An estimated five billion people use mobile phones to help keep us connected with friends and family and to source information. But mobile phones allow us to do so much more than message friends and scroll through Twitter – they are also being used in the fight against neglected tropical diseases (NTDs).
In particular, mobile technology has become an essential tool in the fight against the blinding NTD trachoma. The most advanced stage of trachoma is called trachomatous trichiasis (TT), which causes the eyelashes to turn inwards and painfully scrape against the eye. This excruciating scraping can eventually lead to irreversible blindness. However, if caught in time it can be treated with straightforward surgery that takes 20 minutes.
In 2015, Sightsavers developed a mobile application called the TT Tracker, which enables trachoma surgeons, assistants and supervisors to collect and analyse important data about surgery and performance, and to determine when and where follow-up appointments are needed. This is incredibly useful in remote areas such as the Nikki region in northern Benin, as people living there tend to move around, and adequate healthcare centres are few and far between.
Sightsavers carried out the first ever trachoma surgical campaign in Benin in July 2019, under the Accelerate programme. The first surgeries took place in the Nikki region, one of the most trachoma-endemic areas in the country. Sightsavers’ Dr Alfa Bio Amadou, from the nearby village Banikoara, has been an eye surgeon for over eight years and supported this campaign.
“I wanted to become a surgeon because there weren’t many and it was needed… also, it is a fantastic result when you are able to give back sight to someone from a remote area who was going blind because there is no eye health facility near them,” states Dr Amadou.
“The impact on people with advanced trachoma is that they have suffered for a long time and gradually seen their daily activities and income reduced. That’s why I am happy to perform surgery everywhere trachoma is endemic so that we can reach elimination.”
The TT Tracker is also helping in the fight to reach elimination.
“It standardises and monitors data which makes it easy to trace patients who have received trachoma surgery. This helps us provide quality data to document elimination thresholds,” Dr Amadou adds.
Prior to the TT Tracker, in remote regions, it was challenging to monitor trachoma patients after they had surgery, which is crucial for assessing the success of the surgery and for identifying any additional care needs. But now, thanks to the mobile app, we are able to ensure advanced trachoma surgeries are on track.
“I strongly advise trachoma surgeons and health workers to use the TT Tracker. It greatly reduces workload because the surgeon does not have to record details by hand between each patient and an assistant is able to use the app and help with recording patient data.
“It also means that the patients are better examined and that all stages of the examination and follow-ups are respected,” says Dr Amadou.
Zakari Abdou Loudaye is part of the mobile eye health team fighting trachoma in Benin. Zakari lives in Parakou, the largest city in northern Benin, and he travels roughly an hour and twenty minutes by taxi to work in the remote Nikki region. Zakari is one of 15 people in Benin that have been trained by Sightsavers on how to use the TT Tracker.
During the first trachoma surgeries in Benin, Zakari worked alongside the surgical team using the TT Tracker throughout the entire process, from identifying patients with advanced trachoma, to surgery, to their final post-surgery check-up.
Once a patient is identified, the team uses the TT Tracker to record their name, where they are from, if they have any children, and other details.
Following surgery, Zakari sits with the surgeon to update the patient’s data in the TT Tracker app with information about the surgery and how it went.
A day after surgery, the patient's bandages are removed. The TT Tracker is used to record responses to questions about how the patient feels.
Zakari, or another mobile team member with training in the app from a different location, asks the patients the same questions from the bandage removal during each follow-up until their third and final follow-up, which takes place roughly six months after surgery. As soon as any information is recorded on the TT Tracker it is sent off to the cloud where it is secure, with no chance of getting lost.
“Once you have sent the data it is sent,” explains Zakari.
The supervisors of the surgical team then receive online and email updates telling them which patients need to be followed up with and when.
“This is the third time I have used the TT Tracker; the app is very easy to use. Before the app surgeons and assistants had to record the patient’s information on paper forms.”
The different stages of the patient’s care journey can often occur in various locations with different medical teams, but by recording all of a patient’s information through the app, the surgeon in charge of their care has easy and immediate access to it.
“When you work with so many patients, but you don’t have their data in an app, it is hard to remember where all the different pieces of information live. This helps the surgeon understand what has happened and make decisions about what needs to continue to be investigated.”