Joel sierra nico: big data surprising seeds

World Health:There s an old joke about a copwho s walking his beatin the middle of the night,and he comes across a guyunder a street lampwho s looking at the groundand moving from side to side,and the cop asks him what he s doing.The guys says he s looking for his keys.So the cop takes his timeand looks over and kind ofmakes a litt...

May 29,2020 | Gloria


There's an old joke about a copwho's walking his beatin the middle of the night,and he comes across a guyunder a street lampwho's looking at the groundand moving from side to side,and the cop asks him what he's doing.The guys says he's looking for his keys.So the cop takes his timeand looks over and kind ofmakes a little matrixand looks for about two, three minutes.No keys.The cop says, "Are you sure?Hey buddy, are you sureyou lost your keys here?"And the guy says,"No, actually I lost themdown at the other end of the street,but the light is better here."(Laughter)There's a concept that people talkabout nowadays called "big data."And what they're talkingabout is all of the informationthat we're generatingthrough our interactionwith and over the Internet,everything from Facebook and Twitterto music downloads, movies,streaming, all this kind of stuff,the live streaming of TED.

And the folks who workwith big data, for them,they talk about that their biggest problemis we have so much information.The biggest problem is: how do weorganize all that information?I can tell you that,working in global health,that is not our biggest problem.Because for us, even thoughthe light is better on the Internet,the data that would help us solvethe problems we're trying to solveis not actually present on the Internet.So we don't know, for example,how many people right noware being affected by disastersor by conflict situations.We don't know for, really,basically, any of the clinicsin the developing world,which ones have medicinesand which ones don't.We have no idea of whatthe supply chain is for those clinics.We don't know -- and this is reallyamazing to me -- we don't knowhow many children were born --or how many children there are --in Bolivia or Botswana or Bhutan.We don't know how many kids died last weekin any of those countries.We don't know the needsof the elderly, the mentally ill.

For all of these differentcritically important problemsor critically important areasthat we want to solve problems in,we basically know nothing at all.And part of the reasonwhy we don't know anything at allis that the information technology systemsthat we use in global healthto find the data to solvethese problems is what you see here.This is about a 5,000-year-old technology.Some of you may have used it before.It's kind of on its way out now,but we still use itfor 99 percent of our stuff.This is a paper form.And what you're looking at is a paper formin the hand of a Ministry of Healthnurse in Indonesia,who is tramping out across the countrysidein Indonesia on, I'm sure,a very hot and humid day,and she is going to be knockingon thousands of doorsover a period of weeks or months,knocking on the doors and saying,"Excuse me, we'd like to askyou some questions.Do you have any children?Were your children vaccinated?"Because the only waywe can actually find outhow many children were vaccinatedin the country of Indonesia,what percentage were vaccinated,is actually not on the Internet,but by going out and knocking on doors,sometimes tens of thousands of doors.Sometimes it takes months to even yearsto do something like this.

You know, a census of Indonesiawould probably taketwo years to accomplish.And the problem, of course,with all of thisis that, with all those paper forms --and I'm telling you, we havepaper forms for every possible thing:We have paper formsfor vaccination surveys.We have paper forms to trackpeople who come into clinics.We have paper forms to trackdrug supplies, blood supplies --all these different paper formsfor many different topics,they all have a single, common endpoint,and the common endpointlooks something like this.And what we're lookingat here is a truckful of data.This is the data from a singlevaccination coverage surveyin a single districtin the country of Zambiafrom a few years ago,that I participated in.The only thing anyonewas trying to find outis what percentage of Zambianchildren are vaccinated,and this is the data,collected on paper over weeks,from a single district,which is something like a countyin the United States.You can imagine that,for the entire country of Zambia,answering just that single question ...looks something like this.

Truck after truck after truck,filled with stack after stackafter stack of data.And what makes it even worseis that's just the beginning.Because once you've collectedall that data,of course, someone --some unfortunate person --is going to have to type thatinto a computer.When I was a graduate student,I actually was that unfortunateperson sometimes.I can tell you, I often wasn'treally paying attention.I probably made a lotof mistakes when I did itthat no one ever discovered,so data quality goes down.But eventually that data, hopefully,gets typed into a computer,and someone can begin to analyze it,and once they havean analysis and a report,hopefully, then you can takethe results of that data collectionand use it to vaccinate children better.Because if there's anything worsein the field of global public health --I don't know what's worsethan allowing children on this planetto die of vaccine-preventable diseases --diseases for whichthe vaccine costs a dollar.And millions of children dieof these diseases every year.And the fact is, millionsis a gross estimate,because we don't really knowhow many kids die each year of this.What makes it even more frustratingis that the data-entry part,the part that I used to doas a grad student,can take sometimes six months.

Sometimes it can take two yearsto type that information into a computer,And sometimes, actually not infrequently,it actually never happens.Now try and wrap your headaround that for a second.You just had teams of hundreds of people.They went out into the fieldto answer a particular question.You probably spent hundredsof thousands of dollarson fuel and photocopying and per diem.And then for some reason, momentum is lostor there's no money left,and all of that comes to nothing,because no one actually types itinto the computer at all.The process just stops.Happens all the time.This is what we baseour decisions on in global health:little data, old data, no data.So back in 1995,I began to think about waysin which we could improve this process.Now 1995 -- obviously,that was quite a long time ago.It kind of frightens me to thinkof how long ago that was.

The top movie of the yearwas "Die Hard with a Vengeance."As you can see, Bruce Willishad a lot more hair back then.I was working in the Centersfor Disease Controland I had a lot morehair back then as well.But to me, the most significantthing that I saw in 1995was this.Hard for us to imagine, but in 1995,this was the ultimate elite mobile device.It wasn't an iPhone.It wasn't a Galaxy phone.It was a PalmPilot.And when I saw the PalmPilotfor the first time, I thought,"Why can't we put the formson these PalmPilots?And go out into the fieldjust carrying one PalmPilot,which can hold the capacityof tens of thousands of paper forms?Why don't we try to do that?Because if we can do that,if we can actually just collectthe data electronically, digitally,from the very beginning,we can just put a shortcut rightthrough that whole processof typing, of having somebody typethat stuff into the computer.

We can skip straight to the analysisand then straight to the useof the data to actually save lives."So that's what I began to do.Working at CDC, I began to travelto different programs around the worldand to train them in usingPalmPilots to do data collection,instead of using paper.And it actually worked great.It worked exactly as wellas anybody would have predicted.What do you know?Digital data collection is actuallymore efficient than collecting on paper.While I was doing it, my business partner,Rose, who's here with her husband,Matthew, here in the audience,Rose was out doing similar stufffor the American Red Cross.The problem was,after a few years of doing that,I realized -- I had been to maybesix or seven programs --and I thought, you know,if I keep this up at this pace,over my whole career,maybe I'm going to goto maybe 20 or 30 programs.But the problem is, 20 or 30 programs,like, training 20 or 30 programsto use this technology,that is a tiny drop in the bucket.The demand for this, the needfor data to run better programsjust within health -- not to mentionall of the other fieldsin developing countries -- is enormous.There are millions and millionsand millions of programs,millions of clinicsthat need to track drugs,millions of vaccine programs.There are schoolsthat need to track attendance.There are all these different thingsfor us to get the data that we need to do.

And I realized if I kept upthe way that I was doing,I was basically hardlygoing to make any impactby the end of my career.And so I began to rack my brain,trying to think about, whatwas the process that I was doing?How was I training folks,and what were the bottlenecksand what were the obstaclesto doing it fasterand to doing it more efficiently?And, unfortunately, after thinkingabout this for some time,I identified the main obstacle.And the main obstacle, it turned out --and this is a sad realization --the main obstacle was me.So what do I mean by that?I had developed a processwhereby I was the centerof the universe of this technology.If you wanted to use this technology,you had to get in touch with me.That means you had to know I existed.Then you had to find the moneyto pay for me to fly out to your countryand the money to pay for my hoteland my per diem and my daily rate.So you could be talkingabout 10- or 20- or 30,000 dollars,if I actually had the timeor it fit my scheduleand I wasn't on vacation.

The point is that anything,any system that dependson a single human beingor two or three or five human beings --it just doesn't scale.And this is a problem for whichwe need to scale this technology,and we need to scale it now.And so I began to think of waysin which I could basicallytake myself out of the picture.And, you know, I was thinking,"How could I take myselfout of the picture?"for quite some time.I'd been trained that the wayyou distribute technologywithin international developmentis always consultant-based.It's always guysthat look pretty much like me,flying from countriesthat look pretty much like thisto other countrieswith people with darker skin.And you go out there,and you spend money on airfareand you spend time and you spend per diemand you spend for a hoteland all that stuff.As far as I knew, that was the only wayyou could distribute technology,and I couldn't figure out a way around it.But the miracle that happened --I'm going to call it Hotmail for short.You may not think of Hotmailas being miraculous,but for me it was miraculous,because I noticed, just as Iwas wrestling with this problem --I was working in sub-SaharanAfrica, mostly, at the time --I noticed that every sub-SaharanAfrican health workerthat I was working withhad a Hotmail account.

And it struck me, "Wait a minute --I know the Hotmail people surely didn'tfly to the Ministry of Health in Kenyato train people in how to use Hotmail.So these guys are distributing technology,getting software capacity out there,but they're not actuallyflying around the world.I need to think about this more."While I was thinking about it,people started using even morethings like this, just as we were.They started using LinkedIn and Flickrand Gmail and Google Maps --all these things.Of course, all of these thingsare cloud basedand don't require any training.They don't require any programmers.They don't require consultants.Because the business modelfor all these businessesrequires that something be so simplewe can use it ourselves,with little or no training.You just have to hear about itand go to the website.And so I thought, what would happenif we built softwareto do what I'd been consulting in?Instead of training peoplehow to put forms onto mobile devices,let's create software that lets themdo it themselves with no trainingand without me being involved.And that's exactly what we did.

So we created software called Magpi,which has an online form creator.No one has to speak to me,you just have to hear about itand go to the website.You can create forms,and once you've created the forms,you push them to a varietyof common mobile phones.Obviously, nowadays, we've movedpast PalmPilots to mobile phones.And it doesn't have to be a smartphone,it can be a basic phone,like the phone on the right,the basic Symbian phonethat's very commonin developing countries.And the great part about thisis it's just like Hotmail.It's cloud based,and it doesn't require any training,programming, consultants.But there are someadditional benefits as well.Now we knew when we built this system,the whole point of it,just like with the PalmPilots,was that you'd be able to collect the dataand immediately uploadthe data and get your data set.

But what we found, of course,since it's already on a computer,we can deliver instant mapsand analysis and graphing.We can take a process that took two yearsand compress thatdown to the space of five minutes.Unbelievable improvements in efficiency.Cloud based, no training,no consultants, no me.And I told you that in the first few yearsof trying to do thisthe old-fashioned way,going out to each country,we probably trained about 1,000 people.What happened after we did this?In the second three years,we had 14,000 people find the website,sign up and start using itto collect data:data for disaster response,Canadian pig farmerstracking pig disease and pig herds,people tracking drug supplies.

One of my favorite examples, the IRC,International Rescue Committee,they have a programwhere semi-literate midwives,using $10 mobile phones,send a text messageusing our software, once a week,with the number of birthsand the number of deaths,which gives IRC something that no onein global health has ever had:a near-real-time systemof counting babies,of knowing how many kids are born,of knowing how many childrenthere are in Sierra Leone,which is the countrywhere this is happening,and knowing how many children die.Physicians for Human Rights --this is moving a little bitoutside the health field --they're basically training peopleto do rape exams in Congo,where this is an epidemic,a horrible epidemic,and they're using our softwareto document the evidence they find,including photographically,so that they can bringthe perpetrators to justice.Camfed, another charitybased out of the UK --Camfed pays girls' familiesto keep them in school.They understand this is the mostsignificant intervention they can make.

They used to track the disbursements,the attendance, the grades, on paper.The turnaround time between a teacherwriting down grades or attendanceand getting that into a reportwas about two to three years.Now it's real time.And because this is such a low-costsystem and based in the cloud,it costs, for the entire five countriesthat Camfed runs this in,with tens of thousands of girls,the whole cost combinedis 10,000 dollars a year.That's less than I used to getjust traveling out for two weeksto do a consultation.So I told you before that whenwe were doing it the old-fashioned way,I realized all of our work was reallyadding up to just a drop in the bucket --10, 20, 30 different programs.We've made a lot of progress,but I recognize that right now,even the work that we've donewith 14,000 people using thisis still a drop in the bucket.But something's changed,and I think it should be obvious.What's changed now is,instead of having a programin which we're scaling at such a slow ratethat we can never reachall the people who need us,we've made it unnecessaryfor people to get reached by us.We've created a toolthat lets programs keep kids in school,track the number of babies that are bornand the number of babies that die,catch criminals and successfullyprosecute them --to do all these different thingsto learn more about what's going on,to understand more,to see more ...and to save lives and improve lives.Thank you.(Applause)

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