1. 1 Digital resources in the Eastern Cape, South Africa Stephen Korsman Virologist Groote Schuur NHLS / University of Cape Town 2 December 2014

2. 2 Outline The bad side – Demographics – Telkom – Eskom The good side – Digital aids – Digital pathology – Other opportunities

3. 3 The bad side

4. 4 Demographics Largely rural Poor infrastructure Most people do not have running water Roads are poor People are poor Cell phones are common Internet access is poor

5. 5 Limpopo

6. 6 Telkom + Eskom Copper is valuable No phones No data No power Photo: Gallo images http://citizen.co.za/263549/cable-theft-caused-lenasia-outage/ Photo: Gallo images http://citizen.co.za/263549/cable-theft-caused-lenasia-outage/ Photo: http://www.iol.co.za/news/crime-courts/kzn- ops-make-r3m-copper-bust-1.1677121

7. 7 Photo: Desiree Swart http://www.moneyweb.co.za/moneyweb-gallery/cable- theft-in-moruleng?sn=Gallery Headlines: – Eskom copper cable theft cost R350 million – One village, over 700 cable thefts in four months – One electrocuted, three charged for Eskom cable theft – Telkom cable theft wreaks network havoc: pictures – Telkom 'no' to lines in cable- theft areas – Copper-cable theft costing Britain a fortune (Daily Mail Online)

8. 8 NHLS labs In Mthatha – Power cuts, faulty electricity – Laboratory Information System TrakCare – Requires continuous online link – 2013-14 – copper cables stolen FOUR times – Failure to change from Disa to TrakCare – Wireless (?3G, ?HSDPA?) link needed to prevent theft – Still waiting …

9. 9 NHLS labs Outside Mthatha – Even poorer infrastructure – Hospitals usually have running water The lab may not always be linked up TB testing done using collected rainwater – False positive due to harmless environmental mycobacteria – Do we expect these hospitals to run an online LIS successfully? Northern Cape – minor problems with connectivity Eastern Cape – huge problems with connectivity

10. 10 The good side

11. 11 A lot is being done digitally

12. 12 Forms of digitally aided research Simple  complex Simple e-mail contact + data sharing Skype, YouTube conferences / talks – Not just videos of funny cats! Online / shared databases – HIV, HBV drug resistance – HIV genomic studies – Vaccine development Online data tracking / monitoring – Not just Big Brother watching you! Microscopy across the web

13. 13 Google Flu Trends Google Recorded USA South Africa

14. 14 Organisations Research Without Borders: Big Open Data Thursday, December 4th, 2014 - 2-4pm Columbia University’s Faculty House

15. Don’t forget… http://theglobalhealthnetwork.org or http://tghn.org

16. 16 Online training

17. 17 Possibilities

18. 18 Digital pathology Walter Sisulu University – Anatomical Pathology High resolution digital microscope = Nikon Coolscope Connected via ISDN, later ADSL, to NHLS intranet Sites with Coolscopes: WSU, East London, Port Elizabeth, Stellenbosch Univ, MEDUNSA Anyone with internet could reach the microscope – Login was controlled Second opinions from Stellenbosch University Officially opened in 2007 Part of WSU’s digital medicine programme – Included clinical consultations

19. 19 Banach L, Stepien A, Schneider J, Wichrzycka-Lancaster E. Dynamic active telepathology over National Health Laboratory service network, South Africa: feasibility study using Nikon Coolscope. Diagn Pathol 2008;3:Suppl 1

20. 20 Banach L, Stepien A, Schneider J, Wichrzycka-Lancaster E. Dynamic active telepathology over National Health Laboratory service network, South Africa: feasibility study using Nikon Coolscope. Diagn Pathol 2008;3:Suppl 1

21. 21 Photos courtesy of Marie-Paule Henshall- Howard, GSH NHLS Roche CAP/CTM Mthatha East London Port Elizabeth

22. 22 Opportunities Telephonic consultations with pathologists – Ongoing, underutilised Live access to local instruments via the internet – In development Sharing of log files or run data for pathologist validation of assays – Not yet done Easy to do, smaller labs don’t do many tests with portable run data