Medical tech designed to meet Africas needs Soyapi Mumba
Like every passionate
software engineer out there,
I closely follow technology
companies in Silicon Valley,
pretty much the same way soccer fans
follow their teams in Europe.
I read articles on tech blogs
and listen to podcasts on my phone.
But after I finish the article,
lock my phone and unplug the headphones,
I’m back in sub-Saharan Africa,
where the landscape is not quite the same.
We have long and frequent power outages,
low penetration of computers,
slow internet connections
and a lot of patients
visiting understaffed hospitals.
Since the HIV epidemic,
hospitals have been struggling
to manage regular HIV treatment records
for increasing volumes of patients.
For such environments,
importing technology systems
developed elsewhere has not worked,
but in 2006, I joined Baobab Health,
a team that uses locally based engineers
to develop suitable interventions
that are addressing
health care challenges in Malawi.
We designed an electronic
health record system
that is used by health care workers
while seeing patients.
And in the process we realized that we
not only had to design the software,
we had to implement
the infrastructure as well.
We don’t have enough medical staff
to comprehensively examine every patient,
so we embedded clinical guidelines
within the software
to guide nurses and clerks
who assist with handling
some of the workload.
Everyone has a birthday,
but not everyone knows their birthday,
so we wrote algorithms
to handle estimated birthdates
as complete dates.
How do we follow up
patients living in slums
with no street and house numbers?
We used landmarks to approximate
their physical addresses.
Malawi had no IDs
to uniquely identify patients,
so we had to implement unique patient IDs
to link patient records across clinics.
The IDs are printed as barcodes
on labels that are stuck
on personal health booklets
kept by each patient.
With this barcoded ID,
a simple scan with a barcode reader
quickly pulls up the patient’s records.
No need to rewrite their personal details
on paper registers at every visit.
And suddenly, queues became shorter.
This meant patients, typically mothers
with little children on their backs,
had to spend less time
waiting to be assisted.
And if they lose their booklets,
their records can still be pulled
by searching with their names.
Now, the way we pronounce
and spell names varies tremendously.
We freely mix R’s and L’s,
English and vernacular
versions of their names.
Even soundex,
a standard method for grouping words
by how similar they sound,
was not good enough.
So we had to modify it
to help us link and match
existing records.
Before the iPhone,
software engineers
developed for personal computers,
but from our experience,
we knew our power system
is not reliable enough
for personal computers.
So we repurposed touch screen
point-of-sale terminals
that are meant for retail shops
to become clinical workstations.
At the time, we imported
internet appliances called i-Openers
that were manufactured
during the dot-com era
by a failed US company.
We modified their screens
to add touch sensors
and their power system
to run from rechargeable batteries.
When we started, we didn’t find
a reliable network to transmit data,
especially from rural hospitals.
So we built our own towers,
created a wireless network
and linked clinics in Lilongwe,
Malawi’s capital.
(Applause)
With a team of engineers
working within a hospital campus,
we observed health care workers
use the system
and iteratively
build an information system
that is now managing HIV records
in all major public hospitals in Malawi.
These are hospitals serving
over 2,000 HIV patients, each clinic.
Now, health care workers
who used to spend days
to tally and prepare quarterly reports
are producing the same reports
within minutes,
and health care experts
from all over the world
are now coming to Malawi
to learn how we did it.
(Applause)
It is inspiring and fun
to follow technology trends
across the globe,
but to make them work
in low-resourced environments
like public hospitals
in sub-Saharan Africa,
we have had to become jacks-of-all-trades
and build whole systems,
including the infrastructure,
from the ground up.
Thank you.
(Applause)