New Tools for Migration to Improve Health: How Remittances Can Reduce the Global Surgery Deficit

February 27, 2013

Migration from poor countries to rich countries can change people’s lives. A doctor-founded startup is exploring how migration can save people’s lives.Dr. Adam Kushner is a surgeon who noticed two things. First, migrants’ annual remittances to poor countries are vast: about $440 billion next year, more than triple aid. Second, millions of people in poor countries can’t pay for life-saving medical care. At least a quarter of all deaths in Rwanda and in Sierra Leone could be averted with timely surgical intervention. One of the main reasons people don’t get surgery is lack of cash to pay de facto fees.Kushner founded a startup called CelRx to help migrants buy urgent health care for people back home. CelRx lets overseas relatives make direct, secure payments into hospital bank accounts via PayPal. It costs much less than typical remittances to Africa. It’s also faster: CelRx payments go straight to the hospital, while standard remittances must pass through other offices that can be distant or closed when an urgent transfer is needed. And migrants know exactly where their money is going; they need not trust their cousins’ story about what the money will be used for. (Dean Yang of the University of Michigan and Nava Ashraf of Harvard Business School and co-authors have shown that Salvadoran migrants to the U.S. remit more when they have more control over where the money goes.)I’m delighted to see medical experts working to help the opportunities of international migration strengthen health care in Africa. It’s a refreshing change from the standard and deeply misguided calls for migration to be stopped by coercive measures in the name of health. Coercing migration is neither an ethical tool nor an effective tool to improve health. Kushner is building tools for better health in a world of mobility.CelRx is just getting off the ground, currently negotiating payment systems with selected African hospitals. It’s quite different from other organizations set up to pay for urgent health care in developing countries, like Samahope and Watsi. They are charities to help philanthropically-minded people finance urgent care for people they don’t know. CelRx is for migrants to fund care for specific people they know. In developing countries, like everywhere, family and friends are better than strangers at responding immediately and generously to one’s needs.Kushner is a fascinating figure, worth getting to know. He has performed humanitarian surgery all over the developing world. He lectures about it at Columbia University and at Johns Hopkins where he’s teaching a class called “surgical needs in low and middle income countries”. Surgery is often neglected in global health efforts, which focus on prevention and primary care, but Kushner works to get more attention on surgical needs. He and his colleagues estimate, for example, that 56 million people in sub-Saharan Africa need surgery today. He discusses some of his work in this talk.


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