MobileDiagnosis®: an appropriate technology for tele-microscopy, an effective tool for training

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MobileDiagnosis® Project How it all started: to promoting the human rights of african refugees Lampedusa, 2008 trentamila migranti .l’emergenza.

MobileDiagnosis® was founded in 2008 by Livia Bellina, an Italian pathologist who worked for the Italian National Health Service in Lampedusa island. In April 2008, she found herself in the urgent need to confirm a diagnosis of malaria from a blood sample of an African immigrant. With no other means in her own hands, she took a picture of the microscopic field using the camera incorporated in her mobile-phone, and sent it via MMS for tele-diagnostic purposes to a reference center. This described Method has been filed for patent in April 2008, with the sole purpose of protecting the idea from commercialization and consent its free use and spreading.

Patent: http://www.patsnap.com/patents/view/EP2116884A1.html

MobileDiagnosis®: Dalla Telepatologia alla Educazione, dalla Emergenza ad un Nuovo Sistema Educativo  Dr. Livia Bellina,  Pathologist,Founder and President of Mobilediagnosis®Onlus

Background

The Idea

Mobile phones can be easily used without any adapting device to take pictures of the microscopic field and send them for remote reference.

Background

In 2009 Livia met Eduardo Missoni. He immediately understood the relevance of the her Method, and after only two months they  published the method together in Diagnostic Pathology, an international open access scientific journal. It was the beginning of their collaboration, based on common vision and goals- MobileDiagnosis®, the Association

In 2010 Livia, Eduardo Missoni, Giorgio and Vincenzo Prestigiacomo (Livia’s sons) founded MobileDiagnosis®, a Non Profit Association to advocate the global access to care and to education. Regist. At 28-11-2011reg.n.15053 at Gov.Agency Palermo-Italy FC/P.I 97261360826

MobileDiagnosis® Creative Team

In 2010 was set up a team of young professionals

in web design, architecture, design, engineering,

project specialists, which assemble cooperate with freelancers to promote MobileDiagnosis®.

The team works to increase the visibility of MD and for the development of new methods of remote training and innovative technological solutions for helping the rural communities in a sustainable way.

The current MDCT members are: Giovanni Azzolina, Chiara Consiglio, Francesco Consiglio, Giulia Delia, Nadia La Chiusa, Annalisa Maggio, Roberto Ingrassia, Domenico Scarpinato, Fabrizio Vitrano, Giorgio Prestigiacomo and Ilenia Nucatola.

The Meeting with Eduardo Missoni-MDCreativeTeam

MobileDiagnosis® : The Mission

Promotion of Global Access to Health Care and Education in developing countries or underdeveloped areas of developed countries by inserting the Method in the context of other local projects, in partnership with local partners actors.

The Goal: empowering the currently neglected communities in order to be a part of a world where  the Health and Education are effectively recognized and implemented as fundamental Rights of every human being.

Background

HOW IT WORKS

The Information Flux

The Information Flux

The Activities

The Activities:1. In developing countries: training local work forces

Creating a local "school” for the health education and training of local rural communities – health workers and non health workers (community representatives). Establishing or strengthening health centers for basic screenings , focused on parasitic diseases, neglected diseases, mother and child care, community health care, etc., and link them with the schools

2. In developed countries: training of trainers

Creating a new generation of trainers by activating courses of MobileDiagnosis and a central referent “office” with high skilled consultants and an open-source training centre, with an images library and an interactive school.

3. Planning a global course of MobileDiagnosis®, affordable care and sustainable technologies.

The Project -Creation of a knowledge-centers network based on locally available and affordable resources and poor technology and improving of local health workers that, thanks to a domino effect will improve new health workers. It is operating on three levels:

1) Local level, using the mobile as didactic tool, to educate by showing and comparing the images.

2) National level, thanks to a "mobile to mobile" or “mobile to web” network.

3) Global level by a network linked to a web technology platform, thanks to collaboration with Medting started in 2011. This system is operating locally-globally, and contributes to accelerate the Global Health care provision, distance consulting and education, by connecting the “fragile” subjects, especially in difficult contexts (war, migrations, sex discrimination, cast, clan, family) to a solidarity network of highly skilled specialists and to knowledge centers.

The Partnership Scenario:

Global-Local Partnership and Sustainability of the Project.

MobileDiagnosis®works in partnership with local NGOs, by creating a network of local rural health-education posts, linked together and connected to the web platform of MobileDiagnosis® Network. The web platform will store the images for creating of a central database for educational and distance-schooling. In the rural local educational-health these centers, students from friend's network will be able to apply to for internships, stages and trainings on the field, bringing economic resources contributions (housing, food, local trips, education) that will bring benefits to the local income. These economic resources will allow the future management of projects a local level.”

Past Activities

2012-Tshimbulu,St Francois Hospital

Dem.Repubblic of Congo

2011 - Afghanistan, Herat, Paediatric Hospital

2011 - Bangladesh Dinajpur, St Vincent Hospital

2010 - Bangladesh, Comilla and Bhuapur Grameen rural health centers

2009 - Uganda, Lacor, Gulu, St Mary Hospital

The Future Development of ProjectProviding a network of education centres linked together and connected to the web platform of MobileDiagnosis® Network for sharing of data, images and texts for education, and an open-source training centre, with an images library and an interactive school, to which will be possible to access from the educational page of MobileDiagnosis® site.The next goal is the expansion on a global level of MobileDiagnosis® Project.

ONGOING …. 2012 - Thailand - AIT- Bangkok - Course of MobileDiagnosis® on AIT (Preagreement With Dr. Faiz Shah a medical doctor, head of sustainable development dept. at AIT Extension

2012- Partnership with AIT-YUNUS C( Thailand-Myanmar Project )

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1 Research and development of a new software for the recognition and early diagnosis of parasitic diseases - algorithms for basic local immediate therapy

2 Design and development of innovative, unconventional prototypes of modular health and education centers, thanks to research of new solutions, focused on environment respect and autonomous generation of clean energy, sanitized water, and safe waste elimination in a perspective of sustainability for the complete integration in the local scenario.

3 Research of dynamics that influences the social psychology, acting on the perception of a living environment felt as hostile or unpleasant as, i.e. public areas such as waiting rooms, schools, clinics etc.

4 Developing models for studying mechanisms that characterize the socio-cultural dynamics of different rural communities and their perceived needs, thanks to socio-anthropological surveys studying local behaviour and traditions, to improve in the best way local wellness respecting the local life, traditions, uses.

5 Distance learning through an "open access open-door" web site (work in progress) based on an "interactive course" .This “evolution” of project , thanks to the creation of a network of education centres linked together and connected to the web platform of MobileDiagnosis® Network for sharing data, pictures and texts for education, and an open-source training centre, with an images library and an interactive school will be possible access to this "school" from the educational page of MobileDiagnosis® website.

6 Promoting cultural exchanges and social engagement in different sectors by running workshops for local workers development: farmers, carpenters, plumbers, seamstresses, cooks, knowledge of food hygiene, enhancing the craft traditions, and enabling the development of the small businesses.

Developing Projects:Innovations

Social Relevance

Improving rural peopleIn Paediatric Hospital of Herat the methodproved its potential as tool for bridging sociocultural gaps.

In a context where women access to a male dominated health system is restrained, two women with no education or lab experience learned in a few minutes, driven by the curiosity caused by seeing Dr. Bellina working, to take pictures from a microscope with a mobile phone.

This Method could be an useful tool in all the situations where the students are fragile subjects and/or with learning problems or communication difficulties.

Methods

We tested MobileDiagnosis® in rural health units in Uganda, Bangladesh, Afghanistan and in rural area of Democratic Republic of Congo (Tshimbulu)

Laboratory technicians were trained using the MobileDiagnosis® approach

– international second opinion

was tested (via internet)

Methods

MobileDiagnosis in the world

• 2009-2011 - 90 people participated in the testing.

• Italy - 20 randomly chosen people, completely unaware of microscopy were asked to take pictures on the sole basis of simple written instructions.

• Uganda and Bangladesh - 60 health workers and laboratory technicians - all with very basic previous laboratory training - where involved in “on the job” training. Only locally available materials and technology were used.

• Afghanistan 10 local fully trained laboratory technicians (9 males, 1 female), with an average of one year experience in the lab were involved.

The last “mission”

2012 :Democratic Republic of Congo -22 “students” were involved in Tshimbulu, rural areas of democratic Republic of Congo, at St Francis Hospital .Three medical doctors , and 13 health workers-nurses and 6 students and two laboratory technicians - were involved through “on the job” training. Only locally available materials and technology were used.

A New Educative Tool

A New Educative Method based on Mobile: the innovative, unconventional method, casually born thanks to personal activity “on the field”, during the experiences as volunteer in six of poorest villages amongst the global rural communities is based on three elements plus one:

1) Interactive-creative approach to the students.

2) Interactive-creative spoken lessons, based on logic and algorithms and use of mobile.

3) "On the job" lessons and use of mobile as didactic tool for practical learning.

In a successive phase on a fourth element.

4)Distance - follow up and educational updates.

The method-the lessons

The Lessons start from a personal survey submitted to the students; the evaluation of the students as people and of the local scenario: focusing the survey and discussion on local problems, concerns, difficulties and fears context-related. It is requested that the students answer to questions based on their personal goals, dreams, and their personality. In this earlier phase the survey is still out from any context: the personal student’s experiences could be the same everywhere in the world.

Contextualization

Contextualization: the survey submitted to the students in this second phase is looking for problems, concerns, student’s fears, linked to the local context: They have to answer to several questions, focusing their answers on their concerns, fears, relationship with health, with disease in their communities, their history as healthy or sick persons, their positive or negative experiences. In this phase the students, from a global context enters a local scenario.

Use the logic to solve problems with local possible solutions. All surveys, discussion, meeting, conferences, practical and spoken lessons, are focused on local specific concerns and all possible solutions. Each course is different from the others, because the scenario differs. This "local contextualized approach" creates a personalization of learning and produces a better “resonance” between trainers and trained, with a state of complete mutual trust.

The future development

The future development of project provides a network of education centres linked together and connected to the web platform of MobileDiagnosis® Network for sharing of data, images and texts for education, and an open-source training centre, with an images library and an interactive school, to which will be possible to access from the educational page of MobileDiagnosis® site.

http://www.mobilediagnosis.net

Education Relevance

With few standardized written instructions all participants quickly learned to use m-phones to take quality pictures from the microscope.

Jointly observing and discussing images

of the microscopic field on the m-phone screen and

Possibly on wider portable PC screen enhanced learning speed and health workers interest.

The possibility to immediately enlarge details of the microscopic image on the screen facilitates difficult diagnosis.

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Applications

• Applications:

Applications

Applications

Experience with a Nobel In 2010 upon Prof. Muhammad Yunus’ invitation, Livia visited medical centers in rural areas of Bangladesh and the headquarters in Dhaka. In Bangladesh she lived in rural centers (Tangail and Comilla). For several weeks, she taught and worked with students all day long, from early morning to sunset. In Grameen Foundation's health centers, she organized a school of lowcost telepathology and basic telemedicine, based only on local equipment and available cellphones. 16 lab technicians of 16 different rural health centers where involved. She taught the use of the microscope; theory and practice of laboratory techniques and basic parasitology, urine analysis, hematology and stool sample examination, as well as capturing and sending images from microscopical fields, and differential diagnosis and logic clinic.

Awards, Credits, Qualification, Affiliation, Membership , Partnerships

2010 - WHO published MobileDiagnosis on the Compendium of Innovative Technologies address to Global Health2011 - Rockefeller published MobileDiagnosis in their site as "philanthropic project"2011 - GHWF Alliance admitted MobileDiagnosis as members2011 - M-Health Alliance member2012 - Ashoka Global health Innovator group 2012 - The Rotary Inner Wheel, Palermo Centro, together with University Academic Board conferred to Livia the award “Premio Rosario La Duca, a life for Palermo”, for commitment and work made with MobileDiagnosis on the field in Developing Countries

MobileDiagnosis® website:

http://www.mobilediagnosis.net

MobileDiagnosis® brochure:

http://www.slideshare.net/livia_bellina/mobile-diagnosis-global-project

MobileDiagnosis® Youtube channel and videos:

http://www.youtube.com/user/mobilediagnosis

http://www.youtube.com/watch?v=_751FZ7Ta_U

http://www.youtube.com/watch?v=vvRok5QvO60&

http://www.youtube.com/watch?v=Gb45mZdRhck

MobileDiagnosis® picture gallery:

http://www.mobilediagnosis.net/multimedia.php

MobileDiagnosis® publications list:

http://www.mobilediagnosis.net/multimedia.php?section=publications

Useful links

Acknowledgments -Merci