A recipe for amazing (TEDMED 2014)

glamour1Lauren Vogel is a news editor on CMAJ

What separates a good idea from an amazing one? A TEDMED2014 session I live streamed Wednesday provided plenty of clues. Although the speakers came from widely diverse backgrounds, ranging from journalism to ocean swimming, three strong threads – simplicity, specificity and daring – bound together the lessons they shared.

“Flat Out Amazing” ideas, it seems, start from simple answers to complex questions. Take the single-use syringe, for example. According to the World Health Organization, syringe reuse causes 1.3 million deaths each year. Reading about the problem in 1984, Marc Koska realized there was a simple solution: make a syringe you can only use once.

In 1999, WHO mandated his invention – a syringe that locks and breaks on reuse – as standard kit for all immunization drives. Now, the organization estimates a 1:14 return on the costs of purchasing the new syringes, waste management and training. “But immunizations only represent 5% of the global market,” Koska noted. In coming months, WHO will announce a plan to require single-use syringes for all injections.

The beauty of this solution isn’t just its simplicity, but its specificity and ambition. Rather than taking aim at the unwieldy problems of poverty and medical supply shortages that were driving misuse, Koska narrowed in on the offending tool.

Or take the creation of Cuba's Latin American Medical School (ELAM). Now the largest in the world, it was established in 1998 to answer a critical physician shortage in the wake of Hurricanes George and Mitch. The problem: how do you convince more doctors to work long-term among the poorest of the poor? The simple answer: train doctors from and in those communities. ELAM did just that.

“Tuition, room and board, and a small stipend were offered to hundreds of students from the countries hit hardest by the storms,” explained Gail Reed, founder of the Medical Education Cooperation with Cuba, a non-profit organization that fosters collaboration between Cuba and the United States.

The school has since graduated 23,000 students from 83 countries, and tiny Cuba sends more doctors to assist in developing nations than the G8 combined. “If you are poor, female or from an indigenous population, you have a distinct advantage [applying to ELAM] – an ethic that makes this medical school unique,” said Reed.

Like the single-use syringe, it’s the kind of straight-forward solution we all wish occurred to us first. And the school’s success is tied to its initial narrow focus on the needs and talents of a single patient group. Expanding that focus internationally, especially to cast an eye on underprivileged communities in the United States, was the final audacious stroke.

“These aren’t such new ideas of what medicine should be; what’s new is scaling up and the faces of the doctors themselves,” said Reed. “An ELAM graduate is more likely to be a she than a he … an indigenous doctor, or in the United States, a doctor of colour who speaks fluent Spanish. She is well trained, but also shares the culture of her patients … and whether by subway, mule or canoe, she is teaching us to walk the walk.”

CMAJ is a TEDMED affiliate and our editors will be blogging about TEDMED 2014 this week.

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