ictdchick

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!

As a follow-up to my missions trip to Goma this past summer my teammates and I did a two hour presentation for our church, talking about what we did, and what we’re planning to do.

Normally I’m pretty skeptical about missions. I mean really - what depth is there to going out to beaches over spring break and walking up to random strangers to tell them about God? It’s pure proselytization. But over the past few years I’ve been taking development classes and talking to people in Ghana, and I’ve realized that missions are not purely evangelical; many of the schools and hospitals in Africa are missions in which people have devoted their time and skills towards God’s mission of feeding the hungry, clothing the poor, and curing the sick. But still.. what can one do with two weeks? Short missions trips are always ultimately for the benefit of the person going and not to the community supposedly being served.

This trip was different. We gathered together as a multi-disciplinary group of people who wanted to go to Goma to listen to the people there, to hear what needs were there, and to serve in whatever way we could. We preached, installed wireless routers, and taught workshops on how to play with children. We even painted a mural! I really think we made a difference… and I can’t wait to go back.

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Hi all,

I gave a presentation at the Blum Student Symposium last Thursday.

For anyone that’s interested, the slides (65MB) are downloadable here:

http://tier.cs.berkeley.edu/~melissa/blum-symposium-oct-04-07.ppt

The talk was about current health information practices in rural health clinics in Uganda, how PDAs have been integrated into a particular district, and our projections for what we’re working on now.

The future symposiums look really interesting (See Blum Event Calendar for times and locations):

Legal Aid Organizations and the Rule of Law in Sudan
Presentation by Mark Massoud, Jurisprudence and Social Policy Program Graduate Student
Thursday, November 1st

Media and Development in Zambia
Presentation by Laura Hubbard, Visiting Faculty, Anthropology
Thursday, November 15

Reducing Rape and Mutilation in Darfur with Fuel Efficient Stoves
Presentation by Susan Amrose, Graduate Student, Energy & Resources Group
Thursday, November 29th

I’m terrible with the cross-posting..

For those of you interested in my work in Goma, Congo, check out my team blog:
http://gomateam.blogspot.com

Also, for a more recent technical update, you can check out Eric Nguyen’s blog here:
http://mindtangle.net/2007/09/08/work-update/

For those of you interested in learning more about HEAL Africa, PBS is showing a documentary called Lumo on KQED Channel 9 on Tuesday, September 18 at 11:00 PM. (Those of you not in the Bay Area can check your local listings on the website: http://www.gomafilmproject.org/ ). My church (fpcberkeley.org) is also hosting a preview viewing on Sunday, September 16 at 7:00 PM in G 202.

One of my (many) projects here was to set up GPRS for my multitude of smartphones.  Out of the array I brought with me to Africa, I selected four to bring to Ghana, picking that number so I would have two and each of Paul and Rowena could use one. The finalists: my trusty personal treo650, which gets carted around because it has all my contacts on it and (I confess), Backgammon; the E-ten Glofiish, which runs windows mobile 5, has a slider keyboard, and a very large screen, not to mention a radio, GPS, and all the other bells and whistles a phone can have; the HPs710, another slider phone, considerably smaller, with an additional numeric keyboard, but no touch screen, my current favorite, if only because it was the only one I configured to check email successfully in Uganda; and the HTCP3600, the phone with no keyboard whatsover, but for some reason actually seems to be the most stable.

So one Friday I set out with a mission: to set up all my phones with Areeba Data Services and Tigo GPRS/EDGE. I found the addresses of the head offices, figured out a route, and resolutely headed into the traffic.  Altogether the process was a lot more hassle than strictly necessary.  If they had just put the name of the access point on the website, I could have pretty much done all the work myself.  Instead, I spent three hours at Areeba and another hour at Tigo, trying to convince them that I knew perfectly well how to configure my own phones, no matter how many other know-it-alls had come into their office before. :)  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 (they were recently acquired). But to get to the interesting part:

How to Configure your GSM Mobile for GPRS:

As it turns out, neither Areeba nor Tigo require any authentication, nor any particular special configuration.  So, if you can find the GPRS settings on your phone (under Preferencs on Palm, and under Settings -> Connections on WM) then you just need to set up a connection pointing to the right access point, and to make sure that the phone uses the right access point settings for whatever SIM card you have inserted.  For Areeba, you actually do have to go to the head office, because they have to "activate" your GPRS service on the network, tied to the SIM, because they charge an activation fee of 50,000 cedis (5 Ghana cedis,  aprox. $6).

Areeba Data Services
Access Point: internet.areeba.com.gh
SIM Card: 15,000 cedis, including 10,000 airtime
Airtime: 45,000 minimum balance recommended
Activation: 50,000 cedis
Charges: 19.89 cedis/kb

Tigo GPRS/EDGE
Access Point: web.tigo.com.gh
Authentication: not required, but if necessary you can use User:web/Pass:webhost
SIM Card: 15,000 cedis, including 10,000 airtime
Airtime: no recommendation (I purchased 40,000)
Activation: none
Charges: 9.2 cedis/kb

It’s been noted to me that Areeba is more expensive because they are bigger. Of course - if you are a Tigo customer and most people are on Areeba you are paying a lot more in airtime charges than Areeba customers that never talk to Tigo customers. So I guess it just depends on what your friends have. Or you can be like a lot of the people I see here and just have two SIM cards, one on each network.

Areeba was a bit of a struggle, so if you want to just be a casual Internet user, I suggest trying Tigo or possibly Kasapa (I haven’t tried Kasapa though!).  They are considerably larger and seem to have set up a bureacracy around customer service.  I was given a number and told to head upstairs, where I periodically shifted seats towards the front of the line and I severely objected to their as-yet-unexplained need to make a copy of my driver’s license.  I wasn’t afraid they were going to steal it - I just felt it was completely unnecessary for them to take it.  From there I talked to one agent, who asked me to wait while she served the other customers because it would take 40 minutes to configure my phone.  I waited, and at the end of 20 minutes was told to fill out a form and go pay the activation fee.  When I also mentioned that I needed another SIM card and air time… I was told that I couldn’t pay for the activation until I had a signature on the form with the sim card number and that I had to buy the airtime at yet another counter. But I couldn’t get the signature until I had paid for the SIM card.  Three visits to various cashiers, and one more visit to the customer service rep later, I finally sat down, with the appropriate signatures and lots of money paid to configure the phones.  After that it was relatively simple - she did some things on her computer to authorize my SIM chip, poked around and configured a phone, turned it off and on, and picked yahoo.com to show me that it worked.  I was a little miffed because Yahoo.com is not exactly a small page (m.yahoo.com is okay) and I was obviously paying for the download, so I stopped the page load and picked up m.gmail.com instead, sans images. The end result though!  I can now check my email even when the power goes out.  Ah the miracles of technology!

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It’s been a busy couple of weeks, with not nearly enough access to internet cafes!

This week I am back in Mbarara, currently using the computer science lab (which is empty because the students are all doing exams now), but also meeting with various professors here (again!) and working with Ben and Richard on the Smartphones for OBA project.

The major update is that we are now collaborating with the Faculty of Science at Mbarara (Physics Dept) to figure out solar power options for the health clinics participating in the OBA program. They are currently engaged in research evaluating the degradation of imported solar panels and are the perfect collaborators for this project. They also have experience with circuit-soldering, so they’ll try to use Manuel’s solar charge controllers both for their own experiments and our project.

We also visited the Marie Stopes International Uganda office and one of the Marie Stopes Uganda clinics. They are currently using the VMUS database developed by Microcare, and have two people entering the data from the (triplicate-carbon-copy) forms that are collected from the various clinics participating in the OBA program. Right now the system is down, so the forms are piling up, and they are entering the data into Excel, so they can process the reimbursements. I’ll head back there today or tomorrow to hammer on the SmartForm and figure out exactly what it should look like. At the clinic we spoke to Steven about his experience participating in the program. The major issues he identified are timeliness of reimbursement processing, limitations on the range of treatment options (if someone is diagnosed with a non-STI bacterial infection then they have to pay for treatment in addition to what they paid for the voucher, although I think the consult is covered), and patients coming in with vouchers that clearly don’t have an STI, and therefore are not eligible for subsidized treatment.  So there is a need for better and clearer marketing.  Richard suggested giving distributors placards that (literate) patients can read so they know what services the voucher will cover.  They also have problems with people going to multiple centers, and not having documentation for previous visits, or buying multiple vouchers and having tests done unnecessarily.   We hope that with the SmartForms project we’ll be able to address some of these issues, by making voucher records more accessible, and improving the communications process around the form submissions.  There’s lots of ideas flying around and a lot of work to do!

For the rest of the week (before I take off for Ghana) Richard and Ben and I will be visiting the various health clinics and talking to them about the project, getting a feel for their willingness/interest, as well as the environment in which the phones would be deployed.  We’ll start testing/piloting in August when I get back.

The culmination of our many many meetings was our presentations to the Ministry of Health and the Member of Parliament (MP) for Nakaseke district.  (Although admittedly the MP meeting was a bit of a surprise, so a bit extemporaneous.)  We had been spending our evenings in Luwero (the town near Nakaseke where we were staying) processing everything we learned, and our days visiting the health centers.  We interviewed the in-charges, nursing assistants, and records officers/assistants at 3-4 health centers a day, and asked about stock management, health information reporting, and the general challenges they each faced in their daily work.  Almost none of the lower health centers (HCIIs and HCIIIs) had power (”We use lamps”), but even in the HCs with power the staff had mobile phones.  In those cases, they charge the phone by sending it off overnight with a matatu (the public mini-bus system) driver for the price of 500 shillings.  Most people have nokia candybars that stay charged for about 4 days.

I’m impressed overall with the staff we’ve talked to, and with how well all of the health centers comply with the Ministry of Health’s health information reporting policies.  They each submit weekly reports on highly infectious diseases (sometimes by SMS) as well as more comprehensive (4 page) monthly reports on stock levels, outpatient population, and diagnoses. In Rakai (another district) they submit these reports via PDA and gprs - here, they submit on paper in person to the district hospital in Nakaseke.

You can check out our findings in the presentation we made to the MoH, along with some ideas for integrating smartphones into their existing system.  The presentations (ours and that of the ICT team) were well received, and we are all looking forward to further collaboration on a project proposal, and hopefully a pilot once we receive funding to move forward.  There’s a lot of questions left to be answered (how do we balance paper and digital records? What about power?) and a lot of work to be done, but I have high hopes that handheld computing and communication devices like smartphones can make a positive impact on healthcare in Africa!