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New app gives Thailand’s healthcare chance to go paperless

A doctor using the Family Folder Collector app on an Android pad, collecting information on a member patient. Photo Credit: bangkokpost.com

Thailand’s public health system has developed a mobile app for Android enabled tablet PC’s to monitor and collect household information on patients. The app, called Family Folder Collector (FFC), was developed by a research team at the National Electronics and Computer Technology Centre (Nectec).

Nectec researcher Watcharakon Noothong said the application comprises three major programs, including a walking map, genogram (a pictorial display of a patient’s health and family relationships) and Java Health Center Information System (JHCIS) synchronization.

FFC is designed to make life easier for public health workers who collect data on patients and for patients who are on time sensitive treatment schedules and cannot travel to health stations at any given moment for treatment.

The app is free. The only cost to utilize the service is paying for the tablet PC’s which is being covered by the province’s public health office.

Here are some of the features and capabilities of the FFC app:

  • Google maps shows the exact location and number of households in a given area
  • Genograms can be displayed
  • Chronic disease frequency can be color coded on a house-to-house basis
  • The program can collect and store other vital data, such as a patient’s weight, height, blood pressure and pulse rate, and even calculate a patient’s body mass index (BMI) automatically.
  • The program provides forms for treatment results, initial symptoms, health recommendations, and health behaviors
  • Doctors can schedule future appointments with patients
  • In the near future, the program will also be able to send an SMS to alert patients to get treatment at the health station.

All the collected data is updated and stored on the Android device then synchronized to the JHCIS database server. Public health workers were trained on how to properly input data into the tablet PC’s before pilot testing started. Of a total of 25 districts in the province of Ubon Ratchathani, eight are running the pilot trial of the FFC program, which, in its first phase, covers 123 health stations.

Ubon Ratchathani was chosen as the province since its existing IT infrastructure can accommodate sophisticated ICT’s for healthcare. There are over 1.8 million people in the province, all of whom will be accounted for by health workers using the FFC app.

This do-it-all app is a valuable tool for public health officials and physicians in Thailand. FFC can potentially replace the paper based system of collecting data and monitoring patients in Thailand.

The FFC application can display a genogram, monitor chronic diseases with Google Maps, and locate the house coordinates using a GPS system. Photo Credit: bangkokpost.com

The potential benefits of using this service are bountiful. Patient data will be gathered much easier and will be much harder to lose over time. Doctors can schedule appointments and prescribe treatments without physically seeing patients. Also, analysis of patient data will be faster, more efficient and more accurate.

Thailand may experience a revolution in healthcare if this service lives up to its potential. Currently, each health station has one tablet PC equipped with the program. The FFC application is expected to run throughout the province covering all 346 health stations by 2012.

Furthermore, according to Sinchai Tawwuttanakidgul, director of ICT Centre, Office of the Permanent Secretary, Ministry of Public Health, today there are some 45 provinces that are ready to switch from their paper-based system to the FFC mobile application. It sounds like Thailand is ready to experience that revolution soon.

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Gamification: The future of mHealth?

Photo Credit: mashable.com

A report that was released at the end of July highlighted the emergence of gamification in mobile services, especially in mHealth. In the report, the term gamification is defined as “the use of gameplay mechanics for non-game applications. The term also suggests the process of using game thinking to solve problems and engage audiences.”

Therefore, in the realm of healthcare, gamification refers to the use of game mechanics or game principles in mHealth applications. In some mHealth circles, a sub field has emerged call health games, which are games that are intended to improve the health of the users. The report suggests that gamification is the future of mobile, web and social media technology.

These gaming apps are designed to alleviate health burdens by promoting healthy behaviors and actions, and educating users on the nature of the burden itself.

For instance, there could be a gaming app on the importance of having an insecticide treated bed net for malaria prevention. The app could educate the user on how malaria is contracted and how to treat it by presenting a series of questions to answer for a prize.

At its most basic level, these apps can reward the user with virtual or actual incentives as they complete certain actions that attenuate a health burden. The incentive encourages the user to perform the action.

A recent Gartner report predicts that by 2015, more than 50% of organizations will gamify their innovation processes. “By 2014, a gamified service for consumer goods marketing and customer retention will become as important as Facebook, eBay or Amazon, and more than 70% of Global 2000 organizations will have at least one gamified application,” says the report.

SCVNGR founder Seth Priebatsch agrees. “It feels like the next natural evolution of human-technological interaction to me,” he says. As we complete the social layer, we’ll begin construction in earnest on the game layer.”

In the realm of health, gaming apps can be used as tools to encourage a diet plan, educate about a disease, promote drug adherence, and present treatment options. According to experts, one indirect result is that along with promoting certain actions towards improving health, the games may also generate positive attitudes and improve emotional states towards achieving better health.

Photo Credit: texttochange.org

In the developing world, one such app exists called Freedom HIV/AIDS that was implemented in India and Africa. Designed to promote HIV/AIDS awareness, the app offers games themed for its location. For instance, in India, safety cricket, and Quiz with Babu were just some of the games through which HIV/AIDS awareness was promoted.

Text to Change(TTC) is another mobile service that offers gaming apps to its participants. Implemented in Africa, TTC offers quiz games that educate participants about different health burdens. In the end of the quizzes, incentives are provided to the participants. TTC’s services have been popular with UNICEF, WHO, UN and USAID initiatives.

The games are a great way to engage people with health campaigns that may otherwise be neglected due to lack of social interaction. Another report says that gaming apps can help overcome the guilt associating with failing to complete a health program. The report says, “ Games help patients manage that guilt.  The game navigates patients through their story of successes and failures until they ultimately become victorious.”

If this is one of the roads that will be embarked by mHealth apps, and mobile apps as a whole, at least it will be a fun one. After all, when was the last time anyone had fun learning about HIV/AIDS or vaccinations?

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Sachs says Millennium Villages are a model to avoid famine

Photo credit: Millenium Villages

Last week, renowned development economist and special advisor to the UN secretary for the millennium development goals, Jeffrey Sachs, wrote a series of public articles advocating for use of “cutting-edge technologies” to fight the current epidemic and to create sustainable solutions to avoid famine in the first place.  He said that the Millennium Villages are a good example of ways to use technology in order to anticipate and prevent drought and famine from spreading.
What technologies are the Millennium Villages using?  How do these technologies inform and assist villagers to mitigate potential food insecurity and the affects of climate change?
As listed on the Millennium Villages website, the main goals that for ICTs include:

  • Establish and improve mobile telephone and internet connection
  • Greater access to energy, improved transport and information and communication technologies (ICT)

In addition, each village has individualized goals and projects, depending on their circumstances and resources.  Many of the villages have implemented mHealth initiatives, computer laboratories, other ICT-related projects.  Just a few have organized ICT projects to ensure energy and environmental sustainability.  Those few include:

  • Dertu, Kenya – In 2008, in partnership with Ericsson, Dertu received a cell tower and Internet connectivity; Sony-donated laptops provide Internet access at the school
  • Ruhiira, Uganda – Schools and clinics now have access to electricity through low-cost solar technologies
  • Ruhiira, Uganda – Partnership with Zain and Ericsson has increased cell phone coverage through the construction of cell towers

Perhaps additional ICT-based projects are underway to ensure environmental sustainability and avoid the long-term effects of drought, but they are not listed on the Millennium Villages website.  Sachs’ claim that ICTs have decreased famine and anticipated drought in the Millennium Villages, then, is possibly true, but is not verified by documented evidence available on their website.  A more detailed evaluation of the villages is needed, or a report synthesizing the lessons learned from the ICT projects completed.
As many have pointed out over the past few months during the famine and drought in the horn of Africa, famine is preventable when the circulation of goods is active and well-planned.  Stable distribution of goods, and monitoring of climate change and weather patterns is key to ensuring food security, environmental sustainability, and consistent agricultural production.  ICTs can aid in all of these practices, but their effectiveness is in need of additional documentation and review.

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USAID Famine Early Warning System Helps Trigger Response

Malnourish child in hospital Photo Credit: Abdi Warsameh, AP

Photo Credit: Abdi Warsameh, AP

Farhiya Abdulkadir, 5, from southern Somalia, suffers from malnutrition and lies on a bed at Banadir hospital in Mogadishu, Somalia. Her growth is stunted, her belly engorged, and the muscular tissues keeping her organs functioning are slowly wearing away—the five-year-old is deteriorating to death.

Farhiya is dying from famine, starvation, and malnutrition; but a packet of the peanut buttery Plumpy’nut could help bring her back to life.

The U.N. declared a famine late last month in parts of southern Somalia where tens of thousands of people, mostly children, have died, in what aid officials call the worst humanitarian crisis in the troubled country in over two decades.

Despite dire conditions, where one-third of the population of Somalia is facing starvation, militant Islamist group al-Shabaab has been deflecting international aid where help is needed the most.

A couple weeks ago, Edward Carr who works in famine response for USAID on the ground in the Horn of Africa, observed that despite similar drought conditions in Kenya and Ethiopia, the state of Southern Somalia is critical, “we cannot get into these areas with our aid…famine stops at the Somali border”.

How does he know, then, exactly where aid is needed, how much is needed, and will be needed in the upcoming months?

The USAID-supported Famine Early Warning Systems Network (FEWS NET) is a system helps to identify timely information on the most affected areas, urging the global humanitarian community to move quickly and scale up their relief efforts on evolving food security issues.

FEWS NET summarizes the causes for the famine as:

The total failure of the October-December Deyr rains (secondary season) and the poor performance of the April-June Gu rains (primary season) have resulted in crop failure, reduced labor demand, poor livestock body conditions, and excess animal mortality.

FEWS NET estimates that a total of 3.2 million people require immediate, lifesaving humanitarian assistance, including 2.8 million people in southern Somalia—highlighted areas are the Bakool agropastoral livelihood zones, and all areas of Lower Shabelle.

So what is the next step?

FEWS NET identifies these issues, and using a group of communications and decision support tools, recommending decision makers to act quickly in order to mitigate food insecurity in Southern Somalia. These tools include briefings and support for contingency and response planning efforts.

Currently, FEWS NET has helped organizations, such as the U.N. Food and Agriculture Organization’s (FAO), the Red Cross, and U.N. groups, such as the World Food Program (WFP), who are on the ground delivering aid, obtain timely information on what is needed and where.

Last Wednesday, WFP deployed a plane from Kenya with 10 tons of food—one of the many airlifts of the nutritional packets that will take place in the upcoming months.

The FEWS NET Food Security Outlook in the Horn of Africa for August-September 2011 predicts that in these upcoming months, the famine will inevitably spread and last until at least December.

Hopefully, the FEWS NET is the type of system that will help automate an humanitarian response from the international community—helping internally displaced children like Farhiya suffering from malnutrition, eat something before their condition deteriorates.

 

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A Film Festival Among the Refugees in the Horn of Africa

Man holding video camera casts a shadow on a Film Aid logo

Photo Credit: Film Aid

From July 14-21, this year, refugees at the Dadaab, Kakuma, and Nairobi camps in Kenya enjoyed a new film each night as part of the annual FilmAid Festival, run by FilmForward and FilmAid. The film festival provided entertainment to refugees, as well as a portal for reflection and hope. In addition, educational films were showcased during the day about pressing issues in the camps, such as healthcare, agricultural production, gender-based violence, and drug abuse.
The impact of FilmAid’s programs are difficult to quantify and measure. They affect individuals psychologically and emotionally, but not directly economically or in terms of educational achievement or literacy. Arguably, however, the entertainment and education provided by FilmAid gives people hope, helping them to continue struggling for survival at the refugee camps.

During the day, FilmAid runs its MADS (Mass Audience Daytime Screening) educational films. When possible, the films are produced in part by local people in the camps. Here is an example of a short film produced in Haiti last year to educate refugees on the importance of planting crops and how to water them sufficiently.

 

Additionally, FilmAid worked with local refugees in the three camps to produce short films, which are then shown at the film festival. The films display a level of self-awareness and touch on present social issues in the camps themselves. These films are the epitome of local content produced for a local need.
Last week, FilmAid received a $50,000 grant from the Hollywood Press Association, in part due to their efforts in the Horn of Africa. Grants such as this keep the organization funded and functioning.

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Somali at Dadaab Camp text UN aid tip…

Somali refugee with her child

Credit: WFP/Judith Schuler

Responding to the food security needs of those affected by famine in the Horn of Africa is an enormous logistical challenge…

The most severe drought in a half a decade has made the already unstable region, particularly Somalia, an even more food insecure place. The United Nations is on the cusp of declaring a full-blown famine in Somalia, having deemed nearly a third of the country’s regions (5 of 18) to be experiencing a famine, which means more than 30% of people in those areas are subject to malnutrition—a quarter of all Somalis can relate. Upwards of 12 million people are caught in this perilous situation that also found toeholds in sections of Dijibouti, Ethiopia and Kenya.

The food crisis (and all out famine in parts) is made worse by drought, but high fuel and food prices, and longstanding conflict in the region are primary causes. This makes for an especially complex emergency, where getting the right kinds of aid to people when and where they need it most, logistics, requires smart tools and strategies. This gives credence to the rapid shift in how development aid is being managed and deployed, to a point where technology becomes a vital tool in emergence response.

The ongoing crisis in the Horn of Africa underscores this. The last issue of The Economist carried an article with an insightful lead that quotes a text message from a Somali affected by famine. The sender declared ‘“MY NAME is Mohammed Sokor, writing to you from Dagahaley refugee camp in Dadaab. Dear Sir, there is an alarming issue here. People are given too few kilograms of food. You must help.” Mr. Sokor texted his appeal to two United Nations officials, in London and Nairobi, after finding their numbers on the internet while surfing at a café at the north Kenyan camp.

As many have observed, Mr. Sakor’s strategic use of a near ubiquitous ICT, his mobile-phone, signals the rapidly transforming relationship between the senders and receivers of aid. It is clear that greater accountability and agility will become a demand from the bottom-up. Increasingly, aid recipients will influence the kinds of aid they receive, where and how they get it. “In the humanitarian operation of the future,” says Save the Children’s Mr Porter, “beneficiaries of emergency aid will use technology to tell us what they need—cash, food, or education—find out from us what to expect, and track its arrival, just as we can track an order from Amazon.com now.”

But, the relationship between food security and logistics supersedes complex humanitarian scenarios. As I contend in a previous blog, food insecurity is caused by a wide range of factors, including declining yields, inadequate investment in research and infrastructure, and increased water scarcity, but it is also brought about by immense waste. Logistical woes is a key cause for much of this waste. For instance, more than a third of crops reaped never gets to market in edible fashion because of poor value chain management and practices.

Long term development of the agricultural systems in the region must focus on using logistics technology to improve transportation and warehousing of produce. It’s crucial that we reduce food waste in the drive to improve food security.

 

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To UNICEF and WHO: Don’t forget to monitor your vaccines

Children and women waiting to get diagnosed in clinic. Photo Credit: WHO

In the wake of the drought and famine being experienced in the Horn of Africa, multiple vaccination campaigns have been launched in the region. UNICEF, WHO and Kenya’s Ministry of Health (MOH) are launching a campaign for the children situated in the Dadaab refugee camp in Northern Kenya, which is already triple the amount beyond its refugee capacity. UNICEF is also launching a solo campaign for children in the Horn of Africa, with a particular focus on Somalia.

The UNICEF and WHO-backed campaign in Dadaab will target 202,665 children under five years of age, with measles and polio vaccines, together with Vitamin A and de-worming tablets. The campaign is part of a regional push to ensure all children in drought affected areas are vaccinated against a killer disease like measles which can be deadly for malnourished children, and be protected from polio.

The solo UNICEF campaign for the rest of the Horn of Africa includes a strategy to vaccinate every child in Somalia under the age of 15 against measles which totals over 2.5 million children.

“This is a child survival crisis,” said Elhadj As Sy, UNICEF Regional Director for Eastern and Southern Africa. “Children don’t die just because they don’t have enough food. In various stages of malnutrition, they are more prone to sickness and disease. As big a challenge as the rates of malnutrition pose, the danger for children extends even further.”

“Malnutrition can weaken a child’s immune system, increasing their susceptibility to infectious diseases like measles and polio,” says Ibrahim Conteh, UNICEF Dadaab Emergency Coordinator. “We are acting now because these diseases can spread very quickly in overcrowded conditions like we have now in the camps.”

Measles is a highly contagious disease which can flourish in unsanitary and overcrowded environments like refugee camps. Measles reduces a child’s resistance to illness and makes them more likely to die when they are malnourished and suffering from other diseases.

Launching a vaccination campaign in the Horn of Africa is no simple task, even without a drought crisis to worry about. The region experiences atrocious coverage rates as evidenced by Southern Somalia where vaccination coverage is just 26%, one of the lowest in the world.

This suggests that there may be issues with the cold chain transportation of vaccines in the region. In the developing world, transporting vaccinations is complicated as high temperatures, scarce resources, unreliable electricity, and long distances between health care facilities can all break the chain.

Mobile vaccine refrigerator. Photo Credit: True Energy

This means that as UNICEF, WHO and the Kenyan MOH roll out of their campaigns, they must take extra precautions to make sure vaccine spoilage is minimized as much as possible. So many children’s lives depend on the vaccines being functional and on time.

Most, if not all of the vaccines being distributed in the campaigns will be transported using mobile vaccine refrigerators. There are mobile refrigerators currently in use all over the developing world that utilize innovative vaccine monitoring systems.

SmartConnect box

True Energy, a company highlighted in the past supplies a grid powered or solar powered refrigerator that offers vial vaccine monitoring to monitor the temperature of the vaccines along the cold chain. They also include a SmartConnect SMS monitoring system that sends out an SMS to the recipient alerting them of temperature changes along the cold chain for instantaneous monitoring.

PATH is one organization that has purchased these vaccine refrigerators with the SmartConnect capability. UNICEF has also commissioned these refrigerators from True Energy and is shipping the refrigerators for use in over 30 countries. Furthermore, the True Energy refrigerators meet WHO cold chain requirements.

Therefore, there should be no excuse for inadequate monitoring of vaccines amidst the vaccination campaigns. The technologies exist to ensure cold chain efficiency. Moreover, UNICEF and WHO have both recently dabbled with these existing technologies.

With reports that the drought in the Horn of Africa has not yet reached its peak, the vaccination efforts must be successful or millions of children may suffer the consequences.

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The Caribbean and Climate Change?

Although Caribbean countries are low greenhouse gas emitters, they will disproportionately bear the potential economic effects of continued climate change: greater loss from hurricanes, diminished tourism revenue, and infrastructural damage. According to the report “The Caribbean and Climate Change: The Costs of Inaction”, a study commissioned by Environmental Defense Fund (EDF), the cost of inaction will amount to more than a fifth of GDP by 2100 in Dominica, Grenada, Haiti, St. Kitts & Nevis and Turks & Caicos.

While the region is off to a slow start in its adaptation and mitigation measures, Guyana embarked on a Low Carbon Development Strategy last year, which it says creates a path for the a low deforestation, low carbon, climate resilient economy—a green growth environment. This is an indicator of the state’s commitment to utilize Information and Communication Technologies (ICTs) to improve environmental management and respond to climate change. According to the OECD’s Directorate for Science, Technology and Industry, the biggest gains for smarter environmental and economic strategies and applications are in power generation and distribution, buildings and transportation, sectors which are major emitters of greenhouse gases. To that list, one would add endangered biodiversity, and water management systems–major concerns for the sparsely populated country.

However, Guyana’s admirable green economy backed by ICTs will depend on massive improvements in ICT infrastructure (service and access), that is available to and used by a larger portion of the population. Currently, Guyanese have less access to internet, broadband and personal computers than the average for Latin America and the Caribbean. Improving these indicators will be crucial for the state to achieve its objective of doubling the number of Guyanese employed in the Business Process Outsourcing industry by 2013.

 

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MediBabble: A free tool no health professional should be without

Dr. Brad Cohn (left) and Dr. Alex Blau (right) Photo Credit: ucsf.edu

An Apple app was released earlier this summer that translates medical history questions from English into other languages. The app, called MediBabble, was designed by doctors Alex Blau and Brad Cohn, a duo of physicians from San Francisco.

The idea for the app sprouted from a 2 a.m. conversation while the two were still in medical school. The conversation stemmed from frustrations over not being able to understand patients that did not speak English, and not having an immediate translating tool to help them out.

“Ninety percent of diagnoses come from the patient’s self-reported medical history, so the ability to communicate is critical,” Blau said. “Time is not an asset doctors or patients have. You need that information when you need it.”

MediBabble is currently being distributed for free on Apple’s iTunes, and has more than 8,000 downloads to date. The app has been lauded by several mHealth entities and has even won a few awards for its benefits to the medical world.

MediBabble was designed for Apple products with touch-screen software, such as the iPhone or iPad. The app allows health care providers to play medical history questions and instructions out loud, so far in five languages, to patients that don’t understand English. Currently, the available languages are Spanish, Mandarin, Cantonese, Russian and Haitian Creole.

The questions range from basic examination questions such as “Can you tell me your name?” to more specific inquiries like, “Do you get recurring lung infections?” The app has more than 2,500 exam questions in its arsenal to translate.

Photo Credit: itunes.apple.com

MediBabble’s interface is structured on a symptom-based approach already commonly used by medical practitioners worldwide. It starts by gathering information about the current complaint and then proceeds into social, family and medication histories; and a review of systems; all for over sixty common chief complaints across eleven organ systems.

According to Blau and Cohn, no medical translation app existed prior to theirs. Therefore, this is the first of its kind seen anywhere. A key feature is that the internet is not needed for full functionality. Once downloaded, the app can be utilized anywhere, at anytime as long as the mobile device has power.

This tool is currently paying dividends for health professionals in the developed world. However, MediBabble can easily be utilized by health processionals that encounter language barriers working on the ground in developing countries. The fifth language, Haitian Creole, was implemented for the earthquakes that struck Haiti in 2010. Therefore, it had already transcended the domestic boundaries.

After taking a look at its features, one realizes that the app is already acclimated for use in the developing world:

  • Once downloaded, it does not require an internet connection to deliver its service
  • it provides detailed examination instructions to the user
  • it has a self-guided tutorial that can teach someone like a community health worker or volunteer how to use it on the fly
  • it compensates for the deaf and/or noisy environments by having a mode that enables a full screen display in large letters

Utilizing MediBabble, health professionals from the developed world who go on aid missions around the world will worry less about language barriers. This may decrease the time it takes to examine a patient which means more patients can be examined and treated in the long run. The tool can change the way health workers interact with and treat citizens of the developing world. Therefore, aid agencies and NGO’s that deploy health professionals cannot overlook this tool.

Perhaps it won’t be long until MediBabble is used in the developing world. Blau and Cohn said the next five languages being introduced are German, French, Urdu, Hindi and Arabic. Four of those five tongues are predominantly spoken in certain developing countries.

Furthermore, Blau and Cohn intend to keep their app free. So far they have been able to do it with funding contributions from Apple, Google and Twitter. As long as the app is free, the tool will cost health professionals nothing, making it even more appealing for use in resource poor areas.

 

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Texts and Balances: Nigeria’s 2011 Election

Photo: MobileActive

In Nigeria’s presidential election this April, election observers sent over 35,000 daily text messages to document validity or corruption of the election counting and results.  The theory behind Project Swift Count 2011 was that having election observers at voting locations around the nation equipped with mobile phones could immediately report foul play.  The theory worked—statistically significant samples by independent organizations verified the published election results from the Nigerian election bureau—indicating that corruption was minimal or nonexistent.

The National Democratic Institute worked with the government of Nigeria to hire 8000 election observers to monitor 4000 voting stations.  A parallel vote count was collected and corruption monitored and reported.  The observers documented peoples votes, whether they were pressured by anyone, and if all the candidates were listed.  Then, the observers each sent a minimum of five text messages during the course of voting to verify the following events:

Photo: NDI

1. Voting accreditation booths opened on time

2. Closing of accreditation booths on time

3. Close of voting booths

4. Starting time of vote counting

5. Accurate reporting of final votes at verified time the next day

Subsequently, political corruption was stymied and the election results were accurate in terms of the sample NDI collected.  President Jonathan Goodluck was elected in a fair and clean democratic election.

The project cost around nine million dollars in total, including an independent evaluation of the funds.  A group of independent researchers, including Katrin Verclas of MobileActive, carried out the evaluation, and found that nearly all the money could be accounted as originally proposed.  These clean results have motivated other countries to utilize this system as well.  NDI is currently working with Zambia to monitor their next elections with a similar plan.

Given the high use of mobile phones and the live stream of communication possible via SMS, mobile phones present another solution to promoting democratic elections.  And with the spread of mobile satellite service around Africa, this project is scalable in other nations.

 

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