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. 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 Infectious Diseases Hospital (Clinic and Medical Office) Resilience Hospital (Clinic and Medical Office) Resilience Medical Supply Chain Medical Supply Chain Business Opportunities 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…” “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 Infectious Disease Pediatric (Gastrointestinal (clean water; sanitation) + respiratory + vaccine preventable childhood diseases) Pediatric (Gastrointestinal (clean water; sanitation) + respiratory + vaccine preventable childhood diseases) Vector borne infectious disease: Vector borne infectious disease: Acute- Zika, Chikungunya, dengue, yellow fever, malaria Acute- Zika, Chikungunya, dengue, yellow fever, malaria Chronic (Chagas, helminths, onchocirciasis, schistosomiasis, malaria) Chronic (Chagas, helminths, onchocirciasis, schistosomiasis, malaria) Trauma Trauma Pediatrics- falls, burns, drowning Pediatrics- falls, burns, drowning Adults- traffic accidents, work accidents, violence, disasters Adults- traffic accidents, work accidents, violence, disasters Both are preventable or can be reduced substantially Both are preventable or can be reduced substantially

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

10. Neglected Tropical Disease Distribution

11. Vectors

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

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

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

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

16. Medical Supply Chain Resilience

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