A caucus vote delayed for days by a wonky app. Laid-off workers unable to file for benefits after a website crashes. Online conferences interrupted by uninvited third-parties. These are just a few recent examples of tech fails. If technology can cause such unintended problems in the developed world, imagine what a nightmare it can be in countries with unreliable electricity and limited IT pros.
At its best, tech improves our lives. Smartphones connect us to the world and guide us to remote destinations. With millions homebound, telemedicine has gone from an interesting concept to a vital, lifesaving tool. Yet in many parts of the world, simple solutions accomplish far more than complex technology.
The KISS Rule
Even in advanced economies across Europe, the World Health Organization admits that, “innovations are often assumed to be beneficial, but they may have unintended, and sometimes undesirable, consequences.” The “KISS” rule was first coined by engineer Leonard Johnson in the 1960s. An acronym for “Keep It Simple Stupid,” it holds that most systems work best if you keep them simple.
Transitioning to Electronic Health Records in the U.S. has done more than make patient data available across the country and even the world. It’s made it easier to read. Yet patients complain about doctors focused on tapping into a tablet. Doctors are upset about reduced interaction with patients. Some hospitals have increased admins after transitioning to electronic records. This may be why some health care pros use workarounds that let them rely on paper records. These challenges occur despite advanced infrastructure. What happens when you transition to electronic records in places without reliable electricity?
In the West African country of Ghana, patients wouldn’t just get a physical file during their first visit to a healthcare facility. They often got another one when they returned or if they went to a different specialty within the hospital. Some patients had files scattered across the facility. Because there was no central management system, patients waited several hours while their records were retrieved. Files were often lost or misplaced. Storage space was at a premium.
Switching to paperless records seemed like a no-brainer. And it was––if “no brainer” means “brainless.” Keeping advanced tech working often requires advanced training. In Ghana there simply weren’t enough IT professionals. Medical workers endured spotty wi-fi connections and even power failures. In 2011, some hospitals in Ghana switched to electronic records management systems (ERMS). Despite the name, ERMS does not require printed records to be completely digitized. Instead, the existing filing system is reorganized based on the medical staff’s capabilities. Bar codes on physical files let staff know exactly where they are. Retrieval times dropped to less than 10 minutes.
Software changes frequently. Paper can last for decades, which means even in advanced economies some physical records are always retained. Even in well-connected countries, paper might be preferred.
Some 95% of Kenyan adults have a smartphone. Yet when expectant mothers go in for an ultrasound, they want more than an image on their screen. In Nairobi, they often waited for hours because although there were ultrasound machines available, there weren’t enough skilled operators. Nairobi’s ReaMedica Health combines technology with local talent. They trained midwives to use GE portable ultrasounds. The images could be sent directly via Bluetooth to the expectant mother’s smartphone. For women from rural villages, it could be transmitted to their local healthcare provider. Because many providers use paper files, the company offered print-outs of the ultrasound image. Here simplicity did not win the day. The first print-outs were on ordinary paper. Unfortunately, the health care pros had only seen ultrasound images on thermal paper. Patients and their family members also wanted a high quality print-out. So, despite costing seven times what ordinary paper costs, ReaMedica Health began printing images with a photo printer and glossy photo paper.
Simplicity Wins
Good intentions aren’t enough. A child-powered merry-go round to pump water seemed brilliant. It gained media attention and loads of funding. Most of the 1,000 “PlayPumps,” installed in Africa were never used. There just wasn’t enough available groundwater to make them work. Medical innovations are similar. When U.S. hospitals donate equipment, they get tax credits. Yet in many places few people are able to repair advanced medical equipment when it inevitably breaks down. Sometimes the equipment isn’t even what the hospital needs and it sits idle, taking up room.
That’s why students at several universities are challenging themselves to produce medical devices that match a country’s economic reality. In Nepal, the problem is not a lack of incubators for premature children. At some hospitals, incubators sit unused and gather dust. The problem is lack of electricity. The students enrolled at Stanford University’s Design for Extreme Affordability came up with “comprehensive solutions to challenges faced by the world’s poor. Students learn design thinking and its specific application to problems in low resource countries.” Stanford grad students didn’t just devise a low-cost product. They did something many stateside admins never do. They visited the county. Spending time in Nepal helped them realize that they needed a simple device that didn’t require electricity. The portable infant warmer they developed functioned like a tiny sleeping bag. Its waxlike lining is heated by an electrical warmer that lets it maintain a 98 degree Fahrenheit temperature for eight hours. Even better, when electricity is unavailable another model does the same thing when it’s heated in hot water for 30 minutes.
Embrace Innovations–a nonprofit founded by the Stanford team–licensed the tech to a manufacturer while working with three nonprofit organizations who distribute them. Selling for around $250, the Embrace Infant Warmers have been used for more than 200,000 babies in 20 countries. It is not just a one-way street. Embrace Innovations now operates a company called Little Lotus that sells temperature-regulating sleeping bags, wraps, and blankets for healthy babies in the U.S. It also donates $10 of every sale to its nonprofit partners.
Written by John Bankston