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Every time that kind of bird appeared between the mountains to descend to the community, it aroused the excessive curiosity of its boys and girls. However, it never crossed their minds to play with him or throw stones at him. They knew that what he sheltered under those strange wings were the medicines of his grandfather, his mother or a neighbor. The bird in question was a drone and for two years it was flying over the province of San Juan de la Maguana, in the south of the Dominican Republic.

A total of 167 test flights carried out during this time showed that it is possible to deliver and collect successfully and safely, medicines and blood samples using drones in areas where access through the topography is difficult. It is the main conclusion of a pioneering pilot project in Latin America and the Caribbean on the use of drones for the transport of medical supplies in rural areas promoted by the Inter-American Development Bank (IDB) through its Innovation laboratory BidLab, and with the coordination of Drone Innovation Center of the Caribbean country, created with the project.

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In much of the rural areas of Latin America and the Caribbean, far from urban centers, medical care, if available, often leaves a lot to be desired. In the Dominican Republic, the vast majority of the population uses public health care and the country has a good network of primary care centers, known as first-level, distributed throughout its geography. They are also cared for by recently graduated doctors who, when they finish their studies, carry out their internships in rural areas. They are young people with a great vocation for service who, however, face many limitations due to the low resolution capacity of these centers, where getting a medicine or having a blood test always entails many vicissitudes. Its remoteness from the regional reference hospitals and the difficult access by car due to the topography negatively affect the quality of the service and the number of patients that can be treated.

This is the case of the communities scattered throughout the sinuous mountains of the province of San Juan de la Maguana. There are 69 medical centers there serving about 320,000 people, an average of 4,600 per center. The drone project connected the three hospitals in the municipal capitals with six of these centers. One of them was that of the Montacitos community. There, América Abrego was born and has worked as a nurse for 15 years.

His health center is only 20 kilometers from the reference hospital in the municipality of Bohechío, a seemingly short distance but which can become eternal when health is at stake. She experienced it herself when she suffered a miscarriage and nearly lost her life bleeding. There was no vehicle to transport her and they carried her in a hammock. The situation has not changed much. “Every time we have to do a more advanced analysis or consultation, our patients must get transportation to get to the hospital or call the emergency service. Everything is very difficult. The doctor here diagnoses, but we don’t have the mechanisms. Nor do we have an ambulance, “he explains through WhatsApp.

It is not surprising that the rural medical professionals who used the drone appreciated and valued the pilot project very positively. “In a way, the drone helped them make sense of their profession. Many times they feel frustrated because up there in the mountains they do not have the tools to help the community and influence an improvement in health, ”says Smeldy Ramírez, the BidLab specialist who designed the operation, on a video call.

With good operation and planning, cost savings of up to 68% could be achieved in the transport of medicines, according to the IDB

América Ábrego, as a nurse, confirms it. And you want that, for the good of your community, they implement this system for good. “We already saw the advantages that the drone had when we used it to send analytics. I took the sample, put it on the drone and in less than two hours the doctor had the results to be able to diagnose and make the appropriate decisions. The other day we missed it when a man had blood glucose levels of 425. He was very high in sugar and there was little we could do because we did not even have a saline solution. If we had had the drone, in less than an hour we would have sent the saline solution and also the pertinent insulin ”, laments the health care provider. The journey by road from Montacitos to the Bohecío hospital lasts 50 minutes. The drone took off from that same hospital and landed at the health center in just 10.

The drone can thus become a complement and a reinforcement to improve primary care in remote areas with very difficult access, especially for sending blood samples and essential medicines quickly. Also for urgent cases of medicines that can even save lives. Up there, in the mountains, many people stopped going to health centers because they knew that few sometimes they would solve something for them. Even pregnant women stopped testing, putting their health and their baby’s health at risk.

“The drone is an innovative solution that allows increasing the number of patients who are cared for in rural areas without having to travel to the hospital, with the expense that this entails. If you show that you improve the resolution capacity of these centers, people go to have their laboratory tests performed because they know that they will receive the results on time, they will have a check-up or obtain the medicines with the frequency and suitability they require, “he explains Ramirez.

Shortage

Normally, the 69 primary care centers in the province of San Juan are supplied once a month with medicines and medical supplies. It is done by an off-road van that travels the winding and battered roads of the region. The amount they receive is based on an estimate of monthly consumption, but the reality is that, every month, the communities find themselves with a problem of shortages of one medicine or another, or of several, many times essential. “The drone is not a substitute for supply. In the end it all comes down to a logistics issue, last mile as we call it here, where it can be urgent to have a drug at the right time and that in many cases, if that drug is not there, it can cost you your life, “he says Through video call Orlando Pérez, project coordinator and director of the Drone Innovation Center.

The project trained nurses and doctors from rural health centers as receivers of the drone, so that they would know how to put it to fly again through their own mobile device, and to correctly place the medicines or blood samples. It was also necessary to inform and involve the communities about the possible benefits of using the device. They say that the reaction of the people in the communities at first was a bit incredulous. As long as the two kilos of cargo are not exceeded, drones can transport medicines, yellow fever tests or anything that is needed in health terms, as well as collect batches of blood or urine samples to take them from local health centers to hospitals or specialized laboratories. Drones can make up to a total of six daily flights and one can only go to two health centers as long as they are scheduled to do so.

The IDB and the Drone Innovation Center are satisfied with the results of the project. They ensure that with good operations and planning, cost savings of up to 68% could be achieved in the transport of medicines. The length of time on the move is also reduced by 38% compared to the motor vehicle because the distance to travel is shortened. They recognize that it would be desirable to do a couple more pilot tests to gather additional information in other areas with different conditions and thus learn more and give better recommendations.

But, in any case, they are optimistic with the possibilities that it can already be replicated in other places with conditions similar to those of the province of San Juan. “We leave the whole procedure and the protocol of how to do it. With this, we hope to be able to support public and private decisions regarding the use of this technology when bringing basic health services closer to topographic areas that are difficult to access ”, says Ramírez.

A study by Oliver Wyman says that by 2035 there will be more drones than planes in the airspace. One of the areas of use with the greatest impact would be health

From BidLab they warn, however, that the use of this type of technology is only suitable where it makes economic and practical sense. “It is not profitable to use drones to go to places that are easily accessible, where there is a good road or where stocks are not often depleted. The drone makes sense in short distances, for populations of the last mile, located in areas with poor topography and difficult access, ”emphasizes Ramírez.

The pilot project with drones was carried out with the support of the Dominican Ministry of Health, a paradigm shift in this type of device that was born linked to military strategies for war purposes. Over time, they began to have a more commercial use and even, with the improvement of technology, these small unmanned aircraft were used in natural disasters and in humanitarian aid projects such as the one carried out in Malawi, by the hand of Unicef , for the early childhood diagnosis of HIV-AIDS.

The technology of these devices will continue to improve and their costs will fall. The potential is huge. Today’s drones already resist rain and even have a built-in parachute. Its use is advancing rapidly, especially for logistics issues. A study of the firm Oliver Wyman ensures that by 2035 there will be more drones than planes in the airspace. One of the areas of application of drones with the greatest impact would be precisely that of health. In fact, the drone industry has been working on a proposal for covid-19 and it cannot be ruled out that it be used in aspects related to the pandemic. “The covid represents an exceptional opportunity for possible implementations of the drone thinking about the transport of the tests to detect it and the vaccine when there is one. There it can be of great value ”, Ramírez concludes.

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