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The phone call came in late one night last year. On the outskirts of Gressier, Haiti, two children were ill. The nurses for MotoMeds, a pediatric call center and mobile medicine delivery service run as a University of Florida research initiative, asked crucial questions about the children鈥檚 symptoms.

The principal investigator Eric Jorge Nelson, M.D., Ph.D., was on site to evaluate the program鈥檚 logistics and related research. Nelson strapped on a helmet to join the nurse and two motorcycle drivers on the call. The group rumbled up a mountain road strewn with river stones. As they climbed higher, the road narrowed. Soon, it was little more than a footpath. His driver made a hard left, brushing by a bush and ending up on a goat trail. He gunned the engine, willing the motorcycle onward until it bogged down in mud.

The group dropped the motorcycles, grabbed their gear and started climbing. After 15 minutes of hiking in the dark, they reached the family鈥檚 home about 11 p.m. They were expecting to treat two boys, ages 4 and 7, with skin infections. Instead, they ended up with three patients, including a 10-month-old neighbor girl with a fever and respiratory infection.

For MotoMeds, the late-night run exemplified the challenges 鈥� and honor 鈥� of running a medical call center and medication delivery service in the Western Hemisphere鈥檚 poorest country. Since launching in September 2019, Nelson and his colleagues have learned to expect the unexpected.

Hope springs from tragedy

As part of an outbreak response team in 2010, Nelson saw cholera patients in Haiti dying because they did not have timely access to oral rehydration solution and sound medical advice. Over several years, Nelson鈥檚 team reflected on this observation in Haiti, explored solutions and expanded scope. Through community engagement in both Bangladesh and Haiti, a process called human-centered design revealed that barriers to knowledge and access to care are global issues. Emerging technologies might offer solutions to get early care to children, they decided.

One key barrier is isolation during the nighttime hours. In Haiti, nighttime illnesses can be particularly dangerous. Poverty, a lack of access to health care facilities and other issues can turn a manageable medical condition into a life-threatening one. , who leads research in Haiti for Nelson and is the director of MotoMeds, conducted an extensive needs assessment to determine where families intend to seek care, where they actually seek treatment and the barriers they face.

鈥淰ery often, if we can provide simple oral rehydration solution and reliable medical information, we can avert an emergency,鈥� Nelson said.

But Klarman found that getting to the point where families can readily seek care is anything but simple. In Haiti, the cell phone network is thin and fragile, sometimes making technology-based solutions problematic. Calls to MotoMeds get bounced to Port-Au-Prince, then to a U.S.-based company that uses cloud-based call management software. Ultimately, the parent of a sick child is connected to nurses at the MotoMeds call center in Gressier, who answer through internet-connected laptop computers.

At the call center, Haitian nurses do a detailed assessment of the child鈥檚 condition and triage the illness using a set of questions and clinical guidelines derived from World 网红黑料 Organization guidelines. A local physician is on call in case of medical uncertainty. If it鈥檚 determined that the child needs basic medications or fluids, a text message goes out to MotoMeds drivers through Beacon, an emergency dispatch platform developed for resource-poor settings by a not-for-profit called TrekMedics.

As the MotoMeds director, Klarman has seen the immense value that quick intervention can provide for sick or dehydrated children. Because MotoMeds is a research initiative, nurses accompany the drivers to verify at the bedside what they heard on the phone. Ultimately, Klarman and Nelson hope to refine the system so that basic medication and fluids can be delivered by drivers with a nurse visit for some cases. A preliminary analysis of their work suggests that key clinical features captured on the initial phone diagnoses match the patients鈥� conditions seen at the household, Klarman said.

A ticking clock

The goal is to get fluids and medications to a patient within two hours of a call coming in. MotoMeds has a delivery radius of about 3 miles. Typically, the nurse鈥檚 assessment lasts about 15 minutes and waiting for the motorcycle driver takes about that same amount of time, Klarman said. From there, travel time to the patient鈥檚 home can account for 20 to 45 minutes, based on location and terrain.

The MotoMeds response is especially crucial given the differences in health care that exist in Haiti, Nelson said. While hospitals are sometimes available and accessible, they require payment upon entry. In other cases, the on-duty physician is not licensed to care for children or isn鈥檛 comfortable doing so. During one life-threatening case, a hospital refused admission because the child was 鈥渢oo sick鈥� and the attending physician 鈥� an obstetrician 鈥� was not comfortable treating a child. Incidents like that reinforce the value of MotoMeds, Nelson said.

鈥淭he majority of children 鈥� especially those under age 5 鈥� die from preventable respiratory and diarrheal diseases that have known treatments. The real challenge is how to improve access to those treatments before the illness becomes emergent,鈥� said Nelson, a hospitalist in the UF College of Medicine鈥檚 department of pediatrics, an assistant professor in the UF College of Public 网红黑料 and 网红黑料 Professions鈥� environmental and global health department, and a faculty member affiliated with UF鈥檚 Emerging Pathogens Institute.

Through late January, MotoMeds has enrolled 405 children under a National Institutes of 网红黑料- funded initiative. The program was designed to be scalable, meaning it can be expanded to include additional delivery zones now that its technological and delivery infrastructure is in place. Parents or caregivers pay MotoMeds a flat fee based on what they can afford.

MotoMeds is now entering its third phase, which involves studying the feasibility of limiting nurses鈥� home visits to more complex cases. That, Klarman said, is an important step toward ultimately expanding MotoMeds.

Making a difference

Averting medical emergencies as MotoMeds does is ultimately a more cost-effective and humane approach than allowing them to fester into something more serious, Nelson said. On one MotoMeds trip closer to the center of Gressier, MotoMeds arrived about 11 p.m. to find young parents with a feverish infant. There was a pause as the parents sized up the MotoMeds team clad in red helmets and neon yellow safety vests. Nelson asked one of the nurses what was happening.

鈥淪he said, 鈥楬e has never seen anyone show up at night to take care of children,鈥� Nelson recalled.

Nelson sees it this way: MotoMeds is new and struggles to gain users. But it is also catalyzing trust across the community that someone will answer their calls and indeed show up to their houses.

鈥淚t offers a transformative change model for Haiti and the global health community,鈥� Nelson said.

Media contact: Ken Garcia at kdgarcia@ufl.edu or 352-265-6408.