Our first morning in Kenya was eventful to say the least. The entire group was up bright and early to embark on a long trip from Nairobi to Nyeri that included 2 main stops: the elephant orphanage and a giraffe sanctuary.
At the elephant sanctuary, we were all amazed by the cuteness of the baby elephants as they played and ate with their trainers. We also saw a small gazelle – making everyone even more excited to go on our safari later in the trip.
Upon arriving in Nyeri, we received a warm welcome and were presented with keys to our rooms. After unloading the bus, we all settled in and then proceeded to the Main Hall where Khanjan went over some logistics or “rules of the game”.
After we finished eating, Khanjan wanted to meet with the different teams to go over plans more thoroughly. We went over goals for each of the teams. Jeff and Steve were interested in checking out the demo application I (Mike) made for the mobile web because they really wanted to try out having a kiosk operator using a cell phone rather than a computer. All of the research projects are detailed below:
Mashavu: Networked Health Solutions
Mashavu: Networked Health Solutions is striving to improve access to pre-primary healthcare for Kenyans. By connecting the residents of rural communities with healthcare expertise through a telemedicine system, Mashavu closes the physical distance between the two communities. Kiosk operators utilize computer/smart phone technology, along with biomedical devices, to gather and report patient information. The biomedical devices gather information on the patient’s weight, height, temperature, and blood pressure. The kiosk operator also takes photographs and gathers information on the patient’s basic hygiene and nutrition habits, as well as patient health history. Mashavu kiosks transmit this information through a web-based portal. Medical professionals (specifically nurses) view the medical information and respond to the kiosk operator with personalized recommendations for the patient within 20 minutes. The kiosk operator relays the nurse recommendations to the patient in-person, by phone or using a text message. Over the past year, Mashavu has set up multiple kiosks in locations recommended by the Ministry of Health (MOH) and has had great success, seeing over a thousand patients around the Nyeri district.
The overarching goals of the Mashavu system are to convert non-customers to customers and encourage people to take an active interest in their health. Mashavu has become a validated and multifaceted approach to help connect rural, marginalized patients of Kenya to urban healthcare professionals through years of extensive research and development. Several courses at Penn State University spanning Engineering, Business Administration, and Law, participate in the Mashavu venture. All participating students are engaged in a research project that examines either components of the system or associated information areas. In these endeavors, we have worked closely with the PMOH and DMOH. For example, last year Public Health and Sanitation questions were added to aggregate community data for the MOH. On the request of the DMOH, we undertook a comprehensive study of CHWs and shared the report with the DMOH.
Research is conducted to ensure that the systems we designed are based on evidence and informed perspectives, as well as, to generate and share knowledge to encourage and inspire similar undertakings. During May 2012, 24 students will be traveling to Kenya in order to advance the mission of Mashavu, determine areas of improvement and expansion, and to better understand how to meet the needs of the Kenyan population. The research studies performed will directly influence what services can be added to the system and how Mashavu will move forward. Additionally, all reports resulting from the studies will be shared with the Kenyan Ministry of Health. The proposed studies are listed and explained below:
- Testing Low-cost Biomedical Devices
- Assessing Breast Cancer Risk
- Community Health Worker (CHW) Education
- Seeking Healthcare in Nyeri, Kenya
- Prevalence of decreased visual acuity
1. Testing Low-Cost Biomedical Devices
Telemedicine applications that leverage existing computing and mobile communications technologies have the potential to help overcome some of the healthcare challenges in remote regions. Though there have been a number of successful telemedicine projects, most of them were experiments. A major constraint is that 95% of the biomedical diagnostic equipment used in Africa is imported, extremely expensive, not ruggedized and not repairable when it fails. Bioengineering students have worked to develop sustainable devices that utilize low-cost sensors in minimal hardware that transmit medical data to a laptop. These instruments include a thermometer, sphygmomanometer that measures blood pressure, spirometer to measures peak lung capacity, stethoscope, weighing scale, and pulse oximeter to measure percent oxygen in the blood. Each of these biomedical devices will be tested against equivalent off the shelf devices for validation, accuracy, ruggedness, and failure modes. Additionally, two image capturing devices have also been developed: a dermascope for skin lesions and a scope specifically made for the ears, nose and throat. These will be tested to ensure proper lighting mechanisms have been incorporated into the designs, and medically relevant information can be concluded from the images obtained. We would like to conduct several Mashavu test kiosks in the villages surrounding Nyeri town (Ruiringu, Micha, Gatitu, Githiru, etc) to give people their health indicators (like weight, blood pressure, etc). The sub-chiefs of these locations are familiar with Mashavu and our team and will facilitate the operation of these kiosks.
2. Assessing Breast Cancer Risk
Addressing the increasing burden of cancer in limited-resource countries requires innovative healthcare solutions. This study will explore the feasibility of using telemedicine in addressing the growing burden of breast cancer in Kenya. Through the development of questions specifically designed to predict a woman’s risk of developing breast cancer, the resulting risk profile can inform physician recommendations for breast cancer screening and can also be influential in informing a woman’s screening behaviors. We would like to conduct interviews and focus group with women to better understand their concerns about breast cancer risks.
3. Community Health Worker (CHW) Education
The role of local community health workers (CHWs) is integral to the success of health care in remote areas and through the consolidation of resources these communities can make care accessible. Recent developments in technology continue to strengthen care in communities that can afford to pay for these advancements, while those who cannot pay remain limited. We conducted a comprehensive study of CHWs in 2011 to understand exactly how they work and the various challenges they face. The initial reports of the study were shared with the offices of both the DMOH as well as the AphiaPlus program, a collaborative effort between USAID and JHPIEGO. Educational opportunities were identified by the CHWs themselves, as well as other partners during this study. Subsequently, we have developed several educational materials for the CHWs. We would like to test the efficacy of these materials and work with the CHWs to refine the content and delivery. We would like to conduct CHW training workshops, and then observe the field effectiveness of the workshops on them, with the longer term objective of developing sustainable technology-based solutions for meeting the CHWs’ educational needs.
4. Seeking Healthcare in Nyeri, Kenya
Mashavus attempts to establish telemedicine in and around Nyeri. Currently, there are multiple telemedicine kiosks that are run by trained kiosk operators selected from the local Kenyan community. As the available technology advances and the scope of data these kiosks can transmit continues to grow, it is becoming increasingly important to determine where these kiosks best fit into the existing healthcare system so that they may afford the maximum benefit for the local population. There are many avenues to receive healthcare in Nyeri, Kenya and its surrounding communities, including a hospital, a locally run clinic, a telemedicine kiosk, a chemist, and a traditional healer. Analysis of data gained from focus groups and individual interviews will summarize the healthcare choices, needs, and behavior of the community and will provide a window into how to best provide telemedicine care for the community under consideration. This research project will involve conducting interviews and focus groups in three distinct communities around Nyeru. It will assist in determining how telemedicine kiosks can best serve the local community regarding location and services provided.
5. Prevalence of decreased visual acuity
Studies have consistently identified refractive error as one of the leading causes of visual impairment. These statistics are especially skewed in resource-constrained countries, due to their low rates in screening for uncorrected refractive error. Research has shown that infrequent visits for eye care are directly related to failure to detect eye disease, as many patients are unaware of their own conditions. There is, however, a definite correlation between vision impairment and patient’s perceived quality-of-life, and those with uncorrected refractive error have been found to report increased loss of productivity, employment opportunities, and reliance on others.
This study seeks to assess the prevalence of visual impairment detected amongst Kenyan community members the majority of which we hypothesize will be due to refractive error, based on results from previous literature. The study will also attempt to establish the relative specificity of the refraction results from the I-test phoropter through comparison with measurements of the same refraction error taken with standard loose lens retinoscopy. If proven effective as a diagnostic tool, the I-test phoropter would be ideal for use within the Mashavu kiosks as a vision screener. It is small, portable, and displays relative ease of function—patients look through an embedded set of lenses that can be rotated through in incremental strengths, much like manual refraction. Overall, this study may provide enough preliminary data to prove beyond a doubt the feasibility and necessity behind performing eye exams in the kiosks, and the study’s success may influence the development of similar vision screening protocols for all of the kiosks in the near future. We would like to set up kiosks (along with the other biomedical devices) to measure visual impairment and determine the best approach to address this issue. We expect these kiosks to serve at least 400 people over the three weeks that we will be working in Kenya.
It looks like tomorrow is going to be a busy day for all teams as we all hurry to get our “animals up and running,” to quote Khanjan.