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The Telegeriatric Nursing Training in the Philippines

ACCESS Health Philippines successfully conducted the first Telegeriatric Nursing Training in the Philippines last October 15-17, 2012 at the Global Distance Learning Center (GDLC), Asian Institute of Management (AIM). The training was a joint activity of ACCESS Health International, Ayala Foundation, Inc., Home Health Care, ClickMedix and AIM-Zuellig Center for Asian Business Transformation (ZCABT). It aims to develop a sustainable telegeriatric ecosystem in the country through a combination of public and private partners and develop the business models and discover price points for the different players of telehealth. 

Registered nurses and nursing schools’ faculty attended the two and half day training. The organizers received positive feedback and appreciation from the participants for initiating the training. Also, some issues and concerns were raised such as the liability and accountability in doing telehealth. Further comprehensive research was one of the recommendations in terms of  policy, target market, availability and capacity needs of healthcare service providers,  financing aspect, the need to have an implementing rules and regulations in implementing telehealth to set standards according to health care laws, and the need to take into considerations the lessons learned from the existing innovations for health.

Nevertheless, the Telegeriatric Nursing Training is just the beginning of opening the door of opportunities for the largely untapped nursing community in the Philippines.

Find out more about the event from ACCESS Health.

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Developing eHealth Businesses for Aging Clients

My grandmother is in her 90′s and lives around 200 kilometers north of Manila, Philippines. She’s cared for by a live-in informal caregiver and my little heartache is that I don’t get to visit her often. I’m a doctor and the least I could do is monitor how she’s doing. Her physical therapist drops in once a week, but leaves no beside record of the physical therapy regimen administered to my grandma.

I’ve heard that some households install a CCTV camera in their grandmother’s room, and monitor granny online from London or wherever they work. Others make regular phone calls, or at least sends a SMS to the caregiver to ask for updates. Given the concern and high care we give our grandparents, telehealth services similar to the ones described above could allow for regular monitoring of their condition, which would provide loved ones with security and peace of mind.

Telehealth for the elderly, or telegeriatric services could be provided more widely if local governments would take the lead. It would be great, for instance, if my grandmother could be enrolled in an elderly care program in her town. Aside from being a viable health program, this is also a politically attractive project. The elderly account for around 7% of the population and are influential voters. The question is, how do we induce mayors to include telegeriatrics in their health programs?

Government staff do not readily adopt new technologies for their workflow unless sanctioned by their supervisors. Telehealth is already widely practiced, albeit informally. Doctors and nurses often get SMS and voice calls from family and friends asking them for health advice for little complaints that are too minor to warrant an actual visit to the clinic.

How do we shift from informal telegeriatrics to more programmatic and sanctioned telegeriatrics? Telehealth improves health services when it enhances the interaction between the patient and health care team in between face-to-face visits (Rupper et al 2008). Smith and Clay (2009) recommend that adequate funding be provided by government to jump-start the development of telegeriatric services, and it seems to be the case for the Philippines. Funding is a start, and we also need to figure out the financial details for such services.

First, we can shift informal telehealth to the formal sphere by getting the municipal physician to start officially monitoring three elderly patients using SMS or voice. It could be monitoring blood pressure, blood glucose, or insulin administration, but we should keep the first cellphone-mediated interactions simple and low risk.

After a few weeks, a time and motion study can be done of the first three patients. If it took say five minutes to check on each patient per day via cellphone, then we can multiply that by the number fifty patients with a similar type of hypertension in town, then do the math in terms of financing it as a next phase. The arithmetic on the budget is a rough estimate, but it should help the program managers start designing a program for implementing telegeriatrics on a larger scale.

Sources:

Anthony C Smith and Leonard C Gray, Med J Aust 2009; 190 (1): 15-19.
Randall Rupper et al, Federal Practitioner 2008: 21-25

The Elderly on Building Disaster Resilient Communities in the Philippines

Extreme weather conditions will become the norm in the Philippines, with long droughts and massive floods punctuated by intense typhoons, experts report. The monsoon alone that the country experienced early August  displaced  more than 260,000 people and caused damages to property amounting to an estimated Php 340 million. Communities now face the challenge of adapting to manage and reduce the adverse effects associated with these weather disturbances.

Vulnerable groups are most affected by calamities. These groups include women, children, persons with disability, and the elderly. Given that the Philippines is visited by an average of 20 typhoons annually, and is largely archipelagic, making emergency response a daunting task in far flung areas, each sector must contribute to building resilient communities locally.

In the aftermath of the heavy rains caused by the August monsoon, ACCESS Health International-Philippines organized the webinar, “The Elderly in Disasters” to  begin a conversation on how to care for the well being of vulnerable groups who are displaced in calamities. The invited resource person to speak for the elderly was Mr. Francis Kupang, Executive Director of the Coalition of Services of the Elderly (COSE).

Mr. Kupang gave inputs on Older People’s (OPs) Needs in Emergencies, specifically (1) the situation of OPs during disasters, (2) their needs and the problems they encounter in crisis situations, and (3) how organized OP groups participate in emergency relief services-emphasizing the role of empowered OP groups in building resilient communities.

The salient points shared by Mr. Kupang is that OPs are vulnerable during disasters because of their fragile physical condition and because the setting in evacuation centers are usually not OP-friendly. It is also in the nature of OPs to sacrifice their well being to give way to addressing the needs of the young-usually, their grandchildren or neighbors. Health also becomes a great concern for the elderly during disasters because provisions for their medicines (e.g., for diabetes, or hypertension) are usually taken for granted because priority is given to food and other basic needs.

The awareness of these vulnerabilities have inspired organized local OP Organizations (OPOs) to provide a range of services for their fellow OPs. Some have initiated programs related to livelihood, post-calamity psycho-social interventions, alternative energies, shelter repair, and workshops on Disaster Risk Response (DRR) and building community-based mechanisms in responding to future disasters. Through these efforts, Mr. Kupang noted that OPOs are actively engaged by different emergency service providers including national and local government units (LGUs), and civil society organizations (CSOs)and religious groups who organize calamity relief efforts.

As they continue to participate in building resilient communities, OPOs have formulated recommendations on how to address the unique needs of OPs in emergency situations. Mr. Kupang enumerates the following inputs from OPOs:

  • Conduct a Damage Need Assessment (DNA) in partnership with the OPOs in the community;
  • Establish coordination or working relations with OPOs in emergency response;
  • For national government agencies and LGUs to designate a point person to coordinate all emergency services with OPOs;
  • Prioritize  basic needs for food and health  of OPs during emergencies;
  • For Government agency and LGU emergency service volunteers to have proper orientation and knowledge of how to address OP needs during emergencies;
  • LGUs should develop a comprehensive Disaster Risk Reduction and Management (DRRM) Plan that integrates OP-sensitive policies and measures in emergencies;
  • Enchance OPO participation in DRRM planning and implementation;
  • Establish baseline information of the capacities, vulnerabilities and needs of OPs at all levels of political units (towns, cities, municipalities, etc.);
  • Enchance and / or strengthen the participation of OPs and OPOs in the identification of their problems and needs, and the planning and implementationof community development programmes, including DRRM programs;
  • Integrate OP agenda in all levels of government planning and program development structures and processes;
  • Building partnership with Non-Government Organizations (NGOs) and CSOs in facilitating the formation and / or strengthening of community-based OPO partners in participatory development practice.

Sources:

Abano. Imelda. “Experts: Extreme Weather Becoming the Norm.” Business Mirror Online 30 August 2012 <http://www.businessmirror.com.ph/home/top-news/32096-experts-extreme-weather-becoming-the-norm>.

Tapang, Giovanni. “Pagasa and Hope.” Manila Times.net 16 August 2012 <http://www.manilatimes.net/index.php/opinion/columnist1/29030-pagasa-and-hope>.

The Philippine Telegeriatric Pilot Project: How did it Start?

Access Health Philippines promotes innovations for the healthcare delivery system so that “all people wherever they are, have access to quality and affordable healthcare”. In partnership with Asian Institute of Management – Dr. Stephen Zuellig Center for Asian Business Transformation (AIM-ZCABT), a Telemedicine Project was formed with an ultimate goal of filling the gaps of widening problems in health access and shortage in the number of health specialists.

Elderly in the Philippines comprises 6.8% of the total population (NSCB, 2010), which means 1 out of 5 households have senior citizens. Older people have special needs and challenges in accessing healthcare services. The physical and cognitive disabilities limit their capacity to travel and access healthcare. They need specialist care providers for the aged. With the lack of access or difficulty to access health care, distance medication can be of great help to this sector of the society. This brought the telemedicine team to propose a start up project for the elderly population which is known as the “Telegeria”.

A Telemedicine team was formed which composed of members from different sectors which have stakes in providing better healthcare for the elderly. They are the Ayala Technology Business IncubationACCESS Health Philippines, AIM SRF/AIM ZCABT, ClickMedix, Total Transcription Solution Inc., Coalition of Services of the Elderly, Inc. (COSE) and Alliance of Young Nurse Leaders & Advocates International Inc. (AYNLA).

The Team initially chose to pilot the project in one of the major cities in Metro Manila. However, with a show of hesitation and delayed response from the involved staff, the Team prompted to look for another entity that was willing to adopt the concept and pilot the Telegeria. This is the Home Health Care (HHC) in Quezon City.

HHC specializes in delivering wellness programs and services to seniors and persons with disability in the comfort of their homes. It has a multidisciplinary expert team of physicians, registered nurses, physical therapists, nutritionists/dieticians, medical technologists and trained caregivers. They have been cited as a community resource providing quality home care for seniors across all settings.

HHC agreed to participate in the project seeing the opportunity for a potential innovation that could improve their management system in providing better and more cost-effective health services towards their clients.  A virtual clinic from ClickMedix system was given to HHC for a free trial of one full month. This was applied in their four senior residential facilities.

Check out for the continuation of this project in the coming blogs. This pilot project is being documented by the Program Coordinator and Program Associate of AIM-ZCABT, Davidson Teh and Jayson Soriano, respectively.