Sunday, 1 September 2013


For the past fortnight I have been looking at our work from a different angle.  Literally from above.  A ‘God’s-eye-view’ as it were.

Courtesy google maps.

Earlier this year we did our survey of all of our active home-based care Positive Friends.  Our home-based care teams worked hard and tried to meet all 142 of them – we finally managed to interview 135 of them.  Then there were the ‘secondary contacts.’  Folks who we have been actively involved with in the past – but who for various reason don’t need (or don’t want) active follow-up these days.   Our teams interviewed 96.  We ended up with 231 priceless surveys done with HIV Positive Friends whom Jeevan Sahara has been working with.

This was the fifth time we did the survey at Jeevan Sahara – a simple questionnaire that asks our HIV Positive Friends to tell us what their health was like in the past month.  And also how rated their adherence to the ART medications that most are on at this point. 

What was different this year was the quality of the interviewing.  We were able to meet almost everyone and make sure that almost every single question was asked and entered.  And in a wonderfully timed move – a new version of Epi Info – the tried and trusted free data analysis programme that the Centres for Disease Control and Prevention (CDC) was released. 

My first joy was to use the EPI Info 7 to run through the survey data.  As we explored the figures we found out so many important things about our Positive Friends that we don’t see in the day to day.  We were reminded of the sobering fact that two-thirds of the men are alcoholics or have a history of alcohol abuse.  We saw the good news that most of our folks are now taking their anti-retroviral therapy (ART) and that too accessing it free from the government sources.  We had the sober realization that even though most people rated their health as ‘good’ or better – that a full 4 out of 5 reported at least one health issue in the previous 30 days.  We saw clear documentation that people who are stable on ART enjoy better health than people who are not on ART or have just started their ART.  The list goes on.

Then I did a little looking back in time.  We compared this year’s data with the data of the first survey that we did in 2005.  Striking changes.  Our folk today are clearly healthier than the people we were working with 8 years ago.  And the good news is that we are still in contact with some of them!  An amazing 17 people have been now interviewed in each of the 5 surveys that we did.  There is data just crying to be analyzed here…

So where does the ‘God’s-eye-perspective’ come in with all of this?

Well, it stems from the fact that Epi Info 7 has a mapping function that seamlessly links in with Bing maps (or whatever your favourite mapping utility is).

When I was in graduate school – taking a GIS course meant accessing satellite data which cost a bomb.  I knew that there was little hope of getting high quality sat data for India so I didn’t bother with the course.  

Today it’s all available on line.  A seamless mosaic of images at different levels courtesy of google maps (and their ilk).
And so what Epi Info 7 wanted from me for each of the data points was a geographic location.  I toyed with the idea of getting a GPS and asking our staff to go to each home and get a reading.  Then I thought about using mobile phones.  But to my disappointment none of our staff have mobile phones with those functions.  We are team for whom the terms Blackberry, Galaxy and I-phone are still foreign words.  

But then I realized that I could use google maps.  I sat down with our home-based care teams and showed them the virtual map of Thane.  We identified where a particular person lived – often simulating how the team goes to the particular Positive Friends house.  When we agreed on the location we right-clicked and chose the ‘what’s here?’ function.  Up popped the longitude and latitude for that point in space.  I thus had a geo-tag for the person in question.  I just needed to copy it into the data base – into the newly made columns of ‘latitude’ and ‘longitude’ of course. 

When we had done this for 8 folks to start with, we made our first ‘map.’  The 8 data points showed up on the Thane map.  Showing us where these 8 Positive Friends lived.  I could then have these 8 points show me the spatial distribution of any of the variables that we had asked in the survey.  Who had a fever in previous month?  Bang.  Displayed.   Which are men and which are women?  Add another data layer, change the filter settings – and you have a map showing the distribution by gender.  Which folk are being looked by which of our mini-teams?  A change in the data filter and a new set of info displayed.  Want to zoom in and see who is living close to whom?  The internet enabled map allows me to do so.


Thrilled with our first 8 folks, we then worked on the other 223 odd ones.  It was painstaking work – translating our teams’ on-the-ground experiences of getting to the homes of our Positive Friends into a specific data point.  Many, many of our friends live in the shanty-towns that form so much of Thane.  We can never identify exactly where a person lives given the maze of tiny alleys and the uniform image of row after row of flat roof that a slum looks like from above.  But we can get a pretty good shot at the general location. Somewhere within 30-50 meters or so of where they live.  And a surprising number of folks we were able to actually identify what was most likely their shack!

And so a blearly 10 days later we now have an interactive map of the dear folks we are working with.

The next steps?

One is to link the current levels of ART adherence – and display them so that our staff can see which folks are in a ‘danger’ level – and which ones are doing well.

Another would be to make a map that would show folks who have missed an appointment.  We have a small component of our work were we are providing free ART for 6 months to a few folks.  A simple spreadsheet which compares their next appointment date with today’s date can show if a person has missed their scheduled appointment – and this could be displayed on the map as a red dot for example.

But what would really be a bomb would be to have a real time adherence map.  One where our staff would enter adherence data via phone – and which would then update and display the current levels of ART adherence for all our Positive Friends!  One of the benefits would be build in early alerts – say a person has less than 90% adherence – we would want their case-managers to do another visit in a week!   To do this would need some basic android programming – and some time.

At the same time, we have the sobering reminder that maps alone do not change hearts.
What we really have going for us, are our wonderfully dedicated staff – whose love and care have developed relationships that cross time.  The dots on the screen are a small testament to the web of relationships our staff and others from local churches have made with the HIV Positive Friends we work with.

I may have a geo-tag for one of our Positive Friends – but that is not 100% accurate – and that person may leave and head off for somewhere else anytime.  But there is one who knows not only my exact location in real time – but also knows the hairs on my head.  Our knowledge – however sophisticated we may feel it is today - is always a rough tool, a crude instrument compared overwhelming omniscience of Father God.  But how He delights when we discover and explore!

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