Urban vs. Rural - IEEE ComSoc-SCV to Sonesh Surana, Kurtis Heimerl, Divya Ramachandran, Emma...
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9/18/11 1 Telemedicine for Developing Regions Eric Brewer Tier Group, UC Berkeley (currently also VP Infrastructure, Google) September 14, 2011 Thanks to Sonesh Surana, Kurtis Heimerl, Divya Ramachandran, Emma Brunskill and the TIER Students & Faculty Urban vs. Rural • Value of the cellphone limited by coverage – Even more true with the Cloud • Cellular is an urban phenomenon – Rural areas generally left out – … basestation costs limit rural deployment • This is the real “digital divide” – Not between nations – … but between urban and rural (even in the US)
Transcript of Urban vs. Rural - IEEE ComSoc-SCV to Sonesh Surana, Kurtis Heimerl, Divya Ramachandran, Emma...
9/18/11
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Telemedicine for Developing Regions
Eric Brewer Tier Group, UC Berkeley
(currently also VP Infrastructure, Google)
September 14, 2011
Thanks to Sonesh Surana, Kurtis Heimerl, Divya Ramachandran,
Emma Brunskill and the TIER Students & Faculty
Urban vs. Rural • Value of the cellphone limited by coverage
– Even more true with the Cloud • Cellular is an urban phenomenon
– Rural areas generally left out – … basestation costs limit rural deployment
• This is the real “digital divide” – Not between nations – … but between urban and rural (even in the US)
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Where are we?
3 Manila, Philippines Edmonton, Canada
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Rural connectivity: WiFi?
• Very low cost due to huge volume • Unlicensed spectrum (mostly!) • Incremental deployment
– Limited capital – Start small, grow over time
• Our innovations: – New software for very long distances – Better use of spectrum
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6 NSDI 2007: WiLDNet Results
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New World Record:
382 Kms
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New World Record – 382 Kms
Pico El Aguila, Venezuela
Elev: 4200 meters
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Rural Telemedicine • Aravind Eye Hospitals
– Tamil Nadu, India – 5 hospitals – But too far for most to walk
• Need: – 15M blind in India – 70% of blindness treatable – 7% in rural areas get care
• Goals: – 50 rural vision centers – Diagnosis and prevention
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Aravind Eye Hospital Network
• Achieve 4-5 Mb/s per link • Video-conferencing • E-m ail, training • 6000 consultations/month
Routers used: PC Engines Wrap boards, 266 Mhz CPU, 512 MB Cost: $140
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Real Impact • Over 500,000 patients so far • Centers are cash-flow positive • Roughly 50,000 patients have recovered sight • Growing to 50 centers covering 2.5M people • Hoping to replicate in other cities
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Hardware Faults at Aravind, 2006
Instances* Description Total Downtime
63 Router board not powered 63 days
7 Router powered but hung 10 days
21 Router powered but not connected to remote LAN (burned ethernet ports)
34 days
3 Router on, but wireless cards not transmitting (low voltage)
2 days
3 Router on, but pigtails not connected 45 days
1 Router on, but antenna Line-of-Sight blocked
8 weeks
*Conservative Estimate
>90% of faults are power-related
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What about UPS?
• “Affordable” UPS systems ($300) are of standby-type – Primary source is grid – Secondary source is battery – Good quality power supplied only during outage! – 2006 fault episodes include use of UPS
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Remote Management
• Really don’t want to visit nodes to fix them – Even if you live in the same country! – Remotes locations, risky travel
• Solutions: – Robust engineering (e.g. watchdogs) – Need preventative maintenance – Remote diagnosis helps some – Alternate paths to remote nodes
• Sometimes we use cellular
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Local expertise: Training and Migration
Equipment Supply
Installation
Management
Maintenance
TIER, UC Berkeley Aravind Local Vendor
Jan’06 – Jun’06
Migration at Aravind
2007: 5 more clinic links
Jun’07 – Dec’07 Jul’06 – Dec’06 Jan’07 – Jun’07
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Summary
• Technology can make a big difference – … must optimize the existing (poor) system – … must work with partners on the ground
• Must solve the whole problem – Connectivity, power, app – Doctor, nurse training – Operational sustainability: ecosystem – Financial sustainability
