Observation's from MoTeCH First CWC Outreach - July 6, 2010

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. 

Training Nurses on MoTeCH, by Williams Kwarah

Though the use of mobile phones is permeative in my community today, its application in healthcare delivery is remote. It has never crossed my mind as to how to use a mobile phone to deliver useful health information to clients and health workers until I joined the MoTeCH team about a month ago. There, I began to appreciate the dynamism of technology, that a mobile application will not only ease the work load on the nurse but will regularly send useful and time-specific information to the pregnant woman and children. This is a wonderful innovation which will go a long way to improve the health status of rural communities. Indeed, access to health information is one major constraint that accounts for most unfortunate occurrences in healthcare delivery in rural communities. Thus, I do not only see MoTeCH as a means to unburdening the workload of the nurse and disseminating information to pregnant women and children, but an appropriate and cost-effective intervention that will promote health education in impoverished communities.

Working with Grameen Foundation is a rare opportunity that will push me into new directions whilst at the same time consolidating my vast medical experience with technology. I see it as a chance to indirectly contribute to the provision of quality healthcare services to my people.

Over the past 3 weeks, the team has been training community health officers (CHOs), midwifes and other supporting staff in the selected CHPS zones and health centres on the use of the mobile phones. These training sessions were interspersed with durbars which all fun to partake.

TRAINING

It is amazing to note that although I have not received a formal one-on-one training on the use of the MoTeCH mobile phone system, except for a couple of non-formal sessions with Maria (MoTeCH Field Officer), the system is intuitive enough for me to have been able to learn it very quickly. I have therefore participated in training the nurses in a comprehensible manner that is overwhelming. I felt honoured when I was called to take some august visitors from Monitor Group, South Africa, to see how MoTeCH was training health staff on the use of the mobile phones. I took them to Kajelo CHPS compound. There, I took the nurses through a complete training session while the visitors observed. Afterwards, the nurses were singularly interviewed. This was a great moment to interact and meet with new people and to demonstrate how MoTeCH will be working in the field. I was delighted to realize the visitors were impressed by everything; that gives me more strength to go on.

Overall, the training of community health staff has been very interesting. Most of the younger staff readily pick things quite easily, (they can use the appropriate forms when given simple and complicated scenarios), whereas the much older midwifes have various levels of difficulty. Most find it difficult to even access the MoTeCH application in the phone. Thus, for them, we have trained other supporting staff who will assist them.

Left: Williams training a midwife at Sirigu Health Centre

Notwithstanding the above challenges, we have trained virtually all the staff target to use the mobile phones on two separate sessions.

At the end of the week, we also took all mobile phones that were given to these nurses for practice back to base for configuration prior to final deployment. We also took note of the various outreach dates and venues for the various facilities to enable us plan adequately for launching and mass registration.

DURBAR

In the course of the week, we participated in a Durbar at Nayagnia to commission a CHPS compound. The event was grand with the Upper East Regional Minister, the Regional Director of Health Service, Kirsten Gagnaire (Project Manager, MoTeCH) and a host of others from Columbia University, DHMT etcetera present. The community turn-out was great! The people drummed and danced with ecstasy. Unfortunately, I did not get the opportunity to dance to the local tunes. I hope to get that some other time. I had to leave the grounds with the team just in time to have a training session at Chiana and Katiu.

Williams Kwarah is a MoTeCH Field Officer, and who very recently joined the project. He is from Navrongo.

Videos of MoTeCH Durbars

Some videos of the MoTeCH Durbars in the Upper East earlier this month have now been posted on YouTube for the enjoyment of all of those who could not attend:

http://www.youtube.com/motechghana#p/a/u/1/t87pV4fF2Jk

http://www.youtube.com/motechghana#p/a/u/0/2miVcu68HPQ

Anoinette's Journey Home to the Upper East with MoTeCH

I joined MoTeCH not long ago. I believe it was the right time though as I had the opportunity to travel with the MoTeCH team to the Upper East region to train nurses on how to use mobile phones to register patients, especially pregnant woman and children under five years; to educate people from the eleven implementation CHPS zones about MoTeCH; and to launch the MoTeCH project, which intends to enable these community members to get better access to healthcare service delivery and information to improve upon their lives.


Growing up in the Upper East region, to be precise in Navrongo, I realised access to community healthcare service delivery was a problem in the past. It has always been my dream to help improve this precarious situation or be part of a system that strives to unlock the persistent high level of poor health service delivery in our society. Thanks to Navrongo Health Research Center for improving healthcare service delivery in various communities. Ghana Health Service has also saved the situation by providing additional clinics and CHPS compounds at various communities in the district.

I have also grown to understand the needs of the people of Kassena-Nakana West district. I have realized that healthcare service delivery is a basic need for the people in the district. However, I believe that introducing MoTeCH to the district will make a great impact on the lives of the people of Kasen-Nakana West district and Upper East Region as a whole.

DURBAR
The people of Navrongo speak commonly Kasem and Nakam. They are very friendly and hospitable. I had the opportunity to interact with some communities during our durbars. I realized that organizing durbars in the communities is an effective way of communicating with the community members. During the durbars I got convinced that the messages about MoTeCH went down well with the people based on the question they asked, though there were some few issues in relation to Ghana Health services.

What interested me most in the various communities were the traditional songs, drumming and dancing; after a very long time I had the opportunity to rehearse my traditional dancing skills.

TRAINING

Training the nurses on the mobile phone was yet another aspect that exposed me to new things about the mobile phone technology that MoTeCH will be deploying. I found the training very exciting, because the nurses found it very interesting and were excited about the impact it could have on their work. Nurses were smart in understanding the operation of the phone and the various studies very quickly. We encountered poor network services which makes uploading data into MoTeCH system sometimes difficult. I think this will be a challenge for MoTeCH, though fortunately nurses can save forms on their phone to upload later when they have network. Some of the nurses raised the concerns of their facilities not having electricity or solar panels to enable them to charge the phones. Notwithstanding these few challenges, so far things are moving on well.

-- Posted by Antoinette Akanlise - MoTeCH Support Center Agent

Consumer Research/Field Data for Ghana

This site has a lot of information to inform design of applications and services for Ghana.  Thought it might be of interest to others:

http://www.audiencescapes.org/country-profiles/ghana/ghana/communication-profile-317

Maternal and Child Health News from Ghana

Upper East Region Midwife wins Midwife of the Year award from Jhpiego:
http://www.theworld.org/2010/06/11/midwife-of-the-year/


Family Planning in the Upper East:
http://www.ghananewsagency.org/s_health/r_16663/

Abigail's First Journey to the Upper East

There is always a firs time to do something and I had the opportunity to travel to the Upper East region for the first time, precisely to Navrongo. Since it was my first time to travel that far, I decided not to sleep on the way so that I can look at things on my way through out my journey. Personally for me it was a sightseeing journey. On my way to UER, just at Tamale I noticed that most people are using motor cycles and bicycles. Traffic wardens give way to these cycles to go before the cars, I found that very interesting especially the way they direct the traffic, because in Accra there is nothing like that. Also I realized that animals like sheep, goats, donkeys and cows cross the road most often.

PURPOSE FOR MY JOURNEY
Finally, I arrived in the UER (Navrongo) where our project site is and the main reason to be here is to train nurses in each of our selected CHPS zones, launch the MoTeCH project and then register patients on MoTeCH.

ORGANISING DURBARS

Due to the low level of technology and undeveloped areas in the UER, communicating information to the people effectively is through durbars. So far I have enjoyed all the durbars I attended and I have learnt new things about these people and their tradition. Some of these things are:

• At their durbar grounds the women sing to welcome us, even to the extent of bowing down to greet us. The men also drum and dance to welcome and greet us, they do this separately.
• In most of the communities I visited, they have used calabash and sheep’s skin to make a drum. The drums are played accompanied by whistles curved from wood to produce good sounds for dancing.
• They perform a “strength needed dance”, that believe me you need extra strength to this dance. Honestly, I tried to learn their dance but I didn’t get it so well because it needs so much strength.
• Talk of their environs; I call it nature at it best. A lot of baobab trees , Shea-nut trees with lots of cows, sheep, goats, pigs and donkeys grazing and some taken to the farms by the owners to carry their load to their homes. Also you find the birds also feeding on these cows, sheep etc.
• They have these fascinating names for their communities such as kayoro, Kurugu, Mirigu, nyanyai, ketui, kajelo, kananai etc.
• Languages spoken here are Kassem and Nankam and I have decided to learn the languages while am here. I have started with Kassem and here a few of the common ones spoken often.
• Good morning - Din Wor
• Good afternoon -Din wi
• Good evening -Din didan
• General greeting -din l
• Sorry -Din la
• Thank you -Akin le

TRAINING OF NURSES AND PREPARATION TOWARDS THE LAUNCH

So far, so good! The training is going down well with the nurses and they are finding it very interesting. They hope it is really going to ease the pressure and then feel good about their work. Also the people of these communities are also very welcoming and ready to join MoTeCH for this wonderful and quality health gaining project.

We are still training the nurses and preparing for the official lunch of the MoTeCH project in the first week of July. Like I said earlier on that, so far it’s been very good and we are hoping to achieve the best result out of this project.  

I am really enjoying my stay here, thanks to MoTeCH!

--Posted by Abigail Annang, MoTeCH Ghana Administrative Assistant