101115 Berlino Window


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101115 Berlino Window

  1. 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. 2. Background <ul><li>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. </li></ul>
  3. 3. Objective <ul><li>Testing the viability of our Mobile Diagnosis approach in poor resource settings, and validating health-care applications beyond the laboratory and in extension services. </li></ul>
  4. 4. Methods <ul><li>We tested Mobile Diagnosis with local health workers in rural health units in Uganda and Bangladesh </li></ul><ul><li>MMS availability and local use was verified. </li></ul><ul><li>In Bangladesh (Bhuapur and Comilla) </li></ul><ul><ul><li>structured interviews to define parameters such as diagnostic capacities, workload, extension services, use of clinical and laboratory equipment, availability and use of m-phones. </li></ul></ul><ul><ul><li>testing link with reference centre in Dhaka </li></ul></ul><ul><li>In Uganda (St. Mary Hospital, Lacor Gulu) </li></ul><ul><ul><li>we tested use in training and as didactic tool. </li></ul></ul>
  5. 5. Methods <ul><li>16 rural laboratory technicians </li></ul><ul><ul><li>8 trained on-the-job during 5 days (Bhuapur) </li></ul></ul><ul><ul><li>8 trained on-the-job during 12 days (Comilla) </li></ul></ul><ul><li>technological skill (microscopy and use of mobile phones) tested before training and progress evaluated daily </li></ul><ul><ul><li>understand what to “capture” </li></ul></ul><ul><ul><li>center the target in the field  </li></ul></ul><ul><ul><li>manage the light beam </li></ul></ul><ul><ul><li>approach the m-phone to the ocular </li></ul></ul><ul><ul><li>protect from external light interference </li></ul></ul><ul><ul><li>focus without moving </li></ul></ul><ul><ul><li>shoot keeping the target in the center </li></ul></ul>
  6. 6. Results <ul><li>Where there was a laboratory there was a technician and a microscope, </li></ul><ul><ul><li>microscope often inadequately used for lack of training. </li></ul></ul>
  7. 7. Results <ul><li>Where there was a laboratory there was a technician and a microscope, </li></ul><ul><ul><li>microscope often inadequately used for lack of training. </li></ul></ul><ul><li>MMS commonly accessible in Bangladesh, less so in rural Uganda, but not used in both cases </li></ul><ul><ul><li>Limits: costs, knowledge of potential of tool, need for setting procedure. </li></ul></ul><ul><li>Use of integrated camera m-phones was widely spread. </li></ul><ul><ul><li>14/16 had at least one m-phone </li></ul></ul><ul><ul><li>12/16 had a mobile-phone without camera </li></ul></ul><ul><ul><li>8/16 had a camera-integrated mobile-phone </li></ul></ul>
  8. 8. Results <ul><li>Possible diagnostic use of m-phones was not known, but easily learnt </li></ul><ul><li>results were identical for participants who did not own a mobile-phone </li></ul><ul><li>Optimum results were not immediate and needed minimum one and a half days </li></ul>
  9. 9. Results
  10. 10. Results <ul><li>Image received at central Laboratory in Dhaka </li></ul>
  11. 11. From the 4th day of training onwards, training did not improve use of technology, but diagnostic capacity
  12. 12. Results <ul><li>best result were achieved by two of those who did not own a phone </li></ul><ul><li>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. </li></ul>
  13. 13. Results <ul><li>Microscopy images on the m-phone screen proved to be an excellent educational tool. </li></ul><ul><li>Different cultural attitudes toward the use of available equipment were noted between involved Bengali and African health workers. </li></ul>
  14. 14. Results <ul><li>Mobile Diagnosis was readiliy extended to dermatological, radiological and ultrasound diagnostics. </li></ul>
  15. 15. Conclusions <ul><li>Learning and applying the new use of m-phone was not dependent on previous level of education or expertise </li></ul><ul><li>Challenges: </li></ul><ul><ul><li>training, </li></ul></ul><ul><ul><li>motivation and personal initiative, </li></ul></ul><ul><ul><li>organisation </li></ul></ul><ul><ul><li>understanding of local context </li></ul></ul><ul><li>Mobile Diagnosis may increase quality of diagnostics… </li></ul>
  16. 16. Conclusions <ul><li>But basic laboratory training comes first! </li></ul><ul><li>Dr. Bellina: “Is this a Schistosoma?” </li></ul>
  17. 17. Conclusions <ul><li>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. </li></ul>
  18. 18. Acknowledgements <ul><li>We wish to thank: </li></ul><ul><li>all the health workers and the people that supported our field work in Uganda and Bangladesh </li></ul><ul><li>Professor Muhammad Yunus, for his invitation to collaborate, great availability, courtesy and personal support </li></ul><ul><li>Dr.Baquirul Islam Kahn, Grameen Kalyan Programme Manager for his support and valuable advice </li></ul><ul><li>Dr. Imamus Sultan, Grameen Kalyan Managing Director, for providing logistic support </li></ul>
  19. 19. www.mobilediagnosis.net Thank You!