1. Medical Resilience in
Developing Countries
Joseph (Jay) McIsaac, MD, MS
VP, Director, Partner, Integrated Anesthesia Associates, LLC
Associate Clinical Professor, University of Connecticut
Chief of Trauma Anesthesia, Hartford Hospital
Supervisory Medical Officer, NDMS, US DHHS

2. Disclaimer
• I am an intermittent employee of the US National Disaster Medical
System. Nothing in this talk should be construed to represent the
policies of the US government. All opinions are entirely my own.

3. Overview
•Infectious Diseases
•Hospital (Clinic and Medical Office) Resilience
•Medical Supply Chain
•Business Opportunities

4. Maslow’s Hierarchy of Needs

5. Healthy Population = More Productive
Economy
• “The economic effects of population health can be seen both at the
individual and macroeconomic levels [GDP]. There is no real dispute
about the presence of these effects on economic development…”
-Bloom and Canning, Population Health and Economic Growth, WORKING PAPER NO. 24, The International Bank for Reconstruction and
Development / The World Bank, 2008.

6. Infrastructure

7. Burden of Disease

8. Infectious Disease and Trauma
• Infectious Disease
• Pediatric (Gastrointestinal (clean water; sanitation) + respiratory + vaccine
preventable childhood diseases)
• Vector borne infectious disease:
• Acute- Zika, Chikungunya, dengue, yellow fever, malaria
• Chronic (Chagas, helminths, onchocirciasis, schistosomiasis, malaria)
• Trauma
• Pediatrics- falls, burns, drowning
• Adults- traffic accidents, work accidents, violence, disasters
• Both are preventable or can be reduced substantially

9. Zika Virus Disease
• Mosquito transmitted
• First identified in Africa
• Mostly mild disease (fever,
headache, and rash)
• Birth defects
• Encephalitis
• Guillain-Barre Disease (paralysis)
• Sexual transmission

10. Neglected Tropical Disease Distribution

11. Vectors

12. Vector Control
• Avoid (Good luck!)
• Barriers (window screens, nets)
• Repel (DEET)
• Trap (mosquito magnet, etc)
• Kill (insecticide)
• Interfere with reproduction
• Interfere with habitat (drain standing water)

13. Medical System
• Hospital, Clinic, and Office :
• Staff (health and safety, family security, transportation, training)
• Structural Integrity (Floods, winds, seismic)
• Power and water infrastructure
• -Filtration and purity, storage of water
• -Alt. Power Sources: wind, solar, steam piston or turbine engine
• Supplies
• Medications (pharmacies and manufacturing)
• Bandages, disposables, and equipment

14. Safe Hospitals
• PAHO (WHO) Safe Hospitals Initiative
• Resistance to earthquakes and floods
• Hospital Safety Index
• Baseline Assessment Tool
• Sustainable Design and Construction Guidelines
• Cost Benefit Analysis
• Model Policies

15. Power and Water
• Water storage and filtration
• Alternate power generation
• Solar
• Wind
• Steam
• Fossil fuel

16. Medical Supply Chain Resilience

17. Business Development Focus Group
[Business Plan]
• Technical
• Meteorologist/Climatologist
• Public Health/Epidemiologist
• Infectious Disease Physician
• Entomologist
• Architect
• Civil Engineer
• Logistician
• Business
• Economist
• Contracting
• Finance
• Insurance
• Country Specific Experts
• Partnering
• PAHO/WHO
• Government Agencies (US and non-US)
• Institutional: Major Universities and University Hospitals (US and non-US)
• NGOs