Heart to Heart

The ICHA Blog

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We’re Online! by Mobile Health Team on April 22, 2011 | 27 comments

The morning sun was up and so was the internet connection we had been waiting for. We had Jason's phone call to the network provider on the previous day to thank for it! After some minor tweaking of the phone settings, the mPACT BP tool worked smoothly. Never before in my life had I though I would be so elated to see the message "sending data to ICHA"! Today our task was to visit the four clinics in the KEEA district and ensure that the health workers were able to use the tool well. We also planned to take this chance to update the tool to the smart program that could communicate with the server.

 

My first stop was the Elmina Urban Health clinic. Clement walked with me, pointing out the various features and facilities, while patiently answering the questions I had for him. What I noticed immediately was the sheer numbers of people waiting to see a prescriber. This was not surprising as the Elmina clinic is the largest in the KEEA district. Also, this scene is familiar in most Indian clinics. What was unusual was that only 2 or 3 health workers were at hand at any given time to see the 100+ patients. I met one of the health workers who had attended the orientation for the mPACT program the day before. He showed me proudly that he had his phone out and ready to enter BP data. I was happy to note the enthusiasm in his voice. I briefly interviewed the triage staff who mentioned that they measured the blood pressure, temperature and weight of all patients. It was a little disappointing to note that they were not calculating BMIs as they had been taught before. The lab staff members at the clinic were very friendly. They showed me their diagnostic equipment including two glucometers which were not working because their batteries had died. New batteries that were shipped to them from the United States had been lost in transit. When I inquired about how they measured the blood glucose of their patients, they calmly mentioned that they borrowed a working battery from a guy who worked elsewhere. They said they picked it up from him every morning, used it during the day and returned it in the evening on their way home.

 

Next, Abby, Jason, Clement and I took a taxi to the other clinics. It turned out that the only health worker at Kissi had been called to the regional office at Cape coast, so we directed the taxi driver to take us to the clinic in Komenda instead. Again, there was only one health worker staffing this clinic. The Komenda clinic was much smaller than the Elmina clinic and there were fewer patients waiting in comparison. We updated the phone and asked the health worker some quick follow up questions before we left. Last on our trip was Agona. The town and the clinic are located in a very rural setting, several kilometers off the trans-African highway.Most of the drive was through a narrow unevenly paved road. The entrance to the clinic was very beautiful. Even though the building itself was very plain, there was a garden with blooming flowers that instantly cheered up the surroundings. The Agona clinic was much bigger than the Komenda clinic, but still smaller than the Elmina one. There we met another health worker who was a part of the mPACT pilot group. We were really impressed with this particular health worker's commitment to prevent and treat cardiovascular disease in his community. He had already compiled a database of his regular patients who were being treated for hypertension and hoped to use the phone program as a tool to guide their treatment. This meeting was undoubtedly the high point of my volunteer experience in Ghana.

 

The technical team confirmed that the program was online and they were starting to see a constant trickle of data. Thats all we hoped for at this point. With our mission for the day accomplished, we rode the taxi back to the comfort of the Dawson's lodge.

-The Mobile Health Team

 

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A Cause for Celebration! by Mobile Health Team on April 2, 2011 | 19 comments

It was orientation day! I was prepared to introduce the health workers in the KEEA district of Ghana to the new Mobile Phone Assisted Cardiovascular Teaching (mPACT) BP tool. The mHealth team of ICHA had spent several months designing, creating and testing the program that would eventually allow the Ghanain health workers to enter patient blood pressure data in a mobile phone and receive smart prompts about treatment guidelines. We hoped that these guidelines would make treating hypertension a breeze! However, not everything had been a smooth sail so far. Since arriving in Ghana, we discovered that the phones we had tailored our program to were out of stock in all the stores we checked in. Luckily, we found a similar phone that was within our budget. Once the phone was loaded with a SIM card and activated, I anxiously downloaded the BP tool. The download and one test data entry was successful but the program stopped communicating with our server soon after. The phones still refused to connect to the internet reliably on the morning of the outreach. By this time, the technology team in the US had been up most of the night, reading forums and trying to figure out what was wrong. Finally, Jason called the network provider only to learn that the company was experiencing outages in the Elmina area that would be fixed in 24 hours! We didn't know whether to be happy or sad! Patchy internet meant that the phones would not be able to receive the smart prompt for treatment guidelines. Instead, each time the health workers submitted the data, they would see an error message! However, it also meant that once the internet was up and running, our program would work again!

 

The technology team had been resourceful and prepared for a scenario like this. They had a version of the program that did not rely on the internet for providing the smart prompt. Although we would still not receive any data from the phones using this version of the program, at least the health workers would see treatment guidelines instead of an error message when they submitted data using the phone. At this point, we still had a couple of hours till the outreach was set to begin so we tried to download this "dumb" version of the program in the 30 sec intervals that the internet worked.

 

The health workers started trickling in at 1 pm. Polite welcomes and smiles were exchanged. Then it was time. I worked my way through the materials we had planned to cover, telling the health workers the objective of our program, why they should use it and how they should use it. Thankfully, the health workers had no problem learning the program. Individual questions about data entry were easily managed by Jason and Abby while the rest of the class followed along with me. The health workers were really excited about the prompts for treatment guidelines. As we ran though several example scenarios of the data, there was almost a competition as each health worker tried to be the first to report what guidelines were displayed! As we prompted for questions, we were surprised by the large number of relevant questions and great suggestions we received. Finally, we wound up the orientation and sent the health workers home with their new BP tool. Once the network was up again, we would download the smart program and start receiving data from the phones, but that would be tomorrow. Today, we had launched ICHA's first mHealth program in Ghana. It was time to celebrate.

 

The Mobile Health Team