How often have you said, “My computer is so slow”? Do you remember the days before wireless networks existed? It seems our Internet connections can never be fast enough and we email each other rather than pick up the phone. Transport yourself to a developing country and you will also be transported back in time. How do researchers conduct research without the sophisticated tools and apps that we have access to? One such technology analyst at the Center for Innovation in Global Health is looking to change that at the University of Zimbabwe College of Health Sciences (UZCHS). In a few trips to Zimbabwe, Michelle Cook has played a significant role effecting change in medical education.
Q. Can you tell me how your trip to Zimbabwe came about and the state of technology when you arrived?
I first traveled to Zimbabwe in September 2011 with grants from the Novel Education Clinical Trainees and Researchers (NECTAR) Program and Medical Education Partnership Initiative (MEPI). Prior to visiting, I worked with my counterparts to do an inventory of their needs so there was a lot of pre-planning in the process. When I arrived in Zimbabwe, the six servers that I had purchased to build out the internal storage space had also arrived so I was able to install the servers and get those up and running.
UZCHS pays a large sum of money to the government for a small pipeline that doesn't offer a very fast connection. The speed was equivalent to our Internet of the 1990’s and not capable of running many programs, let alone medical imaging. The speed of the Internet won’t improve because the government restricts it. With such slow connections, it makes it impossible to download large quantities of data to the internal servers; it’s like filling a pool, one tiny drop at a time. To give you an example of how slow the connection speed is, the University lost out an a significant National Institutes of Health (NIH) grant because the time frame for the proposal submission ran out over the 5 days it took to submit the encrypted PDF online. In this particular case, at some point during the weekend the NIH shut down their servers and stopped accepting applications and therefore cancelled the submission while it was in process. By the time the servers came back on, it was too late for submission and the NIH would not accept the UZCHS application.
Q. Getting the network set up must have been a huge challenge. What were some of the toughest challenges that you faced?
The hospital was built during wartime and there was a shortage of steel. Instead of installing reinforcing bars to make thick walls, they poured foot thick concrete making it very difficult to receive a good wireless signal. We’re now working on building up the Intranet and bringing the information to them for storage on their own content servers as well as increasing the wireless access and bringing additional access points. I will also be relocating some of the servers that we brought over last time and will work with their medical school to transition over some of our curriculum and make it available to their faculty and students.
Noah Freedman from the Graduate School of Education will be coming with me to install SMILE (Stanford Mobile Inquiry-Based Learning Environment), a small portable box that contains several USB ports, an SD card slot, a built in router and small LINUX computer. These boxes are great because it allows one person from a large group of people with tablets and smart phones to plug into the box that creates a small wireless network. This creates an adhoc network where everyone in the classroom can share the information. Beefing up the Intranet inside the hospital is the critical part so that all the content is there and the doctors can use it.
Q. What was the faculty/student reaction to the equipment and tools that you installed?
They have loved the Wi-Fi access and increased communication with each other in the hospital. They have also benefited from the additional medical software that we have provided. These tools have proved to be not only helpful, but also critical in diagnosing patient illness. With the help of Lane librarian, Lauren Maggio, we managed to acquire a hard copy of a software program called Uptodate. Uptodate is typically a web-based, medical database but the slow Internet speeds would not make this software especially helpful. Uptodate allows a clinician to input a list of patient symptoms and the database returns a list of the most likely diseases and/or injuries and appropriate courses of treatment. Tools like this cut down on patient mortality.
A deal where Google would have provided 100 Nexxus tablets recently fell through, so now we need to get funding to provide 100 tablets to the hospital. A tablet is perfect for the hospital setting because it is small and fits neatly into a lab coat. The tablets can be installed with freeware applications and other relevant software such as the Oxford Medical Dictionary. If we can get all the tools that the students and staff need it will cut down on the amount of books they carry and shorten the amount of time it takes to look up medical information away from the patient, the faster they can treat the patients, and ultimately the sooner the patients get better. Although the Google deal fell through, I am committed to finding the funding to get them the resources they need.
Q. How has medical education evolved at the medical school?
A part of what we’re doing with the SMILE integration is bringing over the faculty videos from School of Medicine that are used in the flipped classrooms. The whole idea will be to provide the videos so that University of Zimbabwe faculty can integrate the flipped classroom into their model of teaching.
One of the best advantages of working with this university is that they have a program that sends students out for rotations to rural attachments which are clinics throughout Zimbabwe where they normally have one doctor who sees all the patients in a region. The medical school will send out a class of students to treat patients. This is a place where we would like to designate the tablets go. Getting that information out in the field is especially helpful and if the information is on tablet then we don’t need to worry about Internet access. I’ve been working with Kevin Montgomery from the School of Medicine, an electrical engineering genius, and he has came up with a number of ideas for creating solar systems and back up battery systems to support the tablets in the field. I am going to try to get parts in the local market and create something that is sustainable. They have plenty of what is readily available to them, but what they are lacking is impossible to get.
Q. How do you think technology enhances international collaboration?
Before I went to Zimbabwe, there wasn’t anyone who went there to do the hands on physical work to help them get what they needed. After I went to Zimbabwe there was a huge shift in how Stanford was perceived. While I was there, I invited my counterparts to come to Stanford for training. In the interim, we’ve had at least twenty staff members from UZCHS come to Stanford for roughly two weeks for training on our network, learning how we build our infrastructure and how to setup electronic medical databases such as Redcap and STRIDE. Tools like Redcap will allow students to create a research project that is sizable to their needs. They don’t have the databases yet but it will be a long-term goal to provide them since they now have the servers that can house the content. They are basically getting “train the trainer” education where they’ll go back and train faculty, staff and students. As it stands now, if a medical student wants to do a research project, they have to jump through all the political hurdles, and after that there is no ground work laid to help them get started. We are working to change that.