barriers concerning standards and interoperability

mHealth in Nepal (part II of IV)

This is part two (of four) of mobile health series, which I am sharing after completing an online education on mHealth. For those who would like to read the Part One – its here.
The following are some of the concept we discussed in online class, and google group. I think this is very reasonable to developing countries like Nepal. Most of the barriers are specifically from mHealth Africa, but I have here tried to include my nepali perspective as well. Here are few of the barriers that I think I see in Nepal concerning standards and interoperability on mHealth.
  1. Language – Nepal despite being a small country, has a huge demographic variability. The mountains and hill terrain has made number of spoken language (culture) variation. “Nepali” is the official language, and English (UK) is taught from primary and secondary school. There are about 123 spoken languages (in 125 different community) and many who still do not speak or understand English at all.
  2. (limited) Mobile Technology – Most of the mobile handsets used in Nepal are under NRS.4000 (rough estimate USD=50  Euro=40). These are not Google Android OS phones, but Java based technology with proprietary OS from local market (mostly – China and India). There are about 5-6 different mobile company that have stronghold in budget feature phone in Nepal. The only technology similar (standard) in these feature phones is Java. However, almost all have Facebook (Java Application) installed in them. Facebook being number one Social Network in Nepal (at the moment).
  3. Lack of Government Initiatives – There is no standard Government based protocols regarding mHealth in Nepal. Although, Nepal Government has recently begun a trial phase of mHealth program in few districts; there is no details about this in government websites (This is something I  am considering to write for my first assignment also).
  4. Internet (Availability and Cost) – Internet access through mobile handheld is expensive; and this hasn’t reached throughout Nepal. As with mobile network, the mountainous terrain in most of the country is hampering the WiFi (WiDi, or WiMax, or LTE) rollout from Government and Private Initiatives. There is considerable progress, but more need to be done.
  5. mHealth education – is very new to Nepal. Health providers have very little knowledge about mHealth. Data Mining and Research are at its infancy in Nepali Health Community, very few if any are interested in mHealth (for this purpose) at present. Medical School (Doctors, Nurse, Health Assistant, Health Volunteers) do not have curricula to teach mHealth. Courses that offers technology (mobile or any) teaching is in Public Health related education. This education is concentrated in Data Entry, Evaluation and Analysis, but not in Health Education. I am a recent medical graduate and I had no proper formal education on Medical Technology. Most of the course work was limited to using MS Excel (2003) and SPSS (v11)
  6. Lack of (active) Open Source Community – There is a huge gap in programming education in Nepal, that most are financed/taught by proprietary holdings like Oracle and/or Microsoft. Most of the health initiatives related to technology are in the form of Outsourced Code writing by multinationals.
  7. Technical Infrastructures – present today in various Public and Private Health institute are scattered, rudimentary and closed source. Many hospitals and health care institution have both handwritten documents and e-records. Most of the time, its the physical documents that gets used, and the electronic records are forgotten. Most of the times doctors, nurses (or any other health worker) does not know how to use the electronic record. There is no inter portability between any two health care givers (both e-records or physical records).
  8. Lack of Adherence – Health providers do not seem to adhere to e-health technologies. Partly due to the lack of electricity or lack of proper motivation, or knowledge, electronic recording is seldom done in Nepal.
what can i explore for my next part?
well there are Ncell and NTC. and there network. There is Ministry of Health and its working, plus community members who love mobile. keep watch.

Friday Read – The Great Leap in China, Stalingrad, Eritrea

Almost all of my good friends are out of Nepal, and right now with self-study, life is all about a cooping in my room, with books. Instead of bar, barbecue or cinema, life is more about books, Internet and sleep. No Facebook, Twitter, or LinkedIn for the moment. No emails or calendar utility in progress.

Wikipedia has become one important source of entertainment right now. This huge source of information, and my love for history, presents as a great companion in these time of exile. Last night was no different, and when I was done with my books, I went straight to view world maps. Found some irregular border lines, in two places and began my journey for the search of information. Random reading intrigues me, and as much as I presume it to be useless, I just hope, someday everything will come handy.

I began with a small country situated in the horn of Africa – Eritrea. Smaller than Nepal, and bordered with Ethiopia. It’s a developing country, better than Nepal, and has some great good potential, but as with many African nation has fair share of troubles within and outside it, hence a border dispute and fighting with its neighbor has had its toll to the country.

Next on stop was India and its border dispute with China. Apparently there are two border dispute, and as much as I knew about Sino-India war of the late 60s, there was another land mass, near the Kashmir territory that was in dispute. I finally found out more about the seven autonomous regions in China. Tibet plateau is not alone. A long page on these border dispute and the autonomous regions let to a brief history in China, and how Mao came up with a great plan to kill so many innocent humans. Made me sad, and angry. The great leap, the agriculture revolution by the officials which had killed so many innocents, in the name of politics. Reading about these atrocities in the name of a belief made me think the difference between politics and religion. How few smart people ruled the hordes of uneducated like animals. Comparing the democracy with the communism, and the socialist movement with corrupt democracy. A total of 7 million people starved to death during the second agriculture revolution in China – as per the official government figure. An outside figure estimates this to be as much as 48 million, with more people agreeing on terms with the death total of around 30 million. That’s more than the current Nepal’s population of 26.6 million. I was curious to know if something like this had also happen in an entirely opposite scenario, when
I read about the anti-communist genocide by the Indonesian government in the late sixties, in the name of politics. There is a great documentary being released about this, I hope I can see it someday.

Reminiscent and similar to the internet social media rule – 90-9-1 – that for every original source of an idea by one person, there will be nine that will develop on it and improve/degrade it (bake it into their own formula) and distribute to the ninety of us who, with the lack of proper social structure or hence forth the information gap, will follow it. This, I see in both politics and religion – especially in my country (Nepal).

Recently, I met an old friend from Brazil – Sao Palo this past week. We talked about democracy, president Lua, and the evolution of Brazilian culture with its politics. It was a wonderful insight on this huge nation, and I hope Fernando is right when he says, Nepal right now is what Brazil was 20 years ago. I hope, this country turns out great in the near future.

PS.i. This post is not a foul cry to the democracy in Nepal, or the corrupt leaders. I am however, trying to gain knowledge on the evolution of it, and would want to know the path it will follow in future.

Information addiction

Social network
Social network (Photo credit: Wikipedia)

Growing up in Kathmandu has made me realize that I may soon succumb to a lung disease and die of cancer. If pollution does not kill me, the burgeoning population definitely will.

Rampant mumbling and photo stalking in Social Network is not a big addiction. People every where are the same, and its only fair to know few dozens of good people than follow a cohort of brain-popping zombies who do not match my frequency.

What I fathom more than being social is the information available in the internet. Barrage of reading that can take up to 90 minutes every day, has been compulsory addiction to me. I feel hollow and empty if I skip one day. I blame my father for this, as he taught me about this addiction to news. I blame my mother for this, as she taught me, to be able to analyze every bit of social information. I also blame slow internet in my country for this, where, pictures and videos take a decade to load, and simple RSS and atom news come up pretty fast.

Lately LinkedIn specials are all the hype for me. The write ups from these big people have some sound advices and become a great read. Thank you for this addiction, I can only hope that the news I read, the story that gets analyzed become of some use to me in the near future. I want to believe in this addiction of mine as a positive thing.

P.S. – I am not into literature. The thought of reading books has never been a delightful memory. Few books per year, is my number till now. I did like the website – longform which presented a good layout and great read content.