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home / 世界杯决赛2022

a made-in-b.c. contact-texting platform is tackling covid in rwanda and uganda. why not here?

the canadian company can't get a single canadian jurisdiction to take them up on their offer to help amid the pandemic

by joe o'connor, national post

jun 11 2020
read time 6 minute read
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it is one of those embarrassing stories couples’ sometimes share when asked how they first met, and gabby serafini, being someone not easily embarrassed, weaves a doozy of a yarn for her listener, about the wedding in south africa where she was introduced to her future husband, dr. richard lester.
serafini was dating another guy at the time, living in cape town and working with bishop desmond tutu’s hiv/aids foundation. lester, a canadian backpacker, was a friend of the bride and bitten, he would later swear, by a love-at-first-sight bug upon seeing the girl from stoney creek, ont.
serafini wasn’t drinking. lester, his career in medicine still somewhere over the horizon, was knocking back tequila like a sailor on shore leave. as the night ebbed, serafini offered him a lift, a ride interrupted by a stop at the side of the road, long enough for lester to exit the vehicle, get sick and climb back in. as someone who had consumed a good whack of tequila, he figured the driver, his future bride, would be none the wiser.
not so.
“rich didn’t think that i knew he threw up,” serafini says, laughing. “years later when i told him he couldn’t believe it.”
messy as their initial meeting was, it wouldn’t be the last. the wedding goers reconnected in canada. eventually they married and returned to africa in 2005, settling into a practically empty house in nairobi, kenya, with a large, non-functioning, 1950s-era rotary dial phone. the phone was a clue, a hint of bigger things to come, even if lester and serafini didn’t recognize it at first. she had become a chiropractor. he was an infectious disease specialist with ambitions of developing an hiv-aids vaccine under the mentorship of dr. frank plummer, another canadian, and a giant in the field of immunology.
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but lester couldn’t stop thinking about phones. only super-wealthy kenyans had home phones. mobile devices were ubiquitous. texting, an exotic thing for most north americans in 2005, was the norm.
“every eight-year-old in kenya knew how to text,” lester said from vancouver, where he and serafini and their three children, two african-born, have lived for a decade. “i loved the lab, but at the same time we were exposed to the real world at the hiv-aids clinic in nairobi. as treatment for patients was being rolled out, i started thinking, how can we use mobile phones to help patient care?”
here’s how: people accessing the clinic often stopped taking their medication within six months. hiv-aids was stigmatized, the virus equated to a death sentence. lester brainstormed solutions with patients and healthcare workers; a plan emerged. nurses would text patients a weekly message — “mambo” — the kiswahili equivalent of asking, “how’s it going?” the patient could reply with “doing well,” or have a “problem.” had they a problem, a nurse would follow up with a call or a series of texts to determine what the issue was, and offer direction. texting was discreet, efficient, effective. patients receiving messages reported feeling as though someone actually cared. adherence to medications increased, as did healthier outcomes.
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meanwhile, what seemed obvious — using two-way text messaging in a health-care setting — wasn’t. nobody else was doing what lester was. he published a research paper, since cited more than 2,500 times. and so it was that a canadian infectious disease specialist, with ideas of developing an hiv-aids vaccine, became a leading global authority on digital health and the co-founder, with serafini, of weltel, a two-way texting patient care platform.
weltel has been deployed in b.c. to support tuberculosis patients, moms living with hiv, kids living with serious cardiac issues, and remote communities on haida gwaii. it is also being deployed right this very minute in rwanda, uganda, and among the homeless in the united kingdom, as a frontline contact tracing/patient support tool aimed at containing covid-19.
all of which is terrific, but also irksome for lester and serafini. the canadian company can’t get a single canadian jurisdiction to take them up on their offer to help amid the pandemic.
“we knew we had a solution ready to go, one that has worked, and that has been built on years of working with patients on the frontlines,” lester says. “we have published more and done more research on texting with patients — including early pandemics — than anyone in the world, and the slowness in the system here has been frustrating.

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“we still have ongoing discussion with stakeholders, but….”
but now it is mid-june, instead of late january, which is when lester had a rotary phone type revelation. within hours, he had tweaked weltel’s platform for deployment against the virus. he also banged up a grant proposal — he is an associate professor at ubc’s medical school — and was ultimately awarded $500,000 in federal money to see what the platform could do.
of course, he and serafini already knew what it could do, as does dr. sabin nsanzimana, quarterback of rwanda’s covid-19 response team, who emailed lester on april 4, telling him how “useful” weltel was for “contact tracing.” (rwanda, population 12 million, has reported 463 confirmed covid-19 cases and two deaths.)
lester, mind you, isn’t bitter, just temporarily downcast. yet, he is still hopeful. much of the recent chatter around the pandemic has focused on a safe reopening and the potential for a second wave. lester has participated in multiple zoom calls with government and health-care stakeholders of all stripes, lately in ontario, demonstrating weltel’s capabilities, articulating how he has already been there, and done that, during the hiv-aids pandemic in africa.

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rwanda said yes to weltel after one zoom call. meetings in canada, alas, beget more meetings.
for what it’s worth, lester’s pitch to the powerbrokers is straightforward: say joe blow lands in vancouver, and is required to quarantine for 14 days. he registers in a two-way text program at the airport and starts receiving messages daily, asking if he is okay, and whether he has any symptoms. should he reply, “not okay,” a health-care worker can text, call or video chat as follow up, instead of joe blow, in a panic, calling public health and being put on hold for six hours.
assuming nothing is amiss after 14 days, joe blow receives a congratulatory text for completing his quarantine. his personal information is treated confidentially, as a medical record, with the data stored in canada. there is no app tracking his every move, no downloads.
scenario number two has joe blow testing positive for covid-19. he and his contacts — they would need to be traced — are registered in the program. daily texts get sent, and follow-ups made as necessary. one public health nurse monitoring a dashboard of replies can do the work of many, optimizing resources should the dreaded second wave hit. instead of feeling adrift, people stay connected. if the idea sounds simple, it is.

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complicating matters, says lester, is the pandemic: it is uncharted territory. companies with no previous health-care expertise are pivoting to the cause. governments, no experts themselves, must separate the good from the bad. meantime, nothing gets done.
“a lot of companies are jumping in, some with really good ideas,” lester says. “but we should have a better process at looking at what work has already been done. instead of reinventing the wheel, why not start with a round wheel, and see how we can improve upon it?”
common sense. as for tequila? serafini assures her listener that her husband, in his more relaxed moments, still enjoys a glass.
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