Rachel Dzombak

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.

Ethical decision-making and grassroots diplomacy for social entrepreneurs: concepts, methodologies and cases

Social entrepreneurs striving to commercialise products and services in developing communities must understand the cultural context, develop trust-based partnerships across multiple sectors, and work proactively with those partners to achieve the desired social and economic outcomes. This article discusses the importance of reflection, ethical decision-making, and the praxis of grassroots diplomacy in the quest for educating conscientious entrepreneurs who can navigate complex social challenges to create win-win situations for all stakeholders. A concept inventory for ethical decision-making and grassroots diplomacy, as it relates to the education of social entrepreneurs, is presented along with analysis methodologies, real-world cases and practical academic exercises. These cases can be used individually to explore the complexities of entrepreneurial engagement in developing world contexts, or collectively, they can serve as building blocks of a rigorous academic course offering.

The praxis of systems thinking for concurrent design space and business strategy exploration

Systems thinking is a holistic approach to solving complex problems by considering every issue as part of a complex web of interconnected and interacting systems rather than independent issues with unrelated consequences. Such an approach forces attention on the bigger picture and wider processes of change rather than concentrating on discrete outputs at the individual task level. Systems thinking can be especially helpful in navigating the complexity and chaos inherent in technology-based social ventures in developing communities. Lack of clarity in the roles, responsibilities, and returns for the various stakeholders epitomizes this chaos and is a major contributor to the failure of such projects. The E-Spot canvas is a design space and business strategy exploration tool that facilitates group-thinking amongst stakeholders to match project resource requirements with money, time, sweat, and other equities that can be expended by them to sustain their project socially, economically, and environmentally. The canvas serves three roles: an educational tool for studying and practicing systems thinking; an entrepreneurial tool for developing equitable business and implementation strategies; and an ethical reflection tool for understanding motivations and incentives of various stakeholders and for making decisions that optimize short-term and long-term benefit and minimize the risk for everyone involved. This paper discusses the relevance of eight tenets of systems thinking-namely interdependence, holism, multifinality, equifinality, differentiation, regulation, abstraction, and leverage points-to technology-based social ventures from conceptual and practical perspectives. With the help of several examples, the paper describes how the E-Spot canvas operationalizes systems thinking to help identify appropriate stakeholders and determine the forms of equity they might offer towards fulfilling the overarching objectives of the venture while meeting their own needs.

Affordable dermascope for resource-poor settings

Skin diseases in developing countries receive little attention when compared with well-known killers such as HIV/AIDS, pneumonia and tuberculosis. In communities with few doctors and even fewer dermatological specialists (if any), Community Health Workers (CHWs) are charged with meeting the needs of these at-risk populations. However, skin diseases can be difficult to assess by CHWs and often signify larger underlying problems. Teledermatology is being increasingly employed as a means of remotely assessing and diagnosing skin ailments. Typical commercially-available dermascopes cannot withstand the harsh conditions of developing countries and there is a need for inexpensive and ruggedized dermascopes for resource-constrained settings. This paper presents the design and field-testing results for a dermascope intended for use in rural Kenya as a part of an operational telemedicine system. Though the design faced challenges with ambient light, material availability, and camera mobility, the final prototype produced images deemed acceptable for diagnosis by Kenyan clinicians.