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The Doctor Is Only an SMS Away

Through motorcycles and text messages, FrontlineSMS:Medic connects doctors and patients in rural Africa. In the developing...

Through motorcycles and text messages, FrontlineSMS:Medic connects doctors and patients in rural Africa.

In the developing world, most communities don't have access to a hospital, let alone a doctor. Valiant community health workers sometimes serve rural villages, but they don't have the training or technology to assist with major medical problems. The distance between village and hospital, both in terms of travel and communication, often spells doom for residents. But FrontlineSMS:Medic is aiming to change that. It operates through a system called FrontlineSMS, which allows text messages to be sent to multiple users on one computer. With the Medic software, community health workers can text a hospital with a question about, say, a malaria patient and get a quick response. On the other end, hospitals don't have to waste valuable time and resources sending doctors into the field when they don't have to.Two weeks ago, FrontlineSMS:Medic won the N2Y4 Mobile Challenge award for the best use of mobile technology for social good. The award, given out by NetSquared, part of TechSoup, gives the project some needed money to continue to upgrade its software and expand the program. We spoke to Lucky Gunasekara, medical director and co-founder of FrontlineSMS:Medic, and Isaac Holeman, director of clinical programs and co-founder, about the software and their plans for expanding around the globe.GOOD: It would be great if you could give me a basic layman's description of how everything works.LUCKY GUNASEKARA: We can communicate need in real time. Say I am a community health worker in rural Malawi and one of my patients gets really sick. Before this system came along, for a lot of clinics, the patient would die because even though I have some basic health training as a community health worker, there is nothing I can really do. They're still just as disconnected as the communities they live in. Now with our system clinicians see things in real time and they communicate back.G: What is the hospital going to tell me that I didn't know before that will change the prognosis and how the situation results?

ISAAC HOLEMAN: It is really going to depend on the situation. One of the things that is important to us is to use a health care platform that is very flexible. We cater to the different needs. If there is already a diagnosis and a treatment regiment they can help administer medications. If it is something that would require diagnosis, the community health worker is going to need help with that. In an emergency situation, if you're going to have to pick up and walk 80 kilometers to the clinic, it might be too late. If the hospital can send someone on a motorcycle or send a mini-ambulance of some kind to come get you because you alerted them with a text message, that's one great use.G: How many places is this in operation right now?IH: We did the initial pilot hospital serving about a quarter of a million patients in Malawi that began about a year ago and it was pretty successful. After six months they saved more than 2,000 staff hours, saved about $3,500 in motorcycle fuel and doubled the number of people being treated for tuberculosis. Background for the non-medical folks: [tuberculosis] is highly contagious, often fatal if you don't treat it, but it is treatable. So following on that, we expanded rapidly. There are now two additional large cites in Uganda for a total of 1.2 million patients.G: So are you strictly Africa based? Or are there plans to expand other places? Or is Africa really where this is most needed and best implemented?LG: It is needed all over the place. I think for our team that is the "aha" moment. This will work wherever there is a global health need and a lack in health care infrastructure. One interesting factoid is that, in 2006, WHO released their yearly report and it was focused specifically on the healthcare crisis in global health. A lot of times here in the states we hear a lot of the numbers from the AMA that we need more doctors. But in the developing world they really need more doctors. They need them like yesterday. There is a 4.4 million healthcare worker shortfall right now in the developing world, where people are struggling from malaria and HIV and TB. That's the bad news. The good news is that cell phones are everywhere. Right now we have a lot of programs in Africa and we are expanding out to Honduras and Guatemala over the summer.Photos courtesy of Joshua Nesbit.

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