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Harnessing Both Sun and Cell Phone to Close Gaps in Local Health Care
Nancy Scola, 18 Jun 09

Two projects led by US students and their international allies are helping to fill gaps in health care gaps in the Global South. Though one project involves cell phone text messaging and the other equipment sterilizers powered by the sun, they have the same inspiration: using simple technology to build on the value of existing social capital.

These innovations are developing in Malawi and Nicaragua, both counted amongst the all-too-many places on the globe where the holes in the net of public health are so gaping that many people slip right through. Numbers tell that story. Of the fifty thousand Malawians who contracted tuberculousis last year, for example, an estimated 70% of them are also carry HIV. And that's just a small portion those with HIV; nearly one million of Malawi's 14 million people are infected. Yet in all of the country, there are just 250 or so doctors. Nicaragua is somewhat better off, yet nearly half of all of births happen there with no medical professional in attendance. Into those breaches have, in many cases, stepped community health workers (CHWs), local laypeople who work with the local health care system, often as volunteers. The two projects profiled here are equipping those CHWs with simple, appropriate ways to shrink the holes in their country's health care nets.

Image Credit: Salud del Sol
The first is a solar autoclave, or medical equipment sterilizer, created by a group called Salud Del Sol. The autoclave piggybacks off of solar cooking boxes already in wide use in rural Nicaragua. The cooking boxes, which are about the size of several extra-large pizza boxes stacked on top of one another, placed on waist-high legs, are used to cook eggs, plantains, cakes -- everything, that is, "except tortillas," Lori Hanna says. Hanna is the engineering student at the University of Dayton in Ohio who launched the project after spending two months in Sabana Grande, Nicaragua, living and working amongst Las Mujeres Solares, a community group that is using the energy of the sun to patch the country's notoriously poor energy grid.

It was clear, though, that these solar cookers could be used to meet another pressing need. A thousand or so health care clinics dot Nicaragua and are the beginning and end of health care for many Nicaraguans. Most if not all, reports Hanna, lack electricity, and thus have no way to sterilize the scissors, tweezers, specula, and other birthing equipment that are the tools of their trade. The choice, then, is to risk infection, or to expend resources traveling to a city hospital to use sterilizing units. A small autoclave stashed into those solar cookers could, it seems, do the trick. Salud del Sol has worked out the solar autoclave's basic specifications. The challenge now, according to Hanna, is keeping the solar cooker hot enough long enough to let the autoclave kill germs. One simple solution is to assign someone to keep watch: 15 minutes of solid steam passing out of the box means the appropriate time and temperature has been met. In their work in-country, the team is also experimenting with wax-based hourglasses that track both heat and time.

"Just getting the engineering part right isn't enough," Hanna says. "I realized that I also had to do the business plan for it too." When the kinks of the units have been worked out, the cost of the autoclaves, she says, will be borne by donors. The units will built and distributed by Las Mujeres Solares, a practical match since the group already sells the solar cookers required to operate the autoclaves. Beyond Nicaragua, Salud del Sol has ambitions of extending the project anywhere there's a need -- and enough sunlight.

Image credit: FrontlineSMS
The second project is FrontlineSMS:Medic. Like Salud Del Sol does with solar cookers, it too extends the usefulness of a simple, proven technology. In this case, it's FrontlineSMS, a free and open-source software program. Acting as a command center, FrontlineSMS equips advocates and activists with a way to bulk send and manage cell phone text messages from a computer. No Internet connection needed: simply tether a working and network-connected mobile phone to a laptop. The program has already been used, according to the FrontlineSMS site, to organize community workshops in Brazil and to monitor elections in Nigeria.

Its application as FrontlineSMS:Medic was introduced to St. Gabriel's Hospital in Namitete, Malawi, by Stanford student Josh Nesbit. Nesbit's project solves a human resources problem: the population served by St. Gabriel's is spread far and wide through an enormous catchment (to use a bit of public-health speak for the area of service of a health facility). That distribution forced community health workers to travel hours simply to relay news of the sick back to the hospital's medical staff.

And so, Nesbit and his team equipped St. Gabriel's CHWs with hospital-issued cell phones. The workers were shown how to send text messages back to a St. Gabriel's nurse, who would check them through the FrontlineSMS dashboard on his laptop. With a few clicks and about $.10 USD per message, that nurse could, for example, help the CHWs understand the best treatment for TB symptoms or indicate the correct dosage of HIV antiretroviral medication (the latter of which FrontlineSMS can even potentially automate through keyword-triggered responses). That direction from the medical professional would pop up on the CHW's mobile phone, without the volunteer's having to leave the village or town he or she was working in. The topping off of cell phone credits was handled through the FrontlineSMS interface, to help ensure that those resources were being directed to hospital work. To keep the project running, the FrontlineSMS:Medic team is now collecting used cell phones to be traded in for phones to be used in the field.

Like Salud del Sol, FrontlineSMS:Media has hopes of polishing their technology, honing their logistical approach, and expanding beyond their original site. In doing so, they are helping some of the millions of local health workers worldwide to stretch their resources and fill in some of the gaps in their community’s health care systems.

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