In the deep, remote valleys of the Kingdom of Bhutan, a small country in South Asia bordered by China to the north, a boy slips on a plastic headset that looks like a shower cap.
Dr. Farrah Mateen, a 33-year-old neurologist at Massachusetts General Hospital, stands next to him, preparing to collect a set of readings through the headset on a new application on her cellphone. This is how the boy will be diagnosed with epilepsy, and it’s an example of how Mateen and her Bhutan Epilepsy Project are using fast-growing mobile health technology to bring improved medical care to underserved parts of the world.
With the arrival of the Apple Watch, and the competitors sure to follow, interest from hospitals in using mobile devices to diagnose, monitor, and treat patients is expected to speed up. A recent study by Research2guidance, a mobile marketing research firm, found there are already more than 100,000 mobile health apps, for everything from fitness routines and diet suggestions to functions that allow doctors to study images and monitor patients.
Mateen’s quest to study the neurological condition of patients has taken her to China, Bangladesh, India, Jordan, Lebanon, Zambia, and various other countries. The Bhutan Epilepsy Project is her latest endeavor.
Just how underserved is Bhutan? It does not have a single neurologist, nor does it have any technology to diagnose epilepsy, one of the most common neurological disorders and one easily treated with medication.
Mateen, brimming with youth and intelligence, has received funding from the government of Canada and the Thrasher Research Foundation to bring cutting-edge mobile technology to remote Bhutanese. Bhutan Epilepsy’s team of collaborators includes medical specialists, Bhutanese psychiatrists, data readers, and programmers.
The “team is working very hard to improve care of epilepsy,” said the soft-spoken Mateen. “Bhutan doesn’t have a neurologist . . . [but they] have really embraced the opportunity.”
One reason is that its tiny population of 730,000 faces a high burden of epilepsy (estimated at 1 out of 1,000 people). And its geography — most Bhutanese live in rural, mountainous villages — prevents them from receiving trained help for their seizure disorders, Mateen said.
Despite living in rural areas, the Bhutanese are extremely well connected — more than 90 percent own a cellphone — making the country an ideal setting for Mateen’s project.
One complication is that the country’s traditional faith-based practices commonly misconstrue epilepsy as a supernatural curse, and societal myths treat epilepsy as a social stigma. So far, more than 200 Bhutanese with seizures have entered the study.
“Traditional medicine beliefs [say] they have seizures on auspicious days,” Mateen said. “If they find this technology helps them explore their traditional beliefs, it’s . . . a win-win.”
From her humble roots growing up in Prince Albert, Saskatchewan, a small Canadian town, Mateen has become a rising star in the American medical community. Following her studies, she completed a stint at the Mayo Clinic and a fellowship in medical ethics at Harvard. She recently completed her PhD in international health at Johns Hopkins University.
Her Bhutan project is analyzing the mobile electroencephalography, or EEG, versus the stationary EEG technology, which is the standard epilepsy diagnostic tool in American hospitals.
“The long-term goal is to train the [Bhutanese] research coordinators to become even more skilled at EEG so they can provide that service. They are the experts now, really.”
But even experts need to be able to communicate with hospitals and health facilities in other places. One common application of mobile health is through simple text and personalized messaging.
Medic Mobile, a nonprofit operating across Africa, Asia, and Latin America, is deploying customized SIM cards for phones and laptop software to connect community health workers with health facilities.
“What we need to save . . . more lives . . . is coordination,” said Josh Nesbit, Medic Mobile’s chief executive. “It’s about communicating and making sure that every kid gets their vaccinations, that every pregnant woman gets access to basic care.”
The impetus for Medic Mobile was Nesbit’s experience in Malawi, where he observed a single hospital serving 250,000 people. Nesbit recalled a community health worker walking 35 miles every week to hand deliver updates on patients in numerous villages to a local clinic.
By using a mobile phone to communicate with the hospital, the worker could prioritize the villages needing urgent attention. In six months, the hospital doubled the number of patients being treated for tuberculosis.
But not all mobile health experiments are so easily measured, and that is one of the biggest hurdles the new technology must overcome.
Showing clear evidence of success is especially important in developing countries, where already overburdened health systems may not be able to sustain difficult-to-use, costly, or time-consuming programs.
In the early years of mobile health, commonly known as mHealth, there was little evidence on what was and was not working, said Alain Labrique, a professor of international health at Johns Hopkins. But more rigorous evaluation is emerging.
“There has been in the past five years a strong push . . . toward measuring the impact of mHealth initiatives,” Labrique said.
Mateen hopes Bhutan will offer EEG services independently in the future. But for now, she said, the country needs to improve its technical literacy.
“Taking the data is half of it, but reading it is half,” she said. “There has to be process innovation, as well as product innovation.”
She eagerly awaits clinical results for Bhutan Epilepsy. “Is the smartphone going to work or is it not?” she asks. “We are pretty optimistic.”