Scientists ground space-age technology to address global health crises
A health-care worker in Ethiopia shows the standard 2-feet-wide logbook that is carried around the countryside to record AIDS cases and other medical information.
BY TRACIE WHITE
The most striking image of Ethiopia for Kevin Montgomery was a corridor in the Black Lion Hospital in Addis Ababa crammed with more than a thousand AIDS patients. Gurneys with patients lined the hallway. Crowds of patients milled about, leaning against walls, waiting for hours, sometimes for days. Outside, patients waited to get into the waiting rooms, which were overflowing with stacks of papers and files.
"I was completely overwhelmed by the sheer volume of people that needed help," said Montgomery, PhD, technical director of the National Biocomputation Center at Stanford, a collaboration between NASA and the medical school. "It was the most disturbing image of Ethiopia. I'll never forget it."
For Montgomery, it was validation of the overwhelming need in developing countries for advanced technology to deliver health care, particularly in places like the remote regions of Ethiopia. This is why he was in Ethiopia: to share technological advances developed at Stanford with the world outside the walls of his institution.
"We're trying to make an impact on the world by transferring technology out," said Montgomery, who is part of a collaborative effort with governmental agencies to bring telecommunications to Ethiopia's health-care delivery system. "If we just sit in our ivory tower and just write our papers, we do a disservice to the world."
Montgomery, whose work as a computer scientist at Stanford reaches into outer space, is a founder of a new spin-off company, Intelesense Technologies, which provides wireless network technologies that can transfer data around the world almost instantaneously.
In Ethiopia, Intelesense will provide the backbone of a telecommunications system to monitor antiretroviral drug therapies for AIDS. The system will replace paper-based handwritten data collection systems such as the 2-feet-wide logbooks that health officials pick up every 90 days from remote villages to track the progress of the disease. Medical professionals say that a faster and more efficient data system will save lives.
"They're huge," Montgomery said, talking about the logbooks. "We'd ask the community health-care worker about a case, and she'd say 'Just a minute,' then start flipping back through this huge, heavy book. It's crazy."
Lessons from the space programIntelesense is one of nine spin-off companies to come out of the National Biocomputation Center. The Hawaii-based company, with a research and development center in Silicon Valley, deploys wireless sensors globally—in Vietnamese streams, Hawaiian rain forests and Ethiopian villages. The sensors collect information, then transfer the data through the air at 14-mile intervals until it gets back to a base station connected to the Internet. The "Intelenet," as the company calls it, has the potential to track disease outbreaks, from malaria to the avian flu, within a four-hour period, Montgomery said.
Uniquely rugged, these adaptable sensors were first developed for use in monitoring astronauts' vital signs in space. Montgomery and his Stanford colleague Carsten Mundt, PhD, now full-time at Intelesense, realized the potential for other uses and formed the company.
"This isn't new technology," Montgomery said. "We've just made it practical. It's extremely robust. The military loves it."
Since its start up in 2005, Intelesense has deployed its sensors at cost, first in remote locations in Hawaii to help monitor environmental changes for University of Hawaii researchers, then in Vietnam to help health agencies track waterborne illnesses. The company works in partnerships with multiple governmental agencies and universities including the University of Hawaii, the Hanoi School of Public Health and the U.S. Army's Telemedicine and Advanced Technology Research Center (TATRC), a big proponent for using Intelesense to help battle global health crises.
"In Stanford's overall strategy for spinning out innovation, Intelesense is one of those success stories," said Mary Kratz, an informatics expert at the University of Michigan Medical School who is the lead for TATRC activities in Africa. "It can help solve really difficult global health problems, like AIDS."
Bridging the digital divideAs the global community has become increasingly aware of a growing "digital divide" between industrialized and Third World nations, a promising new trend has emerged, according to Eva Harris, PhD, associate professor of infectious diseases at the School of Public Health at UC-Berkeley. Harris is a MacArthur Fellow whose interests and accomplishments in transferring advanced technology to the developing world spans two decades.
"A growing number of experts from industrialized nations are working to bring technology to developing countries," she said, but added that the transfer of technology in engineering and computer science is still lagging.
"While many are very interested in developing gadgets, few take that extra step and go out into the field. A lot of the fanciest gadgets just don't get out."
Montgomery hopes to help turn that tide. He said that he wants to see the Intelesense gadgets "get out into the field." Which explains how he ended up navigating around long-horned cows and baboons on a jeep ride across the bumpy roads between the city of Jimma and Ethiopia's capital Addis Ababa in an effort to learn about the country's AIDS crisis.
Nation plagued by AIDSEthiopia has one of the direst AIDS epidemics in all of Africa. In a country of nearly 70 million people, more than 2 million are thought to be infected with HIV and its one million AIDS orphans face long odds of survival. It's a country centuries behind in technological advancements where oxen are still used to plow fields and women carry well-water home in plastic jugs.
"We're acutely aware of the digital divide," Kratz said. "We need a net meshwork infrastructure to get to the underserved areas in Ethiopia."
Health-care delivery is a particularly challenging problem in Ethiopia because of its lack of power, lack of adequate phone systems and its widely scattered population. About 80 percent of Ethiopians live outside the cities in remote villages. Doctors travel from village to village by foot or by cart. And nomadic tribes create a health-care tracking nightmare.
"The population is very, very spread out," Montgomery said. "The question becomes, how do you provide health care to these remote areas?"
In a collaboration between TATRC and the U.S. President's Emergency Plan for AIDS Relief, Intelesense technology will provide the network capabilities to transfer information between villages and universities and hospitals.
Installing sensors across the Ethiopian countryside will create the wireless network necessary for the U.S. Army's own gadget, a remote personal device, to work. Originally designed as a handheld electronic messenger system for medics in the battlefield, this device will be used by community health-care workers to transmit patient data and create a link between rural outposts and the urban health-care centers. Traveling doctors could gain the same access by carrying one of these remote personal devices in their carts or in their pockets.
The benefits could be immeasurable for the transfer of records essential to antiretroviral therapy, as well as the tracking of blood deliveries by refrigeration truck, Kratz said. Follow-up on the disbursement of antiretroviral drugs is needed to avoid outbreaks of resistant strains of the virus.
The technology could also make obsolete the 2-feet-wide logbooks, long used by Ethiopian health-care workers for patients' records—a loss no one would regret.
"The technology was positively embraced by everyone we met in Ethiopia," said Kratz, who recalled a nurse at a health-care outpost in Jimma whose face lit up when she was shown the handheld personal device and told its potential.
"Wow, with this I could see twice as many patients in a day," she said, stacks of patient encounter forms piled high behind her. "Can we get this tomorrow?"
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