BLIS Project Now in Pilot Phase in Cameroon
The Computing for Good BLIS project is now in a 90-day pilot phase with 3 laboratories in Cameroon using it daily. A similar effort is likely to begin soon in a few laboratories each in Ghana, Uganda and Tanzania. This post is a day-by-day summary of Dr. Santosh Vempala’s trip to Cameroon in late April to deploy the pilot system.
Thursday, April 29, 2010
I had my first full day in Cameroon today. I arrived last night and will be here till May 6th. I will be spending many hours working with laboratory technicians and administrators, installing, and evaluating BLIS and launching a pilot in several labs.
The enthusiasm for the system is quite remarkable. They have already been trying out and giving us feedback on earlier versions sent by email. To ensure the French-speaking regions have no difficulty, we added a language option where each lab can choose its default language and set up all its terms in that language.
Beyond strengthening lab capabilities, saving time for technicians and improving capacity, reducing errors and producing timely reports, folks here are very excited about the possibility of viewing aggregate data and finding patterns (I am too!). Designing this system for a resource-constrained setting might ultimately lead to a system that does more than what systems in technologically more advanced countries do!
Our implementing partner here, an organization called Global Health Systems Solutions (GHSS) will carry on the work of support and maintenance (updating versions, answering questions etc.).
Friday, April 30, 2010
Today was an eye-opening, super-rewarding day. I started at 6:30am local time, spent the morning in the Buea regional hospital lab. The technicians and managing doctor are all very enthusiastic, willing to both maintain their multiple record books and use the system. It finally occurred to me that the right way to do this is to mimic the lab workflow and the person doing the patient registration and reporting back to the patients (a clerk) should be the one doing all data entry so that there is no duplication.
In the afternoon, we went to a large hospital in a French-speaking region (h’opital Laquintinie). The lab here has a whopping 40 technicians and two buildings. They use 4 record books and several forms for each sample/patient.
Most of the technicians and even the managing doctor do not speak English fluently, so it worked out great that we had a language configuration option, where they get to translate everything into french, term by term and then their users have an effective French system. They were so enthusiastic that they are coming in on Saturday (happens to also be Labor day, a major holiday here) to work on the system. I will be there all Saturday starting at 8:30am!
Saturday-Sunday, May 1-2, 2010
We worked from 8am to 2pm, having them execute various tasks on the system, provide feedback, come up with a plan for the laboratory workflow etc. Being a large lab with 40 technicians + clerical staff and 2 buildings, this wasn’t an easy call. In the end, we decided that BLIS would sit in the patient/sample registration building, saving the work of having to record in log books and lab results would be brought back to this desk as they currently are.
As soon as they have a reliable local network, we’ll have C4G BLIS running on their LAN so that staff in the lab can enter results directly. The director, Dr. Madeline Mbange has already given us very good improvements to make. If we can make BLIS work in this large, french-speaking, independent-minded lab, I think it will work anywhere.
Later that evening I met one of the staff members of our local support team, who introduced his family and friends (they have no running water in the neighborhood and no lights in the public alleys); over a drink they realized I like football (soccer), and invited me to join them Sun morning.
So I got to play Sun morning at 6am with a very good team, a full 90min game, with no halftime. Cameroon is an excellent soccer-playing country, and just about everyone plays (well, the men); the public field we played on was the same one where their current superstar Samuel Eto’o played growing up!
We set off at 9am to go to Bamenda, a North-Western, English-speaking town of just under a million people, 5 hours away. We start work in their regional hospital lab at 8am Mon morning.
Monday, May 3, 2010
Monday, the 5th full day of my visit to Cameroon, was at once the most saddening and the most inspiring. I got to see the inner workings of a laboratory for a regional hospital with an HIV ward, a TB section, a blood bank plus the usual lab sections. I got there at 8am and the lines were already long. Patients come to get their samples taken and tested and await results. Those going to the HIV section get counseling before and after their HIV tests. Depending on the level of the virus, they might be put on anti-retroviral treatment. The waiting areas were packed with people and flowing outside.
In this desperate setting, all record-keeping is done in multiple log books. Well, hopefully not for long at this hospital. Several lab technicians (about 10) and the lab supervisor all tried C4G BLIS (basic lab info system) and the common reaction was eyes lighting up. If all goes according to plan we’ll be able to save hours of waiting time per patient, sometimes days. This is in addition to reduced errors, increased capacity and the ability to view aggregate patterns. We worked from 8am to 5pm understanding the lab workflow, figuring out where to place computers and how to make things as easy and efficient as possible.
Tuesday, May 4, 2010
Today we headed back to Buea, stopping en route at Nkongsamba regional hospital, which is not one of our 4 pilot labs but was keenly interested in having an advance copy of BLIS for trying out! They specifically requested that we make a stop on our way.
It was touching to meet all the staff and see their eagerness to embrace new methods. They even had a small surprise party for us. If the pilot goes according to plan, this hospital will be in the first round of hospitals BLIS will be rolled out to. We returned to Buea by 5pm and went straight to the lab to install the latest version (we’ve been making changes every night of my visit here). Tomorrow at 9am is the official launch.
The launch went off as planned, was written about in Cameroon’s paper The Post and mentioned on TV. Within days, Buea started registering and giving out reports via C4G BLIS to every single patient coming to the lab. We’ve been rolling out program updates once or twice a week, and expect to make this less frequent over the coming months. We’re also trying to put in place a thorough evaluation system for a 6-month period.
There’s a long way to go, but many thanks for getting us this far to the International Lab Branch of the CDC in Atlanta (lead by John and Mark), to the C4G class team that was a great help to Ruban and me, to supportive lab staff and directors (Dr. Mouladje, Dr. Mbange and Mr. Chi) and administrators in Cameroon, a high-quality local CDC unit (lead by Judith) and a very competent implementing partner (GHSS, lead by Patrick, and his staff, Sidney, Ngale, Beatrice and Eric).