A rural hospital in Malawi is revolutionizing health care for 250,000 people thanks to a free software program, two laptop computers and a bagful of recycled second-hand mobile phones that now link it with a widely-scattered network of community volunteers. The mobile-phone-based health care initiative uses SMS (short messaging service) or texting to link doctors, nurses, staff and volunteers within the 100 square miles around St. Gabriel’s Hospital in Namitete, helping to overcome the distances between the villages and the hospital.
Like other hospitals in Malawi, a very poor country, St. Gabriel’s bears a huge health burden. Malawi has a national HIV prevalence rate of 15%-20%, and tuberculosis, malaria, pneumonia and malnutrition ravage many HIV/AIDS patients. Children orphaned by AIDS will be as much as one-tenth of the country's population by 2010. With just two doctors and a handful of clinical officers, the hospital relies heavily on more than 600 volunteers who work as Community Health Workers in the hospital's antiretroviral (ARV) treatment program -- drug therapy for HIV/AIDS. Some CHWs are HIV and TB drug adherence monitors; others accompany patients during long journeys -- up to 100 miles, often by foot -- to the hospital. Until now, real time communications between the volunteers and hospital staff has been impossible; now, their text messages are allowing the hospital to make best use of its scarce resources.
FrontlineSMS is a free software program that turns a laptop and mobile phone into a central communications hub that lets users to send and receive text messages with large groups of people through mobile phones. Ken Banks created the software in 2005 after realizing that, while Africans were quickly adopting mobile phones, many were older recycled phones that could not handle data services. To use mobile phones as a communications tool, NGOs needed to use text messages – and for that, they needed a messaging hub that wasn’t web-based. His FrontlineSMS met a need in much of the developing world, and is now being used by nonprofit groups in more than 40 countries for a wide range of activities.
Stanford University student Josh Nesbit had visited St. Gabriel’s and, hearing about Banks’ work, sought him out at Stanford last year. The result was that Josh returned to Malawi with the first version of FrontlineSMS, a laptop computer, and Nokia 6100 mobile phone. The hospital began to explore how mobile phones could help them with patient followup, drug adherence monitoring, and answering medical questions from the community. That work led to this year’s pilot project, which is being funded by the Haas Center for Public Service at Stanford University and the Donald A. Strauss Foundation.
"FrontlineSMS is being used to connect the hospital with its CHWs, expanding the role of the volunteers,” says Josh. “Drug adherence monitors are able to message the hospital, reporting how local patients are doing on their TB or HIV drug regimens. Home-Based Care volunteers are sent texts with names of patients that need to be traced, and their condition is reported. 'People Living with HIV and AIDS' (PLWHA) Support Group Leaders can use FrontlineSMS to communicate meeting times. Volunteers can be messaged before the hospital's mobile testing and immunization teams arrive in their village, so they can mobilize the community. Essentially, FrontlineSMS has adopted the new role of coordinating a far-reaching community health network." In the first few hours of the pilot program, a deceased patient's extra ARVs were secured, the Home-Based Care Unit was alerted of ailing patients, and meetings were arranged (and subsequently re-arranged).
“Solutions to these types of communication problems needn't cost vast amounts of money or take months or years to develop,” says Banks. With so many mobile phones in circulation, what is missing “are the tools to do the job -- in this case a piece of free software and a bag full of second-hand, recycled mobile phones.”
The new communication system soon will be used to let villagers know about free HIV/AIDS testing. PointCare will bring its self-contained testing unit to the villages, rather than people having to travel twice to the hospital’s central laboratory. Funded through the World Bank’s competitive Development Marketplace, the testing unit will report T-cell depletion, anemia and abnormal white cell differentials on the spot, allowing health care workers to know when treatment should start.
The success of the Malawi pilot has inspired Josh to put together a team called FrontlineSMSMedic, which is supporting community health workers in the developing world using appropriate technology. FrontlineSMS:Medic is harnessing the power of global partnerships with healthcare providers, the accessibility of free and open-source software, and the resources provided by an innovative collection campaign, Hope Phones. "We provide tools, not solutions or programs. It’s up to local partners to apply these tools. By empowering clinics to run their own mobile health initiatives, we’re fostering sustainable projects based on need as well as assets."
"ChWs help ensure continuity of care in settings where there are few health professionals, where travel is difficult, and where chronic diseases require complex treatment regimens and ongoing monitoring. As CHWs travel from clinics to reach isolated patients, they face substantial challenges in communicating medical information. Currently, patient interactions are recorded on paper and subsequently brought to clinicians. These records are often informal, and riddled with erroneous or incomplete data. Additionally, CHWs often travel by foot and serve such large areas that they may return to their clinic as seldom as once a month. Patients can have their symptoms documented by CHWs but remain untreated due to slowly-processed medical information."
For other stories of how technology is being used in health care, see:
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