Today’s guest post is by Neil Rens, a biomedical engineering student at Johns Hopkins University. Neil contacted us in May with a vision to introduce several mHealth devices to practitioners in Rwanda during his time volunteering. We loved Neil’s entrepreneurial spirit and happily obliged. Without further adieu, here is his story:
Twenty years ago, the average life expectancy in Rwanda was 28 years, 78% of people were living below the poverty line and over 18% of children died before their fifth birthday (Partners in Health). Fast forward to 2014, and Rwanda’s healthcare (along with economy and political structure) has improved tremendously. Now people live an average of 56 years, only 45% are below the poverty line, and only 6% of children die within their first five years. How did such a transformation occur? And what is next in a country where the life expectancy is only 56 and 11% of people are moderately or severely underweight?
I arrived in Rwanda in June, intent on fixing as many pieces of medical equipment as possible. Having just completed my second year of the undergraduate biomedical engineering program at Johns Hopkins, I was ready to do something outside of the classroom. Doing scientific research in previous summers had proved interesting but less fulfilling than I was hoping, so I resolved to spend my summer doing something where I could see the results of my efforts on people that deserved help.
Enter Engineering World Health (EWH), a non-profit dedicated to addressing the problem of broken medical equipment in developing countries. In spite of numerous donations, a large amount of equipment is not in use. EWH focuses on training locals to fix the equipment. It also runs a summer program where university students can help deal with the backlog of broken equipment and experience cultural immersion in a different country.
While in Rwanda, I became fascinated by the question posed above—how did Rwanda improve so much over twenty years? For healthcare, I believe the transformation was enabled by Community Health Workers (CHWs). Nearly 50,000 strong, the CHWs are people with no background in medicine that undergo a brief 4-day training and then return to their respective communities. Collectively, they focus on maternal and child health, especially in the areas of malaria, pneumonia, malnutrition, and HIV/AIDS. I quickly realized that mHealth devices could enable them to prevent, diagnose, and treat even more diseases.
mHealth initially sparked my interest when I saw an AliveCor ECG iPhone case—literally an ECG at your fingertips. In the two years since then, the field has blossomed. Yet, with the exception of rapid SMS programs for health information, few mHealth technologies have made it to the developing world on a meaningful scale. When I finalized my plans to travel to Rwanda, my friends at Quantified Care arranged for me to borrow a few mHealth devices, including a Cellscope Oto.
Suddenly, I had become an mHealth evangelist. In Rwanda, I showed the devices to whomever I thought might find them interesting or see their potential. Some doctors were dazzled by their small size and integration with a smartphone, but so few doctors have smartphones that the technology seemed unrealistic to them. But I was not discouraged.
I began to imagine a CHW equipped with a smartphone. This healthcare worker could now be capable of diagnosing ear infections, irregular heart rhythms, hypertension, and more.
mHealth devices are particularly promising for CHWs because of the devices’ mobility, common power supply, ease of use, and ability to transmit data between phones and the internet. CHWs serve their villages, which can number 100 households, so they have to be able to easily transport their equipment over challenging terrain in all weather. Devices that use the electricity from a smartphone battery would eliminate the need for another power source, meaning no need for consumables like AA batteries. Moreover, mHealth devices are generally very easy to use. In the U.S., most are currently targeted at consumers, so they have already been designed for people with limited or no medical training. Finally, all of the data can be stored locally on a smartphone and then uploaded into the cloud, which allows clinicians with more training to analyze the data collected by CHWs at a different site.
I am excited at what mHealth could do for countries like Rwanda and look forward to the day when devices like the Oto can be used on a large scale.
Thank you to Neil for this fabulous recounting of his experience in Rwanda. We’re excited as well about the potential for devices, like the CellScope Oto to have an impact worldwide on access to needed medical care.