Star Trek was the inspiration for Tiffany Lundeen’s winning application to save the lives of mothers who experience postpartum hemorrhage.
The winning application, an interactive, voice-controlled virtual mentor that uses a smart speaker—like a phone or Google Home device—to guide birth attendants through complicated and/or emergency procedures, won a $250,000 seed grant from the Saving Lives at Birth: Grand Challenge for Development to develop and test her idea.
Lundeen, CNM, MSN, MA, a midwife and member of the Maternal and Newborn Health Research Cooperative at UCSF Global Health Sciences (GHS) developed the application with her GHS collaborators Dilys Walker, MD, Hannah Park and other members of the Cooperative, as well as partners from software engineering firm Thoughtworks.
The grant was announced July 27 at the seventh annual DevelopmentxChange, sponsored by Saving Lives at Birth, a partnership between the U.S. Agency for International Development (USAID), Norway Agency for Development Cooperation (NORAD), the Bill & Melinda Gates Foundation, Grand Challenges Canada (funded by the Government of Canada), the U.K’s Department for International Development (DFID) and the Korea International Cooperation Agency (KOICA).
Lundeen’s first target for the tool is postpartum hemorrhage (PPH), which is the leading cause of maternal mortality worldwide. The World Health Organization estimates up to 60 percent of maternal mortality in developing countries—about 100,000 deaths per year—is due to PPH.
Using natural language processing software and a conversation user interface, the virtual mentor tool walks birth attendants through the protocol for treating postpartum hemorrhage, ensuring that they use the correct steps in the proper sequence in order to reduce maternal mortality.
As more women in low-income countries come to clinics and other healthcare facilities to give birth, there are too few birth attendants, Lundeen said. In addition, recent research reported that many trained, facility-based birth attendants have suboptimal knowledge about PPH.. While several performance-improvement strategies are currently being used, these approaches require an additional person to provide guidance or manipulation of a device, which is challenging given the personnel shortage and the realities of direct patient care.
Women experiencing postpartum hemorrhage need medications and blood transfusions, Lundeen said. But they also need clinicians who do the right things in the right order and do them rapidly. “In stressful situations, when we're tired or alone, sometimes birth attendants lack the confidence to act decisively. This tool will help overcome the first cognitive barrier: Is this the right thing to do?”
“This tool aims to be the mentor or teacher in the room,” Lundeen said, similar to the computer that inhabitants of the Enterprise consulted in many episodes of Star Trek.
“I’m a Trekkie, and in the series there was a computer you could ask questions and get answers just using your voice,” Lundeen said. “Even the doctors on the show asked the computer for answers. That inspired this solution.”
With the seed grant, Lundeen and the GHS team will continue to work with Thoughtworks and birth attendants in two hospitals near Nairobi, Kenya to develop and test the virtual mentor. She will work with Anthony Wanyoro, MD of Kenyatta University and the staff of two maternity hospitals where he teaches to ensure the tool employs their preferred PPH protocol and uses the English vocabulary they normally employ during clinical care.
When the tool is ready for testing, birth attendants in the Kenya hospitals will participate in a controlled trial in which the virtual mentor is available during PRONTO International’s birth simulation training. Videotapes of the trainings will be evaluated to determine if the application helped improve both the frequency with which birth attendants follow the proper treatment steps in sequence and how quickly they respond.
Once the evaluation shows the tool works as expected, Lundeen will seek funding to test it in actual clinical cases.
“My vision,” said Lundeen, “is that this tool will be able to answer questions, guide any provider through any clinical process, answer the provider's questions and prompts clinicians to deliver kind and respectful care. I believe this will save lives.”