SIEMENS

Healthcare policies always wind up being economic policies as well. When China began its economic reforms two decades ago, it rescinded its “Iron Rice Bowl” — the comprehensive social safety net that included job security and free medical care, and today many rural Chinese have no health insurance and must pay their own doctor bills.

“We thought about how to cut costs so that everyone in China could afford to have a computed tomography (CT) examination if necessary,” says Florian Belohlavek, product marketing manager for the SOMATOM Spirit CT scanner. The device is a part of the Siemens SMART Initiative, which is designed to develop economical, robust, reliable, and easy-to-operate devices particularly for use in rural areas of developing countries. The scanner is characterized by a dual-slice system, which means that one complete rotation of the X-ray tube around the patient records two sectional images simultaneously. That’s sufficient, for example, for essential routine examinations of the head, lungs and spine.

The scanner’s moderate price makes it possible for even small hospitals in China to adopt computed tomography. “The SOMATOM Spirit is usually the first CT scanner hospitals buy,” explains Belohlavek. That’s why Siemens has customized its syngo user interface for this model. The device is manufactured in Shanghai, from which it is supplied mainly to Brazil, Russia, India, and within China. Worldwide sales have already exceeded 2,000 of these scanners. Also made in Shanghai is the SOMATOM Emotion 6 and 16-slice CT scanner, which many hospitals acquire as a second unit. The unit’s fast scan time supports high patient throughput. It also provides high image resolution so that tumors and strokes, for example, can be diagnosed more reliably.

When more advanced imaging is needed, medical specialists in emerging economies as well as their colleagues in industrial countries, use high-end equipment such as the SOMATOM Definition Flash. This CT-Scanner can be found mainly in large medical centers and private clinics.

High Tech in India’s Villages. In India too the government is striving to improve rural healthcare. Most Indians live in one of the country’s approximately 600,000 villages. As in China, the penetration of health insurance in the rural population is very low. The situation is aggravated by the fact that most physicians practice in cities, and many villages are a day’s journey away from the nearest hospital. That’s why in 2001 Siemens developed the concept of a mini-clinic on wheels. The idea is to provide quality and affordable healthcare to India’s interior. The result is the “Sanjeevan” — a bus equipped with the most essential diagnostic devices, including those for X-rays, ultrasound, mammography, and basic lab tests, as well as a supply of refrigerated medications. More than 25 such buses have been sold to local governments, NGOs, and private healthcare providers throughout India.

India is geographically subdivided into 600 districts. Siemens professionals are currently investigating to what extent individual districts are equipped with diagnostic devices. For example, they have found that some districts have no CT systems or catheterization laboratories. Fewer than 200 districts have a magnetic resonance imaging system (MRI).

Experts at Siemens Corporate Technology (CT) in Bangalore are exploring how they can contribute to the country’s rural healthcare system. “Since the people in the countryside have to pay the doctor themselves, they won’t see one until it’s almost too late,” says Manohar Kollegal, program manager for Healthcare Products at CT. “What we need most is better prevention and more affordable examinations,” he adds. He and his colleagues are developing a diagnostic device for analyses of urine, blood, and serum, for example. “We strive to achieve a high quality standard at reasonable cost,” he explains. The prototype is to be completed in the early summer of 2012.

Another device the Indian Corporate Technology team developed is the Fetal Heart Rate Monitor for monitoring the heart rate of a fetus. The device not only measures the fetal heart rate via a sort of microphone but also the mother’s uterine contractions. Having completed its clinical trials in 2011, it is now ready for clinical use in India, and is expected to help reduce India’s high infant mortality. “We have developed proprietary algorithms for our software and incorporated region-specific diagnostic alarms regarding the fetal heart rate,” Kollegal explains.

More advanced solutions, this time in the area of artificial Intelligence, are being implemented at locations throughout Siemens. For example, researchers in the United States and Germany are developing a clinical decision support system that analyzes patient data and suggests the most likely diagnosis to the attending physician. The system is being developed by Dr. VinayShet and his team within the Collective Intelligence lighthouse project.

Ultrasound in Mexico. India is by no means the only country to have a high infant mortality rate. In Chiapas, Mexico’s poorest state, healthcare education and delivery for the mostly indigenous population is hampered by language barriers and cultural differences as well as geography that makes access difficult. To improve on-site healthcare delivery, Siemens has provided 44 ultrasound devices to community health centers. The devices are used for examining pregnant women and small children. Since the devices were introduced two years ago, infant mortality in Chiapas has declined by five percent.

“The Chiapas government has also purchased 35 Polymobil Plus mobile X-ray units from Siemens,” says Mauricio Valero, head of sales for clinical products in Central America. The units are simple to install and clean, and their maintenance costs are low. They are used not only in small hospitals but also in primary care facilities, which often comprise only a single room. In addition to these measures, the Mexican government is also seeking to improve the healthcare infrastructure of Chiapas by building three new hospitals in urban centers. As a part of its breast cancer screening program, the government has equipped two first-level private clinics in Mexico City and Monterrey with a digital mammography system and an ultrasound device for automatic 3D breast scans.

The combination of ultrasound and mammography is considered the best method for detecting breast cancer and avoiding false positives and superfluous biopsies. The government plans to install another six to ten such devices in smaller cities. And it is planning to have the medical images from such screenings interpreted centrally by two or three highly specialized experts in Tuxtla, the capital city of the State of Chiapas. The images will be transmitted to these experts via data links. “The installation of the required telematics infrastructure is slated to be completed in 18 to 24 months,” says Valero.

Patients from Central and South America as well as the U.S. are attracted by the Angiografía de Occidente hospital in Cali, Colombia’s third-largest city. The hospital, which has obtained JCI (Joint Commission International) certification, is where Dr. Antonio Dager operates. Dager is the only cardiologist in Colombia who is qualified to use a new minimally invasive procedure to replace heart valves.

Dr. Dager, who received training in the U.S., uses two Artis Zee angiography systems plus syngoDynaCT Cardiac software, which provides him with 3D images from the body’s interior during the procedure. Over the past three years Dager has performed 90 such procedures. He is now equipping a hybrid laboratory in which he will be able to perform both minimally invasive and open heart procedures. “In order to plan this lab, I visited Siemens in Erlangen last year, where I learned all I needed to know about the required infrastructure. I was able to actually practice all the steps of the procedure in a hybrid lab,” he reports.

China, India, Mexico and Colombia — these examples illustrate that high-end medical care is making progress not only in developed countries, but in emerging economies as well. Despite their economic advances, these countries need to pay as much attention to cost factors as do industrialized countries.

But the challenges in providing healthcare to rural populations — often in relatively inaccessible areas — are disproportionately large. Nonetheless, many developing countries manage to use a practical mix of moderate-cost solutions for basic medical care delivery in rural areas plus high-end solutions for specialized care in large cities to improve the health of their citizens.