From computer scientist to global health techie: a preliminary report

From computer scientist to global health techie:

a preliminary report Neal Lesh

Alerts for Pediatric AIDS medsPediatric review

OutlineBackground: The simplicity and complexity of global inequityField reports:AIDS treatment program in urban TanzaniaSocial justice organization in rural RwandaPDA research project in South AfricaTransition to discussion

Simplicity: rich vs. poor

Simplicity: rich vs. poor

Simplicity: rich vs. poor

Simplicity: rich vs. poorInfant mortality: 5Maternal mortality: 8 per 100,000 birthsLife expectancy: 78 yearsInfant mortality: 95 per 1000Maternal mortality: 500-1000 per 100,000Life expectancy: 45 yearsper 1000 births

Simplicity: rich vs. poorInfant mortality: 95 per 1000Maternal mortality: 500-1000 per 100,000Life expectancy: 45 years

ComplexityCorruption, careerism, tax write-offs5-star poverty alleviation meetingsPaying volunteersImperialism, foreign experts

If you want to build a ship, don't drum up people to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the sea. Antoine de Saint-Exupery

OutlineBackground: The simplicity and complexity of global inequityField reports:AIDS treatment program in urban TanzaniaSocial justice organization in rural, RwandaPDA research project in South AfricaTransition to discussion

My last few yearsSep 2004: back to schoolJun 2005: off to TanzaniaOct 2005: overland to Rwanda Since Jan 2006: bouncing around among Tanzania, Rwanda, South Africa and New York

Tanzania

MDHMDH= Muhimbili University + Dar Es Salaam + Harvard University. US government AIDS treatment program, currently about 25,000 HIV+ patients.Reason for going: they needed a new data person, because current was leaving.

MDH data captureDoctors fill in paper forms for each client visitCarbonless copy goes to HQ for double-entryData stored in Microsoft AccessProcessed in SAS to produce useful reportsPatient monitoringProgram monitoringExternal funders and government reports

Missed-Visit List

More alerts

One Page Patient Summaries

Issues

Mistyped IDsMissing & conflicting dataBacklog Efficiency & scaleability

ChallengesMissing or late lab resultsUse of reports to improve decision making.Detect important trends in data

Rwanda

Every situation differentTanzania -> RwandaAIDS treatment -> Social JusticeUrban -> rural

Rwinkwavu is now a functioning district hospitalFirst Year Rwanda Milestones

Rwinkwavu is now a functioning district hospitalFirst Year Rwanda Milestones

PIH Rwanda HIV & TB Scaleup

Over 400 Community Health Workers (Accompagnateurs) First Year Rwanda Milestones

A food package provide for all at the start of ART and TB treatment

First Year Rwanda Milestones

MilestonesProgram on Social and Economic Rights (POSER). Housing assistanceSchool fees (cost of school is subsidized for over 1450 children).

Milestones:Malnutrition Program5 semaines plus tard

How old?11 13 9

Overall ICT Mission Develop and install OpenMRS:An open source framework for medical record systems in low-income regionsReducess duplication of effortFast-growing collaborative effortInstallations in Kenya, Rwanda, Lesotho, Tanzania, and KenyaJoin today! Come to meetings! Or come to Rwanda to teach Java. Contact Christian ([email protected]) or me for details.

ICT task: keep the internet running

ICT task: manage data collection

ICT task: satisfy reporting requests

Lab System

Hard to get on top of it!Hard to hold on, let alone make progress.Pulled in a lot of directions.Data quality a struggleData use a struggleMight be close now...Probably about to be the national standard

South Africa

Screening on Mobile DevicePatient doing well?Patient goes home with meds, to return next monthPatient referred to nurse or doctorYESNO

Screening on Mobile Device

Shortage of DoctorsConclusion: The shortage of doctors and nurses requires that future expansion occur in rural clinics with most patient visits being managed by health workers with minimal training.

COUNTRYDoctors per 1000 populationHI+ people per 1000 populationHIV+ people per doctorSouth Africa0.489215439Tanzania0.023883826Rwanda0.025512040United States1.62963.69

PlanCurrently validating interface & protocolDouble blind study in top-notch hospital clinicsRevising questions after first roundNext step: operationalizing systemLink to OpenMRSDeploy in down-referral clinicsRemote supervisionReports delivered to clinics

Integrated Management ofChildhood Illness (IMCI)

Potential benefits of point-of-care protocolsMore consistent and accurate use of protocolsMore sophisticated and dynamic protocolsEasier to updateLess trainingImproved supervision & monitoringData collection

Discussion

Some questions I dont have answers toIs there real computer science to be done here?Too much focus on health? What about water, education, economics, etc?How do we evaluate if these systems are worth their cost?

Paying volunteers, discussing work-for-food programs over fancy dinner during famine, *