mHealth – outside Nepal (part I of IV)

The original advisory opinion was requested by...
The original advisory opinion was requested by the World Health Organization in 1993. (Photo credit: Wikipedia)

I got accepted in this wonderful mHealth (Mobile Phone Health) online program/course this past February. Course ware by GFMER (in collaboration with WHO) [details here] Its a six week program, from March to end-April; during which some eighty participants from throughout the world learn more on this topic. I have limited or no knowledge, so am exited to learn about this. Interested in the use of technology in medicine – clinical, non clinical, or even educational. I share here some of the wonderful ideas I came across during the first week of our course. We were to share personal interests and experiences. Very energetic and empowering.

On the assumption of 60% mobile network penetration, and rapid telecom growth in Nepal, here are few great ideas that Nepal could use. Most of them are directed towards rural Nepal. Some of them are already in use, in smaller scales. Most of the list below are ideas and only some are implemented at present. I see some with great potential, and if economy and my team permits, I’d love to collaborate and implement them in Nepal.

use of mHealth for callbacks
phone based intervention
a simple and effective way. I found examples of calling back patients for their scheduled appointments which required them to take medicines. Examples from Africa included HIV/AIDS retroviral therapy and Tuberculosis. While the former is not as big as in Africa, TB is very big in Nepal as well. May be, DOTS program that we have, here could implement callbacks from health centers for increasing regularity on medicine uptake. A phone call every fortnight just to check on patient.

Another big use was calling soon to be mothers, for their Antenatal Visits. World Health Organization (and Nepal Government) recommends at least four visits before delivery. May be health workers / Community Health Volunteers (FCHVs in Nepal’s Case) could start this call backs of all the registered pregnancies. At some level, this is being used in African nation, along with Postnatal callbacks and feedbacks also. If not all, high risk mothers (those with diabetes, gestational hypertension, seizure/epilepsy etc) could be followed up by this method. I know some hospitals in Nepal (read my alumni hospital – Kathmandu University Hospital*) have already begun unofficial callback programs on these high risk matters.

Lastly, vaccination program for the new borns could be assessed by these methods as well. Not that Vaccination and ANC visits are poor in Nepal, but mHealth could also be used to assist in whatever lag there might be, if any. On top of it, these could also be used to gather data, which brings to my next point (below)

use of mHealth for data mining
So there is a huge potential for mHealth and Data. As a clinician who is interested in research and evidence based medicine, I would love to see mHealth approach on it. There were lots of great ideas on data collections – from reporting a local health post for child being sick; to referring a critical case to Tertiary Health Clinic.

There are great examples of implementations as well. Like in one African nation, mHealth is being used to report the lab reports of a patient. Specifically focussing reporting on Anti-Retroviral Therapy and HIV/AIDS status. Other example use data gathering of children who are ill with chest diseases, this way knowing the prevalence of the community.

use of mHealth for education
Once in while (or scheduled) a SMS comes up, reminding me of the bad effect of smoking. Or this SMS has something to say to a pregnant mother, on what to do (or not to do) during her second trimester. There may be also an SMS reminding Female Sex Workers (FSW) of the importance of barrier methods in preventing Sexually Transmitted Infections (STIs); the same SMS may also go to sexually active couples, teens, etc.

In rural and remote areas, a SMS can inform of the doctor visit for health camps, or scheduled health awareness programs. A Female Community Health Volunteers (FCHVs) could get sms reminding / reviewing them of Maternal and Child Health Care topics. They may also do a QnA session via SMS for health information. [Remind you, these are speculations and ideas, I have my own questions of illiteracy in Nepal and optimum-mobile-use know-how].

future is in mobile……?

English: Open Data stickers
English: Open Data stickers (Photo credit: Wikipedia)

Well may be not, but with the ideas presented, mHealth could be a real boom for Nepal. As the technology prices are coming down, smartphones will soon be available to the masses. With new and open technologies like Firefox OS, Linux (read Ubuntu and Android) people have already begun the wheel for innovation in mHealth. Something of greater interest I found in this past week was – Open Data Kit (ODK) . I had heard (not in detail) about EpiSurveyor which is a closed source pricey alternate to ODK.

what is ODK?
Mobile data capturing using Open Data Kit (ODK) is a set of open-source kits of tools to manage mobile data collection solutions. Open Data Kit provides a mobile data capturing solution as stated below:
1. Builds a data collection form or surveys replacing traditional pen and paper data capturing;
2. Collects the data on a mobile device and sends direct to a server;
3. Aggregates the collected data on a server and exports to required Excel format for further analysis in SPSS, SAS, STATA etc.

the above quote is copied from website. not my own words, and I have yet to look into it. But this is pretty interesting, and is a big reason for me to make 2013 as my programming year. Will start with Script language, but thats another story. I end my post here, with a word to look into Open Data Kitt (ODK) and write about it in my next post. I am also weighing in Firefox OS and how it could be used in Nepal (my perspective). So these are the two topics for my next post.

P.S.i. – have decided to write in a schedule of four (or five) days. That way, I can read longer and write louder. My writings will be still first draft, and so filled with (may be) few errata.

P.S.ii. – Next Post – Saturday, March 16th, 8:30am NST.

Part Two – Published on April 24 – Here

YouTube Share – Health Systems Create Healthy Futures: Meet Maya

Source: – Meet Maya, whose healthy birth is the result of stronger health systems. Strengthening health systems is at the center of the World Bank‘s global strategy for health, nutrition, and population. We don’t focus only on one disease or condition, we look at health as a whole — what is preventing people from being healthy, how we can change this, and what impact it will have on development. Watch this short video to learn more.

what have I to say?

could someone create a nepali version of this video. If no one does, I will probably do it in April/May of 2013. If any one interested, please let me know. I don’t think will charge us anything, and this would be very useful, for many health workers for health awareness.

arcane and inhumane – “chaupadi pratha” – origins

Post dinner talks in my family are sometimes boring. I however always enjoy the company and sometimes few topics of immense interest does come up. Today, was that day, and something did come up, that I’d been very curious about, for more than a year now, haven’t dug deep though.

my proposed research title would be –
Perception and Attitude among Nepali women on “chaupadi pratha”, and it’s effect on cultural evolution in Nepal.

what is chaupadi?
I think this is unique to South Asian culture, and I know it is big among Hills and Mountains in Nepal, especially to Hindu Religion. I know it exists among certain Brahmins sect, Chhetris and also among Newars (but they might have another word for it). It’s when declare your daughter/wife/mother somewhat like an untouchable and send them to sleep in the cattle house/barn during their periods (menstruation). “chaupadi pratha” means this culture of kicking a women out of house, every month or so, just because she has her periods.

how strongly I hate this?
This is very disgusting and brutal. Something very prehistoric for today’s time. A cultural disaster, that does not account for the misery it causes to a human life.

why is it still there?
It’s a cultural thing. Your grandmother did it, your mother did it, your sister and your wife do it, and your daughter might be someday coaxed into this. It’s not just culture, but the whole religion that upholds the miserable existence to this ritual. To a point, that this is among handful of few things, that I really hate about in Hindu Culture/Religion.


how was it started? (my thoughts on it)
These are all, based on few minds (mine included) and I cannot say this is with certainty or guarantee of truth. I may be wrong, in which case, I welcome you to correct me, and then teach me.
South Asian culture which expands a time period of roughly five thousand years from Indus Valley and Harappa civilization had following few key points that might have contribute to this.

1. These lands (Nepal and sorrounding South Asia) were extremely fertile, with crops were in plenty. Unlike the Europeans, Middle East, and Africans; South Asia (and east Asia) was with plentiful food. So much extra food, that we have many religious rituals and Poojas, that makes us throw rice into fire. (imagine that, throwing away food – every few weeks, just to please so many gods with doubtful existence).

2. With plenty food came good number of children, and then population burst. Indian subcontinent has been full of people for a long time. It’s the same with ancient Chinese civilization. Mayans and Incas perished because they had food shortage. Towns and city were developing fast and there was nothing else to do except develop more sophisticated way of life. Our Literature and Arts saw it’s renaissance way back, with Mahabharata and Ramayana. We had too many gods to worship, and each of them had its own crazy, yet funny and brave story.

3. There were some very smart people, and some strong, some brave and some really dumb. In times, the smart people made some rules. Made the strong people their body guards (and ruler of the land), brave peole their messenger, and the really dumb people their slaves. Except, South Asian civilization did not really have slave system – it was morphed into some other name – the Caste System. This was integrated into the culture, which in turn was then coated with religion, and a doctrine was established. More rules were made, more gods were worshipped, more rituals were created.

4. For a farmer during the monsoon(the rainy season) or the winter, food was cooked inside a kitchen. This kitchen, as I gather from the present architectural reference in Nepal, is usually very small room, with the smallest possible window built on only one of the four sides of the room. The kitchen also usually has a small half partitioned room, which is usually the pooja room. The place where god and stuffs that represented the all mighty was kept.

5. Suddenly some crazy smart punk might have not liked the idea of eating food cooked by a woman who was bleeding inside the house. The current concept tables and chairs was not and people usually sat on ground with crossed legs, did some weird ritual stuff, before eating. There would be blood on the floor of kitchen (sadly, sanitary napkins were not yet invented), and this would be near the food, and also near the mighty God and its holy sanctum. This punk could not take his food outside (it was raining), and thinks that God would not feel good with bloody floor. Somehow God only feels good by numerous animal sacrifices in temples with red all over it’s floor.

6. Suddenly this punk realizes that, being Hindu usually comes with another great culture of joint family. There would be other women/girls (who apparently would not be in periods at the same moment) in their house to cook food few days every month. This lady may not have to cook or do the already hectic household chores for few days every month. It was a win win situation.

7. The smart people (both men and women) loved this idea, and because they were in ruling class, implement as a new ritual. The smart women loved the idea of this vacation every month. Made few changes and soon were enjoying the freedom outdoors. Dumb people, who by now (sixth, seventh or eight generations later) were relatively poor, and oppressed had to follow this rule.

8. Few hundred years later, the rule got modified somewhere, and now, women who were mensturating now even could not enter their own house. The rule that was created to keep them outside kitchen, now applied the whole of their home. Where else could she go?

9. Farm animals had their own house. All are animals except cows. Cows are like “god particle” in Hindu religion. A women now could not sleep in the same room where the cows were kept. She could however, be in the same room as goats, hens, horse, elephant, dinosaur, or a tiger. No cultural backlash with these animals.

Boom !! – a fully functional and mature religious doctrine is formed. A women is send to this old, rotten old shack to sleep every month. For some it’s the cattle house, for others its much worse. Imagine the horror of infections, mental abuse, and no safety. Just this last week, there was a cheetah attack to one of this shack and a woman lost her two year child sleeping with her mother. In Nepal this culture kills number of women every year, and very little is being done. Awareness and education to parents, mothers, fathers, granddads and grand mothers and the community are usually futile. There is a more than one generation of people that supports this.

this feels like living in a land of past during the dark ages

There is so much more to write about this particular miserable culture. I am however pressed with time, and must get back to books. I will write more on this. I believe this to be a health disaster, and would very much want help change or evolve this into something favorable.

P.S. I have nothing against god. It’s people who twist and turn religion for their own personal gains, that irks me.

P.S.ii. this post is an abrupt outburst of dissatisfied me.