The Baobab tree is famous here in southern Africa. It’s a majestic tree with an enormously thick trunk that also lives and grows for hundreds of years. One organization here in Malawi has adopted the iconic Baobab name to demonstrate their commitment to improve the health of the people of Malawi. Baobab Health, based in Lilongwe, offers innovative and high-tech medical records solutions for hospitals here in Malawi, and we got a glimpse of the recent Baobab medical records system installation in the new ART (AntiRetroviral Therapy) clinic, which provides free medication for HIV suppression to hundreds, if not thousands, of HIV patients within St. Gabriel’s catchment area.

Funding for this new medical records system specifically for St. Gabriel’s ART clinic was generously provided by the fellowship of Issac Holeman, co-founder of FrontlineSMS:Medic, who was stationed at St. Gabriel’s for the majority of this year. It’s an amazing, innovative, high-tech, and robust system that is quite unlike any of the traditional book and paper systems observed in the rest of the hospital.

Here are some highlights:

• Four touch-screen terminals with barcode scanners and label printers are individually stationed in the nurse’s room, two ART clinician rooms, and the ART dispensary.

• Terminals are networked to a main server, and the entire system is powered by either the hospital’s electric grid or a backup battery system that can last for several days.
• ART patients are first received in the nurse’s room. For patients already in the Baobab system, the nurse scans the patient barcode, which pulls up the patient file.

• The system asks if the patient is present, and if the guardian is present.
• If the patient is present, the system asks for weight, and presents a numerical BMI number (to detect malnutrition) and a historical graph of BMI. BMIs that are unacceptably low are highlighted in red, and the nurse will then counsel the patient.

• The system then asks for patient’s health complaints, and the nurse can select from a list of symptoms that are related to HIV.
• The system then asks for numbers of ART pills remaining, and automatically calculates adherence on the spot. The nurse counts the few pills remaining in the bottle (rather quickly by eye). If the patient has missed any pills, then the nurse questions the patient.

• Based on an existing algorithm taking into account BMI, symptoms, and past history, the Baobab system will decide whether or not to refer the patient to the ART clinician in the next room, who has his own Baobab terminal.
• Patients are then automatically scheduled to come back based on the number of pills they will receive.

• Scheduling is optimized to equally distribute patients that come in on each of the 3 HIV clinic days to even out the workload for the ART staff.

The ART clinician brings up the patient record via barcode, and makes the appropriate updates to the patient file.

• The system is capable of performing HIV staging based on the symptoms that he enters into the system and World Health Organization (WHO) HIV staging standards.
• If the clinician observes any respiratory distress (TB) or infection, then the patient is admitted to the hospital.

The patient then proceeds to the dispensary.

• The amount of pills (often extra pills) is automatically calculated by the computer to allow for future calculation of adherence.
• Pill packaging is labeled by barcode and automatically scanned and associated with a patient record.

The Baobab system currently being implemented in the St. Gabriel’s ART clinic is truly a remarkable and revolutionary system. The ART staff that used to almost be overwhelmed by the amount of patients and tasks associated with HIV treatment is now delivering great treatment with remarkable efficiency. It is truly an example of the efficiency that is greatly needed in developing healthcare settings all over the world. However, I am not sure what were the costs of such a system, and whether it is practically affordable for the health organizations here that truly need it.