Help us #save new born babies lives by using #mobile devices for #ultrasound

"Why not save the lives of new borns by making use of mobile devices that can be used for ultra-sound?" with this simple idea my wonderful and inspiring colleagues Vincent De Brouwere and Fabienne Richard started a quest to get a new mobile project up and running.

The project is now before a jury and it would be wonderful if as many people as possible could vote in favor of this proposal, as it will really save lives of new born babies and their mothers.

If we get enough votes, the project will be funded by the Belinda and Bill Gates foundation. Please feel free to support us by voting on the project (here is the link to the voting option), Remark: you must register here first (for free) to be able to vote, it only takes a moment and I think they do it to make sure the voters are 'real' people. You vote by first registering for an account, than signing in and clicking on the 'star' next to the project of your choice. Thanks in advance!

This is what the project is all about:

Title of the project: UltraSound4Africa
Organization:Institute of Tropical Medicine - Antwerp

Organization Location: Antwerp, Belgium

Optimal care during childbirth in rural areas of most low and middle income countries is hampered by 2 major problems: the limited equipment and capacity of health workers for diagnosis, and the quasi-absence of back-up from the hospital, which impacts on their motivation and competence. In order to improve the technical quality of care and the motivation of primary care maternity staff working in rural areas of low-income countries, the Ultrasound4Africa project proposes to develop a two-pronged integrated intervention:

• the provision of low cost smartphone-based ultrasound imaging systems (MobiUS device) that connect rural maternities with specialists. This telemedicine intervention aims at early diagnosis of life threatening obstetric complications, appropriate case management and rapid referral of critical cases to the hospital.
• The development of a network of primary care maternities with their referral hospitals, aiming at providing technical and moral support to health workers working in remote areas.

The pilot test will be implemented in rural maternities of 2 districts in Burkina Faso and Mali where access to Emergency Obstetric Care (EmOC) remains low despite a national policy of abolition of user fees for EmOC. This intervention is expected to improve utilization of antenatal care and skilled birth attendance by increasing women’s trust in primary care services and to contribute to reducing maternal and newborn mortality and morbidity. Ultrasound4Africa will be implemented by national teams at district level and supported by a multidisciplinary team (clinicians, public health specialists and IT specialists) with an extensive experience in sub-Saharan Africa.

Mobile challenge from a diabetic project developed and implemented in Trinidad and Tobago region

In the workshop on Telemedicine in Tromso, Norway, a very lively and motivating speaker has challenged the mobile community, so feel free to think along and give possible references that could help her strengthen her fantastic doctoral research idea.

Her question in short: is there any research on best mobile design delivery that could benefit her mobile project on diabetes, so she can augment her mobile design as to better reach the users (diabetic patients) that are using mobile phones to monitor and keep track of their chronic diabetes health?
Does anyone know of research looking at mobile content design to improve mobile learning assimilation or outcomes? Feel free to drop me a line.

Link to her project: www.salys.org/research.html
Notes on her project (rough notes taken during her presentation of the project):

Mobile dsms: a mobile diabetes self-management system based on peer support by Salys Sultan
Type two diabetes is studied because it is a lifestyle disease
DSMS: which focuses on sustained support, but because it is too costly and time consuming for 1 on 1 patient doctor relation,

Why go for a mobile platform
Mobile phone is personal
Ubiquitous
Connected
Increasingly intelligent
Available anywhere and anytime
Push and pull model

This project came out of the medinet project (link to word document on the medinet project): carribean wide health project
Pilot study of Trinidad and Tobago islands
Bluetooth between blood pressure machine and sugar calculator machine and phone of the patiens
With feedback loop for the patients health
Every islands would have their own medinet architecture
Because of the age, a personal assistant was given to the patients to give support extra.

Peer based mobile DSMS
Heisler (2006) has shown that models that build on peer support have proven to be both successful and cost effective as they combine the traditional peer support.
Group services: contact members, post discussion forums, share results, arrange meetings (real life meetings)
Personal services: capturing observations of daily living 5ODL) readings, activity, food intake, location … and reviewing past results.

Research contributions
Social networking for health care
Health data visualization
Social aspects to motivate and sustain patient adherence
User interface design for the visual impaired


Expectations
To learn relevant techniques to ensure the design of the design of the patient interface services this suitable for motivating and sustaining patient adherence
To establish a plan of action/way forward for scaling the medinet project

www.salys.org/research.html

discussions will be put into categories for discussing
ante project: diverse feedback on mobile use of different age groups
keeping access under three clicks to get to needed information
privacy issues, you as a user says what you want to share

mobile systems used is the operational system of windows, this was done because of the Microsoft funding and giving software and phones.
Java phone option is also available.
The project started and was implemented completely from the Caribean region (great!)
Started with paper prototypes given to the users in order to build the DSMS software (which was build by S. Salys.

A bit more on the evaluation factors that they use in the peer-based mobile project:
Peer-based medical service for DSMS by S. Sultan
Each diabetic group: max 5, hoping sense of competition as well as community, amount of users: 25.

Main outcomes to measure: knowledge health status, system usage, social outcomes,
Did the users increase overall subject matter knowledge. Tool: diabetes knowledge questionnaire by America standard.
Is the phone a good tool for delivering health care

Health status: better self-management behavior, hopefully (with diabetes test to see how there overall health improve?
Result: is mobile tool as health care instrument effective in health

Social outcomes
Did you feel part of the group, activity logs, how much the group feature was used, analyse the logs to make sense of what we saw by qualitative surveys.

Overall objective: whether phone instruments can have a positive effect on health, effective health care instrument.

Algorithm on what effect the combination of the group has on the outcomes (is looking to build an algorithm to improve the outcomes, as part of her doctoral thesis – really interesting!!!)
The groups background was kept as simple as possible: limiting the groups to a similar knowledge of diabetes background (the users were taken from a known group of diabetes people, so they all had similar knowledge of diabetes and how to control it). As the users came from Trinidad and Tobago their economic and social background was almost similar.

Longterm view: ten years down the road.
The trial will depend on the funding available depending on the cost of the strips used in the diabetic analysis (always look at the completeness of the trial, to also include measurable effects: for instance 1 year for short outcomes, 2 year is ideal for getting research value also longterm). Currently it will be a 3 month test to look at possible effects.

The experimental design has come from literature review of existing diabetes/mobile projects.

Peer support as main topic: there are other diseases how telemedicine can be used for discussion forums 2 NST pHd’s working, one on breast cancer, and one on psychiatry and drug abuse). Maybe look at other chronic diseases?

If you study intervention, do NOT do anything else BUT the intervention.
AND if you plan a study take into account festival days (in case of diabetes), as there are 15 festivals in Trinidad Tobago region, and during these festivals everyone is really enjoying life 

Large gaps in mHealth: cost/benefits analysis and parameters suggested: usability, analyse major issues to include in the research using e.g. the physical systems that are already in place as informal observations moments, in the one on one environment an observer can look at the pick-up rate of the competencies (but most users prefer to start using the material once they are in their home, comfort zone). Health care is a private matter: people will change their behavior when they are observed, because of perceived expectations.

Design: text or text to switch (audio), but looking at mobile designs that could result in the best of outcomes.

Telemedicine and eLearning in eHealth: case of Norwegian lessons learned

Tromso workshop 2010 June
Currently I am following, speaking and participating a workshop on Telemedicine and eLearning for eHealth. A one week workshop in collaboration between ITM and NST (WHO centre).

Participants from Sudan, Ethiopia, Ghana, Trinidad Tobago, Norway, Italy, Peru, Brazil, Canada, Belgium.

notes taken Monday 7 June 2010, First content session Steinar Pedersen:
Lessons learned from telemedicine projects which can also be used for eLearning projects in the medical field

• TTT: things take time and be patient, build maturity before implementing technology in a field
• Move from the competence centre to the periphery
• Be aware of the National competition and join forces so the National strength can grow, build round tables. It is better economics and knowledge exchange.
• Anchor level should be as high as possible (top level stakeholders)
• Argue on quality not on cost saving (Inge take this into the m/eLearning overview
• Secure the infrastructure
• The hen and egg problem (interconnectivity problem)
• Link technological developments to health priorities
• Always try to put a medical doctor or nurse in a the middle of the good medical/technological news (much more convincing)
• Use radiologists (or other people that are used to follow things on screens)
• By introducing technology, discussions on medical hierarchy can take place, be aware of this potential dynamic
• Chance of success is better if you introduce it to existing part of the organization, ideally if this service is 24 hours good for organizing the receiving part of the service.
• Create solutions based on national and international standards (e.g. visa card logic, electric power sockets)
• People are ready to be very, very innovative when it comes to do what they already are doing very well even better
• The same doctors and nurses are not very interesting in doing what they were already doing in another way (no benefit, just different).
• Even if developments go very slow, it will be part of the future health care, in that case even the smallest steps count.
• Keep the doctors responsible

Questions from participants, answered by Stainer
Developing countries big challenge is developing policies, how did Norway do it?
They health minister was not that strong, so parallel pillars were build for decision making, but policies can also be taken from similar countries, so you can leapfrog into policies that work.
How to get commitment from all the stakeholders: that is really difficult
Metrics and triangulation, how do you do it? How many refers, how much money is saved in transportation, how satisfied are the health care workers and the patients (the patients seems to be more satisfied and the peripherals are more satisfied (in general) than in the centre.
Were there infrastructural challenges in Norway for setting up Telemedicine? We still need to fly over a CD-rom to exchange data between South and North Norway. When we started out with radiology, there was very low bandwidth, downloads were done overnight because it took so much time. But from a mobile side, there are more mobile subscribers than there are people in Norway. eHealth is also subscribed in the medical curriculum of medical students which is important for longterm implementation. Trust is very important to get successful projects.

Call for young medical researchers that work or reside in the South: essay competition

At ITM we are organizing the Emerging Voices colloquium which will feature new innovative technologies for research and put young researchers in the driving seat of the colloquium.

If you know any medical researchers residing or working in emerging countries, please send them this initiative. There are all sorts of introductions for the winners of the accompanying essay competition: how to present workshops, introductions to using new media in science, and collaborative research work...

The Institute of Tropical Medicine promotes ‘Health care for all’ in its mission statement. However, achieving universal health coverage is easier said than done. Although progress has been made, innovative perspectives are certainly welcome.

The global health scene is still largely dominated by Northern stakeholders. We want to encourage “Emerging Voices” from developing countries to participate actively in international academic conferences and to raise their voice in the scientific debate.

That's why we are organizing our essay competition. We want to give junior or 'emerging' voices from the South the opportunity to present new ideas on how to progress towards universal health coverage.

The authors from the best essays will be invited to Antwerp to participate in an intensive training workshop (2-10 November 2010) before presenting their work at the ITM colloquium.

They will also be encouraged to participate in the First Global Symposium on Health Systems Research (Montreux, Switzerland, 16–19 November, 2010).

A certain number of travel grants will be awarded for those who need it. Take a look at the essay competition rules for more information on how to participate.

The competition is in French and in English, for download see below:

Call for Emerging Voices in Global Public Health

Appel aux talents émergents en santé publique mondiale

Yes, mobile moodle for iPhone is imminent, we will release open source code soon

For those who have been following my mobile blogs, you knew our great Peru/Belgian team (i.e. the Institute of Tropical Medicine Alexander von Humboldt (IMTAvH) in Lima and the Institute of Tropical Medicine (ITM) in Antwerp) was working on something special: a mobile moodle for iPhone.

In 2008, our Peruvian/Belgian team won the Tibotec Reach Initiatives grant, which allowed us to start looking at solutions to get two types of smartphones (iPhone and NokiaN95) linked up with the mobile moodle learning platform.

We started out rather basic, you can read about the first steps in this previous post. And now we are at the brink of releasing the code. Yes, I am not kidding, look at Mobile moodle's monthly newsletter here to see the excitement rising.

Just last week the great Peruvian/Belgian team (Luis Fucay, Beto Castillo Llaque and Carlos Kiyan, with Maria Zolfo and myself cheering on) released the amazing Mobile Moodle for iPhone development, which is currently being bug-tested to ensure we can deliver a (as good as) bug-free open source code for you all to use.
How did they do it? They got hold (after politely being given the permission) of the WPtouch for iPhone code by Dale Mugford of Bravenewcode. They started exchanging notes on the mobile moodle forum and only in an amazing 1 (one!) month of developing, they managed to get this amazing code going.

So keep in touch, tweet it, say it, media it.... and we will soon be releasing the complete codes for you to transform to your own needs.

Oh, this feels so exciting!

This is the more formal part:

The Institute of Tropical Medicine Alexander von Humboldt (IMTAvH) in Lima and the Institute of Tropical Medicine (ITM) in Antwerp developed an educational mobile application allowing access to the latest medical information for continuing medical education (CME) of physicians working in HIV/AIDS care in remote locations in Peru.

The didactic material consists of 3D animations simulating interactive clinical cases which are adapted to mobile devices. In this pilot phase ten Nokia N95 and ten iPhone equipped with a portable solar charger are used by physicians located in 20 urban and peripheral Peruvian HIV clinics.

Critical reading, module revision and suggested reading are distributed along with the clinical modules’ discussion, through mobile phones. The mobile educational platform, MLE Moodle is offered to support the learning events and tracking students’ progresses over time. The platform also functions as a forum for participants for peer-to-peer learning within a network of experts to assure content quality…

If you are interested to see the complete medical logic behind the application, feel free to look at this slideshare of the project:

mLearning Tibotec project presented at eLearning Africa in Dakar Senegal

View more presentations from ignatia.

Free mobile sms service getting to grips with bullying in schools: Bullyproof

If you are a teacher, principle or kids-psychologist worried about counseling or guiding young children on the topic of bullying, this software might be of interest to you.

Bullyproof will be released in March 2010, but you can check it out with the developer Brendan O'Keefe pre-release. This FREE software caught my attention for two reasons: first of all the obvious one in that it could reduce bullying, and second that it uses software that has been around in Africa for some time now, including great live saving medical applications.
Because the software is open source and free, you can adjust it to your language also (if necessary).

Reduce bullying
First of all bullyproof says to decrease bullying by using sms's. The free Bullyproof software, developed by Brendan O'Keefe, enables kids from primary and secondary school to send sms-allerts when bullying is taking place, or has happened. Because more and more young children have access to a mobile phone, and because it is a daily used instrument to those who have it, the technology is low threshold. Sending an sms is also not conspicuous, as I also found my kid sister sms-ing her friends without even having to glance at her mobile phone screen (straight from writing her sms inside the pocket of her jacket).
Bullyproof SMS is a social innovation designed to help reduce bullying. It enables students to report anonymously via their mobile phone, and schools to be notified and respond instantly to bullying or cyber bullying incidences.

The Bullyproof SMS software is available free to all schools and organisations that have an existing policy on bullying. (from their website) How it Works: Students text a report to a dedicated number and the report is then instantly forwarded to the appropriate person(s) mobile phone so they can respond in a timely manner. The report is also automatically forwarded via email to the school counsellor or principal. The Bullyproof SMS software comes preloaded with a database of tips and strategies for students that can be accessed by sending the keyword 'bully tip 1,2,3,4 'etc to a dedicated number.

As we all know their is an increased need to tackle cyberbullying, just this week the BBC wrote another article on it, and some parents indicate cyberbullying is the source for their kids suicide. Some countries like Australia put it high on the educational agenda as more than 1 million dollars is taken out to do research on the topic. Taking all this into account the bullyproof software might be a good and affordable (free) application to check out. If you want to get more information on it, twitter Brendan, he replies swiftly and if you like personal contact, he even offers skype sessions to exchange all the features of the bullyproof software.

FrontlineSMS:Bullyproof Webinar Jan 2010

View more presentations from Brendan O’Keefe.

What is the link with Africa?
Bullyproof is an application based on frontline-sms-software which has been actively used in Africa for a variety of social reasons (elections, social action...). So if you hadn't heard of Frontline which is software from Kiwanja.net, take a look, as it might inspire you to develop some mobile applications for social change as well.

For those of you interested in mobile medical applications, check out the medic frontline-sms examples, really fantastic!!