Last weekend I had the singular pleasure of spending a night with some of the best and brightest young minds in the country. I’m talking about ID Hack, a 24 hour hackathon put on by the Harvard Developers for Development and the MIT Global Poverty Initiative. Unlike some other hackathons the aim wasn’t to create the next Facebook based platform to allow users to rate attractiveness of their friends cousins or something equally vapid and zeitgeisty, it was to put young developers in touch with globally focused NGOs with real technical needs. [Also to stay up all night and eat pizza] We all showed up with a project or problem, pitched to the more than 100 young brains and they formed teams to tackle them.
Our pitch wasn’t quite as straight forward as some, we weren’t looking for a new website, we wanted deeper analytic measures. Our pitch was this: VaxTrac has piles of data, our stakeholders are used to asking for the typical metrics and we provide them. However, we collect more data than a typical immunization program, what metrics can we create from our piles of data that can inform and empower local decision makers? Once we find a metric, how can we visualize it in an interesting way?
I spent the night working with two students; Michael a freshman in CS at MIT, and Wanli, a masters student in Psychology at Brandeis. We wanted a simple analog (probably over-simple) for the efficacy of any particular clinic. We chose the average schedule adherence and vaccination rates for two vaccines with a single dose in the first year , BCG and Yellow Fever. BCG is given at birth and Yellow Fever at 9 months. We looked at the number of doses of each for each clinic and also the average age at which each child who got the vaccine received it. Based on this we built a map showing which clinics most closely adhered to the set schedule. You could clearly between the two maps, which clinics were retaining the most children from the birth dose to the nine month dose. Not bad for a night’s work!
[Note: We mapped real clinics to random cities, this map isn't representative of actual regional performance. Also we were working with meta-data, not patient records.]
Again, I’d like to thank my team. They chose one of the more abstract problems available and I think they did a fantastic job.
Arriving in the tourist epicenter that is Bali—surrounded by five-star resorts and haute couture outposts—was a bit of a change from my normal travel patterns, in which I find myself more often in the remote hills of rural Africa. It was difficult to reconcile what I was seeing with the ultimate reason for my trip, which was to learn more about the challenges faced in delivering health care in the emerging market of Indonesia where 35% of one of the world’s largest birth cohorts is not fully vaccinated.
As a quick primer, Indonesia is a country of 17,000 islands with a population of 250 million people. The country’s gross national income—a good proxy for evaluating how “developed” a country is—puts Indonesia at a level on par with Guatemala or Ukraine. All of these factors make the country a great site for our newest project. The higher relative wealth translates to better infrastructure and a health workforce with more training. However, there are still some interesting challenges stemming from the dispersed geography and the cultural elements of being the world’s largest predominantly Muslim country.
I spent the week leading up to Christmas traveling around the country, meeting with health officials and observing firsthand how the health system operates. In only five days, I was able to visit three different islands (only 16,997 to go!) and see numerous health facilities. We even got to register an adorable Indonesian child in the VaxTrac system as a live demo for several health workers.
While we were also in Jakarta and Bali (for work, I swear) we spent the bulk of our time assessing the health system through site visits on the island of Batam, located 12 miles off the coast of Singapore. This provided us a great opportunity to see the true nature of how vaccines are delivered, the realities of which can never be conveyed without observing directly. It didn’t hurt that we also got a chance to sample the incredible local cuisine.
This trip was phenomenally successful, and we have laid the groundwork for what I think will be an impactful project over the coming years. This could not have been done without the support of many individuals from the Ministry of Health, WHO-Indonesia and CDC-Atlanta, but I would like to especially thank Dr. Sandra from MoH, Dr. Michael Friedman from WHO and Dr. Susana Panero from CDC.
We’ve added a new major release of our immunization tracking software.
Here are some screenshots from our newest version:
Over the past few years, we as an organization have experienced our fair share of obstacles to overcome and other generally difficult tasks. After Thursday though, I think I can say we have finally stumbled upon the single most onerous task to date: training. And I have every expectation that it remain one of the most challenging aspects for projects far into the future.
This past Thursday we conducted the first of several training sessions to introduce our vaccine tracking system to the frontline health workers responsible for the system’s successful use. In fact, the success of this project in Benin–and of the organization as a whole–is far more dependent on the people sitting on the other side of those desks than it is on us. In this particular session, those people included the state director of health and his lieutenant in charge of primary health delivery (under which fall vaccination services), the WHO national vaccination coordinator, municipal-level vaccination program officials and two representatives from each clinic that has been selected for participation in our pilot project.
The training lasted nearly six hours, and even with that marathon session, we will still need to do individual follow-up at clinics to answer questions and ensure proper use. We had approximately 40 people in attendance that represented a wide array of capability. Training was conducted in French by our new regional coordinator, Fidele Marc, supported by our far less fluent staff, Shawn and Mark.
Some of the training is intuitive. At the highest level, we are teaching vaccination professionals about a vaccination tracking system, something that is, at a high level, very similar to what they’re already using. The real difficulty comes from the fact that we have to teach people how to use a computer. We take for granted our own computer literacy which makes it challenging to teach someone who has literally never typed a single character nor even once clicked a mouse. We planned for this as best we could from day one. The software is designed to be as basic and intuitive as possible; the process flow mirrors what the health workers already do with paper records. Also, a large part of our training is dedicated to basic computer usage: turning it on and off, moving the cursor with the track pad, selecting options, entering information with the keyboard, etc.
The good news is that while training is difficult and time intensive, it is entirely within our own ability to overcome. So many other aspects of our project rely on external input: e.g. funders deciding to support us, government officials providing approvals. Training is unique in the sense that all we have to do is dedicate enough time and effort to reach our goals. As an added benefit, we are teaching basic computer literacy to a cadre of people that otherwise would never build that skill set. This prepares them well for a world, even here, that is rapidly becoming digitized and greatly enhances their career prospects.
We have spent the last few days, and the entirety of our weekend, holed up in our hotel putting the finishing touches on just about everything. When we left the US, we figured that we were about 99% ready, leaving us to finish up that final 1% in the first few days here. In hindsight, that 1% was probably closer to 10%. But now it’s done. All of it. We have training materials–in two languages. We have fully functioning and fully translated software. We have 25 computers and 25 fingerprint scanners sitting in 25 backpacks ready to find new homes in 25 Beninese clinics. And the most exciting part, we have our first international VaxTrac employee!
Fortunately, the hard work starts paying off tomorrow. First thing Monday morning, we start training, and we start at the top. We will be teaching the Ministry of Health officials and policymakers in the vaccination program how our system functions. We will get to make high-level health officials treat each other like they’re children about to receive vaccines. The role-playing part of the training is going to be the most entertaining part for us; more importantly, it will likely be the most instructive part for those being trained.
Once we finish with the Ministry on Monday, we will move out into the field for the rest of the week to train frontline health workers. As a key element of that training, we will get to introduce many people to a computer for the first time. Updates over the course of the week may be sporadic due to internet availability, but when present, they should be chock full of photos.
VaxTrac has had many milestones to celebrate over the past few years: winning the Gates grant, successfully testing the prototype, hiring additional staff members. This coming week will rank among those achievements, if not above them. By this time next week, hundreds of health workers will be using the VaxTrac system as an integral part of their everyday work. Hundreds of thousands of people will begin to see improved health outcomes in their communities.
As exciting as this is to us, we have not lost sight that this is arguably the first step–or certainly among the early steps–of a long road to success.