Skilled Volunteerism and Global Health Solutions with Medical Teams International

December 4, 2017

In Uganda, nearly a half million people from surrounding war-torn countries have sought safety in refugee settlements. The U.S. organization, Medical Teams International, operates health clinics in Uganda to help the refugees and locals with their medical needs. But the slow, paper-based system impacts the time it takes to treat patients as well as identify outbreaks of diseases like malaria. Also, it can take up to a month to manually collect and send data from health clinics in Uganda to the United Nations.

Two years ago, Medical Teams decided to find a solution to this problem. They partnered with skilled volunteers, people with specific expertise who are willing to share what they know, to build a technology solution to automate the process and help transform the way refugees in Uganda receive health care. In this episode, we spoke with two of the volunteers chosen for the project, Heidi Brown and Jason Dempsey, who both work in Cambia's IT department.

You can listen to this episode with the player above, on iTunes or on Stitcher, or read the full transcript below.

Links and Resources

Leslie Constans (LC): Welcome to the HealthChangers podcast, presented by Cambia Health Solutions, where we share real stories of health care transformation from those experiencing it and those helping to make health care more personalized. I'm your host, Leslie.

For today's podcast, I spoke with two of the volunteers chosen for the project. Heidi and Jason both work in Cambia's IT department. I asked them why they applied to be skilled volunteers and how the experience changed their outlook, both personally and professionally.

"Wait, you need people like me?"

"It was eye opening that there is this thing where we can actually apply our technical skills, our day-to-day jobs to a real-world problem that's bigger than we are."

Heidi Brown (HB): I first heard about when our leadership sent out an email that there's kind of a call for volunteers and said hey, we would like folks who want to help solve this real-world problem of data collection and reporting needs. And for me, that was a huge, huge opportunity. My mind kind of ran wild and the foundational thought was, "Wait, you need people like me? You need me? You need a project manager?"

It was eye opening that there is this thing where we can actually apply our technical skills, our day-to-day jobs to a real-world problem that's bigger than we are.That's what lit the fire in me. And I applied right away.

LC: How about you, Jason?

Jason Dempsey (JD): I was sort of the same. So when the call came out, I first thought, "Okay, well, I'm not qualified to go help refugees in Africa." But when I looked at what they're looking for, and they needed someone with a data background and someone with kind of a customer-focused experience background, I was like, “Hey, that's what I do on a daily basis.”

Being able to take my day job and think of doing something bigger than me and bigger than what I do on a day-to-day basis. The opportunity to go, to travel someplace like that and experience what these people go through and to make an impact was really ... it was just something I was passionate about and I knew I wanted to apply right away.

LC: So tell us about ... I just would like you both to share your experience. I'm sure there was a lot of preparation going into the trip. Maybe you can talk a little bit about that.

HB: The selection process was in August and we left in early ... late October, early November. Those couple of months were really instrumental in building that skilled volunteers and partnership with Medical Teams.

JD: Those months did go by fast.

Changing Expectations for Success

"It was just a complete eye-opener and led us back to a big conversation in the evening of trying to figure out, okay, our plan is kind of out the window. What do we do now?"

HB: They flew by, didn't they? Oh my gosh. And we met and we met and we put together this plan of attack. We went to Uganda with Medical Teams and when we got there, it was a totally different experience than what we had planned for.

JD: There's no infrastructure. There's no power. There's no way to communicate, you know, between building A and building B. What do we do?

HB: Let alone the Internet.

JD: Exactly. And so it was just a complete eye-opener and led us back to a big conversation in the evening of trying to figure out, okay, our plan is kind of out the window. What do we do now? We've got limited time to produce something, how do we go forward? We had a lot of debate back and forth and we were kind of in these two mindsets of, do we deliver a smaller scope, or do we work for trying to deliver as much as possible?

One of the people from Medical Teams was in the room and he had worked in Africa and worked in these types of situations for years and he kind of sat down and he was like, you know, he's like, "There's no small steps here." And he's like, "Don't be afraid to dream small." That really hit home with us and allowed us to really focus in on what we were doing and say, you know, it's okay to provide what we think might be a small solution to us, is a huge solution for them.

And so providing something that, you know, seems really little and seems like, “Okay, if we just do this one thing, will it really make a difference?” The results we've seen in the end … it's made a huge difference, so that's been really cool.

LC: What did you go in thinking you were going to deliver and what shifted? What changed?

JD: I think that we thought we were going to have a lot more infrastructure capabilities of our own and have ability to communicate between situations. So, think of a normal doctor's office. Here, you check in at the front desk and then they're notified, the doctor's notified that you're here. That communication would have to take place by a person, walking from one building to another.

We had hoped that our app would be able to do something to communicate, okay, you check a person in on the app, their data automatically gets transferred to the clinician, who would be able to pull up that person's record when they got into the office, into the exam room. And we realized the infrastructure wasn't there to support that, so we had to kind of scale down our scope and really focus in on, okay, what can we do if we just provide an application to the doctors or to the clinicians? Can we still collect the information that we need? And I think we delivered something in the end that, yes, we could.

HB: The clinics that we were working in, and Jason can jump in here with his input too, we were kind of preparing for the worst, because we didn't know what to expect. None of us had ever been to a refugee settlement in southwestern Uganda, what were we going to see? And the best way to explain what we did see and what the clinics were like, is to think of them as a rudimentary urgent care facility here, with additional...

JD: Challenges.

HB: With additional challenges.

JD: Think of the basic...

HB: Additional capabilities as well, because some clinics had emergency care, some clinics had in-patient as well as outpatient care.

JD: Yeah, so the ability to provide the care that they do, in the situations that they are in, is amazing.

A Day in the Life

"From the clinicians' perspective, a typical day starts with daylight. There's no power so, you can't get there before dark and really start in on things. So they kind of run with the daylight."

LC: Can you describe that a little bit? Like I'd love to give our listeners, you know, a mental image.

JD: There's a couple of images that really hit home with me. One was the maternity ward, for one of the buildings that we were in. It was basically a concrete block room, with a table-ish type chair and a water bucket with a spigot on the ... in the corner. And you know, no lights. The only light was coming in from the outside, was through the windows, which were, you know, no screens or anything. It's just an opening in the concrete block wall. The floor was kind of dirt, concrete type of situation. And yet they're providing. you know, two to three babies are born in these situations every day, which is much better than if they're born in their fields and in whatever other situation.

The other situation that kind of hit home is a picture that I have of a pharmacist. And she's in this room, it's a tiny, maybe like four foot by four foot, kind of square room with boxes stacked all around her, with drugs. There's bars on the window, just a kind of small opening in the window for people to put their form in that says okay, here's the prescription that I need. They would stack their paperwork there and this pharmacist sits here at this desk in front of the window, every day, again, no power, no light, other than the light coming in from outside.

HB: No air conditioning.

JD: No air conditioning, and she has to be, kind of locked in this room, because she's in the room with all the drugs. She works her day…

HB: …And she's just handing them out for distributing.

JD: Eight to ten hours filling prescriptions. So you know, think of your pharmacist, working in a really small closet with no ... none of those comforts that you're used to.

LC: So can you tell us a little bit about a day in the life at these clinics for both the health care workers, the clinicians and the people they're serving?

HB: From the clinicians' perspective, a typical day starts with daylight. There's no power so, you can't get there before dark and really start in on things. So they kind of run with the daylight. In each settlement clinic, there can be different areas. So that, as we heard Jason say earlier, there's a maternity ward. There's your general, kind of, outpatient diagnosis space. There's also a lab, where lab results are. Blood draws occur and the lab runs the results on those blood draws. There's also areas for sexually-transmitted disease care and emergency care, as well as some facilities have in-patient, overnight stay, sort of procedural facilities.

LC: So a lot of different settings.

HB: A lot of different settings and not every clinic is the same, so some will have some of the basic fundamental care facilities and some will have these more robust facilities.

JD: Yeah, they really go from basically a tent in the field at the intake center all the way up to multi-building kind of areas, where there's different areas for all these different departments that Heidi described.

Processing the Volume of Health Care Data

"That's a 110,000 people have been diagnosed with app within about an eight- to nine-month timeframe. So that tells you just the volume of people that go through every day."

LC: And how many people are they seeing a day?

HB: They'll see upwards to eighty to a hundred patients per clinician per day. Is that about right, Jason?

JD: I think that's about right. So, it's a large number of people that go through and as Heidi was saying, that's a 110,000 people have been diagnosed with app ... or been captured through the app within about an eight- to nine-month timeframe. So that tells you just the volume of people that go through every day.

HB: And that's ... I'm going to add onto that, because this number is really staggering. That's in just five health care clinics in southwestern Uganda alone. There are over thirty clinics in the country all together, with more coming up each day due to the South Sudanese refugee crisis in northern Uganda.

LC: And what is that patient's experience like? Obviously, it's daybreak, they're not feeling well, or they need to check in?

JD: So, that was a big eye-opener for me and the takeaways that I had the first day was patience. It's patience with a "ce" not a "ts" because these people know that Medical Teams are providing really good health care, and they're sick enough that they're going to walk from however long, probably in the dark to get there the time that the clinic opens and wait all day, because it's an all-day long process.

They go to one facility and check-in. They're weighed, have basic vitals and things taken. From there, they're given cards basically saying, okay, yes you can wait or you're an emergency case, you need to be seen immediately. They just wait for their card to come up and wait for their number to be called to be seen by a clinician. So their clinician typically sees them, spends a few minutes with them. Like I said, they see a hundred, or eighty to a hundred people per day, so it's not a high-level of spending a lot of time to get-to-know-you type of care, but they're providing high quality care that same time.

LC: And they're capturing all that information basically on paper.

JD: Exactly. And so as they're doing that, they're making their basic diagnosis, they're writing this in a form that's like a basic blue booklet. So if you remember the blue booklets writing your essays in high school and college, that's what they use for their medical records. So the doctor may write a basic diagnosis in that and send them to the lab.

From there, they may have a test done, or they have to wait again to have the blood drawn, to have the test results come back. Then the doctor gets those test results back and makes a determination of yes, they need this type of medicine or whatever it might be.

Learning from First-Hand Experiences

"We thought we knew the process. We thought we knew what was going on. We thought we knew who are customers were. But really, when we got there, we realized that our customers were these people who were being seen."

LC: So since you've helped them develop this application and the clinicians now have access to, is it on a mobile device, a tablet?

HB: It is, it's an Android-based mobile application and its focus is on collecting patient demographic and diagnoses data.

LC: How does that process look like now for them and their patients?

JD: So now through just a few clicks, they can go through the process. You know each doctor signs into the tablet every day, or every kind of session, and just a few clicks, they can enter the patient's statistics, you know, their age, if they're a refugee or a national, where they're coming from, that type of thing. And then the diagnoses, and then it automatically gets captured and then depending on WiFi capabilities and things, they sync up immediately or sync up a couple of times a day. And that data, then, gets sent to the cloud, which is then monitored and look for things like outbreak potentials.

LC: By the U.N. and other agencies?

JD: Correct.

LC: Yeah.

JD: So you know when we got back, one of the things people asked us about a lot, why did you have to go all the way to Uganda to do this? Couldn't you have just done that there?

And I think that, like we said in the beginning, we thought we knew the process. We thought we knew what was going on. We thought we knew who are customers were. But really, when we got there, we realized that our customers were these people who were being seen.

The clinicians and people using the app, they're just kind of transiting, and they're the middle-man of the whole process. I think that, without being there and seeing what's going on and interviewing these doctors and watching how they diagnose patients and watching how they mark a diagnosis on 11-by-17 sheet of paper and mark the wrong check box. It's super easy to do and you see these things, okay, if they're seeing eighty to a hundred people per day, mistakes are going to happen.

I think that seeing those things firsthand and being part of the process and the interview process and working with these people, helped us to build something better to meet their needs in the long run.

HB: The app is in the field now, in five different health care clinics within two settlements in southwestern Uganda and has already diagnosed over 110,000 patients. Jason, you want to tell the story about how it's already helped with a potential outbreak?

JD: So one of the things that came up, that came in through the data collection, was there's a couple of different ways of diagnosing malaria. So there's a diagnosis of “malaria confirmed” and “malaria suspected.” Suspected means that they're treating the symptoms. If they're confirmed, it means they've actually done a test and confirmed the person does have malaria and they're given drugs to treat that. Through the data, they were able to see a spike happen in the malaria suspected area.

LC: Through your app?

JD: Through our app, through the data collected through the app, yes. And the people from the main office looked at that and said, okay, what's going on? Why has this number gone up? Do we have that many people coming in that, you know, we can't treat or what's going on?

So what they found, they talked to the clinicians and said we're running low on test kits. And so they were being conservative about who they were actually testing. In that case, they're like, we've got more test kits we can send out to the field. And they were able to send those test kits out and change that diagnosis right away, so it improved the quality of data.

Learning to Work as a Team

"That emotion really turned into passion for what we were doing and made every one of us fight for our opinions and fight to build something better than we had thought we were going to build in the first place."

LC: Did you two know each other beforehand? Did other team members know each other? Tell us a little bit about how you came together as a team, went ... I know some of the team members went to Uganda, others stayed here in the United States. How did that work and what did you learn from that process?

HB: The majority of our team members did not know each other upon selection. I think a couple had worked together prior to.

JD: Before we left, the seven of us that traveled over there actually went on a quick little excursion, you know, before we actually started to work and we were stuck together in a van for five days, just the seven of us and driver. And we got to know each other's personalities through that. Since we'd never worked together before, that was really key in making sure that we could hash out things and have tough conversations when we needed to, because we had a really short time to work. I think if it wasn't for that kind of team-building experience, it probably wouldn't have been as successful.

HB: I'd agree. So if anybody can figure out how to go on safari before every project, probably pretty great.

JD: The other thing was just the emotional fact. It's really overwhelming. I've traveled a lot. I've been in lots of different places but I had never been in a situation quite like this and experienced life like you see it there. I think a lot of us you know, seeing it through each other's eyes and having each other to kind of lean on and say, “Hey, we're all going through this together, it's very emotional for us and it's completely different from what we're used to” allowed us to kind of bond together as a team.

HB: That's where the skilled volunteer partnership, where Medical Teams came in very, very handily. They prepped us for that as best they could, for the emotional impact of what we were going to see. And then, we had folks from Medical Teams travel with us that were not the technical SMEs from their team, but more of the organizational and operational folks that have, for lack of a better term, been there, done that and been in these environments and seen these scenarios before.

They were there to help us decompress every day if we needed it and that was really, that was really important, because there were a couple of days that were really emotional. We were emotional. Emotionally-charged from what we saw that day and that's just the first half of our day. The second half of our day, we would come back to our hotel facility, the conference room that we were working in and we still had four or five hours of work ahead of us to

JD: Or more.

HB: Or more. To build our app and go through everything that we learned in the field. How do you do that when you're torn up on the inside about you saw that day? And Medical Teams really rose to the occasion and supported us in that manner, because we were not used to some of that.

JD: That emotion really turned into passion for what we were doing and made every one of us fight for our opinions and fight to build something better than we had thought we were going to build in the first place.

LC: This is fascinating and powerful. I wanted to get both of your perspectives on what does a project like this and skilled volunteerism mean to an organization like Medical Teams International?

JD: They didn't have the skills in-house, or the resources in-house, to be able to do something like this. So they knew and they saw the need and the key in skilled volunteerism is bringing together people who have resources that can help each other. You may not know where to go and how to do it. But then through conversation, or just through reaching out, it kind of creates that bond and creates that trying to do something bigger and trying to work together and “Hey, how can I use my skills to help you out? And how can you use your skills to help me out?”

I'd never really heard the term skilled volunteerism before that and I thought of helping in a refugee settlement, okay, I'm not a doctor, I can't help these people, what can I do? And then, going back to the beginning, how can I take my data knowledge and my customer-focused design kind of processes, and turn that into something that's helping refugees in Africa, is just amazing.

HB: It really is a symbiotic relationship when you enter into a skilled volunteerism partnership. Medical Teams had the need, but Cambia's corporate responsibility and philanthropic side has desire, so we all serve the greater Cambia Cause, which is to transform health care. This gave us the opportunity to transform health care outside of our borders, which probably wasn't in the vision of the Cause when it was first written, but what a great partnership to be able to explore that?

Life Lessons from Uganda

"On a personal note, it changed me from the word go."

LC: What did this experience mean to you, professionally and personally?

HB: Being exposed to a program at that level and given all the uniqueness's about a project that happens in Uganda, really allowed me to grow my skills in flexibility. Being able to roll with the punches, really being open to change of direction. And that just translates back to being able to do my day-to-day job here in a more robust way.

On a personal note, it changed me from the word go. Couple of things that were takeaways for me, was I have completely different views on two key terms, wealth and contentment. Wealth, to me, is much more than a dollar amount or a savings account or possessions. It's about the relationships I have in my life and making connections with people and being there for other people. And contentment, when you see folks who literally have nothing except for the roof over their head, their rations card which guarantees them food and then bins that they have to carry their own water in (which are incredibly heavy, by the way) that gives you perspective on what really matters in life.

My favorite story coming back from Uganda was I got the opportunity to meet the Commandant who represents the Ministry of…

JD: Uganda Ministry of Health?

HB: Uganda Ministry of Health, yeah. And we were all introducing ourselves and saying our names and where we were from and what company we were with and he tried to say my name back to me and he couldn't pronounce it (the way dialects work and certain letters you can't pronounce). And so he says, "I cannot say your name so I will give you a true Ugandan name. And I shall name you Asiimwe and it means 'praise be to God'." And he smiled and we had a little connection moment there. That was pretty amazing.

JD: Yeah, Heidi became Asiimwe for the rest of the trip. I think for me, from kind of a professional standpoint, like she said, flexibility was just the biggest thing that I brought back from the whole trip. Nothing ever worked like you thought it should, even back in the hotel when we were trying to work in the evenings, we may have power, may not have power. You may not have hot water, not have anything working that day. It's something that I've definitely brought back is just being flexible and being able to work with whatever happens and kind of take it as it goes.

LC: Yeah.

JD: On a personal note, the same thing. We're in the field, we got a chance to actually go out and visit some of the homes and the places where the people actually live in the settlements. And through this interview process, working through translators, someone asked the family members and the lady what she thinks about the future and what she hopes for the future of her kids? They had escaped horrors from their country and come to Uganda and had kind of established a life there in the settlement, and she was like, "I don't think about the future." She's like, "To me, it's just a day by day type of life. I know what I can do today and hopefully, what I can do for tomorrow." And she's like, "I don't think about the future, that's something that doesn't even cross my mind."

That really, really hit me hard of you know, I'm planning my next vacation and all these things years in advance. And it really made me feel very lucky to be where I am and to have what I have and made me really grateful at the same time. Just thankful that I am in the situation that I am.

What's Next?

"So what will the future hold? We really don't but we're still in the process of trying to help build that product plan and figure out what's next."

LC: So you went, originally, to Uganda two years ago. It was 2015, in the fall. Now we're in October 2017. I know the project continues, what's next?

JD: So the partnership between Cambia and Medical Teams International is still going on. They're in the process right now of rolling out to additional clinics. I think the plan is for the next year to roll it out to the rest of the clinics inside the whole country of Uganda and really study how it's being used and really develop what the next steps are going to be. So what will the future hold? We really don't but we're still in the process of trying to help build that product plan and figure out what's next.

LC: Thank you so much for joining us today on the podcast. This was a really, really interesting conversation. It was great hearing your stories. Thank you, Jason and thank you, Heidi, or maybe I should call you Asiimwe.

HB: Thank you, Leslie, it was a real pleasure.

JD: Thanks, Leslie. It was great talking to you.

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Skilled Volunteerism and Global Health Solutions with Medical Teams International | HealthChangers Podcast