Teaching, learning, and combatting HIV in Togo
A community health worker in Kara, Togo chatted with her patient in his home, leaving the paper forms aside for now to make the patient feel more comfortable. Had he been taking his medicine regularly? Did he have any concerns?
Meanwhile, Alicia Singham Goodwin ’14 — then a junior at MIT — sat in the background, listening closely and taking notes on the exchange. Elsewhere in Kara, two of her peers were doing the same.
As the conversation wrapped up, the health worker took up her pen and paper to jot down some notes, filling out the form as best she could. She moved on to the next of her five home visits for that day, seeing patients that ranged from new mothers to adult men to young children.
The patients were united by the fact that they all carried the human immunodeficiency virus — HIV. And the community health workers and the students shadowing them were united by the fact that they all were trying to improve those patients’ lives.
For Singham Goodwin and the other MIT students visiting Togo — a coastal country in Western Africa where around 3 percent of adults are living with HIV — that meant refining the system of care through technology. The students are part of the MIT chapter of GlobeMed, a national organization of university students that partner with local communities around the world to help improve healthcare and related initiatives.
“One of the big tenets of GlobeMed is that health is a human right; everyone should be able to access healthcare with no barriers,” Singham Goodwin says. “We work in places where that’s not yet a reality.”
GlobeMed at MIT was working with Hope Through Health, a US-based nonprofit that helps support the Association Espoir pour Demain (AED; in English, the Association of Hope for Tomorrow), a network of clinics that provides the only community-based HIV care available in northern Togo. The 15 community health workers for the clinics are trained members of the local communities who act as medical liaisons, providing home visits for more than 200 patients.
Throughout the year, GlobeMed students work to fundraise and plan for their next trip. Each winter and summer vacation, a few members of GlobeMed travel to Togo to continue the projects they’ve been doing. Those projects include building a patient database, improving basic computer literacy among clinic staff, mapping patient locations using GPS to track infectious diseases, and, most recently, finding a way to manage the vast and complicated data that arrived at clinics in stacks of paper forms.
When GlobeMed first arrived, the system for data collection was time-consuming and error-prone. Each Friday, a community health worker would return that week’s notes to the clinic, where the program director would compile all of them and type all of the data. Paper was costly, consolidating the information was tedious, and there was always the chance of error in the transfer.
The solution that the GlobeMed students chose was an existing mobile platform called CommCare — essentially, a smartphone app that could take the complex paper forms and turn them into a series of clear prompts that a community health worker could easily follow. CommCare was created by Dimagi, a company founded by two MIT alumni.
After carefully observing the health workers for weeks, the students built the forms into CommCare, furnished each worker with a donated Android phone equipped with the CommCare app, and began testing the new system. It took time to get it right.
“Building the forms was an iterative process that never would have worked sitting in Boston,” Singham Goodwin says. “Every week when we went out to watch a new form perform, we’d come back with lots and lots of modifications.”
The students also organized focus groups to hear what the health workers had to say about the new technology. “I think a lot of them were nervous to speak out about the work we were doing,” Singham Goodwin says. “We were foreigners, volunteers coming in with this crazy new technology that they didn’t necessarily understand. After we got to know them — became friends, went to their houses, visited their families — it was a lot easier for them to sit down with us, without their bosses there, and give us feedback.”
Eventually, the team landed on a system that worked smoothly. The flow of questions is comprehensive and natural, and common mistakes or typos are caught and called out: “Did you mean 20 pills? 200 is larger than the maximum prescription size.”
Even better, the app delivers all the patient data from each home visit back to the clinic in a tractable electronic format. “Now, the data all comes into the server automatically,” Singham Goodwin says. “It’s a better way to understand what’s going on with patients.”
With standardized, comprehensive, and electronic data available for each patient over time, the clinic and GlobeMed can work together to find patterns and uncover insights that may help them improve patient care. “I think we’ll learn things we didn’t even think about before, once we get to look at all this data we collected,” Singham Goodwin says.
Now an alumna, Singham Goodwin is working with the clinics in Togo with the support of a Fulbright grant. Twice a year, GlobeMed students will join her, continuing to use their passion for technology and medicine to improve HIV care worldwide.