Connecting technology and experts

Connecting a mobile phone to a microscope also links Ugandan clinics

Regine van Limmeren

A device which connects a mobile phone to a microscope lets rural lab workers in Uganda send photos of microscopic samples for expert analysis and diagnosis.

In many ACP countries, the microscope is the most common tool used in medical laboratories to identify illnesses. Although essential for diagnosing diseases such as malaria and tuberculosis, microscopes are expensive and laboratory services in general are one of the most neglected areas of healthcare provision in sub-Saharan Africa. A lack or training and staff shortages often results in misdiagnosis and patient mismanagement. This, in turn, leads to a culture of mistrust, as patients lose confidence in healthcare professionals and clinical staff question the competence of the laboratory workers.

The rapid development of mobile phone networks in rural areas, however, provides an opportunity to improve the accuracy of disease diagnosis as researchers work to develop a product to link microscopes and mobile phones. In countries like Uganda, for example, where mobile phone networks cover more than 90% of the country, this combination could give rural communities far greater access to specialized health care.

Most people in rural areas are treated in local health clinics. Although these small clinics do not have many facilities, most of them do have a simple light microscope. Often these clinics only have one trained laboratory worker with limited training and basic knowledge of microscopy. The larger hospitals on the other hand, usually based only in large cities or the capital, have more specialized staff.

Linking these two groups to allow an exchange of diagnostic-relevant information could help improve the accuracy of identifying many common diseases and help in the development of epidemic counter-measures and intervention responses. Current microscope systems with cameras are very expensive and need a connection to a computer and the internet. These are often not available in rural health centres but the need for communication between laboratory staff members remains, and should be ideally achieved without having to introduce new technologies.

Integration

Since mobile phones are locally available in many countries and are often equipped with a camera, it seems logical to use them to deliver photos taken through a microscope to the experts in distant medical laboratories. But the question is: how do to do this? One option is to send a picture by MMS (multimedia messaging service), a method of sending photographs over a mobile phone network, rather like text is sent via SMS (short messaging service).

In this project, researchers at TNO (the Netherlands Organization for Applied Scientific Research) designed the Microscopic Imaging Connector, a product which connects the built-in camera of a common, bar-shaped mobile phone (a phone which does not flip or slide open) to the eyepiece of a light microscope. With this system, rural laboratory technicians can capture images of microscopic tissue samples and send them via the mobile phone network to specialists elsewhere.

This new tele-microscopy system makes use of locally available products: the microscope already present in many rural health centres and mobile phones. But in order to capture an image of sufficiently good quality it is important that the mobile phone is focused and stabilized properly. The Microscopic Imaging Connector, therefore, is a mechanical tool which provides accurate positioning and stability to the mobile phone when connected to the eyepiece of the microscope.

With the phone placed in the connector, the laboratory technician can adjust the position of the phone in three directions: horizontally and vertically to centre the image on the microscope’s eyepiece, and backwards and forwards from the eyepiece in order to focus the image, depending on the focal distance of the lenses. A camera with minimum of 5 megapixels is recommended to acquire images on which malaria parasites can be detected.

Unfortunately, phones with such a high-resolution camera are currently not widely available in many countries. And it should be noted that the connector is solely an aid for capturing images by mobile phone, it does not help with the focusing or illumination of the sample under microscope. The quality of the image, and therefore the accuracy of the diagnosis, is still dependent on the skills of the laboratory technician and the ability of the camera to capture a good enough picture. The display quality of both the mobile phone capturing the image and the one receiving it also plays an important role when it comes to the accurate analysis of the image.
The project team hope to start testing the connector in medical laboratories in Uganda in May 2009. But, to have any real impact, the equipment will have to be just one part of a more integrated tele-microscopy service where telecom network providers and local government authorities would also be encouraged to participate.

The connector system makes use of existing technology and removes the need for an expert to be present in every rural health centre. Improved microscopy diagnosis leads to more efficient treatment of patients which not only lowers the medical costs, but may also lead to a healthier society where people can work more effectively to increase their income, continue their education and improve food security.

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Regine van Limmeren designed the Microscopic Imaging Connector in collaboration with TNO, the Netherlands Organization for Applied Scientific Research . For further please contact Nicolas Chevrollier.

08 April 2009

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