Addendum: The Circle of Death (by PowerPoint)

As I mentioned in my first day post, I was delighted when I received a flash drive along with my registration materials that contained speaker bios, PowerPoint slides for each panelist’s talk, and background materials for some presentations. One advantage was that I was able to follow each panelist’s presentation on my laptop instead of furiously taking notes and annoying the attendee sitting next to me with my rapid 80 wpm typing. I can also now look over the slides from the sessions I could not attend.

The second advantage was the ability to blog during the sessions – because I was able to tune out the moderator as (s)he read the text from panelist bios, or the speakers themselves as they read from their slides. Alas, this meant that I still annoyed the attendees unfortunate enough to sit next to me…while they were surfing Facebook on their smart phones and iPads because they had zoned out, too.

I wonder if it ever occurs to speakers that no one will listen to them talk if they can just read the slides on the screen. Granted, many speakers did a great job by elaborating on the content of their slides by discussing programs or activities that related to the text; however, we were most likely not listening to that, either – because we were reading their slides. Most PowerPoint presentations are designed as stand-alone pieces and are written to be read rather than as presentation tools, which is what they are supposed to be. This leads to a high concentration of bulky jargon and large words, which in turn causes the speaker to stumble over some words and mumble others as they wade through their slides. If you have had training in public speaking, you understand that people read differently than they listen. Anyone listening to these presentations would be absolutely lost, as they would be unable to process the barrage of bureaucracy-speak that is clumsily read aloud by each speaker as quickly as possible to leave time for other panelists to read their slides just as quickly so that we can get to questions.

Luckily, we all know what is going on because we are reading their slides rather than listening to anything.


This is the circle of death – by PowerPoint. We all go to sessions and panel presentations, read slides, yawn, get bored, and then give the same types of presentations to pay it forward and bore the audience listening to us. It is a disservice to everyone: it numbs the minds of audiences everywhere and allows presenters to escape a true public speaking experience.

The only way to break the circle of death is to build your presentations differently. Use as few words on your slides as possible. Use pictures and data so that your audience is forced to listen to you explain them – you know it better than they do, so you should not have to read it off your slides. Additionally, if we are actually listening to you, we will get your jokes when you actually crack them, thus bypassing the awkward silence as we emerge from our stupor with the realization that you strayed from your “script.” Better still if you do not need any slides at all! It is a truly intimidating and earth-shattering prospect, but I promise that it is possible – orators did it for thousands of years before computers and teleprompters were invented.

Break the circle of death. Save us from having to read your slides while we ignore you reading from your slides. I may not be able to blog as much, but hey – I am much happier to be listening to you instead.

APHA Mid-Year Meeting, Day 1: Technology and Socializing

Greetings from APHA’s Mid-Year meeting in Chicago!  This year’s meeting is on healthcare reform, which is fortunate for me – with so much focus on international health news and topics, I unfortunately do not know much about the intricacies of the new healthcare reform legislation, or how it is being implemented on the ground.  I think many Americans are in the same position, however, so hopefully I will gain a better understanding of reform and be able to pass it on to you, the reader!

Upon checking in, I was given a flash drive in addition to a program and a badge holder.  This is such a great resource – it contains speaker bios and (most of) the PowerPoint presentations from each session.  After I arrived this afternoon, I attended one of the first break-out sessions of the conference, “Technology Implications of Health Reform.”  The panel was made up of a representative from CDC, the Kentucky state health commissioner, and the CEO of the Cabarrus Health Alliance (which, believe it or not, is actually a county health department!).  Each one gave his perspective on implementing electronic medical records and building a health information exchange on the federal, state, and county level, respectively.  While I appreciate the excitement surrounding the possibilities of electronic health records (EHRs), I pointed out that even clinicians and health institutions that have them are not able to use them beyond searching for records by patient name or consultation date, plus whatever queries have been pre-programmed into the software by the vendor so that the practice can get the “Meaningful Use” dollars from the government.  I have experienced this in my public health surveillance work – providers have no idea how to pull the information that we are looking for from their records.  We have a long way to go before EHRs are useful on a large scale to public health surveillance and research.

Later in the evening, I had a chance to meet some of the APHA section representatives that were given the same opportunity as I was to attend the meeting.  This is apparently the first year that APHA has been able to bring section representatives to the mid-year meeting, so it is exciting to be a part of it.  The challenge will be thinking about how the information at this meeting can be applied to the activities of the IH section.  What do you think?

More cell phones than toilets: Mobile technology emerges as the new lifeline for the world’s poor

A report on inadequate sanitation, released by the UN University, made waves earlier this year when it reported that while 45% of India’s population owned cell phone, only 31% of them had access to improved sanitation in 2008.1  Headlines proclaiming “India has more cell phones than toilets” found their way into several of my e-mail news digests.  “It is a tragic irony to think that in India, a country now wealthy enough that roughly half of the people own phones, about half cannot afford the basic necessity and dignity of a toilet,” said Zafar Adeel, Director of United Nations University’s Institute for Water, Environment and Health (IWEH), and chair of UN-Water.  With the focus on the Millennium Development Goals growing more acute as the deadline approaches, people were understandably astonished.  

It is shocking to think that so many of the world’s poor cannot access appropriate sanitation.  However, the widespread use of cell phones should not be juxtaposed against the conditions of poverty, but should rather be seen as a way to empower the poor to improve their conditions.  The cell phone market has seen explosive growth in the last decade: 90% of the world’s population will soon be within the coverage of wireless networks,2 and there are already an estimated five billion cell phones used globally.3  Villages without running water or electricity often have at least one mobile phone, and people can switch out their own SIM cards for access.  They are being adopted faster than basic services such as routine medical care and schools.2  When a basic toilet costs 15 times more than a basic cell phone ($3001 compared to $203), it becomes easier to understand the discrepancy between access to sanitation vs. mobile technology.  If mobile penetration is so widespread, then, should it not be viewed as a tool and an opportunity for innovation?  

A man holds a cell phone in front of a woman with four children.
Photo taken from mHealth Alliance Executive Director David Aylward's blog entry in the Global Health Magazine.

Some governments and organizations have already caught on.  In Rwanda, for example, the government provides free cell phones to rural health workers to register expectant mothers, get answers to their questions from a health expert, and send monthly status reports to doctors.2  Other programs send reminders to HIV-positive pregnant women to take ARVs and work to reduce stock-outs of drugs in rural clinics.  Pharmaceutical companies are also working with application developers to fight drug counterfeiting: customers will be able to submit a numeric code on drug packaging via SMS and get a reply that states whether the drug is “NO” or “OK,” along with the drug’s name, expiration date, and other information.4  And I have already featured Tostan’s Jokko Initiative, which applies their literacy lessons to cell phone usage and includes a lesson on the health-related utility of SMS.  Other applications include facilitating electronic banking and providing information on crop disease and weather to farmers.2  

Progress on the MDGs should not be overlooked, and the importance of access to sanitation is should certainly not be downplayed at all.  With an expected return between $3-34 for every dollar spent on sanitation, it is absolutely worthwhile to stress the importance improving people’s access to this need.  Now, if only we could develop an app to improve sanitation – that would be perfect.

The Global Focus microscope is sharpening the focus on tuberculosis

Imagine a two-and-a-half pound microscope that can be carried in a backpack, runs on batteries, and only costs $240.  A microbiology major’s dream?  Probably.  But it is also a reality, a winner of the Hershel M. Rich Invention award from the Rice University Engineering Alumni, and one of the most promising technological advances for diagnosing TB and other diseases in low-resource settings. 

Andrew Miller holding his microscope. Photo taken by Jeff Fitlow of Rice University News.


The Global Focus microscope was invented by Rice University alumnus Andrew Miller during his spring 2009 semester.1  He began his senior design project with the goal of developing a small portable microscope as part of a larger “diagnostic lab in a backpack” project.  He fashioned the plastic shell with a 3-D printer, used a top-mounted LED flashlight for illumination, and included a shelf on which the user could slide a cell phone to take pictures and e-mail them.1,2  It provides 1,000X magnification, can fit in a lunchbox, and its design is so simple that five screws attach the outer casing to the single-piece body.1  As soon as he presented the finished product, its potential was instantly recognized.  “This is hugely significant as a point-of-care tool clinicians can use for tuberculosis patients, whether they’re in Asia or Africa or even in West Texas,” said Edward Graviss, director of the Methodist Hospital Research Institute’s Molecular Tuberculosis Laboratory. “The first identification of TB is usually made with a smear, and it will be good to know that in the field instead of having to wait three or four days to get the smear to a lab.” 

Tuberculosis is one of the “big three” global infectious diseases, although HIV/AIDS and malaria typically receive more of the attention.  It is estimated that one third of the entire world’s population is infected with Mycobacterium tuberculosis, with 5-10% of infected individuals becoming ill or infectious at some point in their lifetime.3  The WHO estimates that 1.3 million people died from the disease in 2008.  Southeast Asia has the highest percentage of incident cases, though sub-Saharan Africa has the highest incidence rate and the highest mortality rate per capita.  Someone in the world is infected with the TB bacillus every second. 

The hope is that Miller’s invention will provide an inexpensive and effective tool that can be used for diagnosis in resource-poor settings that may not have electricity or even an operational clinic.  A study testing the microscope’s diagnostic capability was published in the open-access journal PLoS ONE at the beginning of this month.  Out of 63 smears of suspected TB cases from Tehran, Iran,4 similar findings between the Global Focus microscope and a reference-standard fluorescence microscope were reported in 98.4% of cases. 

Miller is now working for a San Francisco company that produces ventricular assist devices, though he is still working on the microscope part-time: he and Rice University have paired up with a medical device consultant to produce twenty microscopes for field testing next month.2,4  Also, a new team of Rice students is currently developing image processing software for smart phones to help untrained clinicians make accurate diagnoses.  “The project was about an opportunity to contribute to global health,” said Miller, acknowledging it helped him land a top job out of college. “It was a great motivator, what kept me in the lab so long.”1