting in line for a cup of coffee. Like the medical student from Nigeria who is perplexed about the dire and immense needs of his country, here seeking guidance on how to deal with such insurmountable need while fighting the bureaucracy of his native land. A Colombian doctor who wants to bring care to the indigent people who are losing their habitat deep in the jungles and are unaware of internet, phones and even electricity. And the Canadian doctor who was so proud of turning the dire healthcare situation in his isolated small town into a rousing success through telehealth. They were all stories shared, overheard and discussed, revealing the tenderness of the human soul, and the humanity of our specious to care for others.
They prove that we are on the right track. That there is a definite need for our services and that many seek it and go to great distances to get it. The fact that so many different problems, locally, nationally and internationally can be addressed and even resolved by a single system of communication is a credit to the vision of our mission.
In observing and interacting with the thousands at the meeting, one realizes that there were three groups of us at that conference; The organizers and promoters of telehealth, the technological developers and researchers of the science of internet, and the largest by far and the most important group were those who are actually providing and developing means to bring telehealth to the people. The largest segment of that group were those, new to telehealth. Here to learn about all the wonderful tools telehealth provides them but most importantly how to setup a system of delivering the care. They are the leaders of their societies, the visionaries, the trendsetters and the heroes.
In addressing the Senate Committee on Commerce, Science, and Transportation awhile back, astrophysicist and space exploration advocate Neil deGrasse Tyson said: "Any nation at any time has the capacity to create a hero, just has to have ambition with goals set so that one among us steps forward and accepts those risks." Today many heroes are waiting to be provided goals and opportunities to step forward, accept risks and move their nation, society, and the world forward. Many of them are healthcare providers anxious to be the hero in their field. We owe it to them to create the needed roads. Telehealth is one such avenue, let us embrace this mission and vision. Lets encourage and assist our fellow colleagues to expand the vision to all corners of our small planet. Lets help them be the heroes.
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5-19-2016 - ATA Annual
We are in Minneapolis to attend the ATA 2016 annual meeting. It has been a rewarding and informative trip. Many from around the world came to share their stories, successes, challenges, visions, hopes, and wishes. To see telemedicine and telehealth used to bring healthcare to far corners of our needy world is very rewarding.
One noteworthy point that becomes very clear and emphasizes the need for our efforts is the universality of the need. From small isolated islands in the South Pacific with small a population to large countries in African deserts and South American jungles with millions, the need is there and it is dire. As the economies of the world gets stretched and environmental challenges increase, the healthcare needs increase. Especially so, for the poor and isolated people. Fortunately new technologies make it possible to bring help to these regions. Meetings, such as the one we just had, reveal these needs and more importantly the solutions to many of them.
It was rewarding to see so many from near and far attending the conference, not only to show their needs but more so sharing their ideas for solutions and collaboration. We look forward to another year of success stories.
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4-28-2016 - Diabetes in Dominica
Dominica is a volcanic outcropping nestled between two French islands, Guadeloupe to the north and Martinique to the south. The extreme mountainous terrain makes it nearly impossible to build an adequate airport to receive large aircraft. So the only way there is by boat or a small plane, making it available only to a lucky few. The island is literally a nature paradise with hundreds of waterfalls and lush jungle full of exotic fauna, birds and reptiles – non poisonous or dangerous. It is home to the only and last Carib Indian tribe. They live on a small reservation on the east side of the island. The majority of the population is of African descent, remnants of freed slaves of the Americas. In the past, the island was managed by the French, then English until their independence in 1978. Healthcare is provided by a handful of doctors and providers from other countries. Several members of the island's elite have gone to medical schools in Europe, US and Canada and manage the only hospital there.
Hurricane David demolished the island in the late 70s, leaving a path of destruction. I with many others volunteered to help. I spent about three months on the island caring for the sick and injured. Despite the utter devastation of the place, surprisingly not many were injured. The people, being used to the Caribbean storms, took shelter in the hills and out of the way of the destructive forces of the hurricane. The poor economy kept much unavailable, still I found the people very healthy. Apparently lack of adequate roads necessitated them to walk everywhere. Crossing the many rivers of the island kept them clean and the jungle supplied them with many wild fruits such as mangoes. Limited interaction with outsiders kept communicable diseases away. Except for some cases of STD, the population was healthy.
Since my visit however, the island has been discovered and the introduction of western diet and food has brought with it maladies such as diabetes, high blood pressure, and heart problems. From under-nutrition to over-eating has lead to an upsurge in chronic non-communicable diseases. A price for advancement the island did not have to pay. Today the increased number of diabetic amputations among young people is causing alarm and major concern.
Telehealth, telemedicine and tele-education can help bring education, healthcare and awareness of these problems. If this technology was available thirty years ago, chances are these maladies would have been prevented and controlled. Still, proper use of telecommunication could bring a turn around in the control of these diseases and put a stop to its devastation. Dominica needs to remain a nature paradise not only for visitors but the locals as well.
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4-14-2016 - MetaECHO Conference
Hundreds of participants from around the world filled Hotel Albuquerque for the MetaECHO conference last week. It was heart warming to see so many with so much enthusiasm using UNM's Project ECHO. Doctor Sanjeev Arora's achievement is phenomenal and it was clearly evident in the way this program has made an impact worldwide.
Many testimonials were given to the credit and the contribution of the program. Especially in the rural areas of the world. An attendee from Canada was almost in tears thanking the program for the profound changes it has made in the rural part of that country. A doctor from a small town in India and another from Ecuador shared their success stories, as did many others. Don Berwick, of Institute for Healthcare Improvement, along with Deborah Elam, President of GE Foundation, were the keynote speakers and their excitement in this work and the potential for the future of the Project ECHO was clearly contagious. Other dignitaries like; Sen. Jeff Bingaman, Chancellor Paul Roth of UNM HSC, Hanumappa Sudarshan MD, founder of the Karuna Trust, Ms. Kana Enomoto, Acting Administrator of the Substance Abuse and Mental Health Services Administration and others added to the overall success of the program.
The theme of the program was to "REACH A BILLION PEOPLE BY 2025!" What a wonderful vision. The beauty of the program is that it touches a billion people not in mass, but rather everyone of them individually. All clearly reached, educated, helped and hopefully cured. Though it may seem a daunting task, it's benefits reveal the unlimited need for it.
Of interest is that it was reported in the last weekend's news that Hugh Jackman, the movie star, has started a coffee business to help the coffee growers of Ethiopia. He said that, "Back in 2009, while making the documentary "Dukale's Dream" for the humanitarian group World Vision, he met a young coffee grower who forever changed his life."
Jackman said; "It's like, you're better to have risked something, even if it doesn't work out, than to have never tried."
He says that through his venture, he hopes to change the world, one cup of coffee at a time. Well just think that if one cup of coffee could change the world, what every call made to Project ECHO could do for our world. So it is that we salute Doctor Arrora and his vision. We hope and pray that more than a billion is reached by his venture and others learn and use the idea to truly make telehealth and telemedicine the key to healthcare for everyone on our planet.
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4-7-2016 - This is the "International Laugh at Work Week"
I will leave you to yourself to work that out. Think back to your career and recall some of the funny moments in your practice. Having to deal with the public on a daily basis does create some interesting times. I am sure many were humorous. Use those recollections to brighten up your day.
I Googeled "Humor in Medicine" and got a site full of cartoons. My favorite is the one that says; "There are some things they don't teach you in medical school. I think you've got one of those things."
Here is a tip for a rewarding practice; "Make every patient smile before he or she leaves your office."
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3-31-2016
The following is from an article that recently appeared in The New England Journal
of Medicine;
"Growing increasingly short of breath late one night, Ms. E. called her health care provider’s urgent care line, anticipating that the on-call nurse practitioner would have her transported to the emergency department (ED). Over the past 6 months, Ms. E. had made many ED visits. She is 83 years old and poor, lives alone, and has multiple health problems, including heart failure, advanced kidney disease, hepatitis C with liver cirrhosis, diabetes, and hypertension. In the ED, she generally endures long waits, must repeatedly recite her lengthy medical history, and feels vulnerable and helpless. She was therefore relieved when, instead of dialing 911, the nurse practitioner dispatched a specially trained and equipped paramedic to her home. As part of a pilot program overseen by the Massachusetts Department of Public Health, the paramedic retrieved Ms. E.’s electronic health record, performed a physical examination, and conducted blood tests while communicating with her provider’s on-call physician. As instructed, the paramedic administered intravenous diuretics and ensured that Ms. E. was clinically stable before leaving her home, where her primary care team followed up with her the next morning.
The Massachusetts acute community care program is one of numerous new initiatives in the United States using emergency medical services (EMS) personnel. These mobile integrated health care and community paramedicine programs aim to address critical problems in local delivery systems, such as insufficient primary and chronic care resources, overburdened EDs, and costly, fragmented emergency and urgent care networks.
Despite growing enthusiasm for these programs, however, their performance has rarely been rigorously evaluated, and they raise important questions about training, oversight, care coordination, and value."
As is clear from the above article, these programs address critical problems in our local health delivery systems by increasing the role of trained mid level providers and expanding their scope of practice. As these demands grow, telehealth, telemedicine and tele-education will play an ever increasing role. By incorporating them properly into our work, we will not be confused in their use at crucial moments and thus benefit everyone immensely.
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3-17-2016 - Spring
Spring arrives in the northern hemisphere on Sunday. Curious thing, seasons. How the spherical position and tilt of a planet can have such a profound effect on everything living. And how the same orientation has an opposite outcome on the other side of our globe. A few degrees of geometrical or geothermal change can influence our very existence.
It is no wonder that many cultures celebrate this time as the start of their calendar year. In doing so, they wish each other health and prosperity. Yet in many parts of the world this is only wishful thinking and a hope. Even in this technologically advanced world of the twenty first century many live in squalid and inhumane conditions. Children grow playing in running cesspools and breath acrid air of industrial residue. According to the United Nation's World Health Organization; more than twelve million die every year due to unhealthy environment. From Dacca to Maseru, from La Paz to Mexico City and even in our own country from native reservations to Appalachian towns, many suffer the lack of proper sanitation and access to healthcare. Where are human rights, how can we help those in need, how can we make a difference?
To paraphrase Beyonce's song; "I Was Here" sung at The United Nations World Humanitarian Day [click and listen]:
"How can we leave this world with no regrets, and leave something to remember, so they won't forget that we were here! Lets leave our mark so everyone will know that we were here! Lets make sure that we meant something in somebody's life and touched some hearts that made a difference, and this world will see that we were here! And brought someone some happiness and left this world a little better just because we were here!"
Today, this is easier than we think. Technology gives us the tool to make a difference, to touch people's lives, to bring some happiness to people in need.
Telemedicine, telehealth and tele-education give us this tool. Lets use it and make a difference!
HAPPY NEW YEAR!
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3-10-2016 - Andre Rieu
Andre Rieu is a world renown conductor/ musician who has been successful because he brings in local and unknown musicians and involves the audience in his performances and makes them happy. Even when he plays sad songs and music.
In making music happy, even when it's not, one must understand humanity. No one appreciates or wants sorrow. So when facing pain, any relief is welcomed. Even momentary and false ones.
No place is this more important and necessary than in medicine. Pain is a presence in life that we have to deal with. In the old days, families were close and comforted each other in such times. Today we use medicine such as opioids, marijuana, etc. and when our patients get hooked, we blamed them and accuse them of being drug seekers and addicts. Perhaps we should have helped them deal with their pain in other ways than drugs.
A friend, once told me that on a trip overseas, he was walking by a river and saw gypsies dancing under a bridge. Joyous, he walked down to join the festivities. Only to find that he had entered a funeral procession. A depression overtook him and he found the contradictory atmosphere of the scene confusing, yet it had a soothing and relaxing quality that reduced the grief of the mourners.
Today's business of medicine of course is not conducive to such approaches. This is especially true in our rural communities with limited access to healthcare. But telemedicine, telehealth and tele-education can help guide many toward alternatives; such as music, meditation, prayer, dance, physical activity, community involvement and many other useful and safe methods.
Lets embrace this technology and through it bring hope and help to our citizens near and far.
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2-25-2016 - Unexplained Fever
I was working at the local university's student health center in early 1970s, when a female student presented there with the complain of general illness and high fever one evening. I quickly realized that something was very wrong with this young lady. She looked quite ill and initial vital signs revealed a rapid pulse and 104F fever.
The student claimed that she had gone camping a couple of weeks ago when she was visiting her family in the Midwest and since then had been feeling weak. But nothing serious till today when she woke feeling lethargic with a slight bellyache. She went to class but the light bothered her eyes too much so she went back to her dorm room and slept. When her roommate came home after classes, she found her delirious and sweaty and brought her to the health center.
A call to the ER at the university hospital was made and the busy ER attendant notified. An ambulance was called, IV started, and she was transferred to the hospital.
I called the ER before leaving work at 11 PM and was told that the patient was admitted to the ICU and that "No, they didn't know what was wrong with her."
Overnight the condition of the young woman worsened. A team of internists and medical students made the early rounds and a new treatment regiment ordered. By late morning however, the patient's temperature spiked to 107F and she passed away that afternoon.
The subsequent autopsy was not conclusive and a diagnosis of Q fever vs. acute liver failure was reported. Although Q fever was identified in 1930s, it was not well known or understood and the drug of choice to treat it; Doxycyline was relatively new. Still, it did not exactly fit the symptoms either. What truly contributed to this patient's demise however, was lack of communication and availability of accurate information, even at a university setting. Years later in the mid 1980s we discovered human monocytic ehrlichiosis, a tick transmitted disease. The disease usually shows up in people with recent tick bites, and their symptoms are typically high fever, abnormal hematology, elevated liver enzymes, and extreme light sensitivity. All of which were present in this young girl. Although most cases respond well to treatment, there have been fatalities and this may have been one.
To this day, I am saddened by the loss of that young lady. Although everything that could be done was done for her according to the knowledge of the time, we still lost her. I hate to think that lack of information and communication could cause the loss of someone else. Today, telemedicine and telehealth can make the latest information available to a provider anywhere in our country quickly, so tragic scenarios like the above case should not happen. Yet many communities are vulnerable. Our budget fights at NM legislature recently, left everyone short. Although some money was allocated to healthcare, still it was $40 million short to care for everyone under the Affordable Care Act. Telehealth can help reduce the burden of cost but we must first have the connections.
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2-18-2016
February 16, 1766 was the birthday of economist Thomas Robert Malthus, born in Surrey, England. In 1798, he published a pamphlet called An Essay on the Principle of Population, in which he argued that the human population of the Earth was growing at a faster rate than the food supply, and that war, disease, and famine along with abortion, birth control, prostitution, postponement of marriage and celibacy were necessary in order to prevent overpopulation.
More recently, Michael A. Morrisey of the University of Alabama wrote an article on the economics of Health Care where he argued that the economy of Health care is Different in that the outcomes are uncertain and that large segments of the industry are dominated by nonprofit providers, and payments are made by third parties such as the government and private insurers making health care unique.
While the above predictions and observations maybe true and correct, the fact remains that our population is growing rapidly and along with global warming resulting in environmental variants. The ever changing population demography further create challenges that healthcare providers have to deal with. While economically, it maybe reasonable to accept the above scenarios as basis of a problem our world is facing, finding a solution to them is our challenge.
In finding ways to reduce cost, expand healthcare to every corner of the globe, and provide expertise for all rare and strange maladies, we must consider the role of technology. And there is no better way to address these issues than the use of telehealth and telemedicine. But since the technology is new, it is up to us to make the economists and politicians see the benefits of it. Thus organizations such our Alliance and the ATA deserve special recognition and support, and it starts by our own healthcare industry and providers to accept and support it.
It is also interesting to note that this week on February 15, 1564, was the birthday of scientist Galileo Galilei, born in Pisa, Italy, who defended the scientific belief and prophesied that, in the future, "There will be opened a gateway and a road to a large and excellent science into which minds more piercing than mine shall penetrate to recesses still deeper."
Galileo said, "In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual."
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2-11-2016
The first call came in at a minute to 2, someone signed in from Arizona. I received an e-mail a couple of minutes after 2 PM, informing me that the conference call was full and that the caller was kicked off. The overwhelming interest and reception for the subject matter is an indication of the importance of it. Of course, I am talking about the Interstate Telehealth Discussion Group monthly conference call we had this past Tuesday.
There are skeptics and deniers and the curious. Everyone wants the program to solve their problems or answer at least some of the questions about what to do about our dire healthcare crisis.
The calls and questions are a testament to the very nature of the problem. Our population is growing, aging, retiring, moving and changing. What the changes are, is the single most perplexing issue on everyone's mind. Changes of this magnitude are confusing and scary. They create uncertainty and trepidation. It is therefore important to deal with them rationally and with a definite plan.
Interstate Telehealth is an issue that will affect all practitioners nationwide. To drive the importance of it home, consider the fact that The Feds, FSMB, ATA, ANA, AMA, and a lot of other state and national public and private agencies are working on it. It therefore behooves us to take the matter very seriously and guide it toward a beneficial, resourceful and coherent set of rules and regulations that will not be a burden to patients and healthcare providers. Hungry healthcare industries are waiting on the sidelines watching this with deep interest. Any uncertainty on our behalf will throw the whole thing in their lap and they will run with it to the detriment of us all. We therefore can not approach this with uncertainty in a wishy washy way. If we let this get away from us, we have no one but ourselves to blame. Lets pay good attention and help each other sincerely and carefully in establishing a solid and beneficial telehealth system for our nation.
As Yogi Berra said: "We made too many wrong mistakes." Lets not make another!
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2-4-2016
February 3, was the birthday of the first woman to graduate from medical school in America, Elizabeth Blackwell, born in Bristol, England, in 1821. The family moved to America when Elizabeth was 11 years old. She wanted to become a doctor after a close friend who was dying suggested she would have been spared her worst suffering if her physician had been a woman. She was rejected by all the big medical schools. Finally the Geneva Medical College (which became Hobart College) in New York accepted her. After graduation she became an advocate for women in medicine. In 1856, together with her sister; Emily Blackwell and Marie Zakrzewska, they opened the New York Infirmary for Women and Children at 64 Bleecker Street.
Today is the birthday of Charles Lindbergh (1902), the first man to fly solo nonstop across the Atlantic Ocean. So it is worthy to remember the achievement of some of our female aviation pioneers: Emily Howell Warner got her pilot's license in 1958 and wanted to fly for the airlines. Although Helen Richey, for a short time was the first female airline pilot in 1934, no other female had been hired for the post since. Warner applied for a job with several airlines every year for several years. She was once asked; "you keep applying and we keep saying no, why do you bother?"
"Because," she replied "One of these days a female will be hired to fly your planes. I want to be that first female." In 1972, she was hired by Frontier Airline as the first female captain.
And not many know that the first African American to get a pilot's license in 1921 was a female named Bessie Coleman.
The fact is that throughout history changes in our traditions, ways of thinking, and policies have been constant. All changes have seen controversial objections and resistance by society. Yet the outcome has strengthen many professions and opened the road for wonderful advances. Today too, many medical professionals and organizational bodies object to telehealth and telemedicine. The growing population and the shortness of providers however demand new ways of thinking and caring for and educating our people. Telecommunication provides us with the tools to help our communities in need.
Our legislatures are meeting right now and need our input to help them reach decisions. Many states, including New Mexico are grappling with budget issues. Lets contact them and inform them of the benefits of telehealth and tele-education so that the budget for the healthcare providers and educators are not cut unwisely.
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1-21-2016
The NM Legislature is now in session and struggling with budget and money issue in this 30 days session. Due to reduced oil and gas prices, state revenues are down and as such many of the budgets maybe under the axe. Education and healthcare receive a good percentage of the state coffer, and thus would be scrutinized and with a Republican control could see damaging reductions. Yet it is our education and healthcare that contributes to the desirability of businesses to move here. All the tax incentives will not help, if a company employees see that their families will not be educated well or receive proper healthcare. At times like this, our lawmakers need our input and help in deciding where to put the limited state money. Or at least where not to cut it.
You can watch the NM Legislature in action via their webcast.
Telehealth and tele-education can help provide great education and healthcare for our citizens, statewide. Our legislatures need to see the advantages of this technology and the benefits it will bring to their constituents and it is our job to make them aware of it. Lets get involved and contact our legislatures and offer them our knowledge and help. They can use our expertise and would welcome help in dealing with the opposition.
1-14-2016 - Wild Horses in my Yard
My dogs, this morning woke me from a deep sleep and a now forgotten dream. The wild horses were back, nibbling on the alfalfa, I keep for the chickens. Their track in the deep snow reveal the long way they travel through the canyon to reach food and water. Their free spirit is a testament to their survival. In good weather, we can see them roaming and running over the mesas of the Pueblo lands of Santa Domingo and San Felipe.
"These horses are Godlike, or mystery beings." a Hidatsa Sioux Indian had once said.
I believe him, for these free roaming animals are one more reason New Mexico is such a magical place. Their energy and vigor add to the spirit of our land and expose the enchantment our state is known for.
The diversity of our people too, make this land special. Our Native and Hispanic folks, have a simple, free and yet culturally rich life deserving attention. To preserve this way of life requires that our people stay unhindered by the assault of all the technological advances on them. Still the technology of the twenty-first century encroaches in all directions and divides communities and townships not equipped. So it is up to us to service the needs of our fellow rural citizens while maintaining their dignity. Telehealth and tele-education give us the tools we need to see to this need. We should use it to help our countrymen without allowing it to change their traditional ways.
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1-7-2016
Well, it is a new year (again) and this old man wonders why we are still struggling on how to practice medicine in the twenty first century. But here we are and our troubled world is in dire need of help everywhere, including healthcare. Now, I was one of the first physician assistants in New Mexico and remember the day I went to get some kind of license from the Medical Board. The board's top man and secretary told me in so many words; "over my dead body!", and that was that - I thought. But by the grace of God and a lot of good folks, I survived, got to practice and went on to fight every state and federal government agency to get recognized, approved, and licensed. Years later I got to hold the job of the very secretary who threw me out of his office. Along the way, I learned a lot, treated thousands and didn't hurt anyone.
Today, we are still fighting for the right of people - like dental therapists - to practice their trade and to bring proper healthcare to the citizens needing their care in cities and out of the way places. Telehealth is a wonderful new tool (well sort of new) that can reach across long distances, around rough neighborhoods, flooded rivers, through mosquito infested jungles, over walled boarders, and through dangerous front lines to bring medical help to the needy. Yet there are those who fight to stop it's progress without providing any alternative solution. Let's make this year one that solves many healthcare problems around the world through telehealth! Let's use this tool to fight the real enemy of man; pestilence and disease. Let us open our minds and our hearts to those who need our help. Telehealth is the SOLUTION!