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Rwanda’s mHealth Boom

Philip Gourevitch is not the only one who's traveled to Rwanda recently and appreciated the extent to which it's "a country looking and moving forward, not back."  This eyes-on-Singapore approach is particularly evident in the field of technology. The UN Foundation's Claire Thwaites reports on one of Rwanda's more encouraging public health-related tech developments:

Supported by the Rwandan Ministry of Health, Voxiva, and the Treatment Research and AIDS Centre (TRAC), TRACnet is an electronic records system that can be uploaded to mobile phones. In Masaka it is being used to track and record the distribution of anti-retroviral medications, ensure drug adherence, electronically create and submit patient reports, and access the most up-to-date information about HIV/AIDS care and treatment.


In Masaka, I was guided through the health clinic by the local program manager, Hareuhana Diaedonne. During the tour, Hareuhana spoke at length about the simple but significant benefits that have been brought about by the introduction of mobile phones to the local healthcare system. Using TRACnet, he reported, data entry that used to take months to record and aggregate now can be collected in just 5 minutes.

President Paul Kagame has made a point to emphasize that he thinks Rwanda's way forward is through investment, not foreign assistance.  Pushing mobile health technology seems like a perfect opportunity to both attract investment and improve the quality of the country's public health care system.

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A little perspective, please

If a country had 65 infections of a disease, causing 4 deaths, in a month, with very poor health infrastructure, you'd be worried, right?  Well, we're talking about cholera in Zimbabwe, not swine flu in Mexico, so more likely not.  But it remains worth noting: these numbers, which are roughly similar -- albeit with fewer deaths -- than those caused by the H1N1 virus represent a vast decrease in infections and deaths from cholera in Zimbabwe, which has experienced a staggering 97,400 cases, including 4,271 deaths, since the devastating outbreak of the disease last August.

Shows you why cholera is first in this list of "five disease outbreaks that are worse than swine flu."

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The Economist’s pandemic flu primer

I just caught a great set of articles in The Economist on the pandemic flu and its costs, with solid reporting on the prep work it takes to adequately confront a budding pandemic (surprise, you can't show up to the party late).  The WHO gets a shout out for its role:

Thankfully, prodding by the WHO and lessons from SARS and avian flu have caused governments to strengthen their disease-surveillance systems, improve communications channels between their health ministries and co-ordinate their stockpiling of drugs.

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Being too careful?

In the wake of the first confirmed death of an American citizen due to swine flu, the Post is reporting that the Obama Administration is considering an "unprecidented fall vaccination campaign," which would add two new shots targeting swine flu to the existing regime (currently just one shot).   The program would cost billions of dollars.

Seems Obama is taking a page out of Margeret Chan's book:  "I'm not predicting the pandemic will blow up, but if I miss it and we don't prepare, I fail. I'd rather over-prepare than not prepare."

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Making sense of flu distribution

Boy do I love computer scientists.  First, Google tracks the swine flu with aggregated search data. Now the NY Times highlights two computer models that use air traffic and commuter data and dollar bills tracked via Where's George? (no love for Where's Willy?).

Readers, anyone see any other interesting tracking models?

The Northwestern Institute model was pretty close with its prediction of 150 to 170 cases by yesterday (the CDC has confirmed 226). Both models see 2,000 to 2,500 cases four weeks out, not exactly a sky is falling scenario. Still, I think WHO head Margeret Chan was prudent to say, "I'm not predicting the pandemic will blow up, but if I miss it and we don't prepare, I fail. I'd rather over-prepare than not prepare."

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WHO: No Need for Travel Restrictions

Joe Biden take note.  Fresh from the World Health Organization:

WHO is not recommending travel restrictions related to the outbreak of the Influenza A (H1N1) virus. Today, international travel moves rapidly, with large numbers of individuals visiting various parts the world. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community...Scientific research based on mathematical modelling indicates that restricting travel will be of limited or no benefit in stopping the spread of disease. Historical records of previous influenza pandemics, as well as experience with SARS, have validated this point.

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Did the Pan-American Health Organization Drop the Ball?

There has been widespread agreement that once the World Health Organization deemed the Swine Flu  Influenza A(H1N1) an international public health emergency the WHO reacted in swift and responsible way.  Procedures for handling international public health emergencies that were formed following the SARS outbreak in 2003 (the so-called International Health Regulations of 2005) seem to have worked as planned; there has been robust international cooperation for dealing with this threat and the WHO has risen to the challenge.

Still, one question unresolved is why there was an eight day gap between the time that Mexico first identified troubling patterns of flu and when these WHO emergency procedures kicked in.  Public health experts with whom I have spoken initially suspected that the delay was caused by Mexican authorities who were slow to report their findings to the Pan-American Health Organization (PAHO), the WHO's regional headquarters in Washington, D.C.   According to a report in the Associated Press, however, this is not so.   Mexico's chief epidemiologist Dr. Miguel Angel Lezana tells the AP that he reported to PAHO about "alarming occurrences of flu and atypical pneumonia in Mexico" back on April 16.   He claims that his messages to PAHO went unreturned.  

When the dust settles questions about this eight day gap should be answered.  Like I said, the WHO deserves praise for how it has handled  Swine Flu Influenza A(H1N1) once an emergency was declared.  Why it took so long to do so is something that the WHO and its member states will have to investigate.

Photo: PAHO's iconic headquarters in the Foggy Bottom neighborhood of Washington, D.C.

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Swine Flu’s Challenge to Realism

It is always pleasing when hard-core realists embrace multi-lateral institutions.  Vis, Stephan Walt explaining why he thinks global cooperation is useful way to deal with potential pandemics.  The kicker? 

All this is not to say that the global response will be perfect, or that the potential pandemic will be contained as effectively as SARS ultimately was. But it does remind us that global cooperation is possible, and that some global institutions do provide valuable protection. Libertarian neo-isolationists and neoconservative institution-bashers should take note.  [emp. mine]

  It must be so lonely on the fringe these days.

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Front row seat for the apocalypse

Henry Niman we hardly knew ye. We loved your mash-up with swine flu updates, but the MSM has got you beat in slickness with its fancy designers.  The NY Times now has a map up, as does the Washington Post. I think the Times map gets the data into my veins more efficiently, but suspect the Post map might be updated more regularly. Prove me wrong Times.

UPDATE: I forgot to mention Google's Flu Trends, through which they've discovered that certain search activities are good indicators of flu activity.  They've got an "experimental" trend map up for Mexico.