Adding Automation in Kenya

The Gynocare Fistula Center was opened by Dr Hillary Mabeya in 2011 as the second clinic in Kenya capable of repairing obstetric fistulas in women.  Wikipedia defines an obstetric fistula as a severe medical condition in which a fistula (hole) develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available.  Before starting my PULSE assignment at Gynocare in June 2012, I had never heard of this condition.  I am hardly alone among Americans or Europeans where adequate medical care equates to the availability of Caesareansections (c-sections) during childbirth.

In Kenya having a c-section or even a physician present are not options available to most women.  In rural areas teenage girls are often married off to middle aged men in order to provide a dowry to the girl’s family.  For the man, this may be his second wife.  The bodies of girls who get pregnant at 14 or 15 years old are often not developed enough to deliver a full-term baby.  The standard for childbirth in remote villages is often a midwife who is unlikely to have received any formal medical training.  The midwives often push on the stomachs of women who have been in labor for many hours without delivery, rather than take the woman for a c-section.  In many cases a fistula tear occurs and the baby dies.  Fistulas also occur in older woman who may have delivered multiples times.

The Non-Government Organization onebyone sponsors fistula repairs at Gynocare by raising money in the western world.  The cost of a repair is approximately $500 per woman which includes surgery and recuperation at the on-site ward.  Woman often stay in the ward for weeks during their recovery.  In order to assist with fund raising, onebyone needed to collect better information on the fistula patients.  Through the PULSE program onebyone requested an Information Technology (IT) resource that turned out to be me.  Gynocare did have some technology that we have come to accept as normal resources in our homes & offices.  What was available were a few older model computers, unreliable wireless internet, and inconsistent electricity.  There were stories of Dr Mabeya completing surgeries using a headlamp when blackouts occurred during surgery.  Gynocare had never had anyone with an IT background available to them before.  I was immediately hit with requests for installing software, fixing slow computers, and updating their website.

The main objective of my assignment was to automate the collection and reporting of fistula patient data.  Onebyone had partnered with a Microsoft spinoff company called Capturx to design a coded form of patient data.  Using a digital pen, handwritten text and data from fields could be collected and eliminate the manual data entry step.  The digital pens work like regular pens but store data inside the pen.  The pens are then connected to a laptop and the data is imported into Excel.  The coded forms allow the pen to distinguish data from patient X on page 5 from patient Y on page 10.  This technology was perfect for a clinic with very few computers and no networks connecting them together.  My job was both trainer and programmer.  I worked with staff members in the reception, nursing, surgical, and counseling groups on how to use the pens to complete their specific areas of the form.  I worked with the office administrators on how to import and edit the data on a daily basis.  Most of these people had very little experience with Excel.  I had to design and write reports that could be sent to onebyone on a monthly basis using the cloud for central storage.  This reporting is critical for onebyone for fund raising and analysis of the patient data.

After a few months of form revisions, testing and more Excel programming than I’ve ever used, it was time to start capturing data.  The results are startling compared to what we consider “normal” families in the west.  In the first two months, 63 women from 16-74 years old had fistula repair surgery.  There were 179 total births with the number ranging from 1 – 12.  The number of women with atleast one stillborn birth was 24.  The lowest marriage age was only 14.  Gynocare has plans for expanding its reach throughout Kenya and adding more surgeons.  Currently Dr Mabeya is the only surgeon and works an incredible number of hours providing this valuable service to these women.

Through my Pulse assignment I got to experience a beautiful country and work with very friendly and caring people.  The IT work was not overly technical except for the digital pens that work like magic.  I was forced to step outside of my normal role and be a 1-man IT shop.  I see the women recovering in the ward everyday as I goto work in the clinic.  Knowing that my work contributed to helping improve their lives was very fulfilling.  I hope that onebyone can use the data to improve their fund raising and find insights that can help other women before they suffer a fistula.  In Kenya I was able to see firsthand the reputation GSK has around the world.  Many people are familiar with our products and efforts to make the world a better place.  I benefited by taking our malaria pills.  I now look forward to returning to my family, GSK with a more global perspective.

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