Category: Services to affected communities

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

markhawkins connectivity, Covid-19, Infrastructure, Services to affected communities

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.

ICT
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.

Conclusion
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.

Using technology to influence communities

markhawkins Education, Services to affected communities Leave a comment

In the UK, for many years, the Government have tried many methods to influence the behaviour of the population for their own good. We know that smoking is bad for us, but its legal. So to discourage smoking, the government places high taxes on tobacco to discourage smoking. On the roads, the wearing of seatbelts in cars or helmets for motor cyclists are mandatory as part of an effort to reduce road deaths. The trouble is that whilst governments want to do things which are to the benefit of citizens, they are often accused of being the “nanny state” if they use too much carrot and not enough stick.  

Softer methods are being tried to influence behaviours in the UK. The government  formed the “Nudge Unit” to explore ways where behaviours in the population can be changed for the benefit of all. The unit uses social media amongst other tools to promote behaviours such as going to the doctor for check-ups are certain times in our lives. This would include campaigns such as breast cancer screening or blood pressure checks for folks of a certain age.  

There are endless reasons why a government may wish to nudge people to do things for their own good. In developed countries, governments will use radio, TV, social media, newspapers and other channels to influence behaviour. But in the developing nations of the Global South, how can governments and NGOs influence the population which a significant number of people might be illiterate, or lack access to infrastructure and technology?  In this article, I want to shine a spotlight on an organisation called Literacy Bridge. They have a very innovative approach to message rural population and a way to measure how successful their approach has been.  

For many years, health NGOs and UN agencies have delivered programmes which improves the health of the nation. Malaria is one of the biggest killers. We know that we can reduce malaria infections through programmes to distribute bed nets. But how do we get the population to use the nets properly and to refresh the insecticide in the nets? How can we promote other health related topics such as breast feeding, routine vaccinations, and other important messages? 

Social media does have a role to play alongside radio and TV broadcasts, but it will exclude a significant percentage of rural communities as many people do not have access to a smartphone. Where smartphones exists, they are mainly used by men which means that some messages targeted at women will not be passed on.

Literacy Bridge  is using technology to get messages to rural communities in a very innovative way. Their talking book is a robust unit built by ARM, a leading edge technology manufacturer which was spun off by the University of Cambridge in the UK. The talking book has a series of pre-recorded messages stored on a memory card which can be played by members of the community where the technology is distributed. The memory card is sufficiently large enough to allow families to record feedback for programme managers to collect.  

Each unit has a unique ID and its location is registered when it is handed over to the community. Whilst it is deployed, in addition to the recoded feedback, the system also logs what messages were played and how often. Over a period of time, project teams will visit the communities to collect the data and to replace the existing content with new messages. This exchange of messages and data can be done using an application on a smartphone.

The talking book runs on standard batteries. In communities where batteries are hard to source, project teams can supply rechargeable batteries with a solar charger.  

Literacy Bridge is a “Not for Profit” and is very keen that its product is reliable and has a very positive impact on the communities where messages are being delivered. Their approach is to partner with organisations to deliver messaging as part of a wider campaign. They are driven by success and have worked with organisations such as Care and UNICEF.  

To deliver reliable and sustainable technology, they do not sell talking books. They use a leasing model through local partners who will ensure that the units are supported in country.  

The quality of content is very important to Literacy Bridge.  They want messages to be accurate, and appropriate to the communities where the technology is being used. The content will be in local dialects and may take the form of interviews with senior role models, songs and plays.  

So, what does success look like?  Well in 2013, Literacy Bridge was running a programme in partnership with UNICEF in Ghana’s Jirapa District in the Upper West Region. They reached 44,000 people in 49 communities. The feedback demonstrated that 50% of pregnant women and children were more likely to sleep under bed nets when using talking books.   

Conclusion: The Literacy Bridge approach  can be regarded as ICT4D. Within the SCI IT team, we like to call it “Technology for Programmes (T4P)” as we feel that simple practical solutions to real problems is the way forward to alleviate suffering now. In the wider ICT4D community, there are people looking at artificial intelligence and big data. I am sure that the big conferences which promote these big ideas as an academic exercise will deliver something amazing in the near future. However whilst academia works hard to ask the big questions on how we can use big data for the greater good, at the same time, we need to stay focused on identifying simple and sustainable innovation which can have an instant impact on communities today.  

For more information, please visit www.literacybridge.org.

Digital aid for refugees

markhawkins Emergency Response, Services to affected communities, Uncategorized Leave a comment

For many years, IT and telecoms have had a very important role to play in most humanitarian responses. The main focus has been to provide reliable communications and connectivity to aid workers who are responding to a crisis. Organisations such as the Emergency Telecoms Cluster (ETC) exist to provide the telecoms and connectivity which emergency responders rely on. In a crisis, it has been recognised that not only aid workers need access to the internet, the wider affected population also needs to access the internet as well. Organisations are starting to provide services to affected populations already. This year, the ETC have fully embraced the concept into its ETC2020 strategy and have established a new working group consisting of Save the Children, Nethope and the CDAC Network. This new workgroup is exploring how we can deliver connectivity to the affected populations.

As the ETC working group is holding meetings to discuss what the “services to affected communities” will look like, Nethope (an IT membership body run by over 25 NGOs) is already on the ground making a difference. In this article, we will explore what is being done to provide connectivity and some of the challenges we face

The Syrian crisis has led to many people being displaced in Europe. More than 11 million people have been displaced which makes this situation the largest mass movement of population since world war 2. More than 4 million people have fled the country completely. Each day, refugees by the hundreds to thousands are on the move. Until a few years ago, Syrians lived in cities which had reliable infrastructure and plenty of internet connectivity. This mobilised population of refugees are educated, and some have money. It has been reported that the three questions asked when a refugee lands are:  1) Where am I? (They are wanting confirmation that they have reached the safety of the EU), 2) How can they get access to the internet and 3) where can they buy food.

GSM mastWithin the wider humanitarian community, the concept of providing connectivity to refugees is being regarded almost with the same importance as food, water and shelter. Reliable internet access is an enabler as organisations are starting to use cash voucher systems over mobile networks to deliver aid. The monitoring and evaluation specialist use mobile technologies to get feedback from affected populations about the aid they received. GSM masts are being set up in and around some of the world’s largest refugee camps where people will be living for long periods of time. At the recent humanitarian summit in Geneva, UNHCR stated that across all camos, the average length of stay is 17 years. With such vast numbers of people staying in these camps for long periods, its easy to understand why the major network operators are keen to get coverage to the camp. It has been said that the Safricom GSM mast in the Dadaab camp has the second highest amount of financial transactions each day via its MPESA system.

Connectivity is not where it ends, it’s what we do with that connectivity which is really important. Information is power and if we can get the correct sort of information to the people who needs it, then there is an opportunity to disrupt established practices for the betterment of all. One example of this disruption is where farmers in remote villages have been linked to market prices in the cities far away. This information has enabled the farmers to negotiate better prices from the middlemen who moves the produce to market. This has had a very positive impact on some remote communities.

 So whilst there are plenty of examples of technology making a difference in places where things are more settled, there is also a need to provide connectivity to people in the time of crisis. This needs to be done from the get-go. For example following an earthquake in an urban setting, alongside medical and rescue people, the telecoms engineer is also an emergency responder. Bringing mobile networks back online is essential as it means that people who are entrapped will be able to call for help using a mobile phone. There is some solid data from Haiti to support this.

Returning to the Syrian Crisis, connectivity is needed for a mobile population. Organisations like the Nethope are responding and have plans to establish a line of internet hotspots along the migration routes in Europe. The main networks have gaps, or where there is coverage, the network is not robust enough to deal with the vast number of users trying to connect. Nethope and its members are working towards a solution which will make a difference.

nethope

The programme Nethope is running is very thoughtful as they are not just creating hotspots, they have thought through how the connectivity will be used.

Cyber security is the top priority. Alongside the physical war, a cyber war is also being waged. The population is running away from danger and may still have families inside of Syria. On this basis, networks need to be secure so that no information can leak out which could place relatives who remain in Syria in danger. There has already been reports of murders following information gained through a Skype spoofing act. Nethope are co-opting some of the best brains from Cisco to make its network secure.

  • Mobile smartphones need power, so Nethope will set up charging stations at every site where a hotspot is set up.
  • Information is needed so that refugees can find out where they can access services such as health care, shelter and so on.
  • Children are not being educated, so there is a plan to develop and roll out an education app which can be accessed at all points along the migration route.

 

All of this costs money and Nethope has launched an appeal. More information about this project can be found online at www.nethope.org.

Conclusion
It is clear that telecoms and IT have a major role to play now in humanitarian response. It is now important that during any emergency response that senior telecoms/IT people are brought into the response senior leadership teams as IT and communications is starting to touch everything we do. The techies have a lot to offer any emergency response and should not be regarded as “the geek who just fixes computers”.