RubiconMD & Global Response Management Bring eConsults to Communities in Mexico and Haiti

Guided by the shared mission of bringing health care services to those in need, RubiconMD, Global Response Management, and Project Lifeline teamed up in October 2019 in order to give volunteer clinicians access to eConsults at the US-Mexico border. After a year of impact, this shared initiative further expanded its footprint, bringing eConsults to communities in Haiti through Middle Ground Corporation.

In the past year, our organizations could not have predicted the health care challenges that would face clinicians and patients across the world. As we reflect on the past year, we wanted to share uplifting patient stories and highlight our combined impact with clinicians on the front lines of care. RubiconMD’s co-founder, Carlos Reines, said it best when he reflected on the past year with GRM: “We’re humbled to be a part of this effort. After personally experiencing how difficult it can be for those without access to specialists, we have found a way to bring that expertise to the front lines of care and support Global Response Management’s initiative. eConsults allow all patients to receive the care they need, regardless of socioeconomic barriers.” 

Bringing care to those who need it most:

As an international medical NGO, Global Response Management works to bring emergency pre-hospital care and training to patients living in or displaced from conflict zones, with a focus on underserved and high-risk areas. The first GRM location that was given access to eConsults was in Matamoros, Mexico at a refugee site about 500 ft. from the US-Mexico border. In this setting, patients are typically asylum seekers who are cared for by both US and local clinicians . To date, eConsults have empowered clinicians serving with GRM by providing insights to specialties like Dermatology, Dentistry, Ophthalmology, Genetic Counseling, among others. Specialists have provided advice on how to best proceed with care plans given both resource and access constraints, and worked with clinicians when it was necessary to escalate the most complex clinical cases.

For example, an on-site clinician was concerned about a 46-year-old male patient with a fracture of the calcaneus who was seen at a hospital 4 weeks prior to presentation and was immobilized in a splint.  The on-site clinician wanted to clarify the management of this patient, including the need for surgical treatment in the context of a resource-limited setting.  Access to surgical facilities was aggravated even further by the COVID-19 pandemic.  The orthopedic trauma surgeon on the RubiconMD platform was able to provide advice on a non-surgical management plan and also highlighted the need for advanced imaging to confirm that the patient can be treated nonoperatively given the fracture characteristics seen on the x-rays.  This advice allowed the on-site clinician to develop a specific treatment plan for this patient and also provided additional support for their request for a CT scan to GRM’s funding agency. 

A Global Response Management staff member, Ryan Kerr, RN, EMT-P, recently wrote a piece about the impact of the partnership. He stated, “RubiconMD eConsults allow us to communicate with specialists in a way that sidesteps the challenges posed by the pandemic, mitigates the concerns we have about safety in the community, and conserves the valuable financial resources of the organization.” Kerr then went on to say that staff members look forward to taking the platform with them to other challenging projects around the world.

Image courtesy of Erica Dietz at Worth Manifesto

Image courtesy of Erica Dietz at Worth Manifesto.

Expansion into Middle Ground Haiti

Most recently, our partnership has expanded to Middle Ground Haiti, a pediatric malnutrition clinic that provides medical care to children and their families. This initiative began in September 2020, and is already making a difference as the sole on-site clinician is able to access a full specialist panel with expertise in treating pediatric patients.

For example, a physician at a GRM refugee site turned to RubiconMD to get treatment recommendations for a pediatric patient with poor seizure control.  The patient was a 7-year-old female with a history of lissencephaly treated with valproic acid at a significantly higher dose than the maximum recommended.  The patient’s family ran out of valproic acid prior to their arrival to the refugee camp and the patient’s seizures were poorly controlled.  The physician at the camp restarted the patient on valproic acid at the recommended dose but the patient’s seizures worsened with weekly generalized tonic clonic seizures. The primary care clinician at GRM needed advice on additional agents to help control the patient’s seizures in this resource limited setting.  The pediatric neurologist on the RubiconMD platform was able to support the on-site clinician by recommending some low cost medication options that were specifically aligned with the patient’s needs and that avoided any follow-up monitoring, and minimized any interactions with the patient’s current valproic acid.

Another eConsult that was submitted on the RubiconMD platform to a genetics counselor significantly impacted the management plan of a patient because its advice suggested a diagnosis of a genetics disorder that was not initially suspected by the on-site clinician.  This was a case of a 9-year-old boy who presented with dysmorphic features, global developmental delay, and low growth parameters. The clinician wanted to clarify this patient’s diagnosis highlighting that access to genetic testing was significantly limited.  They were also interested in advice on additional workup for this patient.  The genetics counselor  shared their thoughts on the differential diagnosis, that included Noonan syndrome and other RASopathy syndromes, and suggested a specific monitoring plan given the known risks associated with these types of syndromes.

If you are interested in learning more about eConsults’ impact and partnering with us, please contact us at hello@rubiconmd.com