Mobile technologies played a significant – and often overlooked – role in the containment of the Ebola epidemic in sub-Saharan Africa, and could very well serve as the foundation for future healthcare initiatives on the continent.
"In many instances … mobile devices provided crucial information for treating the epidemic," Darrell West, of the Brookings Institution, said during a Thursday morning panel presentation in Washington.
West, vice president and director of governance studies and founding director of the Center for Technology Innovation at Brookings, moderated the panel discussion, which featured two executives familiar with Nigeria's efforts to contain the epidemic and Debbie Theobald of Vecna Technologies, a Cambridge, Mass.-based company that provided remote technology in some of the hardest hit regions and is working in Nigeria and other countries on other mHealth projects.
According to the most recent statistics compiled by the World Health Organization, the Ebola virus, first detected in March 2014, has affected more than 24,000 people and killed more than 10,000, primarily in the west African nations of Liberia, Guinea and Sierra Leone. Fifteen deaths have been reported outside those three countries.
In Liberia and Sierra Leone, Vecna armed healthcare teams with CliniPAKs, mobile servers that can draw power from a car battery and give healthcare workers instant access to online resources. Theobald, Vecna's co-founder and executive director of the company's Vecna Cares charitable arm, said the remote hubs were deployed in so-called "green zones" in each country, and linked to tablets carried by healthcare workers in quarantined "red zones" to provide immediate care to infected patients.
That care included access to electronic health records and clinical decision support tools, which enabled front line healthcare workers to identify infected people, separate them from others, communicate with specialists and others and begin a treatment plan.
Nigeria, meanwhile, reported only 20 cases of Ebola and eight deaths – due in large part, officials said, to a coordinated healthcare system that was able to educate, identify and treat its population.
Okey N. Okuzu, founder and CEO of Nigeria-based InStrat Global Health Solutions, said health officials in that country were able to produce an Ebola awareness tutorial within days and push that information out to more than 1,000 front line healthcare workers – who, in turn, relayed that information to thousands more. That and other mHealth tools, he said, meant that frontline workers were much better prepared to deal with any Ebola cases and to prevent an epidemic in their country.
In fact, Okuzu said, the country had an Ebola management algorithm established to show workers how to deal with an epidemic, but it wasn't needed.
While Nigeria was able to contain the Ebola epidemic, it wasn't an easy job pushing new technology into a region that still relied on paper charts. Theobald said the technology itself isn't a problem – it's the people who would use it. In Liberia, for instance, Vecna worked with the International Rescue Committee to promote the use of electronic medical records, and found that most healthcare workers didn't trust what they couldn't put down on paper.
"There were a lot of people who stood back and wanted to watch," she said.
Okuzu called it "the human factor," a resistance to technology that's hard to overcome without education. "In some cases, we have gone to places and said 'Please, please, please, just do this because it helps us.'"
Adetokunbo Oshin, a deputy project director for the Nigerian National Primary Health Care Development Agency's Maternal and Child Health Project, pointed out that the mHealth project worked in Nigeria because it had a specific focus – preventing a potential Ebola outbreak.
"From the onset, the solutions just need to respond to specific problems" to gain acceptance he said. That changes, however, when one starts thinking about scaling the technology.
Theobald agreed. A project that focuses on mobile access to the EMR "is a one-lane highway, but it's a paved one, and it's there," she said. To create sustainability, she added, it needs to encompass much more than one goal or health outcome.
"Don't think of it as an mHealth program that you're putting into place to solve one problem," she said. "Put this into a program that is meant to stay forever."
