why do i support the message
I am a doctor. I have friends who are into medicine. Out of 45, most of my batch mates are already enrolled in post graduate degree in and out of Nepal. Pretty soon, they will be earning a lot (Nepali Standards). Among the 45, Its only me and my better half (Dr Aditi) who are working in public health. For the last two years, we have been working in a small project that tries to uplift health through education, training and service. We call it Nidan Nidan and are very proud of it, even though its in minuscule of what we could have achieved if we try very hard.
why aren’t we trying hard?
frankly, bills don’t get payed while working as non-profit. Your friends basically give that smirk, your family questions you the price that they payed for your graduate degree, and frankly society is kind of deaf and dumb to a public health pledge made by a junior doctor. Reiterating, most of our friends have already begun post graduate, and my family (extended) has this prominent question put forth –
when will you start earning?
Our social dogma places a doctor in the highest educational platform that earns quit a bit more. Money at the moment is one of the major players in our society, and with the weak government and country, most parents want their children to get into either medicine or engineer (another high earning educational ladder).
my question is?
why can’t I earn a good sum of money and do good things, like mentioned in the above video? Why can’t I work in non-profit, do good to many people at once, and make a respectable amount of living through it? Why do I have to compromise between my living standards and then my intentions to do good?
I have options to either become a specialist and work in a tertiary hospital, and earn oodles. OR – work in public health, be a clinician, be an academician and help in strengthening the preventive health aspect of Nepal Why am I not allowed to make a living out the latter is confusing, and unhealthy practice (as per me).
whats my plan?
to be in three different field. First became the initiation of public health project – Nidan (this has already begun). Second thing is to get into post graduate, finish it, and be a specialist. To be all three – an academician, a clinician and a public health expert. A plan that will stretch me to my limit, but I strongly hope to cover all the three fields of health.
jack of all trades, and master of one
The video is from one of the TED events in USA, by Dan Pallotta: The way we think about charity is dead wrong. I did not make it, or own it, have no copy right or left for it; but share it because youtube lets me, and the stuffs presented here reverberates my ideology.
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……?
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.