“What can we learn from Peru?”
Lowering the cost of the drugs is really important. At the beginning, we were paying $30 per injectible per day for nine months. We found a mechanism that lowered our cost of that same injectible to 99 cents. That gave us an opportunity to try and frame our work in a different way. To design an entirely new regimen that could save more lives.
We did not design the process through the doctors. Instead, we trained community volunteers and nurses in a way that allowed them to understand and communicate the entire process- how the disease works, how the regimens work, what common side effects might be associated with the treatments, what the different strategies were around the world that people were using. But more importantly, we told them “We have to be sure that the patients are taking the meds every day. And in the process of seeing the patients take the meds every day, we want you to find out what else is going on at home. Are they eating enough? Is the house big enough? Is it well illuminated? Is it very well ventilated? Do they have jobs? Is there someone there taking care of the kids?” When the patients came back to see the doctor each month, the doctors could understand them better, and start thinking about developing new strategies - not just lowering the cost of drugs, but how to get the patients more food, how to get them a house that gets more sunshine and is better ventilated. All of those things affect the course of the disease.
The volunteers and nurses were very important—they were in the community every day and had the patients’ trust. Then the doctors followed with the clinical aspect. But then other health professionals wanted ways to help. We had a group of psychiatrists and psychologists who talked with patients who were afraid of the side effects. We had a group of business professionals who set up a group to teach recovering patients how they might run their own businesses. The approach gave everyone an opportunity to do something positive.
The cure rate was extraordinary. The team of nurses and health promoters were able to implement similar models for the care of HIV/AIDS patients in Peru, and became convinced it could be applied to other public health problems, especially non-communicable diseases. They understand how to deliver health to the hardest-to-reach patients.
So here’s the lesson from Peru, and it’s a profound one: If we can deliver health through the community-based model for many disease states in this extremely low-resource setting, then we can deliver health in any setting around the world.