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Digital resources in the Eastern Cape, South Africa

Stephen KorsmanVirologist

Groote Schuur NHLS / University of Cape Town2 December 2014

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Outline

• The bad side– Demographics– Telkom– Eskom

• The good side– Digital aids– Digital pathology– Other opportunities

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The bad side

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Demographics

• Largely rural• Poor infrastructure• Most people do not have running water• Roads are poor• People are poor• Cell phones are common• Internet access is poor

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Limpopo

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Telkom + Eskom• Copper is valuable

• No phones• No data• No power

Photo: Gallo imageshttp://citizen.co.za/263549/cable-theft-caused-lenasia-outage/Photo: Gallo imageshttp://citizen.co.za/263549/cable-theft-caused-lenasia-outage/

Photo: http://www.iol.co.za/news/crime-courts/kzn-ops-make-r3m-copper-bust-1.1677121

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Photo: Desiree Swart http://www.moneyweb.co.za/moneyweb-gallery/cable-theft-in-moruleng?sn=Gallery

• Headlines:– Eskom copper cable theft cost

R350 million– One village, over 700 cable

thefts in four months– One electrocuted, three

charged for Eskom cable theft– Telkom cable theft wreaks

network havoc: pictures– Telkom 'no' to lines in cable-

theft areas– Copper-cable theft costing

Britain a fortune (Daily Mail Online)

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NHLS labs

• In Mthatha– Power cuts, faulty electricity– Laboratory Information System

• TrakCare– Requires continuous online link– 2013-14 – copper cables stolen FOUR times– Failure to change from Disa to TrakCare– Wireless (?3G, ?HSDPA?) link needed to prevent theft– Still waiting …

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NHLS labs

• Outside Mthatha– Even poorer infrastructure– Hospitals usually have running water

• The lab may not always be linked up• TB testing done using collected rainwater

– False positive due to harmless environmental mycobacteria

– Do we expect these hospitals to run an online LIS successfully?

• Northern Cape – minor problems with connectivity• Eastern Cape – huge problems with connectivity

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The good side

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A lot is beingdone digitally

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Forms of digitallyaided research

• Simple complex• Simple e-mail contact + data sharing• Skype, YouTube conferences / talks

– Not just videos of funny cats!• Online / shared databases

– HIV, HBV drug resistance– HIV genomic studies– Vaccine development

• Online data tracking / monitoring– Not just Big Brother watching you!

• Microscopy across the web

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Google Flu Trends

GoogleRecorded

USA

South Africa

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Organisations

Research Without Borders: Big Open DataThursday, December 4th, 2014 - 2-4pmColumbia University’s Faculty House

Don’t forget…http://theglobalhealthnetwork.org or http://tghn.org

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Online training

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Possibilities

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Digital pathology

• Walter Sisulu University– Anatomical Pathology

• High resolution digital microscope = Nikon Coolscope• Connected via ISDN, later ADSL, to NHLS intranet• Sites with Coolscopes: WSU, East London, Port Elizabeth,

Stellenbosch Univ, MEDUNSA• Anyone with internet could reach the microscope

– Login was controlled

• Second opinions from Stellenbosch University• Officially opened in 2007• Part of WSU’s digital medicine programme

– Included clinical consultations

19Banach L, Stepien A, Schneider J, Wichrzycka-Lancaster E. Dynamic active telepathology over National Health Laboratory service network, South Africa: feasibility study using Nikon Coolscope. Diagn Pathol 2008;3:Suppl 1

20Banach L, Stepien A, Schneider J, Wichrzycka-Lancaster E. Dynamic active telepathology over National Health Laboratory service network, South Africa: feasibility study using Nikon Coolscope. Diagn Pathol 2008;3:Suppl 1

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Photos courtesy of Marie-Paule Henshall-Howard, GSH NHLS

Roche CAP/CTM

•Mthatha

•East London

•Port Elizabeth

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Opportunities

• Telephonic consultations with pathologists– Ongoing, underutilised

• Live access to local instruments via the internet– In development

• Sharing of log files or run data for pathologist validation of assays– Not yet done

• Easy to do, smaller labs don’t do many tests with portable run data