MeThinking

I Had A Dream – A Digitally Empowered Community Health Worker

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In 2008, I worked for Uganda Chartered HealthNet, deploying PDAs to health workers, so that health records could be transferred to the Ministry of Health using a gprs-enabled access point mounted at a wall in the health facility. We were leaders in the work to digitize health records. OpenMRS was in its infancy while DHIS2 had just been released. The platform that would change the way we support frontline health workers was named GATHERdata. Meanwhile another company, FrontlineSMS was threatening to move our cheese. Frankly the writing had been on the wall. SMS was gaining traction. Essentially, any health worker anywhere, could send in a report without needing a central place to “sync” data. (Can you imagine we did that over an infrared beam??). Here you can see Dr. Elioda Tumwesigye, rally community health workers.

In the same year, i joined an africa-wide advocacy association, the Free Software and Open Source Foundation for Africa – FOSSFA. People always wonder, what is the difference between Free Software, and Open Source software. According to the Free Software Foundation, for a piece of software to be considered truly “free,” its license must guarantee four essential freedoms to its users:

  • The freedom to run the program as you wish, for any purpose.
  • The freedom to study how the program works, and change it so it does your computing as you wish. Access to the source code is a precondition for this.
  • The freedom to redistribute copies so you can help others
  • The freedom to distribute copies of your modified versions to others. By doing this you can give the whole community a chance to benefit from your changes. (Again, access to the source code is a precondition for this).

When you make access to the source code possible, you make it open. When you allow modifications to come right back in, and also be available to everyone else, you become truly open, and truly free. By this time, you are going to need a community, as you will no-longer retain the capacity to work on the tools alone.

First it was hardware – PDAs to Smartphones, and then delivery (from infrared beams, to SMS, to native apps) now the shift (4IR) is to think platform (OpenMRS, DHIS2 and, gladly, Community Health Management System). But can a platform for healthcare tools be free, and open source?

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Since 2010, Medic Mobile (formerly FrontlineSMS:Medic) has supported community health systems in more than 23 countries and is one of the largest implementer of digital health systems in lower-income settings. Medic builds mobile applications for community health workers (CHWs), household caregivers, and patients. We see communication gaps through the eyes of health workers and patients, and employ a human-centered design approach to co-designing health care delivery systems with local implementing partners. Medic Mobile has worked with over 60 partners across Africa, Asia, Latin America, and the US. Based in San Francisco with regional offices in Africa and Asia, Medic Mobile’s technology supports over 25,000 front-line health workers, workers as they coordinate care for over 14 million families in some of the worlds hardest-to-reach communities.

The open-source software that Medic Mobile stewards, contributes to, and deploys is called the Community Health Toolkit. The CHT, a global public good to advance Universal Health Coverage (UHC), can be configured in each health system to serve the needs of that health system.

The CHT has been designed as a care-first platform, solving problems for CHWs and families. Care guides allow health workers to confidently treat at the doorstep and build credibility in their community. Tasks help direct health workers back to the right homes at the right times. Making work visible enables fair pay. It’s obvious, but this utility to people has been key to its adoption and use. Tools can be set out to collect data. Platforms, on the other hand, are set out to solve people’s problems. System owners get high-quality, longitudinal data as a by-product.

We have designed for and developed tools for Improving child health (Immunization, Nutrition, Integrated community case management), Reducing maternal and neonatal mortality (Antenatal care (ANC), Postnatal care (PNC), Family planning) and Strengthening community health systems (Health worker performance, Health system performance, Outbreak surveillance, Direct to Client Communication, Supervision). The platform includes analytics for more complex data visualization and analysis (including geospatial data and map-based visualizations). Medic Mobile’s web-based dashboard pulls data automatically, and can be accessed securely through a web-based login.

The questions for digital tools for the future are going to be beyond just measuring and managing towards quantity at the provider, manager, and health system levels; and we start to look at  performance in regards to speed of care (after onset of first symptom), (universal health) coverage, quality of care, and equity (getting care today, to the family that needs it the most today). Platforms in healthcare should extend to allowing patients to provide feedback on services provided at the home and in health facilities.


The well manicured grass felt bouncy as we queued up to share President Obama’s hand, and take a picture. It was when he saw the sticker on the back of my phone, “We Are All health Workers” – that he got interested, arranged for us to meet separately, so I could share with him what that was all about. This is how I got to share the story of my work.

The alarm always rings, at the best part of the dream. Time check, 515am.

 

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Raising Andela’s Pocket Change

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How do you fix a thing that isnt broken?

John Doe was terrific at Java. John left the university, worked for a software company here, and even found time to lecture at the University. A USAID project came looking and John was the natural fit – top and exceptional Java talent to run a mega IT project. Soon, the project came to a wrap. John – now accustomed to an 8-figure salary and great perks couldn’t get rehired by regular companies. John couldn’t find gigs small enough to sustain his life. Also, there weren’t many Java projects in town – the tech stacks were fast and fluid, the specialist left feeling jurrassic! After a while, John landed an opportunity – but he had to relocate abroad. His skill, though precious and top-notch, is now fit only in specific markets, for people who are ready to pay 8 figures (I know, wait, I mean Ugx). You could say, John is not a fit for this Ugandan “ecosystem” anymore.

Andela is currently being vilified for what smaller software companies are now calling “a drain of the ecosystem” – of all the top developer talent. Junior developers are not spared, they even run a teen-code club (by the way its an excellent free program!). What happens to this talent? The simple version – Get in, get a mac, get trained, and for 4 years develop, as part of a team, world class software, for a global market! Surely what’s evil about this?

Until you start to see the net (and unintended) effects on the ecosystem. Andela requires that developers work in teams, on solutions that are not born of your neighborhood, for a client that stays in a city you only see in the movies. You get a world class education in software development techniques and a great office to work in (Kampala, Kigali, Lagos, Nairobi, New York, Austin, San Fransisco with HQ on the Internet!). Moreover, soon enough, you start earning a really great 7 figure salary. For some of our impressionable young people, its hard to look back. The problems you solve for clients in the global market are so big.  Its like tasting the fruit of the garden… Your eyes are opened, you are wiser, so much more – and now, your peers are in Mumbai, San Francisco, Barcelona and Toronto!

Again – you have to ask, what is wrong with all this?

Andela believes that while brilliance is evenly distributed, opportunity is not. Their mission is to make available opportunities to brilliant talent on the African continent. (Strong Applause Here).

Here’s what I think Andela should consider, in repairing the unintended consequences of its brilliantly executed model:

1 – Reconsider hiring talent straight from the University – because such impressionable kids will loose an opportunity to exercise their skill locally, before it becomes available globally. Moreover on the back of holistic development, Andela would benefit from hiring great software development talent that has actually experienced industry – Education, Agriculture, Health, Finance etc.

2 – Ask your Devs to Develop Others – as part of their full-time contract. We already know that training others supports mastery of any skill. Holding 2-3 mandatory community training sessions by 15 senior devs will create a give-back attitude, strengthen mentor-coach skills and add to the soft skills needed to produce a great Andelan. Just their tee and mac is sufficient branding. Moreover, the social capital one gains from that tends to be invaluable a few years later. Where its happening, take the ALC away from the building.

3 – Give Devs back to the industry – without turning your own lights off. Andela is perfectly positioned to support devs – in partnership with carefully selected local non-profit partners – to work on local technology solutions. This partnership model would be available to companies below a certain budget threshold. Carefully managed, this model has every opportunity to use local problems as the sandbox for training and development – a much added value.

4 – Some people are not cut out for working away from home – or relocation, or working in 4 time-zones. Some people are  perfectly fit for the local market. Andela can create a pricing model that makes such talent available for the local recruitment needs. Yes, they wont be paid top dollar relative to their colleagues, but that’s the opportunity cost of choosing to enjoy all 12 hours of the equatorial sun! And there’s nothing wrong with that.

This morning when I went over to the Andela breakfast, it was to honor an invitation to hear President and Co-founder Christina Sass. I enjoyed listening to her passion, but mostly to her compassion. I agree, we needn’t attach intention where there is none. Andela is not evil, and no they are not snatching the top 1%. Andela have a model, that works. Kampala has talent, that’s brilliant. The world has opportunities, ready to be filled.

Let’s not fail to feed the very ecosystem on which this model thrives.

 

john & hellen burns- Marriage Encounter

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know what works  for your spouse

the best way to be heard is to liste

just because am quiet doesn’t mean am okay

always create a safe place, your children cannot handle your fights

give each other time to process hard conversations, pray, re-evaluate

prov 5:18 – his heart is toward you only, her heart is toward you only.

sexual frustration can be an indicator of lack of trust.

we must develop habits that build trust again.

develop a habit of investing in your sexual relationship.

behave your way into success in your marriage.

 

building habits – with trust.

trust is the ability to lean on each other.

1-Language

language of grace. i fell in love with your future. grace abounds in trust but trust has to be earned. grace is a free gift, and you can give it all the time. grace takes the fear out of failure.

grace allows us to build the confidence that we need to succeed and excel.

in marriage, we need to get over the fact that if someone saw us for who we really are then its over. no. its not dependent on performance. instead learn to pray the prayer of grace about your spouse and children.

2- Rekindle the sizzle

sex is the celebration of love. the more you discover how amazing your spouse is, the more you will enjoy sex.

make it a habit to be best friends. make your spouse the person you want to be with the most. make friendship grow.

An Experience for My Education

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reBlogged from Amplify

My dearly beloved late mother desired that I should become a medical doctor. As it were, I gravitated to computers instead. In my short professional career, I have found my place using computers — and information systems — to improve health outcomes. From the linux based African access point, to becoming part of the Uganda EMR Society, I have marveled at the way information technology is utilized in the Ugandan health system. Suffice it to say, progress has been slower than my liking. But that’s another story.

When I realised I would not attend medical school, I decided that I would pursue something closely connected. A computer science graduate, my work experience experience has spanned Netmark Nigeria household surveys to telling the story of pediatric HIV in Uganda. Along this journey, my colleagues have included architects, designers, communications specialists, and data scientists, to name a few.

Find the rest of this post on GHC’s Amplify publication.

Your Dead Child’s (or Spouse’) Facebook

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Every piece of your life, can potentially be found on Facebook. Your child’s birth photos, from right in the womb, to their sweet 16th birthday are all there. Trips to Antigua and check-ins to the Mall, everything freely shared with that sneaky prompt, “What’s on your mind?”

And then, if you live in Kampala, as I do, chances are a boda-boda, or some other necessary evil, will take the life of your innocent child or spouse or parent or sibling.

Then… Whats on your mind? Well, why not review (and maybe even re-live) the online life of your dearly departed.

Not so fast – last week, a Berlin Court issued an order that barred parents of a deceased gal from obtaining access to her Facebook profile and its records. Facebook accounts, by their very nature, are personal. As this Reuters article notes, the secrecy of correspondence protects not just the child, but also the people who she spoke with, and their privacy must be protected.

The child’s Facebook account  must be a relic of sorts, and rightly so the parents probably want to lock this away or perhaps search it for their own closure. But the people she communicated with, if they are still alive, have their own right of communication privacy. Should familial curiosity override this? I am sure this was a difficult decision for the court to make, but I think their ruling is reasonable.

I remember growing up when dairies had not just yet been replaced by blogs that the given notion was: never read one that isn’t yours. If you are the parent of a young person, you know what it means to know less than 1% of their life. And that was when you lived on a ranch and wrote in diaries. In the information age, that life is spread thinner on at least 3 different social platforms, many of them allowing digital photography.

As a parent of a soon-to-become-teenager, I know that I should be involved in and educating their digital life. I don’t mean to be intrusive, but present. I need to know and be aware of online dangers and things like cyber-bullying, cyber-stalking, or abusive/dangerous/suspicious messages. I need to educate my kids about these dangers, and even advocate for such education/training in their schools. At home, of course it helps to create an environment of trust and dialogue where my children will feel comfortable telling me about their challenges.
On the other hand, when we go to a medical professional to better treat our ailments, sometimes we give up very personal details, stuff that might even be considered evil in the regular (or cultural) domain. One would argue that to this extent parents should consider entering into the privacy of our children in order to prescribe the best remedies.
I agree. Parents should be allowed to go into the privacy of their children precisely and only in a framework of prevention, counseling.
Well, what’s on your mind?

 

2 Commencement Speeches I liked

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Glossophobia is still the world’s #1 fear, yet we have people who seem to have been born with a golden mic in their mouths. They wow us all the time. One of the best seasons to feed on the genius that oratory can be in the commencement speech cycle. They come once a year can carry platitudes and/or conjecture, but often they are delivered by people from all walks of life to inspire and challenge that next generation of leaders. Here are 2 that I took time to dive into…

Mark Zuckerberg – As a young man growing up and working in Africa’s nascent technology space, this man, perhaps together with Google, have had the biggest influence on my generation. I love that he is coming into Africa to see how far a dollar really goes.

“Change starts local. Even global changes start small — with people like us. In our generation, the struggle of whether we connect more, whether we achieve our biggest opportunities, comes down to this — your ability to build communities and create a world where every single person has a sense of purpose.”

My work is in Leadership development, and for me these words cannot ring any truer. If you have heard me say it once, you have heard me say it again, I love computers and all the magic but I love people more. If we can give people a sense of purpose, build a community around service, we cannot get it wrong.

 “Ideas don’t come out fully formed. They only become clear as you work on them. You just have to get started. If I had to understand everything about connecting people before I began, I never would have started Facebook.”

In his book, Never Eat Alone, Keith Ferrazzi writes – Be brave enough to put it all out there, stuff that worked and stuff that didn’t, with your insights on why and how to fix it for next time.

Zuckerberg is famous for dropping out of Havard, but that is not his most proud failure – its facemash, a prank site he put up which drew attention of the ad board. As he awaited his fate, he met Priscilla and as he says, “ But without Facemash I wouldn’t have met Priscilla, and she’s the most important person in my life, so you could say it was the most important thing I built in my time here.”

Oh how we need to teach the virtue of failing smart.

 “I hope you find the courage to make your life a blessing.”

You can read (or watch) Mr. Zuckerberg’s full speech.

 

Donald J. Trump – Quite frankly, as a non-citizen global health advocate working in the expensive bubble that New York is, I happen to share a home city with the man many of my ilk have come to hate. But he is still the leader of the free world, so we got to listen.

“Adversity makes you stronger.  Don’t give in.  Don’t back down.  And never stop doing what you know is right.  Nothing worth doing ever, ever, ever came easy.  And the more righteous you are, the more opposition that you will face. “

…this after the rhetoric on how the media has treated him and his political sojourn thus far.  That’s not how the speech begins, though; he dishes out quite many thankful remarks to leaders, and graduates alike. He also pardoned cadets for minor offences and offered them a clean slate. I wish that life and the rest of us did this for our young people – that at the turn of important milestones is NOT the only opportunity to turn a new page, and a clean slate, but that you have that opportunity daily. Yes, every time the sun comes up, it’s a new slate, a new chance to make it better.

“Just days from now, you will put this vital skill into the service of your ships, your sectors, and your country.  You’ll serve as deck watch officers on our amazing Coast Guard cutters. You’ll bring law and order to the dangerous waters as boating officers.  You will block illegal shipments of cash, weapons and drugs.  You will battle the scourge of human trafficking — something that people are not talking about, one of the big, big plagues of the world.  Not our country only — the world. 

The call to service continues to ring out, as if a call to this generation. I could not agree more. Service is the new way to work; service is the new entry to employment.

Americans will place their trust in your leadership, just as they have trusted in generations of Coast Guard men and women, with respect for your skill, with awe at your courage, and with the knowledge that you will always be ready.  You are Always Ready.    

For a man under so much fire, this speech came off as very composed. Perhaps thoughtful of his first world trip, and realizing the opportunity to speak a less combative audience, Mr Trump did make some strong remarks which are clearly of a bigger vision than his own political lifeline.

You can read the full speech text.

You can catch up on extra snippets as captured by Business Insider and Fast Company

Looking for a Mentor?

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Last week, I conferred with a friend who was overwhelmed with life, and in our conversation, I asked about who her personal advisory board is – she seemed clueless on how to find mentors.

As a young christian man, I have always taken many cues from the Bible. One of those is the leadership development style of Paul the apostle and a young man named Titus. The story is in the book of Titus, tucked between the books of 2nd Timothy and Philemon.

There must be older men who are willing to invest time in young men to mentor them. Surprisingly the bible has many examples of this: Abraham/Lot; Jethro/Moses, Eli/Samuel; Nathan/David; Elijah/Elisha; Barnabas/Saul; Paul/Timothy… and women: Naomi/Ruth; Elizabeth/Mary. If you are a young person and you need to develop in your own leadership and personal growth, you need a mentor.

Well, naturally the next question is who makes a great mentor? Titus 1:5-9 provides some hints on the qualities of a great mentor:

  1. In their Personal life, they need to be blameless, not self-willed, not quick-tempered, not violent, sober-minded, holy and self controlled – notice that these qualities were primarily set for church leaders, but the pattern is clear, a mentor needs to be someone grounded and clearly sober.
  2. Family Life: They need to be a husband of one wife, with faithful children. – I think this one was quite insightful for me. Its been debated whether a traditional family and/or having children is a sign or mark of a leader. I think not, but I think that one with a family and children has more opportunities to practice other virtues of life, including sacrifice, responsibility, and often has more to live for than just themselves. This should make for a good person to learn from.
  3. Social Life: They need to be hospitable, just, not corrupt and not given to drunkenness. I know that we like to bucket our social and professional lives, and in some cases we like to say “my private life” – but really is it? As a leader, do you really ever have 5 sides to the coin? Or is it that who you are in your private confines must be consistent with your public self. I’d choose consistency in a mentor.
  4. Financial Life: A steward of God, not greedy for money –  I think being a steward of God is a high and lofty standard, that requires a world view where one self is not the center of everything that they do. Does your mentor look like someone driven by the desire to get rich at all costs? Don’t get me wrong, money does make smooth so many ways and roads, heck, the church in Paul’s time needed money, as the church still does today. But this is about the attitude towards money that your mentor has – because it might pass on to you.
  5. Professional Life: not accused of insubordination, a lover of whats good, able to correct others, faithful to their values – This is perhaps a hard one. While our attitude to neighbors and garbage needs to be the same regardless, everyone has a different professional path – the goal here is not to cherry pick your dream job, rather the goal is to pick people who epitomize great careers and success in different fields. Unless proven exceptionally consistent, is is harder for your peers to fill mentor roles because their track record is not long enough. Your mentor needs to be someone who inspires you when you look at their work and achievements.

I hope that this list will help not just my friend Susan, but many other young people to look to sit at the feet of the right crop of leaders, men and women of sound mind, exemplary character and inspiring professional and social lives. As we learn from them, we will set the stage for our children’s children.