Healing with knowledge: New approaches to fight TB with ideas and learning

Eric Stephan is CAP-TB's Technical Advisor for knowledge management.

One of the most exciting aspects of our work at CAP-TB is discovering the many ways in which we can magnify the effect of TB projects simply by creating connections among key people and their ideas.  Our project’s work is helping to develop innovative activities to combat TB and MDR-TB --  But sometimes the strongest way to fight a disease is by helping people to ask questions and learn.

If a doctor in Chiang Mai is faced with a challenging problem about treating an MDR-TB patient -- or if a community health worker in Kunming finds a new way of spreading TB information in rural regions -- then these people need ways of reaching out to get answers and to share their successes. Otherwise, a tremendous opportunity is lost.

Recently, our team has been working with some very interesting ideas around knowledge and learning to support our work. Thanks to the profusion of new information tools and technologies -- mobile devices, social media applications -- it is now possible to look at fundamental issues such as training and technical support in new ways.

For example:  Can a TB training workshop reach out and tap you on the shoulder, weeks after the event concluded?  CAP-TB has been planning a monthly series of training sessions to examine TB and MDR-TB cases and cover key issues around treatment. To support the training, our Chief of Party had been talking about the idea of using something similar to online surveys to periodically gauge how well people were retaining the material that we teach in trainings and workshops. Reaching out to a colleague at the University of California, San Francisco, we were referred to a mobile technology tool that is tailored toward that very purpose, but with a much stronger approach. The system is called Qstream, and it was developed by Dr. Price Kerfoot, a urology professor at Harvard Medical School. QStream uses an algorithm to send a small number of follow-up quiz questions to the mobile phones of learners, over carefully timed intervals. QStream is an innovative way of applying the well-known fact that knowledge is more durably grasped by memory when it is reinforced and tested at intervals, and rigorous studies have shown this new technology indeed increases retention. CAP-TB is planning on applying this tool to send the questions to learners over the month after trainings and workshops, boosting their effectiveness as well as providing critical data as to how well they impart knowledge.

CAP-TB has also been looking at how the project can help support an important trend in TB health policy: The issue of decentralization, which aims to make care and treatment more effective by ensuring that clinical expertise and resources are not concentrated in central locations (e.g., a country’s capital), but distributed throughout the country.  The Thailand’s Bureau of Tuberculosis (BTB) is aiming to be at the forefront of adopting this approach. But how can resources be radically shifted without harming the provision of expertise? 

The answer may be by applying an increasingly common web application, the online Support Desk, to the flow of requests for expertise and consultation received by the group of regional TB experts convened by the BTB. A Support Desk system ensures that every incoming request is assigned to a unique online “ticket,” which then allows the issue to be tracked, discussed, forwarded, and resolved within a structured online system. This way, an expert residing in Chiang Mai is equally as “on call” as one in Bangkok or Rayong, and all experts can collaborate and evaluate as a committee, even though they are geographically decentralized. Questions cannot be lost or “fall off the table,” and search and reporting features allow full analysis of recurring issues or needs for new capacity.  The ongoing activities of its experts become far more transparent to the BTB, even while reaping the benefits of decentralization.

New approaches to knowledge and information may well be amplifying the effect of our work against TB and MDR-TB. And every day our staff considers new ideas in leveraging information technology to spread knowledge. But we aim to never become so bewitched by technology that we forget the element that our work succeeds or fails on: The knowledge that resides not on a screen, but inside the heads of our team, our partners, our experts, and our stakeholders. Without that knowledge, fancy websites and mobile tools are empty vessels. We see these knowledge approaches as a way of putting the spotlight more directly onto those same resources that have saved lives for many years before information technology existed.

Posted by: Eric Stephan