KidsCareEverywhere Bridge and Dr. Ronald Dieckmann
Two decades ago most pediatricians in the developing nations relied on dog-eared textbooks and outdated medical journals to arrive at treatment plans and diagnoses for their young patients. Faced with a child feverish with pneumonia or sickened by contaminated water or insecticides, these doctors often did not have access to medical breakthroughs that could dramatically improve their patients’ prognoses. The gap between care for children in wealthy nations and those in impoverished lands seemed destined to widen further.
In recent years, however, thousands of doctors in countries like Vietnam, Ghana and India have been able to call up the most recent medical findings while standing beside a patient’s bed by simply tapping an app on their cell phones, thanks to KidsCareEverywhere, a non-profit founded and led by Dr. Ron Dieckmann, a ClassAct HR73 Board Member. Dr. Dieckmann and his team have traveled the globe since 2006 to train doctors on four continents to use software that not only helps them treat patients in their struggling hospitals but also allows them to continue to grow as physicians and scientists through self-education. Offering a compendium of all the world’s most current medicine and scientific recommendations up to four weeks prior, the software also gives its users the level of validity for its recommendations about diagnosis and treatment.
“Within seconds, they can use the search window in their own language to search for a topic, and then they will have a summary of all the current scientific information in the world,” said Dr. Dieckmann of DynaMed, the software KidsCareEverywhere now distributes for free. “It’s exactly the same software as what we use at the leading hospitals in the United States”.
Interviewed in late August as he and his team prepared to travel to Cajamarca in northern Peru, Dr. Dieckmann said they expected to be met by a crush of doctors and other health care providers eager to learn how to use the software in a region burdened with poverty and isolation. “When people find out that we are at the hospital and we are giving away this software, we cannot keep people out of the room,” he said. “It’s amazing, we can’t shut the door because they keep opening and coming in. We have to station people at the door begging them to come to our next session.”
Though pre-session estimates are 50 people, the crowds at these training programs quickly expand to 300. “They treat us like rock stars, and we’re training away and giving away when we are there,” says Dr. Dieckmann. “We want to give away as much software as we possibly can.” KidsCareEverywhere also hands out free tablets at these sessions to encourage doctors to make use of the app during rounds at their patients’ bedside.
Dr. Dieckmann likes to ask his listeners to give him the most difficult case they have faced that week. “I will plug it into the software, and I will show them how to answer the important clinical questions,” he says. To provide an interactive experience as opposed to a lecture, the KidsCareEverywhere team prefers to keep the size of a training cohort small in order to do hands-on training, ideally at the bedside of a patient. When doctors see the recommendations for that particular pediatric case appear instantly, they become “believers,” Dr. Dieckmann said.
“They leave the session and go out and tell all their friends ‘You can’t believe what they’re giving us for free in the auditorium down the hall. Sometimes they shut the hospital in order for everybody to be sure they got the software.”
Dr. Sofía Huamani of Lima, Peru wrote on the KidsCareEverywhere website: “Thank you for this grand gesture towards the health personnel of 2 de Mayo Hospital, and particularly the residents. Having another year's subscription of DynaMed greatly helps us.”
For the introduction of the software to succeed and for its use to be sustained, medical school deans and hospital administrators have to embrace this tool as well. The team’s on-site training sessions make acceptance on all levels much more likely, according to Dr. Dieckmann.
Along with experiencing the joy of elevating the standard of care in these developing countries, Dr. Dieckmann and his team often confront risks such as disease and political instability. In the Democratic Republic of the Congo the civil war that ended the lives of millions took on personal meaning for the members of KidsCareEverywhere. The team had gone to a hospital in the southeast corner of the central African nation to train doctors in a hospital that then Secretary of State Hillary Clinton had visited the year before when U.S. officials were trying to provide economic assistance. “We trained every doctor in the hospital, and the following year a rebel group came by and killed many of the doctors and actually destroyed much of the hospital,” Dr. Dieckmann recalled.
India, with its three billion people, its extremes of wealth and education, and regions that are almost like separate countries, poses a different set of problems for the teams distributing the software to doctors working in some of the poorest public hospitals. Of those crumbling institutions on which so many Indians depend, Dr. Dieckmann said “They’re falling down. There are piles of rubble on the floor and animals grazing in the hallways. There are electrical wires hanging down in the hallways. The electricity often doesn’t work…It’s every imaginable obstacle that you can conjure up that presents itself to us.”
Despite the failing infrastructure and the travelers’ illnesses that always seemed to plague the KidsCareEverywhere team there, India continues to compel Dr. Dieckmann to return. He is quick to praise its magnanimous and tech-oriented doctors, its rich culture and delicious food. He mourns the training projects there that were abruptly halted when the country suffered one of the world’s worst phases of the Covid pandemic. “India got hit really hard, and many of the people we were working with died,” Dr. Dieckmann said.
Natural disasters such as hurricanes and floods add to the difficulties the KidsCareEverywhere team faces during many missions. Human obstacles come in the form of corruption or the sudden exit of an NGO or corporation from a fruitful partnership. In Dar es Salaam, the team successfully conducted training at the massive Muhimbili National Hospital until the hospital’s funding from Johnson & Johnson dried up. “Then they pulled the plug, and everything collapsed,” Dr. Dieckmann said.
“It’s so disheartening that all of these essential programs and hospitals and services for people are hanging on by a thread and the least perturbation in the system, whether it’s from natural elements or from global instability or corruption, just completely destroys all the work that we do,” he added.
Innate optimism and a talent for improvising that MacGyver would envy keep Ron Dieckmann from succumbing to despair. “We wonder what the next thing is going to be to come up against us, but that’s part of the challenge,” he said. “It’s part of the gratification of it.” He and his team have learned to bring battery-powered projectors, hotspots for web access, and other essentials in order to carry out training no matter what. “We are hellbent on making it happen.”
When Covid hit in early 2020, KidsCareEverywhere, like non-profits around the world, had to scramble to find ways of sustaining its work during the isolation of the pandemic’s first years. In Ghana, their team of ten raced to complete software training as people started dying around them in a region with few medical facilities. A short time later KCE had to turn to a virtual mode of instruction that paled in comparison to the hands-on training mode their teams had previously employed. The number of doctors and nurses who received the pediatric software declined.
Now Dr. Dieckmann and his crew are back on the road, scheduled to travel to Bhutan, Nepal and Cambodia after the training programs in Peru are finished. They hope to reach out to health- care providers beyond physicians such as hospital pharmacists, who often lack the sophisticated databases upon which their counterparts in the United States rely. By downloading and searching the app’s pharmacology database with its 2500 different drugs, these pharmacists can instantaneously determine side effects, complications, and incompatibilities with other drugs, Dr. Dieckmann explained.
The roots of KidsCareEverywhere lie in Ron Dieckmann’s previous travels with his wife and three daughters to developing countries as well as in his own efforts to write and compile textbooks in pediatric emergency medicine. By the beginning of this century, he realized, “The textbook is dead. There is no future for the textbook in American medicine or medicine anywhere in the world…I thought I had to do something quite different.”
With an Australian partner who had developed information services for the United Kingdom’s National Health Service, Dr. Dieckmann in 2003 founded the software company PEMSoft, which issued a decision-support product solely for pediatric emergency medicine. From its beginning he gave away free copies of its software to colleagues in developing countries, starting with Vietnam. When EBSCO Publishing in Ipswich, Ma. acquired the company in 2013, its president, Tim Collins, supported the work of KidsCareEverywhere by agreeing to continue their donations of medical software in low-income nations. Nearly a decade later Ron Dieckmann and his colleagues have given away the EBSCO product DynaMed, a clinical reference tool that encompasses about 15 languages, to their counterparts in 26 countries. Approximately 22,000 people used the software in July of this year alone.
Harder to quantify are the multiplier effects that the software can have once a doctor or pharmacist repeatedly uses it to care for patients and to deepen his or her own education. KidsCare Everywhere has trained more than 10,000 doctors to rely on a free app that would cost them $399 a year if they were practicing in Boston or Tokyo. “If each doctor has used it to some extent and extended the benefits of this software to all his or her patients…and the doctor is seeing up to 10,000 to 20,000 kids a year, we’ve affected the health-care experience of many, many millions of children,” Dr. Dieckmann said.
With the constant feedback KidsCareEverywhere receives from tracking app usage as well as reading reports from health care leaders in hospitals they have visited, the volunteers have come to realize the value of the software for raising the level of medical education. Like doctors everywhere who come away with questions after they treat their patients, practitioners can now return to their homes or offices to call up answers based on the most comprehensive and up-to-date research. For aspiring physicians, KidsCareEverywhere’s software can easily take the place of the weighty textbooks that medical students of Dr. Dieckmann’s generation studied.
“They’re putting up a brand-new hospital in Hanoi, and we were doing some training there, and the doctor who was head of pediatrics said ‘Ron, we are using this program as our entire curriculum for training doctors in our new hospital,’” Dr. Dieckmann said. “By saving the life of a one-year-old through providing more current access to scientific information to the doctor, we are producing an asset to that society that is vastly greater than what we would be doing by working at the other end.” Dr Dieckmann said.
The advances in pediatric care and medical education fostered by KidsCareEverywhere come at a time of dramatic improvements in the mortality rates and overall health of children in developing countries. Dr. Dieckmann attributes those gains to public health reforms like water purification and better sanitation systems. He credits Bill Gates for “really innovative projects” such as widespread mosquito netting distribution, which have decreased infant mortality especially in Africa.
Ron Dieckmann’s own journey to teach pediatricians in some of the world’s poorest countries began in his hometown of Cincinnati, where he recalls having “a great childhood of my own.” Growing up in a working-class family, he said, “I didn’t even know anybody who went to college. I never knew a doctor.” At Harvard where he concentrated in History and Science and lived in Winthrop House, he realized how many things were possible.
At Stanford University’s medical school Dr. Dieckmann said he became fascinated with pediatrics, a career path strongly encouraged by his parents “who really, really loved the idea that I would be taking care of children.” Dr. Dieckmann saw that same generosity of spirit in the “humanity of pediatrics, the kindness of pediatrics.” He went on to complete a residency in that specialty at the University of California, San Francisco.
“When I finished my residency, I realized that what I really loved was emergency medicine and critical care and trauma care because it’s in my personality. I’ve always liked just being in the front lines in this type of situation,” Dr. Dieckmann said. He went on to become a professor of Emergency Medicine and Pediatrics at University of California, San Francisco and to serve as the Director of Pediatric Emergency Medicine at San Francisco General Hospital for 25 years. He also received a masters from the School of Public Health at the University of California, Berkeley.
Dr. Dieckmann’s education at Stanford and his proximity to Silicon Valley during the years when tech giants like Steve Jobs and Sergey Brin were imagining new worlds helped him envision digital possibilities in medical education. “I became very disenchanted with the written word and knew there had to be a better way of doing things through the virtual world,” he said. “And that was absolutely born of much exposure to technology.”
His dissatisfaction with hard-cover textbooks “that got old and dusty” led him to tap the knowledge of friends and colleagues who were immersed in the software culture taking root in northern California. “I think I had the great fortune of being in the right place at the right time,” Dr. Dieckmann said.
Having recently joined the Board of ClassACT HR73, Dr. Dieckmann hopes that his new role will help him expand the mission and scope of KidsCareEverywhere. One path for growth could involve connecting with Class of 1973 members, as well as other alumni, who can provide contacts with leaders in low-income countries. “There are lots of poor countries out there, there are lots of people at Harvard who know people who are running the governments there or the health systems or hospitals… who are really good, strong people that we can work with collegially and in training.”
Dr. Dieckmann also sees KidsCareEverywhere as a model for providing clinical-decision software in other specialties to physicians in low-income countries. “There’s every reason in the world that any specialty could adopt all of our structures and methodologies,” he said. “I certainly would gladly share any of it, and all of it with anyone who is so inclined.”
Classmates who would like to donate to KidsCareEverywhere to help Dr. Dieckmann and his team of volunteers widen the circle of health-care providers who have benefitted from receiving the free pediatric software and training can donate here!