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Increasing connectivity of isolated health worker in poor countires using locally available technology
L. Bellina and E. Missoni*
*Corresponding author: [email protected]
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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.
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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.
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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.
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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
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Results
• Where there was a laboratory there was a technician and a microscope, – microscope often inadequately used for lack of training.
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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
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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
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Results
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Results
• Image received at central Laboratory in Dhaka
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From the 4th day of training onwards, training did not improve use of technology, but diagnostic
capacity
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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.
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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.
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Results
• Mobile Diagnosis was readiliy extended to dermatological, radiological and ultrasound diagnostics.
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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…
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Conclusions
But basic laboratory training comes first!• Dr. Bellina: “Is this a Schistosoma?”
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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.
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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
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