The Clinical study of "the Hemoglobe project"

The Clinical study of "the Hemoglobe project"

Anemia contributes to more than 100,000 maternal deaths and 600,000 newborn deaths each year. To save lives of these mothers and newborns, Jhpiego and our program have developed HemoGlobe, a low-cost anemia screening tool. The HemoGlobe has a finger clip sensor and a cell phone in its system.

At this stage of the development process, we are assisting the HemoGlobe field study to collect hemoglobin readings from the gold standard blood-draw test and use these values to improve training of the HemoGlobe machine learning algorithm.

Colonel Bannerjee and Mr. Anil (center and right of center in the above picture) were instrumental in organization of the event, logistics and getting the word out in the Sundarbans. This resulted in nearly 140 people showing up on the first day.

We enjoyed our off-road trip to each village. On your right, you will see that in order to get to the last-mile india village is quite an adventure.

Children there are very excited to have us. We were chatting with them, but with our physical language, smiles and laughters.

Introduction to Rural Medical Practitioner (RMP) 101

Introduction to Rural Medical Practitioner

Our first introduction for the Rural Medical Practitioner (RMP) was met with some shocking insights. First of all, the RMP are the group of people who are known as the “local doctors.” They have their own medicine shop and typically RMP have the capability to prescribe medications and take basic medical readings such as blood pressure, temperature, examine abdominal pain. Typical illnesses they treat are diarrhea, headaches, cold, cough, malaria, dysentery, and typhoid.  From there the RMP usually prescribes medication and charges only for the prescription.
training.

We used the "van" as a transportation to visit each RMP's kiosk. It a van without a shock absorber. It feels like we are in a race car; the car tells you every detail on what's going on on the road surface.

 On your right is the kiosk of one of the RMPs. It a pretty small chamber which can fit 3-4 people at a time. There are no A/C or fans. It has a load of medicines ready to prescribe to villagers.

At the back of some kiosks, they have beds for IV patient. Most of those patients have diarrhea and need IV treatment. Those beds do not have any fancy things but a simple flat wooden table and a beam to hang the saline bag.















Team Kolkata Nights

First stop: Sundarbans

We just got back from being in the jungle and we are back in Kolkata.  But the trip into the jungle and rural areas of the Sundarbans has been adventurous and quite informative into the rural health care of India.

Our first stop in Sundarbans was Bali, the village, where the Hemoglobe study was conducted along with pursuit of exploring the health care situation of Bali. To reach Bali a boat is required, but before we landed at our base, we had the opportunity to spend the afternoon sightseeing. We have seen kids biking to their school who were sharing the same narrow-road we were riding on.

In about 3 hours, we arrived at the dock. We boarded the ship with the help of crews holding our hand to the boat. The everyone on the boat was a little weary, just prior to our trip we were informed of a tiger attack in the pass few days and we have literally read that on the news paper. Even with the recent events we set out to trying to catch  glimpse of a crocodile or the famous Tiger in their natural habitat. Fortunately, we have seen one giant crocodile sunbathing on the river bank, but, suddenly he jumped into the river. We missed to catch the good shot of him.

The river we've travel along is very wide. The depth is about 100ft. The water is saline. This area is the biggest mangrove forest in India which produce the significant amount of oxygen for Indian citizen.

And just before we are about to arrive at our destination, we spotted a deer! She was so beautiful. We stopped our engine and glide through the river slowly to get closer to her. This was the gift of our day.

Let's end the day with our ditty written by our group member, Sriram.

"When it rains, it pours.
Tiger always roars.
Crocodile slides with jaws open
To welcome us to the Sundarben.
Lives and babies on the way,
Doctor is hours away,
CBID mHealth kiosk will save the day."

Have a good day,
Kolkata Nights

Kolkata Traffic

Kolkata Traffic
The past few days have been eventful for the mhealth kiosk team.  We are continuing to interview with experts in providing healthcare to the rural areas of India.  We have  been gaining valuable insight and well rounded view of the difficulties in the task at hand. There have been different views of the rural health care providers (RHCP), who are currently a unregulated provider to the rural areas. The many problematic aspects we are exploring include incentivisation using political agenda and monetary intake. There is a social and culture background that limits and keeps the people of the rural area apprehensive of outside people. Another aspect is the possibility of RHCP to misuse the technology and allow the RHCP to diagnose the patient.  Because of the lack skills from the RHCP it is not recommended to have RHCP diagnose.

Today the Kolkata nights worked on understanding and getting familiar with a current medical kiosk model. Our job is to determine, using some mini testing and experiments, if the new technology is ready to implement into the rural areas.  We were playing around with the current technology used in our current medical kiosk model, the "ReMeDi" from Neurosynaptic company. The ReMeDi provides 5 forms of diagnostic medical data: Blood pressure, SpO2, Temperature, Digital Stethoscope, and Electrocardiogram (ECG). When we reviewing with Neurosynaptic technical personnel on getting comprehensive training in using the equipment. Our final conclusion will determine if this technology will be acceptable to implement into the rural areas.

Sincerely yours,

Kolkata nights

Welcome to Kolkata

Kolkata Nights Enter Kolkata

We finally made it to Kolkata around 5 am today. The first obstacle begun.It seems like we cannot fit 2 of March's and Sriram's luggages into the taxi's trunk. We ended up with using a old red towel to tie up the trunk.

Jet lagged and sleep deprived we grabbed a breakfast from the exquisite Tolly Country Club where we will be calling our base camp for the next two and half weeks. With no hesitation from our group we joined Dr. Acharya to partake in a tour of the Medica, a private hospital in Kolkata.  The tour and meeting with some of the faculty provided us with insight to the private health care system along with details concerning the government health care system.


In the context of our mHealth project focus, we met several doctors who were more than excited to talk about recent relevant developments and their experiences from the field. Dr. Ehsaan introduced us to the recent work of Fortis Delhi, who have implemented a telemedicine practice in which first-year medical interns provide personal care to patients under the remote supervision of an experienced doctor. While this may or may not have immediate implications for our mHealth work, the fact that the concept has been validated is good support for us should we require a similar model. Dr. Bannerjee shared with us several stories about his work in rural India: how rural medical practitioners in some villages are extremely respected by their patients, and in some areas met with extreme skepticism. Dr. Sata, whom we had lunch with, further elaborated on the difficulty of leveraging such a diverse stakeholder group:

- Who do they reach, and how much are they trusted?
- Who do they trust, and send their patients to should the need for referral arise?
- Why should they trust us when we could encroach on their customer base?
- How do we set up a sustainable value chain for the buyers and providers in this large but disjointed ecosystem?

As we continue our travels and explorations of the Indian healthcare system, hopefully we'll be able to start answering these questions and inch towards a real healthcare solution for the people of India who most need it.



Team Kolkata

Introduction to the Projects

THE BEGINNING (poem about the bond of motherhood)
“Where have I come from, where did you pick me up?” the baby asked
its mother.
She answered, half crying, half laughing, and clasping the
baby to her breast-
“You were hidden in my heart as its desire, my darling.
You were in the dolls of my childhood’s games; and when with
clay I made the image of my god every morning, I made the unmade
you then.
You were enshrined with our household deity, in his worship
I worshipped you.
In all my hopes and my loves, in my life, in the life of my
mother you have lived.
In the lap of the deathless Spirit who rules our home you have
been nursed for ages.
When in girlhood my heart was opening its petals, you hovered
as a fragrance about it.
Your tender softness bloomed in my youthful limbs, like a glow
in the sky before the sunrise.
Heaven’s first darling, twain-born with the morning light, you
have floated down the stream of the world’s life, and at last you
have stranded on my heart.
As I gaze on your face, mystery overwhelms me; you who belong
to all have become mine.
For fear of losing you I hold you tight to my breast. What
magic has snared the world’s treasure in these slender arms of
mine?”
Rabindranath Tagore(India (and Bengal)'s first Nobel laureate)

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As we read about of the love of a mother for her child in Tagore's verse, we are reminded how beautiful and precious this bond is. A very basic requirement for it to flourish is for pregnant women and newborns to be healthy. 

Our team travels to eastern India to broadly work towards that end with following specific goals:

1. Collect data from study to improve accuracy of HemoGlobe.

Anemia is a persistent global health problem affecting millions of mothers and newborns and contributing to 100,000 maternal and 600,000 newborn deaths annually. JHPIEGO and JHU-CBID are developing a community-based screening tool HemoGlobe that transforms rural health workers' cellphones into non-invasive, prick-free hemoglobinometers. Concurrently, GPS information can be transmitted to the cloud for display via Google maps on PCs, laptops or smartphones anywhere. This feature can be used for better targeting of public health resources to areas with high prevalence of severe maternal anemia.

Hemoglobe Trailer

2. Validate the Clinical decision support system concept for RHP.

One often underrated but important provider of health care, including anemia detection and treatment, in Indian rural context is the rural healthcare practitioner(RHP) or rural medical practitioner(RMP). By augmenting his last mile reach of rural patients with a modern and accurate clinical decision system, we can potentially create dramatic change in healthcare delivery to individuals in rural areas who are otherwise least likely to obtain proper diagnosis and treatment.

Team Kolkata