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Millions of Americans live in rural or underserved areas where there are fewer medical care facilities and doctors with specialized expertise. One doctor in New Mexico is trying to help change that with his vision dubbed "Project ECHO." Fred de Sam Lazaro reports in a partnership with the Under-Told Stories Project at the University of St. Thomas in Minnesota.
Millions of Americans live in rural or other underserved areas known as care deserts, where there are few medical care facilities and few doctors with specialized expertise.
As Fred de Sam Lazaro reports from New Mexico, one doctor is trying to help change that.
Perfect. Yes, just relax. No take a deep breath.
Fred de Sam Lazaro:
It was cases like these that inspired gastroenterologist Sanjeev Arora's idea.
Dr. Sanjeev Arora, Founder, Project ECHO:
You liver really feels good.
Fifty–eight-year-old Robert Subia contracted hepatitis C, a viral liver infection, from a blood transfusion decades ago.
Dr. Sanjeev Arora:
Hello, Mr. Robert. How are you?
Regular appointments and scans of his liver are critical to his recovery.
Which appears to be going well.
This is amazing results.
ROBERT SUBIA, Patient:
Need to lose some weight, exercise, which I don't do, and eat better.
FLORENCE SUBIA, New Mexico:
So, we can reduce the fatty liver, so we don't get close to cirrhosis.
This has to move back.
Robert Subia has the strong support of his wife, Florence, and he is lucky in another way. They live close to this Albuquerque center.
About a third of New Mexico's residence live in its vast rural areas, where a trip to get specialized medical care can often mean a daylong journey or even overnight. That is not affordable for a lot of people in a region with one of the highest rates of poverty in the United States.
It was one case in particular that haunted Dr. Arora, a single mother with two young children whose home was a five-hour drive from his clinic.
She had cancer of the liver, and she passed away six months later, leaving these two children. I was asking myself, why did she die? And the answer was, she died because the right knowledge didn't exist at the right place at the right time. And this was not an isolated case.
At the time, amid a hep C epidemic, Dr. Arora was one of very few specialists treating it. His appointment calendar stretched out eight months.
I think you had just started talking about it, and I would love to hear more.
That is when he says the idea came to him to — quote — "democratize that knowledge," have specialists use technology and share their expertise with rural providers, so they could treat their patients much closer to home. He dubbed it Project ECHO, Extension for Community Healthcare Outcomes.
I don't like people to exercise when they are feeling really tired.
His vision is to move beyond the model of one doctor, in this case, a specialist in an urban medical center working with one patient.
To see somebody in a rural area, they see one less patient in the urban area, the total number of patients doesn't go up. We need an exponential improvement in capacity to deliver best practice care.
That is where something like ECHO comes in, where we multiply expertise.
Dr. Alithea Gabrellas, Gallup Indian Medical Center:
It really helps sort of level the playing field, I think, in medicine.
Dr. Alithea Gabrellas practices at the Gallup Indian Medical Center, about a two-hour drive from Albuquerque.
Dr. Alithea Gabrellas:
We were able to treat a lot of people that had been waiting years to be able to access treatment. And we were able to cure a lot of patients. I had the same knowledge as, you know, a high-level hepatologist at the University of Mexico to be able to bring that new resource to my patients.
Is it safe to say it has literally saved lives of your patients?
ECHO uses a hub-and-spoke design to connect a team of specialists, the hub to multiple participants in the spokes via Zoom during regularly scheduled sessions that include discussions on specific cases and mentorship.
This man has one of the most complex cases of multidrug resistance.
Dr. Gabrellas, who completed a fellowship in infectious disease, credits ECHO for keeping her up to date on how to treat a wide variety of challenging conditions, like that of 27-year-old Dana Quintero.
Dana Quintero, Patient:
I ended up, you know, being an ICU — or, I think, ICU, for about, like, a whole week, I think. That's whenever Dr. Gabrellas walked into my room, and she was like, you have an infection. It is called A strep.
Even though this was a fairly serious infectious disease, I felt 100 percent confident doing that kind of care here, because I have instant access to those academic medical centers through ECHO.
Since its creation nearly 20 years ago, Project ECHO's presence has multiplied across the globe. There are now 792 hubs operating in 69 countries focusing on dozens of specialties. It is supported entirely by grants from government and private sources.
One of the first places Project ECHO expanded was in Dr. Arora's native India, a country with myriad public health challenges which have taken a backseat during COVID. Among the campaigns using the ECHO platform is the fight against tuberculosis, which has surged in recent times.
Tuberculosis is preventable and, in most cases, curable, and reaching vulnerable populations is key to reducing the number of cases. Last year, more than half-a-million people died from T.B. in India. The government has pledged to eliminate T.B. by 2025.
And Dr. Kamal Chopra at the New Delhi Tuberculosis Center says the ECHO model will be key.
Dr. Kamal Chopra, New Delhi Tuberculosis Center:
It speeds up our reach to the community. By this ECHO platform at our national level, attendance goes up to 800.
Eight hundred in a single meeting?
Dr. Kamal Chopra:
Yes, in a single meeting.
In central Delhi, Neera and Preeti are among hundreds of volunteers who visit patients in their homes. Recovered from T.B. themselves, they say they use their ECHO training to help patients manage their medication and watch other family members who may be vulnerable.
Preeti, Volunteer (through translator):
We tell them not to ignore even trivial symptoms. Fever or cold, they need to go in and consult with a doctor immediately and get a diagnosis or get medicine
Neera, Volunteer (through translator):
Also, those people who have HIV or diabetes are more likely to get T.B. because their bodies have been weakened.
This democratization of best practices is not a health care issue alone.
Dr. Arora is now trying to expand ECHO into education.
When I look at my own life, what made the huge difference to make me who I am today? It was education. And I really would like to give that opportunity to every child. We have the technology backbone. We have the model.
So far, they have started eight education ECHO programs with some 3,000 participating K-12 teachers from across the state of New Mexico.
For the "PBS NewsHour," I am Fred de Sam Lazaro in New Mexico.
A reminder that Fred's reporting is a partnership with the Under-Told Stories Project at the University of St. Thomas in Minnesota.
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Fred de Sam Lazaro is director of the Under-Told Stories Project at the University of St. Thomas in Minnesota, a program that combines international journalism and teaching. He has served with the PBS NewsHour since 1985 and is a regular contributor and substitute anchor for PBS' Religion and Ethics Newsweekly.
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