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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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E-agriculture…Let’s look at projects in the Caribbean

Radio's signage at the head office

Credit: Radio Toco

E-agriculture typifies the shift from struggling industrial economies to a knowledge-based entrepreneurial economic landscape driven by rapid technological innovation.

ICTs, which are increasingly viewed as tools that can enable farmers to work smarter and boost their returns, have functioned as a source of empowerment, boosting and building capacities, through highly efficient knowledge sharing processes.

Here are two ways in which e-agriculture is helping to transform the Caribbean’s agricultural sector.

  • AgriTalk: An initiative of the Caribbean Farmers Network (CaFAN)

Objective: To facilitate a community of knowledge network of practice for Small Farm Holders and Farm associations and stakeholders across 16 Caribbean Islands by probiding cheap network communications using innovative digital technologies (VOIP) to facilitate timely agriculture related information (market prices, information about fertilizers, crop varieties etc.)

Approach: Partner with Mobile Telecom & VOIP Providers to create a closed user group service at a low cost to members of the network.

Regional-CaFAN- VOIP (ATA Adapters)-Peer Network & Gateway-Pilot

Internet Access- Low cost Edge Service -(Data Cards) Modem and Router – US$20/month

Local Level- CUG with Local Mobile Network -(Digital or C&W) -US$5/month (Free SMS)

VOIP Gateway – At each Network Contact Point (using SMS or code)

Beneficiaries: Nearly 1 million farmers

Benefits to community: Better prices, reliable information, Ease in selling their products etc…

Driving Agency: CaFAN, Farmer Associations

Objective: Aimed at serving the community and broadcasting community programs to alleviate poverty through information and ICTs.

Radio Toco came on stream in November 1997, with UNESCO/UNDP assistance within the framework of UNESCO’s special program “Women Speaking to Women”, and has gone from strength to strength since then.

Approach: A radio station and multimedia center, offering training

Beneficiaries: Rural Community

Driving Agency: Toco Foundation with the help of volunteers

Key lessons from these two initiatives

  1. Technology is secondary to preparing and aligning people and processes
  2. Effective community participation is vital
  3. Strong leadership from village up is essential for success of any ICT4D project (e.g Agri-Talk)
  4. Leveraging ICTs is not necessarily about changing lifestyles in rural communities. In many instances, they will introduce new methods of doing the same old activities.
  5. Agricultural information is a complex process (information infrastructure—access and costs)
  6. Knowledge sharing and strategic content development will be vital

Find out more about e-agriculture projects around the globe here.

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Grad students build novel tool in fight against malaria

Photo Credit: geardiary.com

A new faction has joined in the war against malaria: graduate students. A group of students developed a malaria diagnostic tool that will be rolled out in India and Ethiopia this summer.  Called, the Lifelens project, the tool uses a micro lens on the camera of mobile phones that can ultimately test for and diagnose malaria.

Created by Harvard Business School student Cy Khormaee and UC Davis doctoral student Wilson To, the lifelens product attaches a $50 micro lens to the camera of a Windows 7 enabled smartphone.

With the camera in place, the phone can then capture high-resolution images of the cells in a drop of blood that is placed on the micro lens. Windows 7 software quickly analyzes the images, confirming the presence or absence of malaria. Once the images are analyzed, the results can be sent to public health workers and other health professionals via SMS for further assessment and data collection.

Current standard practices in malaria diagnosis involve administering a rapid diagnostic test (RDT). This method takes a blood sample, usually off of the finger of the patient, and then exposed to a cotton swab containing a solution that reacts with malaria antigens that may be in the blood. However, this method is inefficient and produces many false positives, with only a 40% accuracy rate.

Photo Credit: springwise.com

The lifelens tool acts as a powerful microscope and can easily be sterilized for further immediate usage. It is also more accurate than RDT since it detects malaria cells directly. To and Khormaee say that in the long run, the lifelens tool will be more cost effective than current RDT detection methods.

However, there are some obstacles. The lifelens tool only operates on a Windows 7 enabled smartphone. These phones cost hundreds of dollars and may be affordable in resource poor areas. Also, the lifelens tool is not the only novel technological tool in the malaria detection space. Disposable tests are already in wide use, and others are developing diagnosis technologies, including a DNA-based one that could, like Lifelens, test for malaria and other illnesses.

The lifelens project received an award in the Microsoft sponsored Imagine Cup competition that featured innovative technological tools that use Microsoft software. With this award in hand, To and Khormaee plan to roll out a testing phase for their tool in India and Ethiopia.

Virtually all deaths from malaria occur in the developing world with 90% occurring in Africa. Any advancement in malaria diagnosis is highly valued. The lifelens project is aiming to change the way infectious disease diagnosis is handled. “Malaria is just the beginning,” says To. “We’re building a platform.”

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Army of mothers set to fight malaria in Mali

It was recently announced that an initiative called Mobiles Against Malaria will be launched in Bamako, Mali. The initiative will be executed using mothers who are community health workers in an effort to use mobile phones to prevent, diagnose and treat malaria in a more effective way than it has been.

The project is being funded by Akvo, a foundation created in 2008 that uses open source web and mobile software to attract funders to a spread of projects being done in the developing world.

CHW's at work. Photo Credit: Akvo

Mobile phones will be used by the mothers who were recruited as community health workers(CHW) to record data from neighborhoods on malaria. The CHW’s will visit each household in a particular neighborhood ready to ask pre-formulated questions.

The answers to the questions will be gathered on the mobile phones. For example, some of the questions asked may be ‘how many people live in the house’ and ‘how many people are ill’ and ‘what is the number of newborns’.

After gathering all of the necessary answers, the data will be sent via SMS to a central database located at a local hospital. It is hoped that NGO’s and local organizations will take advantage of the databases to analyze the trends and assist households in need of help. Officials hope the SMS data collection system will shed light on estimating how many insecticide-treated nets are needed in the poor areas in Bamako.

These community health workers will travel to malaria impacted areas around the capital city of Bamako to administer a revamped program. An older version was implemented using CHW’s who tested 2,796 children for malaria with a finger prick test after visiting nearly 100,000 households. That framework will be enriched by the introduction of the SMS-based frontline data collection.

The use of mothers as the CHW’s is a hallmark feature of this program. That along with using the SMS based frontline data collection sets this malaria detection program apart from other ones going on in Africa. Using mothers presents several advantages:

  • mothers are trusted in the community
  • they easily gain trust from other women from whom data is being collected
  • they can persuade women to visit hospitals using that established trust
  • they often have insider knowledge to the neighborhoods they work in
  • they ensure use of treated mosquito nets
  • they support treatment adherence

Along with attaining malaria specific data such as households using insecticide treated bednets, officials hope the program will create easier access to information on the burden. They also hope the cell phone-based application will improve patient management via a cell phone risk assessment and triaging tree, strengthen patient history documentation in the field, enable clinical communication (text, image, audio) between community health workers and clinics, and provide access to previously unrecorded health information.

The program aims to use mothers and cell phones to decrease costs of malaria detection and treatment while improving the access to treatment and treatment adherence. The program will train and utilize 50 CHW’s and 2 hospitals over the span of a year. It hopes that using mobile phones will build off of prior success.



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Millions awarded for maternal health innovations

Secretary of State Hillary Clinton and USAID Administrator Rajiv Shah. Photo Credit: USAID

The Saving Lives at Birth program held its DevelopmentXChange event last week in Washington DC. The event was hosted by Secretary of State Hillary Clinton and USAID Administrator Rajiv Shah and was sponsored by USAID, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and The World Bank.

The program called for scholars, researchers, doctors, and entrepreneurs to develop innovative prevention and treatment approaches for pregnant women and newborns in rural, low resources setting around the time of birth. There were over 600 applications from around the world, and 77 finalists were chosen to attend this 3-day event held in Washington. At the end of the 3-day event, $14 million in grants were awarded to 25 of the 77 finalists.

The 77 ideas and projects fell into two categories: seed grant finalists and transition to scale finalists. The former were completely innovative and fresh ideas while the latter were already existing ideas that were calibrated to fit for maternal health purposes.

The projects and ideas highlighted gadgets, treatment schemes, prevention methods, health centers, strategic plans and a plethora of mobile phone related solutions. Finalists came from all over the United States and from over the world including Bangladesh, Kenya, India, Uganda, Pakistan, Switzerland and Australia.

Some of the 25 award nominees. Photo Credit: USAID

Many of the ideas that had mobile solution components used mobile phones as an ICT. One innovative project was from Kenya called mAfya which aimed to set up health specific kiosks that would offer basic medical services for free for maternal health issues. There was another project from Kenya that aimed to provide pregnant mothers vouchers to use towards health services through mBanking called Changamka.

Among the awardees, one project from Save the Children provided a mobile phone monitoring system for recording maternal and neonatal deaths. This, along with an electricity-free fetal heart rate monitoring component aims to give communities in Uganda better intra-partum response services. Another project originated from Healthpoint services in India that has already set up rural health clinics and provides water, and is looking to expand its maternal health services using an integrated telemedicine and mHealth system.

Saving Lives at Birth, the first program in a series of Grand Challenges for Development led by USAID. The Grand Challenges is an attempt to bring science, technology and innovation to the field of development, lowering the cost of helping the world’s poor and, in the process, saving lives, said USAID administrator Shah.

“Especially in these very difficult economic times … coming up with more innovative, more local and sustainable ways to make it cheaper and easier to help mothers survive child birth and help children survive the first 48 hours of life is what this program is all about,” added Shah.

Maternal and child health issues still need a lot of attention. A woman dies every two minutes in childbirth, and 99% of the deaths are in the developing world, according to the World Health Organization. Also, about 1.6 million neonatal deaths occur each year around the world. Additionally noteworthy is that only a handful of countries are set to meet Millennium Development Goal 5 of reducing maternal mortality by 2/3 by 2015.

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ICT Training for Guyanese Sugar Workers…

Minister of Agriculture Robert Persaud addressing an audience

Credit:Guyana's Ministry of Agriculture

Sugar has been the mainstay of Guyana’s economy for over two centuries. But the sector has been contracting since the abolition of the 1975 Lomé Convention,  a special arrangement under which the South American country’s famed Demarara sugar was allowed duty-free access into the lucrative European market.

The changing global trade environment forced many neighboring Caribbean countries, including Trinidad and Barbados, to shutter their sugar industry. Guyana, on the other hand, is holding firm. The government increased investments in the ailing sector, safeguarding the economy and livelihoods. Sugar is the largest single employer and contributor to the economy. So important is the sector to the country that the largest sugar producer, Guyana Sugar Corporation Inc. (Guysuco), puts more people to work than any other entity. Guysuco is also the country’s main source of foreign exchange, bringing in revenue that accounts for as much as 13% of GDP.

An economy so dependent on an industry prone to speculation, with a productive capacity outranked by other producers and alternatives, begs the question: How can this highly indebted poor country, with a per capita GDP hovering below US$1, 500 revitalize this crucial economic activity?

The Caribbean Farmers Network (CAFAN) points to Information Communication Technologies (ICTs) as a crucial set of tools in a mix of solutions. A view I share, as ICT is crucial for economic development. According to the World Bank, an increase of 10% in mobile phone penetration results in a 0.8% expansion in economic growth. The potential benefits of ICT expansion, especially to rural areas where farming is a mainstay, is wide-ranging. Farmers, irrespective of their crop specialty, are exposed to vital new information services that improves/enables a culture of enterprise.

Although Guyana is a slow starter in the ICT space, the government’s commitment to develop and promote ICT countrywide is strong. Earlier this year, Agriculture Minister Robert Persaud commissioned the second of eight ICT centers for the benefit of sugar workers and their families. Far too often states consider ICT expansion solely a matter for schools, ignoring the wider society and key aspects of the economy. Improving the ICT skill base among Guyanese sugar workers will better prepare them for planned improvements in sugar facilities, such as the new Skeldon Factory.

 

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What have we learned from all this ICT4D chatter?

I have been blogging about ICT4D consistently for two months. This seems an opportune time to highlight my main thoughts on ICT4D, many of which are shared by others in the ICT4D space.

Here’s a list, feel free to add to it.

  • Countries with clear ICT policies tend to do better
  • ICT policies must be integrated within a broader national development plan
  • Good infrastructure and an enabling regulatory framework are needed
  • ICTs are merely tools, the potency of which is largely dependent on context and systemic domains
  • ICTS are not within and of themselves an end
  • There’s immense potential for economic growth, social cohesion, security, political stability, provision of education, healthcare, agricultural services etc
  • Look elsewhere for development’s silver bullet—if it exists, you’re looking in the wrong direction
  • Like development, technologies also have “side-effects” no matter the dosage.
  • We know very little about the impact of ICTs on economic expansion
  • Building and boosting capacity of a critical mass of people is integral (access and use are not synonymous!)
  • Public-private partnerships will be crucial for the sustainability of most initiatives
  • As most successful projects do, start small, take M&E seriously and scale up
  • The slickest tech isn’t always the best option

The latter is perhaps the point that I have examined the least, over the last few weeks. But, I have consistently made the point that traditional ICTs, including radio, television sets and so on, should not be abandoned in favor of the latest tech. Context is everything! Connectivity woes, illiteracy and minimal access to the newest gadgets, among other things, demand that we think in terms of complementarity, cultural appropriateness and the financial constraints of proliferating some tools.

Finding ways to make better use of traditional ICTs like radio is important on two fronts. First, radio is the most potent tool to use for the dissemination of information globally—it’s ubiquitous, even in the most far-off and undeveloped parts of the world, due to its portability, reach and affordability. Second, this era of low cost mobile phones, MP3 players and so on offers new and exciting opportunities to use ‘radio’ and radio techniques innovative to improve livelihoods and enterprise.

Next week, I will review the findings of the African Farm Radio Research Initiative (AFRRI), an action research project—funded by the Gates Foundation—that assessed how radio can improve food security in Africa…

 

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Africa’s mobile economic revolution…half way there?

 

 

 

 

 

 

 

 

 

The UK Guardian’s Killian Fox recently described the rapid rate at which cellphones became ubiquitous (and are used) in Africa as a “mobile economic revolution”.

Some people easily dismissed this assertion as another hyperbolic pronouncement, but there’s truth to it. The expansion of mobile telephony services and access over the last decade did more than merely open up avenues for efficient social inter-action among Africans. It reinvigorated, structured and even cultivated a more efficient culture of enterprise, across banking, agriculture, healthcare, education and governance, in some countries.

But, if this “mobile economic revolution” is to be fully realized, much more ought to be done. Deeper integration of technology into commerce, and greater expansion of telephony access and service provision are two things to consider, among others like financing and marketing that I have looked at in other blogs. The fact is, a half of all Africans still do not have access to a cellphone, despite the rapid expansion observed. This means the enormous economic benefits mobile phones bring to less developed parts of the world is still untapped in much of Africa. According to the London Business School, “for every additional 10 mobile phones per 100 people in a developing country, GDP rises by 0.5%”. So, the expansion in GDP experienced on the continent in the last decade, due to telephony expansion, is, at the very least, half of what it could be.

Furthermore, the depth to which the instrument (cellphone) has been leveraged for commerce is still limited, which means the economic potential is much greater than what obtains. The success of Safaricom’s M-Pesa in bringing banking services to the previously unbanked, for instance, is still limited to a minority of Africans. Further to that, global mobile money transactions is slated to exceed a trillion dollars by 2015. African economies are likely to benefit from cheaper transfer of remittances, and reduced transaction costs across borders, but those benefits will be much greater if more people have access to mobiles. Therefore, boosting the number of people on the continent with access to mobile banking must be a priority for policymakers, to safeguard the “mobile economic revolution”.

The deepening of the “mobile economic revolution” should be contextual. The provision of mobile-enabled financial services such as micro-credit is great, but it doesn’t always function in the poor’s economic interest. The use of mobile phones to offer traditional options, such as layaways, to help the poor improve their entrepreneurial endeavors is negligible. KickStart, a nonprofit that sells human-powered irrigation systems to entrepreneurial farmers, seems to be an exceptional case. The organization introduced an SMS powered layaway program in Kenya that allows buyers to set aside tiny increments via M-Pesa.

KickStart‘s approach to aiding farmers to finance their entrepreneurial endeavors seems much more sustainable, compared to existing micro-finance options, although the time factor is a drawback. However, the main point here is that, the “mobile economic revolution” must never leave the poor behind. The ways in which the individual’s long term economic livelihood is affected is key, if the larger objective remains that of sustainable development.

 

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Fight against HIV/AIDS in India gets helping hand

Argusoft, a Fremont, CA start-up that’s combines video, instant messaging and Internet telephony in a platform for “e-health” programs in the developing world, is ready to implement a mobile phone application that will enable field workers to register HIV-positive mothers and provide regular updates on their care.

The application, called mAID, runs on any java-enabled phone and utilizes the SMS interface. It is designed primarily for health workers that go out into rural communities to inform citizens on different health issues.

Using the application in the field is simple. Cell phones are given to health workers who communicate through the phone to a central database. The health workers are sent daily instructions in the morning via SMS on where to go and which houses to visit. The health workers collect relevant data on HIV/AIDS prevalence and awareness and report the data back to the central database via SMS.

The new program is overseen by the Indian government with financing from the Global Fund, a nonprofit in Geneva that targets AIDS in developing countries. IL&FS, an infrastructure development conglomerate based in Mumbai, is handling logistics.

mAID underwent a pilot test where 35 health workers reached over 2500 patients using the application. The pilot phase ended last month, and based off its results, the Indian government wants to inject 3600 more health workers into the field with the mobile app for a nationwide scale up. There are even talks about using the application in Africa.

Argusoft's Ram Gopalan. Photo Credit: mercurynews.com

The CEO of Argusoft, Ram Gopalan has cited the difficulties of preventing HIV/AIDS as the impetus of his application. “It’s fully preventable, but one of the highest killers of children in the Third World,” Gopalan said.

Gopalan echoes the same sentiments of the Indian Government who have been working to prevent prenatal HIV transmission since 2002, using counseling and testing centers around the country. The Indian Government also cited issues with health worker capacity. Regarding that Gopalan said, “There was a lot of inefficiency, workers misinterpreting instructions, and paperwork getting lost.”

Argusoft is no stranger to implementing eHealth initiatives. In the eastern Indian state of Tripura, Gopalan linked isolated villages with a hospital in the state capital where doctors can remotely diagnose simple but life-altering problems such as cataracts. This telemedicine project has provided eye care for more than 100,000 patients over the past five years.

In the future, Gopalan wishes to introduce a network of accredited family-care doctors from India who could be available 24/7 for live video chats with patients. This is similar to the meradoctor project which already exists in India. In the meantime, the HIV/AIDS burden in India needs some attention as it is the third highest burden in the world in terms of sheer numbers living with HIV.

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