I am Ryan Littman-Quinn and I am the Mobile Telemedicine Programs Manager for the Botswana-UPenn Partnership. Just to give you a background, BUP is a partnership between the government of Botswana and the University of Pennsylvania and it is a PEPFAR-funded organization founded to help address the AIDS epidemic. Botswana suffers from a 40% HIV rate in its sexually active population (2nd highest in the world) so as you can imagine that puts a great amount of stress on the healthcare system that is already quite limited in resources. This combined with the IT infrastructural challenges Botswana faces as a developing country has created a high demand for mHealth solutions. We have several mHealth projects currently running but today I am going to share with you two of our more mature projects.
In general there is a severe shortage of medical specialists in Botswana, and Oral Medicine is no exception. The NEED for this project is the fact that Dr. Phutego… As a result, all complex oral medicine and oral surgery cases in the country (and that is everything from cancerous lesions on the face, to complex tooth infections, to severe wounds above the neck), are referred to him in the capital city of Gaborone. The number of referrals totals around 300 per year, and the entire process of referring a patient to him is limited by cost, transportation, time, and a serious lack of reliable means of follow up.
Currently in 5 locations – solid phone on the map Since February of this year Patients: (perceived benefits) Reduced hospital stay Save money Improved treatment outcome Clinicians: Development of skills and knowledge Surgery preparation Easy consultation not only with Dr. Phuthego, but also with overseas colleagues. Ministry of Health Cost Savings: Automobiles and petrol Driver and nurse food/accommodations Patients’ hospital stay
This is an mHealth project that does not rely on smart phones, but instead any phone with SMS. Service provides access to Botswana clinical guidelines and medline/pubmed queries via SMS. So a healthcare worker with no immediate access to internet can research conditions and lookup botswana national treatment guidelines by simply SMSing key words to a phone number that is connected to a server at the University of Botswana and then receiving SMSes back with their search results. Usually in the form of 3 to 6 SMSes As you can see from this diagram, the Botswana treatment guidelines data is hosted locally on the server, and the pubmed search data is retrieved from their server in washington DC. Focus groups in 4 locations in Botswana 76 participants from various roles within the healthcare system. This included doctors, professors, nurses, consultants, and medical residents.
While the majority of participants indicated that they would use the service on a daily to weekly basis, we discovered that some complexities of the service prevented them from fully embracing it. A key issue arose in terms of design for pubmed portion of our service - a bit too complicated to customize search and also originally the SMS response was abbreviated, which confused many users who were not familiar with the abbreviations being used. The Botswana treatment guidelines were simpler to search and understand- and also the content they were receiving was customized to Botswana. So that part of the service was embraced more so than the pubmed access. So the lesson learned here, which is a very common lesson with M4D projects was the simpler and more customized the service can be for the users, the better. Ultimately embracing this communication channel does fulfill an unmet need for access to medical knowledge in Botswana. Healthcare workers enjoy and appreciate the service and that was the most important part.
As you are all aware, now is an exciting time for mHealth in the world – and LITERALLY right now is an important time for mHealth because of the mHealth summit that is going on in Washington DC and 3 of our projects are actually being represented at that conference. Just want to say that myself and my colleagues in Botswana could not be prouder to be a part of the mHealth movement alongside the other presenters you just saw.
Don’t hesitate to reach out to me if you have any questions. Thanks very much for letting me share our projects with you today. Hope you have a great day!
mHealth in Botswana Mobile Oral Telemedicine Evaluation of txt2MEDLINE & Development of SMS Optimized, Clinical Practice Guidelines M4D Conference - Kampala, Uganda November 10, 2010