In 2010, an earthquake measuring 7.0 on the Richter scale toppled Haiti, affecting the lives of 3 million people and demolishing Haiti’s capitol and several other cities. University of Iowa physician Chris Buresh had been visiting Haiti since 2003 and began making regular trips there as a volunteer, providing medical care to those in need.
A year later Buresh spoke about his experiences at a brown bag lunch, and in the audience was Steve Yagla. Yagla had heard many accounts of this type of devastation but none had ever grabbed him like Buresh’s stories. A big difference was that Buresh had made many trips to Haiti before the earthquake and shared personal stories of Haitians he knew. Yagla wanted to get involved but never imagined making the trip, since he had no medical training. Eventually, after a few months of encouragement, Buresh persuaded him to come.
Yagla immediately recognized that data collection methods at the medical clinics were inadequate. Volunteers entered patient information into a simple spreadsheet on an iPad, and it was a painfully slow process because only one person could input data at a time. There were no patient history records, it was hard to track individuals from one visit to the next, and data values were inconsistent.
After the trip, Yagla recruited two of his colleagues in Information Technology Services to come up with a solution. Over their lunch breaks—33, to be exact—Yagla, Steve Bowers, and Ted Fitzgerald put their heads together to develop an electronic medical record system. The system, TEBOW, has drastically improved the process of collecting and keeping records at the clinics, impacting the care and lives of thousands of Haitians.
“Over the last 10 years, I’ve never had a clinic see more than 1,400 patients in a week,” Buresh says. “That number about killed us. With TEBOW, we have been able to find efficiencies that enable us to see 1,600 patients without breaking a sweat. And we’re doing a better job of it, too.”
Making follow-up care possible
Before TEBOW, doctors filled out dossiers on cardstock. They encouraged patients to bring these records to future visits so the doctor would have background on symptoms, conditions, medications, and vital signs. Hardly anyone remembered to do so, and clinics were forced to start fresh each time a patient returned.
Another problem: patients often used nicknames or were inconsistent with the name given, switching around their first and last name or spelling phonetically. On top of that, birthdates were more like estimations.
Without reliable records, follow-up care was virtually impossible. But TEBOW has changed that.
Clinics can now track patients by name, age, hometown, medical record number, and photo. Health statistics can be monitored over time. Volunteers can also see data on what illnesses and medicines are common, allowing for smarter purchasing of supplies.
“This last trip, we found a 17-year-old that lived in the mountains and had Type 1 diabetes. She didn’t have a phone. Thanks to TEBOW, we were able to get her picture to a guy in a nearby village. He was able to find her and bring her back down the mountain, and we got her admitted to a treatment program,” Buresh says.
In another case, the system helped get a pair of crutches to a child whose leg had been amputated at the knee.
How TEBOW works
TEBOW is a client/server Electronic Medical Record (EMR) system created using Apple FileMaker.
“The core of the TEBOW System resides on a server placed in a central spot within the clinic,” Yagla says. “A wireless LAN (Local Area Network) allows volunteers to use multiple laptops and iOS devices simultaneously to capture information about patients (such as their diagnosis and treatment) as they move through the clinic.”
FileMaker was chosen because it was the only application with the necessary set of tools: a client/server application that works in a wireless local area network, native clients that could function on Windows or Mac OS laptops, native clients that could function on mobile iOS devices (iPads and iPhones), and clients that could also be taken out into rural areas to gather data, with the ability to merge that data back in later.
Yagla approached Fitzgerald and Bowers because he knew they had expertise in FileMaker. Over a period of two and a half months, they taught him FileMaker while creating the system (which Yagla dubbed TEBOW as a combination of “Ted and “Bowers”). The first version of TEBOW debuted in early 2013 and was tested by ITS volunteers in a simulated clinic setting.
Within a few weeks, it was put into action in Haiti and incorporated into the workflow of each clinic.
Yagla has made three trips to Haiti, making many personal connections through his journeys. He took his daughter along on one trip, and was able to round up some old City High soccer uniforms for the kids in a village to wear during their matches. Each time, he is amazed by the compassion and hope he witnesses.
One particularly inspiring story was about a father who came into a clinic begging one of the doctors to take his 4-year-old daughter, Djeline. She weighed only 15 pounds.
One of the Haitian interpreters came back the next day with adoption papers and adopted her. He took her in despite the fact that he and his wife had already adopted two girls and had two boys of their own, and all of them lived in a 10-by-10-foot home.
A year later, Djeline had almost doubled her weight.
The interpreter’s compassion didn’t end there. “Papa” John Gabin also opened a community center that helps meet the basic survival needs of 60 children. Each month, he plans an event for the children to look forward to. By making and selling bamboo pens, he raised $3,000 for the materials to build an 800-square-foot earthen home, where he plans to live with his family and 12 orphans.
Yagla quotes a Haitian proverb to sum up the lessons learned from his trips: “A rock in the water does not know the pain of a rock in the sun.”
“We are the rocks in the water, the Haitians are the rocks in the sun.”