The mHealth Alliance is celebrating its fifth year of coordinating mHealth projects around the world. Patricia Mechael, the Alliance's executive director, discusses her life and career, and explains why she's driven to expand mHealth adoption in low- and middle-income countries.
More than two decades before she joined the Alliance, when mobile phones had only recently begun to spread -- and then to only the upper economic tiers of society -- Mechael demonstrated the same knack for seeking out common interests that she's applied so effectively to growing mHealth around the world.
Back in the ‘80s, while in high school, Mechael found the Cold War perplexing, disturbed by how the United States and the USSR could justify hating one another, could alienate each other so fervently, yet so arbitrarily. A high school science teacher, aware of Mechael’s confusion over the divisive political climate, encouraged her to apply to a National Science Foundation program to study math and physics in the USSR. Mechael applied and got a full scholarship to spend the summer in Russia.
“It was such an eye opening experience to go and experience an entirely different world, culture, people, and yet the things that make us human were common across. [The Russian students and I] all had the same aspirations. We all had a lot of hope about our futures. They were now trying to figure out what they were going to do when they grew up”
Mechael recognized the false simplicity of the opposition between the American and Russian people. This realization of and focus on commonality amidst diverse cultural backgrounds has persisted through Mechael’s career and, recently, she has felt it even more poignantly.
Gaining maternal insight
“I’ve worked on maternal and child health for over 15 years and I now have an 18-month old little boy at home, and personally going through the pregnancy, the delivery process, and just being a mom is such an incredible learning experience and insight into -- and back to Russia -- that these are common experiences that people have everyday throughout the world, and it’s been great to be able to share in that common, shared experience as a mom. Gabriel has helped me in many ways reprioritize and put things into perspective in a very different way than I had been. He’s teaching me how to slow down, he’s teaching me how to appreciate what’s important in life, but also what’s important to other people in life.”
Women’s health and rights first began to shape Mechael’s career when, after graduating from Johns Hopkins University and pursuing a career in international health, she worked on a national perinatal and neonatal study in Egypt. Mechael visited rural villages to spend time with pregnant women, talking with them during their days about their health problems and those of their children.
“It really showed me a whole other aspect of life and the world, meeting people who were living on less than two dollars a day and spending time trying to understand how they viewed the world, what issues were most important to them, how they negotiated different aspects of their lives”
She saw women struggling to conceive and the tension this created within their families, women who did not want to be pregnant and were desperately, dangerously trying to lose their pregnancies, and women having to work through gatekeepers, that is, family members restricting the care for which women could visit hospitals to receive during their pregnancies.
Sharing in the experience of motherhood, Mechael says she feels attuned to the women with whose lives she has intersected over the course of her career, understanding the fears and hopes associated with raising a child. The health and happiness that Mechael wants for Gabriel is, she feels, what every woman wants for their children. It’s these common hopes that drive her, “the things that make me want to get up, do my job, get the technology out in a meaningful way so that women are healthier, their children are healthier, they live longer, they go to school, they have productive lives.”
[See also: mHealth Alliance South Africa bound.]
Keeping focus on common goals
Now Mechael embraces the challenge of coordinating the Alliance’s various stakeholders around the mHealth Commons, which the Alliance’s website defines as “public goods that would accelerate the impact and mainstreaming of mHealth, which do not disproportionately benefit any one player, and are unlikely -- and often impossible -- to be undertaken by any individual stakeholder.” Encouraging the Alliance’s numerous partners/stakeholders to collaborate in developing the mHealth field by sharing ideas and resources, Mechael keeps the organization’s focus on the people for whom their work stands to provide the most needed support in accessing better healthcare information and services. In other words, she works to keep the Alliance’s focus on that which is common to all of its stakeholders.
She has been highly influential in this capacity, according to Alain Labrique, an associate professor at the Johns Hopkins Bloomberg School of Public Health and and director of the JHU Global mHealth Initiative, who has collaborated with the Alliance numerous times.
“She has done an excellent job in balancing the different perspectives and priorities of the diverse stakeholders that make up the landscape of mHealth from the private sector to telecommunications companies to donor agencies and academic research institutions,” said Labrique in a written statement released to Healthcare IT News. “What she brings to the table,” said Labrique, “is a very strategic yet personable way of identifying shared priorities across these stakeholders and moving the conversation forward without getting stuck on the less important parts of the conversation that can often be stumbling blocks.”
A key aspect of Mechael’s aptitude for centering the Alliance’s stakeholders on the common goal of advancing global mHealth is her keen understanding of the necessity for a considered, strategic approach to technological development.
“I probably now spend 60 percent of my time trying to bring people down to earth and 40 percent continuing to create catalytic growth, optimism, and movement in the field. There’s a lot of hype around the use of mobile technology and that it will solve all their problems in the world and it’s just not the case”
Promoting mHealth without addressing its pitfalls would be counterproductive to the Alliance’s work because doing so elides the problems that implementers would need to address in deploying mHealth solutions, thereby ignoring the adverse impact such as oversights could have on users and freezing the field’s growth, perhaps even arousing doubt about the technology’s efficacy.
Mechael has been prescient in stressing the issues attendant to mHealth development, noted Katrin Verclas, a prominent figure in the mobile for development industry and a friend of Mechael’s. “It’s one thing to sell, and it’s another thing to sell with a realistic understanding of what can be accomplished,” Verclas told Healthcare IT News. Impact studies, data privacy, and security, those are things she has brought up early on when nobody else was talking about them. Even within that field, there’s some pioneering work she’s doing even as that field has matured”
Managing the overoptimistic expectations for mHealth allows Mechael to refocus stakeholders’ attention on their common goal of using this technology to improve people’s health, not because its novelty seems to promise salvation. While she spends much of her time, as she said, bringing people down to earth, she’s “doing it in a way that provides some recommendations for how to do [mHealth] and doing it sensibly…there are things that we now know that work really well that can be applied in a way that can actually harness the benefit of mobile without betting the farm on it, and then learning as you go along”
As with any industry, the Alliance must address the economics of its situation, contending with competition over limited resources. While every implementer may have the interests of the people their work affects in mind, they also consider their individual finances, obtaining the resources they need to continue to fund their projects. Mechael faces the major challenge of balancing individual interests with maintaining neutrality and mobilizing interest in the Commons.
“Donors think the Commons is really important, but where they tend to put their money is in direct implementation, and I get that, I understand they want to see direct impact, but to me the incremental cost of investing in the Commons, which benefits all of their implementations, needs to be paired with direct investment in implementation,” she said. “I think some of the donors are really coming around to that, where they’re saying we can put aside some resources for looking at the Commons even though we’re much more interested in the direct impact of what we’re implementing on the ground. It’s taken time for people -- and it’s such a young field still -- to come to that conclusion”
[See also: Developing nations to garner mHELP.]
Millennium Villages Project
Heightened financial interest in mHealth has helped precipitate this change of mind. In 2007, when Mechael was working at Earth Institute on the Millennium Villages Project, the mHealth landscape was relatively barren. “If we look at the field in general, when Patty started working at the Earth Institute, GSMA wasn’t very active and there were not many providers who were even thinking about mHealth,” said Joanna Rubenstein, Jeff Sachs’ chief of staff and Mechael’s boss during her time at the Earth Institute. Exceptional for the time, Ericsson, the multinational telecommunications operator, invested in providing connectivity for the Millennium Villages even though there wasn’t a clear business tie-in to that work. Still, mHealth had hardly registered as a viable business avenue.
“It’s only been in the last year and a half or so,” said Mechael, “that we’ve really started to see much more collaborative, win-win efforts that are helping to move everything forward. I think in the beginning there was a lot of competition over resources because there were very limited resources going into the field … and now what we’re starting to see is much more collaboration, there’s much more funding going into this work”
That increased financial backing has helped the mHealth field grow does not diminish the pivotal role Mechael and the Alliance have played in stimulating this progress. Resources, however much, go to waste, if not subjected to effective coordination. Such seems to be the case for eHealth and mobile for development, two areas that Mechael recounted lacked in coordination, and have been outstripped by mHealth.
“I think the reason why mHealth is way ahead is because we had this Alliance, this neutral broker body that could help catalyze things, but that was not tied to any one player or institution. When I look back at the whole state of the field and where we’ve fit into all these ecosystems, the story of mHealth and the Alliance is quite a remarkable story because it was the field that never should have been, but became, and is now taking the health sector by storm in a way”
Long before the field’s dramatic upswing in popularity, Mechael was one of the first to recognize its potential.
Early influences
In 2000, Mechael was working at a dotcom in New York. She had recently returned from working in Sudan, where she had realized, from witnessing the use of two-way radios, that better tools to facilitate access to care were required to improve access to emergency services and access to health information. She began to wonder about the possibility of using new telecommunications technologies in healthcare settings, an investigation that stems from her exposure to technology during her upbringing.
Both of Mechael’s parents led careers related to computers and information technology. Her father studied agriculture while living in Egypt during the ’60s, simultaneously studying statistics and computers. He decided he wanted to work with computers, not agriculture, and he applied for immigration to the countries he thought would allow him to do so. He moved to New York and got a job working in data processing, after which he spent his entire career in the technological sector, including working on the team at Bank of New York that developed the prototype for ATM. Mechael recounted going to work with her father during this time and watching the newly-fashioned machine spit out monopoly money.
Mechael’s mother had her first child at 19, Mechael at 20, and Mechael’s younger sister at 25. Between her second and third children, she decided she didn’t want to be a stay-at- home mom. At Mechael’s father’s suggestion, she studied electrical engineering and computer science by distance learning, eventually obtaining an associate’s degree. She went on to have a career in the technological sector.
“I grew up in a family where my parents were like ‘If you can think it, you can do it with technology’ and so I was then applying that thinking to healthcare”
Many people were researching digital divide issues concerning the Internet. Mechael had previously worked in isolated rural areas where none of the residents had electricity or access to running water, let alone Internet connectivity. Cell phones had begun to take hold in the U.S. Mechael had also noticed, during her work in Egypt, based out of the American University in Cairo, that some of the wealthy students already had cell phones. She decided to do her PhD research on this emerging technology as a means to support health programs. In 2002, she began perhaps the first PhD on mHealth.
“At the time, she was incredibly ahead of her time,” said Mechael’s PhD adviser, Simon Carter, a science and technology sociologist at the London School of Hygiene and Tropical Medicine, in a recent interview with Healthcare IT News. “She wanted to look at how people were using mobile phone technology for health purposes, and I think that this was incredibly innovative for the time. There was very little research done on how people use mobile phones at all, and that goes for both developing countries and the West. This was a really interesting idea, something I thought could bear a lot of fruit”
Mechael began tackling the issue of researching a topic no one had worked on before and on which there was next to nothing written. Her initial ambition was to profile mobile phone usage in Bangladesh. However, she found that the uptake of phones was too low to sustain research and eventually settled her research in Egypt.
“The whole incident with Bangladesh and coming back, some people might have been really put off by that and worried about carrying on with the PhD,” said Carter. “She never gave me the impression she had any doubts about doing the PhD. She just looked at it as a problem we needed to talk about and then solve.”
The level-headed perseverance, the apparent conviction with which Mechael responded to this and other challenges in her career in mHealth belie the fact that she herself, while conducting pioneering research in the field, did not anticipate her own, pivotal involvement in the mHealth industry.
“I never thought I’d actually work on mHealth. I had been working on mostly global health, primary healthcare programs, maternal and child health, HIV/AIDS programs. I was really just doing my PhD to teach, I wasn’t intending to actually make a career of it. And now, when I look back on it, I think it’s been 13 years since I started researching and writing about the use of cell phones to support health programs, and as a friend likes to say to me you had an entire career in mHealth. I don’t know that anybody else has done that quite from start to finish.’ And I never really thought about it in that way, but it’s kind of true.”
Mechael came on as the Alliance’s executive director in 2011. According to Rubenstein, Mechael was the only person offered the job, “testimony to her experience working with others and their positive experience working with Patty, and her knowledge and her expertise working in the field."