Providing health care in rural and remote areas: lessons from the international space station

Circumnavigating the globe every 90 minutes, 400 km above the Earth’s surface and at a speed of 27 600 km per hour, the international space station typically does not evoke thoughts of rural Haiti. This aerospace behemoth contains some of the most expensive, most advanced technology ever designed. An isolated extraterrestrial outpost of humanity, it represents a marvel of human engineering and ingenuity. It is this very isolation, ironically, that gives it something in common with rural areas in low- and middle-income countries here on Earth. In many parts of the world, basic emergency and acute medical care is lacking. 1 Comparing the international space station’s systems with efforts underway to address the lack of rural and remote health-care services may help clinicians, researchers and policy-makers develop new ideas and improve on existing practices. What happens when an astronaut on the space station has a medical emergency? Certainly, the entire space station cannot gently glide its way down to Earth. At least one Soyuz spacecraft is usually docked for evacuation but there are usually only a few astronauts in the space station at a time. It is not practical for several astronauts to return to Earth accompanying the patient. It would take up to 24 hours for an astronaut to return to the ground to receive medical care – precious time lost for someone in a critical condition. 2 The United