A PEEK into MSF's field-led innovations

In the Central African Republic, Médecins Sans Frontières medical staff struggle to keep up with the paperwork associated with hundreds of children vaccinated in one day; in countries such as Mali, it remains a costly challenge to diagnose conditions such as malarial retinopathy. Every year, MSF sets aside time to talk through innovations to address just such problems. MSF staff from around the world gathered in London mid-May for the organization’s annual Scientific Days. The second day of the event is meant for staff to present the innovative practices or new tools MSF teams are using in their field operations to respond to various needs on the ground — such as increasing people’s access to mental health services or boosting efficiencies in local health centers’ disease surveillance. MSF hopes the event will aid in information sharing of what's working in the field as well as create a feedback loop for innovations with the potential to scale within or outside the organization. Devex caught up with two MSF doctors about two innovations their respective teams are piloting or plan to try out in the field. A tablet-based app for mass vaccinations Part of MSF’s work involves implementing mass vaccination campaigns. Over the last few years, these campaigns have begun to include vaccinations for antigens that require multiple rounds or doses. But because health care staff often vaccinate as many as 300 children per day, the chances of them making mistakes in defining a child’s eligibility for a vaccine are high. In addition, properly documenting a child’s immunization history gets messy. A child who didn’t come for the first round may attend the second mass vaccination campaign, or the child may travel to a different location for the second round, problematic if the child’s vaccination history is noted only in another location. “We thought it’d be nice to have an algorithm that could help the prescriber … and not redo the whole exercise [in the second or third round],” Catherine Bachy, an epidemiologist with MSF, told Devex. In the quest of finding a way to speed up their process then and reduce mistakes, MSF came across a tablet-based application being used by Interactive Research and Development, an NGO focused on research and health care delivery operating in 15 countries, including in Pakistan where it was founded. So MSF, in collaboration with IRD, applied modifications to the application, then purchased and deployed tablets where with the loaded app to pilot test in three different sites in the Central African Republic in April. With the app JennerX — named after Edward Jenner who discovered the vaccine for smallpox — MSF staff enter a child’s basic information and vaccination history. The app then produces a vaccination schedule for the child, including the antigen to be provided. Once staff members have completed the first round of vaccinations — which could run from a few days to a few weeks depending on location and context — they upload the information to a master database, which then helps MSF analyze vaccine coverage, explained Bachy, who is involved in the app’s design and pilot. Before the second round of vaccination begins, MSF staff need to download the whole database to properly administer the vaccines. This time, the app is expected to give the health workers better knowledge of a child’s vaccination history and eligibility, and be able to provide coverage for a child that may have taken the first round in a different location where MSF carries out vaccination campaigns. The first pilot registered 750 children in CAR within a span of a few days, and MSF is preparing for the second pilot testing in June to see if the app will deliver as intended. If all goes well and battery issues are addressed, Bachy said the organization is planning to deploy the app in a mass vaccination campaign in the town of Masisi in North Kivu, Democratic Republic of the Congo in September. An eye for malaria Mobile applications for health number in the hundreds of thousands. However, only a few of them ever get used or adopted on a large scale. For medical fieldwork, it appears the answer is simple: If it doesn’t add value, then there is no point in using it, argued Dr. Estrella Lasry, tropical medicine adviser at MSF. And even if an app does promise value, medical organizations would require testing and proper evaluation. In December 2014, an MSF team went to Mali. Susan Lewellen, a clinical ophthalmologist who was among the first to identify malarial retinopathy, was with them to test out a mobile app called Portable Eye Examination Kit or PEEK, which has been traditionally used for visual acuity tests and other eye impairments The app, with the aid of external hardware that’s slipped over the phone’s built-in camera, allows users to see a person’s retina, allowing for the possible detection of eye problems such as cataracts or macular degeneration in low resource settings. Normally, such eye diseases are diagnosed in clinics or hospitals that make use of expensive devices or technology. But to see whether it can be used as an alternative to detect cerebral malaria, the team had to find out how the app compared with the diagnostic devices ophthalmology students use in school. What they found is that PEEK compared well with the traditional device, and with relatively short training and guidance, it can match up with the sophisticated technology the students were using in labs. “It’s very good … better than any tool we’ve used in the field,” Lasry said. Apart from helping with the detection of cerebral malaria, the app also stores a patient’s demographic and clinical information, and the images taken of the eye — which is helpful in cases where doctors need to examine the eye again later. The team behind the technology is currently updating the hardware, and MSF is waiting for the final product to launch. MSF still needs to evaluate the final product before deciding whether to adopt it, according to Lasry. But she’s already thinking of other potential uses of the app in MSF operations, such as detecting diabetic retinopathy, a complication caused by diabetes that can lead to visual problems or blindness. 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