Can a Silicon Valley startup’s experience in Guyana shed light on the American health care system?

Despite all the amazing progress In medicine In the United States, policymakers and health care providers have yet to find a comprehensive solution to rural health care needs in recent years. As a result, millions of Americans in large parts of the country continue to be underserved. The reasons why rural medicine consistently lags behind the rest of the U.S. health care system are complex, reflecting a range of factors ranging from socioeconomic status, access to technology and connectivity, availability of skilled personnel, well-aligned financial incentives, and overregulation and stifling bureaucracy.

But other countries, some with even more difficult-to-manage rural or remote populations, are proving that with the right combination of innovation, technology and the ability to cut red tape, much more can be achieved.

In global energy circles, there is There is no hotter market than Guyanaa small English-speaking nation of less than a million people nestled between Venezuela, Brazil and Suriname on the northern coast of South America. In 2015, ExxonMobil set up a sting operation in the country with one of the world’s biggest oil discoveries in decadesand now Guyana’s new wealth is transforming the country into what some call the “Dubai of the Caribbean“By 2027, Guyana will be the leading producer of crude oil per capita in the world.

Perhaps even more impressive than Guyana’s rags-to-riches story is its The government’s commitment to dedicate a significant portion of its oil profits to a series of much-needed social programs, including improving the country’s fragile health system, is, however, particularly tricky to implement. 90 percent of the country is covered by a cover of dense primary forests, an area larger than Washington State. Known locally as The hinterlandThis area is dotted with small indigenous communities, most of them fewer than 400 people each. Many are accessible only by several days of river travel on small boats from regional population centers. The government estimates that 100,000 people, or perhaps 12 percent of the country’s total population, live in these micro-settlements amid these rainforests.

Frank Anthony, Guyana’s Minister of Health, knew that the solution to the complex challenge of providing healthcare to hundreds of small, inaccessible villages would require an agile, unconventional approach that relied heavily on a solid technological foundation. “We needed a partner who wasn’t afraid to think outside the box, sometimes even outside the box,” said Mr. Anthony. Observer“There was no manual on how to do it. Much of what we were going to do had never been done before, certainly not in a context like Guyana. Hinterland.”

For help, the minister turned to 19Labsa Menlo Park, California-based technology company that specializes in delivering remote healthcare in particularly challenging environments. Led by Ram Fish, an Israeli-born former Samsung digital health executive, 19Labs (the “19” is a riff on Florence Nightingale, the British nurse widely credited as the founder of modern nursing) is rolling out sui generis “We’ve worked in remote places like Jamaica, Mexico, Kenya and even here in the United States in states like Missouri, Utah and Idaho,” Fish told Observer. “But nothing prepared us for what awaited us in Guyana.”

“The first thing that had to be deployed was basic infrastructure for electricity and connectivity,” recalls Dr. Kofi Dalrymple, a Guyanese-born, US-trained civil engineer who was also involved in the project from the beginning. “Even in the most challenging rural healthcare situations in the US, you can usually count on having a source of electricity nearby. And even if it’s not high-speed internet, there’s usually at least in a way “We need internet access, or at least a phone call. In Guyana, we didn’t have any of these ‘luxuries’ in the vast majority of places where we needed to provide health care. But the minister wasn’t interested in a solution that would force us to wait for the infrastructure to be built. We weren’t just building the car while we were driving it, we were building the road under the car at the same time.”

The other major structural challenge in Guyana—and it also mirrors the contours of the rural health sector in the United States—is the lack of skilled health workers. Fish, along with a team of 10 dedicated professionals from 19Labs, designed a networked telemedicine platform that could connect doctors, nurses, specialists, and other skilled health workers, no matter where they live, from anywhere in the country to these remote villages in the hinterland. Dr. Dalrymple and his company, OnCall Health, set out to deploy SpaceX’s platform Starlink satellite terminals and the remote solar panel systems needed to power them in a handful of selected villages as part of the first phase of the deployment.

Back in the country’s capital, Georgetown, Fish and Dalrymple designed a “situation room” within the Ministry of Health, just a few steps from the minister’s office, as a kind of central control to monitor all the networked remote medical consultations and interventions happening across the country. The Ministry of Health sent trained health personnel to these remote villages to train local community members, such as nurses and midwives, on how to use the telehealth platform. Today, hundreds of remote exams and consultations, even ultrasounds, are performed each week by local community members under the watchful eye of trained professionals hundreds, if not thousands, of miles away.

In the next phase, expected to begin later this year, Fish, Dalrymple and their teams will integrate a fleet of vertical takeoff and landing (VTOL) drones that can transport blood samples to and from a central diagnostic center as well as deliver medications to patients in these remote areas. “A lot of what we’re doing here in Guyana isn’t necessarily revolutionary, but in the United States, a lot of these technologies and methodologies would never see the light of day, stifled by overprotective bureaucrats more invested in the process than anything else,” Fish said. “But in a place like Guyana, the need is so great that when we have to overcome bureaucratic hurdles, we usually encounter very little resistance. Everyone understands that the mission is to save lives and improve quality of life.”

In the United States, as Fish noted, the situation is quite different. Despite access to identical or even better technologies, a complex web of state and federal regulations prevents them from being used wisely.

Eric Bricker, an internist and recognized expert on health care financing, says the ongoing project in Guyana is a testament to what can happen when new technologies and financial incentives are aligned to solve pressing health care challenges.

“A lot of what 19Labs and the Department of Health in Guyana are doing is perfectly sound. In another reality, a lot of it is exactly the kind of solutions that would create a much more accessible health care system for large areas of rural America,” Bricker told the Observer. “But the American system is unfortunately a complex patchwork of federal and state regulations, public and private payers, and other factors that really stifle innovation and problem-solving.”

Consider how Guyana is using drones to deliver medications. In that country, there is no other viable solution to get medications to people who need them quickly in remote areas. “In some states, only a pharmacy can dispense medications, so the doctor would have to delegate the delivery of the medications by drone to a pharmacy. In other states, both doctors and pharmacies can dispense medications, so the doctor could send the medications by drone,” Bricker said. “But of course, there are some exceptions. Typically, these drones cannot cross state lines, because doctors can generally only prescribe medications in states where they are licensed. Then there is the question of who will administer the medications once they arrive at their destination – again, this is highly regulated in the United States.”

Sara Ratner, president of government programs for Nomi Healthsees a whole different set of issues that would never be solved in the United States, such as the minimum bandwidth levels set by the Federal Communications Commission (FCC). “Telemedicine typically involves video consultations, which require a stable and relatively fast internet connection to ensure clear audio and video transmission,” Ratner told Observer. “However, many rural areas of the United States do not have access to these required speeds. And Starlink does not necessarily guarantee the constant connectivity required to meet these standards.”

“In many ways, the United States is letting perfect trump good. In Guyana, they were smart enough to understand that ‘good’ is better than nothing at all. But in the United States, we can’t help but do what we want,” Bricker said. “If some of these new technologies flourish in other parts of the world, they can’t be part of the solution here in the United States unless there’s an elected leader who’s willing to take a risk and say, ‘Look what they’re doing in Guyana, we’re going to do the same thing!’”

Frank Anthony, Guyana’s Minister of Health, may well be the type of leader Dr. Bricker has in mind. He sees the ministry’s network for providing quality health care as being as important to Guyana’s development as any road or bridge project. “Health care, along with education and nutritional security, are the foundational pillars of what we’re building here in Guyana,” the minister noted. “I have a mandate to take risks and make sure it gets done. And it gets done right.”