Growing up in South Africa at the turn of the century, Emma Gibson saw the rise of the HIV/AIDS epidemic and its devastating impact on her country, where many people lacked life-saving health care. At the time, Gibson was too young to understand what a sexually transmitted infection was, but she knew that HIV was infecting millions of South Africans and AIDS was claiming hundreds of thousands of lives. “As a child, I was terrified of this monster that was HIV and I felt so powerless to do anything about it,” she says.
Now, as an adult, her childhood fear of the HIV epidemic has turned into a desire to fight it. Gibson seeks to improve health care for HIV and other diseases in regions with limited resources, including South Africa. She wants to help health care facilities in these areas use their resources more effectively so patients can more easily receive care.
To help achieve her goal, Gibson sought training in mathematics and logistics through higher education in South Africa. She first earned her bachelor’s degree in mathematical sciences at the University of the Witwatersrand, and then her master’s degree in operations research at Stellenbosch University. There, she learned to tackle complex decision-making problems using mathematics, statistics and computer simulations.
During her master’s, Gibson studied the operational challenges facing rural South African healthcare facilities by working with staff at Zithulele Hospital in the Eastern Cape, one of the country’s poorest provinces. Her research focused on ways to reduce wait times by hours for patients seeking same-day care. Ultimately, she developed a software tool to model patient congestion throughout the day and optimize staff schedules accordingly, enabling the hospital to care for its patients more efficiently.
After completing her master’s degree, Gibson wanted to continue her education outside of South Africa and left to pursue a doctorate in operations research at MIT. Upon arrival, she branched out into her research and worked on a project to improve breast cancer treatment in US health care, a very different environment than what she was used to.
Two years later, Gibson had the opportunity to return to health care research in resource-limited settings and began working with Jónas Jónasson, an associate professor at the MIT Sloan School of Management, on a new project to improve diagnostic services. in sub-Saharan Africa. . For the past four years, she has been working diligently on this project in collaboration with researchers at the Indian School of Business and Northwestern University. “My love language is time,” she says. “If I’m investing a lot of time into something, I really appreciate it.”
Sample transport planning
Diagnostic testing is an essential tool that allows medical professionals to identify new diagnoses in patients and monitor the condition of patients as they undergo treatment. For example, people living with HIV require regular blood tests to ensure that their prescribed treatments are working effectively and to provide an early warning of potential treatment failures.
For Gibson’s current project, she is trying to improve diagnostic services in Malawi, a landlocked country in southeast Africa. “We have the tools” to diagnose and treat diseases like HIV, she says. “But in resource-constrained settings, we often lack the money, staff and infrastructure to reach every patient who needs them.”
When diagnostic testing is needed, clinicians collect samples from patients and send the samples to be tested in a laboratory, which then returns the results to the facility where the patient is treated. To move these items between facilities and laboratories, Malawi has developed a national sample transport network. The transportation system plays an important role in connecting remote, rural facilities with laboratory services and ensuring that patients in these areas have access to diagnostic testing through community clinics. Samples collected in these clinics are first transported to nearby district centers, and then forwarded to laboratories located in urban areas. Since most facilities do not have computers or communications infrastructure, laboratories print copies of the test results and send them back to the facilities through the same shipping process.
The sample transport cycle is troublesome, but it is a practical solution to a difficult problem. “During the Covid pandemic, we saw how difficult it was to grow the diagnostic infrastructure,” says Gibson. Diagnostic services in sub-Saharan Africa face “similar challenges, but in a much poorer environment”.
In Malawi, sample transport is managed by a non-governmental organization called Riders 4 Health. The organization has about 80 motorcycle couriers who transport samples and test results between facilities. “When we started working with [Riders]couriers operated on fixed weekly schedules, visiting each country once or twice a week,” says Gibson. But this led to “a lot of unnecessary travel and delays.”
To make sample transportation more efficient, Gibson developed a dynamic scheduling system that adapts to current demand for diagnostic testing. The system consists of two main parts: an information-sharing platform that aggregates sample transport data and an algorithm that uses the data to generate optimized routes and schedules for sample transport couriers.
In 2019, Gibson conducted a four-month pilot test of this system in three of the 27 districts in Malawi. During the pilot study, six couriers transported over 20,000 samples and results to 51 health care facilities, and 150 health care workers participated in the data exchange.
The pilot was a success. Gibson’s dynamic scheduling system eliminated about half of unnecessary trips and reduced shipping delays by 25 percent—a delay that used to be four days was reduced to three. Now, Riders 4 Health is developing their version of Gibson’s system to operate nationally in Malawi. Throughout this project, “we focused on making sure this was something that could grow with the organization,” she says. “It’s fun to see that actually happen.”
Use of patient data
Gibson is finishing her degree at MIT this September, but will continue to work to improve healthcare in Africa. After graduation, she will join the healthcare technology and analytics practice of a company founded in South Africa. Its initial focus will be on public health care facilities, including the Chris Hani Baragwanath Academic Hospital in Johannesburg, the third largest hospital in the world.
In this role, Gibson will work to fill gaps in African patient data for operational medical research and develop ways to use these data more effectively to improve health care in resource-constrained areas. . For example, better data systems can help to monitor the prevalence and impact of various diseases, guiding where health care workers and researchers focus their efforts to help the most people. “You can’t make good decisions if you don’t have all the information,” says Gibson.
To make the most of patient data to improve health care, Gibson plans to reevaluate how data systems are structured and used at the hospital. For ideas on improving the current system, she will look at existing data systems in other countries to see what works and what doesn’t, also drawing on her previous research experience in US health care. Ultimately, it will adapt the new hospital data system to the needs of South Africa to accurately inform future directions in healthcare.
Gibson’s new job – her “dream job” – will be based in the UK, but she expects to spend a significant amount of time in Johannesburg. “I have so many opportunities in the wide world, but the ones that attract me are always where I come from,” she says.