Welcome to The Robin Hood Virus
A Book by Robert Nerbovig

                           Hospital Foundation Startup

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One of the struggling new non-profit start-up companies is WORLD RURAL HOSPITAL CORPORATION which is a non-HMO/PPO healthcare system that is instrumental in providing adequate primary medical care to people of any race, creed, color and walks of life in Emerging Nations around the globe. WRHC has undertaken the goal of providing those same people with both the basic directional assistance and the tools, in the form of jobs and education, to better themselves, their families, their communities, and their countries. THE IDEALS OF WRHC:
1. The needs of the patient come first.
2. Medicine which is focused on the needs of patients in communities, regions,

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nations, and the world.
3. Provide Emerging Nations with physicians, scientists, and other health professionals who are a dependable source of services and information.
4. Conduct basic and clinical research programs to improve patient care and to benefit our global society.
5. Treat everyone we encounter with respect and dignity.
6. Continuously improve all patient care, education and research.
7. Provide for and empower our employees to perform superior teamwork, take personal responsibility, and to seek the highest levels of integrity, innovation, trust, and communication.

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WRHC builds and operates hospitals around the world as a humanitarian, non-political, entity for the betterment of mankind.

The WRHC district hospital system is a collaborative design between WRHC and the local, regional, and/or the national government to make heath care a solution for the whole community. By providing affordable, and in some cases no-cost healthcare, the district hospital system supports the city as well as the outlying rural areas, which make up a single hospital district. Not only does a district hospital system provide a wide range of technical and administrative support for

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the community, but it also provides the training necessary for primary health care and community hygiene as well. Each WRHC hospital has the capacity for complete diagnostic care (with various clinics and departments), institutional/outpatient treatment, and rehabilitation, in order to insure that patients are guaranteed to receive the highest level of competence when dealing with their individual needs. In order for the district health system to recognize itself as an integral part of a district health system and of the larger health system beyond, it will share in district-wide information gathering, planning, implementation, and evaluation of health services programs, which will include budget reviews and the monitoring of programs through management and technological

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information systems. WRHC is currently designing an information and technology system in conjunction with several large and well known international companies which, when completed, will link every hospital and administrative facility to one another, around the planet. Our goal is to bring each hospital into the digital age by providing the latest in digital technology to the administrative offices, the operations areas, and right to the patient bedside. We can accomplish this by using slates, convertibles, and Personal Digital Assistants in conjunction with standard desktop technology. The system will move calls around the country or around the world at the touch of a button. Doctors will be able to exchange patient data, body imaging, and do so while seeing each other face

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to face via video conferencing. Surgeons will be able to utilize the latest in robotics and computer technology in surgical operations and surgical procedures to be carried out from a distance (telesurgery). We are fortunate to have some of the best technological minds available to accomplish this task.

Several factors in our methods of carrying out our goals for each country can have a significant impact on the economy of most emerging nations a moderately favorable impact on the economy of many countries who are not considered as emerging, but are still in their middle developmental stages. In many emerging nations three factors (among several)contribute significantly to a poor general

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1. Unemployment due to lack of marketable skills
2. A poor, Inadequate, healthcare system
3. A circumstance known as the "brain drain."
In many emerging nations the majority of employable workers are generally from an agrarian background. To work in the industrial sector they require training and education, which most countries cannot afford. International companies are not willing to spend the money required to bring the available work force up to standard when trained workers may be more readily available elsewhere. Healthcare in emerging nations is generally provided, sparingly, by the

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government and/or by relief organizations and religious organizations on a limited basis. While the quality of the physicians and nurses may be excellent, the hospital buildings and equipment are far below what might be considered "second rate" even by standards which are lower than those enjoyed in the United States and other developed nations. All access to treatment is really controlled by the financial ability of the patient to pay. Uganda (as an example) is a very poor country, where the annual income per capita is around $300, and 35 percent of the population earn less than $1.00 per day. The treatment for opportunistic diseases associated with HIV infection is too expensive for most people, so even when treatment is available (for example, amphotericin B for cryptococcal meningitis),

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most people will die without treatment because they cannot afford to pay for it. Less than 5 percent of cancer patients get radiotherapy or chemotherapy, usually too late to benefit from it. Therefore, anti-retrovirals for HIV are available if you can pay for them, but only 0.5 percent of people with HIV obtain antiretroviral treatment. What that means is that of the 1.44 million people currently living with HIV, only 7,200 people have access to anti-retrovirals. At present, many American donors are bringing in anti-retroviral drugs and health professionals are being given special training to use them. The monthly cost of these drugs is now $41 per person (in US dollars), which puts them out of reach of most of the population. To put this in perspective,

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consider that the amount of money required to provide medical care for every person in the country is $12 per person per year. The Ugandan government and private donors contribute $3.95 per person per year, and the patients have to come up with the rest. To treat one episode of malaria costs $4, so you can see that this is a very difficult situation. The burden on patients of paying for care is among the reasons why 57 percent of Ugandans do not generally access medical treatment. Another factor in this is that in Uganda, there is one doctor for approximately 19,000 people. However, the distribution of doctors is very unequal. Half the doctors in the country work in Kampala, the capital city. In the districts outside the capital, the ratio is one doctor to 50,000 people. So, when you

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think of all the other diseases from which people suffer in this country-AIDS is within the top five, but malaria is still number one. The doctors just can't cope with the number of people who need care Qualified physicians and nurses in many emerging nations make only a fraction of their counterparts in the United States, Canada, and Europe. Doctors are mobile people. That has to be accepted as a given. However, the problem that arises from this freedom of movement is that better-researched countries are able to recruit doctors from less well-developed countries, and the poorer the country, the most likely it is to lose its doctors - though that country arguably needs its doctors the most. How can a country like Kenya, which pays its doctors less than US$256 per month, compete with the

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salaries offered in more affluent nations? Medical doctors cannot live on a salary of fifty (50) dollars a month. To make ends meet, some medical doctors raise poultry or manage beer parlors. The brain drain is a historic as well as a recent phenomenon. Over four centuries, the slave ships brought the ancestors of 200 million Africans now living in the United States, Brazil, Jamaica and in the diaspora. These 200 million diasporan Africans have the highest standard of living and possess the education and skills that can be used to develop Africa but it will be impractical for them to return to Africa. Today, one in three African university graduates now lives and works outside Africa. There are more Sierra Leonean medical doctors in the city of Chicago than in the entire nation of Sierra Leone.

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Africa's most important export to Europe and the United States is trained professionals, not petroleum, gold, and/or diamonds. The widely held myth is that Africa is only exporting raw materials to the west. Africa is also exporting talented human resources to Europe and America. One million Africans are working outside Africa. At the same time, Africa spends four billion dollars a year on the salary of 100,000 foreign experts. Yet, African nations are unwilling to spend a similar amount of money to recruit one million African professionals currently working outside Africa. WRHC is in a perfect situation as our charter allows us to transcend these issues and contribute to the solution instead of acting as one more cog in the wheel of a seemingly never-

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ending problem.

Our hospitals are to be constructed of the best available materials using pre-fabrication design methods. This process of construction is intended to meet all standards set forth by the International Building Codes and Standards. While giving attention to the Standard Building Codes, it will also meet all Hospital Standards necessary, in order to provide a level of medical care equal to that of any modern hospital in the world. WRHC intends to usestate-of-the-art medical procedures and equipment. WRHC Personnel will be deployed to the hospital construction site. Approximately 150 WRHC personnel will make up an individual

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deployment team (World Team). These teams will include, at a minimum:
supervisors, carpenters, plumbers, electricians, trainers, inspectors, cooks, computer and communications specialists, HR representatives, administrators, payroll and finance specialists, medical personnel, water and waste systems specialists, mechanics, and heavy equipment operators. Once deployed, our teams will establish a construction compound to house, feed, and maintain the efforts of WRHC and local construction personnel while building the hospital. When the hospital is complete the World Team housing will become housing for single medical personnel working at the hospital.
The construction facilities will include:

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pure water facility, waste water facility, electrical generation, fuel storage, construction training facilities, dry and wet construction facilities, cold and dry food storage facility, kitchen, food service facility, dining hall, recreation hall, medical facility, construction administration facility, employee administration facility, housing, vehicle maintenance facility, laundry facility, tool storage, security facility, employee store, warm water generators, sanitary facility, shipping/receiving warehouse facility, general supply facility, construction supply facility, and in some cases we will need a helicopter maintenance and storage facility. Our preferred option is to install pre-fabrication factories at each hospital construction site. These facilities may be

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used after the completion of the hospital to fabricate panels for housing, community centers, commercial developments, and other suburban environments. The patented system relates to a pre-designed series of batteries, which contain vertically slung steel molds from which panels are cast to suit the production requirement. Additionally, a pre-designed number of steel molds are set up, on site, to produce columns and ground beams at a rate to suit the project requirements. The production compound, where the casting facility is located, is positioned on site to best suit the overall layout, also taking materials delivery into account. The pre-fabricated, structural panels can be manufactured in batteries of up to 25 per

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battery. Once cured, two or three men can easily manipulate these lightweight panels into place. Windows and other openings are planned into the battery as are electrical chases and some rudimentary plumbing lines. Once in place, the panels do not need an external covering, but will require an interior surfacing. Those panels used on the interior may not require any surfacing at all other than paint. All panels required for the construction of a single hospital can be manufactured in 30 days or less. The hospital will be constructed on a site designated and donated by the host country using experienced indigenous construction workers. This virtually assures WRHC of having access to a trained work force should any post-construction servicing or additions to the

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hospital building be necessary. WRHC will institute a training program for unskilled workers.

Our Architectural Design Group will be chartered with the task of coming up with as many as six basic hospital designs. While each will share many similarities, each will be slightly different in ways that can conform to minor changes in the landscape or to adapt to specific cultural requirements.

As often as the geo-environment will allow, we will be utilizing solar or co-generation power in all hospitals. The advantage of a single level hospital design is

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that we have massive rooftop spaces, which are perfect for solar fields, incorporating many banks of solar panels. A single level design allows us to make generous use of skylights, for the inclusion of natural light into the clinics, wards, and public spaces. The hospital design will include several interior courtyards, which will allow a greater opportunity for the circulation of natural air. The largest single issue will be the storage of excess electrical energy. In developed nations this excess energy can often be sent back into the established electrical grid with credit given to the initiator (the hospital). At night or during other periods when the solar cells won't provide the energy, the initiator can go back onto the grid to

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retrieve energy for operations. In less developed countries, this is an issue since the grid is often less reliable.

When the first WRHC Rural Hospital opens its suite of new operating rooms, we hope that it will signal a new way of performing surgery. For efficiency, the OR suite will be connected to the Shock Trauma Center and share recovery and sterile areas. Fully wired rooms will contain sterile environment computers, X-ray capability online, voice control lights, laparoscopic cameras and video-enhanced white boards. One room will be able to convert from interventional radiology/catheter lab to a conventional operating room, allowing surgeons to operate if a patient's condition

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deteriorates or presents an option for a combination angioplasty and open technique, without moving the patient. Another room will be copper shielded to prepare for a portable intra-operative MRI. Each OR will use high definition flat panel display screens for crisper details and greater videoscopic control in the body cavity. The screens will be moveable and can be placed for more optimal use by the surgical team as well as for observation outside the OR by students and others. The Chiefs of Surgery, Nursing, and Medicine, at the local level will have 24 hour access via closed circuit television to all surgeries in WRHC hospitals, anywhere in the world. Interested WRHC surgeons, physicians, and nursing staff, around the world will also be able to tune in to observe procedures or the

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introduction of new techniques. While today's OR is cluttered with equipment, cables and instrumentation, the WRHC operating rooms will house bulky equipment in sterile spaces connected to the suites, allowing immediate service access without impeding traffic flow in activity in the OR. Staff will no longer need to run or call from room to room asking about status. With video and other communication technologies, the WRHC suites will allow immediate visualization of all the operating rooms to offer a visual context in each OR and know if they need help if a patient has "crashed", or the surgical team has finished a case. The general OR area will house one or more medical simulators so surgeons and residents can practice new techniques. They can rehearse

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a procedure until they are comfortable. Simplifying the influx of information falls to a discipline called medical informatics, which assembles all patient information electronically. By scanning the patient's RFID device attached to the wrist, surgeons will be able immediately access patient histories and recent test results. Moreover, this hybrid of medical records and technology allows for enhanced documentation and connectivity with other medical departments.

Each new emergency room will contain the most advanced technology available in an emergency setting and offer multidisciplinary care across the entire medical spectrum. The new emergency department will also feature

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comforts designed to ease patient anxiety and promote privacy. Visibility and accessibility are key points for the WRHC Emergency rooms so that staff, and possibly security personnel, can be quickly alerted or informed in difficult situations. Each WRHC ER will feature a chest pain evaluation center, fast track services for patients who are not critically ill and immediate access to CT scan and other radiology services without leaving the suite. Patient rooms will be designed with privacy in mind, as well as workflow efficiency for the medical staff. The space will be designed to be more efficient and with patient and clinical needs in mind. As mentioned earlier, each unit will be next door to the Shock Trauma Center, the Operating Rooms, X-Ray, and the hyperbaric chamber.

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The floor plan is perhaps the most important design element and can only be addressed with new construction. By using a modified hexagon configuration or a circular design with the nursing station in the center, all rooms are equidistant from the staff. With this design, all rooms can be visible from the nursing station. Many hospitals have long corridors, which places some rooms at a great distance from the staff. This makes it necessary to triage patients and place those that are more ambulatory and less ill in the distant rooms. All patient corridors are visible from the nursing station and there are no dead ends where patients cannot be seen while ambulatory. It has been shown that an ideal number of beds for a critical core unit

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is twelve. Big is not always better when it comes to taking care of acutely ill patients. In any WRHC hospital room or ward environment, should a patient's condition deteriorate suddenly, then all the equipment needed will be built into the cabinetry, thereby avoiding a transfer to a critical care unit. This design allows for a comfortable and quiet environment, such that we have noted a virtual absence of confusion and disorientation. Heart patients are especially prone to sudden life-threatening events and therefore minute by minute monitoring is important rather than relying on sporadic "bed checks" during nursing rounds. Each area will be fully computerized with monitoring capability to allow all vital signs including pulse, EKG rhythm, blood pressure, oxygen

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saturation, and temperature to be visualized in the room and simultaneously at the nursing station. If only the EKG is being monitored at the nursing station, many patient problems may be missed until a crisis develops. Hospital acquired infections are of great concern especially with the rise of resistant bacteria. Recent studies have shown that both fungi and bacteria can grow in carpet and upholstery fabric. Linoleum when washed can harbor certain microbial organisms. In an effort to better sanitize and clean patient areas, our suites will have tiled floors with sealed epoxy grout, which is impervious to fluids. The majority of hospital injuries occur due to falls from beds. Both the likelihood of falling and the severity of the injury increase

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with age. Falls tend to occur in the first three days of a hospitalization when the patient is unfamiliar with the surroundings and may be early in the recovery from an operation. Most falls occur at night prompted by a need to use the bathroom and they are more frequent on medical-surgical floors where the nurse to patient ratio is lower therefore bed alarms are vital in these areas. Potential injuries in the shower are decreased by having built-in benches and grab bars. Fall-prevention interventions will involve using bed devices that have a built-in alarm system monitored in the room, and at the nursing station, using both visual and auditory signals to alert the staff that a patient is attempting to get out of bed without help. When this devise is used in combination with guardrails, we feel that

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falls can be decreased by an astounding 75%. Video cameras with night vision have been placed in each suite for added protection. These cameras can be adjusted from the nursing station to either give a panoramic view of the room or a zoom in on the patient to make sure that oxygen, catheters, and the like are not inadvertently discontinued by the patient. At each patient bed, a small flat panel LCD video display (approximately 6 by 11 inches) will be attached to an adjustable swing arm. This display can be used for a variety of things including, watching television, conferences with physicians and nursing staff, as well as the display of medical information and education regarding the individual patient's medical situation. Access to medical condition information

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(how does my new knee replacement work) will be initiated with the input of the patient's bar code identification. By utilizing this technology, our hope is that patients will be better informed and less frightened about upcoming procedures or their future.

     Diversion total to date    $207,500,000
     Donation total to date     $195,000,000

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