Straight From The Top

In our attempts to access the viability of "pill check" in Nairobi, we have had to jump through some hurdles but were able to get to some "big people" on the top. Mainly, these past few days, we have talked to the chief pharmacist at Kenyatta Hospital (Kenya's National Hospital), the field services manager at M.E.D.S (Mission for Essential Drugs and Supplies), the director of the Kenyan Drug and Poisnous Inspectorate Department and one of the people in charge with registration of all drugs that come from outside the country.

<--(MEDS "Commitment Statement", and me touring the facilities) In our meetings, it has become clear that the people who are working in these agencies see "pill check" as an application that would work in some form in Kenya. Mainly, we have been told that this kind of system might not work in Kibera ( which is the place where we focused on for the class). Because in Kibera, there are many unregistered pharmacies and people do not understand the actual implications and consequences of using brand name drugs, generic drugs or counterfeit drugs. In fact, one "pharmacist" we talked to in Kibera, used these terms interchangeably.

From the Pharmacy and Poisonous Board, we were informed that a task force has been instituted to register legitimate pharmacies in Kenya. When pharmacies are registered, issued, certificates are to be placed somewhere in the vicinity of the pharmacy and in addition, either the pharmacist or the pharmacist technician should wear a badge. (See Left for samples of badges to be displayed.

Our findings last week prove to us that there is a lot of bureaucracy in the drug supply chain here in Kenya. Things are not as straight forward as one would like, which makes it extremely difficult to find out what the exact needs are. This week, we have identified and are meeting with an international organization (Health Action International Africa). HAI is part of an independent global network working to increase access to essential medicines and improve their rational use through research.

"Nairobi is a Malaria Free Zone"

(<-- Bahati Clinic)
One of the clinics that was visited by the University of Nairobi students a few months during the first phase of need finding was Bahati Clinic.

Today, we visited Bahati Clinic in hopes of talking to the head pharmacist. Unfortunately, she was not there and we had to wait around for about one and a half hours in order to talk to the doctor.

Bahati Clinic is considered as a level 4 in the range of health care facilities that goes up to level 6. According to the doctor at Bahati, the level 6 health care facility in Kenya is Kenyatta National Hospital. Bahati Clinic is a facility sponsored by the government. A patient only pays 20shillings which is about 25cents. This allows the patient to be seen by the doctor and also provides for free medication.

At Bahati, we were interested in finding out whether the pharmacy experiences stock outs of key drugs for Malaria. We were met with an interesting phrase from the doctor; "Nairobi is a Malaria free zone." He also would not elaborate upon whether the pharmacy always had enough medications for all patients and how often the supplies were stocked.

Joe and I came away feeling that there was some sort of apprehension here on the part of the doctor in divulging information or expressing any unhappiness with the way the government was working with Bahati. In terms of whether the clinic ever ran out of medication, the answer was that "we may not always have every medication but we have the essentials." Answers like this and this sort of allusiveness has been common place since we started about a week ago. The pharmacy and drug question is proving to be a sensitive one indeed.

How Are You?

I arrived in Nairobi approximately one week ago. The weather has been mild and getting used to the time difference has been challenging.
I came to Nairobi with my research partner Joe Giovannetti (two other team members from our team including Macy Parker and Chris Piech did not travel with us) and four others representing three research teams total, to do some need finding on three "Mobile for Development" designs we have been working on in a course at Stanford University, titled Designing Liberation Technologies. The course focused on creating long term design projects that would take advantage of the design process structures and methods that have been developed by the Hasso Plattner Institute of Design at Stanford.
The country focus for this course was Kenya and the community focus was Kibera, described as one of the largest slums in the world.

Walking around the Kibera area has been interesting. It appears that the area is quite often frequented by many NGOs and organizations who are interested in development projects. Waling around the community, we were constantly greeted with "How are You?" in a sing-song sort of way by children who followed us. Below is a scene from Kibera showing one part of the community.


These projects were conceived in collaboration with the University of Nairobi, particularly with students from the department of computer science. The focus on human-centered design, which is emphasized at the d.School as part of their design thinking model, sought that need finding would be conducted before hand. Since we were not privy to being in Nairobi for the course, our collaboration with the UNO students helped tremendously in this stage.

"Pill Check" or Kifaa Cha Tembe is our project. It uses standard Nokia mobile phones to connect malaria patients to up to date information about drug availability and pricing. By texting a short code, a patient can receive a menu of local pharmacies that have malaria drugs in stock, as well as prices and directions to each pharmacy. The other two teams represent the project MMaji and BabyBank.

Our aim for being in Nairobi for the two week duration is to deepen the need findings that have been prior conducted. My research partner and I have been visiting pharmacies and clinics in Kibera and out of Kibera to get a better sense of how our conceived design would function in Kibera or outside Kibera.

<--(AL drug Coartem, used for treating Malaria) In conducting research this past week, it has proved challenging to access the kind of information we need, as it turns out, information and access to mediation and drugs is a very sensitive topic. In a community where medications may actually be counterfeits or placebos, and where people have little knowledge of the effects of wrong diagnosis, it proves to be very difficult to assess and evaluate the reasoning and rationale behind providing such information to patients. Scenes from Kibera Next up, we plan on visiting higher up distributors in Kibera and in Nairobi in general to get a better understanding of the drug supply chain.