Cali’s most vulnerable populations are more than 15 minutes away from an emergency room

Cover image: A heat map showing travel time to an emergency room, ranging from green (10 minutes) to red (30 minutes). Credit: AMORE Project

This article originally appeared on the Faculty of Engineering (Universidad del Valle) website here and was reproduced with permission. It is authored by Andrew James (NCC/Univalle).

Traffic congestion can be an inconvenience, but it can also make the difference between life and death – a significant portion of the low-income population in Cali, Colombia cannot reach the nearest tertiary care emergency department in less than 15 minutes, reveals a new study by researchers from several international institutions including Universidad del Valle (Univalle).

Previous studies conducted abroad have shown that timely and adequate emergency care can prevent 45% of deaths and 36% of related disabilities in low- and middle-income countries (LMICs).

In the context of this study, physician Luis Gabriel Cuervo, PhD student at the Universitat Autònoma de Barcelona in Spain (and Professor Ciro Jaramillo, director of the Research Group on Transport, Traffic and Roads (GITTV) of the Faculty of Engineering of the Universidad del Valle are co-authors of the preprint article entitled:  “Cross-sectional equity analysis of accessibility by automobile to tertiary care emergency services in Cali, Colombia in 2020.”

The researchers used, on two occasions during 2020, a digital platform called Project AMORE to show the negative effects of vehicular congestion on equitable access to tertiary care emergency services in Cali, with the purpose of displaying the information in a simple way, through a “heat map” that illustrates the most disadvantaged areas in the city, in relation to travel times (accessibility) to health services, at different levels of traffic congestion.

In addition to the simplicity of visualizing the problem, the project is novel because it uses dynamic data, which allows to appreciate the changes in accessibility at different times of the day.

Image: Infographic from the AMORE project. Credit: Proyecto AMORE.

The impact of access to health services?

Professor Jaramillo explained that the study was conducted with data downloads obtained in the urban area of Cali, a city in southwestern Colombia with more than 2 million inhabitants, where about half of them live in low-income households.

“The city is our full-scale laboratory and the treatment of spatial data with geomatics tools are essential,” Professor Jaramillo said.

Professor Jaramillo explained that the project integrated demographic data from the Colombian National Census, traffic flow data from the Google Distance Matrix platform; and data corresponding to the 14 tertiary health care centers with emergency services.

“In a catastrophic health emergency, every minute counts-the time it takes to receive the right service can define the prognosis; those who receive timely, quality care have better options,” Dr. Cuervo said.

The researchers explained that the data show which populations take longer to reach a facility within a time threshold under different levels of traffic congestion, i.e., people in vulnerable situations have to travel longer and therefore invest more direct and indirect personal resources to access tertiary care emergency services than the average population.

The researchers commented that there are also consequences, due to vehicular congestion, for those who attend ambulatory health services, for example hemodialysis, chemotherapy, rehabilitation, or radiotherapy patients.

“For those who attend services frequently, time is money: the families of those who frequent in-person ambulatory care incur direct and indirect costs with each trip,” Dr. Cuervo said, adding that direct and indirect costs increase with the length of the trips.

“Imagine having to go for hemodialysis 3 or more times a week, this easily brings a family to ruin and limits family possibilities,” explained Dr. Cuervo, adding that when services are closer to the people, the risks of transportation and the economic impact of the disease are reduced.

“I am excited about the possibility of improving the daily lives of families and patients facing high-cost illnesses by making it easier for them to access frequently used outpatient services without incurring lengthy trips,” Dr. Cuervo said.

In addition, he dreams of a future where no less than 95% of Cali residents can reach the most accessible high-complexity emergency rooms in no more than fifteen minutes by car.

Read more from the School of Civil and Geomatic Engineering: Univalle Researchers Are Mapping Floodplains To Minimize Risk To Life And Property

Impact in Cali, Latin America and the World

Dr. Cuervo explained that in order to achieve change at the public policy level, it is important to provide the best possible data presented in practical and easy-to-use forms.

“Communicating by addressing the needs of decision-makers and in understandable language we can reach the heart and reason,” Dr. Cuervo said, who is a post-graduate alumni of Univalle and maintains strong ties to the institution and his family in Cali, Colombia.

Photo: Profesor Jaramillo in the Transport Lab at the Universidad del Valle (Univalle)

“We want to provide the health and mobility secretariats and other agencies in the municipal government with tools that are useful for making public policy decisions, for example, moving health posts closer to vulnerable populations or repowering available services,” Professor Jaramillo said.

“Cali is the proof of concept, with the study exposing a simple and efficient approach,” added Professor Jaramillo.

Dr Cuervo added that beyond the authorities, the information is useful and appropriate for users and providers of health services, and for members of the community, especially now that the local mayoralties of the Special District are defined.

“It can be replicated in many Latin American cities, since many of them, and certainly in Colombia, already have travel time measurements and georeferenced data on populations and health services,” Dr. Cuervo said.
For example, a previous study revealed that in Dhaka, Bangladesh, a large city in Asia, only 63% of the city’s slum population is less than 60 minutes from most emergency services in congested traffic conditions.