Dr. Sanjeev Arora had been using Zoom for years, long before Covid-19 put it on the desktop of every manager, consultant, and third-grade teacher from Columbus to Capetown. He founded Project ECHO — Extension for Community Healthcare Outcomes — to encourage a two-way flow of expertise by connecting medical specialists with health practitioners via structured “all learn, all teach” video conversations. Sanjeev argues that inequality in health care comes largely from unequal access to knowledge and information, and that the gap can be bridged with mass outreach to medical professionals wherever and whenever they need it. Ashoka spoke with him about his work and the challenge ahead: readying a multi-million-person vaccine workforce in as little as seven months.
Sanjeev, how did 2020 start for you and Project ECHO?
We were working towards our goal of reaching one billion people by 2025 with a new way of sharing knowledge and expertise. Our work has touched 158 countries, and we have ECHO hubs in 40 countries working to improve care in 70 different disease areas: HIV, TB, mental health, diabetes, opioid addiction, childhood abuse, geriatrics. ECHO is also working towards improved health security in 40 countries, in partnership with Africa Union and Africa CDC, for safe surgery and better laboratories across Africa.
We have major goals in education, as well. Eight universities have adopted ECHO, including University of Wyoming, University of Missouri, University of New Mexico. We are training school teachers in math and science, and school principals on leadership, social and emotional learning for teachers and students, assistive technologies for children with disabilities.
So Project ECHO is not a business; it’s not even a social business. We partner with organizations who want to help people: governments, NGOs, corporations, and academia.
How did you first hear about Covid and what did you do?
We first learned about the use of the ECHO Model for Covid-19 from our partners in Vietnam — our hub there is Vietnam Children’s Hospital. This was in February. They immediately organized a training for 12,000 healthcare workers at 273 clinical sites and trained them in Covid-19 infection control practice and response. ECHO is part of their comprehensive containment strategy, which includes scaled up testing and contact tracing and other interventions. Vietnam still has one of the lowest infection rates. Next, in March, we trained health practitioners in India — we have so far trained a workforce of over 300,000 healthcare workers there for Covid-19.
Now you are supporting the pandemic response worldwide. What are ECHO’s training priorities?
There are three priority areas. One is amplifying the country’s public health response, supporting medical workers with training and information on things like PPE, social distancing, using data, communication, how to train at the community level, quarantine, contact tracing, patient isolation.
The second priority area is delivering care. How to set up a Covid-19 floor in your hospital or health center, how to see Covid patients safely, how to protect your own staff, how to adjust the ventilator, or how to avoid using a ventilator? How much oxygen to give? How much anticoagulant, and which one? When to use dexamethasone?
And dissemination of a future vaccine?
Yes, that’s our third priority, and it’s just starting. The world is going to face an unprecedented challenge in about seven months, when a vaccine becomes available — when it’s approved for safety and efficacy and is available in billions of doses. The world has never vaccinated 7 billion people at once. It’s never happened, and the challenges are many. Take a recent survey of U.S. citizens: when asked if they would take a vaccine, only two-thirds said they would. We need millions of healthcare workers trained on how to motivate and educate patients. So we hope to use the ECHO Model to train and develop more than a million frontline health workers to participate in this unprecedented effort for successful vaccine delivery.
So, for example, we’re set to train 350,000 health workers in Africa and start 100 new hubs there and in parts of Latin America and Asia. We are looking for more partners, countries, non-government organizations, international organizations, and corporations who want to partner with us. We have the learning platform and methodology, global network, and technology to meet this historic moment.
When you talk about training up a workforce in seven months to be ready, what are the skills you need?
At ECHO, we train people in two scenarios, where all participants are invited and expected to learn and teach. ECHO links experts like oncologists from MD Anderson and Memorial Sloan Kettering, the largest cancer institutions, with oncologists in, say, rural Africa. We also train grassroots health workers to screen for oral, breast, and cervical cancers in India. We have 900 networks working in the world, some for primary care doctors, some for nurses, some for community health workers, the whole spectrum.
For vaccine delivery, we would like to train and calibrate community health workers around the world on patient education and motivation. We want to train nurses around the world on vaccine delivery and side effect management. There will be great need and opportunity for sharing knowledge at all levels.
Looking beyond the vaccine challenge, how will Covid change the way knowledge is shared?
This is an important question for us as our long-term goal is to democratize knowledge. There is too much inequity in the world. Healthcare is one area where the gaps can be addressed very effectively with knowledge and information. And I see that the role of every expert in the world should be to create other experts — we should all spend at least 10% of our time sharing our expertise and knowledge, gaining new knowledge through exchange, and making the world more equitable.
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