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Measuring lipids

International care to meet national needs

Ken Grant, technical director for international health at Mott MacDonald, discusses latest challenges, future opportunities and why there’s no place for pessimism in his line of work.

The most important next step is to use technology to apply what we know now. For example, we could eliminate 95% of child mortality if we only applied what we already know.

What’s exciting right now?

We’re going to be working on the Fleming Fund, an initiative by the UK Department of Health to help tackle the global problem of antimicrobial resistance in low- and middle-income countries. The threat of bugs developing resistances to drugs is well known, but not enough is yet being done. Drug resistant infections could kill an extra 10M people across the world every year by 2050 if they are not tackled. We’re already seeing resistance to strains of tuberculosis and malaria. Sadly, there has been misuse for a long time, bringing real difficulties to overcome. Of course, it’s not just in human medicine, but also veterinary, with farmers throwing sack loads of antibiotics into fish farms or injecting all their cows, whether sick or not.

We’ll be helping to plan laboratories and upgrade data, working with medical and veterinary staff in the UK and abroad to promote a holistic approach and provide appropriate training, lab work and epidemiology.

What trends are you seeing emerge in developing countries?

There is a real effort to match care with health needs, dependent on the burden of disease. Buildings are part of the solution. There’s an emphasis on creating buildings that aid day cases – getting patients in and out quickly. Technology is key for this evolution. We’re seeing an increase in mobile health clinics. The wide prevalence of smartphones in Africa is also encouraging people to take control of their own health. Apps for fitness tracking and antenatal care, as well as smart messaging are already making a big difference.

What’s a good example of smart technology in action?

A lot of hospitals are now able to show patients how to hold their records on their phone and in the cloud, rather than a central database in the hospital itself. In South Africa, they struggle with huge problems of overcrowding. Often, people start queuing at 4am for repeat prescriptions of HIV or diabetes pills.

Now, they can directly text the manufacturers, who are creating depots in townships, where patients simply present a barcode. Another example is Sri Lanka, where subscribers are now able to measure their blood pressure and heart rate so doctors can diagnose problems digitally and remotely. Certain clinics are linked to Harvard University, so you can now get a consultation in the States via video link-up.

What’s the next big wave in healthcare?

The most important next step is to use technology to apply what we know now. For example, we could eliminate 95% of child mortality if we only applied what we already know.

And the next big challenge?

Appropriate care needs to be our focus moving forward. Continued mass migration to cities presents huge challenges around sanitation and water. With 70% of the world’s population expected to live in cities by 2055, I fear there will be even bigger problems with slum districts, which are still largely unrepresented and passed over in care programmes.

With no clean water and human waste simply slung over the fence, there’s little point treating someone for an infection, if they are going straight back into that filthy environment. We need an integrated approach to tackle the huge burden of communicable diseases that will spread as a result of poor sanitation.

How did you first get into international health?

I started off my medical training as a paediatrician, and then went to work for a Save the Children bush hospital in East Africa. I thought it was great – I was basically paid to live in a Land Rover, which was my idea of heaven at the time. Initially, I was captivated by the fact I could cure 50 ill children a day. But then I realised that if I could teach my driver to inoculate, I could help cure thousands more. I was hooked. When I eventually came home, I retrained to work in tropical diseases and public health.

What achievements are you most proud of to date in your career?

I think the way my teams have worked closely with governments has made a difference. The old US model was to bypass governments and send in the NGOs directly. I feel it’s important to put governments in the driving seat. Embedding systems is the most sustainable way to meet long-term challenges. That will be one of the gains of the Fleming programme – how we create links with other nations and share knowledge to combat microbial resistance.

Are you optimistic for healthcare in developing countries?

Absolutely! There is a rising burden of disease. Finding the solution at scale is a challenge. But the progress we are making in so many areas is heartening. Smallpox has been eradicated. Polio is all but gone, Guinea-worm likewise. We are making progress in tackling neglected diseases such as Visceral Leishmaniasis, which affects a million people worldwide. It’s about putting money where it makes most impact. You can’t be pessimistic in this role. You can only look forward.

Appropriate care needs to be our focus moving forward. Continued mass migration to cities presents huge challenges. We need an integrated approach to tackle the huge burden of communicable diseases that will spread as a result of poor sanitation.

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