IEEE Technology and Society Magazine - Spring 2013 - 51

don't we have a database-like
setup where certain symptoms or vitals values will
indicate that a certain disease is occurring.... so certain symptoms or vital values
are programmed in, such that
the information doesn't actually get sent to the doctor but
the programmed server will
alert for certain symptoms
immediately."
(Kimathi University Student,
Focus Group, Kenya, 2010)
"The telemedicine system
and service should be paired
with a pharmacy, then the
medical consult could be free
and the charges transferred
to another sector like the
pharmacy. If you charge and
don't give drugs, then people
will not come."
(Kimathi University Student,
Focus Group, Kenya, 2010)
"Telemedicine systems should
also be connected to existing
networks, when used in the
community; they should be
connected to transportation
if needed. Also, it should be
connected with larger brands,
like Nairobi Hospital, so people will recognize the service
and trust it."
(Kimathi University Student,
Focus Group, Kenya, 2010)
"More rural places don't
have electricity needed to
support the technology, is
there a way to use solar
power to power the system?"
(Kimathi University Student,
Focus Group, Kenya, 2010)
"Male and female health
workers should be partnered
together, to show respect to
patients, and give them the
option of choosing who will
treat them."
(Kimathi University Student,
Focus Group, Kenya, 2010)

"If Community Health Workers use a technology system,
it would have to be portable.
Can you make the system
small? Reduce the size so
they can travel easily with
the system."
(Kenyan Methodist University
Student, Focus Group,
Kenya, 2010)
These responses highlight and elucidate the breadth of the enlightening conversations with local
participants. These conversations
were made possible only through
the relationships HESE has built
with local institutions such as Children and Youth Empowerment Center (CYEC). Through engaging the
community, university students, and
medical professionals, our researchers gained valuable feedback about
the challenges and potential of the
telemedicine system. These conversations sparked new research
initiatives like delving deeper into
the actual mechanics of how Community Health Workers function
in rural Kenya and the challenges
they face. This small piece of ethnographic research, run in parallel
to the testing of our telemedicine
system, was invaluable to development of a long-term implementation
strategy. We acknowledge that the
opinions of local people, the future
customers and users of the system,
will determine the success of any
intervention. Combining this local
knowledge and the insight gained
by our students visiting Kenya and
seeing first-hand the context of the
healthcare system, will improve
this project and inspire the students
to engage in other technology-based
social innovations. The positive
feedback and guidance received
from these partnerships has confirmed that entry points exist for
technological innovation in rural
health. We encourage all social
entrepreneurs to engage local counterparts, develop partnerships, and
experience how these relationships
enrich research and innovation.

IEEE TECHNOLOGY AND SOCIETY MAGAZINE

|

SprING 2013

Guidelines for Innovators
While technology solutions hold
great potential for addressing the
needs of developing communities,
new and advanced devices are at
high risk of becoming scrap metal
and closet clutter in developing community hospitals. The World Health
Organization (WHO) estimates
that international donors or foreign
governments fund nearly 80% of
healthcare equipment in some developing countries [18].The vast majority of the biomedical equipment
is designed and manufactured in
western countries by engineers not
familiar with the physical, socio-cultural and economic environment in
developing countries. In sub-Saharan Africa, almost 70% of donated
medical equipment is not in use
because of lack of maintenance or
spare parts, or because local personnel do not know how to use it [19].
About 95% of the instruments that
are usable fail within five years since
they are all imported, extremely
expensive, not ruggedized, and not
repairable when they fail [20].
A disconnect between the functionality of medical devices and
the context of developing countries
arises because of the divergent
infrastructures, social and behavioral norms, and larger eco-systems
among western and developing countries. There is an emerging trend to
design devices specifically for use
in developing communities such that
they are inexpensive, rugged, robust,
and culturally appropriate. Biomedical engineers and socially conscious
designers need to be familiarized with the unique challenges of
designing devices for CHWs working in resource-constrained environments. A systematic approach that
takes into consideration pertinent
anthropometric, contextual, social,
and economic considerations in the
design of appropriate technologies
is essential.
As described in the case studies,
there is often a significant disconnect between governmental policies related to CHWs and how the
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