How to build a Covid-19 clinic in the Global South

In this article, I want to share a design I have created for a “Pop up Covid-19 Vaccination Clinic” Its based on the practices as used by the NHS in England. The design is flexible and can be modified to suit local clinical regulations. My focus is on technical infrastructure. If anyone uses the draft information below, its essential to use these plans as inspiration and involve clinical experts in the final design to be deployed.

The Site Plan
The site has been designed to facilitate the smooth flow of people through a one way system. Markings will be placed on the floor to remind patients to maintain the correct social distance. A waiting area is provided outside where patients can queue and have their temperatures checked. With good planning, appointment slots can be given to patients so that they arrive at specific times to prevent overcrowding at the entrance. Before entry, the temperature of each patient will be checked.

This is a “pop-up” clinic which means that it needs to be built quickly and brought into service. The modules in the plan can either be tents or temporary structures made from local materials such as plastic sheeting and timber.

Once inside the clinic, the patient is registered on the appropriate IT system which is defined by the country government where the vaccinations are taking place. Some vaccines will  require a second future dose, so accurate record keeping and recording of patient contact details will be essential. Screening can also be managed at the registration post. Any patients who fail screening for reasons such as previous reactions to vaccines can be taken out of the clinic via a side entrance.

The next stage is vaccination. This site has been designed to support 8 clinical bays, so it is possible to have a daily throughput of 600+ patients if the clinic is open for 12 hours a day. Good HR planning is essential as there should be sufficient staff to allow for breaks. In hot countries larger teams may be needed as the time staff can spend in full PPE will need to be limited.

After immunisation, an observation area is provided if its needed for the vaccine being administered. In the UK, the Pfizer vaccine is using new techniques and as a precaution, patients will stay in the observation zone for 15 minutes. If there has been no reactions to the vaccine, the patient will be free to leave. Should there be a severe reaction such as anaphylactic shock, the resuscitation module is set up where the patient can be managed.

The whole clinic is secured with fencing. Inside the clinic, there are two restricted areas where access is limited to staff only. A main service area is used to host the pharmacy and staff office / rest room. Another secure area is set up to host power generation and waste management.

Other modules can be added to the staff zone such as wash rooms and PPE storage.

The basic IT will consist of an internet connection such as 3G or satellite for remote areas. Secure Wi-Fi hotspots will be set up for the computers and if resources permit, public Wi-Fi can be used to provide patients with information. The software used to manage patient information will need to be determined locally in each country. Its likely to be a government system.

Clinical Waste Management
Waste from the clinic needs to be handle carefully and responsibly. Firstly items of PPE may need to be incinerated so that the risk of contamination is removed. The empty containers which held the vaccine must either be returned to a formal system to recycle the containers or they must be destroyed. The containers must not fall into public circulation as they may be used by criminal gangs to make money from fake vaccines.

Cold Chain
Vaccines must be stored in a medical standard fridge. The specific model of fridge will be determined by the sort of vaccine in use and its environment requirements. As part of the clinic design, there needs to be stable power available for the fridge with back-ups. If power fails, this might result in temperature levels rising which will destroy the vaccine.  The following design concept should be sufficient to mitigate this risk.

The power source will either come from the local grid or generator. An Inverter/Charger is provided and will charge batteries while power is available. Should the power fail, the battery will take over and power the fridge via the inverter. The battery bank will be sized to provide power for at least 24 hours. The Inverter/Charger has built in IOT technology and will send an alert to let management know that power has failed. (Note – core IT infrastructure will also be connected to the same back up power supply).

As a further protection, a smart temperature sensor can be added to the fridge to monitor temperature and send alerts when temperatures are close to becoming too high or too low.

This is a very high level design. There will be various clinical factors to be added. Other modifications may be needed to make the site accessible to disabled patients. This design is a good starting point for a team of experts to begin work.

Mobile World Congress 2018: Latest tech news from Barcelona

The Mobile World Congress is the annual gathering of the mobile phone industry each year in Barcelona. Some commentators (The Register and BBC Technology) have slammed the event as boring. For those who went to Barcelona with the intention to discover new smartphones, then yes, innovation is a little thin on the ground as most smartphones look similar and mostly Android based. 

But the mobile world is much more than smart phones. The Internet of Things (IOT) is a concept where mobile connectivity connects devices and services to the internet. MWC2018 was bursting with plenty of innovation this year. 

IOT is an evolving market and we will see plenty of innovation over the next few years which will be very useful to the aid sector. In this article we will explore a handful of solutions which may be useful to NGOs.

Mobile phone technology have evolved massively over the years. Whilst historically set up for  voice communications, the networks are getting more geared towards providing increasingly  faster data services. Future 5G technology will be able to exceed 100Mb/s. The current 3G and 4G technologies are delivering good services in many countries. In some developing countries,  traditional wired infrastructure does not exists and we are seeing a leapfrog affect where nations ignore building traditional copper infrastructure in favour of building reliable mobile networks.

In the years ahead, it’s likely that many NGO offices will be using major mobile network operators for office internet connectivity.  You might think this approach might be far in the future when 5G arrives. The reality is that good quality mobile internet is “here and now” as long as the right technology is used to access the networks. New multi-channel routers means that we can get more out of existing 3G and 4G networks simply by using multiple SIM cards simultaneously.









e-sim technology: When first introduced, the SIM card was the size of a credit card. The SIM was reduced to the mini format and then followed by micro sim and finally the nano sim. The electronic SIM (e-sim) is a new approach where a virtual SIM card is delivered to device electronically. This approach will make life easier for people who travel as they might in the future have a wallet of e-sims stored on their smartphones so that they can access the best rates and use local numbers in the countries where they are visiting.

E-sims have yet to find their way onto smartphones, but they have arrived already in some technologies such as the Telna GSM router. The router is fitted with four e-sim channels which means that 3G or 4G performance is quadrupled over single SIM technologies. The device is cloud managed which makes provisioning of services easy.

The four e-sims are loaded by Telna, but for organisations which have better rates with other providers who use traditional plastic SIM cards, they still can be used as the SIM cards can be sent to Telna where they are then applied to the device in e-format.

The Telna system could be a suitable option to many NGO field sites as it gives organisations the flexible technology needed to switch providers easily in a rapidly changing market. Reliability can also be improved as different networks can be applied to the four available channels.

This technology is going to be applied to Save the Children emergency response pre-positioned equipment. Traditionally satellite technology such as BGAN and  VSAT has been used in emergency settings, but as we learnt in some parts of the Caribbean in 2017, GSM networks have improved their resilience and come back online quickly. So how much does this technology cost?  The router is $999 and data costs $25 per GB. When compared to some packages in developed countries, this might appear pricy, by when compared to a 5Mb/sec VSAT connection which costs $5,000 per month (maximum throughput of 25GB), the 3G router would only cost $625 to deliver the same volume of data.

One other innovation from Telna is the sticky sim – this is a sticker which goes onto a standard SIM card turning the existing SIM card into a dual SIM.











AT&T: As a global brand, AT&T has some IOT products in the market.  AT&T recently  signed global agreement with Caterpillar (Makers of engines, generators and construction equipment) to use GSM networks to monitor the performance of assets. For NGOs, this IOT offering could be a great way to monitor the health and fuel performance of generators.

AT&T is also working on a range of technologies to support healthcare. Telemedicine technology is available to carry out basic checks such as heart rate / blood pressure and even to analyse saliva for certain indicators. This information can allow qualified doctors in remote locations to diagnose conditions and prescribe medicines.

The transport of Vaccines is also a challenge in hot countries,  the tech flask (in the picture) has the ability to monitor location and temperature of its contents whilst in transit. This gives the confidence to medics that the vaccine is safe and have arrived in good condition.
















WMC2018 is all about terrestrial solutions…, right?  Well amongst the hundreds of 3G tech companies I was surprised to see Eutelsat pushing its latest spin off company Konnect.  Over the past two years or more, Eutelsat has been very vocal about its future VSAT offering (Ka Band). The new satellite internet technology is targeted at the domestic market and aims to go head to dead with other internet providers, especially in rural settings.

With the roll out of fibre across Africa, Satellite based internet could be regarded as a shrinking market. But when you look at the number of physical cables connecting Africa to the rest of the world, it is clear that there is a finite amount of capacity which may be problematic to the various companies emerging to supply internet based services. More sea cables will improve the situation, but in the meantime, the Eutesat/Konnect offer might add some value, especially to rural communities.

Konnect services are not available commercially yet. Trials are planned in Kenya and some other countries in the next few months. At WMC2018, Konnect was showing off a rugged unit which incorporates VSAT, Wi-Fi and a content server. This technology would be a great system to use in a rural school as some content can be loaded onto the box for education (and not rely on live internet). This system is also designed to manage a power feed from a solar energy system.

Conclusion: Whilst the World Mobile Congress lacked breakthroughs in new smartphones (Apple and Google tend to launch products at times of their own choosing), there was a great deal of innovation on display which leavers the benefits of a connected world via GSM. Shengen is regarded as the Silicon Valley of China. Lots of innovators from Shengen were at MWC2018 showcasing a lot of technology. IOT is going to be the new buzzword over the next couple of years. The MWC forum is an area for NGOs should watch as this is where we will be able to identify excellent tools to help our humanitarian community delver technology enabled programmes.

Using ICT to deliver education

Previously, I have explained how advances in solar energy and future budget satellite broadband will be an enabler for educating children. In this article, we will take a closer look at how technology can be used to deliver educational content to children in various settings. Please read on to learn more about the technology, the settings in which the delivery of education needs to be prioritised and finally how the technologist needs to work closely with the educationalist to create value for money ways of delivering educational content.  

The Technology
Technologist have been accused of inventing solutions and then imposing them on a particular setting. This often leads to failure which leads to a lack of confidence in the  IT sector – we can turn this around. Successful projects will start with conversations between the education stakeholders and technical experts who can then seek out the best technical solution to deliver education. The way in which educational content can be delivered is numerous, here are some popular examples: 

·         Individual learning through the use of online applications, tablets and smartphones.
·         Teacher lead tuition in a classroom environment (sometimes with very large class sizes).
·         Supervised learning in a controlled environment.

From a technology point of view, a programme based on teacher-led education will be the cheapest to deploy as a small number of computers will be needed, perhaps just one. This approach also keeps the costs of supporting services such as power supplies and internet connections to a minimum. Using the technology, teachers are enabled to present content to larger class sizes. Outside of class time, teachers will be able to access the equipment to help them to keep their skills up to date and perhaps to learn new subjects to teach? The chief challenge to this approach is to make sure that there are sufficient good teachers in the first place. This can be a massive challenge for some countries where quality teacher development programmes are either poor quality or non-existent.

So how do we provide education to children in the communities where there are no teachers? This is where technology can bridge the gap, but its more expensive. Technologies exists which enables teachers to run classes from remote locations. Some software houses have developed solutions where student computers are linked to the teachers computer.

The teacher has full control over the student computers so that formal learning can be conducted. Using the control buttons, the teacher has the ability to launch specific education content either for the whole class or on a student by student basis. There is also a function which blanks the students computer screen displaying the text “Pay attention to the teacher”.

Via remote links, qualified teachers can run classes to a larger audience over many sites simultaneously. Local supervisors are present at each site to facilitate the students. In an off grid setting, the same technology can be used by classroom supervisors to run some of the pre-loaded lessons.

Looking more closely at self-paced online learning, there are hundreds of providers in the market like Cornerstone who have built up Learning Management Systems for a wide range of topics. Much of this online training has its roots into workplace training for compliance topics such as health and safety. But if a google search is made for LMS which work in an online/offline environment, choices are more restricted. Choices become further reduced when there is a requirement for multiple platforms (Microsoft, Apple and Android).

The purpose of LMS is to serve up training and to monitor the students’ progress. This can lead to a course completion certificate or qualification once the module is complete.

So – what about offline self-paced learning? One of the revolutionary products emerging is the Actionable Data Book (ADP) is an advance on the e-book approach as it contains word search, video and interactive content. Where it differs from the e-book is that the ADP standard is non-proprietary which means that as an IEEE standard which takes a different approach from the propriety systems like Nook or Kindle. The ADP format is a standard which will run on systems regardless of brand.

Context driven solutions
Taking a step back from the technology, let’s look at examples of contexts which education is delivered and some of the associated challenges: 

  • Refugees/IDPs: Figures from the UNHCR (May 2017) states that there are over 65 million forcibly displaced people worldwide. Just over 21 million of these people are under the age of 18. Where populations are displaced, education is disrupted. The conflict in Syria is leading to a lost generation where a significant cohort of children will not receive education. The task to capture 21 children and provide education is enormous. Technology will have a major role to play in addressing the need. In settings where people have smartphones, some education tools can be distributed through apps. In some settings, distributing technology to children can place them at risk from mugging.
  • Disaster Preparedness: There are many communities who normally have access to education, but are at risk from natural disasters such as Cyclones, Tsunamis and Volcanic Eruptions. In such circumstances pre-positioned technology can be sent to places of shelter to set up classrooms so that children can continue education. Such preparedness plans could be aligned so that education delivered could be aligned to national curriculums (if they exists).Quite often such interventions are short term using quick deploy satellite communications systems such as the SpeedCast system used in Australia.


  • Rural: In developing countries, technology enabled education will have a very positive impact on a large rural population. Whilst Africa is mostly off grid in rural settings, the combination of sustainable solar energy solutions and the arrival of low cost internet access within the next two years is going to make the delivery of education easier in rural places. In developing technology aided educations is not going to be cheap. Future programme delivery must be sustainable. This means that it needs to incorporate an ongoing funding model, perhaps with some cost recovery, a reliable supply chain of contents, technical management to keep the technology working, and an element of M&E to capture the programmes impact on communities (leading to continuous improvement).

Education content
What do we teach the children using technology?  This is a question for the education experts to solve and clearly it will be context driven. In the emergency or refugee setting, there are basic life skills content covering topics on how to stay safe in the hostile environment. To deliver education using technology, it’s the educational content which needs to drive the project. Developers of such content should consider designing their solutions to work on as many technologies as possible. In India, the Vodafone Foundation is supporting the Social App Hub, This is a directory of education and life skills apps which have been reviewed and validated by experts.

So returning to our teacher/student example, the success in developing a via product is by ensuring that the solution used to deliver education is content agnostic. If its built in the Microsoft windows environment, we start to get the flexibility so that teachers can either launch pre-made content or even develop their own content using tools such as PowerPoint.

So, to conclude, Technology has the ability to improve education in a variety of settings. With the arrival of cheaper internet access just over the horizon, now might just be the right time to lobby donors for funding to run large scale programmes to educate the next generation.

Internet from Space: Behind the scenes

Each day, hundreds of NGOs and UN agencies access internet services which come from satellites in space. Generally these services are accessed by using large dishes at sites which are located in very remote locations. These dishes and their associated electronics are known as VSAT. Save the Children is operating 50 sites across Africa. Various UN agencies such as WFP and UNHCR operate hundreds of these system. Satellite based internet is very reliable if the right provider is selected. In this article, we are going to unveil the technology behind the scenes in Germany which make this vital service to remote locations so reliable.


Dishes, small and large
The technology deployed to remote field sites is fairly simple. Typically a system will consist of a dish which is 1.2m to 2.4m depending upon which satellite and frequency is used. Inside, there is a modem connected to the dish outside and it’s the modem which feeds internet access into the local office network. At the teleport things are complex, much more complex. Dishes are much larger as they need to connect to many remote stations via the satellite. There may be many large dishes at the teleport as larger organisations may use multiple satellites to reach wide area via multiple foot prints.

The largest teleport in Germany is at Raisting, close to Munich. This teleport used to be owned by Deutsche Telecom but sold on to EMC, a private operator who provides services to hundreds of UN sites. This site was opened in the 1960’s and its build quality is quite amazing.  Further North in Germany is the CETel teleport which is used by Speedcast to provide its service to the 50 sites operated by Save the Children International. The CETel teleport is much newer. Unlike the massive antennas in Raisting, CETel is using smaller lightweight antennas. 

Raisting history – Cold war and football
The first aerial was built on the site between 1962 and 1962. It was initially used to provide telephone links between the EU and the USA. The dish is housed inside a dome and is still in working order, sometimes used for educational scientific experiments. The Dome and its equipment is now set up as a museum.

Aerials located at the site were used as part of the secure hotline which linked the Whitehouse in the USA to the Kremlin in Russia (Formerly the USSR). Whilst a red telephone has been used in movies etc., the cold war hotline was never a red telephone. The link was initially a telex line. Later it was changed to Fax. These days, the link exists as secure email between the two presidents.

 In addition to voice communications this site has seen some historical broadcasts such as the Olympic games. More recently the FIFA world cup was broadcast to the world during 2006 from Raisting. 

red phonedome

How it all works
The teleport is a 24×7 operation which is providing essential communications links to VSAT sites across a huge area from the Atlantic Ocean to the Indian ocean. The clients range from the UN and NGO sites in remote locations to expensive superyachts and cruise liners at sea. This is serious business and a short break in service would cause a lot of inconvenience to many. In the case of some commercial operations such as oil exploration, the loss of internet access could lead to significant financial losses. On this basis, many teleports such as the ones operated by CETel and EMC have ensured that all possible points of failure have been covered.

Electricity is provided to the 20,000V site ring main by the local power company at Raisting. As a backup, there are a number of generators around the site which has the capability to deliver over 4,000 KW of power. This is enough energy to power a small town. Enough fuel is stored at the site to run the generators for a few weeks.

generorator ema tank

In the event of a power failure, generators can take a few minutes to start up. To bridge the power gap, a giant UPS system is in place to keep things running. Many of you will be familiar with the APC UPS which is a combined battery and inverter. The pictures below is also a UPS, but at an enormous scale. This UPS system is so massive that it takes up two floors. The inverter units are on the upper floor, and the batteries are in the bunker. The batteries shown below is just one bank of two in one room, there are other rooms with more batteries. The UPS has enough capacity to run the centre for up to 8 hours.
Other engine rooms exists to provide other essential services. In the picture below left, boilers are used to generate hot water which is feed to the antennas. Elements in the back of the dishes are heated by the hot water loops to prevent ice forming on the dishes. The heating is essential as the snow which forms at around 2 degrees (locally called “Sticky Snow”) can change the reflective shape of the dish, thus causing communications issues for the remote VSAT sites. Heating is really expensive so to ensure that not too much energy is used up, a very sophisticated monitoring system is in place to make sure that just enough energy is used to keep the dishes clear of snow and ice (Local monitoring panel shown in bottom right picture).
heat 1 heat 2

The power and the heating is just part of a much bigger system which connects the remote VSAT systems to the internet. We are now going to look at some the electronics;

idirect hubSignals from the dish will be routed via several systems to clean up the signal by reducing background interference. Space is a very noisy place and as the satellites are 36,000KM away, the signals will be weak, so need to be amplified. These signals will eventually arrive at a modulator / demodulator which is a device which turns internet data format into a form which can be transmitted through space.  

The picture to the left is the iDirect Hub, which is the technology used by Save the Children and other organizations for their VSAT. Other technologies such as NewTec and Hughes are also popular. These technologies are the demodulators and modulators and as you might expect, these hubs also support other tasks such as network monitoring so that technicians at the centre can check that are performing correctly.  

The hubs are kept in a data centre which is separate to the large dishes. It is here where Space meets the Internet. Signals arrive via fibre optic cables from the dishes and then linked to the internet via dark fibre to the internet. 
Some clients may host their own equipment within the teleport data centre.  

The massive aerials at Raisting are mounted on a multi-level building (Which also contains a toilet!). Fairly high up in the building is another electronics room full of racks which just deal with the radio frequency. The picture on the bottom left shows the units which convert the fibre transmitted information from the data centre. The middle picture is the up-converter which converts the signals into radio frequency, and finally the picture on the right is a power amp which makes the signal powerful enough to send to space.

Wigglyamps 1Wigglyamps 2Wigglyamps 3

From Large to Small!
Typically, VSAT stations used in the remote field sites are too large to carry in an emergency and can take time to set up. At the Raisting teleport, there is a team of engineers who design solutions for field use. The VSAT system shown below is designed to be split up into 5 cases. EMC have worked on the transport cases so that each one weighs less that 23KG which is the standard weight for each item of baggage allowed by most airlines.

Portable VSAT is really designed for short term use such as for emergency responses. It’s during a major crisis where responders will need access to the internet so that they can coordinate activities. Initially, even more portable internet solutions such as BGAN will provide instant internet access from a device which is smaller than a laptop, however at $5 per Mb, BGAN is expensive to run, which is why a portable VSAT needs to be flown in shortly after a response has been launched.

fly 1 fly 2

Where organizations have long term operations at remote sites, or short term projects following a disaster, it is important that people working in remote and disconnected locations are provided with a reliable connection. VSAT providers such as EMC, Speedcast, Eutelsat, Castell, AST, NSSL and many more all have reliable teleports. They build in plenty of redundancy such as multiple power suppliers, multiple internet links and even a spare standby dish which can be trained on a satellite if the normal dish fails. I have visited three of these teleports over the years, all operated by different organizations. One thing which is common to all of them is the people. They are highly trained, experienced and committed. Above all, they really enjoy doing their job in the data centre. It’s the quality of the people and technology combined which helps us stay connected with very little downtime at all.