In 1854 one map made medical history and changed the way we represent health data forever. The map, produced by John Snow, marked cholera cases across London and helped visualise the source of the problem. What once would have been represented as a simple list of patient deaths against place of residence, was now represented geographically to highlight the problem - contaminated water pumps, now easily identified by the cluster of data points surrounding them representing cholera cases. From 1854 until now, maps have been helping medical professionals around the world to better track the spread of diseases, improve access to healthcare facilities and respond to medical emergencies. Today, on World Health Day, we are celebrating those maps that have added to the medical field. If ‘a picture speaks a thousand words’, than a map must speak a million.
From London in the 1800’s to present day, maps have been key tools for medical responders. In 2017, the Rohingya Refugee Crisis caused over 600,000 refugees to flee to Bangladesh to escape the escalating violence in Myanmar. The huge influx of people has resulted in the extension of formal refugee camps, resulting in unplanned, unofficial sites. Through the help of dedicated mappers, these unplanned camps have been traced and features have been tagged. Similar to the maps produced by John Snow, modern day mappers are proving the value of map data in highlighting areas likely to act as the source of waterborne diseases. Overlaying key camp assets such as the location of latrines and water pumps, allows humanitarian agencies to establish preventative measures to stop disease outbreaks in camps and establish health plans to support at risk people.
The data from the maps above was collected by OpenStreetMap volunteers and is being used by agencies to monitor and improve camp standards. The process is slow, but data like that presented in the maps above, can hopefully inform decision makers and stop preventable outbreaks of cholera and other water-borne diseases.
Since late 2016 until September 2017, HOT has been working with partners including USAID GeoCenter and DigitalGlobe to support anti-malaria campaigns such as the President’s Malaria Initiative (PMI), Clinton Health Access Initiative (CHAI) malaria program and Program for Appropriate Technology in Health (PATH) Visualize No Malaria campaign. Almost 6000 mappers have added 4,740,674 buildings to the map in malaria zones across Eastern and Southern Africa, Southeast Asia and Central America. By placing at risk people on the map, mappers are helping provide data to create more accurate malaria prediction models, which in turn inform mitigation measures such as indoor residual spraying.
HOT is currently establishing a new field programme in Botswana in conjunction with the Botswana Ministry of Health and Wellness. Combined with the hard work of remote mappers, the field data collection team will be providing the ground information needed to support Africa Indoor Residual Spraying (AIRS).
Despite the illegality of the practice, a 2016 report from UNICEF shows that, across five regions of Tanzania, 51-80% of girls are still victims of FGM. In 2017 alone, 1076 girls were still cut victims of FGM in Mara region of Tanzania. Victims of the practice are often left with lifelong health issues, such as urinary problems and infections, with many girls never surviving the practice through blood loss. Many regions where girls are at risk are unmapped, with inconsistent or unknown village names, which makes navigation extremely difficult. Through initiatives such as Crowd2Map Tanzania, local villages are being mapped and teams of remote and local mappers are providing activists have the information needed to improve FGM prevention programmes. Many of these programmes utilise open source maps to follow up on reports of at-risk girls, locates them, and takes them to safe areas where they can be provided with shelter, support and health education during the ‘cutting season’. In 2017, 2257 girls were saved from the practice as a result of better maps. In the future, these maps will continue to help activists and local government identify areas in need of improved health education, additional healthcare facilities to support victims, and new initiatives to provide security to those at risk.
Mapping Maternity Clinics & HIV Awareness
In Dar es Salaam, annual population growth has reached 5.7%, putting a huge strain on health resources for an already over-saturated city of 6 million inhabitants. In order to better understand the current state of maternal health services in the city, the Humanitarian OpenStreetMap team have been working with Data Zetu and local residents to pinpoint community painpoints. Data was collected by local people using local android smartphones and free, open source applications to collect data on type of healthcare facilities used by residents, the time taken to reach those facilities, cases of staff or medicine shortages at health clinics, opening hours of clinics and cost of health services. The data is shown below:
These maps show clearly areas with high travel times to maternity clinics, and where more medical resources and staff need to be allocated. Data represented through maps allows comparisons to be made which might be overlooked if presented differently. For example, from these maps, the cost of maternal healthcare can be seen as a barrier to many women, but even in areas where cost is not an obstacle, medicine shortage is. The maps establish where medical resources need to be reallocated and redistributed, and where mobile clinics might be of benefit. Maps like these, produced by local people, demonstrate the problems facing women in Dar es Salaam in their ability to easily travel to affordable, well-staffed, well-equipped healthcare centres. This can help decision makers improve health standards.
In Mbeya,Tanzania, the HOT Tanzania team have begun collecting household data on Access to HIV-related Services to better understand how much individuals know about what HIV services available to them, challenges that people face in physically accessing services and their knowledge on PEP (post-exposure prophallaxis).
More can be read about health mapping in Tanzania here.
The Future of Health Mapping
Maps have helped support health crises from cholera, to Ebola, and will continue to be a vital tool for responders and health professionals in years to come. As the international development sector shifts towards participatory, bottom-up approaches, it is imperative that communities continue to be involved in the mapping process and to have access to the open maps that will define the health standards in their countries. If ‘a picture speaks a thousand words’, a map speaks a million.