So I’m talking to my doctor about possible drug interactions between various prescriptions and he pulls out a… (drum roll) palm treo. Oh okay so that’s probably not a major revelation.. doctors love Palm devices and have loved them pretty much since 3COM started making them back in the 90s. (Can I say that yet? Back in the 90s?) And of course my immediate reaction is to ask him what software he uses, mentioning that I’m looking into what software might be useful for rural clinics in developing countries (e.g. Ghana and Uganda and D.R. Congo). He replied: you only need one! It’s called Epocrates.. like Hippocrates, but with an ‘e’! Clever, huh? (Okay I’m paraphrasing, but only a tiny tiny bit.) Then he proceeded to show me a drug database, a symptoms database, and a diagnosis database, all hyperlinked together.
Of course – before everyone goes off running to deliver this very fine product to the masses of doctors in developing countries, there are a couple of catches. The data is very much geared towards doctors in the US, which has a number of implications. 1) Only the drugs that are available in the US are listed, and then with the US names. So, for example, many of the newer malaria medications which haven’t been approved in the US (like Coartem) won’t be there. And other drugs like paracetamol (as it is known in the UK and former British colonies like Ghana and Uganda) will be listed as acetaminophen. 2) There’s a yearly recurring cost of $100. Of course, this might not be out of reach for these doctors, and certainly is about equivalent in price to the paper versions of these reference guides, and about 1000 times more portable.. 3) The pathology is different – a doctor in the US wouldn’t expect TB, where a doctor in Uganda or Ghana would know to look for TB symptoms.
I bring all this up because I spent part of this past summer in Uganda with the 2007 East Africa Blum Fellows visiting some of the Uganda Health Information Network (UHIN) deployment sites in Lyantonde and Rakai. What struck me most was not the specific programs offered by the project (digital submission of health outpatient statistics, and dissemination of malaria and pediatric health information), but rather how they appropriated the devices, installing and sharing their own applications, and using the Excel application to track inventory and patient logs. They just drink up this data, reading whatever they can get to learn more about how they can care for the wide variety of conditions they see every day. So.. in addition to whatever information management functions I can put into place, I hope I can also help put more information in the hands of the doctors and clinicians and nurses I’m working with.
There’s of course still a lot of other issues to deal with – everything from power for recharging to the cost of the devices themselves (~$70 for a Palm, and $300 for a Palm+Mobile Treo) to maintenance and sustainability. I still want to try putting this type of information in their hands, with all of the appropriate warnings, as well as more locally specific information, like local health bulletins or Hesperian’s translated Where There is No Doctor series. Let me know if you have any suggestions for mobile health applications!
At Tigo, I finally pulled out all four phones, handed one to the agent, and asked for the access point. I managed to configure the three in my possession and get them working while she continued to poke around the preferences on my poor treo. Okay okay, to be fair, she was extremely helpful and friendly, and I’m altogether pretty happy with Tigo customer service. With Areeba, however… the whole thing was some weird bureacratic process… and I’ve been warned that I might have to go through it again when they switchover the name of their networks to MTN (