As I wait to provide a link to my final analysis (hint! hint! think with your heart!), here are some interesting notes and insights from a couple of my healthcare related meetings in Kazakhstan this summer:
- Drs. Almaz Sharman and Dana Sharman have been leaders in efforts to bring
Telehealth technologies to Kazakhstan for years. During this meeting, several cultural impediments to mobile health were raised. The guarantee of free medical care by the state causes many Kazakhstanis to ignore preventative measures in favor of acute responses to illness. This could be an impediment to implementation of mobile health services aimed at chronic disease management. Dr. Almaz Sharman suggested that Kazakhstan’s doctors are resistant to change unless supported by the Ministry of Health, possibly an inheritance of the centralized Soviet system of health.
- USAID (Arman Dairov, Ashley M. King, Leslie Perry): An overview of the efforts of USAID in Kazakhstan were discussed, including Maternal and Child healthcare, Tuberculosis and HIV epidemiological research efforts.
- Ministry of Health (Professor Murat Teleuov MD PhD): Dr. Teleuov was able to provide
excellent ideas on the project, including the rejection of several previously considered initiatives. Suicide Prevention Hotlines were rejected due to previous unsuccessful uses, although the problem of lack of advertising was discussed. Efforts aimed at Rural Health and Maternal and Child Health were rejected due to a perceived lack of problems in this area. The greatest interest was in the use of mobile training modules for a new rural Physicians Assistantship program and the use of mobile ECG units for diagnosis of Cardiovascular Disease.
- Nazarbayev University and National Medical Holding: A tour of Nazarbayev
University and the National Medical Holding was conducted. National Medical Holding, a large hospital in Astana, was recently purchased on behalf of Nazarbayev University by the Government of Kazakhstan. This collaboration will be the research nexus in Kazakhstan to explore and export healthcare innovation and best practices to the rest of the country. While touring the National Medical Holding, it was clear that many departments routinely sent physicians abroad to receive additional international training, actively sought out new technologies from the developed world, and had an open mind when in came to research and innovation. Additionally, Telehealth operations are already being conducted by the department of Neurology through an online stream of surgical procedures. The research based mission of Nazarbayev University and progressive orientation of the physicians who serve there suggest this facility could overcome the cultural barriers earlier cited by Dr. Almaz Sharman.
To summarize: there is a lot of interest in technology, in particular new and innovative technology, from healthcare practitioners and development experts in Kazakhstan. Experts disagree as to where such technology can be best applied and also what kind of a solution is necessary.
More informally speaking, I think the pace of medical reform and development reflects a lot
of the economic development of the past twenty years: quick, disparate, and remarkable. I say quick because it was obvious from talking to many people that there is a lot of energy. Projects are rattled off at the drop of a hat. I say disparate because at the same time stakeholders are very aware of shortcomings and candid in describing these shortcomings to an outsider. Success in implementation still largely depends on the energies of a few key motivated individuals. I say remarkable because of how interesting it is to see successful, thoughtful, and ambitious projects, such as the National Medical Holding’s efforts to provide a
live electronic video feed of brain surgery for physicians around the country to view and learn from, or the compassionate care in an advanced biomedicalsetting of the Nurses in the neo-natal intensive care unit, or the excitement with which my tour guides explained the research goals of the new partnership of the National Medical Holding and Nazarbayev University- to see these things right next to, say, a piece of radiological equipment that is, by the radiologists own admission, in need of modernization.