MobileActive.org

Roberta Lamptey Nartey, a family health practitioner in Ghana, used to rely on the walkie talkies of the security guards to communicate between hospitals where she worked. Once she wanted a woman who had had a severe asthma attack transferred from the Korle Bu Polyclinic to the surgery unit of another hospital. Nartey left a message with the night nurses to transfer her patient and wrote a note in the patient's chart, but to her chagrin, the asthmatic patient never appeared in the surgery unit. "I told the security man at the Surgical Unit to send a message to the security man at the polyclinic using his walkie talkie," Nartey wrote. "The security man at the polyclinic then went to the female ward at the polyclinic to remind the nurses on the morning shift that I was waiting at the Surgery Ward." After several layers of communication, Nartey's patient finally made it to surgery.

Today, however, communication for Nartey and other doctors in Ghana has gotten much easier thanks to a mobile phone network connecting about 80% of all doctors in Ghana. The network, which was officially launched early this year, allows doctors to call and SMS each other at no cost for instant communication, consultations, and advice. In a country where 2,000 geographically-isolated doctors serve 23 million people, the phone network has come to be appreciated by doctors and patients alike. Since January, the network has logged about 1 million doctor-to-doctor calls.

MobileActive sat down with Brian Levine, the founder of the network and a recent graduate of the New York University (NYU) medical school and NYU's Reynolds Foundation Program in Social Entrepreneurship. Although Levine calls his network DocWorks (short for "doctor network"), people in Ghana tend to call the network MedicareLine or OneTouch. Levine said that when he first went to Ghana it wasn't with the intention of starting a mobile phone network but a web-based one. "Essentially my goal was to go to Ghana and build a website for communications among physicians," he said. "I thought a website would be panacea and it failed. I was forced to think outside of the box."

Without consistent access to the Internet, a website was useless to the Ghanaian doctors. "Then I came to the realization that cell phones were ubiquitous in the developing world," Levine said. "Cell phones were the way to go."

The network allows doctors to call or SMS each other for free. The doctors use their own phones. All of the calls are made on the OneTouch network, the mobile phone subsidiary of Ghana Telecom, a state-owned company and Ghana's second largest mobile provider. Levine said that doctors have used the network in several ways, including for consultations and referrals to other doctors or specialists. They also use the network to call doctors about past medical histories that are often not readily available. Finally, DocWork has allowed doctors to build a sense of camaraderie. "You have the ability for doctors to build community," Levine said. "You literally can reach out and call someone who is just like you."

However, Levine said that the initial reception by Ghanaian doctors was not always so enthusiastic. "The biggest problem is buy-in by the physicians. They say, 'I've been a doctor for 25 years, why do I need to call another doctor?'"

"The other barrier is getting the word out," Levine said. "A lot of these doctors work in geographical isolation. How do you reach them?" Levine solved this problem by working with the Ghana Medical Association to contact and register doctors around the country. Levine said that the response from Ghanaian doctors who have actually used the service has been overwhelmingly positive. "The doctors love it. They absolutely love it," he said. "You can call for help whenever you want for free.

The network is funded by One Touch and the doctors use their own mobile phones. Levine said that although OneTouch initially saw the agreement as part of their Corporate Social Responsibility, they've found that the network is financially lucrative for them as well. "OneTouch realized that by giving free communication to a very small segment of the population it can bring the users in and get early adopters," he said. "It can be a financial model that makes them money." Levine said that the doctors that use the One Touch network for free calling begin to pay for calls to other people, helping One Touch to create a larger customer base.

A financially sustainable network will make it possible to bring physician networks into other countries and to negotiate with other telecom providers to cover the cost of doctor-to-doctor calls. "A network like this is reproducible," Levine said. The project is also sustainable, Levine said, because at this point his involvement in the project is fairly minimal. "It's Ghanaian run and Ghanaian operated. I didn't start an NGO," he said.

Although there has been any evaluative studies or data on the effects of DocWork, anecdotal evidence suggests that the effect has been positive. Dr Sodzi Sodzi-Tettey, General Secretary of the Ghana Medical Association, told MobileActive that the connections enabled by the network have been helpful. "It's so much easier now that we can talk to consultants and specialists, especially for doctors in isolated districts," he said. Dr Timothy Asibey-Berko, a doctor at the Korle Bu Teaching Hospital, wrote the following in GMA Focus, a newsmagazine published by the Ghana Medical Association:

Have you ever been a house officer or resident and found yourself faced with a medical case you just couldn’t figure out, time is running out for the patient and you can’t get through to your superior because of network fuzz or lack of credit? Or have you found the need to refer a case for specialist management but because you weren’t obliged to make the call on behalf of a patient (and didn’t have credit) you decided not to? What about the time you needed to discuss that monthly presentation with your boss and couldn’t because you ran out of credit before you could get through the patient’s presenting complaints? Remember when your fellow colleagues missed the clinical meeting because it was rescheduled and no one bothered to send text messages around to inform them? Those days are now over.

Levine has big plans for DocWork. In the immediate future he hopes to integrate bulk SMS into the system, enabling doctors to receive SMS alerts of medical emergencies or medical news in Ghana. He also sees MMS as being useful for doctors in the network. "If you're a doctor you can snap a picture with a camera phone and send it to a dermatologist, or take a picture of an x-ray to get a second opinion," he said. A year from now, Levine hopes that the doctors in the network will have smart phones loaded with up-to-date medical references. "We could continuously update the information and give them a whole library in their pocket," he said. He also hopes to bring the project out to other countries, possibly in West Africa. "Building a community over cell phones would be advantageous anywhere, but where Internet access is limited voice becomes much more powerful," he said. "The ability to have an instant conversation in a medical setting is so important for the patient's well-being."

Photo credit to Brian Levine.