Grants:TPS/Anelsona/Wikipedia Project for Offline Education in Medicine (POEM)/Report

Event name

Offline Wikipedia Demonstration, San Pedro de Macoris

medical school and clinic tour in the Dominican Republic, spring 2017

Participant connections

The SIPA team traveled extensively in the Dominican Republic, concentrating on three areas: hospitals and clinics in the San Pedro de Macoris area; rural clinics with a large number of Haitian and Creole-speaking patients on the Dominican-Haitian border; and institutions based in the capital city of Santo Domingo, including the Ministry of Health and the Universidad Iberoamericana Medical School (UNIBE). They were able to conduct extensive interviews with medical students; medical school faculty; physicians working in rural clinics and major hospital emergency rooms; regional and national Ministry of Health officials; and experts in the national digital infrastructure, including mobile use and the electrical grid -- 26 individual interviews and two focus groups (for a total of 63 medical personnel) and site visits to 10 hospitals and clinics, in four provinces in all. The team received strong collaboration from a number of Dominican health care professionals, especially Dr. Ada Turner from the Hospital Antonio Musa and Dr. Marcos Nunez from the Universidad Iberoamericana Medical School.

The principal questions were:

Is there a shortage of medical information that could be addressed by Wikipedia and the Raspberry Pi technology?
If so, would it be technologically feasible in the context of the local infrastructure?
If so, would it be cost-effective in this environment?
If so, would the likely user base be comfortable with the device?
Are competing technologies likely to replace it in the very near future?
What are specific local needs that could be addressed in the next generation of the content?

The teams carried out their interviews and conducted numerous demonstrations of the device in most of these settings.

Outcome

Option 1: Shared Experience: What is one way you shared something from your experience with your community (either locally or globally), after the event?

The team presented the project at the School of International and Public Affairs in April 2017.
A large presentation with all students to more of their peers is scheduled for 3 May 2017.
Instructor Anne Nelson will be presenting at Wikimania 2017 in Montreal in the Medicine Track
Students will publish their own reports by mid May 2017.

In the spring of 2017, the Wikimedia Foundation awarded the Wikipedia Project in Offline Education in Medicine (POEM) a travel grant of $4100 towards travel to the Dominican Republic. The project was based in a collaboration between a capstone project at the Columbia School of International and Public Affairs (SIPA) program in Development Practice, and the Mount Sinai Global Health Program. The project built on research from the previous year's SIPA capstone, documenting the use of offline Wikipedia in Cuba.

The purpose of the 2017 research was to explore the potential of offline Wikipedia medical resources, using a Raspberry Pi 3, to support medical personnel working in rural areas of Latin America without connectivity. We chose the Dominican Republic as a laboratory because of its appropriate conditions for the study, low travel costs, preexisting relationships with the Mount Sinai team, and the ease of negotiating bureaucratic procedures. (The last element is particularly not the case in Cuba.) The teams worked closely with Adam Holt and Lane Rasberry from Wikipedia's Medical project, and would like to thank them for their interest and support.

The Wikimedia grant was used to cover most of the travel expenses for a team of three students to spend ten days in the Dominican Republic in March, and to include the five-day- participation of two faculty members. They were able to build on the findings of two months of online research and local interviews in New York, and a February research trip by three Mount Sinai physicians focusing on medical practices and specific needs for clinical information.

Outcomes: The findings included:

There was an acute need for this kind of medical information. Many clinics lacked internet connections and had minimal printed resources. (The very few computers we saw were mostly used for hospital records and billing purposes, not research.)
Most doctors had smartphones, but most could not afford ample storage or data plans. It appears that mobile would be the primary platform used. There would be limited tablet and laptop use as well.
The Dominican physicians and medical students were generally quick to learn how to use the Internet-in-a-Box. Many were thrilled at the idea they could explore the information in Wikipedia and other resources at their leisure, without using up their data plans.
Both internet connectivity and the electrical grid are erratic in many rural areas. Interviews with the electrical authority and a cellphone provider established that the country will not be able to address this situation until at least 2020, meaning there will be a considerable window for the project's applicability. (Another benefit of the Raspberry Pi 3 is that it can be battery-operated, meaning that it can be used in case of a blackout or a natural disaster (such as hurricane or earthquake).
The medical content loaded onto the Raspberry Pi 3 (predominantly Wikipedia-based) for the initial research was received with enthusiasm. Practical suggestions were made for simple additions. (The most important of these was the app for the Dominican Ministry of Health's protocols.)
Many subjects noted that most Dominican physicians do not speak Creole, yet 10 % of the country's population is of Haitian origin, and in some clinics Creole-speaking patients constitute the majority. There was strong interest in the Creole resources already present on the device (especially "Where There is No Doctor" in Haytien and its extensive Creole medical vocabulary).

Learning Pattern: The SIPA and Mount Sinai teams presented their findings to Lane Rasberry, Adam Holt, and representatives of their institutions on April 4. Another presentation for a larger audience will take place at SIPA on May 3. We have been invited to present at the Wikipedia Medical conference in Montreal in August and will also be available to the Wikipedia community in the New York area.

Next steps:

The SIPA team is producing an extensive report on its methodology and findings, as well as a blog and a video, that will be completed and available to the Wikipedia community in May.
The dean of the medical school at UNIBE, the leading school in the country, would like to proceed with a pilot project in the summer of 2017, testing the use of 5-10 devices for in the same number of clinics. This project could be carried out by one participant from SIPA and one from UNIBE. The SIPA participant would also accompany a physician from the Mount Sinai team, who will be taking the device to Guatemala, where he has volunteered in rural clinics serving a predominantly Mayan population. The Guatemala portion of the research would be approximately one week of the summer period. The entire SIPA portion of the summer research project in the Dominican Republic and Guatemala would be budgeted at $10,000 (including preparation, travel, local transportation to the clinics, and purchase of the devices), plus an additional $2500 that Columbia University would provide. The dean of UNIBE has stated that his school would cover the costs of their participant. If this funding and the staffing can be found in time, the Dominican pilot will take place in July.

Finances

Finances:

Grant amount: $4100

Flights roundtrip to the Dominican Republic for five participants: $1927.80

Housing for five participants (three for ten days, two for six days): $2139.00

TOTAL: $4066.30

Amount left over:

[The three students' meals and incidentals were covered by a $2500 grant from the Earth Institute at Columbia. The two faculty members' meals and incidentals were at their own expense.)

Amount left over

$33.70