We have a new character to meet - the clinic's new laptop!
One of the obvious logistical problems with setting up an electronic medical records system in Sierra Leone is the "electronic" part. It turns out that fixing computer problems in Kono is not as easy as just taking your computer back into the store. You can't order computer-related stuff online and have it delivered. Power is not a public utility and prone to unexpected blackouts. Heat and humidity are hard on fans and hard drives. Even simple problems with a charger can leave a computer useless. And the problems are not merely environmental - malware and viruses seem to be a constant problem.
So what are Katie and I going to do about it?
Recently an American man currently working at the clinic donated the money for a new laptop for the clinic. So Dan Kelly tasked Katie and I with buying one and bringing it with us to go to Sierra Leone. This means that we have a chance to try and address many of those logistical difficulties through our choice of laptop.
Our first thought was to get a simple Dell laptop. But then we did some research. It turns out that there are computers built to resist the heat, humidity, dust, and power inconsistencies common in developing nations - the XO, designed by the One Laptop Per Child foundation. The XO uses a solid state flash hard drive instead of the more common spinning hard drive, because the fewer moving parts, the better. It's small and energy efficient to increase the battery life. The smallness and compactness also contributes to its durability. It doesn't have much processing power, nor does it have much onboard hard drive space, because solid state hard drives are slower. But it doesn't need that for its purpose; instead, the lack of high speed processing or graphics capabilities means that the production cost is low: ~200 USD.
Of course, they're not exactly what we want for the clinic. So we went in search of commercial laptops that approximate the durability, battery power, and minimalism of the XO. That lead us to a segment of the laptop market known as "netbooks." Netbook is a term that describes a small laptop primarily designed for surfing the web, checking email, and using web applications. The first netbooks to become widely known were produced by Asus; this New York Times article describes netbooks as "the Honda Fit" of the laptop world.
After a couple of hours reading product comparisons and looking at Amazon to determine which laptops could feasibly be delivered by today (this was yesterday; we leave Monday!), we settled on the Asus Eee 901. It's tiny - only 9 inches. But Asus is arguably the most reliable brand out there. (I like this story, which briefly tells about two guys that trekked across the Canadian Arctic for 70 days with Eee 901 computers). It also runs on a 20 GB solid state flash hard drive, has great battery life, and wireless capabilities. And, it runs on Linux.
Don't worry about it if you have never heard of Linux. It's an operating system, analogous to Windows, except that it is open source. That means that both Linux itself and all of the computer code used to make it work are freely available for anyone to edit or use. And when I say "freely", I mean "free" - Linux costs nothing. Even better, Linux computers don't get viruses. I won't pretend to be a tech expert; I can't explain all the reasons why Linux is so much more secure.
In the context of the clinic, Linux has the edge on Windows for a few reasons. First, the security. Second, Linux will always be free, and updates itself. Third, while one of the major obstacles to more widespread use of Linux is the fact that it is not always easy to port files from proprietary systems (ie Windows) to Linux, the clinic has hardly any preexisting files to be ported. Last, OpenMRS is a web application - it is written in Java and runs out of Firefox, so it can run perfectly well on either Linux or Windows.
So our new baby laptop arrived today, and she looks great. The hinge for the monitor is sturdy; the chassis is solid. I'm excited that we've had the chance to "buy outside the box" in order to make sure the clinic has a computer that will last.
Let me close by thanking my primary tech consultant, my roommate Sajid. He knows much more about computers than I ever will and is also very happy to help me muddle through. He actually has a blog of his own, where he writes about neat tech policy issues. Take a look, and don't be intimidated by the seeming difficulty of the subject matter - the issues he writes about are very pressing and often don't get the attention they deserve.
Friday, May 29, 2009
Tuesday, May 26, 2009
The chorus
Let me introduce you to some of the characters.
Sierra Leone. That's okay, I've always had a hard time remembering where exactly it is. It's here, in West Africa. European involvement began in the late 18th century when the British established Freetown (the capital) as a territory for impoverished and free former slaves. Of course, before, during, and after that there were many tribes in both the coastal and inland regions of Sierra Leone. But it is the legacy of the freed slaves that colors Sierra Leone's common language, "Krio", a mix of English and several African languages. In fact, the foundations of both Freetown and Krio were laid by Nova Scotian former slaves, and their journey is chronicled in the recent historical fiction novel The Book of Negroes by Lawrence Hill. I haven't read it yet, but I wish I had; it was nominated for a Giller Prize in 2007 and recommended to me by a good friend from Pearson. It's a bit amusing that in the USA it was published under the name "Someone Knows My Name."
So while Sierra Leone's distant past was full of inversions - British freed slaves sent back to Africa, Jamaican militias (the Maroons) of freed slaves brought in to put down rebellions by the British freed slaves - its present is more tragic. A horrific civil war tore the country apart from 1992 - 2002. The rebel faction, also known as the RUF, quickly established themselves in the Kono region and traded its diamonds for weapons for the duration of the war. The RUF is infamous for its inhuman practice of amputating innocent civilians. It's hard for me to even begin to understand their depravity. They would ask their victims "Short sleeves or long sleeves?" (cut at the wrist or the elbow) to force the victim to take part in the torture.
Perhaps more horrific is the widespread use of child soldiers by both the RUF and the government armies. The children were recruited at gunpoint, forced to kill, and then kept intoxicated on a nonstop cocktail of cocaine, marijuana, Rambo movies, and violence. A Long Way Gone, by Ishmael Beah, is the heartbreaking yet inspiring account of Beah's own forcible recruitment into the government army at age 12, his time in the army, and his rescue and rehabilitation by UN agencies.
The civil war burned out by 2002, and the country has retreated from the middle pages of the Globe and Mail to work towards democracy in private. Great strides have been made, for example the first democratic elections in 2007. But as the UN Human Development Index shows, the country still has a long way to go.
Amputees in Sierra Leone. Soon I will be able to put some names into this general category; for now I put them here to symbolize their transition from the fringes of society to the focus of the Global Action Foundation's programs in Sierra Leone.
The Global Action Foundation (GAF). The Global Action Foundation funds initiatives to eradicate extreme poverty. It was founded in 2005 by Dr. Dan Kelly and a few of his friends at the Albert Einstein College of Medicine. Through one of those friends, Dr. Kelly met Dr. Barrie, both characters you'll meet shortly, and together they created, among other things, a clinic to serve the amputee population in Kono district, Sierra Leone. That's where the majority of my internship will be. One thing I like about GAF is that I think Kathy Kelly, co-founder and chairperson, is Dan Kelly's mom.
Dr. Dan Kelly. Currently a medical resident at Baylor in Houston, Texas. He is Executive Director and one of the founders of GAF, and raises the money the organization requires. He is a Princeton alumn and he created this internship through the International Internship Program at Princeton. Both me and my fellow intern Katie Hsih obtained this internship through that program. Apparently he is also a marathon runner; I know graduate students older than him. With a smile and an optimistic outlook, he's covered some ground in the five or so years since he graduated from Princeton.
Dr. Bailor Barrie. I haven't met him yet, but just take a look at the embedded video here. Dr. Barrie is the guy on the ground for GAF, and he is my boss for the summer. I'm really looking forward to it. In my opinion, carefully targeted aid organizations with inspired leadership and few middlemen are the ones that can make the most efficient and effective differences, and Dr. Barrie seems to agree.
Katie Hsih. My fellow Princeton intern. She is studying Operations Research and Financial Engineering, and is very interested in issues of Global Health. She's also much more responsible and careful about planning trans-atlantic trips than I am (which may not be saying much).
The clinic. It's in Kono; more or less here; close to the Guinean border. It mainly sees malaria, acid reflux disease, and typhoid fever cases. It serves 158 amputees. I'm pulling this right off here.
The Survey. One of our main responsibilities is to finish conducting and analyze a survey that assesses the impact of the clinic's health education modules. We're going to look at whether or not people know more about typical disease transmission mechanisms (eg. how does one get HIV?) and prevention methods (how do you use a bednet? When do you bring your child to the clinic?).
OpenMRS. This is the open-source electronic medical records software we will implement at the clinic. I'm very excited about it, but I can see your eyes glazing over. Check out the description and the demo. Why am I excited? Because 1) properly implemented, it will be a more efficient and convenient method of monitoring patient records, 2) it gives the clinic the ability to conduct powerful analyses on its patients. Academic literature is starving for data on clinics such as this one. Furthermore, you cannot improve something (health) until you can measure it. Until I arrive in Sierra Leone and have more interesting things to write about, I'll probably bore you with the details of the planned implementation.
Greta. My guitar. She's coming out of retirement at my Aunt JJ's Bruce Beach cottage to fly 20 hours across the ocean to Sierra Leone.
My Mom. She's worried about me. And she's worried that I won't take any pictures. But she's always worried about me. I love you Mom!
I'm sure we'll meet many more interesting characters, and most of these characters will become more interesting. But that's all for now. In one week I'll be in Freetown.
Sierra Leone. That's okay, I've always had a hard time remembering where exactly it is. It's here, in West Africa. European involvement began in the late 18th century when the British established Freetown (the capital) as a territory for impoverished and free former slaves. Of course, before, during, and after that there were many tribes in both the coastal and inland regions of Sierra Leone. But it is the legacy of the freed slaves that colors Sierra Leone's common language, "Krio", a mix of English and several African languages. In fact, the foundations of both Freetown and Krio were laid by Nova Scotian former slaves, and their journey is chronicled in the recent historical fiction novel The Book of Negroes by Lawrence Hill. I haven't read it yet, but I wish I had; it was nominated for a Giller Prize in 2007 and recommended to me by a good friend from Pearson. It's a bit amusing that in the USA it was published under the name "Someone Knows My Name."
So while Sierra Leone's distant past was full of inversions - British freed slaves sent back to Africa, Jamaican militias (the Maroons) of freed slaves brought in to put down rebellions by the British freed slaves - its present is more tragic. A horrific civil war tore the country apart from 1992 - 2002. The rebel faction, also known as the RUF, quickly established themselves in the Kono region and traded its diamonds for weapons for the duration of the war. The RUF is infamous for its inhuman practice of amputating innocent civilians. It's hard for me to even begin to understand their depravity. They would ask their victims "Short sleeves or long sleeves?" (cut at the wrist or the elbow) to force the victim to take part in the torture.
Perhaps more horrific is the widespread use of child soldiers by both the RUF and the government armies. The children were recruited at gunpoint, forced to kill, and then kept intoxicated on a nonstop cocktail of cocaine, marijuana, Rambo movies, and violence. A Long Way Gone, by Ishmael Beah, is the heartbreaking yet inspiring account of Beah's own forcible recruitment into the government army at age 12, his time in the army, and his rescue and rehabilitation by UN agencies.
The civil war burned out by 2002, and the country has retreated from the middle pages of the Globe and Mail to work towards democracy in private. Great strides have been made, for example the first democratic elections in 2007. But as the UN Human Development Index shows, the country still has a long way to go.
Amputees in Sierra Leone. Soon I will be able to put some names into this general category; for now I put them here to symbolize their transition from the fringes of society to the focus of the Global Action Foundation's programs in Sierra Leone.
The Global Action Foundation (GAF). The Global Action Foundation funds initiatives to eradicate extreme poverty. It was founded in 2005 by Dr. Dan Kelly and a few of his friends at the Albert Einstein College of Medicine. Through one of those friends, Dr. Kelly met Dr. Barrie, both characters you'll meet shortly, and together they created, among other things, a clinic to serve the amputee population in Kono district, Sierra Leone. That's where the majority of my internship will be. One thing I like about GAF is that I think Kathy Kelly, co-founder and chairperson, is Dan Kelly's mom.
Dr. Dan Kelly. Currently a medical resident at Baylor in Houston, Texas. He is Executive Director and one of the founders of GAF, and raises the money the organization requires. He is a Princeton alumn and he created this internship through the International Internship Program at Princeton. Both me and my fellow intern Katie Hsih obtained this internship through that program. Apparently he is also a marathon runner; I know graduate students older than him. With a smile and an optimistic outlook, he's covered some ground in the five or so years since he graduated from Princeton.
Dr. Bailor Barrie. I haven't met him yet, but just take a look at the embedded video here. Dr. Barrie is the guy on the ground for GAF, and he is my boss for the summer. I'm really looking forward to it. In my opinion, carefully targeted aid organizations with inspired leadership and few middlemen are the ones that can make the most efficient and effective differences, and Dr. Barrie seems to agree.
Katie Hsih. My fellow Princeton intern. She is studying Operations Research and Financial Engineering, and is very interested in issues of Global Health. She's also much more responsible and careful about planning trans-atlantic trips than I am (which may not be saying much).
The clinic. It's in Kono; more or less here; close to the Guinean border. It mainly sees malaria, acid reflux disease, and typhoid fever cases. It serves 158 amputees. I'm pulling this right off here.
The Survey. One of our main responsibilities is to finish conducting and analyze a survey that assesses the impact of the clinic's health education modules. We're going to look at whether or not people know more about typical disease transmission mechanisms (eg. how does one get HIV?) and prevention methods (how do you use a bednet? When do you bring your child to the clinic?).
OpenMRS. This is the open-source electronic medical records software we will implement at the clinic. I'm very excited about it, but I can see your eyes glazing over. Check out the description and the demo. Why am I excited? Because 1) properly implemented, it will be a more efficient and convenient method of monitoring patient records, 2) it gives the clinic the ability to conduct powerful analyses on its patients. Academic literature is starving for data on clinics such as this one. Furthermore, you cannot improve something (health) until you can measure it. Until I arrive in Sierra Leone and have more interesting things to write about, I'll probably bore you with the details of the planned implementation.
Greta. My guitar. She's coming out of retirement at my Aunt JJ's Bruce Beach cottage to fly 20 hours across the ocean to Sierra Leone.
My Mom. She's worried about me. And she's worried that I won't take any pictures. But she's always worried about me. I love you Mom!
I'm sure we'll meet many more interesting characters, and most of these characters will become more interesting. But that's all for now. In one week I'll be in Freetown.
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