We just heard a fantastic talk by Jacqui Maher about her work on the Boabab project, fighting AIDS in Malawi, Africa.

First, she gave us an overview of the AIDS epidemic, especially in Africa:

• Africa has 12% of the world’s population, but 60% of the people with AIDs
• In Malawi
  • 14% of adults have AIDS
  • 8 people die every hour from aids
  • there are 280 doctors
  • 3500 HIV/AIDS patients per doctor

When she arrived, patients would wait in long lines to see a doctor and patient intake would typically take 15 minutes.  It was all paper-based an error-prone.  In Malawi, they have a national id program where every ID card has a bar code.  This could be used for easy patient intake.  After they developed the hardware/software solution, it would take less than 1 minute to register new patients and less than 10 seconds for returning patients to get through the intake process.

The solution was designed to help  in a number of areas:

• Patient Registration: entering new patient data, generate national id bar code, or scan an existing one
• Encounters: any patient interaction
• Observations: diagnosis, progression, vitals, patients complaints, drug regimen
• Prescriptions: drugs, ingredients, inventory, etc.

They overcame challenges with spotty internet connections and low bandwidth.  They use a wireless mesh network, which is self-healing.  The portable computer they used was based on the I-Opener (initially bought from the US on eBay, then 2000 were donated) which was hacked to include a touchscreen, ethernet, PoE (power over ethernet) and a bar code scanner.  The software is Ubunto, Ruby on Rails, and MySQL.

More details on the software:

• BART – Baobab Anti-Retroviral Treatment
• OpenMRS Data model
• templating using ERB
• App calls via AJAX
• Rspec tests

Jacqui told a great story about Gem the Janitor (yes, that is his real name) who just picked up the device during a busy time when all of the nurses were busy, figured out the interface quickly and started helping register people.  Now he runs the whole intake process.

Why RoR?

• great community
• common consensus on best practices
• active contributions to OSS
• very accessible information on every part of the stack
• supurb interactive tutorials like peepcode
• Ruby is easier to learn offline that other languages, comes with documentation
• ActiveRecord: makes complex data models easier

Now 265 of the 280 doctors are using this app.  The data collection enables extensive reporting, enables agencies to use the data to focus research & funding, and influence policy decisions.

You can help!

• http://github.com/baobab/
• the developers are on IRC:  freenode #baobab
• more info: www.baobabhealth.org