On February 3rd, Wired Magazine posted an article about eHealth Nigeria entitled “Open Source Tackles Healthcare In Places Microsoft Can’t”. The article discusses how we are using open-source technology to create systems that are better suited for the Nigerian environment. The article focuses on the work that we do with OpenMRS, an open-source electronic medical record system, which we currently have implemented in over 10 sites in Nigeria.
The 3rd Annual mHealth Summit was held in Washington DC last week (Dec 5-7, 2011). It is the largest event of its kind, and brings together leaders in government, the private sector, industry, academia, providers and not-for-profit organizations from across the mHealth ecosystem to advance collaboration in the use of wireless technology to improve health outcomes in the United States and abroad.
eHealth Nigeria was selected to present a poster on a project that we did in conjunction with the Population Council and the Population and Reproductive Health Initiative (based out of the Ahmadu Bello University Teaching Hospital).
The poster was entitled “The use of RapidSMS to facilitate community-based surveillance for maternal and newborn health in rural communities in Northern Nigeria”.
Abstract:
In rural communities of Northern Nigeria maternal, newborn, and child health (MNCH) is hindered due to the lack of timely and accurate health reports, a lack of coordination amongst public health stakeholders, and lack of urgent and follow-up care. The mobile Community Based Surveillance (mCBS) project introduced a means of capturing maternal newborn child health (MNCH) data in Northern Nigeria through the use of coded SMS messages that transmitted the observations of traditional birth attendants (TBAs), a community nurse midwife (CNMW), and skilled community health workers (CHW) to a centralized information system. Four TBAs received a week-long training on cell phone literacy and vital event reporting via SMS. They also received “refresher” trainings on how to recognize 10 different MNCH vital events which included eclampsia, post-partum hemorrhage, miscarriage, and others. For three months TBAs reported vital events via SMS as well as a low-literate manual-count method for comparison. The CNMW then forwarded weekly summaries of vital events via SMS. For urgent events, the CHWs were immediately alerted to respond at the community level, and sent an SMS detailing the outcome. Preliminary analysis of process and outcome data indicated that non-skilled, illiterate TBAs could be trained to effectively send SMS messages to report MNCH vital events. Accuracy and timeliness of rural public health reporting and response improved. As the program is expanded, it is expected that the use of the SMS reports will continue to reduce the time it takes to receive urgent care, improve follow-ups on deliveries, and thus improve MNCH outcomes. The project demonstrates that non- and semi-skilled health workers can be incorporated into in a real-time, community-based, data collection scheme. Furthermore, the project offers a pathway to engage TBAs as productive members of health reporting and referral systems in a severely resource deprived setting.
Recently, AMD released a case study about eHealth Nigeria entitled “AMD helps eHealth Nigeria build a system designed to improve health care”.
As we began to build our data center in Nigeria, we looked for equipment that was durable, low-power, powerful, and would meet all of our needs. After working with ICC, we decided on using AMD equipment.
Episiotomies and perineal tears occur frequently in Nigeria. According to a study that was published in the Tropical Journal of Obstetrics and Gynecology entitled “Rates and Predictors of Episiotomy in Nigerian Women“, 40% of women who delivered at a health facility had an episiotomy and of the woman who did not have an episiotomy, 31.6% experienced a perineal tear.
In order to fix an episiotomy or a perineal tear, good visualization and light is needed so that a health care professional can clearly see the tissue and muscle that needs to be sewn back together. If a episiotomy or tear is not repaired properly, it could lead to a woman’s inability to control her bladder or a fistula.
When a facility does not have adequate lighting to perform an episiotomy of perineal tear, this is what happens:
If subtitles do not immediately show up, hover your mouse over the arrow on the bottom right of the video and click on “CC” to turn it red.
Also in Northern Nigerian health facilities, it is common for a woman to not receive any form of pain killer when undergoing an suturing.
The National Conference on Health Information Technology will take place in Abuja from Nov. 2nd – 4th. eHealth Nigeria’s Adam Thompson will be giving a speech entitled “The problem of Health IT infrastructure in Nigeria and possible solutions”. Take a look at the Program Details to see what other presenters will be at the conference.
eHealth Nigeria, with support from Family Health International and the Population Council, is leading an mHealth Initiative to improve the coverage of PMTCT services in Kano State, Nigeria.
For the position of “Community Mobilization Program Officer”, we are looking for a skilled project manager with experience in health program management. Speaking Hausa is a requirement, experience in PMTCT is very helpful, Public Health experience is greatly desired, candidate will need to possess excellent written and oral communication skills, also familiarity with computers is necessary.
Salary range will be =N= 130,000 to =N= 190,000 monthly depending on experience.
Please contact info@ehealthnigeria.org with you inquiries.
Here is another story from a primary health care center in Kano about a difficult delivery they took in the dark. A quick explanation; many health care workers have resorted to using the light from their cell phone as their primary means of light at night. When taking a delivery, they will shove the cell phone into the front of their head wrap as a make shift head lamp. However, as you will hear in the story below, that method does not work out very well.
If subtitles do not immediately show up, hover your mouse over the arrow on the bottom right of the video and click on “CC” to turn it red.
We are continuing to post stories from health care workers about the difficulties they encounter when delivering babies at night without light. Here is one of my personal favorites taken from a primary health care center in Kano.
If subtitles do not immediately show up, hover your mouse over the arrow on the bottom right of the video and click on “CC” to turn it red.
As we spend time at health facilities in Northern Nigeria, we hear more and more stories from staff about the complications they encounter when having to deliver a baby at night. Listen to one of these stories below:
If subtitles do not immediately show up, hover your mouse over the arrow on the bottom right of the video and click on “CC” to turn it red.
One of our current projects entitled “Safe Delivery: Portable Solar Suitcases to Support Emergency Obstetric Care,” which we are implementing with WE CARE Solar, is working to give women the ability to deliver their babies safely in the night by bringing solar systems to the maternity wards at primary health care centers and general hospitals in Kano and Kaduna states.
While spending time in health facilities across Nigeria, we encounter many different types of experiences and hear all kinds of stories. We would like to share these with you through a new blog category, “Stories from the Field”. These blogs will explain what we experienced or what we were told and will not exaggerate or embellish the story line. We will also try to keep our opinions surrounding the topics to a minimum sense the point of the blog is just to say what happens, not to give an opinion about it.
We will kick off with a story written by one of our Project Coordinators, Hussaina Martha. Please feel free to leave comments in the box below. Names of health facilities have been ommitted and names have been changed for privacy.
Stories from the Field: Aug 16, 2011
On the afternoon of August 16, a seizing woman was carried into a near-by PHC in Kano. She already had 2 seizures while at home and began to have her third on the way to the health facility. Two men, her husband and a friend, carried the woman through the door to the maternity ward where the waiting CHEWs instructed them to put her on the floor. The head CHEW, Maryam, quickly administered 1 dose (10 ml) of Magnesium Sulphate and the woman’s seizing stopped, although she was left barely conscience. Using a standard blood pressure cuff, the woman’s blood pressure was found to be 200/150. Since the PHC is not equipped to handle eclamptic patients, Maryam told the husband that he would need to take his wife to a General Hospital and that she would need to administer a second dose of MgSO4 to ensure that his wife would arrive there safely. MgSO4 is difficult to find in Kano and is therefore quite expensive at a cost of N1,500 ($10) per dose. Initially, the husband began to protest over the cost of the drug, however, the friend who was with them asked the husband “What is N1,500 compared to life?”, and the husband agreed to pay. The second dose of MgSO4 was administered as the woman continued to lay lifeless on the entrance floor.
In order to send the woman to the General Hospital, a referral card had to be filled out which contained the woman’s date of birth, religion, address, blood pressure, and the drug and dose she was given. A copy was given to the woman’s husband to take with them to the General Hospital while another copy was kept for the Population Council (the NGO responsible for providing the MgSO4 to the PHC). With the referral card in hand, a wheelchair was used to transport the woman to the local kekenapep (little yellow buggy) that was waiting outside the facility to take them on the 30 min ride to the General Hospital.
Although this man said he would take his wife to the General Hospital, Maryam said there are some cases when patients refuse to go to the referred facility. One particular case she narrated happened on the August 5th, 2011. A woman was brought to the PHC with a seizure. After giving her MgSO4, her bp was taken and she was referred to the General Hospital for further treatment. At the General Hospital, the doctors made a list of the drugs the woman would need during labour and delivery and told the family to go out and purchase those drugs for the woman. Her family decided instead to take the woman back home to deliver the baby. During delivery, she developed 3rd- degree lacerations to the vagina and anus and experienced a great amount of pain. For the next three days, her family treated her by bathing her with hot water. On the third day, her family finally took the woman back to the primary health center to seek treatment. Unfortunately, the family waited too long to bring the woman to the health facility and after only 20 minutes of being at the PHC, the woman passed away.
Maryam explained that the woman’s husband was not willing to pay the hospital bills and that is why he took her home to deliver. Maryam was the head nurse when the woman was brought back to the PHC and was still very upset over the situation that happened only a few days before we spoke with her. She told us that after the woman died, the family wanted to sit in the health facility to mourn and cry over her death. However, Maryam refused to let them stay in the health facility because she said it was their ignorance and selfishness that caused this woman to die.
