Solar-Powered Medical Resilience in Off-Grid Kenya

The primary challenges plaguing the containment of pathogens from rural to urban transmission in Kenya are limited laboratory services, point-of-care (POC) diagnosis, and treatment mobilization within off-grid, rural communities. These difficulties can be attributed to the general lack of electrical grids and high-bandwidth internet capabilities, pushing Kenyans in these marginalized regions either to divert care of zoonotic diseases towards healthcare facilities in cities of high population densities, or not seek care at all. As seen in the recent Yellow Fever outbreak in Isiolo county, the largely pastoralist rural population of Kenya can serve as a massive risk factor for intercounty transmission of zoonotic diseases if timely diagnosis, vector control, and vaccination are not implemented. However, successful outbreak response through laboratory diagnosis and containment cannot be achieved without cost-efficient off-grid power and consistent internet connectivity.

A lack of sustainable electricity poses an isolative challenge on timely communicable disease response in rural Kenya. Without access to off-grid power, lab samples and vaccines cannot be properly refrigerated, rendering tools for identification and treatment against high-consequence pathogens useless. The unrefrigerated transport of samples and vaccines between rural regions and distant healthcare facilities is costly, and often risks vaccine potency (citing Malawi’s dumping of 20,000 COVID vaccines) and sample viability. Power challenges also limit internet access. Currently, rural base stations in Kenya are powered by diesel, which is expensive, requires large-scale supply chains, and security in isolated contexts. Connectivity is crucial in modern laboratories for communicating results to outbreak surveillance and management systems. Additionally, as more hospitals adopt telemedical capabilities, the lack of internet limits potential rural on-site care via telemedicine. Reaching out to these communities and screening their patients is half the battle; the other half, which we strive to target, is being able to maintain viable samples and treatments so that the next pandemic can not only be contained, but also treated at ground zero.

While we work towards solving this issue within the 153,000 pastoralist Pokot people that compose our community, it is estimated that almost 18 million Kenyans live without access power grid electricity. Projecting to Sub-Saharan Africa, where around 600 million people lack access to electricity, these populations mainly practice either subsistence farming or pastoralism in low-resource areas, priming an environment for vector-borne diseases to traverse the animal to human barrier. Without adequate electricity, connectivity, or refrigeration, it is almost impossible to track the transmission of zoonotic diseases, let alone provide treatment while they are still endemic to a region. Africa disproportionately carries a severe majority of the global malaria burden, with the region carrying 96% of the world’s malaria deaths. Out of the 31 million HIV-positive patients worldwide, almost 69% live in sub-Saharan Africa. Much of the transmission of these diseases could be preventable if tracked and treated early.

Our “solution” is an aggregate of three solutions that range from the use of green energy to power such things as telecommunication connectivity for healthcare, education, e-banking, and telemedicine. It is a solution that reduces the carbon footprint by incorporating solar power to bring cold chain supply, storage, and distribution to fragile environments and communities. Our solution helps to bring down barriers in fragile regions of the world by implementing a solar-power solution to the major issues surrounding health and food security.

We plan to employ the help of Vanu, Inc. The brainchild of MIT alumni Vanu Bose, Vanu provides solar-powered radio/broadband connectivity through their compact carrier-grade outdoor base station towers. Currently, Vanu is in licensing discussions with SafariCom, an existing telecommunications company in Kenya, as Vanu maintains wireless networks on behalf of local mobile network operators (MNO). Combined with the fact that Vanu base stations consume very low power, and utilizes small cell technologies, our innovation can allow for broad network access and low operating expenses despite serving areas of low population density and low revenue per user. Additionally, Vanu technologies can be remotely maintained and repaired through software, eliminating the physical maintenance that often deters off-grid installation. This inherently solves issues of sustainability and cost-effectiveness that deters most MNOs from constructing diesel stations in rural areas. Services have historically been provided at either no cost or $1/month to individual users.

With established internet capabilities, our team also plans to introduce telemedicine technology from GlobalMed. This telemedicine initiative provides transportable exam stations and backpacks, featuring essential diagnostic equipment including digital stethoscopes, 12-lead ECGs, otoscopes, and ultrasounds. Implementing this equipment into off-grid networks now connected with Vanu, medical imaging and diagnostics can be transmitted with these telehealth stations directly to medical centers within Kenya, and even abroad in real-time, granting off-grid areas to quality and precise medical direction. Virtual telehealth visits from physicians worldwide can also be provided using GlobalMed mobile stations, allowing for the greatest accessibility to care through a screen. With the help of Boda Bodas—our team of medical motorcycle EMS teams serving off-grid Kenyan communities—diagnostic equipment can be accompanied with direct medical treatment into remote areas.  This solution limits transmission in patient travel by promoting local telemedical care, while connecting off-grid communities to international medical centers.

Preventive measures will enlist the help of SolerCool Technologies, a company aimed to provide solar-powered refrigeration into off-grid markets. Using phase-change material technology, SolerCool refrigeration absorbs/releases energy to maintain cold temperatures for extended periods of time. Translating this technology into backpacks and other storage devices, vaccines and samples can be transported via motorcycle EMS safely between larger hospitals and laboratories, or stored at rural sites for extended use, maintaining both viable samples and vaccines.

Our solution primarily serves the East Pokot region of Baringo County, Kenya. With a population of 153,000, the ethnic Pokot have been in constant inter-tribal conflicts centered upon access to natural resources. High household densities and a pastoralist lifestyle exasperate exposure to neglected tropical diseases, particularly visceral leishmaniasis, snakebites, trachoma, malaria, and HIV/AIDS. This area has the lowest literacy rate (16%), highest poverty levels (about 80% live below the poverty line), and lowest health outcomes indicators in Baringo. In  2020, 46% of children in Baringo had been immunized against measles, compared to 89% of the general Kenyan population. 88.7% of children in Baringo had received the Oral Polio 3 vaccine compared to 87% of the general population. 92.9% of children in Baringo County had been immunized against TB with the BCG vaccine compared to 95% of the general population. With a density of 29 inhabitants per square kilometer, Baringo County is sparsely populated, remote, and its people are highly marginalized.

Our solution introduces a new approach to treating vector-borne diseases that have become commonplace in Baringo County. As it stands, patients with suspected illnesses from all over Baringo County are transported on the back of our Boda-Boda motorcycle EMS to our local Chemolingot sub-County Hospital, where they are subsequently triaged, diagnosed, and treated. Implementing a healthcare system centered upon on-site diagnosis and treatment with limits the possibility of transmission on transport and in-hospital, and the spread of common hospital-acquired illnesses. Internet connectivity will fundamentally change the scope of transmission mapping, integrating these rural communities into larger nationwide and region-wide disease databases while simultaneously supplying world-class care through telemedicine. It will also allow for positive mHealth interventions, making way for patient-reported health outcomes and further health accessibility from the thousands of mHealth apps on the market. More generally, we hope that internet connectivity will provide a foundation for education, whether that be in literacy, nutrition, physical, sexual, or mental health education. 

Our project lead, Dr. Richard Wamai grew up in Chemolingot, the town in which we are primarily serving. After extensively researching NTDs in LMICs with the World Bank, Harvard School of Public Health, and Oxford University, he returned to his hometown to establish the African Center for Community Investment in Health in 2011 while working with Northeastern University. 

As a member of the Chemolingot community, he and the ACCIH works to study, screen, and treat neglected tropical diseases (NTD, primarily visceral leishmaniasis (VL), snakebites, trachoma & malaria) present within the pastoralist East Pokot region in Baringo County, Kenya. Within Chemolingot, they have created the Research on Multi-Disease and Educational Services (TERMES) Center, which works alongside the upgraded Chemolingot Hospital to map vector dynamics and transmission hot spots, distribute VL diagnostic kits, support and surveille the malnourished, and deliver health education in local languages. Over the past five years, Wamai’s team has provided health education to more than 8,000 villagers in East Pokot; screened more than 3,500 villagers for visceral leishmaniasis; and trained more than 50 health workers to treat people who have the disease. They have also sampled 6,000 sand flies, provided food to over 2,000 households, and distributed more than 1,900 test kits to rapidly diagnose leishmaniasis. The rehabilitation of their laboratory, provision of essential supplies, and training of health workers have helped to improve access and accuracy of VL services and data systems at no financial cost. Additionally, Wamai and the ACCIH works as a liaison between Chemolingot, six other medical facilities in Baringo County, and the government, working directly with the Baringo County Health Department and the National Ministry of Health to advocate for policies addressing NTDs based specifically on community needs. Further community outreach and education programs have been undertaken by Wamai’s students under his direction, where community needs are studied and addressed based on patient reports. These work to inform the actions of ACCIH programs and workers, which are led entirely by members of Chemolingot Hospital. Current needs addressed by the community hospital have been insufficient infrastructure regarding refrigeration, transport of treatments and patients, and consistent, sustainable internet connection & electricity—all of which our solution addresses directly.

Scott Johnson is the Director of International Development at SolerCool Enterprises, and has participated in medical missions within Zimbabwe, Kenya, Rwanda, Ethiopia, Gabon, Cote d’Ivoire, and Haiti. He was instrumental in the field test of telemedical technology in Gabon and Kenya, and the installation of telemedicine-capable clinics in Haiti. He collaborates regularly with companies targeting sustainable development and telemedicine and has direct personal connections allowing us to integrate technology from Vanu, GlobalMed, and SolerCool directly into our site.

The ACCIH strives to serve the 153,000 Pokots in East Pokot, Baringo County. Though we have not implemented the aforementioned solutions into our community yet, these technologies have already been highly integrated into the international tropical medicine scene, just not in tandem as we have modeled, and not focusing on preventing the next pandemic through the limiting of rural disease transmission. GlobalMed already operates in more than 55 countries and provides the highest number of telemedicine consults in the world. Success stories in Africa include medical missions in Kumasi, Ghana, Cape Verde, and a pilot in Zimbabwe. Vanu has provided expanded internet coverage in thousands of villages in India and Rwanda and helped with the Hurricane Maria recovery effort in Puerto Rico. SolerCool has served villages in Kenya and India with their solar-PCM refrigeration. These innovations have already been field-tested, their capabilities field-proven. However, to combine all three technologies in tandem as an affordable model to promote NTD medical prevention in off-grid areas has not been done before, and therefore our site will serve as a pilot for the cooperation of these technologies.

We are applying to Solve because we firmly believe that Solve’s access to interdisciplinary expertise can optimize our intrinsically interdisciplinary approach.

Firstly, we recognize the robust nature of MIT’s study of mHealth technology. Through integrating our communities with both telemedicine and internet connectivity, we would like technical consultations on introducing patient-centered chart technology and remote medical access to work alongside our GlobalMed telemedicine chart platforms. The introduction of MIT mHealth applications can also improve our existing community health education programs, though implementation assistance will be needed to compensate for the wide variation of accessible technology available to the rural community members.  

Secondly, the utilization of Solve’s data scientist network can allow us to methodically track healthcare outcomes and intervention impacts. As our current center is entirely community-based, our care should reflect this. Research and care based on patient-centered and patient-reported outcomes should guide the navigation of gaps in care, reach, and impact. In achieving this, we require the help of Solve’s data analysts/developers to provide efficient disease mapping technology that uses data reported remotely from the villages we plan to serve. Data analysts would also be of great help as we publish papers documenting the significance of our implementations through specific healthcare outcomes, whether that be regional disease transmission dynamics, trends in disease prevalence, or quality of life after telemedicine intervention.

Market consultations from Solve’s specialists regarding scalability will be highly valued. Though our model is a pilot, we plan on packaging this trifecta of technology as an affordable, replicable model, able to be reproduced in any low-resource environment. Actions, negotiations, and investment opportunities to transform our model into a cost-effective solution would be extremely helpful in our plans for scalability.  Of course, fiscal support will always be appreciated in the purchase and implementation of our technology, as our organization is completely reliant on grants and government aid to sustain medical care to neglected communities. 

Our solution is innovative because we see value in the ‘last-mile,’ whether that applies to supply chains, education, or medical care. We operate on the term ‘market-creating innovation,’ first coined by Clayton Christensen, where innovations target those deemed ‘non-consumers.’ In rural Kenya, there is nonconsumption due to the general lack of cost-effective solutions within the market, but that does not necessarily mean there is not a demand for services like internet connectivity and refrigeration. Addressing this coverage gap means increasing viability of medical services, internet connection, and solar power through lowered costs. Since the market inherently exists, we do so by providing sustainable solutions with the potential for growth, and more importantly, actively partnering with existing structures like Chemolingot Hospital and SafariCom. Fundamentally, when this model is reproduced, off-grid regions will be introduced into the market, opening huge opportunities that both rural and communities can benefit from.

Our solution is innovative because of the breadth of impact despite our relatively low investment, and its focus on building upon existing community infrastructure, rather than introducing completely unfamiliar interventions. In integrating solar cell towers with Vanu, we are currently in licensing discussions with SafariCom, an existing telecommunications company in Kenya. This is because Vanu maintains wireless networks on behalf of local mobile network operators (MNO). Combined with the fact that Vanu base stations consume very low power, and utilize small cell technologies, our innovation can allow for broad network access and low operating expenses despite serving areas of low population density and low revenue per user. This inherently solves issues of sustainability and cost-effectiveness that deters most MNOs from constructing diesel stations in rural areas, while also supporting the expansion of local service providers.

We also recognize the impact that GlobalMed and SolerCool will have on development within the region. Rather than relying on traditional methods of patient, specimen, and vaccine transport, keeping all medical care, refrigeration, and diagnostics on site (now with the added provision of internet connectivity) will not only limit the risk of rural-urban transmission, but also introduce these satellite villages into global research. Introduction into global research is facilitated by GlobalMed station’s ability to securely connect to hospital sites and provide real-time data exchange and consultations. Greater community education and surveillance on high-consequence pathogens can result, along with larger research investment into the region. Additionally, with stability provided by greater access to medical care and the internet, opportunities like online education can now also be pursued.

Next Year:

1. Community Education: Before full integration of this new technology, we hope that we can educate the Boda-Boda EMS crews, partnering hospitals, and community members on basic life support and how to use our technology. This is part of a greater effort to encourage the community itself to sustain our technological interventions, and possibly even improve upon its implementation and usage. As we regularly send Northeastern University undergraduate interns to our ACCIH site, they will be qualified to teach basic medical care and electronic health record alongside community healthcare workers given their backgrounds in EMS/hospital care.

2. Integration of Technology: After applying for grants and arranging negotiations with each respective solution company, we hope to install their technology into our site within a year. With connectivity, we hope that MIT Solve can aid mHealth technological provisions.

Next 5 Years:

3. Initiation of Research, Regular Diagnostics, and Scalability Planning: With help from the MIT Solve network, we plan to publish multi-faceted research initiative demonstrating the efficacy of our interventions on specific healthcare outcomes, both tangible (disease characteristics from GlobalMed documented electronic health records) and intangible (quality of life). With financial consultations, we plan on repackaging this technology as a collaborative package, focusing on reproducing our model in surrounding counties after optimizing healthcare and resource utilization.

1. Comparing Vector Dynamics with Disease Dynamics: The quality of our medical care will be measured by how medically resilient the population is to changes in vector transmission.

2. Healthcare Utilization: Comparing critical care facility usage before and after telemedicine intervention. Will telemedicine lessen strain on sub-county hospitals?

3. Viable Vaccination/Samples Rate: Record changes in viable vaccination/sample rate, specifically vaccinations/samples that require prolonged refrigeration in transport.

4. Healthcare Outcomes: Demonstrations on how telemedicine consultations increase physical and quality of life outcomes, especially for patients suffering from neglected tropical diseases. Additionally, record changes in acute medical emergency mortality rate to measure efficacy of telemedicine EMS crews.

5. Proportion of access to electricity and internet connection.

6. Record improvements in literacy rates and educated employment.

Activities:

Tech Implementation: Successful implementation of SolerCool Refrigeration, GlobalMed Telemedicine Technology, and Vanu Solar Cell Towers into off-grid communities. Notably, GlobalMed EHR will be integrated into existing hospital records.

Community Education: Provide basic life support medical education to community members and local healthcare providers. Facilitate introduction of technology by community healthcare provider workshops on GlobalMed electronic health records and diagnostics technology, connecting to Vanu, and cold chain storage.

Outputs:

Immediate access to comprehensive emergency care and temperature-regulated vaccines by off-grid communities via motorcycle EMS crews. Better knowledge of basic life support measures by community members

Sustainable internet access in off-grid communities

Centralization of electronic medical records, and inclusion of medical records for those in off-grid contexts.

Short-Term Outcomes:

Reduction in hospital utilization/relief of hospital burden in acute care environments. Expansion of rural EMS system with associated reduction in out-of-hospital mortality for treatable illnesses.

Development of disease/vector dynamics tracking

Greater vaccination rates and on-site diagnoses of neglected tropical diseases & communicable diseases

Patient-reported outcomes centralized into national disease mapping database, promoting early prevention

Government support of pilot model

Long-Term Outcomes:

Government sponsorship/funding of model for implementation into greater off-grid areas

Inclusion and investment of off-grid areas as research centers through solar-powered internet connectivity and consistently improving healthcare outcomes

Solar-powered villages and telemedical healthcare as a standard for low-resource contexts. Model is implemented both in rural areas, and in wartime healthcare facilities.

Improved literacy rate, educated employment, nutrition, and poverty reduction due to new availability of online education.

SolerCool Refrigeration

SolerCool utilizes phase change material (PCM) technology that have high latent heat values, are non-flammable, low-cost and readily available. These materials provide temperature control, effectively absorbing heat, and releasing heat at a later point in time. The use of solar energy to drive this process in novel: solar radiation causes a compressor within the vapor compression cycle to run, allowing for the PCM to freeze. As PCMs maintain temperature, solar energy is therefore able to provide the maintenance of environments cold enough to hold vaccines and samples. Transferring this technology to both backpacks and larger storage devices, SolerCool is able to provide mobile refrigeration in low-resource contexts, powered solely by the solar radiation. All technology has precise temperature maintenance, and offer end-to-end traceability with smart sensing and IOT capabilities. Refrigeration can be maintained for 10-12 hours, perfect for last-mile deliveries and transport of vaccines/samples from the field.

GlobalMed Telemedicine Devices

GlobalMed Telemedicine Devices utilize off-grid networks in conjunction with their specialized telemedical equipment to transfer medical imaging and data in real-time. All equipment is fitted with data-capturing tools capable of data transfer as long as connectivity is available. Their mobile telehealth stations are able to capture diagnostic imaging through peripheral equipment (EKG, ultrasound, stethoscopes, otoscopes, etc.), have multi-user video consultations capable of connecting physicians from across the world, and have data synchronization with their HIPAA compliant EHR platform. These provisions open the opportunity for off-grid regions to receive telehealth consultations from the world's top medical centers, bridging inequities in healthcare resource access. Additionally, EHR data can be extrapolated for research studies on NTDs where data was previously unavailable, providing rural communities with a new platform for research and advocacy

Vanu, Inc. Solar Cell Towers

Vanu partners with local MNOs to provide low-cost/free internet access with a special target in low-density off-grid regions. Low power consumption and relatively low construction needs allows Vanu to provide broadband access at low operating expenses, and therefore low revenue per user. Their solar cell towers are a much better alternative to traditional diesel towers; in addition to sustainability and climate friendliness, oil in these regions are often expensive and therefore in contention. Solar power therefore mitigates costs associated with security. Additionally, the need for skilled maintenance is decreased, as Vanu solar towers can diagnose and repair tower issues using remote software updates.

The lead team on this particular initiative is ethnically diverse, including Dr. Richard Wamai from Kenya, Alex Chang from Taiwan, and Scott Johnson of American/European origin. Firstly, we recognize the privilege that inherently comes with being a resident of America. Though our work is humanitarian in nature, we recognize, and have an immense caution against developing a 'savior-complex,' as we understand that such a perspective is inherently rooted in passive racism and condescension. As such, we operate with the strict notion that there are new perspectives to be learned from all groups of people, regardless of race, sexual orientation, gender, or socioeconomic background. Our research team in Chemolingot is primarily composed of local community workers, and though researchers and students arrive at the center to pursue medical/population research, there is an active effort for non-Black students to relinquish prejudices and simply learn from the culture that surrounds them. This could mean actively participating in community outreach programs, but also emphasizing the understanding of Kenya's history through literature prior to their arrival. Our work also actively advocates for female self-determination, especially notable in our community education campaigns for sexual and maternal health. Recently, we held a 3-day Women's Group training, focused on empowering community women to recognize signs and symptoms of trachoma, visceral leishmaniasis, and snake bites, along with workshops on making female sanitary supplies at home. Throughout our work and community, we strive to promote an environment of equality, acceptance, and respect, as we understand that character defines a person's value.

The business model would be built upon the insights and work of the Clayton Christensen Institute whereby we bring the disruptive technology and innovation to those living in the fragile regions, “train the trainer,” and then empower them to enter into the marketplace when it comes to their health and food security, a productive and prosperous future, and an environment that gives them access to the world and the world’s resources. The issue is not that markets do not exist in off-grid communities, but rather the fact that the greater international market was never accessible to them. In providing off-grid communities with low-cost internet connection and telemedicine, the international community can introduce investments into regional infrastructure now that internet access has opened a virtual market. With targeted investments into populational health, ecological intervention, and education, the affordable access provided to these ‘last-milers’ can conversely bring local communities into spotlights of research and development, priming these regions as hotbeds for innovation. In addressing food and health insecurity, these communities can now pursue online education, propelling their next generation into the international workforce. We see this model as cyclic, a positive feedback system, only requiring an initial jumpstart which we will supply with grants. 

We are essentially a market intermediary, providing services and technologies that will provide the long-term stability and sustainability needed for LMICs to access markets. In utilizing the jumpstart grant money from MIT Solve, this pilot brings several solutions that are not only sustainable in themselves, but are attractive to further investments and granting options because they are eco-friendly and reduce the need to rely on ever-expensive and unpredictable fossil fuel solutions. Our solution includes a model for “buy-in” from the local population and from the NGO’s, government entities, and others who already have a presence in said fragile community, region, or location. We do not require our community to pay for our technology; we want our community to serve as a proof of concept such that outside investors and governments recognize, and are attracted to the neglected market potential of off-grid regions given intelligent investments. With our current partnership with the Kenyan government, a proof-of-concept may be just what is needed for contractual service with the government, mitigating the out-of-pocket costs for these communities, but maintaining and expanding our same mission to other off-grid communities and beyond.

• Safaricom Foundation - $60,000 dedicated to a new maternity wing at Chemolingot Hospital through the World Bank
• Northeastern University - $100,000 for preliminary field research
• Probitas Foundation - $204,206 for Study dedicated to strengthening management of Visceral Leishmaniasis
• Abu Hijleh Kenya Experiential Education Fund - $25,000 for NTD research in Kenya
• Bill and Melinda Gates Foundation - $248,050 for NTD Equity Programming in Sub-Saharan Africa
• National Research Fund, Govt of Kenya- $200,000 for Research on Visceral Leishmaniasis Dynamics
• USAID - $100,000 for Proof of Concept for Integrated Service Delivery and Mobile, Prize-Linked Health Insurance for the Non-wage Sector
• Multiple $100k+ Grants from Izumi Foundation for Visceral Leishmaniasis Research in Chemolingot