// kumbh
P photo
mela
Kumbh Mela Burning Man
=50,000 people
5000 ft
How does the Kumbh Mela compare to that other enormous, crazy pop-up city, Burning Man?
By total area, it would take approximately four Burning Man festivals to fit inside the Kumbh Mela grounds in Allahabad, India. By population, it would take more than 1,000 Burning Mans to equal the 2013 attendance at the Kumbh Mela. That’s using a conservative estimate of 50 million pilgrims over the course of the Kumbh; some estimates put the number as high as 100 million.
the relative tranquility of the hospital had much more to do with a lack of utilization than an inherent efficiency or readiness. How would trauma be handled on a larger scale? How was the sector hospital prepared to surge in size in the case of an emergency? Connecting these hospitals was a fleet of more than 100 ambulances which were responsible for transferring patients from the sector hospitals to the central hospital. The ambulances, like the doctors who staff the hospitals, were drafted from community health centers across the state. Each ambulance arrives with its own driver, who is then provided with accommodation at the Mela. “The ambulances themselves appear to be new and well maintained, with clean stretchers to transport patients and a hand-held radio device for communicating between ambulances and with central dispatch.” said Kazi. “Each ambulance carries an oxygen tank, a host of emergency medications, and four disaster kits: for drowning, burns, bomb blasts and stampedes. It is evident that a reasonable amount of thought has gone into designing each of the kits, but there are no paramedics (which is typical in India) and a physician must accompany seriously-ill patients. It appears that an ambulance makes 5-6 trips a day.” Yet, while the facilities at the sector hospitals
may have been well stocked, health records were nearly non-existent. As our team observed, after a one-glance patient encounter, the doctor quickly scrawled down age, sex and a chief complaint. These notes were mostly illegible, largely incomplete and essentially useless. It’s understandable given the strain on each doctor, but it made syndromic surveillance all but impossible. To address this issue, Harvard’s team created a simple iPad-based electronic medical record that tracks chief complaints and prescriptions and then deployed an enthusiastic team of Indian medical students and interns to gather the data from four clinics each day. The iPads were linked to a webbased portal that synced and collated the data, ran simple analytics, and provided real-time results. The building blocks—a few iPads and a webbased application—are elegantly simple, and the manpower manageable. But thanks to the proliferation of internet connectivity across India, these tools could allow rural clinics to “leapfrog” from handwritten charts to a portable, web-based system accessible on any mobile device. This would give previously unconnected clinics the benefits of real-time syndromic surveillance without the burden of a resource-intensive electronic health record system, something American physicians have struggled under for years.
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Spring 2013 // Emergency Physicians International
“First, we want to show that it is feasible to use low-cost technologies to gather quality data in a resource-scarce setting,” says Kazi. “The fieldwork for the project is being done with a small team of passionate (and remarkable) students wielding a handful of iPads. If we can do it, the government certainly can too.” So far the Harvard team has gathered more than 30,000 patient records, an impressive number by any research standards, and arguably the largest public health dataset ever gathered on a transient population. Their findings have been stable and predictable; most complaints are of cough and cold, and most prescriptions are for anti-inflammatory drugs, like ibuprofen. Prior experience might suggest that generating quality data in resource-scarce settings is prohibitively expensive and that ad hoc planning is therefore unavoidable. By collating and analyzing data from over 30,000 patients, the Harvard team turned that assumption on its head. With current smartphone and tablet technology and cell phone coverage, even the poorest, most remote medical systems can employ a cloud-based electronic medical records that spot outbreaks before they happen and save thousands of lives.