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.
像每一位充满激情的 软件工程师一样, 我密切跟踪着 硅谷科技公司的动向, 就像足球粉关注 他们的欧洲球队一样。 我看科技博客上的文章, 听手机上的播客。 但是在我看完文章后, 锁上手机屏幕,摘下耳机, 我又回到了撒哈拉沙漠以南的非洲, 这里的风景挺不一样的。 我们频繁有长时间的停电, 低电脑普及率, 缓慢的网速, 和人满为患,却人手不足的医院。
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.
自从艾滋病爆发以来, 病例变得越来越多, 医院就很难妥善管理 艾滋病患者的治疗记录。 在这样的环境下, 进口的医疗设备根本没法发挥作用。 但是在2006年,我加入了 猴面包树医疗(Baobab Health), 这个组织雇用地方工程师, 进行因地制宜的研发工作 来解决马拉维共和国的医疗问题。
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.
我们设计了一个电子医疗记录系统, 供医疗人员看病时使用。 在研发过程中我们意识到, 我们不仅要设计软件, 还要提供配套的基础设施。 我们没有足够的医疗人员 来全面检查每一个病人, 所以我们在软件里置入了临床指南 来帮助护士和工作人员, 辅助他们的工作。
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.
每个人都有一个生日, 但并不是每个人 都知道自己的出生日期, 所以我们写了能够估算生日的算法, 能准确到某天。 我们如何跟踪住在贫民窟的病人? 他们连门牌号都没有。 我们用地标来估计他们的位置。
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.
马拉维没有能够 分辨病人的身份识别信息, 所以我们设计了独特的 病人身份识别系统, 让病人的记录在 不同诊所之间实现连接。 这些身份识别信息 以条形码的形式贴在病人的病历上, 由病人保管。 有了条形码身份证, 只要用扫描器一扫, 就能拿到病人的记录。 没有必要在每次去医院的时候, 重新填写他们的个人信息。 突然之间,看诊的队伍变短了。 这意味着病人, 很多是背着小孩的母亲, 不需要花那么多时间候诊了。 如果他们丢失了自己的病历, 还能通过搜索他们的名字找到。
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.
但是,不同的人读和拼写 名字的方式也大不相同。 我们不区分R和L, 不区分英语和方言的名字。 甚至是发音, 一个标准化的依据发音的拼写方法 并不好用。 所以我们要改变它, 来帮助连接和匹配现有的记录。
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.
在iPhone被发明以前, 软件工程师只开发了 电脑版的软件, 但是依据我们的经验, 我们的电力系统并不能为电脑提供 可靠的电力供应。 所以我们把 触屏的销售点终端机, 就是在零售店里用的那种, 改成了医疗工作站。 那个时候,我们进口了 网络工具,i-Openers, 这是在互联网热潮时期, 由一个破产的美国公司生产的。 我们改造了它们的屏幕, 加上了触觉传感器, 并改用可充电电池来供电。
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.
刚开始的时候,我们找不到 一个可靠的网络来传输数据, 特别是在偏远的医院里。 所以我们建造了自己的信号塔, 创造了一个无线网络, 并连接到了马拉维的首都, 利隆圭的诊所。
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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.
和在医院工作的一群工程师一起 在医院内工作, 我们目睹了医疗人员利用这个系统, 慢慢建立起了一个信息系统, 管理着马拉维所有主要公共医院中 艾滋病人的医疗记录。 这些医院的每个诊所 都有超过2000个艾滋病人。 在以前,医疗人员要花几天时间 来计算和整理季度报告, 现在只要几分钟就能完成, 而全世界的医疗专家 都来马拉维来学习 我们是怎么做到的。
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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.
跟随全球科技潮流 让人深受启发,而且乐在其中, 但是让这些科技 在资源匮乏的环境下运行, 像撒哈拉沙漠以南非洲的公共医院, 我们不得不成为万事通, 从零开始,搭建整个系统, 包括基础设施。
Thank you.
谢谢。
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