Closing the distance
A neurosurgeon uses technology to reduce disparities in medical care and education in remote areas
By Marzieh Ghiasi
Published on November 3, 2011
http://www.mcgilldaily.com/2011/11/closing-the-distance/

Image by Afra Saskia Tucker

“Two worlds, One spirit,” a collection of photography and sculpture by Ivar Mendez, the chairman of the Brain Repair Centre at Dalhousie University, was on display at Musée des Maîtres et Artisans du Québec. His black and white photographs capture the sharp boundary where dark, coniferous forests meet snow-covered mountain slopes in Northern Labrador. This landscape is marked not only by tremendous beauty, but also by human suffering.

Mendez, a trained neurosurgeon, explores humanity’s struggles through art, while seeking to alleviate it through medicine and technology. I sat down with Mendez prior to a discussion on his work on September 24, which was organized by former McGill professor, Dr. Norman Cornett.

In recent years, Mendez has made headlines by facilitating the adoption of remote-presence robots to provide specialist neurological consultation services in remote areas of Canada. Remote-presence robots allow physicians to operate in a clinic thousands of kilometers away, using a video game-like joystick to move a robot throughout. These robots can rotate 360 degrees, and have a monitor that shows a live-feed of the physician. In addition, they are equipped with high-resolution cameras and sound equipment, allowing for real time examination and interaction with patients. Despite the unusual experience of interacting with a robot, Mendez says that patients, family, and staff quickly adapt to this futuristic associate.

In Canada, as well as in Mendez’s native Bolivia, aboriginal populations – often located in remote areas – suffer disproportionately from lack of access to specialist care due to distance and climate. Mendez excitedly speaks about the potential to expand such services and take expertise to where it is needed most.

“To listen to the heartbeat of a baby in the mother’s womb thousands of kilometers away,“ Mendez said. “[to] determine which mothers are at risk.”

He views technologies such as remote-presence robot systems as a means of reducing disparity and providing equal access to medical care, even in remote areas such as the Canadian arctic. These communities, too, are quickly accepting and integrating technologies. Mendez describes a community in Northern Labrador that, after the province proved unwilling to purchase a remote-presence robot, came together to raise funds to do so independently.

Though he has helped found neurosurgical units Asia, Africa, and South America, Mendez’s interest in technology is not limited to the medical field. In another initiative, presently in its second year, children in Inuit communities in Northern Labrador are provided with laptops and put in touch with children from Nova Scotia and the Bolivian Andes.

“These kids can communicate with art, math, and music,” he said. “[This] instills in children the idea that, no matter who we are, our contributions have the same value.”

Mendez also emphasizes the importance of investing in cross-cultural exchanges. He described a school in the north of Canada where, for the first time, two students have entered 12th grade, and will be the first two high school graduates in several years. Communicating with graduating students in Nova Scotia via the laptops motivated these students to continue their education. In this way, the introduction of innovative technologies can provide services to people who lack access, and offer these communities a means for growth.

“The change will come from within,” Mendez said. “We can help provide the environment for the children to one day become the leaders of the future, and change their own communities.”

Today is international Towel Day, a day of tribute to the late Douglas Adams, the brilliant author of, among many works, The Hitchhiker’s Guide to the Galaxy (1979). Despite passing away quite young, Douglas Adams has had an undeniable influence on popular culture. When I first read Hitchhiker’s Guide in my late teens, I felt as though I had finally been let in on a big universal joke. The sci-fi genre was one I was well-acquainted with, but this was something entirely different– it was the seriously funniest or the funniest serious work I’d ever read. I finished the rest of the series within the span of a few weeks that summer and keep going back to them to this very day for wisdom and insight that just can’t be found elsewhere.

A towel, it says, is about the most massively useful thing an interstellar hitchhiker can have. Partly it has great practical value. You can wrap it around you for warmth as you bound across the cold moons of Jaglan Beta; you can lie on it on the brilliant marble-sanded beaches of Santraginus V, inhaling the heady sea vapors; you can sleep under it beneath the stars which shine so redly on the desert world of Kakrafoon; use it to sail a miniraft down the slow heavy River Moth; wet it for use in hand-to-hand-combat; wrap it round your head to ward off noxious fumes or avoid the gaze of the Ravenous Bugblatter Beast of Traal (such a mind-bogglingly stupid animal, it assumes that if you can’t see it, it can’t see you); you can wave your towel in emergencies as a distress signal, and of course dry yourself off with it if it still seems to be clean enough.

More importantly, a towel has immense psychological value. For some reason, if a strag (strag: non-hitch hiker) discovers that a hitch hiker has his towel with him, he will automatically assume that he is also in possession of a toothbrush, face flannel, soap, tin of biscuits, flask, compass, map, ball of string, gnat spray, wet weather gear, space suit etc., etc. Furthermore, the strag will then happily lend the hitch hiker any of these or a dozen other items that the hitch hiker might accidentally have “lost”. What the strag will think is that any man who can hitch the length and breadth of the galaxy, rough it, slum it, struggle against terrible odds, win through, and still knows where his towel is is clearly a man to be reckoned with.

-Douglas Adams, The Hitchhiker’s Guide to the Galaxy (Chapt. 3)

While Douglas Adams was indeed onto something, if I were to travel across time and space carrying only a towel, I’d only be comfortable with one which had the following printed on it:

*Source: Topotaco via Gizmodo

To Mr. Adams, faeries or not, I’d like to think you are enjoying the view of the garden from the restaurant.

Things just got a little more interesting in the world of cyberpolitics.

Google revealed today that they’ve detected a sophisticated attack on their infrastructure originating from China back in December, an attack which they say impacted more than twenty other large companies in various sectors. Specifically, the attackers attempted to access Gmail accounts of Chinese human rights activists. Google does not lay blame on any specific party, however, it does indicate that it is reconsidering its approach to China.

These attacks and the surveillance they have uncovered–combined with the attempts over the past year to further limit free speech on the web–have led us to conclude that we should review the feasibility of our business operations in China. We have decided we are no longer willing to continue censoring our results on Google.cn

Externally Google has been pressured by various NGOs and governments with respect to its approach in China since it decided to censor its search results in the country. A move which some claimed was antithetical to the Company’s mantra “Don’t be evil.” In fact Google along with other search results faced a US congressional hearing back in 2006. Nonetheless, many queries in google.cn continue to deliver this note as part of the results: ” 据当地法律法规和政策，部分搜索结果未予显示。” or “According to local laws, regulations and policies, some search results are not shown.” Until today, it appeared that the revenue from China outweighed the costs.

With this move, the pendulum has clearly shifted. However, many questions remain regarding how decision was arrived at and how it will play out: Whether the costs of operating in country have become too much compared to the net revenue (to the tune of 22 billion dollars in the second quarter of 2009)? Or if Google is simply finding its infrastructure too vulnerable in the country? Has Google returned core values with respect to freedom of information, or caved in to external pressure regarding China’s censorship policies? Will China comply with Google, or will they reach a compromise? And if Google does indeed pull out of the Chinese market will its place be filled with other foreign search giants like Yahoo, or will it set precedent?

This is really the first major news this decade about cyber-attacks. Cyber-attacks have become commonplace in recent years, however in this case the economic and diplomatic stakes are incredibly high. Beyond the scope of the attack on Google, and the battle of the nerds… cyberwarfare between nations is not such a remote possibility as the internet and information technology take a more prominent role in national infrastructures. The following is an excerpt from a piece I wrote late last year on the transformation of war:

“… Constructivism takes an optimistic approach towards norms and progress. However, while norms can change to ameliorate conflict among nations, they can just as easily bring an ever-changing face to war. Indeed the 20th century was witness to a shift in the paradigm of warfare that took conflict from the trenches into cities. The democratization of war was a shift in norms which instead of creating taboos of war, propagandized war. This led to even more destructive weapons and created a situation where wars were supplied by, and waged on citizens. It is possible that even if the killing of human beings as a part of warfare becomes taboo (to the extent that state-sanctioned slavery is today), war itself might evolve. Going back to the definition of war, it is an act that is a means and not an end; and certainly any act that engages two parties in aggression, and achieves the desired outcome by force may constitute warfare. For example, in a world that is becoming increasingly reliant on technology, cyber attacks are becoming increasingly threatening^*. Equipment disruption, invasion of data banks and information highway can all be considered modes of cyber warfare. This type of warfare would not require massive troop mobilization; and it may not lead to civilian casualties, unless that is desired. But compromising critical systems in a nation could paralyze it and threaten its security. This type of warfare would have little resemblances to historic wars, however, it would achieve the same outcomes.”

*Hildreth, S. A. (2001). Cyberwarfare. Congressional Research Service policy paper.

http://www.mcgilldaily.com/articles/20738

Diagnosis gone digital
By Marzieh Ghiasi
Monday, October 5th, 2009

Almost every field has adopted digital technology, and medicine is no exception. However, the transformation of health informatics in the past decade has not simply been a change in tools of the trade, but a change in the very way knowledge is acquired and applied.

13th century Anatomical Illustration | Source

As a discipline that brings together health care and information science, health informatics is involved in setting up resources like search engines that doctors can use to retrieve clinical data. These tools can be grouped into two categories – information retrieval systems (IRS) and clinical decision support systems (CDSS).

Pierre Pluye, a physician and associate professor in the Department of Family Medicine at McGill University, investigates these electronic resources. He explained how IRS provide a way to filter the staggering amount of available information down to only the most relevant.

“There are 19 million abstracts on Medline [an online biomedical database]. Physicians do not have time [to read every single one]… because basically you would have to read 24 hours a day, seven days a week just to keep updated,” said Pluye.

CDSS differ from IRS in that they provide patient-specific information. Clinicians can use calculator-type programs that look at a patient’s history to determine their likelihood of contracting diseases or experiencing medical complications.
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A venerated sage with vast power and knowledge, you gently guide forces around you while serving as a champion of the light.

“Judge me by my size, do you? And well you should not – for my ally is the Force. And a powerful ally it is. Life creates it, makes it grow. Its energy surrounds us, and binds us. Luminescent beings are we, not this crude matter! You must feel the Force around you, everywhere.” *source

I was kind of hoping to be a STer like Picard or Spock or Data… even Worf would’ve been fine. Turns out I am just an old little green hippie inside… we know these quizzes never lie!

In other news, the web’s abuzz about Google Wave. From the preview, I can’t decide whether they’re streamlining user-experience by collapsing multiple services into one, or creating an entirely new service that may even be too bloated with functionalities. But Google rarely disappoints and the fact that this is open source is good news and the real-time document editing capabilities look fantastic. I can’t even begin to describe how many times I’ve needed something exactly like this for collaboration projects, because Google Docs just does not do it… so I am definitely looking forward to when this thing actually comes out.

What I am really looking forward to though is this upcoming summer (yes, summer still hasn’t quite started here, you can still breathe in Montreal) there are some exciting things coming this way.

As posted in Neglected Tropical Diseases Society

• Josh Ruxin, an assistant clinical professor of public health at Columbia, describes “The Best Buy in Public Health” or the strong potential to make real change with modest investments in the NTDs.
• Thomas Pogge, Professor of Philosophy & International Affairs at Yale University, and Philip Hedger, executive managing director of international affairs at Pfizer, debate approaches to creating incentives and stimulating innovation in the pharmaceutical industry to address health of impoverished populations.
• A recent publication in the PLoS suggests that rise in global temperatures may lead to the emergence of more tick-borne pathogens and tick-borne epidemics.
• Highlighting the critical role of the internet in dealing with international health issues, Scandinavian scientists have developed a web-base diagnostic tool which allows for observation of thousands of parasitic specimens using geospatial system imaging platforms. Web-based tools have great potential not just for global access to better diagnostic tools, but for more timely epidemiological information, as displayed by Google’s Flu Trends.

Or rather the archetypal nerd. Today was apparently Bill Gates’ last day at Microsoft:

http://www.mcgilldaily.com/view.php?aid=6929

Net neutrality threatened by market forces
By Marzieh Ghiasi
Monday, January 28th, 2008

Massive websites like Amazon may one day be able to pay for more information roadspace than smaller sites.

David Pullmer / The McGill Daily

As most people won’t wait more than four seconds for a page to load, the speed of delivery on the net has become more important than ever. In recent years, this need for speed has pitted companies that provide Internet services against web sites who want as much traffic as possible. What is at stake is net neutrality – the current state of affairs in which users can access Internet sites with equal speed, regardless of whether the site is eBay or mcgill.ca.

Internet Service Providers (ISPs) act as the intermediary information carriers between users and web sites. In recent years, in what has become largely a battle of revenues, ISPs have sought to implant tiered network infrastructure and charge web sites – or content providers – for services.

Large content providers, such as Yahoo!, eBay, and Google, receive much of their revenues from new applications and advertising. Their wealth depends in large part on the masses of visitors to their site. Dr. Muthucumaru Maheswaran, a computer science professor at McGill, explains that the ISPs, who make it possible for sites like eBay to have so many visitors, want a piece of the revenue pie.

“The people who actually make the networks are anxious because they’re not sharing that wealth,” he said.
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If you haven’t heard about this already you will definitely will within the next few days. The past few weeks Google has been unrolling new technology left and right. The most exciting debute, though, belongs to Street View, part of the Google maps suit, and something which will likely be integrated into Google Earth soon. The name of the feature is pretty self-explanatory. Essentially by selecting “street view” on the map, you are given the option to zoom in to one of several cities (currently the feature is available for five cities in the US) and take a ride in the streets, viewing a 360° view of your selected location.

This has been done in the past, both by private and governmental organizations and the pictures are readily available online if you look hard enough for them. Google itself, in fact, has contracted several companies specializing in street photography. (View some of their work) However, what I think is exciting about Google integerating this feature into their service is thier ability to take a currently existing technology, take it to the next level, and make it available to the mass population. Additionally, I think that being able to view the world on the street level in Google maps and Earth was an inevitable next step.
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