Barry Mendelow

Rural Doctors Advance Care with Wireless

In the impoverished Transkei, a rural area on the eastern side of South Africa about twice the size of New Jersey, it could take weeks between the time a villager is tested for a disease at a local clinic and the time treatment can begin. But in a pilot project conducted between a wireless application developer and two public-health agencies, three laboratories there are now using Short Message Service (SMS) technology to send test results to six clinics in the region and speed up treatment times. Because doctors and nurses now receive patients' lab results the same day the tests are completed, they can begin treatment immediately instead of letting the patients return to their villages and risking the further spread of disease. Initiated by South African application developer ExactMobile in partnership with the Eastern Cape Department of Health, which runs the clinics, and National Health Laboratories, which runs the labs, the project has overcome the absence of network infrastructure that marks remote areas such as the Transkei. Beyond aiding public health, the pilot also shows the viability of rural communities serving as test beds for wireless applications with a minimal investment. ExactMobile, which donated its services, spent only about $1,250 on software development. The payoff for its support: The Eastern Cape Department of Health is now soliciting funds from the South African government to deploy the ExactMobile application to more clinics and labs in the Transkei region. Project leaders decided to focus on tuberculosis (TB) first because the disease is so highly contagious and rife in the Eastern Cape. Rudi Thetard, who works at Management Sciences for Health, a nonprofit organization that focuses on improving TB treatment, estimates that doctors treat about 15,000 cases each month in the Eastern Cape, with a cure rate of about 50% -- although he says the cure rate is probably even lower in the Transkei region because it's so isolated and poorly served by laboratory services. TB treatment cannot begin without a verified lab result diagnosing the patient as infected, and before this project, laboratory services to rural areas were almost nonexistent and relied on infrequent transport to and from the clinics. In the pilot project, the South African Institute for Medical Research donated motorcycles to deliver the samples every day, with trips taking one to four hours, depending on the quality of the roads. As soon as laboratory personnel enter results into a computer, the application automatically sends them via SMS to a cell phone carried by a doctor or nurse in the outlying clinic (Motorola donated the cell phones). This combination of motorcycles and wireless delivery cut the time to get lab results from weeks to as little as a few hours. National Health Laboratories spokesman Barry Mendelow says that in the three months since the wireless implementation in six clinics, the number of samples referred for TB testing increased by 333%, compared to the three-month period before the project started. Because clinics can get results faster, they can treat more people, which has resulted in more patients and clinic staff seeking the tests. The ExactMobile application could also provide the basis for gathering statistical information on diseases in rural areas. Mendelow says that the prospect and utility of a single national database of lab test results, from which reliable national statistics could be drawn, would be greatly facilitated by the distributed access made possible by the new mobile data communications technologies. (Source: M-Business / CMP Media LLC 9/1/01, issue # 110, page 47.)