Archive for November 2008
In light of today’s tragic events in Mumbai, I’d like to highlight the efforts of mumbaiVOICES, an online disaster analysis created as a result of 11 July 2006.
In the wake of a disaster, “ordinary citizens find very few avenues to express their feelings, when it is in fact they – the lay bystanders, the rush hour commuters, the slum dwellers, the taxi-drivers — who have been at the frontlines of the disaster response.” mumbaiVOICES broke away from expert analysis to explore the stories of ordinary people on the street, on the railway platform, in the hospital ward, in the taxi-cab, to discover what they saw, what they recognized as strengths, and what they thought needed improvement.
mumbaiVOICES is the result of a unique partnership between Mumbai citizens and professionals from the fields of medicine, public health, disaster management, economics, urban planning, and computer science, from India and abroad, who created a website and collaborated to analyse findings and create recommendations. Satchit Balsari, MD, MPH helped create mumbaiVOICES with colleagues.
“On July 11th, 2006, the city of Mumbai bore witness to terrifying human tragedy. A series of seven explosions killed at least 200 people on crowded commuter trains and stations. All seven blasts came within an 11-minute span, between 6:24 and 6:35 p.m. In the hours and days following the blasts, ordinary Mumbaikars demonstrated remarkable ingenuity and resourcefulness in coping with the tragedy.”
160 testimonies were recorded by Mumbai citizens, collected via direct responses on the website
mumbaiVOICES.com, as well as interviews recorded by the team, which were then transcribed on the website. This collected narrative was summarized to form a chronology of the disaster from first-hand accounts of witnesses, those affected, and emergency response personnel.
The evolving account of how hospitals responded to the disaster was very interesting – most striking to me was that the hospitals had to intuit that there was a disaster as there was no alert from the police or authorities, and then emergency doctors had to quickly create a workable system to cope with injured people, mustering all available personnel including medical students, and in one site, senior professors took over triage at the door in order to sort the flood of incoming patients accurately.
My deepest sympathy goes out to all those in Mumbai, and the friends and families across the world who have been affected by these tragedies.
I have been hearing ancedotally (based on very few data points) that charitable giving is not going to be that impacted by the current economic crisis. I don’t agree with this view, but apparently there is some evidence for this line of thought when looking at past recessions (according Philanthrophy2173). This time things are very different and there could be a fairly substantial impact on giving in general and on global health charities. There were two stories in the WSJ this week about the impact of the global economic meltdown on philanthropic giving. The first article states that even the Gates Foundation will be reducing donations by approximately 10% (they provide about $3 billion in funding per year which is how I came up with the $300 million figure).
The impact of this economic crisis will be widespread and will impact health in developing countries in the short run (we have already seen massive inflation in food prices and staples such as rice). Decreased funding flows will not only come from reduced giving, but from governments being forced to cut budgets (France is already cutting funding to NGOs), and also from worldwide layoffs of migrant workers who send hundreds of billions of dollars in remittances back home to support their families (on forecasts and drops in remittances see more here, here, here and here).
Below are a several articles you should check out if you care about this issue and about what the funding environment might look like over the next 12-18 months:
1. Gates Foundation Feels Pinch From Market Turmoil, Wall St. Journal 11/24/08, Link
2. Big Players Scale Back Charitable Donations, Wall St. Journal 11/25/08, Link
3. John Holmes – Impact of the Financial Crisis on Humanitarian Funding, Link
4. Comment on the MIT Course blog: Health in a Global Crisis, Link
*5. For a special review see a great post by Lucy Bernholz, Link
Two recent awards were given out in the area of technology for humanity. The first was a generic “best of 2008″ in technology PopSci award. It was great to see PopSci pick a technology for developing countries as one of their top products, the CellScope, which we covered in a post on mobile phones for global health (hat tip BOPreneur). Additionally there was the annual Tech Museum awards which you can read more about over at CNET (the Star Syringe was their health awardee).
With collapsing infrastructure, no national electric power grid, and ravaged by war, data collection is extremely challenging. Here is a neat tool developed by Professor Braa from Oslo (first seen on Science Daily and then at AidWorker).
“Information scientists at the University of Oslo have refused to become disheartened by illiteracy and the lack of power supply in rural Africa…For the last 14 years, the Department of Informatics has been engaged in the development of sophisticated health information systems for a number of countries in Africa.”
“In the municipality of Tombodu, the village-based traditional birth attendant registers births, children who die immediately after birth, stillbirths and illness or death of the mother by placing small stones in a box with five compartments. Every month the box is taken to the health centre where the stones are counted and the resulting figures included in the health centre’s monthly report to the district authorities. The data are entered into a regional database which is part of the national system…
“The point is to make a standardized system for collecting health data from all parts of the country. This will give local and national authorities, as well as the WHO an overview of the health situation and other data that will help them decide where to take remedial action.”
Using stones to count reminded me of using a different type of “stone” or bead to aid women in ovulation prediction (cycle beads). Read the full story here:
(2008, November 12). Sierra Leone: Collecting Health Data In Areas With No Power Supply. ScienceDaily.
Cat Laine over at AIDG alerted me to Maternova…After a little bit of effort I think I finally figured out what they are up to, and the potential is exciting. From what I can tell, Maternova is acting as a clearinghouse and agent to spur the production of low cost life changing technologies in the area of maternal and child health. They are building a portfolio of innovative projects and products. What they are doing is critical for many reasons, one is that they are filling a major gap by coordinating and organizing in one particular area. There are many individuals and groups working globally on similar issues, however attempting to bring some of these ideas together under one umbrella is much more powerful than those projects standing alone.
Here is an introduction to 2 of their several products:
“Embrace is a $25 incubator designed to save premature and low birth weight babies. The product’s mission is to help the 20 million vulnerable babies born every year around the world, who can’t access traditional incubators that cost up to $20,000. It is not yet on the market.”
“Study findings show the use of a neoprene suit can save the lives of women suffering from obstetrical hemorrhaging due to childbirth. Hemorrhaging accounts for about 30 percent of the more than 500,000 maternal deaths worldwide each year due to childbirth…”
I read on the Maternova website that they are thinking about linking up with mothers in the US as one funding stream. This seems like a great idea, especially if it is to get high volume low cost donations (e.g. <$10-$20). Part of the sales pitch could include an appeal to our global community – today we truly live in a global community and are inextricably linked to one another. Our fates are intertwined like never before. I could see making a pitch like this to appeal to new grandparents, parents, uncles and aunts to make donations in the name of their newborns. I’ll follow up with more information on Maternova…
A few days back Aman wrote a post about Google Flu Trends. Thought I’d add a few thoughts here after reading the draft manuscript that the Google-CDC team posted in advance of its publication in Nature.
By the way, here’s what Nature says: Because of the immediate public-health implications of this paper, Nature supports the Google and the CDC decision to release this information to the public in advance of a formal publication date for the research. The paper has been subjected to the usual rigor of peer review and is accepted in principle. Nature feels the public-health consideration here makes it appropriate to relax our embargo rule
Ginsberg J, Mohebbi MH, Patel RS, Brammer L, Smolinski MS, Brilliant L. Detecting influenza epidemics using search engine query data. Draft manuscript for Nature. Retrieved 14 Nov 2008.
Assuming that few folks will read the manuscript or the article, here’s some highlights. I should say I appreciated that the article was clearly written. If you need more context, check out Google Flu Trends How does this work?…
- Targets health-seeking behavior of Internet users, particularly Google users [not sure those are different anymore], in the United States for ILI (influenza-like illness)
- Compared to previous work attempting to link online activity to disease prevalence, benefits from volume: hundreds of billions of searches over 5 years
- Key result – reduced reporting lag to one day compared to CDC’s surveillance system of 1-2 weeks
- Spatial resolution based on IP address goes to nearest big city [for example my current IP maps to Oakland, California right now], but the system is right now only looking to the level of states – this is more detailed CDC’s reporting, which is based on 9 U.S. regions
- CDC data was used for model-building (linear logistic regression) as well as comparison [for stats nerds - the comparison was made with held-out data]
- Not all states publish ILI data, but they were still able to achieve a correlation of 0.85 in Utah without training the model on that state’s data
- There have attempted to look at disease outbreaks of enterics and arboviruses, but without success.
- For those familiar with GPHIN and Healthmap, two other online , the major difference is in the data being examined – Flu Trends looks at search terms while the other systems rely on news sources, website, official alerts, and the such
- There is a possibility that this will not model a flu pandemic well since the search behavior used for modeling is based on non-pandemic variety of flu
- The modeling effort was immense – “450 million different models to test each of the candidate queries”
So what does this mean for developing world applications?
Here’s what the authors say: “Though it may be possible for this approach to be applied to any country with a large population of web search users, we cannot currently provide accurate estimates for large parts of the developing world. Even within the developed world, small countries and less common languages may be challenging to accurately survey.”
The key is whether there are detectable changes in search in response to disease outbreaks. This is dependent on Internet volume, health-seeking search behavior, and language. And if there is no baseline data, like with CDC surveillance data, then what is the best strategy for model-building? How valid will models be from one country to another? That probably depends on the countries. Is it perhaps possible to have a less refined output, something like a multi-level warning system for decision makers to followup with on-the-ground resources? Or should we be focusing on news+ like GPHIN and Healthmap?
Another thought is that we could mine SMS traffic for detecting disease outbreaks. The problem becomes more complicated, since we’re now looking at data that is much more complex than search queries. And there is often segmentation due to the presence of multiple phone providers in one area. Even if the data were anonymized, this raises huge privacy concerns. Still it could be a way to tap in to areas with low Internet penetration and to provide detection based on very real-time data.
“A report released by the United Nations last month suggests that inequality in New York, Washington, Atlanta and New Orleans rivals that of some cities in Africa…The life expectancy of African Americans in the United States is about the same as that of people living in China and some states of India, despite the fact that the United States is far richer than the other two countries.”
Source: UW Geography Blog
“More Black Americans are infected with HIV than the total populations of people living with HIV in seven of the 15 countries served by PEPFAR…Despite extraordinary improvements in HIV treatment, AIDS remains the leading cause of death among Black women between 25-34 years and the second leading cause of death in Black men between 35-44 years…U.S. policy treats AIDS as a foreign policy priority, but virtually ignores the epidemic among Black citizens here at home,”"
Source: Louisiana Weekly
In case you missed this in the NY Times today – fascinating experiment with a new Google tool on the frontiers of diseases surveillance and global health trends. Remains to be seen how useful this will be and lots of validation needs to be done, but this is yet another example of people outside of traditional health/public health communities who are on the leading edge of public health innovation:
“What if Google knew before anyone else that a fast-spreading flu outbreak was putting you at heightened risk of getting sick? And what if it could alert you, your doctor and your local public health officials before the muscle aches and chills kicked in? That, in essence, is the promise of Google Flu Trends.
“Google Flu Trends (www.google.org/flutrends) is the latest indication that the words typed into search engines like Google can be used to track the collective interests and concerns of millions of people, and even to forecast the future.”
We have discussed before how data indexed on the web can used for all sorts of fascinating things. We had a previous posts on global health job trends and also on publications that use the terms global health and private sector. The graphs below show a large increase in both areas, however there are dozens of caveats with this kind of trend analysis and the below graphs have to be taken with a grain of salt:
1. Global Health Job Trends (see for full post)
2. Trends: Development/Global Health in the Business Press (see for full post)