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101115 Berlino Window

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  • 1. Increasing connectivity of isolated health worker in poor countires using locally available technology L. Bellina and E. Missoni* *Corresponding author: eduardo.missoni@unibocconi.it
  • 2. 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.
  • 3. 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.
  • 4. 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.
  • 5. 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
  • 6. Results
    • Where there was a laboratory there was a technician and a microscope,
      • microscope often inadequately used for lack of training.
  • 7. 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
  • 8. 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
  • 9. Results
  • 10. Results
    • Image received at central Laboratory in Dhaka
  • 11. From the 4th day of training onwards, training did not improve use of technology, but diagnostic capacity
  • 12. 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.
  • 13. 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.
  • 14. Results
    • Mobile Diagnosis was readiliy extended to dermatological, radiological and ultrasound diagnostics.
  • 15. 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…
  • 16. Conclusions
    • But basic laboratory training comes first!
    • Dr. Bellina: “Is this a Schistosoma?”
  • 17. 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.
  • 18. 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
  • 19. www.mobilediagnosis.net Thank You!