Posted on Leave a comment

My Local Library: More Than a Repository of Books

20130313-203052.jpg

Posted on Leave a comment

The Racketeer by John Grisham

John Grisham’s latest novel (much like Barbara Kingsolver’s latest) also transported me back to the mountains of Appalachia where I’d spent many years as a young woman.  Because it is in the many small and forgotten towns buried deep in these mountains and off the main Interstate 81 that our man Malcolm Bannister, aka Max Baldwin, finds himself—first as a small-time lawyer, then as a wrongly incarcerated felon, and finally as a slick mover and shaker who befuddles the FBI, the cops, and the entire legal system to unfold a gruesome murder mystery that also serves as his ticket out.

Grisham, the master crime and legal storyteller doesn’t disappoint, and in a most unassuming tone, has Mal narrate the series of events that span not just Appalachia but the entire eastern seaboard, as well as several countries in the Caribbean. 

For those familiar with the American system of law enforcement and criminal justice, it is a thrilling ride; and for those who might not be so familiar, it is a brilliant and fascinating primer to America’s style of justice that aims to keep the bad guys off the street and does not discriminate between blue-collar and white-collar crime– and all the while wheels and deals in espionage and subversive tactics to get at the truth. 

A fine ride it is, and confirms yet again that Grisham is king of this genre.  I’ll bet good money there will soon be a motion picture made from it, and one can only hope it will be just as entertaining as the book.

the racketeer 

Posted on Leave a comment

Rains or Not, India is Falling Short on Drinkable Water

By Published: March 12, 2013

CHERRAPUNJI, India — Almost no place on Earth gets more rain than this small hill town. Nearly 40 feet falls every year — more than 12 times what Seattle gets. Storms often drop more than a foot a day. The monsoon is epic.

Water containers are lined up at a community tap in Cherrapunji. Some people must walk long distances to get water.

But during the dry season from November through March, many in this corner of India struggle to find water. Some are forced to walk long distances to fill jugs in springs or streams. Taps in Shillong, the capital of Meghalaya State, spout water for just a few hours a day. And when it arrives, the water is often not drinkable.

That people in one of the rainiest places on the planet struggle to get potable water is emblematic of the profound water challenges that India faces. Every year, about 600,000 Indian children die because of diarrhea or pneumonia, often caused by toxic water and poor hygiene, according to Unicef.

Half of the water supply in rural areas, where 70 percent of India’s population lives, is routinely contaminated with toxic bacteria. Employment in manufacturing in India has declined in recent years, and a prime reason may be the difficulty companies face getting water.

And India’s water problems are likely to worsen. A report that McKinsey & Company helped to write predicted that India would need to double its water-generation capacity by the year 2030 to meet the demands of its surging population.

A separate analysis concluded that groundwater supplies in many of India’s cities — including Delhi, Mumbai, Hyderabad and Chennai — are declining at such a rapid rate that they may run dry within a few years.

The water situation in Gurgaon, the new mega-city south of Delhi, became so acute last year that a judge ordered a halt to new construction until projects could prove they were using recycled water instead of groundwater.

On Feb. 28, India’s finance minister, Palaniappan Chidambaram, proposed providing $2.8 billion to the Ministry of Drinking Water and Sanitation in the coming fiscal year, a 17 percent increase.

But water experts describe this as very little in a country where more than 100 million people scrounge for water from unimproved sources.

Some water problems stem from India’s difficult geography. Vast parts of the country are arid, and India has just 4 percent of the world’s fresh water shared among 16 percent of its people.

But the country’s struggle to provide water security to the 2.6 million residents of Meghalaya, blessed with more rain than almost any place, shows that the problems are not all environmental.

Arphisha lives in Sohrarim, a village in Meghalaya, and she must walk a mile during the dry season to the local spring, a trip she makes four to five times a day. Sometimes her husband fetches water in the morning, but mostly the task is left to her. Indeed, fetching water is mostly women’s work in India.

On a recent day, Arphisha, who has only one name, took the family laundry to the spring, which is a pipe set in a cement abutment. While her 2-year-old son, Kevinson, played nearby, Arphisha beat clothes on a cement and stone platform in front of the spring. Her home has electricity several hours a day and heat from a coal stove. But there is no running water. When it rains, she uses a barrel to capture runoff from her roof.

“It’s nice having the sunshine now, but my life is much easier during the monsoon,” she said.

Kevinson interrupted her work by bringing her an empty plastic bottle. “Water,” he said. Arphisha bent down, filled the bottle and gave it back to him. “Say, ‘Thank you,’ ” she said. “Say, ‘Thank you.’ ” When he silently drank, turned and went back to playing, Arphisha laughed and shrugged her shoulders.

In the somewhat larger town of Mawmihthied several miles away, Khrawbok, the village headman, walked nearly a mile on a goat path to point out the spring most residents visit to get drinking water. Taps in Mawmihthied have running water for two hours every morning, but the water is not fit to drink.

Khrawbok said that officials would like to provide better water, but that there was no money.

Even in India’s great cities, water problems are endemic, in part because system maintenance is nearly nonexistent. Water plants in New Delhi, for instance, generate far more water per customer than many cities in Europe, but taps in the city operate on average just three hours a day because 30 percent to 70 percent of the water is lost to leaky pipes and theft.

As a result, many residents install pumps to pull as much water out of the pipes as possible. But those pumps also suck contaminants from surrounding soil.

The collective annual costs of pumps and other such measures are three times what the city would need to maintain its water system adequately, said Smita Misra, a senior economist at the World Bank.

“India is lagging far behind the rest of the world in providing water and sanitation both to its rural and urban populations,” Ms. Misra said. “Not one city in India provides water on an all-day, everyday basis.”

And even as towns and cities increase water supplies, most fail to build the far more expensive infrastructure to treat sewage. So as families connect their homes to new water lines and build toilets, many flush the resulting untreated sewage into the nearest creek, making many of the less sophisticated water systems that much more dangerous.

“As drinking water reaches more households, all the resulting sewage has become a huge problem,” said Tatiana Gallego-Lizon, a principal urban development specialist at the Asian Development Bank.

In Meghalaya, efforts to improve the area’s water supply have been stymied by bickering among competing government agencies, said John F. Kharshiing, chairman of the Grand Council of Chiefs of Meghalaya. In one infamous example, the state built a pump near a river to bring water to towns at higher elevations.

“But they didn’t realize that the pump would be underwater during the monsoon,” Mr. Kharshiing said. “So it shorted out that first year, and it’s never been used since.”

Sruthi Gottipati contributed reporting from Meghalaya State, India.

Posted on Leave a comment

How Virtual Health Assistants Can Reshape Healthcare

Guest post written by Thomas Morrow

Thomas Morrow, M.D., has 25 years experience across the healthcare industry. He currently serves as an unpaid advisor to Next IT, and a medical director at Genentech.

Advanced data analytics tools, voice recognition and new user interfaces are a few of the technologies buzzing with promise to cure our healthcare system – but all of these new tools overlook a critical stakeholder: The patient.

Providers, payers and physician groups are expected to spend more than $69 billion on healthcare-related IT by 2017. For the most part, solutions designed to improve efficiency have taken center stage.

But making lots of small, incremental efficiency gains in hospitals or physician offices will not be enough to ensure proper care for all those who seek it. Consider this: There’s just one licensed physician for every 370 people in the U.S.

Addressing this problem in a vacuum is not only misguided, it’s unsustainable. The U.S. population will continue to outpace the capacity of the physician community, regardless of the most promising physician-focused technologies.

At the heart of our healthcare crisis is not physician inefficiency – although there is certainly major room for improvement. Our issues go much deeper. It’s time for a different strategy – one that focuses on keeping patients healthy.

Empower the Patient

Healthcare quality organizations, like the National Committee for Quality Assurance suggest that millions of people in the United States do not receive the basic recommendations for preventive health services such as immunizations, pap smears, mammograms, colorectal cancer screenings and the like.

Even more alarming, more than 133 million Americans have at least one chronic illness – from heart disease to diabetes to arthritis – but the estimated medication adherence rate in this group is just 50 percent – costing the U.S. healthcare system between $100 billion and $289 billion annually.

Meanwhile, nearly 40% of doctors say patient non-adherence significantly influences their ability to provide optimal care. Physicians rely on large clinical trials and long-term studies to find the best way to keep populations and individuals with chronic disease healthy over long periods of times.

While physicians prescribe therapy and lifestyle modifications based on these clinical trials, the number of patients who follow the rules, and the percentage of patients who are actually reaching their goals (controlled their blood pressure, cholesterol, diabetes, etc.), is small. That  begs the question: What can we do to increase adherence to healthcare regimens, and where’s the breakdown?

Patients need guideline-driven answers, but they also need someone, or in this case, some thing, to help them stay on track. Patient-centered virtual health assistants, designed to respond to voice or text questions through mobile devices, are our best option to give patients 24/7 access to current information, specific to their age, social setting, likes and dislikes, tastes, financial ability, literacy and culture.

If we don’t directly address the patient need for better information, we’re cultivating a system designed to force patients to rely on physicians for care at every turn. More inefficiency. More physician burden. More spending.

Most experts agree that increasing patient engagement and improving self-management skills for chronic disease will greatly reduce healthcare inefficiencies, but right now, there are limited resources available to patients for around-the-clock guidance, available to answer the 3 a.m. questions.

Our natural opportunity to remove the access barriers, increase patient literacy and greatly improve engagement is to employ technology that enlists patient participation. It’s the only way to sustainably improve the state of healthcare. This is where we need the most help from tech.

Personal Advice: Where and When Needed

To treat a headache, consumers can simply read an aspirin bottle and take the recommended dose. But how do patients handle something more serious – especially if their physician is out of reach?

Effective tools require comprehension of the disease itself, and also patient history. The adoption of mobile, smart devices opened the door for personalized intelligent health assistants that can encourage patient adherence through two-way conversation.

For example, a virtual health assistant that proactively reaches out to the patient when they fail to enter their scheduled insulin injection, or multiple sclerosis medication dose, can help patients to stay on track and troubleshoot potentially precarious situations.

We need the ability for something to assist a patient with diabetes, who also has a five year old with a gluten sensitivity, decide what to cook for dinner. We need an assistant to remind a 70-year-old with early dementia what to do when he forgets his heart pill – double up or just take his next dose early.

We need an assistant to advise a young mother what to do with a child who has a fever. And we need this all to be done in an affordable, scalable manner, through a pervasive and accepted platform.

Custom solutions to tackle specific illnesses, with the ability to analyze personalized information, will create true wellness partners for patients.

Beyond the Check-Up: Better Patient-Physician Communication

There’s another major benefit to VHAs: These tools give healthcare entities a greater understanding of the patient as an individual, offering in-depth insights into behavioral patterns, motivators and indicators. VHAs that integrate with electronic health records allow active monitoring of their patient base, and provide context for deeper, richer conversations.

Caseworkers, specialists, physicians and drug makers are consistently missing opportunities to collaborate, due in large part to logistic barriers. Further complicating the issue, these conversations often happen above the patient, leaving gaps in the flow of information, and patients with more questions than answers.

Caseworkers are under the gun to manage hundreds of patients, but can most likely reach just about 10 percent of them on any given day. Each case, and patient, is unique – and there simply aren’t enough resources to go around. A virtual solution designed to integrate information from each piece of the physician-patient dialog, can give caseworkers the information needed to reach the patients that need them most urgently.

Advanced VHAs have the ability to recognize speech and understand user intent – solving problems at the patient level – addressing the 300 million people who need help with the day-to-day health decisions.

And they bring limitless options to the table. Retail pharmacies can reach out to people not taking their prescribed medication on a recommended basis. Hospitals and physicians can deeply engage patients. Providers can proactively recommend preventive health screenings for cancer.

For the entire healthcare community – from drug maker to case worker – VHAs are our best opportunity to take advantage of a technology that can truly impact the long-term wellbeing of patients.

Posted on Leave a comment

Would You Like Freedom Fries With That?

Tom Toles