Draft 03/7/05  Last complete version           

 

 

International e-Health Research Collaboration Method for Global Health Research

 

Rodolfo J. Stusser, MD, MPH¹, Richard A. Dickey, MD, FACP, FACE², Robert L. Kriel, MD³, Linda E. Krach, MD⁴

 

¹Unit of Clinical Biostatistics, Informatics, and Primary Care Research, Havana University Vedado Health Community Center, Havana, 10400, Cuba. stusser@infomed.sld.cu 

²Departments of Internal Medicine and Endocrinology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157-0001, USA. mdrad@charter.net

³Departments of Neurology, Pediatrics, and Pharmacy Practice, University of Minnesota, Minneapolis, MN, 55414, USA. kriel001@umn.edu,  

⁴Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, 55414, USA. LKrach@aol.com

Text word count (Abstract & text)=  1,612

Correspondence to:

Richard A Dickey, MD

1941 20^th Avenue Drive NE, # 56

Hickory, North Carolina 28601

USA

Telephone: (828) 327-7269

E-mail: mdrad@charter.net

 

Key words:  e-health; Internet; research collaboration; global health; primary care

 

Abstract

 

The potential benefits of collaborative research at a distance between professionals in countries with different levels of wealth and income, could contribute greatly to improvement in global health research.   We propose the implementation of complementary e-health research tactics as a way to strengthen the cooperative international research strategy without encouraging emigration of talented professionals from lower income areas.  While Cubans have had initial experience in research collaboration using electronic communication, we propose based in the Cuba case study a more comprehensive approach to global health research collaboration.  A research cooperation program in the Vedado Health Community Center, the “Vedado e-Health Project,” could be the starting point to improve the international collaboration with the Cuban primary care-family medicine program.  This concept could improve cooperative research between lower and higher income countries.

 

Challenge in Global Health Cooperative Research

 

Emigration of talented professionals from low and middle income countries to North America and Western Europe is a serious and growing trend.  Emigration of such professionals, apart of the economic incentive, is related to the tenure-track system, prestige, and the opportunities for the individual to obtain supporting funds for innovative long-term “hypothesis-driven” research.[1-4]  Such emigration limits the capacity for global health research.

 

In the last decade there has been exponential growth in the use of the internet and other information and communication technologies (ICTs) for research on internet health content, and as support for multi-center health surveys, clinical trials, biomedical research, data bases, automated data mining or “data-driven” discovery of hypothesis, publishing, and research collaboration among professionals of the world.[5-7]  These practices could be of great importance for global health research.

 

The aim of this paper is to suggest the implementation of complementary and simultaneous e-health research tactics between professionals in countries of low-middle and high income to strengthen their research collaboration strategy in a comprehensive approach.

 

This analytical study of the Cuban case was made in the non-government organizations (NGOs) conceptual and operational framework of the rich scientific exchanges of the authors with the Global Forum for Health Research Foundation from 1998 to 2005, the International Society for Internet in Medicine from 1999 to 2005, and the United States (US) People to People Ambassador Program delegations with Cuba from 2000 to 2005.

 

Past Health Research between Cuba and Other Countries

 

 

Under the influence of Spain for over 400 years, Cuba built the bases for modern agriculture, industry, education, medicine, and science.  Since 1762 and more after 1898 Cuba benefited from the advanced open market system for sanitation, city planning, use of high technology, higher education, biomedicine, pharmacy and the scientific influence of the universities, hospitals, and laboratories of the US.  This helped Cuba to achieve by its own economy in the 1950s, after the US and Canada in the Americas, the fifth largest number of physicians per capita and the third lowest infant mortality rate---thirteenth lowest in the world.[8-9] At that time, Cuba had much immigration from Europe and other countries, and little emigration. 

After 1959, Cuba changed to the centralized planning system of the Soviet Union (USSR).  This was followed by the loss of half of Cuba’s professionals due to massive emigration.  From 1960, with the help of the USSR and Eastern Europe, and, since 1990, of the restricted model of China and investment from Western Europe, Cuba was able to maintain good rates of health growth.  Cuba achieved this largely as a result of 1) Soviet financing all the Cuban defense, economy, education, health and science in the first 30 years, 2) substituting lack of hygiene, food, resources, supplies and medicines, with doctors intensive labor preventing infant mortality and epidemics in the last 15 years, and 3) United Nations Agencies giving access to North American and Eurasian biomedical and computer technology and “off-line tele health education and research” for 46 years.

In spite of over four decades of political dispute with the US, Cuba continued education programs and increased research and development in biomedicine and informatics.  However, personal meetings and exchanges in training and fellowships, sabbaticals and internships between Cubans and professionals and students from Western countries became very limited.  In addition, travel restrictions and limited funds for most of the 130,000 Cuban professionals and students at 1,000 Cuban health units, further stifled their professional exchanges with their Western counterparts.[10]   In contrast to the situation in most other countries, access to full foreign web sites and mails is monitored and not yet available to most Cuban professionals and students.  Exchange through monitored e-mail with foreign colleagues is possible, although limited, for a small fraction of them. However, both accesses have begun to be improved since 2004.[11]

Since the 1960s the Cuban health system has achieved an outstanding record for access to basic health care.  Cuba also has a record of providing the highest level of and least costly medical support to the countries in the Southern hemisphere.[10]  Furthermore, during the 1990s Cuba reached the world’s second highest ratio of physicians per capita second only to Italy.[12]  Cuba has continued to enjoy a low infant mortality rate (29^th place now)sharing now (Canada is first) the second place in the Americas with the US.[13]  Cuba developed a significant network of forty biomedical research centers,[10-11] yet only has the eighth place in Medline registered publications in the Americas.[14]   An example of Cuba’s widely acknowledged accomplishments in pharmaceutical, biotechnological and medical equipment is the development by the Finlay Institute, in 1986, of the first and only effective vaccine against meningitis B.[15]

 

However, the Cuban economy has become heavily impacted maintaining the second most powerful defense force in the Americas for four and a half decades.  Cuba in the 1990s lost USSR financial aid, and struggles to maintain its health system due to Cuba’s own restrained economy, facing various international sanctions.  A long and deep economic crisis has further increased the pressure for Cuban professionals to emigrate again, and sending a third of them to work in southern countries, increases Cuba’s health care, education, and research difficulties.

 

Possible International e-Health Care Research Program

On-line tele health research networks of teams of researchers can be created following the models of the North American laboratories without walls (“collaboratories” or “netlabs”).[5, 16-19] While there may be significant strategic, ethical, sociological, legal and even technological hurdles to be overcome by the low-middle and high income research communities, their professionals could collaborate even better on global health research..  Such a research initiative would require the transfer and assimilation of advanced internet and other ICTs’ tools for research collaboration, from the North American cardiovascular disease, InterMed for Informatics, HIV/AIDS initiatives, within others. Other tools await development.[5, 16-19] 

Cubans and other low-middle income professionals have had successful experiences in the fields of genomics, proteomics, and imaging research through “netlabs” with the US, Canada, Western Europe, and Japan, working in biotechnology, neuro equipment and vaccine projects.  With collaborators overseas they have designed and coordinated experiments in patients, simulations in silicon, and data analyses with costly equipment and software.[20]   These professionals could participate actively in sophisticated basic and  technological research, as well as can assist public health and clinical/surgical research without having to emigrate. They could enroll in electronic graduate programs of higher income countries.  Initially, special networks of high connectivity and speed using fiberoptic wide band width technology (rather than satellite) would facilitate on-line e-health care research in coordinated projects.   Funding could come from low-middle income governments and global sources [e.g., Western NGOs and governmental organizations (GOs)] perhaps with the assistance and coordination of United Nations Agencies.  In return for the concept of “scientific collaboration”, low-middle income researchers could receive information, experience, technology, and funds to sustain their own projects. Personal and team grants might come from the global sources of funds and, in the future, funding could also come from their own NGOs and GOs. At the same time, Western partners would benefit by strengthening the global health research networks with others, including the South, receiving more cost-effective collaboration.

 

Initial e-Health and Clinical Research Initiatives

 

In Cuba these could start by the existent proposal for the “Vedado e-Health Project”. At the primary care research unit of the Vedado Community Polyclinic, the first author of this article [RJS], a member of the American Academy of Family Physicians (AAFP), designed this project with informal assistance of the Universities of Washington, Wake Forest, Minnesota, Boston, Hokkaido, and Natal.  This is a health primary care research project of the badge family medicine program of the Cuban health system working to apply informatics, telematics, and ICTs’ on health measurement, data bases, clinical care, management  and assessment of individuals, families and communities, in part based on an AAFP goal for 2005 and on a Grand Challenge for Global Health of the Gates Foundation.[21]  At present however this project has an inadequate budget and limited internet and teleconferences access due to the priority given to industrial research.[22]

 

The Vedado research center may be able to coordinate clinical epidemiological studies and trials in other research initiatives (e.g., health policies and systems, HIV/AIDS, atherosclerosis, cancer, Alzheimer’s disease, depression, disability in elderly, within others).  International initiatives could be expanded over time, and with additional funding, to other Cuban polyclinics, hospitals, and institutes, establishing a national e-health, clinical and surgical research collaboration network among all health care levels, and with the scientific basic and productive centers too.[23]  This e-health research program offers an important venue to fortify the active support of Western scientific staffs to the biomedical and health progress in Cuba while political issues are resolved, strengthening the collaborative research, discouraging the emigration of talent from Cuba, and promising, with the use of this proposed approach, an increase in the research capacity of the 210 countries where global health problems and threats call for solutions. 

 

 

Acknowledgement:  None is required for this article.

 

Conflict of Interest:  There is no conflict of interest or source of funding for this article.  It was not funded by any organization.  Nor is there any conflict of interest for any of the four authors.  The views expressed are those of the authors and do not necessarily represent the views or policies of the Cuban or US institutions with which the authors are affiliated.

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