Changing health care careers a sign of the times

By David South

Hospital News (Canada), June 1992

Ontario’s health care system is in the midst of a big change. But where are the new jobs going to be and how can health care workers prepare for the coming crunch?

“Anybody who thought they could progress through the health care system until retirement is in for a shock,” said Ruth Robinson, a national health care consultant for Peat Marwick Stevenson and Kellogg management consultants. 

Radical changes are taking place in the health care system and it looks like traditionally safe occupations are in for a shake-up. 

“Hospitals are being pressured to change fundamentally,” said Ms. Robinson. “The net effect is fewer jobs. A lot of people will have to think about new careers.”

In the Ministry of Health working document entitled Goals and Strategic Priorities, released in January, the fundamental shift from treatment to disease prevention and health promotion is laid out in generalities. 

The goals range from health equity for aboriginals, women, children and AIDS patients to better management of costs to development of a stronger health care industry that will jump start the economy. And they range from the reorganization of professional responsibilities to promotion of services outside institutions with the goal of keeping people out of hospitals. 

One thing is clear, the talk is about big changes. But talk is cheap to laid-off health care workers looking for new jobs. 

The provincial government’s recently passed, but yet to be proclaimed, Regulated Health Professions Act will have serious repercusions for all health care providers. 

“Traditionally, doctors have an exclusive domain over a wide area,” said Charlie Bigenwald, executive director of health human resources planning at the Ministry of Health. “Even though other people could do things, they had to be delegated by a doctor. With the legislation, we have pushed back what doctors can do. This means there will be more opportunity for a wider variety of health care workers to get into those areas.”

Midwifery is one of the benefactors of changes in regulations. The Ministry of Health is looking into having a university-based program for midwives. 

Ms. Robinson predicted nurses and middle management will suffer the most in the change to community-based health care. 

“Nurses will need to get a bachelor degree if they hope to compete for jobs,” she said. 

As for middle managers, who often have clinical skills, they will have to reconsider staying in health care, she said. “They will disappear significantly. They can advance themselves by getting back to clinical skills or consider management positions in non-health care areas.

“There is nothing to be ashamed of about career changes these days,” she added. 

In the shift towards community-based care, opportunities will arise for health care workers who can offer creative solutions to improve service delivery. 

“For nurses, we currently have something called the Nursing Innovation Fund where individuals can apply for a wide variety of developmental things like attending workshops, conferences and training programs. We process 2,500 applications a year,” said Mr. Bigenwald. 

The Ministry of Health hopes the future sees a health care system that adds to the province’s economy rather than drains it. 

“We spend $17 billion a year on health care. We never looked a the health care system as an economic motor in the past. The question we are asking right now is ‘why can’t an Ontario firm make the carpets, beds, sutures etc?’, said Mr. Bigenwald. 

Ms. Robinson said “Governments are running out of money and can’t increase funding. They will be looking for more partnerships in the private sector. In this climate, creative solutions to health care delivery have a great opportunity.” 

Finding Fortune in Traditional Medicine

Traditional medicines and treatments could help provide the next wave of affordable drugs and medicines for the world. But a phenomenon known as ‘bio-prospecting’ – in which global companies grab a stake in these once-free medicines – has been placing traditional medicines out of reach of Southern entrepreneurs. Pharmaceutical patents (http://en.wikipedia.org/wiki/Patents) taken out by international drug companies are making traditional medicines expensive and inaccessible to the poor.

Indian scientists have identified more than 5000 bio-prospecting patents, worth some US $150 million, taken out by companies outside India.

Now governments in countries like India are moving to protect these recipes and the plants and animals they are made from.

The Indian government has labelled 200,000 traditional treatments as public property and free for anyone to use. These treatments are key parts of the 5000-year-old Indian health system called Ayurvedic medicine (http://en.wikipedia.org/wiki/Ayurveda) – ayur means health in Sanskrit, veda means wisdom.

“We began to ask why multinational companies were spending millions of dollars to patent treatments that so many lobbies in Europe deny work at all,” said Dr. Vinod Kumar Gupta, head of the Traditional Knowledge Digital Library, which lists in encyclopaedic detail the 200,000 treatments.

“If you can take a natural remedy and isolate the active ingredient then you just need drug trials and the marketing. Traditional medicine could herald a new age of cheap drugs,” Gupta told The Guardian..

Currently, it is very expensive to follow the Western approach to developing drugs. A so-called “blockbuster drug” can cost US $15 billion and take 15 years to bring to the market. With patents lasting 20 years, a drug company can have as little as five years to recover its development costs. This helps explain the high prices for drugs.

Unlike traditional healers in the South, multinational corporations can marshal the money, time and legal resources to file patents.

In the past, India has fought expensive and lengthy battles to revoke patents on traditional remedies. One example is the battle over the popular Indian spice turmeric powder (used for healing wounds, among other things). A patent awarded to the University of Mississippi in 1995 was successfully withdrawn after a legal battle by the Indian government.

The Indian government’s move to make traditional medicines and therapies public property promises to unleash a new wave of natural remedies and drugs and to expand the market for Southern health entrepreneurs drawing on traditional knowledge and recipes.

As the world’s economy continues to suffer, finding new ways to earn incomes and spark a whole new generation of businesses will be crucial to recovery.

The World Health Organization defines traditional medicine as “the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses.”

The importance of traditional medicines in primary health care can be seen in Asia and Africa, where its usage reaches 80 percent of the population in some countries (WHO). Herbal medicines alone are worth billions of dollars a year in sales. Examples of traditional remedies include antimalarial drugs developed from the discovery and isolation of artemisinin from Artemisia annua L., a plant used in China for almost 2000 years. In 2003, doctors found scientific evidence supporting the use of traditional Ghanaian plants to help wounds heal. Parts of the African tulip tree and the Secamone afzelli are made into pastes which are applied to wounds.

The downside of traditional medicine is the urgent need for better regulation and safety standards. While more than 100 countries have regulations for herbal medicines, counterfeit, poor quality or adulterated herbal medicines are still a major problem.

Herbal treatments are the most popular form of traditional medicine, and are highly lucrative in the international marketplace. Annual revenues in Western Europe reached US $5 billion in 2003-2004.. In China, sales of products totalled US $14 billion in 2005. Herbal medicine revenue in Brazil was US $160 million in 2007 (WHO).

One initiative is ensuring there is a solid future for traditional medicine in India. Charity Bodytree India, set up in 2004 by a group of health, human rights and education workers, addresses issues surrounding access to health care and the disappearing traditional medical practices amongst isolated indigenous communities. Bodytree has established a successful educational programme that trains young people from different indigenous communities to become community health workers and operates programmes of health education for community groups (http://www.bodytree.org/index.html).

Almost four-fifths of India’s billion people use traditional medicine and there are 430,000 Ayurvedic medical practitioners registered by the government in the country. The department overseeing the traditional medical industry, known as Ayush, has a budget of 10 billion rupees (US $260 million).

In the state of Kerala in India’s South, Ayurveda medical tourism has become a good income generator. And it is so popular in the nearby nation of Sri Lanka, hotels can have Ayurveda included in the name.

Indian entrepreneurs are drawing on increasing awareness of the importance of healthy living and rising interest in vegetarian diets – what were once holidays are now health experiences. With global obesity rates rapidly rising, along with the attended diseases like cancer and diabetes, more and more people are looking for a dramatic change to their eating and lifestyle habits to ensure long-term health. And traditional medicine has solutions.

By David South, Development Challenges, South-South Solutions

Published: March 2009

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

Follow @SouthSouth1

Google Books: https://books.google.co.uk/books?id=PBB0LYdAPx8C&dq=development+challenges+march+2009&source=gbs_navlinks_s

Slideshare: http://www.slideshare.net/DavidSouth1/development-challengessouthsouthsolutionsmarch2009issue

Southern Innovator Issue 1: https://books.google.co.uk/books?id=Q1O54YSE2BgC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 2: https://books.google.co.uk/books?id=Ty0N969dcssC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 3: https://books.google.co.uk/books?id=AQNt4YmhZagC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 4: https://books.google.co.uk/books?id=9T_n2tA7l4EC&dq=southern+innovator&source=gbs_navlinks_s

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Traditional Medicine is now a Proven Remedy

Once dismissed as old fashioned, ineffective and unscientific, traditional medicine is now seen as a key tool in bringing healthcare and healing to poor people bypassed by existing public and private health measures.

Acknowledging traditional medicine as a useful tool goes back to the World Health Organisation’s Alma-Ata Declaration in 1978, which urged governments for the first time to include traditional medicine in their primary health systems and recognise traditional medicine practitioners as health workers. During the last 30 years there has been a considerable expansion in the use of traditional medicine across the world. Despite their ancient origins, it is still critical these medicines do meet efficacy and health standards and are proven to work.

In Mongolia, when the Soviet Union collapsed a decade and a half ago, new market forces meant that supplies of conventional medicines became prohibitively expensive for most of the population. With one doctor for 600 people in the rural areas – and the vast distances to be covered – medical services were virtually unobtainable in rural communities.

This situation led to a revival of Mongolia’s 2,000-year-old traditional medicine. This includes acupuncture, cauterisation, manual therapy, blood letting and therapies using mares’ milk – all integral to the rural way of life.

Research by the Japanese Nippon Foundation – the largest private foundation in Japan – explored how Mongolia’s public health care could be improved through traditional medicine. It focused on the possible use of traditional medicine alongside Western medicine, the depth of faith in traditional medicine, the affordability of traditional medicine, and the lifestyles of herdsmen living in remote areas away from hospitals. The project, launched in 2004, distributes medical kits with 12 types of traditional medicines to households in rural areas. As they use them, the households pay for them. The kits, which mostly target stomach and intestinal ailments and fever, have so far been distributed to 10,000 households (50,000 people) across the country. The Foundation found doctors’ house calls were down by 25 per cent after one year of the project.

In India, Gram Mooligai and its Village Herbs label helps bring quality healthcare to the country’s 170 million rural poor currently left out by public healthcare programmes, or who can’t afford private services. At present, the Indian government has been unable to find adequate funds to provide healthcare to all its people. Gram Mooligai uses a network of 300 women health practitioners to reach villagers who spend on average US $50 a year on health services – so far, they reach 30,000 households. It has built trust with the poor by offering herbal remedies based on India’s strong Ayruvedic heritage of herbal healing. It also draws on India’s rich biodiversity by harvesting medicines sustainably from native plant species – over 18,000 are known.

The company is owned by a network of rural growers that manufacture herbal remedies like Trigul balm for joint pain, Sugam cough syrup and Jwaracin fever reducer. Gram Mooligai combines modern heathcare with local remedies familiar to rural villagers.

The website gives a good example of this folksy approach. In answer to a villager whose daughter is complaining of pain in her legs and back, the villager is advised to give her milk and ghee (clarified butter). “Add nuts and dry fruits to her daily diet in small quantity. If she is lean, then a weekly massage with Lakshadi Thailam (which is available in the Ayurvedic shops) is very useful. Slightly warm the oil before massage and add a pinch of common salt to the oil for better absorption.”

By David South, Development Challenges, South-South Solutions

Published: September 2007

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

Follow @SouthSouth1

Google Books: https://books.google.co.uk/books?id=73-VBgAAQBAJ&dq=development+challenges+september+2007&source=gbs_navlinks_s

Slideshare: http://www.slideshare.net/DavidSouth1/development-challengessouthsouthsolutionsseptember2007issue

Southern Innovator Issue 1: https://books.google.co.uk/books?id=Q1O54YSE2BgC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 2: https://books.google.co.uk/books?id=Ty0N969dcssC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 3: https://books.google.co.uk/books?id=AQNt4YmhZagC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 4: https://books.google.co.uk/books?id=9T_n2tA7l4EC&dq=southern+innovator&source=gbs_navlinks_s

Southern Innovator Issue 5: https://books.google.co.uk/books?id=6ILdAgAAQBAJ&dq=southern+innovator&source=gbs_navlinks_s

This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.