On a recent fact-finding tour of rural healthcare facilities in Rwanda and Mozambique, Edward Friedman, Director of the Howe School Center for Technology Management for Global Development, came to a sobering realization: the near total absence of doctors, nurses and other medical personnel.
Friedman has been researching sub-Saharan healthcare infrastructure for the United Nations Development Programme since 2006, with instructions to assess technology’s potential to boost the productivity of the region’s ragged patchwork of clinics.
Summing up the dire situation with a single stark ratio – one doctor for every 25,000 people – he quickly determined that advances would be inconceivable without the use of information technology.
“It struck me that it would not be possible to train enough healthcare workers to improve the system in any reasonable time period,” he recalled. “We would need to use computers.”
Back on the Stevens campus, he is working with a team of computer scientists, largely composed of undergraduates, on a computer-based primary health care system that would greatly expand the number of villagers receiving routine checkups, diagnoses for simple diseases and preventive medical services such as maternity and early childhood care.
The so-called Early Detection and Prevention System, developed several years ago for clinics in rural India, detects diseases and nutritional deficiencies by providing likely diagnoses based on patients’ symptoms. The Stevens team is adapting and enhancing it for use in Rwanda.
The system, which focuses on common, easily identified diseases, was designed so that technicians without prior medical or computer instruction could operate it after short training sessions. Clinic workers begin by entering patients’ health histories and other personal information, and then ask a series of questions about their current conditions. The program prompts follow-up queries based on those responses and ends by printing a summary of the information, accompanied by possible diagnoses.
The program requests additional information, such laboratory tests, based on its analysis. A trained healthcare worker then reviews the report.
While the system cannot resolve complex health problems, Friedman called it hugely effective nonetheless, “because in 70 percent of cases, patients don’t need a doctor.” It also prompts rural technicians to provide preventive care, such as visits to women flagged with high-risk pregnancies and vaccinations for children.
He identified the system, developed by the Indian-American entrepreneur and philanthropist, Abraham George, while conducting a worldwide search for effective healthcare models in rural, technology-deficient regions. His research took him to clinics in rural India, where patients had little experience of books, much less of computers.
“I thought the introduction of mysterious technology might be a big impediment, but they love it. The government clinics are so perfunctory. The workers there barely talk to them and patients feel anonymous,” Friedman recalled. “Here they get a printout of their visit, know that their story exists and that a health care worker has taken time to process it.”
Doctors in India, he added, say the preliminary health data contained in the printouts represents a significant time-savings, allowing them to see twice as many patients, while shortening their queues by eliminating unnecessary visits.
A five-member senior design team joined the project this fall to address another infrastructure challenge: the dearth of Internet connectivity throughout much of Africa. The students are engineering a critical piece of the healthcare network – a communications link between community healthcare workers in remote villages and doctors – that does not rely on the Internet.
They plan for workers to use cell phones as modems to send medical reports to a server, followed by text message alerts to physicians, who would use smart phones to access the site’s URL.
“Cell phone communications there may be even slower than a dial-up Internet connection,” said Frank Riccobono ’10, a member of the team. “Our challenges are to compress the data so it will transmit reliably and quickly, and to figure out how to display a large amount of data on a telephone screen that is no more than 2×4 inches so that the doctor can read it.”
Riccobono siad he was drawn to both the project’s technical challenges and “the chance to make a big difference.”
“I’ve read a lot about poverty and disease in developing countries, but I rarely ever hear about communications,” he said, adding, ““It’s not every day that a senior in college gets to help an entire country.”
While most international health care dollars are being spent on three diseases in Africa – HIV/AIDS, malaria and tuberculosis – Friedman believes it will be difficult to improve peoples’ lives substantially until comprehensive programs are in place to deal with general health issues that lead to infant and maternal mortality. This infrastructure must include clinics in walking distance of where people live, he says.
Friedman settled on Rwanda for the initial deployment after attending an African IT summit there in 2007 that also drew high-ranking officials from the World Bank, the United Nations and the government of China, as well as corporate and academic leaders. He was impressed with the country’s embrace of technology and its clever use of the little it had. In order to enhance Internet capacity at its hospitals, for example, the government requires its administrative agencies to stream all of their bits per second to hospitals after 6 p.m.
As Internet service and other communications links become more widely available, the clinics will be able to access specialists worldwide for online consultations, he adds.