BioEd Online

"8 cases suspect avian influenza." "3 in second village." "Suspect AI outbreak in Stung Treng." "Close access to village." "Is school open?" "Does anyone have a car?"

This stream of text messages was sent by health officials, field scientists, police and local villagers. They were testing a social-networking approach to tackling an outbreak during an influenza pandemic planning exercise in Stung Treng Province, Cambodia, last October.

They were helping to test and refine GeoChat, one of a suite of three open-source software tools designed to help respond better and faster to disease outbreaks and natural disasters.

The software was unveiled last week by InSTEDD (Innovative Support to Emergencies, Diseases and Disasters), a non-profit organization based in Palo Alto, California. The company was founded in 2006 with donations from philanthropic bodies such as Google.org and The Rockefeller Foundation in New York.

The testing exercise was done in cooperation with the Mekong Basin Disease Surveillance network, an intergovernmental scheme created in 1999 to share outbreak and disease data by the six countries bordering the region, Cambodia, China, Laos, Myanmar, Thailand and Vietnam.

InSTEDD is also putting the system through its paces with the US Centres for Disease Control and Prevention in Atlanta, Georgia, and HIV clinics in rural Tanzania.

Coordinating the response

"InSTEDD didn't start by assuming a certain piece of technology was the solution. They listened to the needs on the ground, to the requirements, capacities and infrastructure limitations, and then went back to the lab and designed targeted, useful tools," says Karl Brown, an associate director of the Rockefeller Foundation.

The software has been designed, for example, to work in areas where Internet connections are poor or non existent, but where network access via mobile phones is often available, says Taha Kass-Hout, InSTEDD's director of global public health and informatics. The software has also been designed to plug into, and to be compatible with, whatever databases and computer systems users already have.

The potential of electronic networking for disaster response has been demonstrated repeatedly since the 2004 Indian Ocean tsunami, when blogs quickly became the main way to coordinate damage assessment, relief and volunteers. But official disaster-response bodies are often organized along hierarchical command and control chains, says Kass-Hout, and have been slow to embrace community Web and mobile tools.

When Hurricane Katrina hit New Orleans a year later, the slow and uncoordinated government response was put to shame by volunteer civilians who used Google Earth, Google Maps, text messages and other electronic methods to swiftly track down missing people, coordinate shelters and distribute aid.

Seeing the big picture

The goal of the new software, says Kass-Hout, is to get faster and more coordinated responses to disease outbreaks and natural disasters. To do this, GeoChat enables team members to communicate their position and important information using text messages, email or a web browser, with data instantly synchronized on every team members' mobile phone or laptops.

The second tool in the InSTEDD suite, Mesh4X, helps to overcome another problem. The various government, military and relief agencies at a disaster scene often use incompatible technology, which can impede data sharing and cooperation.

Mesh4X can swap data seamlessly between different databases and software. So, for example, disease case reports, or a request for blankets and food, can be filed by fieldworkers using a mobile phone or other device, with all their data being instantly shared across participating groups irrespective of whether their own database system is Microsoft Access, Oracle, MySQL, or spreadsheets such as Microsoft Excel.

Dream stream

The last tool of the trio, Evolve, provides automated data mining and visualization to help make sense of the flood of information from relief operations. Like an RSS reader — only more sophisticated — Evolve automatically aggregates and sorts related information from field and media reports, emails, hotlines, surveillance and other data streams.

The output can be shared across agencies, to help decision-makers spot, and respond to, crucial events such as an expanding cluster of cases of respiratory illnesses, or villages identified as most in need of aid during an earthquake.

InSTEDD is helping to strengthen cooperation among the many organizations taking part in the Mekong Basin project, says Yin Myo Aye, who is based in Bangkok, and is regional coordinator of the Mekong region for the web and email-based disease reporting system ProMED.

InSTEDD can make a great contribution to no-hassle information sharing, says Firoz Verjee, a researcher at the Institute for Crisis, Disaster, and Risk Management at George Washington University in Washington DC.

But, he says, technology alone is not enough. Major improvements will only come when humanitarian operations adopt universal information policies and practices including a more sophisticated take on how to measure and report humanitarian activity.

Although "today's senior decision-makers with UN and non-UN humanitarian agencies may still be reluctant to wholly commit to technology-based operations", says Verjee, "the next generation of decision-makers will not have that discomfort."