Like every passionate software engineer out there, I closely follow technology companies in Silicon Valley, pretty much the same way soccer fans follow their teams in Europe. I read articles on tech blogs and listen to podcasts on my phone. But after I finish the article, lock my phone and unplug the headphones, I'm back in sub-Saharan Africa, where the landscape is not quite the same. We have long and frequent power outages, low penetration of computers, slow internet connections and a lot of patients visiting understaffed hospitals.
Kot vsak strasten programer, skrbno sledim tehnološkim podjetjem v Silicijevi dolini, tako kot nogometni navdušenci v Evropi sledijo svojim ekipam. Berem članke na tehnoloških blogih in na telefonu poslušam podcaste. A ko preberem članek, zaklenem telefon in izvlečem slušalke, sem nazaj v podsaharski Afriki. kjer pokrajina ni čisto ista. Imamo dolga in pogosta obdobja brez elektrike, slabo razširjenost računalnikov, počasno internetno povezavo in veliko pacientov, ki pridejo v bolnišnice s premalo osebja.
Since the HIV epidemic, hospitals have been struggling to manage regular HIV treatment records for increasing volumes of patients. For such environments, importing technology systems developed elsewhere has not worked, but in 2006, I joined Baobab Health, a team that uses locally based engineers to develop suitable interventions that are addressing health care challenges in Malawi.
Zaradi epidemije HIV-a so se bolnišnice trudile z obvladovanjem običajnih kartotek zdravljenja HIV za naraščajoče število pacientov. V takih okoljih uvoz tehnoloških sistemov, proizvedenih drugje, ni deloval, a leta 2006 sem se pridružil ekipi Baobab zdravje, ki uporablja lokalne programerje za razvoj primernih ukrepov, ki bi obravnavali izzive zdravstvene oskrbe v Malaviju.
We designed an electronic health record system that is used by health care workers while seeing patients. And in the process we realized that we not only had to design the software, we had to implement the infrastructure as well. We don't have enough medical staff to comprehensively examine every patient, so we embedded clinical guidelines within the software to guide nurses and clerks who assist with handling some of the workload.
Zasnovali smo elektronski sistem zdravstvenih kartotek, ki ga uporabljajo zdravstveni delavci med obravnavo pacientov. In med tem procesom smo spoznali, da ne potrebujemo le programske opreme, ampak tudi postavitev infrastrukture. Nimamo dovolj zdravstvenega osebja, da bi podrobno pregledali vsakega pacienta, zato smo v programsko opremo vdelali klinične smernice v pomoč medicinskim sestram in delavcem, ki prevzamejo nekaj delovnih obremenitev.
Everyone has a birthday, but not everyone knows their birthday, so we wrote algorithms to handle estimated birthdates as complete dates. How do we follow up patients living in slums with no street and house numbers? We used landmarks to approximate their physical addresses.
Vsak ima rojstni dan, a ne ve vsak, kdaj je rojen, zato smo napisali algoritme, ki obravnavajo okvirne rojstne dneve kot celotne. Kako sledimo pacientom iz slumov, brez imen ulic in hišnih številk. Uporabili smo razpoznavne znake za približno določitev njihovega naslova.
Malawi had no IDs to uniquely identify patients, so we had to implement unique patient IDs to link patient records across clinics. The IDs are printed as barcodes on labels that are stuck on personal health booklets kept by each patient. With this barcoded ID, a simple scan with a barcode reader quickly pulls up the patient's records. No need to rewrite their personal details on paper registers at every visit. And suddenly, queues became shorter. This meant patients, typically mothers with little children on their backs, had to spend less time waiting to be assisted. And if they lose their booklets, their records can still be pulled by searching with their names.
Malavi nima osebnih izkaznic za unikatno prepoznavanje pacientov, zato smo morali vpeljati unikatno pacientovo identiteto (ID), da smo povezali kartoteke v različnih klinikah. Te ID so natisnjene kot črtne kode na nalepkah, ki so na osebnih zdravstvenih knjižicah, ki jih ima pacient. ID v obliki črtne kode enostavno preberemo s čitalcem in hitro dobimo pacientovo kartoteko. Prepisovanje osebnih podatkov v register ob vsakem obisku ni več potrebno. In nenadoma so se vrste zmanjšale. To pomeni, da so pacienti, ponavadi mame z majhnimi otroki na hrbtu, manj časa čakale na obravnavo. In če knjižico izgubijo, lahko z njihovim imenom še vedno najdemo kartoteke.
Now, the way we pronounce and spell names varies tremendously. We freely mix R's and L's, English and vernacular versions of their names. Even soundex, a standard method for grouping words by how similar they sound, was not good enough. So we had to modify it to help us link and match existing records.
Način izgovorjave in črkovanja imen izredno variira. Prosto menjamo L in R, angleško in izvorno obliko imena. Celo soundex, standardna metoda za združevanje besed glede na to, kako podobno zvenijo, ni bila dovolj. Zato smo ga morali prilagoditi, da nam je pomagal z ujemanjem in povezovanjem že obstoječih kartotek.
Before the iPhone, software engineers developed for personal computers, but from our experience, we knew our power system is not reliable enough for personal computers. So we repurposed touch screen point-of-sale terminals that are meant for retail shops to become clinical workstations. At the time, we imported internet appliances called i-Openers that were manufactured during the dot-com era by a failed US company. We modified their screens to add touch sensors and their power system to run from rechargeable batteries.
Pred iPhonom so programerji razvijali programe za osebne računalnike, a iz naših izkušenj vemo, da naš energetski sistem ni dovolj zanesljiv za osebne računalnike. Zato smo na novo uporabili zaslone na dotik, ki so namenjeni prodajalnam, da so postali delovne postaje na klinikah. Takrat smo uvozili i-Openers, internetne naprave, ki jih je v obdobju "dot-com" proizvedlo propadlo ameriško podjetje. Prilagodili smo ekrane in dodali senzorje na dotik ter njihovo napajanje, da ga je lahko poganjala baterija za polnjenje.
When we started, we didn't find a reliable network to transmit data, especially from rural hospitals. So we built our own towers, created a wireless network and linked clinics in Lilongwe, Malawi's capital.
Ko smo začeli, nismo našli zanesljivega omrežja za prenos podatkov, še posebej iz ruralnih bolnišnic. Zato smo zgradili lastne stolpe, ustvarili brezžično omrežje in povezali klinike v Lilongweju, prestolnici Malavija.
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With a team of engineers working within a hospital campus, we observed health care workers use the system and iteratively build an information system that is now managing HIV records in all major public hospitals in Malawi. These are hospitals serving over 2,000 HIV patients, each clinic. Now, health care workers who used to spend days to tally and prepare quarterly reports are producing the same reports within minutes, and health care experts from all over the world are now coming to Malawi to learn how we did it.
S skupino programerjev, ki delajo v bolnišnici, smo opazovali, kako zdravstveni delavci uporabljajo sistem in iterativno zgradili informacijski sistem, ki sedaj upravlja HIV kartoteke v vseh glavnih javnih bolnišnicah v Malaviju. Vsaka od teh bolnišnic skrbi za okrog 2000 pacientov. Sedaj lahko delavci, ki so prej porabili dneve za pripravo četrtletnih poročil, to storijo v nekaj minutah, in strokovnjaki s celega sveta, sedaj prihajajo v Malavi, da vidijo, kako nam je to uspelo.
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It is inspiring and fun to follow technology trends across the globe, but to make them work in low-resourced environments like public hospitals in sub-Saharan Africa, we have had to become jacks-of-all-trades and build whole systems, including the infrastructure, from the ground up.
Navdihujoče in zabavno je slediti tehnološkim trendom po svetu, a da delujejo v okoljih z malo viri, kot so javne bolnišnice v podsaharski Afriki, moraš biti sam svoj mojster in zgraditi celoten sistem, vključno z infrastrukturo, od samega začetka.
Thank you.
Hvala.
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