We’re travelling with lots of stuff–may be only 20 lbs of clothes each, but we have a complete 15 watt solar electric system, and a 5 watt one. Baby blankets, bulb syringes, medical equipment, calcium, school and office supplies, two gps, one computer, 40 lbs of paper household records. lots of rechargeable batteries. I’m preoccupied with power issues. Most of the work we plan to do requires a computer and computers require electricity. The last time I was here I begged space at the Catholic Mission in Katangi and spent a day working in something like a monk’s cell with one table and one chair and a power outlet. This time, if the sun shines, that won’t happen.
One of my goals for this trip is to lay the groundwork for a community health information system that will integrate the household survey we’ve done each year, trying to identify where the children under 5 are, with a means for tracking households involved in our various projects, and clinical information: patient registration, reason for visit, labs, and medications.
Almost anything we do at the clinic will require additional power. There is a solar panel and battery that is just enough to run the vaccine refrigerator, microscope, and some lighting. MPH student Kathryn Chinn has been working on ideas for the hardware for this system: a wireless router and a computer that can serve as a server. The software is a more difficult question. It would be nice to have it all intergrated, but that will require custom programming. We’re looking at open source electronic health record called GNU Health and DHIS, District Health Information System. There is also software designed specifically for mortality and nutrition surveys. The Gates Fdn has funded research on rural health information system needs in Africa.
The US is well along converting from paper to electronic health records; when we opened the Kisesini clinic in 2007, patients brought their records in little note books that they carry with them. At each visit, the go different places, the doctor writes a note and even a prescription in their book. They can take this to the pharmacy in town. We initiated a card system for tracking problems and patient register (in a big book). The lack of continuity in tracking health problems and treatment in the developig world is certainly a disparity that results in poorer health outcomes.
I hope to explore with the clinic staff, nurses and lab tech, what they preceive to be the greatest needs and their capacity to maintain and operate a computerized system. I want to explore satellite based internet access. I hope to find out where the Kenyan Minisitry of health is on information systems in small clinics, whether they have plans and models.