Making a difference in Malawi

September 2011: From the air, it looked like a leopard’s coat: hills of dry grass were dotted with random dark spots of green mango trees and large boulders. I landed in the capital of Malawi, Lilongwe, at the peak of the dry season in south eastern Africa.

Independent since 1964, and democratic since 1994, Malawi is a landlocked country of 15.5 million people, nestled between Mozambique, Zambia and Tanzania. Running from North to South along the Great Rift Valley.

Malawi enjoys a healthy wildlife and stunning diverse landscapes with flat plains, woodlands, wetlands, rainforests, and mountains up to 3,000m tall. Its eponymous lake, with warm crystal clear water and sandy beaches, is part of the lives of many Malawians whether it is for daily use, fishing, tourism or for 98% of its hydro-based electricity. Nevertheless, with only 6% of the population having access to power, an average life expectancy of just 50 years, an HIV/AIDS rate of 12%, and 65% of the population below the poverty line, statistics unfortunately rank Malawi among the world’s least-developed countries: 171/187.

In the days following my arrival, these cold, hard facts about Malawi’s difficulties were quickly overshadowed by the exceptional kindness and friendliness of Malawians. Among them are the members of Baobab Health Trust, a Malawian organization delivering medical informatics solutions to hospitals and clinics across Malawi. I noticed the office of Baobab Health one day while driving in Lilongwe and I met with founder Gerry Douglas to offer to work as a volunteer. The next day, and for the next three months, I worked at Baobab Health and was in charge of three projects related to image processing and electronics. Working for a Malawian NGO with Malawians engineers and for Malawians’ interests was truly one of my greatest and most memorable experiences.

Created in the USA in 2000, and officially Malawian since 2008, Baobab Health is replacing Malawi’s traditional paper-based system of medical records with an electronic system in hospitals and clinics, with the goal of improving healthcare delivery and reducing its costs through better planning. In Malawi, there is on average one doctor for 50 000 people (versus 400 in Europe and the USA) so the task of collecting and updating medical records is usually assigned to health workers with no computer experience. Also, nurses and low-skilled clinicians provide most of the healthcare to people and would benefit greatly from a clinical decision support system for medical diagnosis. Existing medical informatics solutions from the Western world are not adapted to emerging countries like Malawi, so engineers at Baobab Health have developed their own open-source software and custom hardware solutions by stripping down a computer to its bare essentials: a touch-screen, no keyboard and an intuitive, highly optimized, user-interface that guides clinical practitioners through each task (registration, diagnosis, prescription) while also preventing error entries.. The result is a much more accurate and faster data collection that benefits both patients and doctors, but also the nation in helping making policies and planning drug purchase.

Malawi is a low-resource and challenging environment for deploying modern IT technology. Power cuts, communication network outage and chronic fuel shortages regularly affect main hospitals. Health centres in the countryside reaching most of the population are simply out of all grids. To overcome these problems, Baobab Health finds innovative and sustainable solutions with customized workstations, low-power servers, alternative sources of energy and continuous power backup. This allows an HIV clinic to run with three touchscreen workstations, three label printers, a network switch and a server for less power than a single 100-watt light bulb. Engineers also set up their own communication antennas to interconnect the different centres for monitoring, support or service delivery. Baobab Health can pride itself on having, in its system, 1.5 million patients registered across 23 sites and over 122,000 patients on anti-retroviral therapy.

I first heard of Baobab Health in the book The Boy Who Harnessed The Wind. It tells the remarkable story of William Kamkwamba, a young 14-year-old Malawian boy, who had dropped out of school. Using books from the library and parts from a scrapyard, he managed to build his own windmill to power his family house. Baobab Health helped to spread the word of his engineering talents at a TED conference in 2007. From that moment, William Kamkwamba became a media sensation and is now able to pursue his studies in the USA. This extraordinary and inspiring story is sadly unknown to most Malawians and its youths who desperately need role models and encouragement to believe in themselves and their future.

Emerging countries can benefit tremendously from new technologies, provided that they are carefully adapted to the particular needs and issues of each region. I left Malawi during the rainy season and the land was then covered with lush, green vegetation: it had transformed itself as much as Baobab Health has transformed my vision of engineering.