Medical tech designed to meet Africa's needs | Soyapi Mumba

40,490 views ・ 2018-02-04

TED


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00:12
Like every passionate software engineer out there,
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I closely follow technology companies in Silicon Valley,
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pretty much the same way soccer fans follow their teams in Europe.
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I read articles on tech blogs
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and listen to podcasts on my phone.
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But after I finish the article,
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lock my phone and unplug the headphones,
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I'm back in sub-Saharan Africa,
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where the landscape is not quite the same.
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We have long and frequent power outages,
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low penetration of computers,
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slow internet connections
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and a lot of patients visiting understaffed hospitals.
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Since the HIV epidemic,
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hospitals have been struggling to manage regular HIV treatment records
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for increasing volumes of patients.
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For such environments,
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importing technology systems developed elsewhere has not worked,
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but in 2006, I joined Baobab Health,
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a team that uses locally based engineers
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to develop suitable interventions
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that are addressing health care challenges in Malawi.
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We designed an electronic health record system
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that is used by health care workers while seeing patients.
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And in the process we realized that we not only had to design the software,
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we had to implement the infrastructure as well.
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We don't have enough medical staff
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to comprehensively examine every patient,
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so we embedded clinical guidelines within the software
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to guide nurses and clerks
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who assist with handling some of the workload.
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Everyone has a birthday,
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but not everyone knows their birthday,
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so we wrote algorithms to handle estimated birthdates
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as complete dates.
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How do we follow up patients living in slums
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with no street and house numbers?
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We used landmarks to approximate their physical addresses.
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Malawi had no IDs to uniquely identify patients,
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so we had to implement unique patient IDs
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to link patient records across clinics.
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The IDs are printed as barcodes
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on labels that are stuck on personal health booklets
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kept by each patient.
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With this barcoded ID,
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a simple scan with a barcode reader
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quickly pulls up the patient's records.
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No need to rewrite their personal details
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on paper registers at every visit.
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And suddenly, queues became shorter.
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This meant patients, typically mothers with little children on their backs,
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had to spend less time waiting to be assisted.
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And if they lose their booklets,
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their records can still be pulled by searching with their names.
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Now, the way we pronounce and spell names varies tremendously.
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We freely mix R's and L's,
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English and vernacular versions of their names.
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Even soundex,
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a standard method for grouping words by how similar they sound,
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was not good enough.
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So we had to modify it
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to help us link and match existing records.
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Before the iPhone,
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software engineers developed for personal computers,
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but from our experience,
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we knew our power system is not reliable enough
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for personal computers.
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So we repurposed touch screen point-of-sale terminals
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that are meant for retail shops
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to become clinical workstations.
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At the time, we imported internet appliances called i-Openers
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that were manufactured during the dot-com era
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by a failed US company.
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We modified their screens
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to add touch sensors
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and their power system to run from rechargeable batteries.
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When we started, we didn't find a reliable network to transmit data,
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especially from rural hospitals.
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So we built our own towers,
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created a wireless network
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and linked clinics in Lilongwe,
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Malawi's capital.
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(Applause)
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With a team of engineers
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working within a hospital campus,
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we observed health care workers use the system
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and iteratively build an information system
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that is now managing HIV records
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in all major public hospitals in Malawi.
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These are hospitals serving over 2,000 HIV patients, each clinic.
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Now, health care workers who used to spend days
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to tally and prepare quarterly reports
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are producing the same reports within minutes,
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and health care experts from all over the world
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are now coming to Malawi to learn how we did it.
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(Applause)
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It is inspiring and fun
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to follow technology trends across the globe,
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but to make them work
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in low-resourced environments
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like public hospitals in sub-Saharan Africa,
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we have had to become jacks-of-all-trades
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and build whole systems, including the infrastructure,
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from the ground up.
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Thank you.
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(Applause)
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