Radio Ethiopia

Health information transmissions go live

Richard Downs


The most striking image of Ethiopia for Kevin Montgomery was a corridor in the Black Lion Hospital in Addis Ababa crammed with more than 1,000 AIDS patients.

Gurneys with patients lined the hallway. Patients crowded the halls, milling about, leaning against walls, waiting for hours, sometimes for days. Outside, patients waited to get into the waiting rooms, which were overflowing with stacks of papers and files.

“I was completely overwhelmed by the sheer volume of people who needed help,” says Montgomery, PhD, technical director of the National Biocomputation Center at Stanford, a collaboration between NASA and the medical school. “I’ll never forget it.”

His trip to Ethiopia this spring underscored what he knew must be true: In developing countries, particularly in places like Ethiopia’s remote regions, advanced technology to deliver health care would make a world of difference.

“We’re trying to make an impact on the world by transferring technology out,” says Montgomery, who is part of a collaborative effort between U.S. and Ethiopian government agencies to bring telecommunications to Ethiopia’s health-care delivery system. “If we just sit in our ivory tower and write our papers, we do a disservice to the world.”

Montgomery, whose work as a computer scientist at Stanford reaches into outer space, is a founder of a new spin-off company, Intelesense Technologies, which provides wireless network technologies that can transfer data around the world almost instantaneously.

In Ethiopia, Intelesense will provide the backbone of a telecommunications system to monitor antiretroviral drug therapies for AIDS. The network will replace paper-based handwritten data collection systems such as the 2-foot-wide logbooks that health officials pick up every 90 days from remote villages to track the progress of the disease. Medical professionals say that a faster, more efficient data system will save lives.

“They’re huge,” Montgomery says, talking about the logbooks. “We’d ask the community health-care worker about a case, and she’d say ‘Just a minute,’ then start flipping back through this huge, heavy book. It’s crazy.”

Lessons from the space program

Mary Kratz

Entering the telemedicine center at Jimma University.

Intelesense is one of nine spin-off companies to come out of the National Biocomputation Center. The Hawaii-based company, with a research and development center in Silicon Valley, deploys wireless data-acquisition devices globally. The information flies through the air at 14-mile intervals until it reaches a base station connected to the Internet. The “Intelenet,” as the company calls it, has the potential to track disease outbreaks, from malaria to the avian flu, within a four-hour period, Montgomery says.

Uniquely rugged, these adaptable dataloggers were first developed for use in monitoring astronauts’ vital signs in space. Montgomery and his Stanford colleague Carsten Mundt, PhD, now full time at Intelesense, realized the potential for other uses and formed the company last year.

“This isn’t new technology,” Montgomery says. “We’ve just made it practical. It’s extremely robust. The military loves it.”

For their first project, an environmental research collaboration with the University of Hawaii, they deployed sensors to monitor the weather, water and even movements of non-native goats (wearing GPS collars) in hard-to-reach places, including the steep valleys of Kauai’s north shore. The next project took them to Vietnam, where they’re working with public health officials and the Hanoi School of Public Health to monitor drinking water safety by measuring pH, dissolved oxygen, turbidity and temperature, among other variables.

More far out — they’ve begun working with the U.S. Army and NASA to gather and transmit data from experiments on microsatellites in space, aiming to launch late this year.

Bridging the digital divide

Mary Kratz
  Kevin Montgomery places a data-acquisition device atop a water tower in Jimma, Ethiopia. The device will serve as a node in a health information network.

The trip to Ethiopia was supported by the U.S. Army’s Telemedicine and Advanced Technology Research Center, a proponent of using Intelesense to help battle global health crises.

“In Stanford’s overall strategy for spinning out innovation, Intelesense is one of those success stories,” says Mary Kratz, an informatics expert at the University of Michigan Medical School who is the lead for TATRC’s activities in Africa. “It can help solve really difficult global health problems, like AIDS.”

As the global community has become increasingly aware of a growing “digital divide” between industrialized and Third-World nations, a promising new trend has emerged, according to Eva Harris, PhD, associate professor of infectious diseases at the School of Public Health at UC-Berkeley. Harris is a MacArthur Fellow whose interests and accomplishments in transferring advanced technology to the developing world span two decades.

“A growing number of experts from industrialized nations are working to bring technology to developing countries,” she says, but adds that the transfer of technology in engineering and computer science is still lagging.

“While many are very interested in developing gadgets, few take that extra step and go out into the field. A lot of the fanciest gadgets just don’t get out.”

Montgomery hopes to help turn that tide. He says that he wants to see the Intelesense gadgets “get out into the field.” Which explains how he ended up navigating around long-horned cows and baboons on a Jeep ride across the bumpy roads between the city of Jimma and Ethiopia’s capital, Addis Ababa, in an effort to learn about the country’s AIDS crisis.

Nation plagued by AIDS

Ethiopia has one of the direst AIDS epidemics in all of Africa. In a country of nearly 70 million people, more than 2 million are thought to be infected with HIV, and its 1 million AIDS orphans face long odds of survival. It’s a country centuries behind in technological advancements, where oxen still plow fields and women carry well water home in plastic jugs.

“We’re acutely aware of the digital divide,” Kratz says. “We need a net meshwork infrastructure to get to the underserved areas in Ethiopia.”

Health-care delivery is a particularly challenging problem in Ethiopia because of its lack of power, lack of adequate phone systems and its widely scattered population. About 80 percent of Ethiopians live outside the cities in remote villages. Doctors travel from village to village by foot or by cart. And nomadic tribes create a health-care tracking nightmare.

“The population is very, very spread out,” Montgomery says. “The question becomes, how do you provide health care to these remote areas?”

In a collaboration between TATRC and the U.S. President’s Emergency Plan for AIDS Relief, Intelesense technology will provide the network capabilities to transfer information between villages and universities and hospitals.

Installing the dataloggers across the Ethiopian countryside will create the wireless network necessary to carry messages from the U.S. Army’s own gadget, a rugged hand-held messaging device. Originally designed for medics in the battlefield, this device will be used by community health-care workers to transmit patient data and create a link between rural outposts and the urban health-care centers. Traveling doctors could gain the same access by carrying one in their carts or in their pockets.

The benefits could be immeasurable for the transfer of records essential to antiretroviral therapy, as well as the tracking of blood deliveries by refrigeration truck, Kratz says. Follow-up on the disbursement of antiretroviral drugs is needed to avoid outbreaks of resistant strains of the virus.

The technology could also make obsolete the 2-feet-wide logbooks, long used by Ethiopian health-care workers for patients’ records — a loss no one would regret.

“The technology was positively embraced by everyone we met in Ethiopia,” says Kratz, who recalled a nurse at a health-care outpost in Jimma whose face lit up when she was shown the hand-held messaging device and told its potential.

“Wow, with this I could see twice as many patients in a day,” the woman said, stacks of patient encounter forms piled high behind her. “Can we get this tomorrow?”


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