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911 Where There is None: Community-based emergency medical systems development in Mwanza, Tanzania

We empower young Tanzanians to design, build, manage and sustain their own emergency medical systems through mobile technology and training.

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EXPLAIN YOUR IDEA

Despite the fact that there are approximately 4-5 billion mobile phone subscribers globally, the majority of the world’s population does not have access to a dedicated emergency number like “911” to call when minutes count. To address this near-universal lack of reliable pre-hospital care in resource-limited communities, Trek Medics International has developed Beacon, a text message-based emergency dispatching software designed specifically for communities where advanced 911 technologies are unaffordable or inappropriate. By relaying text messages from the scene of an emergency to trained responders throughout the community, Beacon enables the nearest available emergency care providers to quickly locate, treat, and transport the patient to local hospitals.
 
Trek Medics’ approach to emergency medical systems is based on the belief that 90% of the resources needed for effective emergency response are already available within the community — namely, young adults equipped with the phones in their pockets and the vehicles already on the road. Our program targets young adults from the full range of educational and economic backgrounds and provides them with vocational training in basic emergency care and mobile phone technologies, while also offering them early exposure to the health sciences and meaningful opportunities for leadership development -- the same career path aspiring young physicians and nurses have been taking in wealthier countries for generations.

WHO BENEFITS?

Since 2015, we’ve trained over 100 young adults in Mwanza as community first responders -- medical students, community health workers, and boda boda taxi drivers -- now providing 24-7 coverage to 125,000 people, with over 160 emergency responses. By providing young adults with the tools to build, manage and sustain their own response systems, we’re able to help them address the “daily disasters” that would otherwise go untreated, while also laying the foundation for a stronger health workforce.

TELL US MORE ABOUT YOU

We’re a NYC based 501c3 that provides EMS technology solutions in resource-limited areas. Our programs rely on local partners (fire-departments, motorcycle taxi drivers et al.) and we’re seeking to partner with other NGOs and technology partners committed to community health systems strengthening.

WHERE WILL YOUR IDEA BE IMPLEMENTED?

  • Kenya
  • Rwanda
  • Tanzania
  • Uganda

EXPERIENCE IN IMPLEMENTATION COUNTRY(IES)

  • Yes, for more than one year.

EXPERTISE IN SECTOR

  • I’ve worked in a sector related to my idea for over a year

HOW HAS YOUR IDEA CHANGED BECAUSE OF BENEFICIARY FEEDBACK?

Our idea has changed in two ways:
1) Priority incentives for participants are less tied to financial remuneration than expected, focusing more on community standing and professional development. The most common incentive requests include professional recognition (uniforms, training certificates, photo ID cards, vehicle decals), mobile phone subsidies and health insurance. We've seen many different types of community organizations that can serve as the local lead, not just fire departments or hospitals, but also youth development and community-based organizations, civil defense groups, NGOs etc
2) We've found that the beneficiaries see potential applications for our software beyond traditional "911" systems, including:
i. Emergency response for vertical programs (e.g., maternal-child health only)
ii. Regularly scheduled medical transfers as part of a referral network
iii. Access to health care and transport for disabled persons and special needs communities
iv. Emergency requests for blood donations issued by the blood bank
Because these are all separate local business opportunities, the feedback has made us evaluate how our software can be more easily customizable.

HOW IS YOUR IDEA UNIQUE?

Our idea is unique because it's the only approach to EMS development we're aware of that is:
1. Comprehensive -- covering all components of an EMS system
2. Equitable -- ensuring the same access and standard of care irrespective of socio-economic status
3. Locally relevant -- tailored to meet local healthcare and cultural realities

Our Beacon software eliminates a dependence on expensive and inappropriate EMS technologies that have been developed for the public infrastructure of Western nations by leveraging the people and resources that are already being used to provide medical care and transport, and thus strengthening both the formal and informal emergency response systems already utilized on a daily basis to transport the sick and injured.

Our approach is also unique because it empowers local communities. Designed to gain buy-in from the outset, a range of organizations can be engaged as equal stakeholders in the system as no single agency can do it alone. Our goal is not to have these communities outsource their EMS systems to us. Rather, we can offer them the tools and training to design, implement, manage, monitor and sustain their own community-based systems.

WHY DO YOU THINK THAT THE PROBLEM YOUR IDEA SOLVES FOR HAS NOT BEEN SOLVED?

Communications – Modern EMS systems were developed in the wealthiest nations in the 1950s-60s and relied on landline-based telecommunications and many different radio solutions. Because most LMICs didn't have widespread access to landline telecommunications, it was difficult to use Western technology to coordinate existing resources, whether formal (a technician in an ambulance) or informal (a neighbor in a pickup truck). Without reliable communications to alert the community when and where an emergency happens, responders and vehicles can only be used incidentally. Thanks to the proliferation of mobile phones, new dispatching systems designed specifically for these communities are underway.

WHAT ARE SOME OF YOUR UNANSWERED QUESTIONS ABOUT THIS IDEA?

What will the proof points be for the government and mobile network providers to adopt and champion access to 24-7 emergency medical response at the community level on a national scale? Both of these groups would seem to have a lot to gain by supporting a sustainable, community-based approach to EMS development. In both cases, we feel we have the evidence and data to back up the argument for increased engagement, but we are still early.

IS THIS IDEA NEW FOR YOU OR YOUR ORGANIZATION?

The idea is not new, but our role in these programs has changed substantially since we began in East Africa. At first we saw our primary role as program managers, helping communities build capacity in four areas: training, transportation, communications and management/policy. This is how we're currently operating in rural Dominican Republic where very limited resources and capacity existed when we began. There's lot of need for this type of support elsewhere, but as a startup it's difficult to win the larger grants needed to fully fund these types of programs without a longer record of achievement. In East Africa we've also seen that the need for our communications software is still great, but there's also more baseline capacity in training, management and transport, in general. By working with partners who have more capacity we're able to focus on improving and scaling the software. Moving forward our goal is to operate in roles where we're providing the software and technical advising needed to help local organizations improve performance, coverage, and operations, but management stays local. This would also allow us to assist more at the policy level where expertise is needed.

WHO WILL IMPLEMENT THIS IDEA?

Our aim is to partner with organizations, agencies and individuals who are already involved in local response. Formal: Fire and police departments, civil defense, Red Cross, local hospitals; Informal: bodaboda drivers, medical students, youth groups, NGOs etc. Each and all represent the human, intellectual and physical resources needed to launch a functional program: to determine the coverage and design of the system, identify necessary and available resources, and manage their operations.
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In Spring 2015, Trek Medics sent out an open invitation to local communities interested in implementing Beacon free of charge. After receiving an overwhelming reply from East Africa, our Director of Field Programs, Benjamin Gilmour, packed his bags and set off to Eastern Africa to scout out seven locations in Tanzania and Kenya. Upon his return, he had little doubt he’d found a strong partner in the Rural Tanzania Health Movement (TRHM), a community-based health organization in Mwanza, Tanzania, dedicated to improving health care for all. A few months later, we sent another Australian paramedic, Scott Campbell, out to Mwanza to work alongside TRHM’s Director, the indefatigable Dr. Marko Hingi, and begin building a community-based response system. Less than four months later, a new community EMS system and training program has been born, far exceeding all of our expectations.


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SHARE ONE SENTENCE ABOUT THE IMPACT YOU WOULD LIKE THIS PROJECT TO HAVE FIVE YEARS FROM NOW, AND ONE QUESTION YOU NEED TO ANSWER TO GET THERE.

24-7 access to reliable emergency care and transport for one billion people who previously never had a way to call for help when it was needed.
How do we convince governments to champion it?

MY ORGANIZATION'S OPERATING BUDGET FOR 2015 WAS:

  • Between $100,000 and $500,000

MY INTENDED BENEFICIARIES ARE:

  • Within 50 km of where our team does most of its work

HOW LONG HAVE YOU AND YOUR COLLEAGUES BEEN WORKING ON THIS PILOT PROJECT TOGETHER?

  • More than a year

WHY ARE YOU INTERESTED IN JOINING AMPLIFY'S PORTFOLIO OF INNOVATORS?

In 2010, two of our staff were in a healthcare management class together that covered IDEO's approach to human-centered design in-depth. It made a big impression on both of us early on, and inspired us to create a toolkit for designing community-led EMS systems and a field guide to let them be managed locally, and accessible to all regardless of prior EMS experience. We hope that by joining Amplify's Innovators, we can drive this approach further with the help of other dedicated changemakers.
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Attachments (2)

User Experience Beacon_IDEO.pdf

User Experience Map for our community-based emergency medical systems and dispatching software.

beacon infographic.png

Beacon workflow diagram showing the First Responder's experience using any mobile phone, with or without internet.

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Jason Friesen We've featured your idea in a new blog post celebrating additional ideas from this Challenge. Thank you for your participation in this Challenge! https://challenges.openideo.com/blog/celebrating-youth-empowerment-challenge-ideas

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