About six billion people
all over the world do not get adequate healthcare
because the right knowledge does not exist
at the right place at the right time.
Project ECHO was developed to democratize knowledge,
so that underserved people all over the world
can get best practice care.
We say we would like to move knowledge
instead of moving patients.
In 2003, there was an eight month wait to see me
in my hepatitis C clinic.
I would see patients with liver cancers,
liver failure, cirrhosis.
They were dying of a liver disease
that we knew how to treat.
If only we had seen them earlier.
New Mexico is a rural state, but patients sometimes
didn't have the right car.
Sometimes they didn't have the money to travel
these long distances.
It was at this time that I got this idea
for the ECHO project.
To use technology, one-to-many video conferencing,
to leverage the expertise of a multi-disciplinary team
and bring this expertise to remote areas.
We established a hub-and-spoke model
where we had the university as the hub
and we had these spoke clinics which were in rural areas.
These were connected to each other
so that patients could get the care where they lived.
As we did this week after week, what we found was
that these primary care clinicians became experts.
Forced multiplication had occurred.
We had exponentially improved the capacity
to deliver best practice care.
And now we wanted to help many, many more people
all over the world.
India was almost a perfect replication site for ECHO.
First, in the cities in India there are experts
who have the knowledge that is required
to treat all the patients.
Second, there was an adequate internet infrastructure.
Third, the government had a very important priority
to bring better healthcare to rural areas.
Millions of people were dying every year
of diseases we knew how to treat and cure.
ECHO India operates many programs
throughout the country, focusing on critical issues
like hepatitis C, tuberculosis, mental health, HIV,
maternal and child health, and cancer.
Cancer in India is a growing problem.
We have more than a million cases in a year,
out of which 50 percent die every year.
One of the reasons why many of our patients come late
is back in the rural area, there is a dearth of knowledge
as well as medical training for diagnosis
and treatment of cancer.
So, we need to train people in cancer diagnosis
and cancer awareness, and also to be able to share
their learnings with each other.
A very good afternoon to you all.
Cervical cancer screening is very important in our country.
Almost eight women are dying every year.
So I'll be talking about visual inspection with acetic acid.
A typical ECHO session
lasts for one hour, and it consists of directives,
followed by question and answer session.
And that is followed by two case discussions,
which is presented by our spokes.
The first case will be presented
by Doctor Ganitha.
I'm going to present a case of a 40 year old
with history of irregular intermenstrual bleeding.
A visual inspection with acetic acid was positive,
and then a scissor-wide lesion was noticed.
So it's not only a question
of the expert talking to the mentees,
or to the spokes, but also spokes learning from each other.
The ECHO model breaks down the barriers
to moving lifesaving knowledge.
Using virtual rounds, primary care providers present
on-patient cases, share best practices,
and receive guidance and mentorship from specialist teams.
ECHO creates a whole new community of practice,
in which all teach and all learn.
In our training, we have learned
about cancer superficially.
But ECHO has actually helped us to learn a lot
about preventive aspects.
And this is how we learned screening for breast cancer,
cervical cancer, as well as for the oral cancer.
We were able to come in contact with many more doctors.
We were able to gain their knowledge.
And now it is easier for us to impart the same knowledge
to our coworkers, to our students, to our patients.
Everything they have taught us.
We started off as a hub
for cancer control in India,
and in the last two or three years,
we've trained more than 400 medical officers,
as well as paramedical workers in the rural parts
of the country.
And these individuals, in turn, have become master trainers.
And they are training more people.
Our work in India has the potential to be catalytic,
in which the government of India can adopt this model
and result in massive system change.
Each year, PGI Chandigarh was treating 1200
to 1500 patients a year of hepatitis C.
600,000 were treated.
There is no way this battle can be won.
So ECHO came in and established spokes
in the 22 district hospitals and three
government medical colleges.
And in 18 months, district hospital doctors treated more
than 50,000 new patients.
The cure rate is 93 percent.
That's the difference that ECHO has really made.
ECHO has huge implications
for the developing world.
Africa has 56 countries.
14 of those are currently using ECHO.
And they're even going beyond that
because they're now actually doing some system strengthening
work by helping laboratory workers develop a community
of practice amongst themselves.
They're also working with the African CDC
to look at global health security.
So they've gone beyond just the provider level,
but now looked at how they can make the whole
infrastructure in healthcare that much stronger.
My hope is, and my dream is
that ECHO projects will get integrated
into healthcare systems, so that it just becomes a way
of doing business.
I think I have to hand it to them.
A very interactive session.
Thank you so much.
We'll see you sharp at 3:00 p.m. next Thursday.
We're very, very proud to have spokes like you.
And if the model is adopted globally,
it has the potential to change the world.