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March, 2009:

WECARE goes to Africa Part III

Laura’s back in Africa for her third trip to Kofan Gayan Memorial Hospital, a rural municipal hospital (district hospital) in northern Nigeria, where she’s provisioning solar power to support lighting (led headlamps and DC led floodlamps) and communications (icom walkie talkies) for a maternity ward.  While she’s there, she’s emailing periodic updates about her progress, which I’ll crosspost here.

From:  Laura Stachel

Cross-posted from wecaresolar.com
Hello friends and family,
I’ve been in Nigeria for 5 days and it’s been a whirlwind of activity and accomplishments. Please take a look at the WE CARE website: www.wecaresolar.com if you want some detailed updates. The solar project is phenomenal – the solar panels are being installed, wiring is being done, and lights will be up in the maternity ward, operating room, and labor and delivery by the end of Monday. We’ve also installed outlets to enable suctioning in the operating room, and ongoing battery charging for the walkie-talkies and LED headlamps. Nurses in ALL of the wards are using the LED headlamps, and I’m learning that they are no longer having to postpone critical nursing care due to lighting problems. So intravenous lines are being placed on time, babies are getting the antibiotics they need, and stress levels are going down. The new antenna for the walkie talkies has been installed, and the repeater will be put in place on Monday. Then I will test the system to
verify that the walkie talkies will extend for 12 miles. That means that all the hospital employees on call will be able to use them, not just the ones who live on the hospital grounds. I also met with a group of visiting American doctors and convinced them to donate surgical supplies to the labor and delivery ward.  Finally, I have been observing and working with hospital staff, who have asked me to initiate a meeting next week to review difficult cases with poor outcomes, and to promote improved standards of care. They see me as  an allie and have responded to my gentle criticisms of their care in the most productive way possible.

And for the most special surprise – I procured a solar powered blood bank refrigerator and solar panels for the laboratory today

I’m going to be visiting the ministry of health on Monday, because the hospital wants to have a celebration in honor of WE CARE on Wednesday.

I haven’t been sending out my field notes about hospital care as I have in the past. I have been witness to many sensitive things, and worry about publicizing this for the world to see. If you would like any of my notes for your personal perusal, just let me know. They are at least as detailed and moving as the ones I blogged a year ago.

Finally, some of you have asked me how to make donations.  If you have not had a chance to make a donation to the WE CARE project and would like to, the website will accommodate donations through PAYPAL for a tiny fee, or you can send a check to: WE CARE, 3009 Hillegass Ave, Berkeley, CA. 94705.

They Fixed the Kindle!

Omigoodness. I managed to get my hands on a Kindle 2 this past weekend and aside from the fact that the Whispernet (Amazon’s renaming of Sprint’s EVDO Internet service) is totally inaccessible for me, and it would be an absolute pain for me to actually put any books on the device, I really really really want the new Kindle. :)


Kindle 2 ($360) Kindle (discont’d) Sony Reader PRS-505  ($299)

My major complaints about the original Kindle were that it was flimsy, thick, clunky, and the buttons were not well designed. The plastic it was designed from made its weight distribution funny – so it actually even aggravated my tendonitis. I liked the WhisperNet feature, and the keyboard – but the slowness of the screen made annotating books a pain at best, and referencing the annotations wasn’t really useful enough to merit the design flaws. Amazon’s closed ebook format isn’t great either – most of stuff I want to read just happens not to be available in Kindle format (i.e. academic papers, textbooks, papers that I’m reviewing/editing), so I ended up with the Sony Reader which supports viewing of native PDFs as images, with additional support for portrait or landscape viewing (I wish there was a button), and a zoom button for magnifying the text if you have OCR’d text accompanying the image. Since I didn’t want to take a suitcase full of books with me to Uganda, I sliced the bindings off of them, scanned them to pdf and OCR’d them, and I’m reading them on my reader instead. Much better carrying a slim e-book reader on the plane than the 2-inch thick copy of James Scott’s Seeing Like a State.

The Kindle 2 is even slimmer than the Sony Reader, also comes with a leather case, and has the advantage of incorporating wireless and a keyboards for just $60 more. Kindle has access to a larger selection of copyrighted e-books, “Kindle Editions” at much better prices, with a much cleaner interface. Sony’s software, frankly, is flaky, slow, and crashes a lot. But at least I can put my PDFs on it directly. I think for the Kindle I still would have to email my PDFs to amazon and pay them 10-15 cents to upload them to the Kindle in some weird, potentially mangled, format. I might be able to put up with that from Berkeley, but depending on email access for giant PDFs out here is totally impossible. And I like my WYSIWYG PDFs. In that sort of vein – Sony’s ebook philosophies are actually more “free thinking” than Amazon’s (for all those copyleft people out there) and the Sony Reader supports the open eBook format (ePub), and as Wired notes, actually provides access to more public domain books than Amazon offers on the Kindle through a recent deal with Google Books.

What I really want is for Amazon to build a Kindle that supports GSM, so I can stick a Ugandan SIM card in it and download Kindle books over the local network? Please? Or I guess I can wait until i get back next year…

I have this vague theory that the Kindle devices might make decent computing platforms for rural areas.  Imagine – data connectivity, low-powered devices that don’t need to be charged more than once every two weeks or so, built-in keyboards, screens that are visible in sunlight, a large screen, and a price point comparable to smartphones, or less?  What the heck am I doing working with smartphones with tiny screens, batteries that die in a day, and keyboards that are too small for healthworkers to read?  Oh yeah… waiting for the ebooks to take off, the platform to stabilize and open up, and um.. trying to finish up my dissertation before starting another project. But if amazon is willing to throw some summer interns at me this year, and a few Kindles, I think I could manage to host them here in Uganda.  Umm.  We just need to find an EVDO network or get Sprint to subsidize the roaming charges? =)  Anyone know someone at Amazon?

There’s also a Sony Reader PRS-700, which I haven’t seen, retailing for $399. It includes an LED light (which I think is great, since I can’t get my booklights to attach, and I think it is lame to have to wear my headlamp to bed, or to have to lift the mosquito net to turn off the lamp on my nightstand), and a touchscreen. I can’t imagine how the touchscreen actually works – I think it’s something I’ll have to see to really understand/evaluate.  But ultimately I think Sony will have to move towards integrating wireless into their readers…

Orange Telecom Launches in Uganda

One of the more quiet headlines of the week in Kampala is the launch of a new mobile service provider – the France Telecom owned Orange Telecom. Reactions are mixed but hopeful. Orange is the 5th major operator here, following South African owned MTN, Zain (pakistani-owned? Formerly known as Celtel), Uganda Telecom/Mango, and Warid (also foreign owned). Village Phone is a virtual network operator, using high gain antennas to extend MTN’s network to fixed locations in remote villages.

By far and away, MTN is the dominant operator. Zain/Celtel was the first to market, but as my Ugandan friends say “then they started cheating us, overcharging – we will not forget.” So when MTN arrived with giant masts, reliable infrastructure, and fair rates, the Ugandans switched en masse.

UTL is the government owned operator (they may be partially privatized, I would have to check), so they also carry the stigma of distrust of high prices, as well as perception of inadequate infrastructure. In my experience – their GPRS is great, EDGE is not so good, but their overall coverage is not as widespread as MTN or Zain.

Warid is a new arrival – as of about 2 years ago, and already they have a reputation for being an all-over network – that is what their billboards say (if you have time, browse my flickr photos from fall 2008). They don’t have huge market share yet but people say they will make gains. In the meantime, they are also entering the broadband market, offering low cost Internet services via a city-wide WiMax network at less than $100/month with minimal installation costs. Revolutionary in an area where VSAT is the norm.

Orange. Another provide means more competition. Will it force an existing provider out of business by driving prices lower? Will more money go into infrastructure rollout in rural areas?

Another extremely important aspect of telecommunications rollout in Uganda is the Uganda Communication Commission’s rural communications development fund, the RCDF. Using part of the income from the taxes on the voice communications, take bids from the mobile phone operators to fund projects to develop unreached rural areas that don’t have mobile coverage yet – and might not be a viable market normally. I think it is structured well here, with a good balance of investment in innovation and practical deployment. Orange has the potential to be another player here, if they are willing to participate in Uganda’s development, and not just trying to tap the mobile phone market. The two can be mutually beneficial. We shall see.

First HealthyBaby Birth

The mother receives the baby from the nurses at the clinic.

The mother receives the baby from the nurses at the clinic.

As I have been pre-occupied with writing lectures for my class, and setting up my research, my collaborating partners at Marie Stopes International Uganda have been busy launching a new phase of the output-based aid voucher program, financing in-hospital delivery of babies, in addition to the in-clinic treatment of sexually-transmitted infections (STIs). The new program, called HealthyBaby is eligible to mothers who qualify under a specific poverty baseline and covers four antenatal visits, the delivery, and a postnatal visit. Last week they just started distributing vouchers, and this past weekend was the delivery of the first baby whose birth was covered by the program.

Like the HealthyLife program, the mother purchases a voucher for 3000 USh (approximately 1.50 USD, the HealthyLife program charges 3000USh for a pair of vouchers treating both sexual partners). The voucher then can be broken into several sticker stubs, one of which is submitted with a claim form on each visit.

The first mother puts her thumb print on the HealthyBaby claim form

The first mother puts her thumb print on the HealthyBaby claim form

The hospital then submits the claim form with the voucher to the funding agency (my collaborating organization), who then pays the hospital for the cost of the visit – labs, any prescriptions given, the consultation fee, etc. You can see in the picture to the right the nurse filling out the paper form and the mother putting her thumbprint on it. Filling out the forms can be tedious and error prone – this particular clinic had almost 18% of their STI claims rejected for errors last October. In the same month another clinics had 38.6% of their claims rejected. I am trying to work on digital systems that can help improve communications between the clinics and the funding agency, and also decrease the cost and burden of claims administration.

The Claim Mobile project actually focuses on the HealthyLife program – the STI treatment program, rather than the HealthyBaby program, but I hope to demonstrate the sustainability and replicability of the system that I’m developing by training the engineers here to retool my system for HealthyBaby – so by the time I leave, I am hoping it will be in place for both programs.

By coincidence, this first birth occurred in one of the two clinics where I’m running the pre-pilot of the Claim Mobile system.

The Drawbacks of Having the Perfect Noise Isolating Headset in Uganda

I love my headset. I got them at Costco a few years back after months of research, and hours of pestering Joe Hall and various other friends on what kind I should get, whether noise-canceling technology was actually worth the money, etc etc etc.

The fact was that I spent a lot of time on airplanes and figured it might be worth the investment to spend some money on a headset such that I might be able to hear music and my recorded interview data over the sound of the airplane engines! And sometimes it is nice to be able to sit in a shared office and have some privacy.

The long and short of my research: Noise Canceling technology requires batteries and external power, and is ultimately bulkier and heavier. Noise isolation is great because you can actually turn down the volume being sent towards your ears, they work like earplugs, and it doesn’t require additional power. And they are cheaper. But it can be a little weird because – you are totally deaf to the outside world (i.e. you can’t tell if a flight attendant is trying to get your attention), and if you eat something you can hear yourself chewing, and sometimes they don’t work so well if you are running. Mine are fine as long as the cords are hanging relatively free, since V-Moda redesigned the cables with a cloth cover.

You can plan ahead, but sometimes you have to improvise a bit to make high-tech things work once you leave home...

You can plan ahead, but sometimes you have to improvise a bit to make high-tech things work once you leave home...

The V-Moda ones are especially great (not that I’ve actually compared them) because they come with a carrying case. The ones I got came with a little compact leather case that open when you pinch it, and a v-shaped cord wrapper, which was initially a little mysterious to me but now I think is the best thing ever. I want one for all of my corded accessories! Unfortunately the new ones don’t come with the v-shaped thing – they come instead with a rectangular carrying case sized for the iPhone and the iPod Touch. I don’t blame them, but as an iPod Nano owner I’m glad I got my headset earlier.

Okay so that was a long intro. Onto my sob story. I was walking home the other day from work, and I decided to listen to one of my interviews on the way, so I pulled out my Nano, and my headset. As I connect the headset to my nano, I notice that one of the silicon ear fittings is missing. I should note that this happens to me almost every plane flight – these things fall off all the time and it drives me nuts. Why I don’t have spares is beyond me, but they give you three pairs in different sizes (small, medium, large), so I just picked my size and left the other two pairs at home when I came. On a plane, this is mostly fine – I mean, where can a little black rubber thing go on a plane anyways? I’ve always found it eventually. But this time, when i pulled the headset out, I managed to drop the earfitting onto an area of the ground littered with black pebbles, bits of trash, and random grass growth… and a ditch. Yikes. Ever hopeful, I searched anyways, to no avail.

So I walked home, listening to the interview, with one ear happily isolated from noise, and the other ear listening to the interview and the caws of the maribou vulture-storks, with a piece of metal uncomfortably perched in the canal. I had thought through this situation before, and I plotted, considering my options, and wondering if I could wait for someone to bring a batch of spare fittings to me in April…

My solution: well, since noise-isolating headsets are essentially earplugs with sound coming through them, why not use earplugs? So I got out an earplug, my handy-dandy leatherman, and hollowed out the center. The leatherman, as it turns out isn’t all that useful for hollowing out the centers of things, so once I made divots on either end of the earplug, and cut it to the appropriate length, I used the pen from my Palm Centro to poke a hole through the center, such that the middle could grip well onto the headset. I think it actually works better than the silicon fitting – at least it is less likely to fall off, even though it doesn’t look nearly as slick. And now it is much easier to tell the left from the right.

It goes to say that 1) I’m pretty privileged to have the gadgets that I do have, 2) to have the options that I have with which to fix them and 3) I should have brought extra silicon fittings with me (I’m not a boy, but the boy scout motto is Be Prepared after all). But I think this also says a lot about ICTD and technology transfer in general. What happens when we take information technologies and deposit them in developing regions without a thought towards their repair and maintenance?

Eventually things break, parts get lost, and things must be repaired. And spare parts don’t exist, or even if they do exist, or can be acquired, they are difficult or too expensive to acquire. So some people improvise. Others just allow the donated equipment to lie fallow until a new donation arrives, or another benefactor comes to repair the equipment. I have seen rooms full of dead computer equipment, “computer graveyards,” in Mexico, India, Ghana, and Uganda. I like mobile phone projects because there is a rapidly growing infrastructure and ecosystem outside of our own projects to support the repair and replacement of the mobile phones we are deploying – yet the truth is that often we are using very specialized phones. So even as mobile phone project developers we must be aware of the maintainability and serviceability of our devices. At least these objects are generally familiar to mobile phone service reps! (Maybe less so the android phone and the Palm phone. The blackberry seems to have gained popularity though. Obama has given it a popularity boost out here too!) Laptops are serviceable because they can be carried to a service center. But desktops are the hardest to carry because people are afraid to move them – afraid to break them, especially with the associated heavy CRT monitors.

And so while I was able to repair my headset, I have to admit that my solution isn’t perfect – they certainly aren’t the same as they were before. Getting the technology out here is one thing – making it work over a long period of time is yet another.