Global Health Ideas

Finding global health solutions through innovation and technology

Archive for the ‘Innovation’ Category

Finding Fever – Flu and Border Controls

A quarantine officer monitored a thermal scanner Tuesday at Incheon International Airport in South Korea.  Jung Yeon-Je/Agence France-Presse — Getty Images

A quarantine officer monitored a thermal scanner Tuesday at Incheon International Airport in South Korea. Jung Yeon-Je/Agence France-Presse — Getty Images

Thermal scanners purchased after the SARS outbreak have been mobilized for border screening. Super-cool, but do they work to stop the spread of an epidemic?

The New York Times led with this image, but now the story link has been updated. Here’s the original text by Donald G. McNeil, Jr. on border controls:

Given extensive human-to-human transmission, the World Health Organization raised its global pandemic flu alert level on Monday, but it recommended that borders not be closed nor travel bans imposed, noting that that the virus had already spread and that infected travelers might now show any symptoms.

However, many countries are tightening border and immigration controls, and on Tuesday Britain advised against any nonessential travel to Mexico. Japan announced that it would no longer allow Mexican travelers to obtain visas upon arrival. The United States, France and Germany have also warned against nonessential travel to Mexico.

Here’s my understanding of how it works: the thermal scanner camera detects infrared radiation (IR). Basically any object emits IR which intensifies as it gets hotter. The camera has a sensor which detects IR and converts it into a temperature reading. In this system it does it visually.

However, when you first get flu, you don’t have a temperature, and the thermal scanner only measures skin temperature on your face, so an early fever (which raises your core temperature) is also not detectable.

So – does it work? Work done by Bitar et al as a followup to SARS control was published in February 2009: International travels and fever screening during epidemics: a literature review on the effectiveness and potential use of non-contact infrared thermometers In the early stages of a pandemic when less than 1% of people will be feverish, fever screening at the border is of limited use – from the paper “When we fixed fever prevalence at 1% in all studies to allow comparisons, the derived positive predictive value varied from 3.5% to 65.4% ” So thermal scanners aren’t very useful when very few people have fever.

However, check out this view from William Saletan in Slate: Heat Check – Swine Flu, Body Heat and Airport Scanner

On another note, I’m wondering why journalists don’t seem to have quick access to infectious disease specialists. In the New York Times, an environmental health epidemiologist is quoted in the debate, and here in the Cape Times, a sociologist who now specializes in the public understanding of biology. Where are the infectious disease experts? Maybe the CDC needs to draw up a list of media contacts among their top virologists and infectious disease specialists. Maybe part of science education should be a course in writing on science for the public, as well as how to write (and read!) papers.

Laurence Altman wrote a nice article in the New York Times about assessing the flu threat: Sound the Alarm? A Swine Flu Bind

For ongoing info: here’s the WHO, the CDC and if you really want to geek out: ProMED-mail.

Written by farzaneh

April 29, 2009 at 4:06 am

Art for Global Health

art_condom-dressesI recently discovered the UCLA Art|Global Health Center, the mission of which is to “unleash the transformative power of the arts to advance global health“. The arts have the ability to capture issues and tell a story in a way that can make a profound impact on our (social) consciousness and is not something we talk about enough as a tool. One of the more famous examples of this is the AIDS quilt which was conceived of in 1985 by an AIDS activist in memory of Harvey Milk. That quilt has had over 14 million visitors and is the largest community arts project in the world.

The UCLA center has some ongoing projects and last year opened “Make Art | Stop AIDS” that featured traditional art as well as things like condom dresses. Make Art/Stop AIDS “is organized around a series of seven interconnected and at times overlapping concerns expressed in the form of open-ended questions, some of which include direct art historical references to the epidemic: What is AIDS?; Who lives, who dies?; Condoms: what’s the issue?; Is it safe to touch?; When is the last time you cried?; What good does a red ribbon do?; Are you angry enough to do something about AIDS?; and, finally, Art is not enough. Now it’s in your hands.”

Creative art projects have the ability to move the human mind unlike the constant barrage of issues, numbers and headlines that desensitize us over time. If you have seen or heard of any interesting arts based global health projects let us know.

More Sources
Adriana Bertinin’s condom dresses

Addressing HIV/AIDS-Related Grief and Healing Through Art

History of the AIDS Memorial Quilt

Condom fashion show, China

Written by Aman

April 13, 2009 at 9:49 pm

World Health Day: The Future of Global Health

The WHO has decided to focus this World Health Day on hospital infrastructure during times of emergency. The folks over at Global Health Progress have a good round of what some bloggers are saying and include health journalism folks as well as thoughts from the AvianFlu diary. I thought I would go off theme and briefly throw out some thoughts on the bigger picture and encourage you to use this day to think about what is the future of global health? In this context of thinking about the future in 10, 20 or 30 years, the world is in turmoil and we are questioning the fundamental nature of market driven economies, why not use this as an opportunity to do the same for global health in a forward looking way? Think about where we are and whether we are prioritizing the right things and moving in the right directions?

Approximately 10 (only TEN!) years ago there was no Google, Kiva, Gates Foundation or knowledge about the cost differences between generic and brand name drugs (see this great talk on the Future of Global Health by Jim Yong Kim and his discussion of how they reduced the price of treating MDR TB patients by 80-90% in 1999) amongst major care organizations (absolutely stunning). Mobile phone penetration was less than 1% in developing countries and social entrepreneurship wasn’t hot, the vast majority of us probably hadn’t even heard of that term.

Where we were ten years ago is arguably a profoundly different world from where we are today and per the video below “we are living in exponential times“. To give you further inspiration to think differently today definitely watch the below (via 2173):

The acceleration of technology for social change and global health is going to increase, in this decade alone the convergence of movements in philanthropy, entrepreneurship and technology all enabled by the internet and mobile phone revolution have allowed people to collaborate, innovate and communicate on an entirely different level. I don’t know what the future of global health is – but I wonder how open source collaborations will contribute to solutions and whether twittering for global health will be around in five years and for whom and what purpose? Or will we just be doing more of the same. I wonder if we will be doing entire marketing and health education campaigns via mobile phones and how this will evolve. Will there be convergence of people and ideas working on global and domestic health? Will the flow of innovation and products from “South” to “North” become the next hot topic? I wonder if we will have a TED just for Global Health?

We might face a global crisis in 2030 but we will also be better equipped to face that crisis.Today is a day we should be thinking about what all the possibilities are and how we can get there in the fastest way possible.  The last idea I will throw out as food for thought is to think about what have been the top 10 biggest developments in global health in the last decade and how will these shape the future?

Other thoughts on World Health Day:
UN Dispatch, link
Human Rights Watch, link
The Lancet Student, link
Global Institute Blog, link
Charity Navigator, link

Written by Aman

April 7, 2009 at 9:05 pm

Social challenges

Update: Voting opened Monday and will close Friday 3pm Pacific time. We are expecting a high turnout. Your support will be critical. To cast a ballot voters need to select three projects.

NetSquared has a new social challenge “N2Y4“. Voting opens Monday and Melissa and I submitted a proposal called “ClaimsMobile” to the new competition. “ClaimsMobile” is a mobile phone and web database application for management of patients’ medical and financial information in a Uganda output-based healthcare project. We have been working with partners at the Mbarara University, the NGO Marie Stopes International Uganda, and small private clinics in the region. Check it out. Voting starts April 6th (Monday) 11 AM California time and runs for five days. If you like our idea, vote for it… and be sure to look through the range of amazing proposals – everything from education to international justice to community programs. The word cloud says it all.

wordcloud

There seem to be a lot of “social challenges” these days. In the past nine months, I’ve been asked to vote for a Peace Corps projects photo idea at NameYourDreamAssignment, a girls’ tuition fund in Burkina Faso, a geotourism project in Ecuador, a women in sport challenge, as well as support a handful of ideas among the 7875 proposals submitted to the popular Ideas for Change in America campaign; all hosted on platforms like Ashoka ChangeMakers, GlobalGiving, NetSquared, and Change.org.

These challenges, like California ballot initiatives, work best if voters take the time to learn the issues. Spend some time to select projects from an area you know or have a great deal of interest – the NetSquare’s word cloud is a useful first step to sort ideas. If that fails, Stoltz at Web2…Oh Really recommends picking the project with the least votes… and I’ll close by suggesting “ClaimsMobile” for your short list.

Written by Ben

April 4, 2009 at 7:52 pm

Milwaukee: hub of water technology in global health?

It’s been more than two years since we reported on Seattle as the new Geneva, that is, as the new epicenter of global health activity. An article in this morning Journal-Sentinel (Water-engineering firms see potential, challenge in developing countries) – which includes an exclusive interview with the Acumen Fund’s chief executive Jacqueline Novogratz – suggests that Milwaukee is angling to do the same for water technology:

It’s an issue that almost certainly will preoccupy business leaders in metro Milwaukee in their strategy to brand the region as an international hub of water technology. The metro area is home to scores of water-engineering companies. Gov. Jim Doyle and the University of Wisconsin-Milwaukee this month announced plans to invest millions of dollars for UWM to become a center of freshwater research.

An 2008 article from the same newspaper (Area’s tide could turn on water technology) provides more evidence:

[F]our of the world’s 11 largest water-technology companies have a significant presence in southeastern Wisconsin, according to an analysis of data from a new Goldman Sachs report.

Wall Street has tracked automakers, railroads and retailers almost since there were stocks and bonds. But water remains a novelty. Goldman Sachs Group Inc. didn’t begin to research water treatment as a stand-alone industrial sector until late 2005.

While several large MNCs have shown an active interest in clean water in developing countries (e.g., Procter and Gamble, Vestergaard Frandsen, Dow) open questions remain as to what role large MNCs will play in providing access to safe water for the one billion people who don’t have it.

(Thanks to Dr. Jessica Granderson for sending the link)

Innovation as a Learning Process

Cross-posted from Design Research for Global Health.

The California Management Review recently announced the winners of the 2009 Accenture Award: Sara Beckman of Berkeley’s Haas School of Business and Michael Barry, founder of design consultancy Point Forward and Adjunct Professor at Stanford, for their article, Innovation as a Learning Process: Embedding Design Thinking (Fall 2007, Vol. 50, No. 1).

From the award website (which is still on the 2008 winner as I write this): “The Accenture Award is given each year to the author (or authors) of the article published in the preceding volume of the California Management Review that has made the most important contribution to improving the practice of management.”

The paper makes a compelling argument that innovation can be achieved by management and provides a model for cross-functional, cross-disciplinary teams to engage in this process. The relevance to global health as I’ve discussed before (really what this entire blog is about) is that the process can help us improve health systems through innovation.

The challenge in coming years will be how to get organizations and institutions working in global health – foundations, Ministries of Health, NGOs, development programs, health research centers, etc. – treating innovation as a way of working, not simply an input or an output.

The abstract/lead-in isn’t openly available online so I’m copying it here:

Companies throughout the world are seeking competitive advantage by leading through innovation, some — such as Apple, Toyota, Google, and Starbucks — with great success. Many countries – such as Singapore, China, Korea, and India — are investing in education systems that emphasize leading through innovation, some by investing specifically in design schools or programs, and others by embedding innovative thinking throughout the curriculum. Business, engineering, and design schools around the U.S. are expanding their efforts to teach students how to innovate, often through multi-disciplinary classes that give students a full experience of the innovation process. However, what does leading through innovation really mean? What does it mean to be a leader, and what does it mean to engage in innovation?

There is a vast literature on leadership covering a wide range of topics: the characteristics of a good leader, how leadership is best displayed in an organization, leadership and vision, authority, leadership styles, and so on. There is also a growing body of literature on innovation and its various facets, much of it focused by application of the innovation process. Hundreds of publications describe the process of innovation for products — both hardware and software — and a growing number of publications focus on innovation in services. Further, there are dozens of books on innovation in building and workplace design.

Here we examine a generic innovation process, grounded in models of how people learn, that can be applied across these sectors. It can be applied to the design and development of both hardware and software products, to the design of business models and services, to the design of organizations and how they work, and to the design of the buildings and spaces in which work takes place, or within which companies interact with their customers. The model has evolved through two streams of thought: design and learning.

This video, which seems to be unaffiliated to the authors, summarizes the article [correction - I just found out that Shealy did work with the authors on this video - Tues-24-Mar-2009 12:18PM PDT]:


 
[Innovation as a Learning Process from Roger H. Shealy on Vimeo]

Here are slides from Beckman and Barry’s presentation at the Inside Innovation 2007 Conference and the Google scholar view of who is citing this work.

[(Dis)claimer: Sara Beckman served on my dissertation committee and Michael Barry provided guidance on my applied research in Mongolia]

Why bad presentations happen to good causes

Cross-posted from Design Research for Global Health.

Giving talks is not one of my strong suits, but it seems to be a part of the job requirement.  Earlier this month, I had the opportunity (even though I’m no good, I do consider it an opportunity), to give a couple talks, one to the Interdisciplinary MPH Program at Berkeley and one to a group of undergraduate design students, also at Berkeley.  Despite the difference in focus, age, and experience of the two groups, the topic was roughly the same: How do we effectively use design thinking as an approach in public health?

The first session was so-so, and I suspect that the few people who were excited about it were probably excited in spite of the talk.  It started well, but about halfway through, something began to feel very wrong and that feeling didn’t go away until some time later that evening.  Afterwards, I received direct feedback from the instructor and from the students in the form of an evaluation.  I recommend this if it is ever presented as an option.  Like any “accident”, this one was a “confluence of factors”: lack of clarity and specificity, allowing the discussion to get sidetracked, poor posture, and a tone that conveyed a lack of excitement for the topic.

It’s one thing to get feedback like this, another to act on it.

top10causesofdeath-blogThe second session went much better, gauging by the student feedback, the comments from the instructor, and my own observations.  This in spite of a larger group (60 vs. 20) that would be harder to motivate (undergraduates with midterms vs. professionals working on applied problems in public health).  I chalk it all up to preparation and planning.  Certainly there are people that are capable of doing a great job without preparation – I just don’t think I’m one of those people.

Most of that preparation by the way was not on slides.  I did use slides, but only had five for an hour session and that still proved to be too many.  Most of the time that I spent on slides, I spent developing a single custom visual to convey precisely the information that was relevant to the students during this session (see image).  The rest of the preparation was spent understanding the audience needs by speaking to those running the class; developing a detailed plan for the hour, focusing on how to make the session a highly interactive learning experience; designing quality handouts to support the interactive exercise; and doing my necessary homework.  For this last one, I spent 20 minutes on the phone with a surgeon friend, since the session was built around a case study discussing surgical complications and design.

Three resources I found really useful:

  1. Why Bad Presentations Happen to Good Causes, Andy Goodman, 2006. This commissioned report was developed to help NGOs with their presentations, but I think there is value here for anyone whose work involves presentations. It is evidence-based and provides practical guidance on session design, delivery, slides (PowerPoint), and logistics.  Most importantly, it is available as a free download. I was fortunate enough to pick up a used copy of the print edition for US$9 at my local bookstore, which was worth the investment for me because of the design of the physical book.  It’s out-of-print now and it looks like the online used copies are quite expensive – at least 3x what I paid – so I recommend the PDF.
  2. Envisioning Information, Edward Tufte, 1990. I read this when I was writing my dissertation. Folks in design all know about Tufte, but I still recommend a periodic refresher.  This is the sort of book that will stay on my shelf.  Also potentially useful is The Visual Display of Quantitative Information. For those working in global health, don’t forget how important the display of information can be: (a) Bill Gates and the NYTimes, (b) Hans Rosling at TED.
  3. Software for creating quality graphics.  The drawing tools built into typical office applications, though they have improved in recent years, are still limited in their capability and flexibility, especially if you’re looking at #2 above.  In the past 10 days, three people in my socio-professional network have solicited advice on such standalone tools, OmniGraffle (for Mac) and Visio (Windows): a graphic designer in New York, an energy research scientist in California, and a healthcare researcher in DC.  Both are great options.  I use OmniGraffle these days, though I used to use Visio a few years back.  If cost is an issue, there are open-source alternatives available, though I’m not at all familiar with them (e.g., the Pencil plug-in for Firefox).

Written by Jaspal

March 26, 2009 at 10:42 am

Video Games for Health: Tetris Therapy for Trauma?

Very early fascinating research, which will hopefully be developed further. This is not a top 10 list you want to be on, but considering the global burden of disease projections for 2020 include depression (#3) and war (#8) in the top 10 contributors to disability, greater understanding of the mind and brain function is desperately needed. Additionally, considering mental health is such a complex and difficult issue, it’s great to see potential innovation in this area. Source: BBC News

(sorry I cannot find the blog I read this on, send me a note and I’ll add your link in):
tetris


Previous related posts:
Where are the games (to educate on HIV/AIDS risks)? Link
Donate computation time …on your PS3? Link
Free Rice Word Game. Link

Written by Aman

March 11, 2009 at 10:03 pm

“Innovating for the Health of All” open for registration (Havana, November 2009)

Forum 2009
Innovating for the health of all
Innovando para la salud de todos
Havana, Cuba, 16-20 November 2009

Registration here

The letter:

Dear colleague,

Forum 2009: Innovating for the Health of All is this year’s milestone event in research and innovation for health. Organized by the Global Forum for Health Research, it will take place from 16-20 November in Havana, Cuba, at the invitation of the Ministry of Public Health.

What exactly is “innovation”?* How can decision-makers and practitioners work together to foster innovation for health and health equity? What can we learn from innovation policies and initiatives around the world? These questions will be answered in Forum 2009‘s interwoven discussions of social innovation and technological innovation.

This event will bring together some 800 leaders and experts from around the world to share ideas and forge new partnerships. It will include a unique mix of stakeholders from health and science ministries, research agencies and institutions, development agencies, foundations, nongovernmental organizations, civil society, the private sector and media.

As you expand your networks, you will also be able to learn from discussions on social entrepreneurship for health, public-private product development for neglected diseases, eHealth, knowledge-translation platforms, national health innovation systems, donor-country harmonization and coherence, and innovative financing strategies.

With the theme “innovation,” we are challenged to be innovative in the programme itself including new session formats that are more interactive, new ways to network and share information, and new opportunities for inclusion.

So please join us. Registration is now open on http://www.globalforumhealth.org. We very much look forward to seeing you in Cuba.

Yours sincerely,
Professor Stephen Matlin
Executive Director
Global Forum for Health Research

PhotoVoice(+cultural probes) for clean water and sanitation in Mumbai

Last Thursday, I had the opportunity to view a PhotoVoice exhibition at the University of California, Berkeley organized by Haath Mein Sehat (HMS), a group working to improve access to clean water and sanitation in six slums of Hubballi and Mumbai, including Dharavi.

It was exciting to see a group effectively blend the advocacy elements of PhotoVoice with the design elements of cultural probes. The difference between the two approaches is less in the methods and more in the use of the outputs. In this case, they organized the exhibition to raise awareness and break down stereotypes of slum life, and they are using the photographic corpus to guide the design of both programs and technologies related to their core mission.

What I was most interested in from a design perspective were the instructions given to community photographers and how this tied back to the mission of HMS. The results below followed from the simple prompt: “Represent your daily experience with water”.

Written by Jaspal

March 2, 2009 at 1:09 pm

Microbicides – Where are they Now? How much have we spent?

I was just sent this information (thanks to Becky!) about a new round of funding for microbicides, which comes on the heels of promising results from a trial of the PRO2000 microbicide candidate. We covered this a couple of years ago and at the time I said – the potential of this drug is revolutionary. With microbicides there was great excitement and hope, then there was failure and now there is some maturity. Okay, maybe I am overstating the case, the take home point is that we still don’t have a product and this is not cheap, easy, or quick. Developing a drug is complicated, involves huge risk, can take decades and is highly uncertain. Let’s review the drug development time line again for those of you not familiar – the graph below gives the most simplistic picture:

rx_development_timeline_crude

The early microbicide discussions took place almost 15 years ago (International Working Group on Vaginal Microbicides, source). Over half that amount of time, from 2000-2007, $1.1 Billion has already been invested in microbicide R&D! It takes anywhere from $200M to $1 Billion to bring a single novel drug to market. Let’s hope one of these compounds works and makes it through phase III. But how much will we have spent? $2 Billion, $3 billion? If it works, it will have been worth the money, however, we must ask if we took the most efficient financial route to get to the end point and if there were better financial models – that is a valid question.

Designing for Better Health Competition

Ashoka’s Changemakers along with RWJF is sponsoring a very cool competition – “Nudges” – read below for details and please pass along (thanks to Roberto for sending). The competition was named after Cass Suntein’s book Nudge, Cass has been asked to join the Obama administration. In addition to checking out the competition link below, see the RWJF Pioneer Blog which I follow. The “Nudge” competition is about the little reminders, notifications, and encouragements towards action. With health, behavior change is one of the hardest things to impact and we haven’t been very good about designing or focusing on subtle pushes which are fundamentally critical to health care.  While I could name quite a few innovative ideas we have covered on this blog, one that comes instantly to mind is the teachAIDS animation created by Piya Sorcar (it’s got technology, education and behavioral impact components). I am looking forward to seeing what innovations this competition yields.

Designing for Better Health Competition

Ashoka’s Changemakers is collaborating with the Pioneer Portfolio of the Robert Wood Johnson Foundation to launch a global search for “nudges” – innovative little pushes – that help people make better decisions regarding their own health and the health of others.

We are inspired by people and organizations like the Destiny Health Plan that provides “vitality bucks,” an alternative currency that allows people to earn travel and shopping rewards every time they make healthy choices. Another motivating example is CARES, an anti-smoking and savings program in the Philippines that offers smokers the option to invest the money they would normally spend on cigarettes into a savings account. “Designing for Better Health” is investing in the most valuable of all resources – people themselves. Here are the many ways in which you can participate:

Do you know innovators who work to help people make choices that improve their health? By nominating them, you will provide them the opportunity to promote their projects on a global platform and get connected with potential funding.

Visit http://www.changemakers.net/designingforbetterhealth

Written by Aman

January 28, 2009 at 9:27 pm

International Action: Clean Water Solutions in Haiti

I was recently contacted by a non-profit organization based in Washington D.C called International Action (IA) to help them raise awareness about the problems they are tackling in Haiti. IA installs water treatment systems in Port-au-Prince, Haiti using chlorinators. Chlorniators, according to IA, are very cheap, simple, easy to install and maintain. It would be interesting to see how this method stacks up against other water sanitation efforts in terms of costs & financing, logistics, sustainability, adoption/use and impact.

Haiti Innovation recently profiled IA: “At the end of five years, IA aims to have installed 500 chlorinators covering most of the Port-au-Prince metropolitan area, giving clean water for the first time to 2.5 million people.” You can view some of the locations IA is working in with their nifty Google maps mashup:

ia_locations_haiti

Below is a guest post from Amelie over at IA:

Guest Post by International Action

Among 147 countries Haiti scores last on the water poverty index scale according to the World Water Council (WWC). This means that Haiti is the country with the worst access to clean water in the world.

In fact, most water sources in Haiti are contaminated with human waste and disease. The result is a tragedy. Haiti has the highest infant mortality rate in the Western Hemisphere and this is due to preventable waterborne diseases such as chronic diarrhea, typhoid and hepatitis.

International Action, a Washington D.C based non-profit installs water treatment systems called chlorinators on top of local public water tanks. They now protect more than 450,000 Haitians with clean, safe drinking water in 23 of the poorest neighborhoods in Port-au-Prince.

International Action’s special tablet chlorinators are easy to install, use and maintain, they do not require electricity and therefore they are ideal for the developing world. The system is simple: 10% of the water runs through the device, dilutes the chlorine tablets and mixes it with the rest of the water in the tank. The chlorine levels are safe, pre-set and regularly tested. A chlorinator can provide clean water for up to 10,000 people for the smaller model LF1500 and 50,000 for the larger one LF2000.

ia_water_haiti

The biggest installation in Jalousie supplies a community of 50,000. The local hospital has instantly noticed a reduction in the cases of waterborne diseases which they must treat. Analyses of the water have shown that germs of typhoid, cholera and hepatitis are no longer present in Jalousie’s water; waterborne diseases have virtually disappeared in the communities which have the chlorinators installed.

During the month of December, International Action has installed 6 new chlorinators in the neighborhood of Delmas 30. The population is thrilled because although they receive water from CAMEP — Independent Metropolitan Water Company — four days a week, they do not drink it because it is contaminated. In early December, CAMEP called International Action for help. 50,000 more Haitians are now protected with clean, safe drinking water provided by International Action.

For more information visit our website at www.haitiwater.org

Written by Aman

January 2, 2009 at 1:56 pm

Popsci and Tech for Humanity Awards

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).

cellscope

Video:
celscope1

Written by Aman

November 19, 2008 at 9:14 pm

Google Flu Trends for developing countries?

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.

Google Flu Trends: Predicting the Future

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.”

googleflue

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)

jobgraph


scholargoogle_articles

Written by Aman

November 11, 2008 at 4:31 pm

M-Money Maturing

Russell Southwood had a short story (full report at balancingact-africa.com) on Kenyan banks crying foul with the rapid expansion of mobile money credits acting profitably as current account institutions without the same regulatory oversight.  From Southwood’s emailed summary:

“Currently, the two leading mobile phone service providers – Zain and Safaricom – are offering money-transfer services in the country under Sokotele and M-Pesa brands respectively… To avert undue competition with the banking fraternity … M-Pesa and Sokotele services have to meet the capitalisation requirement as stipulated in the Banking Act. According to the Act, a deposit taking institution should maintain a minimum capitalisation of Ksh250 million ($3.5 million). This is however expected to double come December next year before hitting Ksh1 billion ($14.2 million) by 2010 after capitalisation requirements were amended in this financial year’s budget.”

How small is too small for regulation?  As clear from Kenya, small transactions at scale can leverage significant economic activity and worry the big bank competition.

The question was raised elsewhere this week.  The World Affairs Council of Northern California and UC Berkeley are holding a roundtable dinner next Wednesday with space reserved for UCB students if they address, in 150 words, some of the industry challenges as microfinance and m-money mature.  So any UCB students reading this post, check out BalancingAct for a few ideas.  A few choice subjects:

- When is a bank account a bank account?
- Does the market want mobile phone enabled financial services?
- What’s makes a successful customer business model interface?

The growth of the mobile services in microfinance has been breathtaking and defining the space where traditional banking, microfinance and mobile services intersect will continue to be a challenge as the technology matures and demand continues to grow.

Written by Ben

October 17, 2008 at 1:06 pm

Global Health Council 2009: New Technologies + Proven Strategies = Healthy Communities

The Global Health Council has released the theme for their 2009 conference to be held in Washington, DC: “New Technologies + Proven Strategies = Healthy Communities”.  I’ve been helping them with development of their CFP over the summer months – the focus is largely on ICT, but there is consideration given to other technologies also.  This is an applied conference with significant international representation.  In terms of a broad global health meeting, this is the best I’ve attended.

Written by Jaspal

September 2, 2008 at 2:30 pm

Mobile Phones & Global Health III: Ultrasound, Imaging & ECG to Go!

1. Microsoft is funding research in Argentina and India into low-cost electrocardiogram (ECG) machines. The devices, which can cost less than $100, use cell phones to transmit data to a computer, where it can be analyzed and then conveyed to a doctor.

2. Using Rubinsky’s gear, a doctor could use a cell-phone screen to view a cross section of tissue. In this image, a doctor uses a cell phone to magnify a patient’s breast tissue and examine it for a tumor.
SOURCE: Business Week

==============================================================
This is our third post on mobile phones and international/global health (post 1, post 2). This post is largely imcomplete, but I wanted to get it up. The above pics and quotes below are based on a feature in Business Week:

“It’s not easy to lug an ultrasound machine into a remote village’s health clinic—much less keep it running. But a cell phone? No problem…”

“According to the World Health Organization, about half of the imaging equipment sent to developing countries goes unused because local technicians aren’t trained to operate it or lack the necessary spare parts. So researchers are stepping up efforts to employ wireless technologies to deliver crucial medical services, particularly in underserved areas…Scientists from the University of California, Berkeley, have just developed a prototype technology that uses cell phones to deliver imaging information to doctors.”

“The University of California professor says that by reducing a complex electromagnetic imaging machine to a portable electromagnetic scanner that can work in tandem with a regular cell phone and a computer, he has essentially replicated a $10,000 piece of equipment for just hundreds of dollars.”

Another source – Imaging technology could be useful in poor countries:
Some types of medical imaging could become cheaper and more accessible to millions of people in the developing world if an innovative concept developed by an engineer at the Hebrew University of Jerusalem fulfils its promise. The device uses cellular phone technology to transmit magnetic resonance images, computed tomograms, and ultrasound scans (PLoS One 2008;3:e2075; doi: 10.1371/journal.pone.0002075)

One other recent article in this area, from PC World -
Mobile Phones and the Digital Divide: Whether you’re building an application for the 3G iPhone in the United States or trying to figure out how to deliver health information via SMS (Short Message Service) to a rural community in Botswana, the mobile space is diverse and exciting in equal measure.

Also be sure to check out:
- Why people seek out health information, link

Written by Aman

August 27, 2008 at 9:58 pm

2000 Nominations needed: Life-Changing Tech for the World’s Poor

By Sept 1 Please vote for AIDG (Appropriate Infrastructure Development Group) to help them get $500K, only 9 days left! I have great respect for the folks over there and what they are doing. Click on the image below for more information. Here is the AIDG blog and here is a short description of their project is below. Your vote can help push them to the next round:

Description
“Half the world lives on less than $2 a day, but there are few products made for them other than by charity NGOs and universities. Look around yourself. Much of what you will see was made and marketed by a major corporation. I want to bring together experts in development engineering to help corporations create products that will alleviate poverty for people in developing countries. The right products can bring clean water, save weeks of labor, and help the poor lift themselves out of poverty.”

Written by Aman

August 23, 2008 at 11:28 am

Beijing Olympic Cause Marketing & Global Health Ads

We previously mentioned the malaria ad sponsored by ExxonMobil during the Olympics. I have seen this several times now during coverage and said in the original post:

“with regard to ExxonMobil’s commercial on Malaria during prime time, when over 1 Billion people were watching, this might have been the largest audience ever for a global health ad.”

I realized after I said this that I probably made a major miscalculation. The NBC channel broadcast I have been watching is only produced for an American audience. The top estimates I have seen for viewership at a given time hit 66 million people. So while Exxon may have had their ad broadcast across countries and major national networks, it is likely that somewhere between tens and hundreds of millions of people saw their commercial – which is still an impressive number. Thanks to Responsible China I found the youtube version of this ad, which is below. In addition I have also seen GE’s portable re-designed low cost EKG machine advertised several times as well. Despite what you may think about these companies it is better than nothing to see MNC’s promoting social causes. We blogged about the EKG machine previously and the commercial is the first one below, followed by the malaria ad. For another check, definitely check out ResponsibleChina.

Written by Aman

August 23, 2008 at 7:23 am

Rapid HIV CD4 Counter (8 minutes)

With slight modifications I lifted the below from the CIMIT Blog (note Video on their blog), certainly a needed innovation for global health:

Via CIMIT: Microfluidic CD4 Cell Counting for Resource-Limited Settings

“The HIV pandemic has created an unprecedented global health emergency. In response, the price of effective, life-saving HIV drug treatment has been reduced by 99%. More than $10 billion is now invested each year to treat people suffering from HIV and AIDS…BUT Treatment is only half the battle. “

“Of the 33 million people living with HIV worldwide, fewer than 10% have access to CD4 counts, the critical blood test used by clinicians to decide when to start treatment. Fewer than 1% have access to viral load assays, which are used for infant diagnosis and for patient monitoring. Both tests are considered essential to effective treatment. The Use Case for appropriate CD4 and viral load tests appropriate for resource-limited settings is clear”:

  • Tests need to be performed by a minimally skilled health worker,
  • A the true point of care,
  • Reliably and inexpensively, and
  • Wth reasonable accuracy and precision. The HIV pandemic thus represents an unprecedented opportunity to drive technology development in point-of-care diagnostics.

“Based on this Use Case, William Rodriguez’s lab has developed a series of technologies for an integrated CD4 cell count device, with microfluidics as the key platform…Integrating these microfluidic technologies has led to a prototype handheld device that can accurately capture CD4 cells from a 10 microliter fingerstick sample of whole blood, and accurately measure CD4 counts in under 8 minutes.

Written by Aman

August 7, 2008 at 8:38 pm

Mobile Phones and International Health Links Part II

I missed a few links from our previous post on global health and mobile phones, so this is part deux, which will be followed by Part III later this week. As you can see from the frenzy of recent activity – the mobile phone for health revolution is moving ahead rapidly, where it will take us and how useful it will ultimately be will be known in due time. And as mentioned, this is a case where the “Third World is First”, innovation is happening far ahead of what we are seeing in the US. There are a several good links below. For those seeking more documentation beyond news items, see the report from the Bellagio e-health conference which I believe is being organized by the UN Foundation, Vodafone Group Foundation and the Telemedicine society of India.

CellScope: Mobile-phone microscopes, Link
Dan Fletcher, a professor of bioengineering at the University of California, Berkeley (Go Bears!!), has developed a cheap attachment to turn the digital camera on many of today’s mobile phones into a microscope. Called a CellScope, it can show individual white and red blood cells, which means that with the correct stain it can be used to identify the parasite that causes malaria.

Cellphones for HIV, Link

Mobile Phone Telemedicine Interview: Full Interview at MobileActive.org
(title and link via Drew – thanks!)

mHealth and Mobile Telemedicine – an Overview
Great links below and full news link here

  • Sizing the Business Potential (Link)
  • Relationship among Economic Development (Link)
  • mHealth: A Developing Country Perspective (Link)

Wireless Technology for Social Change: Trends in NGO Mobile Use, Link

Related to above: “Technology plays crucial role in vaccination distribution”, Link

The Pill Phone for US Markets. This kind of application was used long before in developing countries – now it is slowly entering the US market: “In a first-of-its-kind application, Verizon customers in the US can get information and set reminders regarding medication and dosage with “the Pill Phone”. Link

Managing Symptoms By Mobile Phone May Revolutionize Cancer Care For Young People, Link

New wi-fi devices warn doctors of heart attacks, Link
“The Bluetooth wireless technology that allows people to use a hands-free earpiece could soon alert the emergency services when someone has a heart attack…” How they will manage the data flow and response is a big question in my opinion.

Other Links:

  • Microtelecom for the Next Billion Mobile Users, Link
  • MobileActive08 is the only global gathering that is connecting leaders who are working at the convergence of civil society, mobile technology and social change. Link

Written by Aman

August 3, 2008 at 7:45 pm

Mobile Phones and Global Health Link Drop

Over the last year there I have noticed a tremendous up-tick in mobile phones for health/global health stories. The innovation in this area has been worldwide and the sense I get is that use outside the US and in developing countries is far more creative and wide ranging (I haven’t done the research, but this is probably a case where a country like the US will be taking lessons from less developed regions or the “South” as people love to say). We did a previous link drop on SMS/Text Messaging for Global Health that you should check out. Below I begin with two links about the power of mobile phones in general followed by recent links in a plethora of areas from countries around the world. Enjoy:

“Within the next three years, another billion people will begin to make regular use of cell phones, continuing the fastest adoption of a new technology in history” Taken from a very good post on “Mobile Phones for Development” over at CrissCrossed.

New NextBillion MIT Network: “Eventually there will be more cell phone users than people who read and write.” —Eric Schmidt, CEO, Google. The goal of the Next Billion Network is to deploy innovative mobile technologies that help people reduce friction in their local markets from the bottom up. (Link)

_____

  • Telemedicine and Monitoring AIDS Treatment in Africa (Link)
    “With software developed by Ericsson and phones donated… health workers can call up the medical records of pregnant women from an online database and then, by cell phone, tell care-givers what to do during an emergency…”

    • Another story on the above: A toll-free mobile service being launched in selected remote areas in Africa promises to save lives by connecting people with emergency medical cases to health personnel. (Link)
  • STOMP (STop smoking Over Mobile Phone): “Clinical trials have shown that using STOMP doubled reported quit rates from 13% to 28% after six weeks“. This would be of tremendous use in LDC’s as smoking is a serious global health issue. (Link)
  • Glucose (Diabetes) and exercise monitoring (Link)
    • Tracking chronic conditions remotely and sending info to clinicians (Link)
    • Managing symptoms for cancer care (Link)
    • Cardiomobile exercise and monitoring system: “The Cardiomobile system works by the patient attaching to their chests a mini ECG (electrocardiogram or heart signal) monitor and wearing a cap with a lightweight GPS receiver, both connected to a mobile phone via Bluetooth.” (Link) ; mini ecg picture (Link)
    • Mental Health Monitoring: Mobile phones and the internet will soon be used to help up to two million Australians manage their mental health problems. (Link)
    • India to develop their unique mobile phone health monitoring system (Link)
    • Erricson to offer mobile health services across India (Link) via Sneha
    • Review Article: Innovation in practice: mobile phone technology in patient care. (Link)

    OTHER

    • Solar Charger For Mobile Phones (Link)
      • Nokia Phones go Green: “Today Nokia chargers save 90% more energy, 65-80% of the phone components are recyclable and have reduced packaging by more than 50%…” (Link)
      • Kenya’s mobile revolution (Link)
      • iPhone health and fitness applications (Link)

      Written by Aman

      July 28, 2008 at 8:30 pm

      Stat of the Day: Dabbawala 99% Error Free Rate

      As many of you may know, the tiffin delivery/dabbawala system in India has achieved remarkable rates of success in setting up a complex delivery system. Their ability to deliver millions of meals a year without making mistakes makes me think about how this system can be transferred to healthcare and for what purpose… something to think about. As Dr. V took inspiration (WSJ, PDF) from a highly standardized and high volume system, I am wondering the same thing for a system already in place in a low resource setting. Food for thought, well worth checking out:

      From The Economist (link):
      “Using an elaborate system of colour-coded boxes to convey over 170,000 meals to their destinations each day, the 5,000-strong dabbawala collective has built up an extraordinary reputation for the speed and accuracy of its deliveries. Word of their legendary efficiency and almost flawless logistics is now spreading through the rarefied world of management consulting. Impressed by the dabbawalas’ “six-sigma” certified error rate—reportedly on the order of one mistake per 6m deliveries—management gurus and bosses are queuing up to find out how they do it.” Full story link here.

      Hat tip Intangible Economy.

      Written by Aman

      July 21, 2008 at 10:35 pm

      Follow

      Get every new post delivered to your Inbox.