Full Charge!

This morning, we distributed the first batch of solar panels from G24 Innovations. I was also able to reconnect with CHWs I hadn't seen in a while. Everyone was extremely happy - I'll let the pictures tell the story.

Of course, Alex ran the session. The instructions were quick and easy, and everyone was rather celebratory:


To close the meeting, the CHWs sang a song for me that they had prepared - I'm not sure what the lyrics were, but "phones" and "messages" were included! Afterward, I traveled with Dickson Mtanga and Mary Kamakoko to their villages - it took a good two hours on a bicycle. We spent another 3 hours biking around and seeing patients, before I started back to the hospital. Dickson and Mary, using their new panels:

SMS for Patient Care, in its Truest Form

I sat down with Alex today, to discuss the FrontlineSMS and its impact on the Home-Based Care (HBC) program at St. Gabriel's. Essentially, he's a one-man, mobile care unit - focusing on chronically ill patients and those who simply cannot travel to the hospital. The backpack, pictured above, is full of medical supplies.

The SMS network has brought Alex to the homes of 130 patients who would not have otherwise received care. That's about five responses, per week, to requests for remote medical attention.

Before the SMS program, Alex was visiting around thirty patients a week, rotating through the HBC roster. He now follows up on five patients per week, usually checking in on those who have been recently discharged from the hospital. The CHWs take care of the rest - since the program started, approximately 520 HBC patient updates have reached the hospital via SMS.

The difference in Alex's HBC activities amounts to about 500 hours and over $1,000 in fuel saved. He has responded to ~40 requests for healthcare supplies (usually dressing materials for wounds and cervical cancer patients). With FrontlineSMS blasting automated responses to drug inquiries and Alex responding to questions regarding basic care, the central SMS hub truly serves the CHWs and their patients.

Alex, who is a highly capable nurse, also holds full shifts in the male ward at the hospital, and is one of two staff members coordinating antiretroviral treatment (ART) for the catchment area. His multitude of responsibilities make time saved in managing the Home-Based Care program extremely valuable.

The first batch of solar panels from G24 Innovations (www.g24i.com) arrived today - I tested one of the products and it quickly charged my phone, to completion, amidst a thunderstorm. More on this later - we are gearing up for training and distribution on Monday.

Tuberculosis, Meet FrontlineSMS

On Christmas morning, Silia stopped by the guest house to talk about the SMS program. He's responsible for testing, drug provision, and follow-ups for TB patients. He described how he's using FrontlineSMS and the network of cellphone-wielding CHWs. Almost all of what follows developed in my absence.


Some sputum-positive patients don't turn up to receive their medication. It's Silia's job to track these patients and get them back on their drug regimens. Before the SMS program, he was visiting an average of 17 patients per week - this took him three trips on his motorbike. Each trip would take ~9 hours. That's 27 hours per week spent tracking patients in various villages.

The SMS network has allowed Silia to share his workload with the CHWs. He now tracks an average of 20 patients per week via SMS. He simply texts CHWs nearby patients that haven't turned up. As Silia says, the CHWs provide "immediate feedback."

The program has been running for roughly 26 weeks. With the shift to SMS-based patient tracking, Silia had an additional 700 hours to utilize. Not surprisingly, he's been using FrontlineSMS to supplement other areas of his work.

He now visits an average of 4 patients per week, for different reasons. Some messages from the CHWs tell of patients who are too ill to travel to the hospital. Silia will respond by bringing a new supply of drugs. Other messages relay symptoms of community members - e.g. "A man has a chronic cough, and we suspect TB." Silia will visit the patients, and collect a sputum sample. He'll return to the hospital to do testing and send the results, by SMS, back to the CHW.

Finally, when patients at the hospital test positive for TB, they're told which CHWs near their home have cell phones.

Some numbers from the TB program for the last 6 months:

700 hours of follow-up time saved
450 follow-ups via SMS
(At least) $2000 in motorbike fuel saved
100 new patients enrolled in TB treatment program

Coming up: Impact on Home-Based Care, PMTCT, Public Health, and HIV/AIDS programs

The Real Story

Here's the truth - this project involves people, rich in character and experience. It's not only about the technology. If I'm interested in the tech fulfilling its potential, I've got to pay attention to the people.

Case in point:

I spent yesterday mulling over text messages sent through FrontlineSMS over the last four months, noting which CHWs had communicated least. I put together a list of a few CHWs I suspected might be having signal issues. Looking at the map, three of six CHWs on this list were clumped together - clearly, they must not have good reception.

I told Alex about my findings, this morning. He took a look at the names and said, "Well, Bernadeta took her phone with her to Zambia, we've discovered that Chrissy is not able to write her own name, and Jereman's phone battery was stolen while it was charging at the local barber shop." My time away from the hospital almost made me forget the multitude of stories swirling around these phones and the hospital they're linked to. With 100 phones in the field, three random problems are to be expected.

Whether or not everyone agrees, I think personal stories convey a project's successes, as well as their failures. Silia, a hospital attendant who runs the hospital's TB program, said yesterday, "The SMS project is very, very good - I can get much more work done, instead of driving the motorbike everywhere. It's very simple - we can expect feedback about patients immediately." I met the new hospital administrator today, and his second sentence was, "You know, it's not only beneficial for communication. The volunteers are now committed to their work, and more will follow."

I'm letting stories from patients, CHWs, and the medical staff at St. Gabriel's drive my exploration into this project's value. I turned to people for the direction of the initiative, and I'm turning back to them to measure part of its impact.

The first batch of solar panels arrives tomorrow.

Back on the (Wet) Ground

I'm back in my old room at the hospital's guest house, and it's pouring rain. I arrived just in time for the last Home-Based Care course - 21 new, volunteer CHWs were reviewing referral procedures, patient rights, the contents of their drug kits, etc. The group, seen above, is copying acronyms into their notebooks. Here's a snapshot of what they're writing:




At the end of the session, the CHWs were asked to turn in a piece of paper describing the location of their home. Most of their responses were paragraphs long - some included extensive maps.


Joanna, who is running PointCare's CD4-count outreach program, relayed an interesting conversation with one of the CHWs a week ago. She traveled to their farthest site - a good 100 mile drive - and ran into Zakeyo, who said, "You know, Josh is coming on the 19th." I checked FrontlineSMS, and Alex hadn't warned him. It's exciting to know that the next time I see him, I'll pass along a solar panel accompanied by a solar-powered light.


Tomorrow, I'm going to spend some quality time with FrontlineSMS - working through the communication over the last four months.


Please comment freely, or shoot me an e-mail, with any questions. I have just two weeks before I return to Stanford, and I'm trying to make the most of it! As always, thanks for reading.

CNN - "Texting to save lives"

That's the headline the CNN Technology site is using to pull visitors to a story covering the project. Here's the link:

Text service provides more than a Band-Aid for rural health service by Steve Mollman

It's amazing to see Alex and Grace on the site, and I think Steve wrote a wonderful article. I'm headed back to the hospital for Christmas break, and I'll be updating the blog regularly - starting now. Here's a (very) quick 30-second video, as a re-introduction to the project and a few of the people involved.