Joel Selanikio: The surprising seeds of a big-data revolution in healthcare

Translator: Mathias Severinsen Reviewer: Anders Finn Jørgensen

Der er en gammel joke om en politimand på patrulje

There's an old joke about a cop

who's walking his beat in the middle of the night,

midt om natten.

and he comes across a guy under a street lamp

Han støder på en mand under en gadelampe

som kigger på jorden og går fra side til side.

who's looking at the ground and moving from side to side,

and the cop asks him what he's doing.

Politimanden spørger ham, hvad han laver.

The guys says he's looking for his keys.

Manden siger han leder efter sine nøgler.

So the cop takes his time

Så politimanden tager sig tid og leder

and looks over and kind of makes a little matrix

inden for et lille område

and looks for about two, three minutes.

i to til tre minutter. Ingen nøgler.

No keys.

The cop says, "Are you sure?

Politimanden siger, "Er du sikker på,

Hey buddy, are you sure you lost your keys here?"

at du mistede dine nøgler her?"

And the guy says, "No, actually I lost them

Manden siger, "Nej, jeg mistede dem faktisk

nede for enden af vejen,

down at the other end of the street,

men lyset er bedre her."

but the light is better here."

(Laughter)

There's a concept that people talk about nowadays called "big data."

Der er et begreb folk snakker om for tiden

som hedder Big data.

And what they're talking about is all of the information

Det refererer til al den information vi skaber

that we're generating through our interaction

ved vores brug af internettet.

with and over the Internet,

everything from Facebook and Twitter

Alt fra Facebook og Twitter

til musikdownloads, film, livestreaming af TED.

to music downloads, movies, streaming, all this kind of stuff,

the live streaming of TED.

And the folks who work with big data, for them,

De folk som arbejder med Big data,

they talk about that their biggest problem

siger deres største problem er,

is we have so much information.

at der findes så meget information,

The biggest problem is: how do we organize all that information?

at de ikke ved hvordan de skal organisere det.

Fra mit arbejde inden for global sundhed, kan jeg sige,

I can tell you that, working in global health,

that is not our biggest problem.

at det ikke er vores største problem.

Because for us, even though the light is better on the Internet,

Fordi selv om lyset er bedre på internettet,

the data that would help us solve the problems we're trying to solve

findes den data som kan hjælpe os med

at løse vores problemer, faktisk ikke på internettet.

is not actually present on the Internet.

So we don't know, for example,

Så vi ved for eksempel ikke hvor mange folk,

how many people right now are being affected by disasters

som lige nu er påvirket af katastrofer

eller konfliktsituationer.

or by conflict situations.

We don't know for, really, basically, any of the clinics

Vi ved stort set ikke for nogen klinikker i udviklingslandene,

in the developing world,

which ones have medicines and which ones don't.

hvilke som har medicin og hvilke som ikke har.

We have no idea of what the supply chain is for those clinics.

Vi kender ikke klinikkernes forsyningskæde.

Vi ved ikke - og det finder jeg ganske utroligt -

We don't know -- and this is really amazing to me -- we don't know

hvor mange børn som blev født, eller hvor mange børn der er,

how many children were born -- or how many children there are --

in Bolivia or Botswana or Bhutan.

i Bolivia, Botswana eller Bhutan.

Vi ved ikke hvor mange børn som sidste uge døde

We don't know how many kids died last week

i nogen af de lande.

in any of those countries.

We don't know the needs of the elderly, the mentally ill.

Vi kender ikke de ældre og psykiske syges behov.

For all of these different critically important problems

Inden for disse meget vigtige områder, hvor vi vil løse problemer,

or critically important areas that we want to solve problems in,

ved vi stort set ingenting.

we basically know nothing at all.

And part of the reason why we don't know anything at all

En af grundene er,

is that the information technology systems that we use in global health

at den informationsteknologi vi bruger i global sundhed

to find the data to solve these problems is what you see here.

til at indsamle data for at løse disse problemer,

er hvad du ser her.

This is about a 5,000-year-old technology.

Det er en omtrent 5000 år gammel teknologi.

Some of you may have used it before.

Nogle af jer har måske brugt den før.

Den er på vej ud nu,

It's kind of on its way out now,

men vi bruger den stadig til 99 procent af vores arbejde.

but we still use it for 99 percent of our stuff.

Det er et spørgeskema.

This is a paper form.

And what you're looking at is a paper form

Det er et spørgeskema i hånden på en sygeplejerske fra Indonesien

in the hand of a Ministry of Health nurse in Indonesia,

who is tramping out across the countryside

som vandrer mellem landsbyer

in Indonesia on, I'm sure, a very hot and humid day,

på en dag, som sikkert er både varm og fugtig.

and she is going to be knocking on thousands of doors

Hun kommer til at banke på tusindvis af døre

over a period of weeks or months,

over en periode på uger eller måneder

knocking on the doors and saying,

og sige, "Undskyld mig, vi vil gerne stile dig et par spørgsmål.

"Excuse me, we'd like to ask you some questions.

Do you have any children? Were your children vaccinated?"

Har du børn? Er dine børn vaccineret?"

Because the only way we can actually find out

For den eneste måde vi kan finde ud af

hvor mange procent af børn som er vaccineret i Indonesien,

how many children were vaccinated in the country of Indonesia,

what percentage were vaccinated,

is actually not on the Internet, but by going out and knocking on doors,

er ikke på internettet, men ved at gå ud og banke på

nogle gange titusindvis af døre.

sometimes tens of thousands of doors.

Sometimes it takes months to even years to do something like this.

Det kan tage måneder, endda år at gøre det.

You know, a census of Indonesia

En folketælling af Indonesien ville sikkert tage to år at udføre.

would probably take two years to accomplish.

And the problem, of course, with all of this

Problemet med alle de spørgeskemaer er -

is that, with all those paper forms --

and I'm telling you, we have paper forms for every possible thing:

- og jeg siger dig vi har spørgeskemaer for hvad som helst.

Vi har spørgeskemaer for vaccinationsundersøgelser,

We have paper forms for vaccination surveys.

We have paper forms to track people who come into clinics.

for at følge op på folk som har været til lægen,

We have paper forms to track drug supplies, blood supplies --

for at følge medicinforsyning, blodforsyning,

all these different paper forms for many different topics,

en masse forskellge spørgeskemaer om mange forskellige emner,

they all have a single, common endpoint,

som alle ender det samme sted.

and the common endpoint looks something like this.

Det ser ud nogenlunde sådan her.

And what we're looking at here is a truckful of data.

Hvad du ser her er en bil fuld af data.

Det er data fra én undersøgelse om vaccinationsdækning

This is the data from a single vaccination coverage survey

in a single district in the country of Zambia

i ét enkelt distrikt i Zambia,

from a few years ago, that I participated in.

som jeg deltog i for få år siden.

The only thing anyone was trying to find out

Det eneste vi ville finde ud af var,

is what percentage of Zambian children are vaccinated,

hvilken andel af Zambiske børn som var vaccineret.

and this is the data, collected on paper over weeks,

Det her er dataen indsamlet i ugevis på papir

from a single district,

fra ét enkelt distrikt, som svarer til en kommune i USA.

which is something like a county in the United States.

You can imagine that, for the entire country of Zambia,

Man kan tænke sig at svare på det ene spørgsmål for hele Zambia

answering just that single question ...

looks something like this.

ville se nogenlunde sådan her ud.

Bil efter bil fyldt med stakkevis af data.

Truck after truck after truck,

filled with stack after stack after stack of data.

And what makes it even worse is that's just the beginning.

Og det værste er, at det bare er begyndelsen.

Because once you've collected all that data,

Fordi når først man har indsamlet alt dataen

of course, someone -- some unfortunate person --

må en eller anden stakkel skrive det ind på en computer.

is going to have to type that into a computer.

When I was a graduate student,

Da jeg var kandidatstuderende,

I actually was that unfortunate person sometimes.

var jeg faktisk, nogle gange den stakkel.

I can tell you, I often wasn't really paying attention.

Ofte var jeg ikke særlig opmærksom.

I probably made a lot of mistakes when I did it

Jeg lavede sikkert en masse fejl

that no one ever discovered, so data quality goes down.

som ingen nogensinde opdagede, så datakvaliteten falder.

But eventually that data, hopefully, gets typed into a computer,

Men til sidst bliver dataen forhåbentligvis skrevet ind på computer,

and someone can begin to analyze it,

og nogen kan begynde at analysere den.

and once they have an analysis and a report,

Så snart de har en analyse og en rapport,

kan man forhåbentligvis tage resultatet af dataen

hopefully, then you can take the results of that data collection

and use it to vaccinate children better.

og bruge det til at vaccinere børn bedre.

Because if there's anything worse in the field of global public health --

For hvis der findes noget værre inden for global sundhed,

I don't know what's worse than allowing children on this planet

end at lade børn dø af sygdomme som kan forebygges med vaccine.

to die of vaccine-preventable diseases --

diseases for which the vaccine costs a dollar.

Vaccine som koster bare én dollar.

And millions of children die of these diseases every year.

Millioner af børn dør af disse sygdomme hvert år.

Rent faktisk er millioner et skøn,

And the fact is, millions is a gross estimate,

because we don't really know how many kids die each year of this.

for vi ved ikke hvor mange børn som dør hvert år.

What makes it even more frustrating is that the data-entry part,

Og hvad gør det endnu mere frustrerende er,

at dataindtastningen jeg lavede som kandidatstuderende,

the part that I used to do as a grad student,

kan tage seks måneder.

can take sometimes six months.

Sometimes it can take two years to type that information into a computer,

Det kan tage to år at taste ind på en computer,

And sometimes, actually not infrequently,

og nogle gange sker det faktisk aldrig.

it actually never happens.

Now try and wrap your head around that for a second.

Prøv at forstå det et sekund.

You just had teams of hundreds of people.

Du har grupper på hundredevis af folk.

They went out into the field to answer a particular question.

De har været i felten for at svare på et bestemt spørgsmål.

Du har sikkert brugt hundredetusindvis af dollars

You probably spent hundreds of thousands of dollars

på benzin, fotokopiering og godtgørelse,

on fuel and photocopying and per diem.

og så af en eller anden grund stopper fremdriften,

And then for some reason, momentum is lost

or there's no money left,

eller pengene slipper op,

and all of that comes to nothing,

og det hele løber ud i sandet, fordi ingen taster det ind på en computer.

because no one actually types it into the computer at all.

The process just stops.

Processen stopper bare. Det sker hele tiden.

Happens all the time.

This is what we base our decisions on in global health:

Det er, hvad vi har baseret vores beslutninger på i global sundhed:

little data, old data, no data.

lidt data, gammel data, ingen data.

So back in 1995,

Så tilbage i 1995 begyndte jeg at tænke over,

I began to think about ways in which we could improve this process.

hvordan vi kunne forbedre denne proces.

Now 1995 -- obviously, that was quite a long time ago.

1995 er selvfølgelig lang tid siden.

It kind of frightens me to think of how long ago that was.

Det skræmmer mig lidt at tænke på, hvor lang tid siden det er.

Årets storfilm var "Die Hard with a Vengeance."

The top movie of the year was "Die Hard with a Vengeance."

Som du kan se, havde Bruce Willis mere hår dengang.

As you can see, Bruce Willis had a lot more hair back then.

I was working in the Centers for Disease Control

Jeg arbejdede inden for sygdomsbekæmpelse,

and I had a lot more hair back then as well.

og jeg havde også mere hår dengang.

But to me, the most significant thing that I saw in 1995

Men for mig var, det vigtigste jeg så i 1995, den her.

was this.

Det er svært at forestille sig, men i 1995

Hard for us to imagine, but in 1995,

this was the ultimate elite mobile device.

var det her den ultimative håndholdte enhed.

It wasn't an iPhone. It wasn't a Galaxy phone.

Det var ikke en iPhone eller en Galaxy telefon.

It was a PalmPilot.

Det var en Palm Pilot.

And when I saw the PalmPilot for the first time, I thought,

Da jeg så Palm Pilot for første gang tænkte jeg:

"Why can't we put the forms on these PalmPilots?

"Hvorfor kan vi ikke putte spørgeskemaet ind på de her Palm Pilots

And go out into the field just carrying one PalmPilot,

og gå ud i felten med bare én Palm Pilot

som har samme kapacitet som titusindvis af papirsskemaer?

which can hold the capacity of tens of thousands of paper forms?

Why don't we try to do that?

Hvorfor prøver vi ikke det?"

Because if we can do that,

For hvis det fungerer, hvis vi bare kan

if we can actually just collect the data electronically, digitally,

indsamle dataen digitalt helt fra starten,

from the very beginning,

we can just put a shortcut right through that whole process

så kan vi springe over hele processen

of typing, of having somebody type that stuff into the computer.

at have nogen til at taste det ind på en computer.

We can skip straight to the analysis

Vi kan gå direkte til analysen og at bruge dataen til at redde liv.

and then straight to the use of the data to actually save lives."

So that's what I began to do.

Så det begyndte jeg at gøre.

Working at CDC, I began to travel to different programs around the world

Jeg begyndte at rejse til programmer i hele verden

and to train them in using PalmPilots to do data collection,

og træne dem i at bruge Palm Pilots til at indsamle data

instead of using paper.

istedet for at bruge papir.

And it actually worked great.

Og det fungerede fantastisk.

It worked exactly as well as anybody would have predicted.

Det fungerede så godt som man kunne have forestillet sig.

Der kan man bare se. Digital dataindsamling

What do you know?

Digital data collection is actually more efficient than collecting on paper.

er faktisk mere effektivt end at indsamle på papir.

Imens det stod på, var min forretningspartner Rose,

While I was doing it, my business partner,

som er her med sin mand Matthew idag,

Rose, who's here with her husband, Matthew, here in the audience,

ude at gøre noget lignende for Amerikansk Røde Kors.

Rose was out doing similar stuff for the American Red Cross.

Efter at have gjort det nogle år gik det op for mig at jeg havde besøgt

The problem was, after a few years of doing that,

I realized -- I had been to maybe six or seven programs --

måske seks eller syv programmer, og jeg tænkte:

and I thought, you know, if I keep this up at this pace,

"Hvis jeg fortsætter i det her tempo gennem hele min kariere,

over my whole career,

maybe I'm going to go to maybe 20 or 30 programs.

når jeg måske ud til 20 eller 30 programmer.

But the problem is, 20 or 30 programs,

Men at træne 20 eller 30 programmer i at bruge den her teknologi,

like, training 20 or 30 programs to use this technology,

that is a tiny drop in the bucket.

er en dråbe i havet.

Behovet for bedre dataprogrammer inden for sundhed,

The demand for this, the need for data to run better programs

just within health -- not to mention all of the other fields

for ikke at nævne alle de andre områder i udviklingslande, er enormt.

in developing countries -- is enormous.

There are millions and millions and millions of programs,

Der er millioner af programmer,

millions of clinics that need to track drugs,

millioner klinikker som har brug for at registrere medicin,

millions of vaccine programs.

millioner af vaccineprogrammer.

There are schools that need to track attendance.

Der er skoler, som har brug for at registrere fremmøde.

Der er et væld af forskellige områder, hvor vi har brug for at få data.

There are all these different things for us to get the data that we need to do.

Og det gik op for mig, at hvis jeg fortsatte på samme måde,

And I realized if I kept up the way that I was doing,

I was basically hardly going to make any impact

ville jeg stort set ikke have haft nogen indflydelse

ved min slutningen af min karriere.

by the end of my career.

And so I began to rack my brain,

Så jeg begyndte at vride min hjerne,

trying to think about, what was the process that I was doing?

og tænke over de metoder jeg brugte,

How was I training folks,

hvordan jeg trænede folk, hvor flaskehalsene var,

and what were the bottlenecks and what were the obstacles

og hvad der var i vejen for at gøre det hurtigere og mere effektivt.

to doing it faster and to doing it more efficiently?

And, unfortunately, after thinking about this for some time,

Desværre, efter at have tænkt over det et stykke tid,

I identified the main obstacle.

identificerede jeg hovedproblemet.

And the main obstacle, it turned out --

Problemet var, viste det sig, og det var en hård erkendelse,

and this is a sad realization --

hovedproblemet var mig.

the main obstacle was me.

So what do I mean by that?

Så hvad mener jeg med det?

I had developed a process

Jeg havde udviklet en metode, hvor jeg var i centrum for teknologien.

whereby I was the center of the universe of this technology.

Hvis man ville bruge teknologien, måtte man i kontakt med mig.

If you wanted to use this technology, you had to get in touch with me.

Man måtte altså vide, at jeg eksisterede.

That means you had to know I existed.

Så måtte man skaffe penge til min flyrejse og mit hotelophold

Then you had to find the money to pay for me to fly out to your country

and the money to pay for my hotel and my per diem and my daily rate.

og til min godtgørelse og dagsatser.

So you could be talking about 10- or 20- or 30,000 dollars,

Det kunne handle om 10.000, 20.000 eller 30.000 dollars

if I actually had the time or it fit my schedule

hvis jeg overhovedet havde plads i min kalender

and I wasn't on vacation.

og ikke var på ferie.

The point is that anything,

Pointen er, at et hvilket som helst system som afhænger af et enkelt menneske,

any system that depends on a single human being

or two or three or five human beings --

eller to, tre eller fem mennesker, ikke kan skaleres.

it just doesn't scale.

And this is a problem for which we need to scale this technology,

For at løse disse problemer må vi skalere teknologien så hurtigt som muligt.

and we need to scale it now.

And so I began to think of ways in which I could basically

Jeg begyndte at undersøge,

hvordan jeg kunne fjerne mig selv fra billedet.

take myself out of the picture.

Og det tænkte jeg over i temmelig lang tid.

And, you know, I was thinking,

"How could I take myself out of the picture?"

for quite some time.

I'd been trained that the way you distribute technology

Jeg havde lært at måden man distribuerer teknologi,

within international development

inden for global udvikling, altid er gennem en konsulent.

is always consultant-based.

It's always guys that look pretty much like me,

Det er altid mænd som ligner mig,

flying from countries that look pretty much like this

som flyver fra lande som ligner det her,

to other countries with people with darker skin.

til andre lande hvor folk har mørkere hud.

And you go out there, and you spend money on airfare

Og man tager derud, bruger penge på flyrejse

and you spend time and you spend per diem

og bruger tid og penge til godtgørelse, hotel og alle de her ting.

and you spend for a hotel and all that stuff.

As far as I knew, that was the only way you could distribute technology,

Så vidt jeg vidste, var det den eneste måde

man kunne distribuere teknologi, og jeg kunne ikke finde en vej udenom.

and I couldn't figure out a way around it.

But the miracle that happened --

Men så skete miraklet, jeg kalder forenklet for Hotmail.

I'm going to call it Hotmail for short.

You may not think of Hotmail as being miraculous,

Du ser måske ikke Hotmail som et mirakel,

but for me it was miraculous,

men for mig var det et mirakel, fordi jeg lagde mærke til,

because I noticed, just as I was wrestling with this problem --

akkurat som jeg kæmpede med det her problem -

I was working in sub-Saharan Africa, mostly, at the time --

på dette tidspunkt arbejdede jeg mest i Subsaharisk Afrika -

I noticed that every sub-Saharan African health worker

Jeg lagde mærke til, at alle de afrikanske sundhedsarbejdere,

that I was working with had a Hotmail account.

som jeg arbejdede med, havde en Hotmail konto.

Og det slog mig at folkene fra Hotmail

And it struck me, "Wait a minute --

I know the Hotmail people surely didn't fly to the Ministry of Health in Kenya

sikkert ikke var fløjet til Kenyas sundhedsministerium

to train people in how to use Hotmail.

for at lære folk at bruge Hotmail.

So these guys are distributing technology, getting software capacity out there,

Så de distribuerer teknologi og software,

but they're not actually flying around the world.

men de behøver ikke flyve jorden rundt.

Jeg må prøve at forstå det her.

I need to think about this more."

While I was thinking about it,

Imens jeg tænkte over det,

people started using even more things like this, just as we were.

begyndte folk at bruge endnu flere ting, ligesom os.

They started using LinkedIn and Flickr and Gmail and Google Maps --

De begyndte at bruge LinkedIn, Flickr, Gmail, Google Maps osv.

all these things.

Of course, all of these things are cloud based

Alle disse ting er internetbaserede og kræver ingen træning.

and don't require any training.

They don't require any programmers.

De kræver ingen programmører.

They don't require consultants.

De kræver ingen konsulenter fordi firmaernes forretningsmodel

Because the business model for all these businesses

requires that something be so simple we can use it ourselves,

kræver at vi kan bruge produkterne med lidt eller ingen træning.

with little or no training.

You just have to hear about it and go to the website.

Man behøver bare høre om dem og besøge deres hjemmeside.

Jeg tænkte: "Hvad ville ske hvis vi lavede software

And so I thought, what would happen if we built software

to do what I'd been consulting in?

som kunne erstatte min konsulentvirksomhed?"

Instead of training people how to put forms onto mobile devices,

I stedet for at træne folk i

at lægge spørgeskemaer ind på håndholdte enheder,

let's create software that lets them do it themselves with no training

lad os skabe software, som lader dem gøre det selv,

uden træning og uden at involvere mig.

and without me being involved.

Og det er præcist, hvad vi gjorde.

And that's exactly what we did.

So we created software called Magpi, which has an online form creator.

Vi lavede et program som hedder Magpi

som har en online sørgeskema tjeneste.

No one has to speak to me,

Ingen behøver snakke med mig.

you just have to hear about it and go to the website.

Man behøver bare høre om det og besøge hjemmesiden.

You can create forms, and once you've created the forms,

Man kan lave spørgeskemaer, og så snart man har lavet dem,

you push them to a variety of common mobile phones.

kan man overføre dem til mange almindelige mobiltelefoner.

Obviously, nowadays, we've moved past PalmPilots to mobile phones.

Nu til dags har vi selvfølgelig skiftet fra Palm Pilots til mobiltelefoner.

And it doesn't have to be a smartphone, it can be a basic phone,

Og det behøver ikke være en smartphone.

Det kan være en almindelig telefon som den til højre,

like the phone on the right, the basic Symbian phone

en helt almindelig Symbian telefon,

that's very common in developing countries.

som er meget almindelig i udviklingslande.

And the great part about this is it's just like Hotmail.

Og det bedste er, at det her er helt ligesom Hotmail.

It's cloud based,

Det er internetbaseret, og det kræver ingen træning,

and it doesn't require any training, programming, consultants.

programmering eller konsulenter.

But there are some additional benefits as well.

Men der er også nogle sidegevinster.

Da vi byggede det her system var pointen ligesom med Palm Pilots,

Now we knew when we built this system,

the whole point of it, just like with the PalmPilots,

was that you'd be able to collect the data

at man kunne indsamle data,

and immediately upload the data and get your data set.

uploade det umiddelbart og få sit datasæt.

Men vi opdagede også, at da det allerede ligger på en computer,

But what we found, of course, since it's already on a computer,

kan vi lave kort, analyser og grafer i realtid.

we can deliver instant maps and analysis and graphing.

We can take a process that took two years

Vi kan tage en proces som tog to år og koge den ned til fem minutter.

and compress that down to the space of five minutes.

Utrolige fremskridt i effektivitet.

Unbelievable improvements in efficiency.

Cloud based, no training, no consultants, no me.

Internetbaseret, ingen træning, ingen konsulenter, ingen mig.

And I told you that in the first few years

Og som jeg fortalte, i de første år

of trying to do this the old-fashioned way,

da jeg prøvede at gøre det på den gamle måde,

going out to each country,

ved at besøge hvert land,

we probably trained about 1,000 people.

trænede vi nok omkring 1.000 mennesker.

What happened after we did this?

Hvad skete efter de her ændringer?

In the second three years,

I de følgende tre år fandt 14.000 mennesker hjemmesiden,

we had 14,000 people find the website,

sign up and start using it to collect data:

meldte sig til og begyndte at bruge den til at indsamle data,

data for disaster response,

Data for katastrofeberedskab,

kanadiske grisebønder som registrerer sygdomme og svinebesætninger,

Canadian pig farmers tracking pig disease and pig herds,

people tracking drug supplies.

folk som følger medicinforsyninger.

One of my favorite examples, the IRC, International Rescue Committee,

Et af de bedste eksempler er IRC, International Rescue Committee,

they have a program where semi-literate midwives,

som har programmer hvor lavtuddannede jordemødre

using $10 mobile phones,

ved hjælp af 10$ mobiltelefoner

send a text message using our software, once a week,

sender tekstbeskeder med vores software en gang om ugen

with the number of births and the number of deaths,

med fødselstal og dødstal, hvilket giver IRC noget

which gives IRC something that no one in global health has ever had:

som ingen andre inden for global sundhed nogensinde har haft:

a near-real-time system of counting babies,

Et system som næsten i realtid kan tælle

of knowing how many kids are born,

hvor mange børn som bliver født og hvor mange børn som findes

of knowing how many children there are in Sierra Leone,

i Sierra Leone, hvor det her finder sted,

which is the country where this is happening,

and knowing how many children die.

og at vide, hvor mange børn som dør.

Physicians for Human Rights --

Physicians for Human Rights -

this is moving a little bit outside the health field --

nu bevæger jeg mig lidt uden for sundhedssektoren -

they're basically training people to do rape exams in Congo,

træner ganske enkelt folk i at lave voldtægts-lægeundersøgelser i Congo,

where this is an epidemic,

hvor det er en forfærdelig epidemi,

a horrible epidemic,

and they're using our software to document the evidence they find,

og de bruger vores software til at dokumentere beviser,

including photographically,

også fotografisk,

so that they can bring the perpetrators to justice.

så de kan få gerningsmanden for retten.

Camfed, another charity based out of the UK --

Camfed, en velgørende organisation fra England,

Camfed pays girls' families to keep them in school.

betaler pigers familier for at lade dem gå i skole.

They understand this is the most significant intervention they can make.

De forstår, at det er den vigtigste forskel, de kan gøre.

De plejede at registrere udbetalingerne,

They used to track the disbursements, the attendance, the grades, on paper.

fremmødet og karaktererne, på papir.

The turnaround time between a teacher writing down grades or attendance

Fra det tidspunkt en lærer skrev karakterer og fremmøde ned,

and getting that into a report was about two to three years.

til det kom i en rapport, kunne der gå to til tre år.

Now it's real time.

Nu sker det i realtid, og fordi det er et billigt internetbaseret system,

And because this is such a low-cost system and based in the cloud,

it costs, for the entire five countries that Camfed runs this in,

koster det, for de fem lande, som Camfed opererer i,

med titusindvis af piger, omkring 10.000 dollars per år.

with tens of thousands of girls,

the whole cost combined is 10,000 dollars a year.

That's less than I used to get

Det er mindre end hvad jeg fik

bare for at rejse ud og lave en to-ugers konsultation.

just traveling out for two weeks to do a consultation.

So I told you before that when we were doing it the old-fashioned way,

Jeg fortalte før, at da vi arbejdede på den gammeldags måde,

I realized all of our work was really adding up to just a drop in the bucket --

var vores arbejde bare en dråbe i havet -

10, 20, 30 different programs.

10, 20, 30 forskellige programmer.

Vi har gjort store fremskridt, men jeg må erkende,

We've made a lot of progress,

but I recognize that right now,

at selv med den indsats vi nu har gjort,

even the work that we've done with 14,000 people using this

med 14.000 folk som bruger det,

is still a drop in the bucket.

er det stadig en dråbe i havet. Men noget er ændret.

But something's changed, and I think it should be obvious.

Og jeg tror det er indlysende.

What's changed now is,

Det som er anderledes nu er,

instead of having a program in which we're scaling at such a slow rate

at istedet for at have et program, som skalerer så langsomt,

that we can never reach all the people who need us,

at vi aldrig kan nå alle de folk, som har brug for det,

we've made it unnecessary for people to get reached by us.

har vi gjort det unødvendigt at folk kommer i kontakt med os.

We've created a tool that lets programs keep kids in school,

Vi har skabt et værktøj, som lader organisationer holde børn i skole,

track the number of babies that are born and the number of babies that die,

følge antallet af børn som bliver født og dør,

catch criminals and successfully prosecute them --

at fange kriminelle og succesfuldt retsforfølge dem,

to do all these different things to learn more about what's going on,

til at gøre en masse ting for at lære mere om,

hvad der sker, at forstå mere, at se mere

to understand more,

to see more ...

and to save lives and improve lives.

og at redde liv og forbedre liv.

Thank you.

Tak.

(Applause)

(Bifald)