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John Hoffmire: Taking the hospital to the patient

Published: Monday, March 10 2014 7:25 a.m. MDT

In this July 17, 2011 photo, an Indian tribal villager, left, is bandaged after a cataract surgery as others wait their turn inside the Lifeline Express, a charitable mobile hospital, in Jagdalpur, Chattisgarh state, India.

Kevin Frayer, Associated Press

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Ben Young did the vast majority of the work on this piece.

When you think of a hospital, what images come to mind? For most, the image of a hospital includes a spacious building with rooms full of complex equipment, beds and medical personnel. While common in the developed world, these familiar sights are largely unseen in the developing world, especially outside of large cities.

Unfortunately, this lack of medical infrastructure is not due to lack of demand. In India and China alone, the number of rural poor, those who often need doctors the most, numbers almost 300 million, comparable to the population of the United States. Coupled with this, hospitals in the big cities are consistently overcrowded, leaving no time to serve this huge block of people in need, let alone engage in preventative medicine.

More importantly, even if hospitals were to expand, millions of people would still remain ill due to a simple, common problem: distance. For many living below the poverty line, hospital care is simply too far away to be a feasible option, even when services are provided for free. This problem is most prevalent in countries where a paucity of infrastructure makes traveling expensive and difficult when healthy, and almost impossible when needing medical attention.

However, several programs around the world have begun to gain traction in reaching out to those in need. One particularly successful program operating in India is called Lifeline Express. Funded and held jointly by governments and private companies, including support from the U.N., Impact India and Tata Motors, Lifeline Express brings free medical care by train to those in need. This is especially effective thanks to India’s sprawling railway network, which has more than 68,000 miles of track.

Founded in 1991, Lifeline Express began as a three-car operation with a railcar donation from Indian Railway, and initial funding provided by the Ford Foundation, USAID and Impact UK. The train had one car outfitted for surgery, with operating tables and accompanying diagnostic equipment. The other two served as support cars, carrying medical equipment and a pathology lab while also providing housing and food for the volunteer medical staff. In 2007, the three-car train was joined by a new five-car train. This new train includes updated equipment, as well as a second operating theater that can operate independently in the event of an emergency.

Due to bureaucratic red tape, as well as the popularity of the program, a visit from Lifeline Express begins about a month before the train arrives. After receiving the proper permissions from local governments, Lifeline representatives begin coordinating logistical activities. These involve handouts, billboards, volunteers helping people register for treatment, as well as queue management.

When the train arrives, volunteer doctors on the train focus on treatable disabilities. Major surgeries are conducted to restore movement, correct clefts and improve hearing and sight. The surgeries are performed almost constantly throughout the three- to four-week visits. Since its first run in 1991, Lifeline Express has served more than 800,000 of the disabled poor in India.

Beyond the success in India, the Lifeline Express model has expanded into neighboring countries as well. Not only are there multiple trains running in India, but trains have also been launched in China and Zimbabwe. Similarly, Bangladesh and Cambodia have adapted the model to river boats with great success.

Lifeline Express is not a magic bullet to solve all health issues for the poor. Future support of prevention and education programs will be needed to enact long-term change. And yet, in the meantime, Lifeline will continue to be an excellent short-term option.

John Hoffmire teaches at SaÏd Business School at the University of Oxford.

Ben Young is a graduate of BYU and currently works as a business analyst for Precoa in Portland, Ore.

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