Telemedicine in Latin America: educating healthcare personnel

Investment in educational projects is one of the steps that public and private organizations in Latin America must take to boost the benefits of virtual health and telemedicine.

An opinion paper written by Dr. Walter Curioso, from the University of Washington, in the United States, states that e-learning is probably the most viable option for providing fast and efficient knowledge to future healthcare professionals.

Isabel Lobos, executive director of Tula Salud, an NGO that trains doctors and nurses virtually in Guatemala, agrees. For her, virtual programs can have a greater impact than face-to-face education in a country where there are 0.4 healthcare professionals per 1,000 people.

“Educational processes usually reach the same people. We are talking about the institutional heads, the directors, or chiefs, those who are in a middle ground within the staff. Very rarely they can reach the grassroots, those who give care in less favorable conditions, much more solitary. These people should be more or as well trained as those at an urban level”, she says.

Susan Groenwald, former president of Chamberlain University in the United States, also appreciates the potential of digital training. “We could train community workers. They can play critical roles in helping patients and their families with medication instructions or just waiting in their homes”, she considers.

Although it offers opportunities for development, e-learning remains a debt in several regions of Latin America. There are healthcare workers who choose to train in English-speaking schools, which can be difficult as most Latin countries tend to rank low or very low on the English Proficiency Index.

How Hippo can help

The COVID-19 pandemic revealed the need for the world to embrace digital tools in medicine. Hippo Technologies is leading this crusade to improve healthcare services.

One of its latest innovations is a voice-activated, hands-free, and head-worn tablet. Its function is to provide a virtual learning space to keep the next generation of healthcare workers engaged in clinical practice. The company also developed the Virtual Care platform, which combines the advantages of in-person learning with the safety and convenience of remote care.

The future of medicine is here, and Hippo is paving the way for regions like Latin America to keep up.

Telemedicine in Latin America: invest to expand

In certain parts of Latin America, virtual health begins to take steps to meet the challenges and provide digital services to the population. One of the first is to design and execute investment projects in this new industry that gained momentum due to the COVID-19 pandemic.

This is the private (green) and public (blue) expenditure on health in Latin American and Caribbean countries. (Source: WHO, Global Health Expenditure Database, 2016)

According to the Inter-American Development Bank (IDB), resources for telemedicine should be included in plans to improve infrastructure and equipment in healthcare centers. Its experts assure that it is necessary to overcome the inequality gaps that exist in Latin America in the 21st century. These are reflected, for example, in the 2018 Broadband Development Index, which revealed that the region lags the most advanced member countries of the Organization for Economic Cooperation and Development (OECD).

One of the Latin American NGOs developing initiatives to bring telemedicine closer to the people is Tula Salud, which works in rural Guatemala to reduce malnutrition and maternal and infant morbidity and mortality. In 2015, it created the Kawok mobile app to record clinical data and generate medical reports. “Having the support of technology to reach a population that is generally excluded or neglected is an excellent opportunity,” says Isabel Lobos, its executive director.

To identify how prepared the States are to invest efficiently in telemedicine, the Pan American Health Organization (PAHO) prepared a tool that measures the level of maturity of healthcare institutions. According to the guide, there are six variables to be studied: organizational readiness, processes, digital environment, human resources, regulatory aspects, and human resources. Its specialists recommend that the authorities adopt it before executing a plan.

Telemedicine in Latin America: the pending digital divide

Despite the benefits they generate during the COVID-19 pandemic, virtual health and telemedicine need to overcome challenges to grow in Latin America. One of the most prevalent is the digital divide that marginalizes those who live in the lowest socioeconomic strata and lack access to internet services.

In 2017, the International Telecommunication Union (ITU) estimated that there are more than 200 million people of working age who are digitally excluded in the region. A year later, the Inter-American Development Bank (IDB) reported that 56% of people used the internet, but only 45.5% of households had a broadband connection.

These differences in Latin America are of concern to the United Nations Educational, Scientific and Cultural Organization (UNESCO), which states that “digital inclusion is a crucial element […] in the region, where internet services […] are considered essential to ensure the well-being of citizens”.

Entrepreneur Marcel Roehrs witnessed the backlog when he founded Doctor Online, a platform that connects doctors with patients in Guatemala. “During our early days, smartphone penetration was not that great in the country. We realized that there was a lot of need among people who were not being attended to because they were far away and didn’t have money,” he says.

The inhabitants of the most neglected regions are often indigenous people. Historically, they face more obstacles to receiving medical attention in their countries. One of the reasons for this is that public institutions provide care mainly in Spanish. According to the United Nations Children’s Fund (UNICEF), there are 522 native peoples in Latin America, who speak 420 languages and make up around 10% of the population.

The marginalization of indigenous communities occurs in a subcontinent that is highly unequal in other services such as education, employment, among other variables. For example, according to the United Nations (UN), the poorest 20% of the population keeps almost 4% of the total income, while the richest 20% has a little less than half of the total income.

Telemedicine in Latin America: in search of trained personnel

The success of digital health and telemedicine depends on people with the training and experience to deliver top-caliber care. It is a visible reality in any territory, especially in Latin America, where more trained healthcare professionals are needed to provide services to the population.

According to 2017 statistics by the World Health Organization (WHO), the Latin American region registers one of the largest shortages of healthcare personnel in the world. On average there are 2.28 medical doctors per thousand inhabitants, a figure below the minimum level, which is 2.3 professionals per thousand people.

The need for human resources is most urgent in countries such as Haiti, Guyana, Honduras, and Guatemala, where there is less than one doctor per thousand inhabitants.

The relevance of nurses

The COVID-19 pandemic reinforced the importance of having nurses in healthcare services. Susan Groenwald, former president of Chamberlain University in the United States, explains: “They are the ones who are at the bedside and therefore have the broadest perspective of what people and their families need”.

Although they are key for patients, nursing professionals are also in short supply in Latin America. According to the Pan American Health Organization (PAHO), during 2018 and 2019 there were 9 million 555 thousand 748 workers in the Americas. Most of them labored outside most of the Latin region: 80.9% are in the United States, Canada, and Cuba.

More than the number of professionals

In addition to a greater number of workers, virtual health and telemedicine in Latin America require personnel with the skills to manage digital tools, such as mobile apps or remote conference sites.

Javier Santa Cruz, founder of Doctors Co, a platform that connects doctors with patients in Guatemala, has noticed this need since he started selling his service.

“The main challenge is to get buy-in from the medical community, one of the industries that is furthest behind in technology and one of the most resistant to change. They do not want to transform the ways they worked 20 or 30 years ago. It’s a challenge to introduce new inputs to them,” he says.

Telemedicine in Latin America: an introduction

The COVID-19 pandemic broke paradigms of human work and, as expected, changed the medical industry. It triggered the practice of telemedicine and digital health. Patients stopped visiting clinics and started scheduling appointments and receiving care through their laptops, tablets, or smartphones.

This medical revolution seems to be growing every day in a world where more than half of the population uses the Internet. According to an article on medicaleconomics.com, the adoption of telehealth by patients in early 2020 increased by 33% over 2019. In addition, the market is expected to reach $185.6 billion by 2026.

According to Talía Wegman-Ostrosky, an oncogenetician at Mexico’s National Cancer Institute, the advance of telemedicine responds to the facilities it offers compared to face-to-face services. For example, according to Forbes, it saves patients more than 100 minutes of their time compared to an in-person consultation.

“It’s here to stay. […] It avoids travel expenses, waiting times, crowds in hospitals. It can serve all of Latin America, so we can bring medicine to places where there is none,” Wegman-Ostrosky told SciDev.Net magazine in November 2020.

While generating promising benefits for physicians and patients, telemedicine faces challenges in penetrating some regions, such as Latin America.

According to a 2011 report by the Economic Commission for Latin America and the Caribbean (ECLAC), the challenges “arise mainly from inequalities in access and quality of healthcare, demographic and epidemiological changes in the population, the pressure exerted on service systems by the scarcity of resources, and problems of sustainability of public spending.”

Given these circumstances, the Pan American Health Organization (PAHO) assures that Latin American countries must take two actions to implement telemedicine: identify the availability of resources and trained personnel, as well as enact legislation to regulate it.

Marcel Roehrs, co-founder of Doctor Online, an online medical consultation platform originally from Guatemala, agrees with PAHO. He also points to a factor that, in his opinion, will facilitate the entry of virtual healthcare in Latin America: time.

“The more people know about telemedicine, the more they try it, and it becomes the standard. I wish it were a matter of months, but more time must pass for these new behaviors to become the norm. The trend has just started, but there is still a long way to go before it becomes mainstream,” he says.

How your snoring affects your well-being – “Healthy Attitude” podcast review

Bedtime may be the favorite time of the day for thousands of people, but it does not always represent rest time for everyone. Has the snoring of your relative or partner ever kept you awake at night? Yes, it has happened to all of us. But we must be aware of a reality: in addition to causing annoying noises, snoring can be an indicator that our companions are suffering from more than just a stuffy nose.

Dr. Ana Carolina Bassol, a graduate of Mexico’s National Institute of Respiratory Diseases, knows about this firsthand. The pulmonologist works at the Galenia Hospital in Cancun, in the south of her country, and has treated dozens of cases of sleep apnea, a condition related to snoring.

This sleep disorder, known in the medical community for being underdiagnosed by professionals and neglected by patients, affects a significant number of Latin Americans in the 21st century. According to this study (in Spanish), 20% of middle-aged adults have at least mild sleep apnea and 80% of cases remain unidentified.

Dr. Bassol is aware of these figures and the possible consequences of suffering from this condition, such as heart disease. That is why she participated in the podcast “Healthy Attitude”, produced by the hospital center where she works, to inform and educate Spanish speakers about snoring and sleep apnea.

Here is a summary of her intervention in the program.

What is sleep apnea?

Sleep apnea is the total or partial blockage of the upper airway (of the respiratory system) for more than 10 seconds and sometimes even for minutes. It occurs specifically in the pharynx, a tube that connects the nostrils and the oral cavity. This duct is opened by muscle tone but can close when the tone weakens during deep sleep.

According to the doctor, there are several factors that can disrupt the passage of air through the pharynx and increase the likelihood of sleep apnea. Some of the most important are large tonsils, a long tongue, a small nose, and a small chin. She also emphasizes fat deposits, as they can cause the pharynx to collapse even when the individual is awake (due to the great weight they exert on the neck).

How do I know if I have sleep apnea?

To know if you suffer from this syndrome, you can pay attention to the intensity and frequency of your snoring when you sleep. This is one of the most frequent symptoms of the condition, as it occurs when the air causes vibration of the relaxed tissues of the throat.

Another sign that can reveal if you have this condition is the sensation of choking when you just wake up. In fact, sleep apnea can cause you to stop breathing when you sleep. But do not worry: the brain is smart and will never let you die from lack of oxygen. The organ specializes in sending a signal of stress substances (such as adrenaline) that allows you to return to a light sleep and regain the muscle tone that keeps your pharynx dilated.

What else can sleep apnea cause?

According to Bassol, the problems associated with sleep apnea are not only limited to the pharynx but can also trigger negative consequences in the circulatory system.

Whenever there is an obstruction in the upper airway, oxygen in the blood can decrease, which generates inflammatory substances that increase the formation of clots. In addition, adrenaline injections from the brain increase blood pressure, increase heart rate, and change chest pressure. These last modifications place the heart in stressful situations. This is why sleep apnea is linked to cardiac conditions such as acute heart attacks, arrhythmias, heart failure and pulmonary hypertension.

What else can I do to detect sleep apnea?

Bassol comments that the clinical manifestations of sleep apnea when the body is conscious are drowsiness, anxiety, and depression. If you are overcome with doubts and you are not sure about what you have, there are two ways to achieve an accurate diagnosis.

The first option is to take a respiratory polygraphy test. Professionals perform at your home to gather information about your oxygen saturation, your chest and abdominal movements and your airflow in the airway. To get it, they need you to sleep one night with an equipment composed of nasal prongs, a chest monitor, two elastic bands (one on the thorax and one on the abdomen) and an oximeter.

On the other hand, the second alternative is to take a polysomnography test. It is more complete than the previous one and includes an electroencephalogram, an electrocardiogram, and the measurement of other arterial gases, as well as the muscle tone. This is performed only in sleep laboratories and requires observation of the patient for an entire night. It is the best choice if you are a person with previous diseases, such as heart failure.

If you want to listen to the complete podcast (in Spanish) and learn more about sleep apnea, you can click here.

Why older adults should practice calisthenics

Cristian Bianchi has been a physical trainer for more than five years. He founded one of the first gyms specialized in calisthenics in Guatemala City, with the objective of offering people an opportunity to forge healthy lifestyles.

He learned about this training method during one of his trips to Europe. It consists of using only the body’s weight during exercise. The goal is to gain control of body mass, without the need for resistance or additional loads.

In 2015, the American College of Sports Medicine (ASCM) indicated that calisthenics is the leading sport in the world. In addition, it said it helps reduce the number of individuals who die from lack of physical activity, which, according to the World Health Organization (WHO), amounts to approximately 3.2 million each year.

For Bianchi, this training is key to reducing that global figure and is far from excluding people because of their age. In 2021 he serves about 120 students in his gym, three of which are senior citizens.

Today he explains five reasons why older people, regardless of their injuries or conditions, should also practice calisthenics.

Maintains body mobility

To help his pupils, Bianchi follows the Best Progress Method (BPM), which establishes demanding routines according to the abilities of the person. The instructor says that older adults often do basic, assisted exercises, such as push-ups, squats, planks, or chin-ups.

According to Bianchi, the first reason that should motivate them to practice calisthenics is that it allows them to maintain body mobility. Through constant exercise, they can get into the habit of staying active. Thus, their muscles are less likely to atrophy and become completely sedentary.

“Usually, conditions don’t let grandparents move around as much. With calisthenics we prevent their muscles from atrophying because they never stop straining,” he says.

Gives more independence

When designing his routines, one of Bianchi’s priorities is to make sure that older adults understand what they will use the movements for in their daily lives. “For example, squats allow them to later get up from a chair. That way they have control over their body and do not always need help,” she says.

In the instructor’s opinion, the second reason derives from that teaching: calisthenics give a sense of independence to those who are older. Exercises expand their possibilities of acting by themselves every day.

In addition, the trainer emphasizes that calisthenics promote mental health, since it improves self-esteem and allows people to feel that they are still capable of achieving their goals.

“When we are old, we may perceive ourselves as less capable, but calisthenics help us maintain the certainty that we can still do things,” he states.

Helps to recover a correct posture

According to Bianchi, the body gets used to living as the usual stimuli demand. He mentions, for example, that people who spend their days in front of the computer can develop spine, back, neck and general posture problems.

“That’s why we hear older people say that their back hurts. They lead a life with bad stimuli,” he explains.

For him, calisthenics are a source of appropriate stimuli that allow the body to be stretched, moved in all directions and to recover a proper posture. In his opinion, this benefit is even more relevant during the COVID-19 pandemic, which demands us to stay in our homes and use digital devices more often.

“In the pandemic many stopped moving as they did before. That is why it’s important to build those healthy habits throughout life,” he considers.

Encourages closer relationships

A 2016 study by Harvard University in the United States says that one of the keys to achieving happiness is to build deep relationships. Bianchi says that calisthenics, in addition to improving physical condition and appearance, helps cultivate bonds between older adults and family and friends.

“It improves the quality of life for everyone. It is not the same to have a grandparent who can travel or walk, as it is to have one who can barely move. If there are more activities that people can do together, the relationship is likely to grow,” he indicates.

Helps to lead by example

One of the concerns of the 21st century is the high exposure of children and adolescents to screens. Research reveals that the amount of time is close to seven hours a day. For Bianchi, older adults should also practice calisthenics to inspire young people to prioritize health and stop focusing so much on the digital world.

“We need to show young people that it has an inclusive approach. When people tell me they cannot practice it, I show them videos of some grandparents training with their grandchildren. And people get engaged and question why they should not practice it if grandparents can,” he says.