Internet aids infectious disease efforts in Africa

Marilynn Larkin

Contributing Editor
The Lancet

In June, Julia Royall, project director of the US National Library of Medicine, (NLM)'s Office of Health Information Programs Development, left the USA for Mbita Point, a small village situated on Lake Victoria in Kenya. A new, "incredibly remote" research site had opened as part of the international Multilateral Initiative on Malaria (MIM), says Royall, who is helping to put in place a network that enables malaria researchers in Africa to benefit from "high-speed internet and web access 24 hours a day, 7 days a week."

The advantages of such connectivity are "tremendous", says Kwadwo Koram, a senior scientist at the University of Ghana's Noguchi Institute in Legon. Koram especially values the "instantaneous" accessibility of abstracts and articles from PubMed. He recently found an article on a molecular marker for chloroquine resistance-a subject of his team's research-and quickly downloaded it, printed it out, and shared it with his colleagues. "Everyone was ecstatic. This is changing the way we work."

Free access for malaria researchers to full-text articles from selected journals (including The Lancet) will soon be available in a 2-year collaborative pilot project of NLM, MIM, and the American Association for the Advancement of Science, says Royall. In return, the scientists agree to answer publishers' questions about the value of the journals to their research.

Instant messaging is also gaining a foothold over the high-speed system, adds Koram, noting that an entomologist in Navrongo uses an instant message module for problem-solving discussions with a colleague at Noguchi Institute.

Although many non-profit organisations and commercial entities provide internet access and technological support in Africa, the NLM project is unique in that "our primary concern is the researcher. We got into the technology aspect because we had to, but our focus is on outcomes", emphasises Royall, whose own research deals with the impact of information technology interventions on malaria morbidity and mortality. "This really is a new way of doing science," she continues. "Now African scientists who are using the system are collaborating mainly with research facilities in the USA, UK, France, and other parts of Europe. An important next step is to set up research networks that enhance communication among the African scientists themselves."

Yet, many health professionals in Africa do not have high-speed internet access, reminds Leela McCullough of SATELLIFE/ Healthnet (Watertown, MA, USA). SATELLIFE has developed "parallel systems"-eg, free e-mail-based services-"to ensure that no one is excluded." Moderated discussion groups (also archived on the web) "give health professionals a voice-an opportunity to make their feelings heard, to promote dialogues and information-sharing."
The AFRO-NETS (African Networks for Health Research and Development) discussions recently included a "heated debate" about the use of insecticide-impregnated bed nets. Other discussion groups include ProCAARE (Program for the Collaboration Against AIDS and Related Epidemics) and E-DRUG (Essential Drugs in the Developing World). SATELLIFE also compiles small text-based publications, HealthNet News and HealthNet News-AIDS, which provide selected current, peer-reviewed articles and news stories, and GetWeb, which translates web content into an e-mail message for those who don't have web access.

Charles Musisi, who was systems manager for HealthNet in the early 1990s, notes that some of the early projects are still active. For example, health care workers in Zaire's Vanga Hospital used HealthNet to send dispatches about their progress in treating trypanosomiasis to health organisations in the north of Africa, says Musisi, who now heads Uganda Online. And in response to a cholera epidemic in Zambia, the medical librarian at the local university obtained "life-saving" treatment literature from a "partner library" at the University of Florida (Gainesville, FL, USA) and disseminated the information to local health practitioners.

Musisi also works with the Network Startup Resource Center (NSRC), a non-profit organisation based at the University of Oregon (Eugene, OR, USA). Together, they set up a new collaborative research system between Makere University's Institute of Public Health and Johns Hopkins School of Public Health in Baltimore, MD, USA. And, with funding from the US National Science Foundation and other sponsors, NSRC helped train members of the African Network Operators Group to manage e-mail, mailing lists, help desks, and related services at local universities and research institutes, adds NSRC's Steven Huter.

NSRC, which has been assisting technicians in Africa and elsewhere for more than a decade, provides help only when asked, emphasises Huter. "To build sustainable networks, you have to have local hands cultivating local expertise. They understand how to work in their country and culture in a way outsiders never can."

Royall agrees. To use the internet successfully in the fight against infectious diseases in Africa, she says, "it's not enough to simply install equipment to make faster connections. It's the whole colonial way of doing science that really has to go. My feeling is that African scientists working together will soon be an important part of the picture-part of a new, collegial model. This really is a watershed time."

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