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Creating massive impact: how to distribute a telemedicine device in 180 sites all over the Philippines

Many of us have tried to figure out what to do with our lives after medical school. For some, it was easy. For others, it was a twisted path that we hoped would eventually lead to the right destination.

Dr. Kristine Mae Magtubo (KM or Kristine to her friends) started out wanting to be a pediatric oncologist or obstetrician in her medical school days in the University of the Philippines College of Medicine.

Now she leads the RxBox research program. RxBox is an electronic medical device that is a bp app, pulse ox, ECG, thermometer and electronic fetal monitor in one. It is able to send the data to an electronic medical record and allows users to engage in telemedicine by connecting them to remote clinical specialists. It is now used in 180 health centers to date.

With the help of her team at the University of the Philippines National Telehealth Center, RxBox has helped rural and remote health facilities to help more Filipinos have access to quality health care where they need it, when they need it.

When asked what inspired her to work in public management, she said it was the PinoyMD Scholarship Program which allowed her to join the Doctors to the Barrios program. The Doctors to the Barrios program (DTTB) is a well-known government program that deploys graduate doctors to places where health resources are scarce, while also giving them the opportunity to get a degree of Masters in Public Management.
“When we graduated from the DTTB program, I was offered to stay where I was deployed as a Municipal Health Officer (MHO), but I wanted to do greater things for the health of populations.”

“At around the same time, a former mentor asked me if I wanted to do something in eHealth.” eHealth is a rapidly evolving field of medicine that deals with the use of technology for health. This is where she came into the National Telehealth Center.

“I was mortified at the thought of running a nationwide project! Aside from that, I could not even make my phone work half the time then, let alone inspire others to adopt technology. I was scared talaga!” What made her decide however, was her a lot of discernment. “I took a breath and thought about it – in Sagada no less, and said yes. At the time, I told myself, ‘Wala namang mawawala if I tried it out.’

At this point, RxBox has been around since 2007. It was the brain child of Dr. Alvin Marcelo of UP Manila National Telehealth Center and Dr. Luis Sison of UP Diliman Electronics and Electrical Engineering Institute. Dr. KM came in in 2013, when the University of the Philippines National Telehealth Center, headed by Dr. Portia Marcelo, was set to deploy the RxBox to more municipalities.

“I had to learn a lot,” Dr. KM says. “I had to find my voice in the big world of eHealth and even now it’s a struggle sometimes to speak above the noise.”

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RxBox already had a version led by the team led by Engr. Nathaniel Cruz, who works in UPD – Electrical and Electronics Engineering Institute, also with Dr. Sison. The challenge was to deploy the units, with limited resources and time. When Dr. KM entered, she became poject manager and research associate, specifically to address that challenge. “From then until today, we’ve been able to deploy the RxBox to 180 health facilities from Batanes to Tawi-tawi, all of whom our less than 10 person team supports daily. We were able to do this with the support of DOST and its agencies, of course. We’re poised to deliver 1000 more by the beginning of next year.”

It wasn’t at all easy. She has encountered so many challenges along the way. “I was not eHealth – aware when I assumed my post. I dealt with this by relying heavily on my teammates at NTHC. Sa totoo lang, sa kangkungan ako pupulutin kung di ako marunong magtanong.” She rectified this by having to learn a lot very quickly. Even then, the field was also developing very rapidly, which also presented to her a lot of challenges in learning along with the current advances.

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Having to learn how to doing things over and over until you get it right, was also a challenge. “The principle of iteration, which is software developer lingo, is to come up with something and test it, and if it’s not okay, go back to the drawing board. Repeat that process until you have a stable repeatable release. “It’s not easy kasi as doctors we don’t really iterate. Kasi di pwedeng gawing test subjects ang patients, and failing may cost you someone’s life. That’s why guidelines exist. But in working with technology and in innovation, I had to unlearn that. Kasi you need to test quickly and fail quickly so you can improve quickly. Within reason and the bounds of ethics of course.”

Now working with people in the software and electronics field, she says, “I had to learn to communicate with other fields in non-doctor speak, and I had to learn their language as well. I learned that there are many different ways of thinking about health and health services.” This led to contrasting ideas on how health solutions should be approached.

Meeting the minds of a medical practictioner, with developers, required a establishing a lot of common ground. Dr. KM states how her experience as a Doctor to the Barrios allowed her to engage both the end users and the creators of the project. “DTTB ako eh. Kahit saan pa ako mapadpad dala ko yun. And there is value in that experience. That’s what I brought to the table. Mahirap kasi the people designing these tools, often, they have very little first-hand experience in the community so the usability of the tech lowers. I had to make sure everyone in our team is well grounded in the community to ensure that all of what we do is for our users talaga.”

When asked where she dreamed RxBox to be headed, she said, “I really want to see the RxBox to be as ubiquitous as a BP app in a clinic. That’s my dream – to be as easy for any Filipino to have access to quality health care as it is for me to order a fast food meal wherever I am in Manila.

“I want to remove the paralyzing helplessness health workers in remote areas feel when a patient comes to them for help and wala silang magawa. They should have tools, and should be supported.”

“Patients should have access to the care they need where and when they need it. I truly believe this is possible in our lifetime. But much of how we do things, how we think out problems and how we relate to each other in the health sector need to change. We need to change. “

Many people want to enter into innovating for the health care sector. Dr. KM says that there is still so much to be done, especially in telemedicine beyond the RxBox, as well as innovating for public health as a research are. “I’m observing the innovation landscape in the Philippines and I see that public health is among the areas where people, even from the private sector, want to make a difference. Pero at this time, mahirap para sa kanila to enter the sector. That’s a problem. Also, how do we make sure our patients really benefit? So many questions, so little time! Hahaha. “

With having accomplished so many things, and being faced with so many challenges, one might ask what keeps her going. “Coffee. Lots of coffee,” she laughs, then says, “I guess when you’ve seen inequity first-hand, di mo mapipigilan but to do something about it. RxBox has allowed me to create impact beyond my wildest dreams.” There were times when she wanted to quit, she says. “Kasi ang hirap, kasi ang daming nakaharang. Kasi ang gulo. Pero andito pa rin ako, kasi serving this purpose gives me joy. The company that she has met along the way, played a large role. “Being with other people trying to do the same thing, especially nung nakilala ko sila through the Newton Agham Leaders in Innovation Fellowship by the UK Newton Fund, DOST and AIM, helps. Naiinspire nila ako every day. Lahat kami same heartaches, pero same dreams din. We want a better Philippines and we show up for work every day because we know our work, no matter how small, helps to make that happen.”

Any regrets? Doc KM says, “I’m very happy I jumped and ‘tried it out'”. Kasi leaping into the unknown and getting to do this has been the ride of a lifetime. I wouldn’t trade it for anything.”

I had one last question to ask her, which was, “What advice would you give to doctors who wanted to create an impact?” Her reply was, “Just do it, but in all seriousness, just go for it. As in love, there’s no rule book. You just have to believe in your heart that you can do this, and then work hard at it every day. Now the “this”, only you can find out what that is. It takes a lot of self-awareness but like Steve Jobs said, “You’ll know when you find it”.

“Don’t worry about ‘creating impact’ per se as much as focusing on the problem you’re trying to solve. It does not matter if you can only change one person’s experience at a time, or if you have the chance to do that for a lot of people. As long as you’re making a difference, you’d have created impact already.”

“Endeavour to be really good at what it is you do, no matter how menial you think your work is.

Vote for Dr. Kristine Magtubo, a Rappler Digital Mover finalist!

  1. Click the link below.
  2. Proceed to ‘Digital Mover’ category.
  3. Look for ‘Kristine Mae Magtubo’ then click the vote button.

Note: One vote per device (pc, smartphone). For PC’s, you can do multiple voting using different browsers (firefox, chrome, safari).

Deadline is on November 4, 2016.

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