Taking on tuberculosis: Tech in the World in Peru

This January, our team of five computer science students traveled to Peru to take on one of the developing world's thorniest global health challenges: the menace of tuberculosis in Peru.

The Tech in the World 2016 team: Neel Mehta ’18, Saranya Vijayakumar ’18, Annie Wei ’16, Francisco Rivera ’19, Fanney Zhu ‘17

We were the latest recipients of the Tech in the World fellowship, a three-week J-term fellowship sponsored by Developers for Development (D4D), an international development and computer science club at Harvard. This fellowship's aim is to immerse talented computer science students in a developing country so they can build technical solutions to intractable public health problems.

Rampant TB, effective treatment, low adherence

Peru has the world's 2nd-highest incidence rates of tuberculosis. Socios en Salud, Peru's largest public health NGO and sister organization of Boston-based Partners In Health, has taken the lead on battling this threat with its cheap, effective, and widely-deployed TB treatment programs that treat the disease, the economic damages it causes, and the social stigma surrounding it.

The catch is that the treatment program is long (around 90 days) and, if patients start but fail to complete the treatment, their TB is at risk of progressing to multiple-drug resistant tuberculosis, or MDR-TB, which is orders of magnitude more difficult and expensive to treat.

To ensure adherence, Socios en Salud has pioneered the Directly Observed Treatment System (DOTS), by which patients visit an office daily and take their medication in the presence of a medical official. This way, doctors know with certainty whether or not patients are adhering to treatment.

The trouble is that adherence rates remain low and the current paper-based DOTS system is time-intensive, disorganized, decentralized, and fraught with human error. Socios en Salud tasked us with developing a software system, eDOTS, to digitize and automate this procedure.

Our product: an Android app to streamline TB treatment

Over the course of three weeks, we worked closely with Socios en Salud's IT staff, project managers, nurses, and TB experts to design, test, and build an Android app to implement the eDOTS system. With this mobile app, doctors can:

  • Register or check in a patient using their fingerprint via an attached fingerprint scanner
  • Log a visit (i.e. a DOT) in seconds
  • View a patient's complete visit history at a tap
  • Schedule new visits

This system is fast, centralized, and easy-to-use, and, crucially, it removes the flood of paper that was troubling the DOTS system.

 

A user searching for a patient by fingerprint and government ID code 

We traced the progress of our product, from sketches to final polishes, through our weekly blog posts: see week 1, week 2, and week 3.

Socios en Salud plans to begin field-testing our app with the ultimate goal of incorporating it into their DOTS procedures around the country.

An experience that truly shaped our worldviews

Sitting in Cambridge, it's very difficult to actually understand the problems facing the developing world but very easy to think you do. Traveling to Peru forced us to rethink all of our assumptions and realize the unique challenges of international development. For instance, in Cambridge or Silicon Valley, you have the luxury of being able to build products from scratch using the most advanced tools and with no cruft holding you back. Shortly after arriving to our office in Peru, however, we realized we had to work with mountains of existing code (most of it in Spanish) and use a decade-old database system that required us to use technologies and languages none of us had ever heard of before. Instead of having a smooth pipeline that would instantly move our code to Socios en Salud's servers, we had to email our code to our contact so he could paste it in and re-upload it, often with several hours of latency. Socios en Salud were certainly progressing fast and ahead of the curve, but technology in Peru is nothing like technology in the US, a takeaway we could only have realized by working there.

 

Exploring the sights in Lima’s historical city center

At an even broader level, we realized the mindset we had to have when working in international development. It's very easy, and very tempting, to assume that you know what's best for the people you're helping and to throw out whatever they've tried in favor of your own ideas. We needed to have the humility to talk to them at length about the problems they were facing and what they had tried, since they knew these things better than we ever could. We had to make compromises: instead of throwing out their old app and starting afresh, we realized the pragmatism of building off what they had started and not losing the work and thought they had put into the product already.

Just as importantly, we gained a better appreciation for the Peruvian people, their culture, and their history by touring Lima, seeing ancient Incan and pre-Incan ruins, enjoying local food (from ceviche to a purple corn soda called chicha morada) and pastimes (sandboarding, whitewater rafting, ATV riding, and more), and talking to everyone we met. That's the real thrill of international development: to work with and appreciate people very different than yourself.

Some content from this blog originally appeared on the Harvard School of Engineering and Applied Science website. Read more here.

This post was written by The Tech in the World 2016 team: Neel Mehta ’18, Saranya Vijayakumar ’18, Annie Wei ’16, Francisco Rivera ’19, Fanney Zhu ‘17