Healthcare in Rural Kenya – Disease Intelligence Network

[Some of these posts will include topics that I’m working on. For such topics, I’d really like feedback. Now I know you don’t think you have anything to contribute, but that’s a lie. I want these blogs to be understandable by everyone, both in vocabulary and concepts. So if there’s something you don’t understand please point it out. I have no other way to gauge how crazy my writing is becoming. So with that introduction, here is my first Blogged program idea.]

One of the problems in healthcare is that it is slow. If we ever want to find something out we commission a study, which takes a year or so. If we want to change something, it’s like turning an aircraft carrier (which, I’ve been told, is difficult). In the US, it’s a system, which is quite disconnected and has little incentive to be fast or dynamic (but that’s a whole different discussion). But, in starting from a very basic system, is there a way to speed things up? The first thing that needs speeding up is disease information. Collection has been so slow up to now, that only strategic information could be used. How many million people are infected with HIV? Is hypertension on the rise this decade? And when I say strategic, it’s like counting the number of men in your army compared to your enemy’s. Keeping to the military analogy, tactical is talking about things like how to defend a particular hill; we do no generally use tactical information in modern healthcare.

In Kenya, disease moves much too fast. Three of the top culprits here are Respiratory Tract Infections, Malaria, and diarrhea. These three conditions don’t even last a week (if you’re lucky), so no existing system is nearly fast enough. What do we do?

Well it’s actually quite easy (if you’re Nuru). We ask people about the sickness in their family that week. And since they meet once per week anyways in their Nuru groups, it won’t be that hard. And once we have this information, we can begin to do things like targeted interventions with our Nuru Healthcare Representatives (who we hope will become Community Health Workers; more on the details of this later).

Say there is a diarrhea outbreak. Say 10 people in Area A get diarrhea on Monday and Tuesday. On Wednesday, they would then report to the Health Rep during their Nuru meeting. So on Wednesday afternoon, we can equip the Health Reps with anti-diarrheal drugs to take to Area A on Thursday, and with soap to get to Area B next door to prevent diarrhea from spreading there. And it could be the same story with Malaria and respiratory infections.

Today it’s diarrhea, but it could ultimately include many more things. To make it fast and efficient, we may make it phone-based (we have internet phones out here) and use online servers to process the data (i.e. a farmer could send a text message to find out what his Malaria risk was that week). We’re planning to get GPS on all our farms, so it could be possible to produce a map of our results, helping us to predict outbreaks. We’ve considered doing regular weighings which could help identify malnutrition, HIV, and TB. We could integrate screenings for other common diseases as well. We’ve even considered expanding the Disease Intelligence Network to the Poverty Intelligence Network and including all the information we have (farming yields, pests and weed growth, etc), making it a useful set of data for all programs.

The most important part of the Disease Intelligence Network is this: Information->Response. This is what we care about. There are about a million applications to this basic idea, but the unique thing about this is that we have connected information directly with a response, and both are fast enough to make a difference; the thing that makes DIN special is that it is tactical. And, God willing, tactical will mean lives saved.