The hill tribes of thailand: Synergistic health care through point-of-care testing, small-world networks, and nodally flexible telemedicine

Hill tribes in Thailand approach 1 million people, about half Karens. We studied isolated Mae Hong Son Province in northwest Thailand near the Myanmar (Burma) border, where demographic research revealed overburdened health resources (938 people per hospital bed, 8721 per physician, 1068 per professional nurse, 4573 per technical nurse, 17,046 per pharmacist, and 5137 per primary care unit [PCU]). We explored the potential for point-of-care testing (POCT) in health care delivery in the mountainous topology of windy roads, with bridges washed out and long transit times to PCUs and community hospitals. We found limited application of POCT in PCUs and community hospitals, which represent the most accessible nodes in the small-world networks (SWNs) of province health care delivery. We surveyed community hospital facilities that lacked blood gas and electrolyte testing, despite serving as network local hubs. We investigated telemedicine, a nodally flexible option to improve SWN connectivity, which is planned to connect 3 PCUs in the southern part of the province where seasonal rains make travel impractical. POC coordinators, social services, and disease-specific testing will reduce errors and improve cultural balance for those who prefer care in or near their villages. We propose an efficiency function and conclude that synergistic POCT, SWNs, and telemedicine will improve health care for mountain hill tribes without sacrificing routine care for other people in rural and urban areas. For distributed clusters of populations, emergency services and care of the critically ill will be improved through enhanced evidence-based decision making when these improvements are implemented.