Telemedicine saves lives in disaster zones

By Imogen Mathers

Another year, another record smashed for the number of people forced by war and disaster to flee their homes. On World Refugee Day (20 June), a report by UNHCR (the UN refugee agency) revealed that 65.3 million people were living displaced from their homes in 2015, more than 21 million of them refugees. [1]

It is also an age of unprecedented unforced migration, as people move across borders to seek better lives and opportunities: in 2015, 244 million people — 3.3 per cent of the world’s population — lived outside their country of origin. And this extraordinary age of mobility involves not just people, but also goods, money and ideas. Communication advances create unprecedented development opportunities, connecting people and organisations as never before.

For the medical relief charity Médecins Sans Frontières (MSF), increasingly sophisticated ICT platforms offer more than an efficient way of communicating across the 60-plus countries where it operates. The digital transfer of specialist medical knowledge across continents and time zones helps improve MSF’s support for people affected by war and disasters, including some of those 65 million displaced people.

I spoke to Raghu Venugopal, a doctor based in Canada, who runs MSF’s telemedicine network. Established six years ago, the network uses an encrypted online portal where medics in the field can upload case files, photographs, ultrasounds and X-ray images, and seek advice from specialists working in MSF headquarters or hospitals thousands of miles away.

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If field doctors are presented with complex injuries that they think would benefit from specialist knowledge, they can call upon a global network of specialists to get that information.

“Let’s take a real case of a little girl in war-torn eastern Congo who has had her hand shot with a gun by armed forces and the doctors are wondering if they should amputate or not,” Venugopal explains. “They take a photograph, log on to the system with a live internet connection, upload the story, the history and a photograph of the child. A few hours later, advice comes back from a specialist, advising them what to do.”

Ultimately the doctor in the field bears the burden of making the final decision, Venugopal says. “But friendly consultation can come from a specialist.”

Several steps are involved behind the scenes. Once a case file is uploaded, operators at MSF headquarters like Venugopal — themselves experienced field doctors — get an email or phone notification. They allocate the case to a suitable specialist, who also gets a notification, logs on and responds, usually within 24 hours.

With this system, medics living continents apart and with different schedules can support each other by logging in as and when they can, storing and forwarding the advice. This is vital in the fast-paced, emergency work the MSF is involved in, Venugopal says.

Using experienced field doctors to coordinate the system also means that, were a patient’s condition to deteriorate, the operators can ensure the patient gets the necessary support.

Real-time telemedicine is also on the rise at MSF, Venugopal says, though this has a different use — paediatric care in Somalia, for example — and requires a higher bandwidth to enable doctors to communicate in actual time.

Another development is the introduction of the Arabic language in MSF’s medical communication systems. Up until recently, most of its telemedicine took place in English, Spanish or French, but the growing number, intensity and complexity of crises — and the use of siege warfare — in the Middle East and North Africa, means an Arabic service is essential.

In the case of the Congolese girl, the specialist advised medics not to amputate her hand but to debride the wound — removing non-viable tissue — so that some function would remain. Cases like these show how profoundly technology and the rapid sharing of knowledge can help alleviate suffering in dangerous parts of the world.

Imogen Mathers is producer/assistant editor at SciDev.Net. You can reach her on @ImogenMathers and [email protected].

 

References

[1] Global trends: Forced displacement in 2015 (UNHCR, 20 June 2016)

 

This article was originally published on SciDev.Net. Read the original article.

Using cellphone data to help Nairobi crack commuter stress

Jacqueline M Klopp, Columbia University

A collaboration between Kenyan and American universities has produced the first comprehensive public transport data for a micro minibus (matatu) system in Africa. Digital Matatus continues to collect and update data on matatu routes in Nairobi and is supporting projects elsewhere. The aim is to use technology and local partnerships to help planning as well as commuters use semi-informal transit networks more efficiently. Jacqueline M. Klopp, who put together the team, shares her insights

*How is your project empowering communities and planners in Nairobi? *

Good information about transport is critical for citizens in any place. It is unacceptable that this is ignored in many places in Africa. If people can’t even see their routes as routes and their system as a system, it gets harder to engage in conversations about improvements.

Involving the public in data collection – through crowd sourcing – to produce critical public services such as maps and transit apps helps build new conversations on how the system can be improved.

Transportation planning in so many cities is top down, a kind of tyranny of experts. This was well illustrated on one of the highway projects in Kenya where the bus stops that everyone uses were not catered for with terrible consequences. Mapping when done collaboratively, openly and with citizens can be a useful tool in improving transportation planning.

What is the biggest opportunity for crowd sourcing data in African cities?

The rapid expansion of cellphone use offers one of the biggest opportunities to collect critical data. In Nairobi, almost every adult has a phone, and increasingly these are smart phones. This means everybody can help generate data about the city including about its transportation system. They can do this in two main ways.

First, “digital exhaust” of the phone or the geo-location data that gets transmitted through calls can be helpful. This becomes part of big data that can be analysed to see how the city moves. In Abidjan, Orange released this data and IBM research used it to help optimise bus routes. But telecommunications companies often don’t like to make this data open, even when anonymised.

The second way to generate data is for citizens to actively share information. This can be through various forms of social media as in the popular Nairobi transport app ma3route. In Mexico City Mapaton is collecting data on public transit from inputs in apps even by playing games.

The potential is enormous. One powerful example is the Nairobi accident map that uses five months of crowdsourced data on crashes. This is validated using police records and shows visually where there are clear safety problems that require interventions such as street redesign.

How can more cities get involved in the digital matatus project?

Since Digital Matatus successfully mapped out the Nairobi minibus (or matatu) system, more groups in cities are replicating this process. These cities include Kampala, Maputo, Accra, Lusaka, Amman, Cairo, Managua and elsewhere.

Digital Matatus has been providing informal support for a number of these cities. But we would like to scale this effort up, build better tools and provide a resource centre and network where groups in different cities can share and help each other.

How is crowdsourcing data different in particular cities? Are there regional variations, or variations based on the democratic nature of governments?

All places are unique and create challenges. For example, in Nairobi routes are numbered but in many cities this is not the case. And the complexity and size of transport systems differ. Cape Town and Nairobi are about the same size as cities with around 3.5 million people. But Cape Town has over 600 routes while Nairobi has 138.

Teams in Accra and Maputo involve the city governments in mapping minibuses called trotros. In other cities, there is a standoffish approach by local government to transit mapping by citizens. So a lot of variation exists based on the political interests and institutions involved in the transit system, how the system is regulated and the strategy around mapping.

What are the challenges of mapping informal transit networks that may not even see themselves as networks?

There are a lot of technical challenges. These include, stops that are sometimes not marked or named. And routes may not have names or numbers and can vary. It takes many trips to understand some routes or to distinguish multiple routes which look like one.

Also fares are often not set and fluctuate based on unclear factors, such as a rainstorm.

In addition, the data format that is most commonly used for transit was developed for formal systems so it can be hard to clean and fit the data into this format. However, we have found ways to do this by minor modifications.

*What are the lessons learned from your project in Nairobi? *

Creating quality transport data for cities like Nairobi that have high levels of informality is challenging. But it is possible.

We also learned that there is demand for this information from citizens and planners. We now know that the data collection and editing tools need improvement. Another lesson is that making the mapping process inclusive and collaborative is critical to provoking new planning conversations.

Once we had proof of concept and our data was being used by a wide variety of people and organisations, including the World Bank, we thought they would understand the need to create more data and really support these efforts. Instead, we learned that getting financial and institutional support for these initiatives involves a serious struggle.

Mainstreaming new forms of data collection into the transportation sector will take a lot more work if we’re going to monitor the sustainable development goal targets on transport, access and safety.

What needs to be done to make sure that data is updated?

Transit systems are dynamic, and it is critical that data is constantly updated. In the near future, we will be moving to real time data across the globe so buses, for example, will give a continuous feed. Mexico City just mandated this. Kigali is starting such a system. Eco-Mobility and University of California Berkeley are experimenting with technology in Nairobi supported by bus owners who wish to see where their vehicles are at any moment.

But this will take some time. And, regardless, we still want to leverage cellphone technology to create basic data on the structure of transport systems in cities like Nairobi. Digital Matatus is also moving forward with a new editing tool and also experimenting with crowdsourcing. We are exploring a new app developed by MIT students called ma3tycoon. Our team also continue efforts to get government, multilaterals and transportation planners to understand the importance of this base data for planning- and ultimately for improving conditions for passengers.

_This is an edited version of an interview first published by ITDP _

The Conversation

Jacqueline M Klopp, Associate Research Scholar, Center for Sustainable Urban Development, Columbia University

This article was originally published on The Conversation. Read the original article.

State Department Press Briefing on Fake Embassy in Ghana

In Monday’s daily press briefing at the U.S. Department of State, deputy spokesperson Mark C. Toner answered questions about the discovery of a fake American embassy in Ghana, which had been issuing fraudulent visas and other travel documents for as long as ten years.

Here is the transcript of that portion of the briefing:

QUESTION: Yeah, a couple of different subjects. First of all, it’s been revealed that a fake U.S. embassy was shut down in Ghana. It apparently operated for 10 years.

MR TONER: Don’t say it like that. (Laughter.)

QUESTION: A couple of questions.

QUESTION: (Off-mike.)

QUESTION: Yes. How long – when did the State Department become aware of this, is one question.

MR TONER: Sure.

QUESTION: And the other is this embassy – so-called embassy – had access to blank forms that were deemed authentic, issued visas. And so how many people got into the United States from these visas?

fake embassy Ghana press briefingMR TONER: Sure. All good questions. All right, there’s a lot to unpack here. I’ll do my best and then answer any follow-ups. So yes, the quote/unquote “fake embassy.” This was a criminal fraud operation masquerading as a fake U.S. embassy in Ghana, in Accra, and it was shut down, as you know. No visa obtained – no fake visa, and let’s be very clear; we’re talking about counterfeit visas – that no visa that was obtained through this fraud scheme was ever used to enter the United States.

What happened was that the operators of this fraud operation were able to obtain real Ghanaian passports or even foreign passports that were either lost, stolen, or somehow sold to them. A handful – and I think it was fewer than 10 – of the passports seized by law enforcement contained expired U.S. visas. So they then used these expired visas to, as – to counterfeit off of, to – as prototypes or whatever, as models to attempt to produce counterfeit visas. So the visas in questions were not stolen from the U.S. embassy, and again, this operation – this fake embassy – made and printed counterfeit visas using the expired visas as a blueprint.

So none of the individuals, as I said, who purchased these counterfeit visas were able to use them to travel to the United States. And why is that? Because it’s very, very hard to counterfeit U.S. visas these days. It’s a highly secure document. It’s got numerous security features designed to prevent successful counterfeiting, and so this operation failed basically because they couldn’t produce – please.

QUESTION: Were people nabbed coming into JFK or somewhere? Did actually anybody try to use these to get in?

MR TONER: My understanding is that no – is that no one was actually even attempted or caught at the border. Now, I – we’re still going through some assessment of this operation, but my understanding at this point is that no one was actually stopped at the border trying to enter into the United States using one of these fraudulent visas. My understanding is that, frankly, the counterfeits – visas were of pretty poor quality, so it may have been the fact that these people, once they paid for them and got them, realized they weren’t going to be able to use them to get into the United States.

QUESTION: And for how long did the State Department know that this operation was going on?

MR TONER: We only learned about this this year.

QUESTION: Even though it had been there for 10 years with a U.S. flag flying —

MR TONER: Yeah, no, apparently —

QUESTION: — outside three days a week?

MR TONER: So – yeah, I mean – look, I mean, I don’t want to – I’ll refer you to the Ghanaian authorities to speak to how this operation existed for so long without it coming to their notice. You can imagine the ways in which that could happen.

QUESTION: Yes, we can.

MR TONER: But yeah, we learned about it this year, and the extent of the counterfeiting and visa fraud only became apparent – I think we had an anti-fraud operation called Spartan Vanguard, and that helped, I think, bring the extent, as I said, of this to light.

I think I’ve answered more or less all the —

QUESTION: Yes.

QUESTION: Did you learn about it and bring it to the Ghanaian officials’ attention, or they shut it down?

MR TONER: I believe it’s that we learned about it and brought it to the Ghanaian authorities’ attention.

QUESTION: Can you just answer this?

MR TONER: Yeah, I’ll try.

QUESTION: So you don’t believe that anyone ever tried to use any of these, that these —

QUESTION: How did they operate for 10 years, then, if —

QUESTION: — these people who didn’t have the perceptive qualities to realize they were walking into a fake U.S. embassy and then pay that fake U.S. embassy then were able to discern on their own that the visas didn’t look good enough, and so they decided not to try? That just seems so wholly unrealistic, it cannot be possible in this universe to be true, on a universal level.

QUESTION: Or make a report on that to the authorities?

QUESTION: That nobody tried – all these people who went to a fake U.S. embassy then realized, based on the quality of the visa, that it wouldn’t work and just gave up? Mark, that doesn’t pass the laugh test, seriously.

MR TONER: Well, no. Look, so first of all, many of the people who engaged in this activity – and I’m not talking about the people who ran the operation, but the people who tried to obtain visas – it was – they were duped. They were conned. And once they were conned, you don’t necessarily go running to the police and say, “I just obtained illegally a U.S. visa, and oh, by the way, it looks terrible, doesn’t it? I can’t use this to get into the United States.”

Again, I didn’t say categorically that no one did. I thought I said “to our knowledge.” As of today, we do not believe that anyone actually used or was stopped at the border trying to use one of these fake visas to enter into the United States. I can’t speak to what their motivation was for not trying that, but it’s not —

QUESTION: If you didn’t stop anybody, how do you know that all of them didn’t get in?

MR TONER: Well, again, I mean, we – I’m sorry, I’m trying to —

QUESTION: If everybody who – if you never stopped a single person with one of these fake visas, how can you plausibly say that you know that they didn’t all get in successfully into the United States?

MR TONER: Well, look, we – so whenever anybody applies for a visa, we collect the biometric data as part of their visa application. So when you come to the border and they look at your visa, they verify – there’s biometric data at the port of entry. So that’s right there – in a fake visa from a Ghanaian fake embassy, you’re not going to have that biometric data. It’s going to send up alarms. It’s going to not register. And so, as I said, to my knowledge we have not been able to say – although we may find out yes, there were two or three of these individuals, and we stopped them at the border. I just don’t have that in front of me right now.

QUESTION: Okay, all right.

MR TONER: Yeah.

QUESTION: Follow-up on this?

MR TONER: Sure, and then I’ll get to you, Margaret.

QUESTION: So do you have any reason to believe that there might be other operations in any other countries similar to this?

MR TONER: Well, we’re running this – as I said, I mentioned – it’s got a very cool name, Spartan Vanguard or something. Yeah, Spartan Vanguard. But it’s an anti-fraud operation, and that’s what this is. The intent of it is to kind of sniff out and find out where these fraudulent operations are ongoing. This is a longstanding practice, it’s just that now it’s awfully hard to do because, as I said, of the things that – the security that they’re able to build into these visas. I mean, we all have it. Whether it’s your credit card or whatever, it’s a lot harder to counterfeit that kind of stuff today. But I can’t speak to – say that I’m sure there’s other operations ongoing, and we’re going to keep – remain vigilant and try to stop them.

QUESTION: But are there any particular areas that you might see more of that activity?

MR TONER: You mean regions of the world?

QUESTION: Yeah.

MR TONER: I don’t have that. I don’t know that.

Press reports on the fake U.S. embassy: NPR, The Washington Post, The Daily Caller, Ghana Business News, Ventures Africa, BBC News, Fox News, Foreign Policy, Telegraph/Reuters, Voice of America, and Daily Mail.

Lessons from Malawi: When men tackle mother/child health

Sheryl L Hendriks, University of Pretoria; Elizabeth Mkandawire, University of Pretoria, and Lucy Mkandawire-Valhmu

Talk of gender mainstreaming – the assessing of all policies, programmes, laws and interventions on the basis of their impact on both men and women at all levels – often attracts sceptical criticism.

Malawi child healthOne of the most significant challenges the concept has faced has been the absence of specific goals on gender equality in various areas of policy. But our recently completed study in Malawi shows that participatory governance – which emphasises citizen participation in governmental processes – could support the practical implementation of gender equality.

The participation of local community leaders, such as traditional authorities or opinion leaders, in policy development can facilitate the implementation of interventions to further gender equality. This is particularly the case where interventions aim to influence changes in men’s and women’s behaviour for gender equity.

Gender inequalities are exacerbated by the common misconception that the term “gender” means women. There is indeed a need to address women’s concerns to overcome socially ingrained barriers that prevent them from realising their human rights. But men have a particularly important partnership role to play in achieving gender equality.

The problem is that men are often depicted as perpetrators of inequality and women the victims. Typically, the shared interests of men and women are overlooked by policymakers and development practitioners. The result is that development agendas drive the two sexes further apart.

Maternal and child health is one such shared interest. Both men and women have a common desire to prevent maternal and child mortality.

Our study of men’s involvement in maternal and child health in rural central Malawi in Ntcheu District investigated what facilitates men’s involvement in maternal and child health.

The importance of involving men

Although Malawi is one of the poorest countries in the world, it is one of the few to achieve the Millennium Development Goal 4 of reducing child mortality by two thirds between 1990 and 2015.

Among the initiatives that contributed to this achievement was the introduction of a safe motherhood project in 1998. The purpose was to improve service delivery to decrease infant and maternal mortality and morbidity. At the time maternal mortality was high: 1,120 per 100,000 live births.

Initially the programme focused on women. But it was soon recognised that men played a key role in decisions related to women’s sexual and reproductive health, including access to health facilities and resources.

It has been shown globally that men’s involvement in maternal and child health is a common feature for safe motherhood initiatives. Involving men in antenatal care increases women’s uptake of antenatal care messages as well as their access to nutritious food.

Under the safe motherhood project women and men receive nutrition information and guidance at clinics. In addition, men receive advice on how to support their partners during pregnancy.

And inviting men to attend antenatal care clinics enabled testing of both partners for HIV.

Overcoming barriers

Several barriers have been identified to men’s involvement in maternal and child health. These include gender stereotyping, fear of testing for HIV, lack of a definitive role for men in maternal and child health, time constraints, facility environment and women’s reservations about men’s involvement.

But our study found that many of these barriers can be overcome by involving traditional authorities and community opinion leaders. The traditional leaders established bylaws to reinforce men’s attendance of antenatal care visits. Community opinion leaders encouraged men to participate in antenatal care. As cultural leaders and the custodians of culture, they helped to enforce change.

For example, imposing fines on men who did not attend antenatal care visits with their partners encouraged them to change their behaviour. Goats or chickens were payable for the fine, taking away a product of nutritional value.

In some communities, clinics gave priority to women who attended antenatal care consultations with their partners by serving them first.

But bylaws in some communities infringed women’s human rights. An example is a bylaw that states that a woman who attends antenatal care consultations without her husband won’t be attended to.

Impact of study

Traditional authorities are in a good position to advise policymakers on strategies for enlisting men’s involvement in maternal and child health and influence positive behaviour change. We found that these authorities and other opinion leaders influenced men’s behaviour when it comes to maternal and child care.

The findings suggest that traditional leaders need support to establish appropriate bylaws and regulations that promote men’s involvement in maternal and child health as well as gender equality.

This study suggests that gender mainstreaming isn’t just a myth. It is actually possible. Including men as partners is important for achieving gender equality. There are also immense possibilities for mainstreaming gender using bottom-up approaches and making use of existing structures to support implementation.

The Conversation

Sheryl L Hendriks, Professor in Food Security; Director, Institute for Food, Nutrition and Well-being, University of Pretoria; Elizabeth Mkandawire, PhD candidate and Research Assistant, University of Pretoria, and Lucy Mkandawire-Valhmu, Associate professor, University of Wisconsin-Milwaukee, College of Nursing

This article was originally published on The Conversation. Read the original article.

Mental health should get urgent attention in Africa

By Munyaradzi Makoni

[CAPE TOWN, SOUTH AFRICA] Mental health is becoming one of Africa’s healthcare challenges that needs to be addressed urgently.

But, from World Psychiatric Association International Congress, which I attended in South Africa last month (18-22 November), I realised that it is not getting the attention it deserves.

Indeed, it is becoming incumbent upon the WHO to support efforts aimed at tackling mental health challenges in Africa. I couldn’t agree more that the WHO should support the African Union (AU) in its bid to see the World Bank switch from loans to grants to fund health projects globally.

It is becoming incumbent upon the WHO to support efforts aimed at tackling mental health challenges in Africa.

Munyaradzi Makoni

And I couldn’t agree more with the AU chairperson, Nkosazana Ndlamini-Zuma, when she aptly put it during the opening of the congress: “The World Bank shouldn’t give loans for health. They should give grants for health.”

It’s understandable: Physicians would get more funding for their work, patients will get greater care and governments will drop lack funds on a list of challenges confronting mental illness.

Ndlamini-Zuma’s comments followed a statement by Shekhar Saxena, director of mental health and substance abuse at the WHO that the World Bank had committed to supporting mental health more strongly after meeting the WHO in April this year.

Saxena had said any country applying for World Bank loans for health projects would have to ensure including mental health component.

The WHO statistics, says Ndlamini-Zuma, showed that 40.5 per cent of countries globally had no mental health policy in spite of estimates that one in every four people would suffer a mental health condition, called for more action.

On average there are nine psychiatrists for every 100,000 people in the West, but just 0.05 for 100,000 people for the African region, according to the WHO report.

“We need a pan-African movement to ensure there is no discrimination against mental health patients, and we need to develop programmes and proper policies around mental health,” Ndlamini-Zuma says.

Africa should update existing mental health policies and community-based interventions and see these formalised at AU level, Ndlamini-Zuma added, explaining that with poor human resources, the continent has to find other ways of helping improve mental health without relying exclusively on psychiatrists.

“In Africa we cannot rely on Western models where there are abundant resources. We need to look at creative ways of using what we have,” she notes.

The congress highlighted the World Psychiatric Association global survey of 193 countries which revealed shocking results.

People with mental illness could vote in 11 per cent of the countries surveyed but they enjoyed no employment rights in more than half of the countries, and 42 per cent of the nations prevented those with mental illnesses from entering into to any kind of contract.

Dinesh Bhugra, president of the World Psychiatric Association, told the audience they had launched a mental health Bill of Rights in the House of Lords in London, United Kingdom, two weeks before the congress, and a of total 61 organisations around the world had signed it.

“I need every bit of help from everyone here to change the way we treat our [mental health] patients, who are the most vulnerable,” Bhugra says.

And who would dare not act to change such circumstances?

This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.

 

This article was originally published on SciDev.Net. Read the original article.