The dissemination work done by Nuwan Waidyanatha in Colombo is yielding unexpected results. A nice write up in Fast Company. Now if the same consortia can somehow figure out a surveillance program of bureaucratic inefficiencies, then the relevant governments of these countries may actually be able to respond well and respond fast, given that identification is just one component to controlling epidemics. Increasing the efficiency with which epidemics are identified is a step forward, but what comes after–implementation of crowd control, region-wide communications, and swift deployment of medical personnel–is the real test.
The present day disease surveillance and notification system in Sri Lanka, confined to a handful of diseases, known as Notifiable disease, and reporting large numbers of common cases, is what the British introduced in 1897 as part of the quarantine and prevention of diseases ordinance. This paper based surveillance and reporting system has its shortcomings that the health professionals themselves have voiced. The Real-Time Biosurveillance Program (RTBP) pilot, during the first week of April, interviewed health workers and health officials in Kurunegala District to study the notification and response policy and procedures. These interviews revealed that in some occasions by the time health officials receive the notification to inspect the patient, with the infectious disease, at the patient’s residence, the patient had already died; health workers literally pull their hair trying to decipher the illegible handwriting on the paper forms; they also mentioned that they have to travel long distance from their villages to the Medical Officer of Health (MOH) office to pickup the paper forms with the patient’s information. These inefficiencies and excessive costs can be drastically reduced with ICT; with a technique as simple as a communicating the information via SMS text messages that costs Rupees 0.
The literarcy rate in Tamil Nadu is above that of the national average. Health workers assisting in the Real-Time Biosurveillance Program (RTBP) in Tamil Nadu, all of whom are female, 68% have 10 years of education and the rest only 12 years of education. They have more than 10 years experience working in the field providing primary health care and reporting on relevant health statistics to the government. These health workers (few of them are in the photo with their backs to you) were given training and mobilized with the mHealthSurvey, mobile phone application, for submitting patient disease/syndrome data for the surveillance of epidemiological events. Data that used to take over 15 days to relay up to the paper chain, but was not subject to any detection analysis (i.
The health departments and health workers involved in the Real-Time Biosruveillance Program (RTBP) pilot see the benefits in the m-HealthSurvey for real-time data collection, TCube Web Interface for near-real-time outbreak detection, and Sahana Alerting Module for real-time health risk information dissemination. Preliminary lessons to date indicate the need for more robust mobile application for data collection with complete standardized content in disease-syndrome for reduction of noise and increase of reliability in the datasets. More rigorous capacity building and frequent use is required for health officials to take advantage of the full potential of TCWI. Further exercises need to be carried out with the Sahana Alerting Module to understand its shortcomings. Given that the system has been in preliminary use for less than six months, it is anticipated that the usability issues will subside in time to come.
A m-HealthSurvey Certification Exercise was carried out as part of the m-Health Real-Time Biosurveillance Program (RTBP) to measure the usability and adoptability of the m-HealthSurvey mobile application. The exercise was conducted with health workers in Sivagangai District, Tamil Nadu, India and in Kurunegala District, Sri Lanka. The final results of the exercise will be published in the near future. m-HealthSurvey is a mobile application developed by indian Institute of technology Madras’s Rural Technology and Business Incubator (RTBI) for collecting near real-time patient disease, syndrome, and demographic data for rapid detection of disease outbreaks. It is a J2ME midlet that allows users to select categorical data as well as type information to generate patient clinical records to be submitted via GPRS to a central database.
m-Health Real-Time Biosurveillance Program (RTBP) interviewed Medical Officers in Kurunegal District in Sri Lanka and Sivagangai District in Tamil Nadu, India, during the months of September and October, 2009. These interactions revealed that outpatient health record entry in real-time by Medical Officers, using the mobile phone key pad is inefficient and the idea was rejected by them. The aim of the RTBP is to collect digitized patient disease, syndrome, and demographic information from the point of care to rapidly detect disease outbreaks. Village Health Nurses in Tamil Nadu examine at most 70 patients a week. Ninety percent of the Village Health Nurses opt to jot down the records on paper and later enter them leisurely after the day’s work is complete.
The Real-Time Biosurveillance Program (RTBP) information communication system comprises an upstream health data submission by last-mile health workers, data processing by epidemiologist, and downstream alerting by health officials.There are four components to the RTBP software: mobile phone application, desktop web application, database, T-Cube analytic tools, and Common Alerting Protocol messaging. The individual components are to be developed by Rural Technology and Business Incubator, Respere (Private) Limited, and Auton Lab. Following are the four software requirement specification documents – 1) Sahana biosurveillance module (database and desktop web application) 2) Mobile J2ME application (data collection) 3) T-Cube web interface (analysis and event detection) 4) Sahana Common Alerting Protocol Messaging Module (publishing SMS/Email/Web alerts)
Village Health Nurses (VHN) are the last-mile health workers attending to the primary health care needs of the rural villagers in the state of Tamil Nadu; where the real-time biosruveillance program (RTBP) is being pilot tested in India. They work under harsh conditions. For instance transportation schedule is limited to a bus that leaves in the morning and returns in the afternoon. Baking and sweating in the hot sun in Sivaganga District of Tamil Nadu, they walk for several kilometers, carrying a heavy load of Registers, making house calls to give the much needed health care to the rural poor. During a recent workshop, in Tamil Nadu, a discussion around the accountability of submitting data revealed that the VHN sometimes cheat on the statistics they tediously record on large volumes of paper forms.
Sixteen Sarovdaya Suwadana Center Volunteers working in the capacity of Research Assistants for the real-time biosurveillance program were trained in the use of the m-HealthSurvey mobile application. The training took place at the Sarvodaya Kuliyapitiya District Center, April 23 – 25, 2009. The three day program comprised lectures on disease surveillance and notification, use of mobile application for communicating patient data, and a field visit to understand the working environment. The Suwadana Center Volunteer training workshop report carries the full story.
Press Release 2009 from Brown Lloyd James. ICTD2009 highlights new developments in technology for developing countries “Dr. Artur Dubrawski, Director of the AutonLab at Carnegie Mellon University and Mr. Nuwan Waidyanatha, Senior Researcher and Project Director of LIRNEasia in Sri Lanka, are presenting their collaborative project using mobile telephony. The project uses the T-Cube Web Interface, a tool developed by Carnegie Mellon University to visualize and manipulate large scale multivariate time series datasets, to support real-time bio-surveillance.
Remember in Star Trek Dr. Leonard McCoy, nicknamed Bones, would use a handheld device (shaped like a mobile phone) to scan the vital signs report of a patient; the little screen on the device would make some electronic noises and display some random illuminated pixels, which he would interpret to diagnose the condition of the patient; thereafter, he would use the same device or the wrist device to call “Sick Bay” tell them what to do with patient diagnosed outside of the facility. He would even transfer the diagnostic report to Sick-Bay for the on duty staff to pickup to get ready before the patient arrived. A team of researchers at the University of California, Berkley are using mobile phones that display faint blue dots on the screen received through a text message to diagnose signatures of Malaria. The Science and Technology article of the Economists tells the story about Dr.