Project Update, 20 Oct 2015

[Rodrigo Gidra]

Hello Everyone,

Our founder Ivan Gayton, our product manager Dan Cunninghan and our lead developer Ka-Ping Yee
are in a 2 week trip to Chad (https://en.wikipedia.org/wiki/Chad). The objective of the trip is to collect UX data
 and test the application in the field. When they return we will have valuable informations and insights on how to
drive our solution to address common field problems and better usability.

I want to share with you some moments they are having in the trip.

here some updates and photos from twitter:

https://twitter.com/dancunningham/status/653623932927496192
https://twitter.com/ProjectBuendia/status/653892482225336320
https://twitter.com/ProjectBuendia/status/654639962076356608
https://twitter.com/dancunningham/status/654637128752701440

talking to dan using our core team chat -
Dan wrote:

"On way back from Ngama! The tablet works! People are unused to tablets though, and very slow typing. We're thinking about giving typing lessons. And making a nutrition game for mums to take home and play and share with the dads too.

There was one urgent case who needed to be put on IV and sent straight to hospital (2 hour drive). They got the IV in on the 5th attempt. Pretty amazing. I hope the kid makes it.

We walked around the town and met people too, really interesting and the market practically overflowing with food, which begs the question: why are more than 5% of children here acutely malnourished?Seasonal and social factors appear to play a large part e.g. families who rely on subsistence farming getting into debt when they borrow food when their stock runs out, to be repaid (with interest) the following year, making their situation even harder each year."

"We just followed the morning round in ITFC. This is what it looks like!It's an amazing process to watch.5-6 people using 8 different forms in parallel, lots of copying of information into format specifically suited to facilitate each person doing their job for the day!Lots of interaction between different team members, especially doctors, nutrition assistants and nurse assistant. Nurses dip in and out really just participating for the really complicated cases, otherwise they basically know what they're doing and just get on with the job."

Ping wrote:

"MSF just put out this beautiful photo story about the situation in Chad. Lots of useful context. Highly recommended!"   https://msf.exposure.co/chad

Dan wrote:

"One of the babies died today :-( She was in a really bad shape when I saw her, very very thin and on Oxygen. She was drinking the high calorie milk from her mum and I thought that was a good sign. Half an hour later she died. She had only been admitted today after a few weeks of treatment from a traditional healer and she had quite bad scars on her legs from that.So sad and what a waste of a little girl's life.Another little boy who was in ICU yesterday is now doing so much better, transferred to the less intensive ward and sitting and smiling. He loved playing with the tablet and seeing his face in the camera. He was crying when I had to take it away. I hope he'll get a chance to use technology like that again soon.Amazing seeing children get better so quickly with some quite basic treatment and a brilliant team.Yesterday we heard in a workshop we ran with a wide cross section of the team that one of the key benefits we can facilitate is a much greater ability to discuss cases with information at hand, helping them really work as a team and make decisions based on a complete picture of the patient's story. "

Dan wrote: "something incredible happened this morning which I think is our strongest evidence yet for the value of Buendia.We had picked 3 patients in the ITFC at random and fully entered their entire history - two from the moment they were referred from ATFC and one who I’ve been following all the way from when they first arrived at a remote clinic on Thursday.The morning round had finished (2 doctors and they do half the patients each) and we planned to have Emanuelle (the expat MD) try repeating the morning consultation for those patients **without using the paper chart** - just using the tablet.The MD opened up the first patient’s chart. The first thing he wanted to see were the other doctor’s notes from the last few days. This wasn’t easy with the current design (@nadav your notes design with the ability to scroll back through all the days I think would have been ideal for him). After that he looked up and down the observations and he immediately saw “we have a problem”. The child had a high fever - which had not been acted upon by anyone - and their weight was not improving - in fact it was at the lowest point it had ever been and significantly lower than even when they were admitted into ATFC!Swiftly we switched from a testing session to the MD coordinating emergency action for the child. Nurses were called to check his temperature - 39C! - and put him in a wet towel.This child should not have been in Phase II with a high fever and sustained weight loss. He was on the wrong medication, nobody had acted on his high temperature, and furthermore it was discovered on closer examination of the paper notes that lab tests for malaria had been ordered several days ago and never been carried out.A smear test for malaria came back positive.So what happened?What Emanuelle could spot was the relationship between weight graph, MUAC and temperature that triggered alarm bells for him. The layout helped this, as did the colouring.We saw that a well-designed presentation of information really did trigger possibly life-saving action in a way that the paper system - as they are currently using it - had not done.

It seems that the doctors have their side of the chart (scribbled notes) and the nurses have their side of the chart (observations) - and then the nurses have their own notes on what each patient needs doing each day - as do the nutritionists.Everyone’s working off the bit of paper optimised for doing their job and there’s really no single consistent view of the patient. The system on the surface of it looks like it works - and usually does - but I can see why it’s quite easy for things to be missed - especially at busy times and there are not enough nurses"

and this was the last update so far from our team in chad.
Soon we will post more about the trip!

Rodrigo