“As long as I can get into Africa, I would be happy with anything.”
That was what I said to my AoSC advisor Dr. Shannon Galvin when we first met to talk about what my research interests are. Since I became interested in global health in college, I have been wishing to venture into this special part of the world and see what it really is. I really didn’t mind which country to go to, and today I feel very fortunate that I could make such choice at FSM, for it has so many amazing projects for us to choose from.
Among the many potential mentors that Dr. Galvin recommended for me, I decided to work with Prof. David Kelso and Prof. Kara Palamountain from the Center for Innovation in Global Health Techologies (CIGHT) at the Northwestern University. I found this to be very ideal for me as I am always fascinated by new medical technologies. But more importantly, I really wanted to learn more about how we can share these new devices with more people – not only how we can deliver new technology to those living in low-resource settings, but also how we can persuade people to incorporate the technology into their daily clinical practice with sustainability.
Prof. Palamountain and Prof. Kelso already had this one project going on for years, and it involves the making of a new tablet app that can walk a healthcare worker through the entire Integrated Management of Childhood Illness (IMCI) protocol with great ease. The IMCI protocol is a diagnostic algorithm created by the World Health Organization for healthcare workers to diagnose childhood diseases with accuracy and efficiency. Since its development, the IMCI has been implemented in more than 100 countries around the world and significantly lowered under-five mortality rate.
So now, let us ask this one question: since this clinical protocol is so effective in saving children’s lives, how much more impact would we be able to make if we can turn the IMCI paper manual into a tablet app? How about a tablet app with videos demonstrating all the clinical examination skills as well as with the ability to store medical records?
As my two mentors described this tablet app’s potential to me, it did not take more than a second for me to feel the same excitement and passion that they have towards this novel idea. This year they have finally finished the first version of this tablet app, and as a result they are ready for the first testing in the “field”. So that was where I came in – all the way into Africa.
Because of my mentors’ long term connection with University of Cape Town in South Africa, I was able to conduct my research in Cape Town. If I have to pick the most challenging part about this project, it would be the process of trying to get the local University, government, and clinic’s approvals. Those approvals really took months to finalize, and then the rest of the research and logistic planning fell into place within a couple weeks. My mentors have been incredibly supportive every step of the way, and I thought what really made us such a great team was our shared belief that we can truly do something amazing for the world.
Our primary goal is to see if our tablet app can be realistically incorporated into clinical care and training. To assess that, we not only have to make sure that our tablet app works perfectly in clinical setting, but also find out whether health workers would even like to use our tablet app. We understand that many health workers in Cape Town have practiced the IMCI for decades and become very experienced with using the paper manual. It is very possible that they would want to stay with the paper form and thought that using technology would slow them down. Thus, as much as we would like to simply distribute our wonderful tablet app to everyone now, we have to investigate these factors to be certain that our tablet app will be beneficial to patients and health workers.
Comparing to planning all the logistics and coordinating with my local contacts, designing the research method was relatively straightforward.
The project was five weeks long, with the first week being a preparation period and the rest being the data collection period. I tested our tablet app with two study populations: 1) nurses who come from different countries to Cape Town for their first IMCI training at the Red Cross Children’s Hospital near Cape Town, and 2) nurses who have practiced IMCI for at least 1 year at a busy community clinic in a local township. I taught all volunteer nurses how to use the tablet app, observed them using it, and then recorded how well they carried out the IMCI protocol with the paper manual versus the tablet app by measuring only their service delivery time. I also interviewed every nurse to obtain their feedback and thoughts on using our app.
The study design was simple, but the user experiences that I have observed turned out to be so incredibly rich and informative. Even though the results indicated that using our tablet apps prolonged the patient encounter time by about 3 minutes, the nurses not only loved our app, but also requested us to go back and do months-long study to further investigate our app’s impact on their clinical practice. What made this even more incredible is that our research group HAS the time and resources to continue working with these nurses. The trust and connection that we have built through this tiny study are all the affirmations we need to continue making our IMCI tablet app better. And what is even more important than that? Well my friend (as they say in South Africa), it is that we all WANT to see it through.
At the start of my blog, I talked about how I really wanted to go to Africa to see what it is like living there. But as you probably noticed by now, that mentality is important as well as trivial at the same time. How people live in different parts of the world is always changing. Things can stay the same but forces of change are always greater, and our kind wish to do good for the world can make ‘change’ a truly positive one. Fortunately, new technology is a very versatile way to create change. Prof. Kelso and Prof. Palamountain’s team believes that a simple tablet app can change the world for the better. I too believe with them, and with this faith, I actually felt that I was changing the world.
For everything that has happened, I want to thank everyone and everything I have encountered throughout my journey to the other end of the world – yes, I have literally been to Cape Point, the most Southern tip of Africa! That means I can finally checked off another thing off my bucket list.
MD Candidate, Class of 2017