Increasing connectivity of isolated health worker in poor countires using locally available technology

L. Bellina and E. Missoni*

*Corresponding author: eduardo.missoni@unibocconi.it

Background

• We previously showed that current mobile phones can be easily used without any adaptor to take images from the microscope and send them for remote reference.

Objective

• Testing the viability of our Mobile Diagnosis approach in poor resource settings, and validating health-care applications beyond the laboratory and in extension services.

Methods

• We tested Mobile Diagnosis with local health workers in rural health units in Uganda and Bangladesh

• MMS availability and local use was verified.• In Bangladesh (Bhuapur and Comilla)

– structured interviews to define parameters such as diagnostic capacities, workload, extension services, use of clinical and laboratory equipment, availability and use of m-phones.

– testing link with reference centre in Dhaka

• In Uganda (St. Mary Hospital, Lacor Gulu) – we tested use in training and as didactic tool.

Methods

• 16 rural laboratory technicians – 8 trained on-the-job during 5

days (Bhuapur)– 8 trained on-the-job during 12

days (Comilla)• technological skill (microscopy and

use of mobile phones) tested before training and progress evaluated daily

– understand what to “capture”– center the target in the field – manage the light beam– approach the m-phone to the ocular– protect from external light interference– focus without moving– shoot keeping the target in the center

Results

• Where there was a laboratory there was a technician and a microscope, – microscope often inadequately used for lack of training.

Results

• Where there was a laboratory there was a technician and a microscope, – microscope often inadequately used for lack of training.

• MMS commonly accessible in Bangladesh, less so in rural Uganda, but not used in both cases– Limits: costs, knowledge of potential of tool, need for setting

procedure.

• Use of integrated camera m-phones was widely spread. – 14/16 had at least one m-phone– 12/16 had a mobile-phone without camera– 8/16 had a camera-integrated mobile-phone

Results

• Possible diagnostic use of m-phones was not known, but easily learnt

• results were identical for participants who did not own a mobile-phone

• Optimum results were not immediate and needed minimum one and a half days

Results

Results

• Image received at central Laboratory in Dhaka

From the 4th day of training onwards, training did not improve use of technology, but diagnostic

capacity

Results

• best result were achieved by two of those who did not own a phone

• at the end of the training, two participants (one in each group, both owners of a m-phone) were not able to take or send quality images, nor to adequately manage the microscope.

Results

• Microscopy images on the m-phone screen proved to be an excellent educational tool.

• Different cultural attitudes toward the use of available equipment were noted between involved Bengali and African health workers.

Results

• Mobile Diagnosis was readiliy extended to dermatological, radiological and ultrasound diagnostics.

Conclusions

• Learning and applying the new use of m-phone was not dependent on previous level of education or expertise

• Challenges:– training, – motivation and personal initiative, – organisation – understanding of local context

• Mobile Diagnosis may increase quality of diagnostics…

Conclusions

But basic laboratory training comes first!• Dr. Bellina: “Is this a Schistosoma?”

Conclusions

• Need to prioritize strengthening of basic skills and more efficient, innovative and appropriate use of locally normally available technology, rather than the development of costly new ad hoc technology.

Acknowledgements

We wish to thank:• all the health workers and the

people that supported our field work in Uganda and Bangladesh

• Professor Muhammad Yunus, for his invitation to collaborate, great availability, courtesy and personal support

• Dr.Baquirul Islam Kahn, Grameen Kalyan Programme Manager for his support and valuable advice

• Dr. Imamus Sultan, Grameen Kalyan Managing Director, for providing logistic support

www.mobilediagnosis.net

Thank You!