Know one teach one

Better access to the literature, better health care in developing countries

Having commented on the Canadian health care system recently, I turned my thoughts to less fortunate societies where health care and the information to support it are in short supply. A recent article in the Mayo Clinic Proceedings (1) discusses a number of initiatives to improve access to online medical literature in developing countries. The authors identify three problems: inadequate and cost-prohibitive electronic access to medical journals, slow Internet access speeds, and the high cost of Internet access. They go on to discuss some effective projects that are seeking to overcome the odds.

HINARI
A number of initiatives, notably the Health InterNetwork Access to Research Initiative (HINARI) program of the World Health Organization (WHO) and its partner publishers, provide free Internet access to the online versions of many medical journals to individuals with IP addresses from developing countries. Over 3,750 journal titles are now available to health institutions in 113 countries. But slow access speeds and high costs impede progress. And as a Thai physician laments in a guest article on the Open Medicine Blog, countries like his don’t qualify for HINARI access. In remote areas of Thailand, and many countries like it, accessing journals is very difficult in remote areas.

eGranary
To counter the problems of Internet connections there is a project to install web-based digital libraries stored on local servers at African universities and other institutions. The eGranary, part of The WiderNet Project based at the University of Iowa, is working with WHO and the US National Institutes of Health to extend and improve the digital library model. This represents an opportunity to make an exponential advance in providing low-cost, high-bandwidth access to much-needed health care information. Educational organizations, such as Africa Partners Medical, are teaching African health professionals the principles and practice of evidence-based medicine using the eGranary digital library. As Dr.Larry Ebert, one of the founders of Africa Partners Medical, has said, "No one of us can solve the immense health care needs of the African continent, but together we can make a difference."

Some Non-Digital Solutions
Equitable and efficient online access for developing countries is highly desirable. The move to open access online journals will have a hugely positive impact. But there are other important initiatives for getting information to those who need it, of which I will mention a couple.

ICN Mobile Library
On another front, the International Council of Nurses launched the ICN Mobile Library in 2001. This project delivers state-of-the-art health information to thousands of nurses in remote clinics and health centres in developing countries (2). Mobile libraries contain more than 80 titles covering topics from disease prevention, surgery and anesthesia to how to look after a refrigerator and manage a health centre store. These materials are housed in a transportable trunk resilient to moisture, insects and hard knocks. The first units were shipped to Kenya, Zimbabwe and Botswana.

Books With Wings
Another initiative, which has its roots at my own University of Manitoba, is the Books With Wings project, which collects and ships medical textbooks and lab equipment to those in need (3). Books With Wings began as the Kabul Medical Library Project, initiated in 2005 by Dr. Richard Gordon and medical students at the University of Manitoba. Their efforts resulted in the collection and shipment of over 1,700 textbooks to Afghanistan. The project has since grown to involve medical students and staff at 13 universities across Canada. This year 3,800 current textbooks (17,000 lbs. worth) were collected, enough to supply five medical libraries and one dental library in Afghanistan.

How to help
The worthy projects mentioned here welcome donations or sponsorships at these links:

Africa Partners Medical

Books With Wings

eGranary and The WiderNet Project

ICN Mobile Library

References:
1. Roberts LR, Missen C, Grimes GC. Casting a wider net: improving access to medical literature in developing countries. Mayo Clin.Proc. 2007 July;82(7):846-848.

2. Rural Africa benefits from ICN mobile libraries. International Council of Nurses. Int.Nurs.Rev. 2003 Mar;50(1):8-9.

3. Books with Wings. Info-Rx: newsletter of the Health Sciences Libraries [serial online] 2007 May/June. Available from: http://myuminfo.umanitoba.ca/index.asp?sec=857&too=30&eve=