Joshua Okello of Kampala, Uganda, helped develop a fetal monitor app and a tool for diagnosing malaria. (Photo: 'TakePart Live')

An App a Day Keeps the Doctor Away

Or brings her to you. How mobile phone technologies are transforming health care in Africa.
Sep 25, 2014· 4 MIN READ
Rebecca L. Weber covers social justice, the arts, the environment, and more for The New York Times, CNN, Dwell, and many others. She lives in Cape Town, South Africa.

Health care workers in West Africa are going to need all available tools at their disposal to contain the Ebola virus that’s already killed thousands. Annie Feighery has one that can help.

Feighery is cofounder and CEO of mWater, a tech-oriented nonprofit dedicated to helping local authorities provide clean water and effective sanitation. Broadstreet, mWater’s new app, is designed to track the virus and its effects. With the U.S. promising to train some 500 health workers a week, Feighery hopes Broadstreet can be a part of that training.

President Obama dispatched not a biochemist or a physician but a former Microsoft executive and expert in emerging technologies and open data named Steve VanRoekel to lead the U.S fight against Ebola, so it’s safe to say technological solutions will be at the center of the American approach to stemming the disease’s spread.

Kathryn Jacobsen, associate professor for epidemiology at George Mason University's Department of Global & Community Health and a leading researcher on the Ebola outbreak, said via email that mobile technology can be a key element in fighting Ebola.

"There is a push to design (or adapt) and implement new information technologies in Ebola-affected areas," she said. "It will be helpful for specialized software applications to be created to support Ebola containment efforts, and these will likely take advantage of the smartphones and other computer technologies already widely used in West Africa."

Broadstreet is an adaptation of the mWater app, which Feighery helped develop and has been used to crowdsource water maps in developing countries for several years. It uses HTML5, which means it runs in any Web browser—including phones with only basic Internet access—and is fully functional whether or not a cell tower is in range. That’s significant because some of the areas most at risk for Ebola are rural and underdeveloped.

A water and sanitation group in Liberia called Equip Liberia is already using Broadstreet, Feighery said. Equip’s team uses mWater software to monitor water sources, which is important because access to clean water for washing is critical to Ebola control and prevention.

Broadstreet may also prove useful in areas where Ebola has not yet broken out.

“In Ghana, we are partnering with a group of doctors who are organizing themselves via Google Groups to increase their capacity for containment in advance of the potential for Ebola to break out in Ghana,” Feighery said. “They said the Broadstreet app would be most helpful in rural clinics, where it can be difficult to communicate with central organizers of the response.”

Existing apps, such as the Centers for Disease Control and Prevention’s Epi Info, tend to be geared to scientists and doctors, said Feighery. They are less automated and may require more time and higher levels of literacy, whereas Broadstreet is aimed at community health workers.

A midwife in Kampala, Uganda examines a pregnant woman using

the WinSenga app and modified Pinard horn.

(Photo: TakePart Live)

Those on the front lines against Ebola just need a few moments, using Broadstreet, to report symptoms and exposures, report community needs, and add locations to contribute to crowdsourced maps showing where Ebola has broken out and where food and water are needed.

“Health care workers can leave a digital trail, mapping households and cases,” said Feighery.

Broadstreet is one of a number of new apps and text-based programs, many of them developed by Africans, that are leveraging their mobility to enable care for patients in parts of Africa that lack a developed infrastructure of health services.

They are mainly geared to people with no other access to a health care professional, to patients with basic “dumb” phones, and to health care providers working in poor, rural, and mobile clinics.

Joshua Okello, a 25-year-old programmer based in Kampala, Uganda, who helped develop the inexpensive prenatal diagnosis tool WinSenga, said it’s significant that it’s Africans coming up with new approaches and tools for health care providers. Locals are familiar with both the challenges of providing health care in underdeveloped areas and what tech solutions might work.

The Broadstreet app is being used in the

fight against Ebola. (Photo: Broadstreet/Facebook)

“No one knows the problems you face in your community better than you,” Okello said. “It’s illogical that someone outside of your community would have a better solution than you. We cannot wait for solutions from the U.S., India, and China.”

Pregnant women in rural Uganda have limited options for prenatal care, and ultrasounds exams—a routine part of checkups in the developed world, ultrasounds examine a fetus’ development and growth—aren’t available for most expectant mothers.

So Okello and his team modified a preindustrial device called a Pinard horn to send data to cell phones, and wrote an algorithm to monitor fetal heart rate. Midwives running WinSenga on a smartphone can more easily and accurately get a quick read on a key indicator of fetal condition.

In much of Africa, unstandardized care, poor equipment, and relatively inexperienced medical personnel are the norm. Health care providers with more experience tend to move on to the city, where there are more opportunities.

Technologies for midwives and others must therefore be easy to teach and use. WinSenga’s interface is through a touchs creen and easy to explain. Okello conducts much of the training himself, but, he said, “on good days I have a doctor or gynecologist with me, who can give much more info.”

Though Okello’s team was awarded a grant through the 2012 Microsoft Imagine Cup and placed as a finalist for the Innovation Prize for Africa in 2014, WinSenga needs some $50,000 to complete clinical trials and scale the product for market. Just a few midwives have been able to use it to this point.

“The only reason we are still running is because we are passionate about what we are doing,” said Okello.

While WinSenga and Broadstreet are trying to scale up, other apps and tech-based tools are already in wide use on the continent.

One organization taking a retro approach—using a phone to make phone calls—is The Medical Concierge Group in Uganda and Kenya. Physicians provide free consultations and advice.

A smiliar tool is WhatsApp Doc, which allows users in Uganda to send a WhatsApp message to the doctors on call.

Cell phone provider MTN offers Hello Doctor in South Africa, where users have access to health tips and can text a question to and get a call back from a doctor. After building a base of hundreds of thousands of users over the past few years, Hello Doctor is now expanding to other countries.

MedAfrica, which took first prize in the 2012 Ericsson Application Awards, aggregates health services, including tips on how to handle all sorts of first aid situations, from anaphylaxis (massive allergic reaction) to swallowed poison. It maps nearby medical practitioners and has a list of emergency contact numbers.

The Trilogy Emergency Relief Application, developed by the Red Cross and Bharti Airtel, has already helped millions. The SMS system providing phone users—there are 821 million mobile-phone subscriptions among the continent’s 1.08 billion people—with potentially lifesaving information about the Ebola outbreak. TERA's usefulness was proved in 2013, when the Red Cross used it during a cholera outbreak in Sierra Leone; the number of cholera cases fell dramatically soon after it was deployed. The text messages it sends will provide reliable, up-to-date information on Ebola's spread, as well as instructions on how to avoid the contagion and what to do if infected.

Additional reporting was done by David McNair.