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How Cell Phones Could Help Liberia Win the Fight Against Ebola

UNICEF has designed a simple text messaging system that, combined with other tech innovations, could help stop the deadly virus from spreading in West Africa.
Photo via Flickr

In a hotel room in Liberia's capital city of Monrovia, a group of technologists and Silicon Valley types have been posted up in what they call the "nerd suite." Over the last few weeks, they have overseen the efforts of UNICEF's innovation unit in the country, readying a set of technological solutions to help in the Ebola outbreak response.

Led by technologist and mobile designer Chris Fabian, members of the innovation unit first landed in Liberia about two months ago to bring mobile solutions, both old and new, to assist the government in its fight against Ebola.


On November 3, UNICEF launched a pilot version of a text message-based platform in Liberia called U-report, which will allow young people across the country to access and provide information about Ebola from even the most basic mobile phone. The U-report platform was first utilized three years ago in Uganda, and now has more than 500,000 users across sub-Saharan Africa, but it is new to the West African nation, where more than 2,700 people have died from Ebola since the hemorrhagic fever crossed over the border from Guinea in April.

The Liberian version of U-report was designed with the help of young girls from the impoverished West Point neighborhood in Monrovia, a city devastated by Ebola since the virus arrived in June. According to the World Health Organization, at least 20 percent of infections across West Africa have occurred during the burial process, but Fabian said the women did not want to discuss that topic. Instead, they asked about touching their significant others, how to explain the outbreak to their parents, and whether other Liberians their age were having the same issues.

In photos: Fighting Ebola in the slums of Monrovia. Read more here.

"They said, 'There's so much stuff we don't do anymore, we can't go clubbing, we can't go to the beach," Fabian said.

Liberia's U-report system allows users to send a simple text message to ask a question, then receive a text message response back. Knowing people's interests helps Fabian and his team tailor the information to specific groups and demographics.


U-report can also be used to send out messages asking for information, which is then filtered through a database and, in some cases, passed along to government officials and other key players in the crisis response. The girls worked with Fabian's team to write more colloquial versions of the questions. A question like "Are you aware of the Ebola disease" was rewritten to say "do pple no abt Ebola."

The aim of U-report is to facilitate conversations that resemble casual discussion. As Fabian wrote in a recent blog post, "in a situation like the Ebola outbreak where conversation is vital, and where so much of the world (whether in the American media hysteria or rural Liberia) doesn't have the facts about the disease — conversation must be tuned to local ears."

UNICEF installed the same system in Nigeria in April, just months before a Liberian man brought Ebola to Africa's most populous country in July. The communication platform was part of the country's multi-faceted — and eventually successful — fight against Ebola. In Nigeria, UNICEF said citizens wanted information about how to prevent the spread of the disease. One rumor involved using salt and water as a cure for the virus, a false solution that turned out to be deadly in some cases. U-report functioned as a way to push out correct information.

In a country like the US, where much of the population is on Facebook and Twitter, culling social media sites might offer similar insights. However, Fabian explained that in Liberia — where less than one percent of the population is connected to the internet — there is a need for a separate system. By relying on basic cell phone networks and SMS instead of LTE and smartphones, U-report helps fill that gap.


The Fight Against Ebola. Watch the VICE News documentary here.

"We don't have to make a decision on whether there's a need," Fabian said, referring to the need for technology in the Ebola response efforts. "There's so much need, but where is the need going to turn into a piece of action quickly."

UNICEF is far from the only group looking at technological solutions to the Ebola crisis. IBM, for example, stepped in at the end of October, working to give Sierra Leone's government and health workers perspective on the outbreak by providing hotlines and processing data from texts and calls. On Thursday, Facebook announced it would provide free internet to treatment facilities and aid workers in the Ebola-stricken countries by utilizing internet hotspots.

As Patrick Vinck, a research scientist at the Harvard School of Public Health, told VICE News, the eagerness to develop tech solutions is perpetuated by the fact that anyone can buy a plane ticket, land in the middle of a disaster zone, and try out a promising new technology. Testing and implementing new technology is faster and easier than ever, but, according to Vinck, this "can be very, very disruptive when the wrong technology is used and things don't go as planned."

'First responders become quickly overwhelmed by people who want to do good, it's so easy to develop technology and push it on people.'

"Something we've found is that first responders become quickly overwhelmed by people who want to do good, it's so easy to develop technology and push it on people," he said.


Vinck said it's important to integrate humanitarian principles into the new approach or technology, while still relying on individuals with years of experience.

"The introduction of new technology has to be paced not only by technologists, but by humanitarians themselves," he said.

Another key issue to keep in mind, Vinck explained, is scalability. While it might be easy to come up with an idea and build the software to make it work, it's another thing to scale that idea for use among hundreds of workers or across an entire country or region.

Fabian recalled how somebody had the idea to send thousands of iPhones to Liberia for response efforts. He said most of Liberia's networks are already overloaded by increased traffic during the outbreak, so smartphones are not the most efficient option. There's also the question of who would fix the phones when they aren't working. Plus, he explained, it would take business from local shops that sell mobile phones.

"It's so obvious if you are here, use what's locally available," he said. "Work with what people already have because that's how you make something scale."

Mapping Ebola outbreaks: area of infection is way bigger than previously thought. Read more here.

Along the same lines, Vinck explained that technology should only be implemented if it adds value and has a clear impact, not just because it's nice and shiny.

Paul Amendola, a technical advisor for health information systems at the International Rescue Committee, told VICE News that his team is not going to push a new approach if it is simply "technology for the sake of technology."


Amendola and Vinck, however, are fully behind a major overhaul in the way digital data is collected in West Africa, especially when it comes to medical records. Amendola said that the benefits of digitized records and data could be enormous because data is not readily available from previous Ebola outbreaks, and therefore extremely beneficial from a clinical standpoint.

In most outbreak scenarios, medical records are collected on paper inside the treatment center, leading to contamination. Amendola explained that many records have been soaked with chlorine and destroyed.

"By using technology, we're piloting tracking a patient through an Ebola treatment unit using data on servers," he said. "The potential there is enormous and something where the technology didn't exist before."

Beyond the benefit for Ebola outbreaks as a whole, Vinck said there is a "clear advantage" for using technological tools for data collection in West Africa. Neglected health systems have played a large role in the spread of the virus, and throughout Sierra Leone, Guinea, and Liberia, medical records are typically kept on paper. Vinck said it's a "really concrete case where technology makes a direct contribution."

With that idea in mind, UNICEF launched another pilot program in early November specifically targeted at digitizing medical data and records for healthcare workers in Liberia. At the request of Liberia's Ministry of Health and Social Welfare, Fabian and his team developed an initiative called mHero.


According to Fabian, mHero is a set of tools for healthcare workers in the country who are not connected to digital infrastructure. They will be able to record live data, while also improving access to information they might need about supplies or treatment options. The program is rooted in a mobile health system UNICEF launched in Nigeria that tracks births in real time — tallying approximately 18 million births in three years.

'Sometimes you just need a pulse of information and that's what lets decision makers act more quickly.'

"Sometimes you just need a pulse of information and that's what lets decision makers act more quickly," Fabian said, explaining that mHope will strengthen the health system both during the Ebola outbreak and afterward, when a local team of entrepreneurs will be trained to takeover.

Vinck, who also runs the KoBo Toolbox for field data collection, which provides technological data solutions for groups like UNICEF and IRC, said the current Ebola outbreak is the first time where there is a widespread interest in the adoption of digital data collection in the context of a humanitarian crisis.

But with an array of solutions already in their arsenals or being readied for implementation by international humanitarian organizations and local governments, there is potential for different technologies to compete with one another and prove ineffective if responses are not coordinated.


According to Amendola, there are many different partners on the ground right now trying to do important work, but the systems and approaches aren't always speaking to each other. Similarly, models have to be tweaked from location to location, as an approach that works in Liberia's rural Lofa county, might not work in Monrovia.

With groups like the Red Cross, IRC, WHO, and Doctors Without Borders (MSF), Amendola said one of the great lessons of the Ebola outbreak has been in improving coordination with everyone involved — both related and unrelated to technology. While he said constant conference calls and on-the-ground communication has greatly improved during the crisis, approaches have been more staggered when it comes to rolling out technology.

"It was such a rapid response there's all sorts of apps being used for all sorts of data collection," Amendola said, speaking about the ramping up of response efforts in recent months. "Which is sort of one of the challenges. What needs to happen is more coordination and standardization."

Vinck said one overlooked issue is the growing divide between large budget international organizations equipped to utilize the most advanced technology, and local organizations getting by with the most basic cell phone. He said this digital technology divide is problematic, and that it's particularly important to focus on bridging the gap even after the crisis is over.

"That divide is growing and important, small organizations are the first responders and have to do the best with what they have," he said. "We have a responsibility to make sure they are not left behind, but embracing [the technology] and moving forward."

Follow Kayla Ruble on Twitter: @RubleKB

Photo via Flickr