Connecting the Bloody Dots in Public Health and Technology
I was delighted to read the medium post by Lifebank’s founder celebrating their one year anniversary. Lifebank provides a life-saving service, collecting and delivering blood to where it’s needed. I’ve seen firsthand the need for blood and the service Lifebank delivers. Nigerians have dismal access to blood products, an issue that is personally disturbing as I have been in situations where friends and family have required blood during childbirth. This led me to write about it in 2012. In that post, I lamented and called for a blood banking system to be built. I’m glad that Temie went ahead and created one. Even more disturbing are my experiences as a health professional. I’d like to share one of such experiences from a little while ago when I did a medical elective in a Nigerian public hospital.
It was a summer in the noughties. I’d returned to Nigeria to pick up some tropical medicine as a medical student in Europe. On one of the days, I came across a young man in his early twenties. He was of a similar age to me at the time. He had come into the hospital vomiting blood. He’d vomited so much blood that he needed to be transfused. Due to a dry blood bank, his family had to scamper to find blood. After much effort and despair, they somehow found enough blood and he was stabilised. He was eventually found to have advanced liver disease due to hepatitis B.
I recall thinking that this young man with liver disease from hepatitis B, puking his blood away, could so easily have been me. I became acutely aware of the limitations of Nigeria’s health system. Aware of how people die daily due to the inefficiencies in the system. Inefficiencies that conspire in emergency settings to ensure that few escape alive. After my stint at that public hospital, I knew that my lot lay in improving Nigeria’s health system, via a system-wide approach. Not just in giving care to one individual at a time. My conviction became a desire to prevent the need for emergency care. While indispensable, emergency care costs a lot and is often of poor quality. A great need exists to prevent or reduce the need for it.
A few months ago, My work with Wella Health led me to visit with a client. He works as a retail pharmacist selling medications to people. He like me has a great passion for preventive care. He would always inquire and vaccinate his patients when needed. When I visited, he related to me his appreciation for our engage platform. ‘Your platform made mine and my patient’s day today’ he told me. ‘How?’ I asked.
As was his usual practice, he’d encouraged a patient who was at risk of hepatitis B to get vaccinated. The hepatitis B vaccine requires 3 doses to be effective. He gave the patient the first one and inputted the details on our platform. The next dose would be due 1 month later. As humans are wont to do, the pharmacist forgot about it. So did the patient. This is not uncommon. As little as 25% of patients complete their vaccine doses in some instances.
When 1 month elapsed, in came the patient asking for her next vaccine dose. Said the patient to the pharmacist: ‘Thank you for the SMS reminder, I totally forgot about the vaccine’. A surprised pharmacist, whom had forgotten himself. Caught himself as he was about to ask, ‘what SMS?’. See, when he inputted the details on our engage platform, we automatically scheduled a reminder SMS to be sent to the patient. This reminder came at the correct time, seemingly originating from the pharmacy. The patient got the SMS reminder and attended for her vaccine. She is now unlikely to get hepatitis B. She will not go on to need blood from complications of liver disease, unlike the young man I met.
Vaccination reminders is a tiny proportion of the reminders we send. We send thousands of important reminders to patients on antihypertensive medications. A catastrophic consequence of not taking these medications correctly is a bleed in the brain. Called a hemorrhagic stroke. People with this type of stroke need quite advanced care. Care that’s often not available in their locality. Flying doctors, an air ambulance company ferries many of these. Its founder sees an over-representation as a result.
This 2015 Nigerian paper suggests hemorrhagic stroke rates in Nigeria are similar to high-income countries.
When people on antihypertensives take their medications, fewer people get strokes. Less emergency care is needed. Unfortunately, a recent review suggested that up to 63% of people on these drugs don’t take them correctly. This exposes them to huge risks of stroke, kidney and heart disease. Simple SMS reminders double their odds of taking their medications.
A few months ago, a respected tech guy asked why I persist with Wella Health. ‘You’re losing money, not gaining traction fast enough. Yet you persist in this small SMS thing’. He suggested we pivot, focus on more important things that would bring in money faster. My feelings: For as long as I can prevent an air ambulance from needing to transport someone with a bleed in the brain. Stop a young man from needing blood transfusions as he pukes his guts out. Via a simple SMS that costs 2 Naira (0.0063 US cents). I will continue to try.
We need an air ambulance service. We need a blood delivery service. We need excellent emergency care. We also need to not need them, except when we truly need them. I will continue to find ways to make our preventative 2 Naira SMS at Wella Health reach millions more people and be financially sustainable.
Thanks to Ayobami for reading the first draft of this and helping with some editing.