The Tom-Tom-Bit

Luís Ángel Fernández Hermana - @luisangelfh
12 September, 2017
Editorial: 131
Fecha de publicación original: 1 septiembre, 1998

The patient man is prepared to pluck the feathers off a chicken’s egg one by one. (Bambara proverb)

Manhica (Mozambique). — Satellites, systems for global positioning (GPS) and for geographical information, aerial photographs, advanced cartographic programmes and digitalised maps, data bases, integrated systems for personal and territorial identification, a data centre with more than a dozen networked computers, the Internet, a modern laboratory and a human team for the collecting and processing of information in the field, make up the nucleus of an advanced representation from the Information Society in one of the most unlikely places imaginable: Manhiça a small town 80 km away from Maputo, the capital of Mozambique, one of the poorest countries in the world. This network of human and technological resources form the basis of activities at the Centro de Investigacion de Salud de Manhiça (CISM) At the Centre there is research, training of health workers and aid to the population on health problems of local significance, from the most common ailments –which under these particular socio-economic circumstances are much more serious because of lack of resources– right up to large endemic diseases such as malaria.

Putting these three activities — research, training and health care (assistance)– into practice with a universal aim and, at the same time, a high degree of accuracy in their execution, would be impossible without the support of information technology given the circumstances that what is truly endemic is their subsistence economy, an old mistrust of a medicine based on the most elementary prophylactic measures and the enormous difficulties of establishing efficient communication between a scattered rural population and health care centres. If there is one thing that characterises health research in Africa it is the enormous gap that exists between what is supposedly happening and what actually happens, above all because of the lack of “hut to hut” information. These deficiencies are often glossed over by grand statistical projections, and although nobody really knows where the figures come from, they are accepted without criticism because they come to us under the auspices of such eminent acronyms as the WHO, UNICEF or organisations of similar calibre.

The CISM is one of the first, if not the first, African centres to confront this problem via the intensive use of information technology and this does not simply mean a bunch of machines and computer programmes. It is a complex combination of human and technological networks which absorb and process information with specific objectives such as the developing of clinical vaccination trials or the study and follow-up of certain diseases over time within a stable population group – quite a complicated business given the turbulent socio-economic conditions. The first step in this information system are the field workers. It is their job to gather basic information, identify the positions of houses via GPS and later place them on digitalised maps which incorporate all the data corresponding to family units, population census and the distribution of health identity cards as well as gathering the first demographic data and details of morbidity and mortality.

This infantry battalion are transforming the ancestral Tom-Tom system of communication –communication by word of mouth– into a new kind of information and knowledge transmission: the Tom-Tom-Bit.The results of their exhaustive follow-up of 35,000 people scattered over a 10km2 area ends up at the data centre of the CISM ready to be processed. The picture emerging from this pioneer work is beginning to change our perceptions and knowledge of some of the diseases endemic amongst the African population, either because factors which contribute to their propagation and mortality rates were not previously taken into account, or because of an improved evaluation of their real economic impact, and this will undoubtedly mean that strategies for combating these diseases will also improve. In the case of malaria, for example, there have been advances in the degree of accuracy with which the disease has been described up until now including, amongst other things, the possibility of other factors augmenting the infection, such as bacterial ones, or the economic costs of this terrible affliction to each person, family unit and the government itself. For the first time, prophylactic measures can be taken based on the real situation of the people it is directed at and not on speculation elaborated in some office thousands of kilometres away. On the other hand, Tom-Tom-Bit acts as an early warning system. What under other circumstance might be considered isolated incidences of certain illnesses, could be identified as the first signs of an epidemic by the complex communication system developed by the CISM and also help to design a strategy for dealing with it.

After two catastrophic wars — the War of Independence from Portugal and the Civil War – which ended just under four years ago– Mozambique is beginning to undergo the first signs of a certain economic revival, most noticeable in Maputo. But this is against the background of the deep abyss of poverty which has opened up in this beautiful country. Subsistence economy is what millions of people still live on, depending on their hands, physical strength and intangible solidarity networks for survival. In the rural areas these hands, physical strength and solidarity belong to the women and it is they who bear the brunt of the families’ domestic economy, practically from the cradle to the grave. The day that we went out with technicians from the CISM to visit their regular work areas, the real map of Mozambique unfolded before our eyes as soon as we set foot on a path no more than 300 metres from the centre of the town of Manhiça. The pathway soon became a labyrinth through a landscape dotted with isolated huts in which only women and children lived. The sick, lying on mats at the doors of their huts simply waited for death or a miracle cure of some kind. Old women, who had somehow managed to survive wars, poverty, illness, received each day a pitiful pot of spinach stew supplied by a neighbour. Alone, isolated, suffering from scabies and other parasites that eat their skin alive, they wouldn’t hear of going to hospital. They were all convinced that they would be considered useless and killed off there. Now, at least, like many of their neighbours, from infants to adults, they receive some kind of treatment right there from the staff of the CISM. Poor palliative care in the midst of the most abject poverty. And an example of the way our vision is focussed (or rather perversely out of focus) on health problems. 95% of world spending on research and development in the field of health is directed at resolving the problems (real or invented) which affect inhabitants in the wealthy countries of the world, while only 5% goes towards the diseases decimating poor countries. This makes the contribution of centres such as the one at Manhiça so important, where research as a tool for development is combined with the training of local personnel and health care.

The CISM is a project promoted by the Fundació Clinic de Barcelona (part of the Hospital Clinic), with the participation of the Instituto Nacional de Salud de Mozambique and the Agencia Española de Cooperacion Internacional (AECI). The Spanish epedemiologist Pedro Alonso is the scientific director of the centre where more than 60 people, researchers and both Spanish and Mozambiquan technicians, work.

Translation: Bridget King.