Dr. Eric Nelson is committed to the pursuit of accessible health care around the clock, both day and night.
The University of Florida Department of Environmental and Global Health and Department of Pediatrics associate professor has been with UF since 2016. Apart from his time at the UF College of Public Health and Health Professions, Dr. Nelson explores outbreak response and practicing as a pediatrician at UF Health Shands Hospital.
His broad experience in research and clinical medicine has laid the foundation for one of his most significant projects: MotoMeds, a telemedicine and medication delivery service, aiming to improve nighttime pediatric care in Haiti.
Housed in the UF Emerging Pathogens Institute, Dr. Nelson’s lab is grounded in providing solutions for large-scale outbreaks through the lens of cholera research, a waterborne disease that preys upon marginalized populations with vulnerable environments, ineffective government leadership, conflict or natural disasters.
“Anchoring your work in its mission, principles and values is essential,” he said. “We take a systems-based approach to consider the whole arc of an outbreak.”
The lab identifies “pain points” along the arc, then recruits teams to assess and address each dilemma through strategies like facilitating early access to care or developing clinical decision support software to aid the formulation of accurate diagnoses. From there, his team relays these outputs to public health officials.
As MotoMeds celebrates its four-year anniversary, Dr. Nelson reflects on the telemedicine service’s mission and progress since its inception in September 2019.
MotoMeds was conceptualized on a Jeep ride home from volunteering at a cholera treatment center in Port-au-Prince, Haiti, where Nelson and his team brainstormed solutions for addressing the gap in health care access throughout the night.
Oftentimes, pre-emergent illnesses like diarrhea, and the dehydration it causes, can escalate into emergencies during the nighttime hours when children are most vulnerable. Because of the lack of overnight access to essential resources, Nelson’s team would greet dehydrated patients in dire need of care when the clinic opened in the mornings.
With MotoMeds, parents of sick children can contact the call center located in Gressier, Haiti, at any time during the night, consult with a nurse who will develop a treatment plan and if necessary, receive basic medications delivered by a MotoMeds driver.
“MotoMeds allows a lot of children to access care during the night, especially the type of children whose families do not have many resources,” said Marlene Lindor, a MotoMeds call center nurse.
The service is currently offered using a sliding scale payment system, affording all families the opportunity to receive care, regardless of their ability to pay.
According to Nelson, MotoMeds serves between 100,000 and 200,000 people, primarily in Les Cayes, one of the largest cities in Haiti. To put this into perspective, Haiti’s population is approximately 11 million, surpassing the 10 million living in Sweden, a country 16 times larger in size.
“The need is massive in Haiti,” he emphasized. “It’s so important that we build something that’s resilient in that environment.”
An anonymous MotoMeds delivery driver in Les Cayes added that most Haitian hospitals deny families access to care without advance payment, leaving patients with nowhere to turn in life-or-death situations.
“But MotoMeds shows you that it’s care before money,” the driver said. “It’s life before money.”
When addressing universal access to basic health care, Nelson referenced Target 3.8 of the United Nations Sustainable Development Goals, which aims to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
Despite gradual improvements in health care access over the last century, Nelson said progress has stalled over the last 15 to 20 years and gone backward since COVID-19.
“If we keep using the same approaches year in and year out, it’s going to flatline forever,” he said.
Furthermore, new barriers to early care are constantly emerging due to factors like conflicts and infrastructure problems.
“So, we have to think outside the box,” he said. “MotoMeds is an evidence-based innovation that can bypass some of the main barriers to access care, including poverty, geographic isolation and nighttime presentation of illness.”
Another pressing issue that MotoMeds works to reverse is the colonization of global health. When U.S.-run public health centers are placed in foreign countries, the narration is often skewed toward championing American academics and staffing, he said.
“We work really hard to dispel the white-savior model of global health coming from a developed country into a developing country,” he said. “Part of decolonization is empowerment training and capacity building in these countries.”
The MotoMeds service is staffed entirely by local Haitian nurses and nurse practitioners, and motorcycle delivery drivers.
“It all runs under the umbrella of conducting research with ethical oversight,” he said. “And we monitor everything. If anything goes sideways, we identify it, and then, we train to address those problems.”
Most recently, a team led by Dr. Adam Levine at Brown University, in collaboration with Dr. Nelson’s team at UF, developed a set of guidelines that were published in The Lancet Global Health. The guideline presents a scoring system to address severe dehydration in patients who are experiencing diarrheal disease. The paper focuses on machine learning led by Dr. Levine to derive the scoring system. The models were then inserted into software developed by Dr. Nelson. The scoring system, and associated digital tools, outperform the current World Health Organization, or WHO guideline.
Now, his team is promoting the adoption of this new guideline with major partners worldwide.
For Nelson, witnessing the positive impact of his work take flight is a feeling unlike any other. He ultimately hopes to expand MotoMeds’ reach to assist as many people in need as possible.
“I used to think it was just about saving a life, but that’s a very ‘doctor-ly’ way of looking at it,” he said. “In public health, you want to create policies, terms and ideas that benefit a population beyond yourself—and that is what’s most fulfilling.”