Starting tomorrow I am going to go “off the grid” until mid to late September, no (or at least very little) computer use, email or blogging. Tomorrow we will all be getting together. With Jaspal back from Mongolia this week, Ben back from Uganda this month, Mahad back from Jordan and South Africa it is going to be great to link up with them this weekend near Niagara Falls. After a few weeks I’ll be back at it.

In the meantime I will leave you with a few links and a few other blogs to check out:

1. Safe sex ring tone sings ‘Condom, condom!’, link
2. From Indian IT Tycoon, Health Care for the Poor, link
3. Want to raise $2500 in 90 minutes? link

There are many blogs to read, here are a three that are new to me over the last few months:

- UN Dispatch
- PSI Behavior Change Blog
- Vanessa’s public health musings

And my longstanding favorites are of course AIDG and NextBillion.

1. Microsoft is funding research in Argentina and India into low-cost electrocardiogram (ECG) machines. The devices, which can cost less than $100, use cell phones to transmit data to a computer, where it can be analyzed and then conveyed to a doctor.

2. Using Rubinsky’s gear, a doctor could use a cell-phone screen to view a cross section of tissue. In this image, a doctor uses a cell phone to magnify a patient’s breast tissue and examine it for a tumor.
SOURCE: Business Week

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This is our third post on mobile phones and international/global health (post 1, post 2). This post is largely imcomplete, but I wanted to get it up. The above pics and quotes below are based on a feature in Business Week:

“It’s not easy to lug an ultrasound machine into a remote village’s health clinic—much less keep it running. But a cell phone? No problem…”

“According to the World Health Organization, about half of the imaging equipment sent to developing countries goes unused because local technicians aren’t trained to operate it or lack the necessary spare parts. So researchers are stepping up efforts to employ wireless technologies to deliver crucial medical services, particularly in underserved areas…Scientists from the University of California, Berkeley, have just developed a prototype technology that uses cell phones to deliver imaging information to doctors.”

“The University of California professor says that by reducing a complex electromagnetic imaging machine to a portable electromagnetic scanner that can work in tandem with a regular cell phone and a computer, he has essentially replicated a $10,000 piece of equipment for just hundreds of dollars.”

Another source – Imaging technology could be useful in poor countries:
Some types of medical imaging could become cheaper and more accessible to millions of people in the developing world if an innovative concept developed by an engineer at the Hebrew University of Jerusalem fulfils its promise. The device uses cellular phone technology to transmit magnetic resonance images, computed tomograms, and ultrasound scans (PLoS One 2008;3:e2075; doi: 10.1371/journal.pone.0002075)

One other recent article in this area, from PC World -
Mobile Phones and the Digital Divide: Whether you’re building an application for the 3G iPhone in the United States or trying to figure out how to deliver health information via SMS (Short Message Service) to a rural community in Botswana, the mobile space is diverse and exciting in equal measure.

Also be sure to check out:
- Why people seek out health information, link

More from our leadership and management folks over at MSH. By Sylvia Vriesendorp:

Leading and managing is not just about doing things differently by intentionally using the practices that we have identified for managing and leading. There is also a ‘being’ element involved. One of the things we have discovered as we implement our programs that shifts are taking place in the way people are and in their perspective on their work. We have called these “leader shifts.’

We have observed five shifts:
1. A shift from a focus on the lone heroic leader who will save us and solve our problems to the power of collaborative action that is fueled by commitment and a personal stake in success.

2. A shift from pessimism, despair and cynicism to a sense of hope, possibility and optimism.

3. A shift from blaming others to identifying challenges and taking personal responsibility to tackle them, one at a time.

4. A shift from intense busy-ness and multiple streams of activities by different groups and people that do not add up to significant positive change to coherent action by multiple parties that is driven by a shared purpose.

5. A shift from a focus on self and one’s own comfort and well-being to generosity and a concern for the greater good.

These shifts are not permanent, once made. Each time we find ourselves in a corner or a bad place, we tend to shift back to the left side: waiting for someone to save us, pessimism, blaming others or other things for our situation, incoherent action, if any and a focus on our own needs. It takes awareness and focus to shift back to the right column.

So a critical question in enabling and developing leadership is what tools might be available to do so. One are we have explored is support in a virtual space, as such we can reframe the question to this – Can we develop leadership in virtual space?
Read the rest of this entry »

I am fascinated by “alternate” modes of thinking, being and doing. This op-ed in the NY Times about interviews they conducted with people after the massive earthquake in China this summer is a perfect example of this. It is a short read, I encourage you to check it out.

Where’s the Trauma and the Grief? NY Times August 2008
“Three months ago, an earthquake struck China’s Sichuan Province, killing nearly 70,000 people…To my eyes, this part of the region looks forlorn. Houses and stores have been reduced to empty shells. Piles of rubble line the streets…”

“I asked if people in the village have suffered any psychological aftershocks from the trauma. Another villager, Tan Fubian, piped up and said that they just try not to think about it. These were weird, unnerving interviews, and I don’t pretend to understand what’s going on in the minds of people who have suffered such blows and remained so optimistic. All I can imagine is that the history of this province has given these people a stripped-down, pragmatic mentality: Move on or go crazy. Don’t dwell. Look to the positive. Fix what needs fixing. Work together.”

“I don’t know if it’s emotionally sustainable or even healthy, but it raises at least one interesting question. When you compare these people to the emotional Sturm und Drang over lesser things on reality TV, you do wonder if we Americans are a nation of whiners.”

By Sept 1 Please vote for AIDG (Appropriate Infrastructure Development Group) to help them get $500K, only 9 days left! I have great respect for the folks over there and what they are doing. Click on the image below for more information. Here is the AIDG blog and here is a short description of their project is below. Your vote can help push them to the next round:

Description
“Half the world lives on less than $2 a day, but there are few products made for them other than by charity NGOs and universities. Look around yourself. Much of what you will see was made and marketed by a major corporation. I want to bring together experts in development engineering to help corporations create products that will alleviate poverty for people in developing countries. The right products can bring clean water, save weeks of labor, and help the poor lift themselves out of poverty.”

We previously mentioned the malaria ad sponsored by ExxonMobil during the Olympics. I have seen this several times now during coverage and said in the original post:

“with regard to ExxonMobil’s commercial on Malaria during prime time, when over 1 Billion people were watching, this might have been the largest audience ever for a global health ad.”

I realized after I said this that I probably made a major miscalculation. The NBC channel broadcast I have been watching is only produced for an American audience. The top estimates I have seen for viewership at a given time hit 66 million people. So while Exxon may have had their ad broadcast across countries and major national networks, it is likely that somewhere between tens and hundreds of millions of people saw their commercial – which is still an impressive number. Thanks to Responsible China I found the youtube version of this ad, which is below. In addition I have also seen GE’s portable re-designed low cost EKG machine advertised several times as well. Despite what you may think about these companies it is better than nothing to see MNC’s promoting social causes. We blogged about the EKG machine previously and the commercial is the first one below, followed by the malaria ad. For another check, definitely check out ResponsibleChina.

[youtube=http://www.youtube.com/watch?v=yB47wx-b6sY]

[youtube=http://www.youtube.com/watch?v=s7qVlbG1i7A]

ProMED – mail is a global electronic reporting system for emerging infections. It was created over a decade ago when personal email was new and the list-serv was the latest word.  The virtues of  ProMED is that it is fast, low-tech, egalitarian, bottom-up, open and transparent.  It is modern disease surveillance that delivers facts to those who need to know.  It began, according to current editor, Larry Madoff, MD, as an idea “Wouldn’t it be great if people who had access to the Internet in far-flung places, and were seeing something unusual, could send an email to this list?  We wouldn’t have to wait for a public health laboratory to notify the Under Minister of ..Health, who would notify the Minister, who would notify the World Health Organization.  We would all know at once.”  Email messages to the list are selected into a few posts each day, which are moderated and commented on by a panel of experts and then sent around the world.

Don’t underestimate simplicity – ProMED alerted the world to the SARS epidemic.

Safety Net – by Madeline Drexler
On February 9, 2003, Catherine Strommen, an elementary school teacher in California, took one last look at her favorite chat room, Teachers.net, before going to bed.  One of the posts came from China, from “Ben” who described an illness that began like a cold, but killed people in days.  Several people he knew had died, and hospital doors were locked.

Alarmed, Strommen emailed an old neighbor and friend, Stephen Cunnion, MD, a retired Navy physician and epidemiologist who now lived in Maryland.  A practical, no-nonsense man, Cunnion started searching the web.  With no success, he tried a new tack – sending an email to ProMED-mail.  After quoting Strommen’s missive, he asked: “Does anyone know anything about this problem?”

The tiny ProMED staff conducted its own web search.  It, too, came up empty handed.  On February 10, it sent out to tens of thousands of subscribers a posting headed: “PNEUMONIA – CHINA (GUANGDONG): Request for Information.”

Thus did the world first learn of SARS, the new and deadly infection that had begun in November 2002, and would kill 774 people and infect 8,000 in 27 countries.  The next day the World Health Organization issued a belated bulletin on the raging epidemic…

Read more of Madeline Drexler’s article here.

Now we’re in the age of H5N1, and as of Monday, ProMED-mail has decided to report suspect human cases of H5N1 from Indonesia.

Here are a few excerpts from the many responses from readers:

******
I write in support of reporting H5N1 cases, even if unconfirmed by
the relevant authorities. The best example of [the benefit of] such a
policy is that of SARS [severe acute respiratory syndrome], which was picked up by ProMED-mail before official acknowledgement, and which many believe played a significant role in the subsequent efforts leading to its containment. Further, as a matter of consistency, ProMED-mail does not wait for official word before reporting on any of many other outbreaks elsewhere in the world.
- –
Henry Huang
Dept. of Molecular Microbiology
Washington U. School of Medicine
St Louis, MO, USA

******
If ProMED-mail continues this policy of not reporting suspect cases
of infectious disease when a country is in flagrant violation of the
IHR (and basic common sense public health), then ProMED will be of
little use. Such a policy merely encourages other miscreants to do the same.

- –
Len Peruski, PhD
Associate Professor (Adjunct)
Microbiology and Immunology
Indiana University School of Medicine, Northwest Center
USA

******
The last thing we need is to play ostrich and delaying tactics games
with HPAI [highly pathogenic avian influenza] outbreaks in any part
of the world. Experts should be trusted with enough pre-confirmatory judgment to alert cases of suspected HPAI, rather than play a waiting game that could cost the world millions of lives if we fail to prepare and take precautionary actions. Waiting games could be costly. A report indicating a new strain of HPAI in Nigeria is worrying enough, but not galvanizing steps to stop or slow down the spread of the virus anywhere in the world is like sitting on an atomic bomb waiting for the right trigger.

- –
Babatunde Bello
PATRA CONSULT
Lagos, Nigeria

******
I was so disappointed in your recent decision on suspect bird flu
cases in Indonesia. We are not getting any valuable information from Indonesia and very, very little from [elsewhere]. ProMED-mail has always been an excellent source of news on disease outbreaks, and you have always marked them as suspect until confirmation, so why do you want to treat something as deadly as the H5N1 virus any differently?
I ask you to reconsider your decision. It is the RIGHT thing to do.

- –
Carol Owens

******
In my opinion you are definitely NOT creating alarm and despondency.  Suspected cases are, as a rule, looked up and followed by experienced ProMED ‘watchers’ who can weigh the information and be alert if necessary. Being alert is quite different from being alarmed. The disclaimer of ProMED-mail is clear enough about the intent to be as truthful as possible, and holding the reader responsible and implicitly capable of taking the risk resulting from reading the posts.

I am in favor of ProMED-mail posting on all known and suspected cases of human H5N1 or other types of human ‘bird’ flu.

- –
Dr. T. Veenema
Nieuwegein
The Netherlands

And now, the official decision from ProMED moderators:

ProMED’s motive in seeking to screen out unsubstantiated reports of suspected human cases of H5N1 avian influenza from Indonesia was simply to avoid creating alarm and despondency.

ProMED-mail has now decided to report all suspected human cases of H5N1 from Indonesia because the usual flow of information – first suspect and then confirmation — is disrupted there because of their public health policy.

In countries where the standard flow is working properly, it is counterproductive to report suspects because many of them will not be confirmed as positive, thereby causing undue alarm. Over time, this could have the effect of “crying wolf” (repeated false alarms leading to a true alarm being ignored).

ProMED – mail is an effort of the International Society of Infectious Diseases

This just in: Groundswell Awards has added a new category for “Social Impact”, where social technologies improve society. Nominations are due by September 1, so get yours in soon! See this post for guidelines.

From the Groundswell Blog, Charlene Li writes:
First, while social technologies are clearly having an impact on the way people communicate and work with each other, as well as how businesses operate, it’s also having a profound impact on our civic and social involvement — just witness the investment political candidates are making in social technologies.

Second, the press and buzz frequently point out the more nefarious sides of social technologies, such as online stalkers on social networking sites, or potential privacy violations of services like Google Street View. While valid concerns, I’d like attention also to focus on the unsung examples where social technologies can do good.

Winners get a free ticket to Forrester’s Consumer Forum, a fantastic event in Chicago October 11 and 12, where they will be recognized for excellence. This is your chance to strut your stuff!We hope this award category will inspire others to develop technologies that solve pressing societal problems. One of the biggest problems I see happening is technology being developed in a vacuum, rather than developed to solve a specific problem. Nico MacDonald put it well in a recent post about the social impact of the Web:

What we are seeing at present is people with solutions looking for problems: they believe that in some ways computing and the Internet were almost consciously created as appropriate solutions to the lack of democratic and civic engagement. This won’t work, and this instrumentalist approach will tend to undermine the perception of the real value of these tools by ordinary people, as they see these projects (such as e-voting and e-democracy) fail

I don’t know if I really agree with this sentiment, I think finding new ways of doing things can allow you to address intractable problems. Maybe what Nico is saying is cool tools don’t get you all the way. Fair enough, but I think they can actually spark possibilities.

INSPIRED? Check this post out at coolhunting.com to see some incredible projects: Social Networking for a Cause

This is a follow up post by Sylvia on global health leadership:

In my previous writing I mentioned the importance of having a language around leadership and management that is actionable. The trait approach to leadership, which focuses on inborn personality characteristics, is not very helpful. After all, we cannot change people’s personalities. But behavior is changeable. This is why we are focusing on practices, action verbs if you will. We studied effective public health leaders and asked people who closely work with them to describe in behavioral terms what they do that earned them the label of ‘effective leader.’ We did a content analysis of the hundreds of pages of interviews and the following 8 practices emerged. These are the practices of leading that we are now teaching others to use to improve health services:

• Scanning (taking in information and being aware of internal and external environments)

• Focusing (directing energy and attention to priorities),

• Aligning/mobilizing (bringing others on board and moving towards a shared vision) and

• Inspiring (calling on the best in everyone to contribute to the greater good)

The practices of managing are

• Planning (thinking through and preparing the way forward),

• Organizing (lining up the necessary resources and putting in order the necessary systems)

• Implementing (doing the work) and

• Monitoring & evaluation (observing, examining and assessing progress).

The nice thing about these practices is that most people already know how to use them in their work, albeit it not intentional and not enough of some of them or too much of others. The leadership training helped them become more intentional and systematic.

We are seeing that more intentional use of the practices of leading and managing affects a teams’ work climate, makes managers more invested in setting up good management systems and makes them more aware of the importance to stay abreast of developments and trends in the internal and external environment that requires a change. We have discovered that when this happen, services tend to improve, even if, at first it is only in a very limited area.

In programs where we have helped teams to use the practices of good management and leadership we have seen them produce significant improvements in health indicators. For example, staff in health facilities in Aswan governorate in Egypt, by being intentional about their leading and managing practices, have more than doubled the number of antenatal care visits per woman and increased the use of contraceptives. What had changed was their sense of responsibility for making things happen. One of the doctors, focusing on improving the cleanliness of his clinic discovered a child with a heart murmur and shifted from his lesser challenge that was focused on the clinic’s appearance to the detection of children in the community with rheumatic heart disease. This disease is primarily caused by repeated attacks of tonsillitis and easy to treat if it is discovered early. Through his use of the practices of leading and managing he was able to mobilize his staff to go out in the villages and do a simple screening (the practices of scanning and focusing). By doing this he prevented much more serious complications later in the life of those children. It is one of those measurable results that is immeasurable in its impact of the affected families.

Introductory post by Sylvia Vriesendorp, our new guest blogger:

“We want better leadership!” It is an often heard call in health programs around the world. Yet when asking those who make this call what exactly they’d like to see done or changed that would produce the missing leadership, the voices stop. Let’s look at reproductive health: one woman dies every minute in pregnancy and childbirth; 99% of these women live in developing countries (UNFPA). These women are not dying of medical mysteries; they are dying because they do not have access to simple, inexpensive, life saving interventions. They are dying because they do not have access to modern contraception methods, even when there are supplies in the country and trained staff to dispense them.

Why is that so? We believe this is happening because many health programs are poorly managed and led. And as long as we believe that only a handful of exceptional human beings, like Mother Teresa, Ghandi or Mandela, can lead and manage us out of these tragic circumstances, we are forced to stand by or throw technical solutions at what are, in essence, challenges of management and leadership. This is a huge dilemma that is exacerbated by a lack of actionable language about management and leadership. After all, if leadership and management cannot be defined, how can we know what to teach?  It is also a dilemma for those who manage and lead health organizations. How can you get your staff to become better managers and leaders when you don’t have any language to help them develop? How can you yourself become a better manager and leader if you adhere to the theory of ‘Great and Exceptional Men and Women’ as they only people who can lead us out of our current stagnation?

There are countless models of leadership; many emphasize personality traits and characteristics (like charisma) that assume that true leaders are wired a particular way, from birth. If leadership were to be innate like that, we are in trouble. We are especially in trouble when we take talented health professionals away from their clinical practice and promote them up to a level where their technical skills are no longer useful and where they discover they have no clue on how to manage and lead. We have turned, in this way, countless superb clinicians into mediocre managers who do not lead. Worst of all, such an approach gives us no guidance on how to prepare current and future generation of managers who lead and produce intended results.

So what to do? We are engaged in remedying this situation in many countries and at many levels, a few teams of health managers at a time. In the process we are learning much about how to turn passive and unempowered midlevel managers into inspired activists for better health. We’d like to share these with you.