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Dr Peter Rohloff first travelled to Guatemala one idle summer to practice his Spanish. He was surprised to learn the majority of the population are of Mayan descent. He’d come to a country to learn a language they didn’t even speak.

 

So instead, he decided to learn Kaqchikel and K’iche’. He founded Wuqu’ Kawoq (now the Maya Health Alliance), and began providing health services in indigenous languages. He leads a double life, shuttling between Boston’s Brigham & Women’s Hospital and his clinics in Guatemala.

 

Rohloff is on the front lines, working with those on the receiving end of health policy decisions. The story of one of his patients, Crecencia Buch, shows that in global health, there are no easy answers.

0113_WuquKawoq_2059-med

Dr Peter Rohloff first travelled to Guatemala one idle summer to practice his Spanish. He was surprised to learn the majority of the population are of Mayan descent. He’d come to a country to learn a language they didn’t even speak.

0113_WuquKawoq_2059-med

So instead, he decided to learn Kaqchikel and K’iche’. He founded Wuqu’ Kawoq (now the Maya Health Alliance), and began providing health services in indigenous languages. He leads a double life, shuttling between Boston’s Brigham & Women’s Hospital and his clinics in Guatemala.

 

Rohloff is on the front lines, working with those on the receiving end of health policy decisions. The story of one of his patients, Crecencia Buch, shows that in global health, there are no easy answers.

“Impossibility is an assumption. Part of the excitement of being in global health is that we get to challenge that boundary.”

PETER ROHLOFF

“Impossibility is an assumption. Part of the excitement of being in global health is that we get to challenge that boundary.”

PETER ROHLOFF

In Guatemala, Spanish dominates education, government and health care. That is significant for Crecencia because she has been diagnosed with cervical cancer.

 

Unlike Shree Ram’s patients in Nepal, Crecencia is not geographically remote: her village is only two hours from the national hospitals. Here, language and logistics restrict her access to health care.

While Crecencia’s treatment may seem expensive compared to mosquito nets, when compared to most medical costs in the US, it’s a bargain. It seems the price of life is cheaper in some countries.

 

At the same time, living in a rich country doesn’t make you rich, and it doesn’t make you healthy.

At Boston Health Care for the Homeless, Cheryl Kane and her team have started providing palliative care for patients with terminal illness. It is both financially and emotionally draining.

 

With end of life care, cost and benefit come into sharp focus because the time frame is often weeks, not years.

 

Just as in Guatemala, budgets are balanced with life and death consequences. But in the US options are limited. Even if policy-makers could escape the shadow of politically charged terms like ‘death panels’, the Affordable Care Act explicitly prohibits the use of cost-effective studies for Medicare.

“We have to make decisions somehow. And I don’t believe that tossing a coin or leaving it up to individual health care providers is the best way to do it.”

PETER SINGER

“We have to make decisions somehow. And I don’t believe that tossing a coin or leaving it up to individual health care providers is the best way to do it.”

PETER SINGER

In the UK, they have embraced data. The National Institute for Health and Care Excellence uses metrics similar to the DALY to determine which treatments are available on the National Health Service.

 

It’s an approach that could rein in spiraling health care costs in the US. But Chris Murray, the man who invented the DALY, has reservations about such a system.

“I would not sign up to living in a community where there was a rule that said that you spend health dollars to only get the most DALYs.  I don’t want to live there. I want to live in a place where that’s a factor.”

CHRIS MURRAY

“I would not sign up to living in a community where there was a rule that said that you spend health dollars to only get the most DALYs.  I don’t want to live there. I want to live in a place where that’s a factor.”

CHRIS MURRAY

While resistance to priority-setting in health care remains strong in the US, overseas the issue is less politically charged. Nevertheless, Peter Rohloff is spending big on Crecencia.

 

Back in Guatemala, how does she respond to her cancer treatment?

WHERE WERE THOSE NUMBERS FROM?

In the graphic ‘How much health can $1,000,000 buy?’, an estimate of the number of DALYs averted by treatments like Crecencia’s radiation therapy is compared to interventions described in DCP2.

 

All other statistics in the video are from IHME.

“There are important things that will not always be visible in an algorithm. We have to live in a world in which we are comfortable with not knowing everything, but continuing to ask more questions.”

SUSAN ETLINGER

“There are important things that will not always be visible in an algorithm. We have to live in a world in which we are comfortable with not knowing everything, but continuing to ask more questions.”

SUSAN ETLINGER

Should we fund individual treatments whatever the cost? Or should we maximize population impact?

 

There is no simple answer to José’s dilemma. We are hard-wired to react to personal stories like Crecencia’s. At the same time, Big Data offers a new way to see the big picture.

 

That picture shows that globally we’re living longer, healthier lives, but also reveals great disparities in who enjoys these benefits. Whether driven by data, doctors on the front lines, or a balance of the two, the potential to significantly improve health care for hundreds of millions of people is well within our reach.

DO SOMETHING ABOUT IT

Here’s a list of great websites to help you decide where to focus your charitable dollars:

 

Wuqu’ Kawoq (Maya Health Alliance) | The NGO that provided Crecencia’s health care (among many things it does in Guatemala)

 

Possible | The NGO that restored Bayalpata Hospital

 

Institute for Health Metrics Evaluation (IHME) | Chris Murray’s data gurus

 

The Life You Can Save | Peter Singer’s Effective Altruist website

 

Against Malaria Foundation | Rob Mather’s malaria nets NGO

 

Watsi | Crowdfunding health care website

 

Boston Health Care for the Homeless | NGO in Boston

CREDITS

DIRECTOR
Rob Tinworth
PRODUCER

Jonathan Schütz
Miles O’Brien
Joseph Sousa
CAMERA
Brad Dillon
Cameron Hickey
Kristy Campbell
Vanessa Carr
EDITOR/WEBSITE
Rob Tinworth
MUSIC
Chee Wei Tay
GRAPHIC DESIGN
Mitch Butler
EDUCATIONAL DEVELOPMENT
Elizabeth Hutton
FIELD TRANSLATION GUATEMALA
Sarah Messmer
David Flood
Meghan Webb
Nora King
FIELD TRANSLATION NEPAL
Bhinnata Piya
Nirajan Khadka
Netra Kunwar
LOGISTICS NEPAL
Pradip Bagale
TRANSLATIONS
Diwas Gurung
Jagat Kunwar
Kushal Paudel
Pritam Shah
Pushpalata Poudel
TRANSLATIONS
Roshan Bista
Sudan Thapa
Sabuna Timilsina
Jillian Moore
Michael Dykstra
Magda Sotz Mux
Jui Shrestha
Katia Cnop
Kate Douglas
Grace Fletcher
Boris Martinez
SPECIAL THANKS
Gary Glassman
Joseph Rhatigan
ADDITIONAL MATERIAL
Katia Cnop
Pond5
Against Malaria Foundation
Remy Steinegger

CREDITS

DIRECTOR
Rob Tinworth

 

PRODUCER
Jonathan Shütz
Miles O’Brien
Joseph Sousa

 

CAMERA
Brad Dillon
Cameron Hickey
Kristy Campbell
Vanessa Carr

 

EDITOR/WEBSITE
Rob Tinworth

 

MUSIC
Chee Wei Tay

 

GRAPHIC DESIGN
Mitch Butler

 

EDUCATIONAL DEVELOPMENT
Elizabeth Hutton

 

FIELD TRANSLATION GUATEMALA
Sarah Messmer
David Flood
Meghan Webb
Nora King

 

FIELD TRANSLATION NEPAL
Bhinnata Piya
Nirajan Khadka
Netra Kunwar

 

LOGISTICS NEPAL
Pradip Bagale

 

TRANSLATIONS
Diwas Gurung
Jagat Kunwar
Kushal Paudel
Pritam Shah
Pushpalata Poudel
Roshan Bista
Sudan Thapa
Sabuna Timilsina
Jillian Moore
Michael Dykstra
Magda Sotz Mux
Jui Shrestha
Katia Cnop
Kate Douglas
Grace Fletcher
Boris Martinez

 

SPECIAL THANKS
Elizabeth Hutton
Gary Glassman
Joseph Rhatigan

 

ADDITIONAL MATERIAL
Katia Cnop
Pond5
Against Malaria Foundation
Remy Steinegger

The documentary film is out now. Watch on Amazon or Vimeo.

The Life Equation is funded in part by The Pulitzer Center.