“When I started out on my training and looked at the medical libraries and all their knowledge,” says Khuluma Mnanzwa, “I had no idea that one day I might be able to carry an entire library in my pocket.”
Mnanzwa is a nurse at Port St John’s Hospital in Nyandennilse in the Eastern Cape. A traditionally poor ward in OR Tambo, it’s been at the forefront of a two year project to evaluate smartphones and tablets for improving healthcare in rural areas funded by Qualcomm’s Wirelesss Reach program and the Henry E Niles Foundation and operated by the Eastern Cape Department of Health with the Nelson Mandela Metropolitan University and MTN South Africa.
The results, says Mbuyiselo Goduka – CIO of the Eastern Cape Department of Health – have been so good that he’s promising that the department will supply 1 000 more devices over the next two years. That’s despite the fact that the authority hit the headlines last year for not being able to pay its workers due to lack of funds.
“When we were first approached to start this pilot in 2008/2008,” Goduka explains, “Our finances were not n a good state, and they’re not doing much better now, so it took a long time to get this off the ground… But we’re no longer testing this any more, it’s been given to the Department of Health.”
Goduka was speaking at at a presentation of the results of the trial, at which the Department confirmed it will take over managing and funding the project on an ongoing basis, with an eye to establishing it in every clinic in the province.
When she was first approached to be part of the pilot, Mnanzwa’s reaction – like most of the doctors and nurses involved – was sceptical.
“I thought I was wasting my time during the training,” she says, “What would a nurse do with a phone?”
During the trial 125 phones and tablets were distributed to 63 nurses and 62 doctors in a range of rural practices which typically had poor access to specialist services and consultants on the medical side and little to no mobile infrastructure on the tech front.
Each device was preloaded with a simple ebook app, Aldiko reader, with access to the Eastern Cape Mobile Health Library Portal, maintained by US firm fhi360. The library was stocked with a range of standard medical textbooks in PDF format which were preloaded onto the phone before sending it out. An expanding stock of extra material is available online, including more specialised reference books and up-to-date journal articles from sources like The Lancet.
Most of the texts are freely available under agreements for improving access to medical literature for developing nations, but the library is carefully curated by a medical team at Nelson Mandela University to make sure it’s relevant to South African needs and policies. Users can install the app and access it from their own phones if they wish.
While a straight-forward ebook reader might seem a very basic way to distribute medical information via an app, compared to the flashy bells and whistles of interactive patient records that are becoming common in posh Sandton surgeries, there is a reason for its simplicity says fhi’s Berhan Gebru.
“We couldn’t change a single word from the approved textbooks,” Gebru explains, “Just one comma or zero misplaced by reformatting the text would have been an unacceptable patient risk. So we try to keep the digital versions as close to the hard copies as possible.”
So there’s a lack of sophistication when put next to a slick app with lots of graphics, the response from those involved in the trial as been overwhelmingly positive.
“I was completely computer illiterate,” says Dr Kholeka Spelman of Cofimvaba Hospital, “My patients thought I was playing games or watching TV at first, but in rural practices where we don’t have specialists this kind of access to information is invaluable.”
Doctors involved in the trial say that the biggest benefits have been access to information about more obscure ailments, and from a medical point of view, spotting severe conditions sooner and referring people to better equipped facilities faster.
No longitudinal study has yet been carried out to quantify the benefits however.
What’s the one thing that you’d change to make your tablet and app better we asked Spelman? “Better bundle management” was the surprising answer to a knowing humm goes up from the crowd. Treating kids with HIV and acute care patients armed only with a smartphone is one thing: wrestling with top mechanisms for transferring airtime into data is apparently a challenge of a far higher degree.