Tag Archive for 'global'

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First Meeting of the FrontlineSMS:Medic team in Palo Alto

Published on March 7, 2009 in Health. 0 Comments Tags: , , , , , , , , , .

First Team Meeting

I just returned from a long weekend in Palo Alto, my first face to face meeting with most of the FrontlineSMS:Medic team. It was fun! If you’re surprised that we hadn’t met in person before, you might be interested in how we learned about each other and decided to work together.

  1. Spring 2007: Josh Nesbit, an undergraduate at Stanford University, meets Ken Banks.
  2. Summer 2008: Josh begins using FrontlineSMS at St. Gabriels Hospital in Namitete, Malawi.
  3. Summer 2008: Lucky Gunasekara is working as a researcher in mobile and web media for a consulting company in Tokyo, Japan. In his free time reads about mobile phone penetration in developing countries and begins to dream of connecting community health workers and patients to electronic health records via SMS on mobile phones.
  4. Early Fall 2008: Isaac Holeman plans to work with a friend at a clinic in East Africa after he graduates from Lewis and Clark the following May. Having no clinical training but some tech experience, he begins planning to integrate OpenMRS into mobile phones using SMS.
  5. November 2008: Dr. Wayne Centrone of Health Bridges International wants to set up a health records system at their clinic in Peru and contacts Daniel Bachhuber (who has more tech experience) to ask for help.
  6. Daniel and Isaac are friends; they randomly share their ideas and decide to join forces under the name MobilizeMRS and apply for the NetSquared USAID Development Challenge. Their proposal is to merge FrontlineSMS with OpenMRS. Their project becomes a finalist.
  7. Early 2009: Through a series of emails and phone calls, Josh, Daniel, and Isaac team up.
  8. Josh meets, by chance at lunch, Lucky, who now studies at Stanford Medical School. Lucky joins the team, and invites his friend Nadim Mahmud to join on and help develop a 500,000 patient mHealth impact study in Bangladesh for the summer of 2010.
  9. Lucky is selected as one of 10 featured announcements out of 700 student commitments at the 2009 Clinton Global Initiative University. At CGIU, Lucky meets Ken Banks and pitches connecting FrontlineSMS, OpenMRS, and a revolutionary cell phone-based diagnostic technology, developed at UCLA. Ken agrees to formally give his support and former President Bill Clinton makes the announcement.
  10. February 23rd: They relaunch the venture as FrontlineSMS:Medic. The Medic team is currently beginning software development and already have firm implementation plans with over 15 partner clinics in Africa, Asia, and Latin America

Daniel and I both flew down from Oregon to Palo Alto on Friday, and got to know Josh, Nadim, and Lucky at a noodle bar down town. The real work began Saturday morning with a massive 11 hour team meeting. The five of us spent a lot of the morning working on our application for the Dell Social Innovation Challenge. That application is now posted, so we’d appreciate your feedback and your votes!

After a short break for burritos, we met with a handful of other Stanford med students to discuss our plans for the next year. We’re still working out the details about who will help set up where, and we decided it was useful to place the various upcoming implementations of FrontlineSMS:Medic into three categories.

Research Studies: These sites will conduct randomized controlled trials or prospective impact studies on a stable, accepted build of medic.

Innovation Pilots: These sites will innovate, experiment, and provide feedback on the latest features as soon as possible.

Implementer Partners: These sites will receive tech support, may receive hardware, and will have a FrontlineSMS:Medic team member on site for a short time or not at all.

We definitely have our work cut out for us with all these sites. We’ll introduce you to each project individually as things progress.

Technical details absorbed the next chunk of our meeting. Every exchange was good-natured, and yet the rapid back and forth was so intense it felt almost like an argument. For hours upon hours. I thought many times of something Clay Shirky recently said about innovation: “Don’t look at crowds and don’t look at individuals, look at small groups of smart people arguing with each other.”

Our discussion of features and interfaces led us to be empathetically and anthropologically about the community we hope to serve, and it exposed a truth that had quietly undergirded many of our earlier conversations. We are taking a grass roots approach to scalability. Many people will read the word “scalability,” and think of massive, efficient hospitals serving many hundreds of thousands of patients. They might think of organizations that have a large, university trained technical team to work on medical informatics. That’s scale, right? In contrast, by focusing on grass roots scalability we are thinking first and foremost about the small or medium sized clinic or hospital where perhaps no one has an awful lot of training with technology. Most of them will find one computer and some phones a lot less daunting than complex computer networks, servers, and complicated software installation. These organizations probably have just one person to work on medical informatics, and chances are this person is doubling as a TB officer, nurse, or janitor. If our project achieves significant scale, it will be first because we expand our simple approach to many resource constrained organizations, and secondarily because any one organization may implement FrontlineSMS:Medic at significant scale.

We’ll post more about the fruits of this discussion soon. In the mean time why don’t you check out Nadim’s post about the visit he and Lucky made to UCLA to discuss integrating FrontlineSMS:Medic with Professor Ozcan’s LUCAS technology.

Cross-posted at the FrontlineSMS:Medic team blog.

In Defense of Irrational Medicine

Published on January 13, 2009 in Health. 12 Comments Tags: , , , , , .

A recent post at the change.org global health blog discusses a few global health programs that do not improve global health very much for how much they cost. Examples include Hospital ships and flying patients to the US for medical care. You could say that these programs use resources irrationally, Alanna goes so far as to say that such programs are immoral.

I think a key issue at the heart of some such of programs is the balance between long term effectiveness and the fierce urgency of now. I agree that the programs she describes would play a very small role in an ideal global health care service, but ultimately what we need more than any specific program is for people to give a damn. Some people have excess resources; we need them to care enough that they are willing to share some of those resources with the rest of the human family. If irrational programs will occasionally inspire people, perhaps they are worth the cost.

I’d like to discuss an example. The organization Partners in Health works in Haiti, and will occasionally fly patients to Boston to receive complex treatments that are not available in Haiti. They call it their Right To Health Care program. One recent patient was a young boy who needed to have a hole in his skull repaired. The flight and the procedure were admittedly expensive; the same amount of money might have purchased many bed nets or vaccines. But for the health care providers involved, the issue at stake was whether they were willing to treat this little boy like a beloved family member, whether they were willing to do whatever it would take to help him be healthy. In this instance PIH chose to respond to the fierce urgency of now.

PIH’s difficult work is possible in part because they have attracted very dedicated staff by telling controversial and emotionally charged stories, and following up with stories of hope and healing. Such acts are not purely metaphysical, they shape PIH programs. PIH has incredible, even enviable support in the communities where they work, in part because community members hear about stories like this little boy’s and they think, “wow, these people must really truly care about us an awful lot.” I also know individuals in the USA who have had the course of their lives changed by this brand of irrationally inspiring dedication. I’ve met people who heard a PIH story like this and decided that they were going to donate what they could to PIH every month from that point on – indefinitely. In my own case, I read of such efforts and decided that I too would become a doctor for the poor. I dare say my contributions to humanity will outweigh the cost of flying one needy child to Boston and performing a pro-bono surgery. I cannot emphasize enough how plausible it is that I might not have come to care, that I might have marched though life without being inspired.

Logistically, economically, such decisions do not make sense. They are irrational. And yet, a great many people ache for that kind of leadership, and to emulate such reckless devotion. I am forced to conclude that there are depths of the human soul which I do not yet understand.

Questions about Social Cleansing, Genocide, and the Israel-Gaza Conflict

Published on January 11, 2009 in Faith. 5 Comments Tags: , , , , , , , , , , , , , , , .

I agree with Michelle, who blogs about Genocide on change.org, when she says “I have yet to see anything that shows that Israel has set out to systematically wipe out the Palestinian people from the face of the planet.”

Does that necessarily mean that Israel does not “desire to completely exterminate a set population” by “causing the death of all of the groups members, or enough of them that the population as defined will not survive for long?” (this is the definition of genocide). Is it possible that Israel is determined to destroy a “set population,” but that the set population includes all violent extremist Palestinian Muslims rather than Palestine as a whole? Quotes like this, from a recent New York Times article, seem to indicate that many Israelis are indeed out to completely destroy a very specific ideological/religious population within Palestine.

“We do feel bad about it, but we don’t feel guilty,” Mr. Jager added. “The most ethical moral imperative is for Israel to prevail in this conflict over an immoral Islamist philosophy. It is a zero sum conflict. That is what is not understood outside this country.”

It could be construed that Mr. Jager believes all of Islam to be immoral, but it is more likely that the zero sum conflict he mentions is about “prevailing over” a specific, violent faction of Islamists who reside in Palestine. To make the argument that this could constitute genocide, one would need to demonstrate that culturally/ideologically/religiously, violent extremist Palestinian Muslims are a qualitatively distinct subset of Palestinians.

Is it possible that an ideological propensity to violence makes this particular population of Palestinians qualitatively different from the majority of other Palestinians who are just terrified and desperate and want to be protected? Personally, I think that when you imply that people who use Islam to justify radical and violent aggression are the same group as peaceful Palestinians or peaceful Muslims in general, you are doing a disservice to peaceful Muslims. Radical violent Islam is sooooo different than the religion and cultural identity of the Muslims I know. As a practitioner of an Abrahamic religion (Christianity), I sometimes feel like I have more in common with peaceful Muslims than peaceful Muslims have in common violent extremist Muslims. Having never been to Palestine it’s easy for me to think of all Palestinians as just one bunch, but having never been to Rwanda I probably would have said Hutus and Tutsis were all just Rwandans until the ethnic conflict started.

The second criteria for genocide, that the group be exterminated by killing of its members, I think is even more clear. Israel publicly justifies bombing the university in Gaza by saying that Hamas was making bombs there. Israel is “taking out” any people who proscribe to the violent ideology and support the violence, whether or not they are soldiers or leaders in any traditional sense.

The argument that genocide is occurring, and Israel’s acts are intentionally genocidal, targeting a specific ideological/cultural group that is a small subset of and dispersed throughout the geographic area of Palestine is important because it forces us to ask an important question. Are there some cultural/religious/ideological groups that we wish would cease to exist (whether or not we condone violent means)? Are there bounds to moral relativism? Can we draw a line in the sand and say this or that line of thinking is poisoned; it must be changed (again, by non-violent or violent means – I would choose non-violent). Is it possible that genocide could be just the violent approach to something that we actually want to happen (don’t know about you, but these thoughts are very unsettling for me).

I’ve been wondering at how many Americans tacitly support what is happening right now in Israel/Palestine. I wonder if it is because many Americans support genocide in this case. They want to see violent religious (especially Islamic) extremism disappear forever and they are willing to condone violence and accept that some, perhaps many non-extremists will be caught in the cross-fire. Of course most would not call it genocide, but I suspect that more Americans support Israel in this conflict because they think that the killing is going to help eliminate religious extremist ideology (I think that sounds like genocide). I think fewer Americans would support Israel if they perceived the conflict solely as part of an endless tit for tat, cycle of violence.

To close, I’d like to suggest one reason why it could be productive to argue that Israel’s actions are genocidal. Right now most relatively uninformed observers would say that Israel is attacking Palestine. When we point out that the nature of this attack does not constitute genocide on the Palestinian people, we mask the possibility that the purpose of this attack is to permanently alter the cultural/religious/social order of the world. If we are not clear that the goal is to change culture, than we too frequently seem to be reduced to understanding the conflict as a brutish tit for tat that says Israel is justified in fighting back. If so, when will the cycle of violence end? And how? An alternative is to step back and admit we want to drastically change the cultural/religious/social order of this part of the world. What tools do we have at our disposal to change culture? I learned of one from our president elect, Mr. Barack Hussein Obama. It’s called community organizing. I know the Gaza strip is dangerous right now, and I daresay community organizing in this region must necessarily be the burden of peaceful Muslims rather than Christians like me (perhaps explaining in part why western powers have failed to promote non-violent social change in this region).

Personally, I feel that genocidal intent is the best explanation I’ve heard of WHY this conflict is happening (I’d love to be proven wrong). Once I understand better why it is happening, it is easier for me to determine what the alternatives are. Ultimately my most important question is, do others come to the same conclusions about culture change and peaceful alternatives when they hear about genocide in this context? Probably not, unfortunately, but I’d love to hear your opinions.

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