The leaves of the shea nut tree at Kurugu CHPS Compound could only protect us for so long. The configuration of wooden benches, health record books, and babies fell neatly in the shade at the start of last Tuesday’s Child Welfare Clinic (CWC). But as the sun moved across the sky, families started to grow uncomfortable in the heat. Vaccinations and Vitamin A supplements were paused momentarily to move everyone back into the shade, but a few spats were inevitable as mothers differed in their recollection of who came after whom. Despite the weather, the crowds, and being several months pregnant, Community Health Officer Erica kept a cool head and managed to see all 100+ children.
Attendance at that day’s CWC was slightly higher than usual because the community got wind that MoTeCH and Mobile Midwife registrations would be taking place. However, this is a pretty typical day for the staff at a CHPS (Community Health and Planning Services) compound. Long queues of patients and few health care providers mean that each patient encounter is relatively brief and formulaic. Provision of care is centered around the big killers—polio, diphtheria, pertussis, haemophilus influenza, measles, malaria, worms, malnutrition—but with such time and staffing constraints, there is little flexibility to respond to emerging and, even worse, emergent illness. Furthermore, how do they treat the patient who isn’t at the facility to begin with?
The very first release of MoTeCH takes steps to ensure that no one falls off the map by calling patients to remind them that they are due for care. MoTeCH also identifies the patients who are past due and notifies the CHPS staff every Monday morning at 8am by text message. Previously, it would take at least a month to know that someone has defaulted. This delay can be devastating in the delicate first months of life. And once you’re done manually processing all those hand-written records to identify the at-risk individuals, there’s no time left to track them down.
MoTeCH has the potential to transform health care delivery in the UER beyond mere efficiency gains, however. Patient records are currently bound into massive ledgers: one for children, one for pregnancies, and one for sick visits. The book you are carrying that day prescribes your approach to your patient. When you are carrying your Nokia 1680 Classic with MoTeCH version 0.6.8, you are pressed to think about the patient in front of you and determine what care that individual needs. Perhaps this 4-year old is here for a weight check, but as I pick him up to put him in the weighing sling, I notice he feels warm—how long has he had that fever and cough? A pregnant woman might come in with symptoms of malaria, only for you to discover that she hasn’t had any prenatal care thus far. Having more time is great. Spending that time doing the right work is even better.
--Posted by Amanda K Johnson. Amanda K. Johnson is a second-year MD candidate at Harvard Medical School working with MoTeCH for the summer.
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