[OLPC library] Example Health/Education hybrid hypothetical project

[Josh Hehner]

Case Study:

Example Health/Education hybrid project -
Extending OLPC an educational roll-out into the health field

or

How I would use the XOs in a hypothetical dream project


The setting is las Comunidades Campsinas de Fernandez y Barrancos,  
located about a half-hour up the river valley from Mancora, on Peru's  
north coast. Spread out among dry, rolling hills are a number of  
families living in shacks, peasants and farmers, their dusty fields  
and goat pens. There is a two-room schoolhouse, a church, and a small  
outpost of the Ministry of Health. Water is collected from a communal  
spigot, or the river itself when its riverbed is not dry. There are  
no phone lines, electricity comes only to a water pumping station  
nearby, not to any homes in the village.


Distribution

The dream goes like this:

OLPC rolls out broad distribution of XOs to every school-aged child  
in the region. This is supported by supplementary XOs being  
distributed to local teachers and those required to tie them in to a  
larger educational and support network.

In the health project they are also distributed to those identified  
as potential Health Promoters: community health workers, moms,  
elders, healers, leaders within community institutions, those who may  
already be serving in informal health caring rolls, who want to  
participate in supporting the health of their community and who are  
attracted by the opportunity to learn more.

XOs also go to an interdisciplinary health team which is formed,  
consisting of paramedicals (more advanced First Aiders, Paramedics,  
nurses, midwives, etc...) along with a small team of regionally-based  
doctors and specialists (they get XOs too if they lack their own  
computer technology that's adequate enough to participate).


Training

A training program consisting of workshops, help sessions and ongoing  
training is developed specifically for the health team. They meet for  
didactic sessions but also work on a number of practice scenarios.  
Plans are made for Continuing Medical Education. Training topics  
include both the technical aspects of using the XO, as well as  
capacity building for Health Promoters & paramedicals.
[edit] Infrastructure

We put in the support infrastructure required to help the project  
survive and grow. These include institutional partnerships and  
commitments from community groups, our NGO as well as the Ministry of  
Health. They commit resources and personnel, agree to schedules, make  
themselves available on-call for the medical system as well as for  
overseeing Base Hospital certification programs.

The physical infrastructure to enable connectivity to the OLPC  
project is put in place, perhaps cheap repeaters on the hilltops or  
IP over power lines. These link us to our Base Hospital group in  
Mancora on the coast (located on the PanAmerican highway, and  
therefor accessible to Peru's network backbone).

Training & technical support structures are put in place, equipment  
is tested, backup equipment stocks maintained.


Activities

Scenarios depicting the possibilities in a variety of areas:

Prevention

Materials are distributed via the network and worked into educational  
curriculum on important relevant topics such as sanitation & hygiene,  
dehydration, Dengue fever & mosquito control, etc...

Health Promoters are also able to circulate with patient education  
materials, working directly with families and community members  
teaching and discussing these topics.

Children and youth find materials on healthy living, diet, exercise,  
lifestyle choices, sexual health, etc..., perhaps materials that  
engage them in activities rather than simply presenting static  
information.

Assessment

Juanita's little brother has developed a stomach ache and seems to  
have little appetite. She logs on to her XO, and though she looked  
through some of the self-diagnostic health materials, she's been  
taught to recognize times when medical assistance might be necessary.  
With her XO, she is able to identify and contact the current on-call  
Health Promoter, who this evening happens to be Snr. Caballo, primary  
school teacher. Via videoconference, she is able to explain what is  
going on, and to answer some questions about her brother's recent  
symptoms. Snr. Caballo is able to determine that her brother's  
symptoms aren't grave, and works through the Rehydration Fluid  
educational materials with Juanita and her mom. He tells them to call  
back if anything worsens, and stops by in the morning to check on them.

Pilar the obstetrician circulates to visit several expectant mothers  
in her area. She enters documentation about her home visits into her  
XO and works with the midwife so that she can be summoned when labour  
begins. She also uses the device for presenting healthy mom & new  
baby educational materials, and for reviewing childbirth standing  
orders with the midwife.

Chico and his mother have been caring for Chico's grandfather who is  
diabetic. One evening he gets back after trucking sacks of yucca out  
to the coast and seems especially lethargic. They decide to contact  
one of the town Health Promoters, who immediately notifies the on- 
call paramedic. They arrive at Chico's house and follow standing  
orders to test abuelito's blood sugar and provide symptom relief  
(cookies and juice). The leave behind a glucometry peripheral, teach  
monitoring, and point the family towards the diabetic patient  
education materials, which include signs & symptoms, diet & exercise  
info., and a blood-sugar logging activity (shared to the health  
network).

Intervention

Jorge buries a machete in his thigh while felling an algarroba tree.  
His eldest daughter, Maria Gracia, hears his cries from the campo  
next to their hut, and runs for her XO. She contacts Emergency  
Medical Dispatch, and within seconds is communicating with the on- 
call Paramedic. She is shown via videoconference how to control the  
bleeding, while a tuktuk cum ambulance is dispatched. The regional  
doctor is also brought online to assess the damage, but is able to  
determine that cleaning and a line of stitches are all that are  
required. The emergency team arrives and a nurse dresses the injury.  
They also order antibiotics through the medical network, which  
automatically notifies the pharmacy and tasks a health promoter with  
brining them by that evening.

While using the Distance activity to measure the rising water level  
in their flood plain / river valley, Jordano's friend Antony falls in  
swept from the edge. By the time he is pulled out he is not  
breathing. Jordano uses his XO to videoconference with the on-call  
Emergency Medical Dispatcher. While engaging First Responders, the  
EMD coaches Jordano in CPR, watching and encouraging his efforts,  
popping helpful graphics up on the screen when an instruction is not  
clear. Their efforts keep Antony viable until a health promoter can  
bring the town's Public Access Defibrillator over, and Antony is  
revived. Using Jordano's XO's GPS coordinates the response team  
rapidly finds them and begins transporting Antony out to the Ministry  
of Health Outpost on the coast, and, via teleconference while en- 
route, the on-call Doctor works with the emergency medical team,  
reading vital signs via telemetry and providing patch medical orders.

Base hospital

Fernando participates in his family's annual check-up this year, and  
for once they don't have to spend a weeks wages transporting the  
family to the regional health outpost, and he's interested in being  
trained as a Health Promoter. The community's nurse helps assess the  
family while directed by the doctor, and enters their medical details  
in the secure database.

Community health volunteer Yolanda is completing her servicio rural  
during her medical school, and is doing home visits in the community.  
She provide relevant patient education materials and schedules  
consultations with her colleagues at the Base Hospital. While  
visiting the Lama family, some of the family member complain about  
nagging coughs. A family member has recently returned to the village  
after working in a poor neighborhood in the capital. The base  
hospital Doctors are able to assess the family using Yolanda's help  
and telemetry equipment. They schedule an appointment for  
teleconsultation with the local TB specialist, and order lab tests  
which a paramedical swings by to administer. A course of therapy is  
established, medication distributed and its consumption directly  
observed (DOTS-Plus) via videoconference.

Public health

Edith circulates from house to house as part of the Ministry of  
Health's mosquito eradication and Dengue control program. She uses  
her XO to document what she finds including being able to photograph  
the state of water storage, basins and collective spigots.  
Presentations running on her XO and shared with the family's machines  
help her explain the goverment program, Dengue's vector and the need  
for larvicide packets and well-covered cisterns. She is also able to  
geotag her findings, localizing them despite an absence of landmarks,  
street names or numbers, and plot public health findings on a map.  
Later that summer when there is a Dengue outbreak, the data gathered  
reveals a cluster centered on an abandoned well, and the problem is  
quickly dealt with. 
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