FrontlineSMS:Medic: Text messages save lives

“Text messages save lives” announces a large red banner on the face page of the website for FrontlineSMS:Medic. True indeed!

The whole project began in the summer of 2008, when Josh Nesbit, a senior in the Human Biology program at Stanford University, with a concentration on International Health and Bioethics, traveled to St. Gabriel’s Hospital in rural Malawi. St. Gabriel’s serves a population of about 250,000 Malawians spread over an area 100 miles in radius. The poorest of the patients have to walk up to 100 miles to get to the hospital; while those with more resources can ride bicycles or oxcarts. Thus, as can be expected, people only come to the hospital when they must. In order to address concerns of peoples’ accessibility to the hospital, St. Gabriel’s has been using an approach that is becoming increasingly popular in similar clinics around the world. The hospital trains and employs volunteer community health workers who travel to the patients’ homes to check on them, deliver medication and serve as conduits of communication with the base hospital.

A problem that is often faced in contexts like this is the fact that the community health workers have to travel to places far from the hospital, and if they see something that might require immediate intervention, their only option is often to physically travel back to the hospital to make the report.

FrontlineSMS:Medic is poised to change this. FrontlineSMS is a mass text messaging software developed several years ago by software engineer and anthropologist, Ken Banks. It is available free of charge to nonprofits. FrontlineSMS:Medic is a specialized version developed for public health applications similar to one described above in Malawi, by a collaboration set up between Ken Banks, Josh Nesbit and a team of dedicated volunteer software developers and community activists. All it requires is community health workers equipped with the very basic mobile phones, some training in sending and receiving text messages, and one laptop in a central location (such as the local hospital) connected to a GSM modem and running FrontlineSMS:Medic. At very little cost even by local standards, a community health worker can be in instant contact with the base hospital, reporting in their day’s observations and any emergencies that might come up. Not only that, various automated routines can be easily set up. For example, any incoming message from a community health worker containing the name of a drug automatically sends back a response indicating the correct dosage, side effects and common cross-reactivities of that drug.

Further developments are on the horizon. For instance, charging the mobile phones in remote locations where the community health workers function can be challenging. Nesbit and collaborators are exploring several sources of cheap and easily transported solar panels, that can be used to charge the mobile phones when electricity is unavailable or unreliable. With proper planning, these panels can be shared between several community health workers working in a given area.

The team is also exploring the use of camera phones, so greater degree of multimedia use can be implemented.

There are also thoughts of eliminating the laptop altogether, which will further cut costs. One possibility being explored envisages the use of the Android – the new mobile platform from Google – as a hub for several dozen community health workers.

Similar projects based on FrontlineSMS:Medic are now being implemented in other countries such as Bangladesh, Burundi, Uganda and Honduras.

As technology gets further refined and operating procedures better ironed out, there is no doubt that projects using FrontlineSMS and possibly other similar applications will continue to spread to other resource poor areas of the world. One concern that has been raised regarding this approach is that using text messaging requires basic literacy among the health workers, and the ability to use English or a handful of other language scripts. However, as camera phones and other types of multimedia applications become more integrated into cheaper and cheaper cell phones, it is foreseeable in the near future that this type of technology may be within the reach of community health workers who do not have the requisite literacy in the requisite languages. Indeed, it is only human imagination that sets a limit on what is possible!

Solar power to sterilize medical instruments in rural clinics

Here is an inspiring story of a young engineering student from University of Dayton whose summer internship in rural Nicaragua eventually led to the founding of a nonprofit organization with the goal of harnessing solar power to improve healthcare in that community, and possibly, in time, in many others around the world.

It is common knowledge that one of the banes of poor rural clinics anywhere in the world is the unavailability of sterile dressing and surgical instruments. Unlike the large metropolises in affluent countries where the emphasis is on single-use disposable instruments to the extent possible, many poor clinics have only one or two sets of scissors, scalpels and the like. If one operation of an infected carbuncle has just concluded and you walk with a bleeding knee with a piece of bone sticking out… well, you’re just out of luck. The careful doctor or nurse or often a less formally trained healthcare worker will just wash off the instruments with water (which may not be clean to start with) and soap (if available), dab some disinfectant if you’re really lucky, and then off you go under the knife! Autoclaving, defined as the technique for sterilization of clinical equipment and supplies by subjecting them to high-pressure steam at 121° C or more for a certain period of time, is simply a luxury (in terms of power and/or fuel costs) that cannot be indulged in more than once a day or less. The result could be post-surgical infections, which are, in any case, more likely to fester when the patient is malnourished, has poor hygiene, and lives in a place that is hot and humid.

If the new nonprofit, Salud del Sol (Spanish for “Sun Health”), is successful in its mission, this situation may soon start changing, at least in one tiny corner of the world.

It all started with Lori Hanna, then a sophomore in Mechanical Engineering, traveling to Nicaragua in the summer of 2006 for an internship program through her school. There, she was to work with a community group called Las Mujeres Solares (Spanish for “The Solar Women”). This group was started with help from Grupo Fenix, a local organization dedicated to researching, developing and applying appropriate, renewable-energy technologies in Nicaragua. Grupo Fenix taught these women how to build and use the solar cookers. The solar cookers made a big impact in the community, because they save fuel (firewood), are a safe place to store food between meals, and can be used to bring in extra income.

Lori, just like any other intern in her place, was duly impressed by how this simple technology had changed the lives of these rural women, and also by the dedication and energy of these “solar women”. What was unusual, however, was that she did not stop there. Further enquiry revealed a project that involved redesigning these solar cookers to serve as autoclaves to sterilize clinical instruments, which had been initiated and later abandoned as that particular funding source had dried up.

Lori took this idea and ran with it. She decided to do her honors thesis on this redesign, and later involved other classmates from different disciplines, until in 2008 she and her friends won an award for their business plan for a nonprofit based on this technology, and the new nonprofit, Salud del Sol, was born. The mission of this new nonprofit is to provide communities in Nicaragua with the opportunity to improve their own healthcare systems by building and selling solar autoclaves, thereby also creating monetary incentives for members of these communities. The founders of Salud del Sol have visions of expanding this project all over Nicaragua, and possibly to other countries. Thankfully, the sun is one resource that is generally abundantly available in most resource-poor places of the world. Interestingly also, the Salud del Sol website provides free access to a detailed design of the solar autoclave, so it is readily available to any nonprofit or social business which wants to utilize it. The website also lists current major challenges in solar autoclave design, and solicits thoughts and ideas from readers to improve them.

A tale of camels, the sun and vaccine refrigeration

Yes, you read it right! There is in fact a thread of logic – very sound logic, if I may add – that connects camels, the sun (or solar panels to be precise), and vaccine refrigeration. Professor Winston (Wolé) Soboyejo, a professor of engineering at Princeton University, and a native of Nigeria, has devised a simple, yet elegant way to refrigerate vaccines as they are transported on camel back to remote places with no road access. In a must-see video, Professor Soboyejo describes the challenge. In these remote places, the only way for children to be vaccinated is for the vaccines to be brought in from the cities first by land rovers and then by camel trains. The roughly week-long journey in the places he studied (Kenya, Ethiopia) is not only arduous, but also wasteful. In current practice, the vaccines are kept refrigerated by ice packs. Once the vaccine container is opened, all the vaccine that is not used up before the ice melts, is wasted. Professor Soboyejo and collaborators thus came up with a simple (apparently!) plan – if Mohammed cannot go to the mountain, then bring the mountain to Mohammed! In other words, they decided that a self-sustained and economical powerpack will travel with the vaccines – on camelback. Deserts have ample sunlight. So, they decided to use solar panels to charge batteries, which would in turn keep the refrigerators cold at all times. They optimized their design on real camels – of all places – in the Bronx Zoo! In the development process, they had to overcome some unanticipated challenges, e.g., the variation in the hump sizes of camels! With exquisite forethought, the solar cells were designed to be lightweight and built with locally available material. For example, the frames are made of bamboo. The vision is that this technology will not only deliver vaccines safely to children in remote desert lands, but also spawn local industry which will manufacture the solar cells. Bravo!