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Re: [Health] [Health-jamaica] Ebola, MERS, Zika, N.N. and GNU Health

From: Christoph H. Larsen
Subject: Re: [Health] [Health-jamaica] Ebola, MERS, Zika, N.N. and GNU Health
Date: Wed, 3 Feb 2016 18:00:45 +0700
User-agent: Mozilla/5.0 (X11; Linux x86_64; rv:38.0) Gecko/20100101 Thunderbird/38.5.1

Dear All,

Thank you everybody for your incredibly encouraging input. Of course, we are all aware of the fact that GNU Health is focused on empowering equitable access to health care, which is even more remarkable, as we seem to be in an environment that gets increasingly monetised.

I would like to add my two cents to the "Neglected Tropical Diseases" issue. The original term has been coined to divert the focus of rich donor nations away from non-communicable and priority communicable diseases, and let's just assume that it was a well-meant effort. However, what are those "NTDs"? Do they include poverty-induced obesity, hypertension and diabetes, as nowadays commonly seen in urban Kenya, where healthy foodstuff has slipped beyond the reach of the average breadwinner? Or are they spelled E-b-o-l-a, as in some obscure, albeit deadly infection found among some bushmeat eating tribes? Or named echinococcosis or kala-azar in Turkana, just beyond the reach of mainstream public health interventions in East Africa? My feeling is that NTDs have swiftly grown to become emerging pathogens, which require vigilance, lateral thinking, local funding and empowerment, all spiced up with a decent dose of good ole' common sense.

I fully agree with you that donors have - for a long time! - used the development arena for their own purposes. After all, they have become increasingly outspoken about their "geopolitical interest" in recent years.

However, let's not throw the baby out with the bath water: It was actually the fact that "events" have been blatantly disregarded by the donor or international community, when ominous things happened along the Guinean/Sierra Leonean border. Attention to events would have meant to attribute importance to public health, common-sensical epidemiology and national empowerment. However, this was not to happen, and the rest is history... Hence, it really depends on the situation, when "patients", "events" or "statistics" are important. In a way, this is exactly the Chamaeleon-like face of holistic health, as we add layers of insight as well as abstraction to routine health care to cater for the individual, common and greater good.

The wide range of approaches that is required is also highlighted when implementing disease surveillance: Passive surveillance, as well as sentinel surveillance as an aspect of it, can be done comfortably from with GNU Health as a starting point, yet needs data aggregation, analysis and warehousing at the end.

Active surveillance, however, requires a whole lot of added witchcraft, which is well described as emergency preparedness, and the deployment of the latter. This gives a pretty good overview of the process: We had to train 400+ contact tracers within four less than four days in Freetown to react swiftly to new cases, the most critical of which occurred in densely populated slums. Netbook have never been considered as a viable option. Tablets or even better phablets with powerful batteries (4000 mAh) are. The same is true for community health workers, may of which could just handle a simple mobile phone comfortably, and successfully reported along ten critical event triggers that were likely to indicate a suspicious Ebola-related event... which in turn triggered an emergency response from the district. All this in an environment with close to zero electricity outside the district capital, iffy mobile networks and sporadic internet access, yet accomplished with wonderful and highly motivated, resilient people.

Writing software nowadays is not only an art, but depending on the way how the former is made available, also a highly political act. I think GNU Health got this very right. Still, software is nothing but a tool, which can be used either way. Therefore, I humbly feel that it is crucial that we take in the whole picture and all layers of realities to let those in need guide us towards making the best out of our unique positioning.

Stay well!


On 02/02/16 20:40, Armand MPASSY-NZOUMBA wrote:
Dear Chris and Luis,

Let me add my voice to this debate and I apologize in advance if my
"straight talk" hurt community members.
I am happy to see that GNU health is really getting the attention that
it deserves from health professional at global level. I have worked for
big health institutions. I tested and developed a number of health
related applications. Most of these systems were aimed at delivering
statistics. This is indeed what most of these institutions are merely
interested in (from an IT point of view).

In my opinion (this is only my opinion), GNU Health is mature enough to
be used as a standard and multi-purpose health application. This
includes all the needs expressed by Chris. It is based on Tryton. I
would not repeat here the robustness, reliability and flexibility of
this platform. It includes all health related standards (including
ICD-10). More, The patient is at the core of the system. It is free and
Open source software. GNU Health has a very detailed patient database.
Of course we should make a difference between the database and the
interface of system. The interface can be extended by adding new
modules. However the core of the system does not need to be changed.

The challenge I experienced with most applications and most IT projects
developed in big organization is that:

1/ They were initiated to satisfy the needs of these organizations, not
the needs of those who really need it (the health professionals on the
field). Why: because most international actions on health (EBOLA and now
Zika) are still what I will call "event-based". This means that most
funds and resources are allocated  to the diseases that make the most
"noise", those that will be announced in big media like CNN. Although I
agree that it is important to focus our attention on these diseases, we
should not forget the primary focus of GNU Health:

- To improve the health of the people in the small cities and rural
areas of Africa, Latin America or Asia
- To bring equity in health

GNU Health is definitely achieving this goal.

2/ UP to now there was very little interest in developing IT tools that
will improve the work of health professionals on the field. Even Ebola
has not changed that. Fortunately GNU Health is going against this trend.
Most doctors continue spending hours dealing with issues that could be
improved if they had tools like GNU Health. A lot of patients die for
the same reason.

Did we ask ourselves the questions why these epidemics are recurring?
Luis mentioned it a little bit. How can you call a disease "neglected
tropical" disease. Who is neglecting what?

3/ Having said that the main challenge currently is to promote GNU
Health. No matter how much effort it will take, let's make sure that
each health professional in developing countries know about this
wonderful system (GNU Health). Let's make sure that most of them have
tested it. The Tryton and GNU Health community have done a wonderful
job. Let's make sure GNU Health reach the health professionals on the field.

Kind regards,


Dr Christoph H. Larsen
296/33 Lương Định Của, Ngọc Hội 2, Vĩnh Ngọc
Nha Trang, Khanh Hoa, Vietnam
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