Khanjan Mehta

Reliability of a Telemedicine System Designed for Rural Kenya

Objective: Access to health care in rural areas of developing nations is hindered by both the lack of physicians and the preference of many physicians to practice in urban settings. As a result, rural patients often choose not to sacrifice wages or time to visit distant health care providers. A telemedicine system, Mashavu: Networked Health Solutions, designed to increase access to preprimary health care in rural areas, was field-tested in rural Kenya. This study aims to examine the reliability of the system compared to the traditional face-to-face method of health care delivery. Method: Reliability of the telemedicine system was tested using a modified intraobserver concordance study. Community health workers operated the system in various remote locations. Patient health information including chief complaint, medical history, and vital statistics were sent via Internet to a consulting nurse. After patients completed the telemedicine consultation, they also met in-person with the same nurse. Subsequently, the nurse’s advice during the in-person session was compared with his feedback provided through the telemedicine consultation. Results: When comparing the nurse’s advice given through the telemedicine system with the advice given through more traditional face-to-face, in-person consultation, the nurse provided consistent medical feedback in 78.4% of the cases (n = 102). The nurse’s advice regarding patient action (eg, clinical referrals or no further care necessary) was the same in 89.2% of the cases (n = 91). Conclusion: The study found that this telemedicine system was able to provide patients with approximately the same quality of care and advice as if the patient had physically travelled to a clinic to see a nurse. In rural areas of developing nations where there are high logistical and economical barriers to accessing health care, this telemedicine system successfully increased the ease and lowered the cost of connecting rural patients with nurses to provide preprimary care.

Empowering Community Health Workers with Technology Solutions

This article will provide evidence that empowering community health workers with appropriate technologies can address primary healthcare needs in developing countries. Through a comparison of case studies from various countries, a review of available resources and challenges facing CHWs, and primary data collected in Kenya, we will highlight the potential remedial impact of technology initiatives for empowering Community Health Workers.

Design of Affordable Greenhouses for East Africa

Reflecting the severity of global food insecurity, over 60% of the East African population is considered malnourished, with many regions in a state of famine. There is broad agreement on the need to help small-scale farmers move from subsistence to sustainable and profitable farming by boosting their agricultural productivity, reducing post-harvest spoilage losses and providing market linkages. Inflation, resulting in high fuel and fertilizer prices, prevents farmers from producing larger harvests. Most countries in East Africa have an agrarian economy with over 80% of the households depending on agriculture for their livelihoods. The climate is characterized by biannual dry seasons where many farmers suffer due to water shortages coupled with poor soil nutrition. While short periods of rain benefit local farmers, heavy rainfall sometimes destroys cash crops. Greenhouses are permanent glass or plastic-covered structures that allow farmers to grow vegetables and fruits yearround through mechanically-controlled temperature and irrigation systems. Greenhouses can help farmers in East Africa grow and protect crops in both wet and dry seasons. Large commercial farms, many of them owned by multi-national corporations, employ greenhouses that span several acres of land to produce high-value cash crops including fruits, vegetables and flowers for the export market. East African companies import and sell greenhouses priced at over US

Use of Telemedicine to Diagnose Tinea in Kenyan Schoolchildren

2,000 to commercial farmers. While greenhouses can significantly increase smallholder productivity and improve livelihoods, current designs are inappropriate and too expensive. The adoption of affordable and context-appropriate greenhouses can lead to improved livelihoods for farmers and entrepreneurs while fostering food security. This paper describes the constraints and design tenets for low-cost (~

Opportunities for Social Innovation at the Intersection of ICT Education and Rural Supply Chains

200 bill of materials) greenhouses and discusses results from three years of field-testing such greenhouses in Kenya, Tanzania and the United States. Currently, the field-tested prototypes excel in affordability, maintenance, and crop protection. This paper strives to blur the boundary between context-driven design, applied research and development by seeking collaborators to refine and localize the technology with the ultimate objective of disseminating it broadly.

WishVast: Building trust and social capital using cellphones

OBJECTIVE Internet-based telemedicine has the potential to alleviate the problem of limited access to healthcare in developing countries. The Mashavu project aims to deploy kiosks that transmit health data and pictures from patients in underdeveloped countries who have no immediate access to healthcare to clinics for analysis by trained personnel. To test this principle, we investigated whether dermatophytic fungal infections (tinea) could be diagnosed by Kenyan clinicians solely from pictures of the lesions. SUBJECTS AND METHODS Six physicians, five physician assistants, and five nurses from Nyeri Provincial Hospital took a test consisting of 15 pictures of potassium hydroxide (KOH) prep-confirmed tinea lesions and 15 pictures of KOH prep-negative lesions obtained from local children. RESULTS The mean (standard deviation) sensitivity and specificity for the whole group were 73% (19%) and 83% (11%), respectively. The physicians had the highest sensitivity and specificity, although only sensitivity reached statistical significance when compared with physician assistants. CONCLUSIONS These results suggest that telemedicine can be used to diagnose simple skin conditions in a low resource setting with reasonable sensitivity and specificity.

Leveraging design thinking to build sustainable mobile health systems

The conventional model of education can be viewed as a linear transmission system, where information goes from a teacher to a student. At the same time, in rural business supply chains, products and services are delivered in a linear manner from producer to agents to consumers. These linear supply chains and education systems are top-down and hence struggle with quickly adapting to market dynamics and globalization. They are inherently inefficient and difficult to scale, resulting in widening educational divides and “last mile” supply chain challenges. This paper highlights opportunities for social innovation that emerge at the dynamic intersection of informal education systems and rural supply chains in the developing world. We discuss the largely untapped potential of ICT education in creating an unconventional means of education integrated into the supply chains that provide livelihoods for a large demographic in the developing world. Our approach seeks to utilize the potential of ICT education in three ways: to increase ease of access and relevance of material through its integration into the supply chains, teach life skills beyond conventional vocational training and introduce a feedback loop that enables players at all levels of the supply chain and education system to actively contribute to the design of the system. This multi-level information and communication technology (ICT) platform can be used to facilitate iterative learning where the knowledge emanates from the participants and their indigenous ways of knowing and doing. Interaction at all levels provides agency to the participants while serving as a means for the long-term preservation of such local knowledge. Our team has designed and piloted Prerana, an ICT platform in collaboration with the Self-Employed Womens Association (SEWA) and the Rural Distribution Network (RUDI) in western India. We conclude the paper with a case study of the working mechanics and field-testing results of this system.

Characteristics of a 3D-printed prosthetic hand for use in developing countries

This paper describes the basic concepts and operation of a cellphone-based social networking system called WishVast. WishVast is an innovation that attempts to harness the pervasiveness of cellphones in developing countries to build trust and optimize resource utilization & supply chains to facilitate people to people trade with the ultimate goal of alleviating poverty.

Designing breathalyser technology for the developing world: how a single breath can fight the double disease burden

Abstract Mobile health, or mHealth, technology has the potential to improve health care access in the developing world. However, the majority of mHealth projects do not expand beyond the pilot stage. A core reason why is because they do not account for the individual needs and wants of those involved. A collaborative approach is needed to integrate the perspectives of all stakeholders into the design and operation of mHealth endeavours. Design thinking is a methodology used to develop and evaluate novel concepts for systems. With roots in participatory processes and self-determined pathways, design thinking provides a compelling framework to understand and apply the needs of diverse stakeholders to mHealth project development through a highly iterative process. The methodology presented in this article provides a structured approach to apply design thinking principles to assess the feasibility of novel mHealth endeavours during early conceptualisation.

Challenges facing medical data digitization in low-resource contexts

Arising out of civil conflict, disease, birth defects, and traumatic accidents, many people in developing countries lack hands or fingers. Prosthetic hands can help give these people a sense of agency and increased ability to perform everyday tasks. Unfortunately, many prostheses are prohibitively expensive and often require frequent maintenance and repair. Therefore, they are financially and geographically inaccessible to most people living in developing countries. A 3D printed, open-source hand is one possible solution owing to its low cost and potential for customization. However, the hand must be appropriate for the environmental conditions and lifestyles found in developing countries. To characterize the functionality of the 3D printed hand, a series of daily task and object tests were carried out. While the prosthesis was able to successfully complete a number of tasks, it had difficulty with those that required intricate movements and with heavy objects.