Cuba and local care

In on-the-cuban-paradox, the preventive primary care system was shown to have immense benefits and greater efficiency than a reactive system.

This community-driven healthcare model means that there is one doctor for every 20-30 families, which enables care to be provided in a highly contextualized manner. Locally care works very well, but why?

Local care does not need to imply physical locality as in the Cuban interpretation. It is more important to consider the more abstract case of locality, as a multi-dimensional construct consisting of the network of people a person is close to, the physical locale of the person, the ethic/cultural/religious locality of the individual etc. a-cyberphysical-neighbourhood.

Local factors of well-being

social-determinants-of-health

Looking at the social determinants, shows that a large percentage of health and well-being is based on social and environmental factors that are highly localized

• One size fits all approach doesn’t work, interventions, especially preventive ones are personal and community based.

Remote care is remotely effective

As globalized as the world becomes, the human brain isn’t built for maintaining and managing a global network of people to care for. Video conferencing tools like Zoom provide a bridge, but it feels like a low-resolution experience of the real thing.

Telemedicine is an interesting area of experimentation, but once again in the pursuit of greater efficiency, it degrades the humanity and care in the patient-clinician relationship.

Anecdotal evidence:

1. We try not to get into long-distance relationships especially when the relationship is not already established
2. Most of our support network at any time comes from those locally around us - and when placed in an environment without that, we create a network

Primary research:

1. We need to make robots to hold our hands to augment our virtual experience : Robot Mediated Handholding Combined with a Mobile Video Call Makes the Users Feel Nearer and Closer
2. Remote kissing
3. Bidirectional Tickling Interface

If virtual interfaces are able to catch up to the affective potential of in-person interactions, we are still far away from that future.

Empathy in telemedicine

This is dependent on the types of support solicited. Most clinicians would fulfil the Informational support part of the social support behavioural code.

1. Patient perception of physician empathy in stroke telemedicine
2. The Emerging Issue of Digital Empathy
3. Effect of telemedicine via videoconference on provider fatigue and empathy

There are mixed reviews here. In (1), the stroke telemedicine patients report good reviews albeit with a low N. In (2):

Affective behavior patterns, specifically empathy utterances, were less evident in telemedicine consultations.9

And as per (3), telemedicine also increases the cognitive burden on providers, leader to higher incidences of provider burnout. Just because we can do telemedicine and it does improve efficiency doesn’t mean that we should reduce considerations to pure efficiency.

Global factors of well-being

Connecting similar people across different locales

Of course, virtual communities play a crucial role, especially in connecting people with similar conditions together: it is hard to find people with similiar situations in a local space.

Types of support, analyzed using the Social Support Behavioural Code:

1. Informational Support (advice, info)
2. Tangible support (goods and services)
3. Emotional support
4. Esteem support (compliments, validation)
5. Network support (access to companions, prescence)

Definition of companionship: engaging in social interaction in order to satisfy the intrinsic needs of social integration and enjoyment, rather than for problem-solving purposes.

Healthcare Support Communities

Social support groups are based on the premise that people who share similar difficulties, disease, condition, or distress would be better able to empathize with one another and exchange support

Despite the different frameworks of support classification that these studies used or discovered, informational and emotional support have generally emerged as the most common types of social support exchanged online

Other healthcare virtual communities research: Rotating leaders build the swarm Value creation in virtual communities

Creating information and knowledge flow across locales

The biggest problem with localization is that information does not easily flow between locales. This means that local knowledge that could be relevant to other locales is hidden, hindering collective intelligence.

This leads to silos. Global networking helps here, to break down silos and distribute information to where it is needed.

Sharing resources and tools

In a highly localized system, every local node is left to fend on its own. A global network is able to detect and allocate resources efficiently to support nodes in their operation.

public-goods can be easily shared through the network at zero cost. the-marginal-cost-to-distribute-is-low. Public goods could be ideas, software, broadly useful projects etc.