In the mountain highlands of western Uganda, Kikanda Batelemao, a community health worker, walks along a rugged dirt road to visit Florence Mbambu, a pregnant woman living more than 35 miles from the nearest health clinic. With every step he takes, he is helping to lead a healthcare revolution: a revolution that is transforming healthcare delivery in some of the poorest and most remote places on earth.
In his pocket, Kikanda carries an old cellphone, but on that simple phone he carries the means to bring new hope to the patients he visits. That phone carries with it the possibility to make healthcare accessible to everyone, no matter where they live or how little money they make.
Located just north of the equator, nestled deep in the Rwenzori Mountains of western Uganda, is Bwera General Hospital. Bwera is a public hospital administered by the Uganda Ministry of Health. Here, in one of the poorest but most spectacularly beautiful places on earth, extremes abound. The ratio of doctors to patients is just 1:100,000. Paved roads are few and far between. Electricity is a luxury enjoyed by only a few. But almost everyone, in even the tiniest and most remote villages, owns a cellphone. And cellphone towers are ubiquitous, marching across the landscape in every direction.
For Josh Nesbit, a premed student working one summer at a clinic in Malawi, Africa, the sight of those cell towers would change his life. As he watched pregnant women walk 50 miles or more to see the single doctor in his rural clinic, he also noticed that his cellphone got better reception than it did in San Francisco. Nesbit realized he could use that insight to fundamentally transform and improve healthcare delivery in Africa and other developing nations. The result of that epiphany is Medic Mobile, the organization Nesbit co-founded after returning to the United States in 2009.
“There are a billion people who lack access to healthcare. There are 300,000 women who will die in childbirth this year. And there are at least 10 countries where one in four children will not live to age five. Those are all linked, and they are all unacceptable. Being poor should not mean that you have poor healthcare.”
— Josh Nesbit, CEO, Medic Mobile
Learn more about the VMware technology that powers Medic Mobile’s health care vision.
The genius of the Medic Mobile approach lies in its simplicity. “For those of us who work in these communities,” says Dr. Danny Devito Gotto of ACODEV, “we need something that is simple to use, cheap to use, and readily available. We have mobile phones,” Gotto continues. “We have community health workers. We have clinics. The problem is linking the three together. That is what we love about Medic Mobile.”
Josh Nesbit, Medic Mobile’s CEO, realized that a cellphone could dramatically transform healthcare because it allowed community health workers in remote villages to communicate, in real time, with the rural clinics they served. But there was a technical challenge that needed to be overcome first. The problem was how to deliver the healthcare platform to everyone who needed it. “We realized that we couldn’t possibly support every deployment,” Nesbit says. “We needed to make the software radically accessible to any clinic anywhere that needed the tools to be successful.”
The solution Medic Mobile devised was to build a mobile healthcare management system that could be installed in a snap on a mobile phone, and runs on a Linux-based VMware® Workstation Player™ desktop virtualization platform. It hosts the Medic Mobile software tool kit, a tool kit that combines smart messaging, decision support, easy data gathering and management, and health system analytics. The result is a variation on the concept of software as a service (SaaS). As Nesbit says, it is instead, “Software Is a Service.”
Working with VMware, Medic Mobile developed a modified SIM card (often made with a tool as simple as a pair of scissors) that can be inserted into any regular cellphone manufactured after 1992. Medic Mobile calls the device a parallel SIM card. This hardware device is a microcontroller that allows the community health worker to run the Medic Mobile software tool kit apps.
VMware enables the Medic Mobile tool kit to be used in almost any kind of environment, support any language, and work with or without internet connectivity, locally or in the cloud. Medic Mobile also uses the VMware virtual infrastructure extension (VIX) to automate the delivery of its healthcare apps where internet connectivity makes that possible. VIX allows the Medic Mobile system to automatically send and receive SMS (text) messages over any cellular Wi-Fi network.
Working with Prasanna Nanda, a VMware engineer in the Take 3 (T3) program, and VMware R&D team engineers, Medic Mobile designed these tools to work on the simplest of mobile platforms: the inexpensive cellphones that are widely available even in the poorest countries of the developing world.
“It’s not medical innovation. It’s a system innovation and a delivery innovation. It’s rethinking who’s providing care for whom.”
— Josh Nesbit, CEO, Medic Mobile
Prasanna Nanda is a leading Development Operations Engineer at VMware. A few years ago, he decided to enter VMware’s Take 3 (T3) program. This program allows VMware executives and employees to take up to three months to work on a project of their choosing. Nanda determined that he wanted to use his skills to develop something that would “help a lot of people,” he says, “and make an impact.”
The Take 3 program introduced Nanda to Medic Mobile. Over the next several months, Nanda delivered on his personal mission. He helped Medic Mobile develop a virtual appliance to run Medic Mobile’s free, scalable software tool kit. Aided by R&D volunteers and complete support from VMware management, Nanda also helped solve key software development problems for Medic Mobile, including creating the ability to integrate previously incompatible healthcare software systems so that they could work together in the Medic Mobile VMware Workstation Player platform.
Nanda shares all the credit with his VMware co-workers and the support of VMware management, without whom, he says, he could not have done what he did. When asked why he decided to devote his time and skills to Medic Mobile, Nanda simply says, “I learned what they do and how they work, and I asked what I could do to help.”
More than 10,000 health workers in 23 countries in Africa and Asia use Medic Mobile’s tools today. These 10,000 health workers care for more than five million people living in the poorest and remotest places on earth. But Josh Nesbit is not satisfied. “We have really ambitious five year goals,” Nesbit says. “By the year 2020, we want to be supporting 200,000 health workers and improving healthcare for at least 100 million people.”
Medic Mobile is driving a revolution in healthcare delivery by addressing the most critical delay for millions of people worldwide: their decision to access healthcare. As Dr. Danny Devito Gotto of ACODEV explained earlier, the ability to communicate healthcare data in real time makes a tremendous difference, often between life and death. Because of this, Gotto says, “Medic Mobile is the future of healthcare in Africa.” The same could be easily said about Asia and the poorest and most remote communities of North and South America as well.
Nesbit says that Medic Mobile is taking advantage of what he calls a “really amazing moment in human history, where a new technology and a new infrastructure was spreading faster than anything we had ever seen before.” The conjunction of mobile technology and the cellular tower infrastructure was that moment. On that summer day in Malawi, Nesbit realized its potential and resolved to act. Medic Mobile’s mission is to ensure that potential comes to full fruition.
“Our vision,” Nesbit says, “is that the things that we know save lives should be made accessible to everybody, no matter where they are, no matter how much money they make, no matter to what social group they belong. The vision is global health equity.”
Nesbit asks of us, “Who is a health worker?” He than answers that anyone working to break the stubborn link between poverty and poor health is a health worker. Medic Mobile’s slogan is one that proclaims what the solution is: “We are all health workers.”