Leonardo da Vinci said “simplicity is the ultimate sophistication“, but it seems like the “modern” computing world never heard that quote, or ignore it. Today, a single application takes hundreds of megabytes, both of disk and RAM space. Slow, buggy, inefficient systems at every level.
Probably the best example on this cluttering mess comes from the mobile computing. Most phones are bloated with useless software that not only hinders the navigation experience, but pose a threat to your privacy. Yes, all this software is proprietary. Worst of it, you can not even uninstall it.
Fortunately, there is hope. Let me introduce SXMO, the Simple X on Mobile project. As the authors describe it, SXMO is a minimalist environment for Linux smartphones, such as the PinePhone. SXMO embraces simplicity, and simplicity is both elegant and efficient.
MyGNUHealth running on PinePhone and SXMO
Full screen mode of MyGNUHealth on SXMO
SXMO uses a tiling window manager called dwm (Dynamic Window Manager), which allocates the different applications in the most efficient way. The dwm project is available as a single binary file, which source is intended not to exceed 2000 lines of code. That is amazing.
Simplicity is robust, and that again applies to SXMO. All the necessary components expected on a mobile phone (making and receiving calls, browsing the Internet, SMS messaging,..) just work. Moreover, SMXO comes with a scripting system that allow us to write solutions to our needs. For instance, the screenshots you see were taken with a script of 3 lines of code. Just place the little program under your “userscripts” directory, and voilà!, you’re ready to make screenshots from your PinePhone!
Browsing the Internet and the GNU Health homepage
Menu driven navigation in SXMO dwm in the PinePhone
In the end, most of current desktop environments today are huge, bloated and buggy. The discovery of SXMO has been an eyeopener. The perfect companion for my PinePhone.
I’m using SXMO on my PinePhone as a daily driver, and I just love it. Thanks to simple distributions such as Archlinux, Parabola or PostmarketOS, and simple Desktop / window managers as DWM, a am finally enjoying Libre mobile computing.
I feel projects like this take us back to the roots, to the beautiful world of simplicity, yet delivering the latest technology and showing us the path o the future.
MyGNUHealth 1.0 us out! The GNU Health Libre Personal Health Record is now ready for prime time!
This is great news. Great news because citizens around the world have now access to a Free/Libre application, focused on privacy, that puts them in control of their health.
Health is personal, so is the health data. It’s been years since I got the idea of expanding the GNU Health ecosystem, not only to the health professionals and institutions, but making it personal, accessible to individuals. Now is a reality!
Throughout these years, the mobile health (mHealth) has been governed by private companies that benefit from your health data. Private companies, private insurances, proprietary operating systems, proprietary health applications. Big business, no privacy.
MyGNUHealth running on KDE Plasma desktop and Arch Linux
GNU and Libre Software
The GNU Health ecosystem exists because of Free software. Thanks to communities such as GNU, we can have fully operational operating systems, desktop environments, databases and programming languages that allow us to use and write free software. GNU Health is one example.
The Libre Software movement fights for the advancement of our societies, by providing universality in computing. In the case of GNU Health, that freedom and equity in computing is applied into the healthcare and social medicine domains. Health is a non-negotiable human right, so it must be health informatics.
What is MyGNUHealth?
MyGNUHealth (MyGH)is a Health Personal Record application focused in privacy, that can be used in desktops and mobile devices.
MyGH embraces the main health domains (bio-psycho-social). All the components in the GNU Health ecosystem combine social medicine and primary care with the latest on bioinformatics and precision medicine. The complex interactions between these health domains play a key role in the state of health and disease of an individual, family and society.
MyGH has the functionality of a health and activity tracker, and that of a health diary / record. It records and tracks the main anthropometric and physiological measures, such as weight, blood pressure, blood sugar level or oxygen saturation. It keeps track of your lifestyle, nutrition, physical activity, and sleep, with numerous charts to visualize the trends.
MyGNUHealth is also a diary, that records all relevant information from the medical and social domain and their context. In the medical domain, you can record your encounters, immunizations, hospitalizations, lab tests,genetic and family history, among others. In the genetic context, MyGH provides a dataset of over 30000 natural variants / SNP from UniProt that are relevant in human. Entering the RefSNP will automatically provide the information about that particular variant and it clinical significance.
The Social domain, contains the key social determinants of health (Social Gradient, Early life development, Stress, Social exclusion, Working conditions, Education, Physical environment, Unemployment, Social Support, Addiction, Food, Transportation, Health services, Family functionality, Family violence, Bullying, War) , most of them from the World Health Organization social determinants of health.
A very important feature of MyGH is that it is GNU Health Federation. That is, if you want to share any of this data with your health professional in real-time, and they will be able to study it.
Lifestyle and activity trackerSocial domain and its contexts, along the book of life
Mood and energy assessment
Medical genetics showing the relevant information on a particular natural variant / SNP
The PinePhone and the revolution in mobile computing
Of course, in a world of mobile phones and mobile computing, we need free/libre mobile applications. The problem I was facing until recently, that prevented me from writing MyGNUHealth, was the fact that there was no libre mobile environment. The mobile computing market has been dominated by Google and Apple, which both deliver proprietary operating systems, Android and iOS respectively.
The irruption of the Pine64 community was the eye-opener and a game changer. A thriving community of talented people, determined to provide freedom in mobile computing. The Pine64 provides, among others, a smartphone (PinePhone), and a smartwatch (PineTime), and I have adopted both.
Starting up MyGNUHealth application in the PinePhone
KDE Plasma mobile applications on the PinePhone
I wrote an article some weeks ago (“Liberating our mobile computing”), where I mentioned why I have changed the Android phone to the PinePhone, and my watch to the PineTime.
Does the PinePhone have the best camera? Can we compare the PinePhone with Apple or Google products? It’s hard to compare a multi-billion dollar corporation with a fresh, community-oriented project. The business model, the technology components and the ethics behind are very different.
So, why making the move? I made the change because we, as a society, need to embrace a technology that is universal and that respects our freedom and privacy. A technology that focuses on the individual and not in the corporation. That moves takes determination and commitment. There is a small price to pay, but freedom and privacy are priceless.
Taking MyGNUHealth and the PinePhone to the outdoors.
As a physician, I need to provide my patients the resources that use state-of-the-art technology, and, at the same time, guarantee the privacy of their sensitive medical information. Libre software and open standards are key in healthcare. When my patients choose free/libre software, they have full control. They also have the possibility to share it with me or with other health professionals, in real-time and with the highest levels of privacy.
We can only manage sensitive health data with technology that respects our privacy. In other words, we can not put our personal information in the hands of corporate interests. Choosing Libre Software and Hardware means much more than just technology. Libre Software means embracing solidarity and cooperation. It means sharing knowledge, code and time with others. It means embracing open science for the advancement of our societies, specially for those that need it most.
MyGNUHealth will be included by default in many operating systems and distributions, so you don’t have to worry about the technical details. Just use your health companion! If your operating system does not have MyGH in their repositories, please ask them to include it.
Governments, institutions, and health professional need affordable technology that respects their citizens freedom. We need you to be part of this eHealth revolution.
Happy and healthy hacking!
About GNUHealth:
MyGNUHealth is part of the GNU Health, the Libre digital health ecosystem. GNU Health is from GNU Solidario, a humanitarian, non-for-profit organization focused on the advancement of Social Medicine. GNU Solidario develops health applications and uses exclusively Free/Libre software. GNU Health is an official GNU project.
The non-profit organization with 3500+ medical students and 65 universities across the country is now part of the GNU Health Alliance of Academic and Research Institutions
It’s a great day for Bangladesh. It’s a great day for public health! Today, GNU Solidario and the International Federation of Medical Students Association, IFMSA Bangladesh, have signed an initial 5-year partnership on the grounds of the GNU Health Alliance of Academic and Research Institutions.
IFMSA Bangladesh is a non-for-profit, non-political organization that comprises 3500+ medical students from over 65 schools of Medicine across Bangladesh. They are a solid organization, very well organized, with different standing committees and support divisions.
IFMSA vision and mission fits very well with those of GNU Solidario advancement of Social Medicine. IFMSA has projects on Public Health (reproductive health; personal hygiene; cardiovascular disease and cancer prevention, … ), Human rights and peace (campaigns to end violence against women; protection of the underprivileged elders and children.. ). I am positive the GNU Health ecosystem will help them reach their goals in each of their projects!
The GNU Health Alliance of Academic and Research Institutions is extremely happy to have IFMSA Bangladesh as a member. IFMSA Bangladesh joins now a group of outstanding researchers and institutions that have made phenomenal advancements in health informatics and contributions to public health. Some examples:
The National University of Entre Ríos (UNER) has been awarded the project to use GNU Health as a real-time observatory for the COVID-19 pandemic, by the Government of Argentina. In the context of the GNU Health Alliance, UNER has also developed the oral health package for GNU Health; and implemented the GNU Health Hospital Management Information System component in many public health care institutions in the country. The team from the UNER has traveled to Cameroon to implement GNU Health HMIS in several health facilities in the country, as well as training their health professionals.
Thymbra Healthcare (R&D Labs) has contributed the medical genetics and precision medicine. Currently, Thymbra is focused on MyGNUHealth, the GNU Health Personal Health Record (PHR) for KDE plasma mobile and desktops devices, and working on the integration of MyGNUHealth with the PinePhone.
Khadas has signed an agreement to work on with the GNU Health community in Artificial Intelligence and medical imaging, as well on integrating Single Board Computers (SBCs) with GNU Health (the GNU Health in a Box project)
The fact that an association of 3500+ medical students embrace GNU Health means that all these bright future doctors from Bangladesh will also bear the ethics and philosophy of Libre Software to their communities. Public Health can not be run by private corporations, nor by proprietary software.
IFMSA has 5 years ahead to make a wonderful revolution in the public health care system. Health institutions will be able to implement state-of-the-art health informatics. Medical students can learn GNU Health inside-out, and conduct workshops across the country in the Libre digital health ecosystem. Most importantly, I am positive GNU Health will provide a wonderful opportunity to improve the health promotion and disease prevention campaigns in Bangladesh.
As the president of GNU Solidario, I am truly honored and looking forward to start collaborating with our colleagues from Bangladesh, and, when the pandemic is over, be able to meet them in person.
My most sincere appreciation to IFMSA Bangladesh for becoming part of the GNU Health community. To the 3500+ members, a very warm welcome!
Let’s keep building communities that foster universal health care, freedom and social medicine around the world.
For further information about the GNU Health Alliance of Academic and Research Institutions, please contact us at:
Last week I got the PineTime, a free/libre smartwatch. In the past months, I’ve been working on MyGNUHealth and porting it to the PinePhone.
Why doing so? Because running free/libre operating systems and having control of the applications on your mobile phones and wearables is the right thing to do.
Yesterday, I told myself: “This is the day to move away from Android and take control over my phone”. And I made the switch. Now I am using a PinePhone on Manjaro running KDE plasma mobile. I have also switched my smartwatch to the PineTime.
The mobile phone and smartwatch were the last pieces of hardware and software to liberate. All my computing is now libre. No proprietary operating systems, no closed-source applications. Not on my laptop, not in my desktop, not on my phone.
Facing and overcoming the social pressure
At the moment I ditched Android, I felt an immense sense of relief and happiness. It took me back 30 years ago, early FreeBSD and GNU/Linux times, being in control of every component of my computer.
We can not put our daily life activities, electronic transactions and data in the hands of the corporations. Android phones shipped today are full of “bloatware” and closed-source applications. We can safely call most of those applications spyware.
The PinePhone is a libre computer, with a phone. All the applications are Libre Software. I have SSH, most of the cool KDE plasma applications I enjoy in the desktop, I can have them now in my pocket. Again, most importantly, I am free.
Of course, freedom comes with a price. The price to face social and corporate pressure. For instance, somebody asked me yesterday how to deal with banking without the app. My answer was, I never used an app for banking. Running a proprietary financial application is shooting at the heart of your privacy. If your bank does not let you do your transactions from any standard web browser, then change your bank. Quick digression… the financial system and the big technological corporations are desperately trying to get rid of good all coins and bills. This is yet another attack on our privacy. Nobody needs to know when, where and what I buy.
A brighter future depends on us
Some people might argue that this technology might not be ready for prime time, yet. I would say that I am ok with it, and the more we join, the more feedback we provide, and the better end result we’ll get.
The Pine64 project is mainly a community-oriented ecosystem. Its hardware, operating system and applications are from the community and for the community. I am developing MyGNUHealth Personal Health Record to be run on KDE Plasma, both for desktop and for the PinePhone and other Libre mobile devices. It is my commitment with freedom, privacy and universal healthcare to deliver health informatics in Libre, privacy focused platforms that anyone can adopt.
MyGNUHealth Personal Health Record running on the Desktop and on the PinePhone. The PineTime smartwatch as the next companion for MyGNUHealth. All these components are privacy focused, Free/Libre Software and hardware.
It depends on you to be prisoner of the corporation and massive surveillance systems, or to be in full control of your programming, health information and life. It takes commitment to achieve it… some components might be too bleeding edge or the camera might not have the highest resolutions and you won’t have the Whatsapp “app” (removing that application would actually be a blessing). It’s a very small price to pay for freedom and privacy. It’s a very small price to pay for the advancement of our society.
InfiniTime firmware upgrade using Siglo.
It’s been many years since I’ve been in the look out for a truly libre phone. After many projects that succumbed, the PinePhone is the first one that has gained momentum. Please support the PinePhone project. Support KDE plasma mobile. Support Arch, Manjaro, openSUSE, FreeBSD or your favorite Libre operating system. Support those who make Libre convergent applications that can be run on mobile devices, like Kirigami. Support InfiniTime and any free/libre firmware for smartwatches, as well as their companions as Siglo or Amazfish.
The future of Libre mobile computing is now, more than ever, in your hands.
In his escape from Rome, Peter encounters Jesus and asks him, Jesus, Quo vadis? (“where are you going?“) Jesus responded, “Back to Rome, to be crucified again”. Peter follows him, ends up being captured and crucified upside down.
(Painting: Domine quo vadis? (1602) by Annibale Carracci. Source Wikimedia)
Two thousand years have passed, yet those who defy the status quo are still being prosecuted and crucified, one way or another.
Too much hypocrisy and lack of empathy
The prosecution and public lynching that Richard Stallman, creator of the Free Software movement, has suffered in the last year and half is unparalleled. Many of those who used to praise his work and figure, are now taking the first row in the lapidation of the heretic.
Richard Stallman might not be the best in social interactions, but neither am I. Richard is not politically correct either. Some things he has said can be controversial and even disturbing. But that does not make him a criminal or a monster. In more than one occasion, I’ve noticed that I’ve misunderstood his words after talking to him or re-reading the article.
We all are imperfect beings, with imperfect genes, living in an imperfect society. We come from different cultural, social, educational and generational backgrounds. I find this enriching and fascinating. Yet, there is still too much hypocrisy and lack of empathy in our society.
Let me share a short personal story. In 2018 I was invited to give a talk at LibrePlanet. I flew from Spain to Boston, and I was excited to meet with the colleagues from the community, so I signed up to the “Welcome dinner”. To my surprise, I got this response by email upon arrival:
"The Welcome Dinner is for all women, gender queer, non-binary, and gender non-conforming people interested in free software. If you don't identify as such, we kindly request that you don't attend the dinner this year."
So I checked whether all the list elements, looking for latino, hispanic, vegan, …. but no luck… after a long haul flight, I found myself excluded from the event. Where is the diversity, where is the inclusion, where is the empathy? Ironically, I found out that the very same person who sent me the email excluding me from the dinner is now part of the debunking campaign against RMS.
Let he who is free of sin cast the first stone
Who are we to judge? On what moral grounds are they judging Richard Stallman?
Discrimination on the basis of species is as terrible as any other form of discrimination (sex, race, age..). Those who eat meat are complicit of the daily holocaust of millions of sentient beings. Those who drink milk are complicit of the systematic rape, slavery and murder of millions of persons who have the same right to live in freedom and dignity as we humans. In addition, non-vegans are responsible in the climate change emergency, pandemics and other terrible side effects of factory farming.
I am convinced that many of those who are judging RMS are meat eaters and consume dairy products. So, before they accuse him for something that he might have said, they should take a look at themselves and their ethical / moral status, for what they are actually doing. I also think that many of them would not have joined this evil campaign if they knew how much pain and suffering it has caused to Richard.
Divide and conquer. The attempt to eradicate the Free Software movement
The existing plutocracy controls de media and distorts reality. The panem et circenses formula works great in creating a numb, docile society. Their mass control devices and programs activate the dopaminergic reward pathways on the person brain, creating a short but intense feeling of instant gratification through selfies, filters, likes. You willingly provide them your personal information. They know where you are, they know what you do. They will also make a lot of money selling your information to others who will refine the mind control process. This becomes a closed loop.
They have gradually eradicated critical reasoning. Activism and social justice are now forbidden terms. “Free Software” is now “Open Source”. To be a cool programmer and a good citizen, you have to share your code “Where the world builds Software“. It’s a proprietary platform, but this fact would not make a difference to you anymore at this point. You have become part of them, and your principles about the initial Free Software movement have faded away.
After creating the “idyllic community”, it was time for them to find a common enemy. The witch-hunt started by debunking the creator of the Free Software movement and then anyone that would defy the status quo. Vilifying RMS on the news and social media was an easy task for them, provided that they control most of the media and that they already counted with an “army” ready to burn heretics. The army members did the dirty job for them, proudly posting on their timelines how they contributed to the ruthless public mobbing, lynching and lapidation of someone who most of them, didn’t even know. The rest is history.
Time to hit the reset button
No doubt that the Free Software Foundation and the movement of free software and free culture is badly injured. The enemies of social justice and freedom in our society have tried to eliminate the Free Software Foundation and divide the community.
Yet, we are strong and resilient. Let’s come together, reunite and return even stronger. Society is facing very challenging moments, and we need the Libre Software movement to be a reference of evolution, diversity, respect and inclusion. The enemies of freedom and equity want us divided, so they gain control. We can not let that happen again.
Let us all take some time for self-reflection, to get rid of any resentment. Let us find room for forgiveness to our fellow members of the Free Software movement and hit the reset button. Let us put aside the confrontation among us that will take us nowhere.
Let us also support financially the Libre Software community. Most Libre Software projects and organizations depend on the financial contributions, and they should be able to grow with the support of their individual members alone. That will bring independence from the corporation.
Our mission as individuals and members of the Libre Software movement goes way beyond programming. The code that we write in C or Python must also be the source of an optimistic message to this and upcoming generations around the world. A genuine and honest message of freedom, equity, compassion, empathy and solidarity.
It was not easy… we’re so used to celebrate the GNU Health Conference (GHCon) and the International Workshop on eHealth in Emerging Economies (IWEEE) in a physical location, that changing to a virtual conference was challenging. At the end of the day, we are about Social Medicine, and social interaction is a key part of it.
The pandemic has changed many things, including the way we interact. So we decided to work on a Big Blue Button instance, and switch to virtual hugs for this year. Surprisingly, it work out very well. We had colleagues from Gabon, Brazil, Japan, Austria, United States, Argentina, Spain, Germany, Chile, Belgium, Jamaica, England, Greece and Switzerland. We didn’t have any serious issues with the connectivity, and all the live presentations went fine. Time zone difference among countries was a bit challenging, specially to our friends from Asia, but they made it!
Social Medicine, health literacy and patient activation
The non-technical talks covered key aspects in Social Medicine, Citizens, health literacy, patient activation and Global digital health records, given by Dr. Richard Fitton, Steve and Oliver, two of his patients. Armand Mpassy talked about the challenges about GNU Health for IT illiterate Case study: Patient workflow at the outpatient service.
Individual privacy and crypto
On privacy and cryptography subjects, we had talks from Isabela Bagueros from Tor, Surviving the surveillance pandemic, Ricardo Morte Ferrer on A proposal for the implementation of a Whistleblower Channel in GNU Health, and Florian Dold on GNU Taler: A payment system by the GNU Project.
openSUSE Leap, packaging GNU Health and Orthanc
On operating systems, Doug Demaio from openSUSE talked aboutThe big Change for openSUSE Leap 15.3, the new features on the upcoming release of this great distribution, bringing sources of SUSE Linux Enterprise (SLE) closer to the community distribution. I can not stress enough the importance of getting professional support on your GNU Health installations. Health informatics should not be taken lightly, and is key to have a solid implementation of the underlying operating system components, to get the highest levels of of security, availability and performance in GNU Health.
Axel Braun, board member openSUSE and core team member of GNU Health, focused on packaging GNU Health and the openSUSE Open Build Service (OBS). The presentation Hidden Gems – the easy way to GNU Health, put the stress on making GNU Health installation even easier, in a self-contained environment.
Sébastien Jogdone, leader of the Orthanc project, presented Using WebAssembly to render medical images, an open standard that allows to run C/C++ code on a web browser. This is great news since GNU Health integrates with Orthanc PACS server.
Qt and KDE projects in the spotlight
If we think about innovation in computing, we think about Qt and KDE. GNU Health integrates this bleeding edge technology in MyGNUHealth, the GNU Health Personal Health Record for desktop and mobile devices that uses Qt and Kirigami frameworks.
Aleix Pol, president of KDE e.V., presented Delivering Software like KDE, putting emphasis on delivering code that would be valid for many different platforms, specially mobile devices.
Cristián Maureira-Fredes, leader of the Qt for Python project, in his presentation Qt for Python: past, present, and future!, talked about the history and the upcoming developments in the project, such as PySide6, the latest Python package and development environment for Qt6. MyGNUHealth is a PySide application, so we’re very happy to have Cristián and Aleix on the team!
Dimitris Kardarakos, presented a key concept on modern applications, that is convergence, the property of the application to adapt to different platforms and geometries. His talk Desktop/mobile convergent applications with Kirigami explained how this framework KDE framework, that implements the KDE Human Interface Guidelines, helps the developers create convergent, consistent applications from the same codebase. MyGNUHealth is an example of a convergent application, to be used both in the desktop as in a mobile device.
I did go into details on MyGNUHealth design in my talk, MyGNUHealth The GNU Health Personal Health Record (PHR).
Argentina leading Public Health implementations with Libre Software
Many years of methodical and intense hard work in the areas of health informatics and public health have paid off. The team lead by Dr. Fernando Sassetti, head of the Public Health department of the National University of Entre Rios, has become a reference in the world of public health, Libre Software in the public administration, and implementations of GNU Health in many primary care centers and public hospitals in Argentina.
The National Scientific and Technological Promotion Bureau (Agencia Nacional de Promoción Científica y Tecnológica), chose Dr. Sassetti project based on GNU Health as the system for management of epidemics in municipalities. Health professionals were trained in GNU Health epidemiological surveillance system, as well as the contact tracing functionality.
Ingrid Spessotti and Fiorella de la Lama on their talk Outpatient follow-up and home care of patients with suspected or confirmed COVID-19, explained some of the functionality and benefits of these GNU Health packages, for instance:
Real-time observatory and epidemiological surveillance
Automatic notification of notifiable disease to the National Ministry of Health
Reporting on cases and contacts
Calls registry, monitoring of signs and symptoms.
Risk factors on each individual (eg, chronic diseases, socioeonomic status…)
Geolocalization of suspected or confirmed cases
Clinical management and followup for both inpatient and outpatient cases.
Carli Scotta and Mario Puntin, presented the Design, development and implementation of a Dentistry module for GNU Health: experience at the Humberto D’Angelo Primary Care Center in Argentina, a package that will be the base for the upcoming dentistry functionality in GNU Health 3.8 series.
The GNU Health Social Medicine Awards 2020
GNU Health is a social project. In every GHCon, we recognize the people and organizations that work to deliver dignity to those who need it most around the world.
Our biggest congratulations to Prof. Angela Davis, Proactiva Open Arms and Diamante Municipality!
As you can see, we still can do great conferences in the context of the pandemic. I hope to see you and hug you in person at GHCon2021.
The GNU Health project believes in coding standards, specially in those that can be widely used. In 2011, the United Nations University (UNU) adopted the GNU Health Hospital Management Information System (HMIS) component, in part because of its strong focus in social medicine and environmental health, but also because it complied with most of the World Health Organization standards.
Using WHO standards is key for global health. The GNU Health federation provides timely and accurate health information to citizens and health professionals globally. We are able to generate this large, distributed networks of information thanks to protocols and standards, that permit the aggregation of data from thousands and even millions of nodes.
GNU Health at the United Nations – International Institute for Global Health
GNU Health HMIS provides many WHO standards and UN models, such as:
ICD-10, International Classification of Diseases, tenth revision
ICD-9, Volume 3, for coding procedures
ICF, International Classification of Functioning, Disability & Health
ICPM, International Classification of Procedures in Medicine (to be replaced by ICHI)
WHO List of Essential Medicines
Pediatric growth charts
Vaccination schedules
MDG / SDG (Millennium Development Goals / Sustainable Development Goals, such as the MDG6 to tackle HIV, Malaria and Tuberculosis
Health professionals, institutions and governments around the world can trust GNU Health as the WHO compliant Hospital Management and Health information system.
GNU Health training for WHO Africa Regional Officers
Throughout these years, GNU Health and WHO have been cooperating in areas of Universal Health access, Mother and Child health or campaigns to fight HIV/AIDS, Malaria and Tuberculosis.
It has been nearly a decade of work, at the technical, functional and community level. The training of WHO regional officials, as well as to the health professionals have had a quite positive impact. Proper coding using WHO standards in GNU Health, both for health conditions and procedures / interventions result in good quality, epidemiological reports, better management of the internal resources and improved health promotion and disease prevention campaigns.
First newborn registration in the GNU Health implementation at Cameroon district hospital
Moving forward: ICD-11 and ICHI
The current International Classification of Diseases, tenth revision (ICD10) has been of great help to standardize coding health conditions, but it has its limitations and it definitely needs a review in both the coding system itself as well as the need of specific health areas.
To overcome these limitations, the World Health Organization started ICD-11, the latest revision that includes many more health conditions, the much needed areas of mental health and sexual health, as well as a great method to combine conditions, called cluster coding or postcordination. Cluster coding allows the combination of two terms in for the condition. This concept brings much more flexibility and contextualization.
In terms of health procedures, the International Classification of Health Interventions (ICHI) is estimated to be released by the end of this month. ICHI will replace the International Classification of Procedures in Medicine (ICPM).
The International Classification of Health Interventions will become the standard coding system for reporting and analyzing health procedures. In words from WHO, “the classification provides Member States, service providers, managers, and researchers with a common tool for reporting and analyzing health interventions for statistical, quality and reimbursement purposes.“.
ICHI delivers a coding method based on three axes: Target, Action and Means. It is valid for all context of health (primary care, surgical, dental, nursing, community health). It contains over 7000 interventions that can deliver at an individual or population basis.
GNU Health leads the integration of WHO References
Depending on the individual and environment, a particular pathology can have different clinical representations of the disease. Diabetes mellitus (DM) can be controlled or can have devastating consequences for the individual. Most of the times the socioeconomic determinants play a key role on the epidemiology, clinical outcomes and disease progression, and assessing health as a whole – from the molecular basis to the socioeconomic determinants – is one of the areas where GNU Health excels.
GNU Health provides the WHO International Classification of Functioning, Disability and Health, that has been key in many context, to assess the impact of the environment in many patients. This was studied in the GNU Health implementation in Laos (see my post “GNU Health: Helping Laos Heal from UXO physical and emotional trauma.“).
WHO diagram on relations among reference classifications
GNU Health is ICD-11 ready, and waiting for you
The upcoming release 3.8 for the GNU Health HMIS component includes de ICD-11 Morbidity and Mortality Statistics (MMS) linearization, as well as the existing ICF package. We are waiting for WHO to release the stable version of ICHI.
The ICD-11 will officially come into effect on 1 January 2022, so we have a year to train and get used to it. The GNU Health HMIS community server can be your perfect training companion. It’s online 24×7 and you can test the new codings in this server.
At this point, you can already start testing the ICD-11 functionality, and how it interacts with the other references as the ICF. Of course, you can become part of the GNU Health team, either as an end-user of as a member of our development and research team, and provide feedback and improvements!
These new additions will be of great help to achieve our common mission towards Universal Health Coverage and Sustainable Development Goals. At the end of the day, GNU Health is a social project that uses really cool Libre technology. I am positive that the immense majority of our health related problems, both at individual and population level, can be solved by means of Social Medicine.
As Dr. Rudolf Virchow said, Medicine is a social science, and politics is nothing else but medicine at a larger scale.
It is official: GNU Solidario, the Spanish NGO behind GNU Health (GH) and Khadas Technologies have signed the “GNU Health Alliance of Academic and Research Institutions”, to research and deliver Artificial Intelligence to the world of medicine.
This is very exciting. GNU Health covers genomics, medical genetics, Dx imaging and social medicine, areas where definitely we can use the power of AI for better diagnostics, personalized treatments, decision support, disease prevention and health promotion.
The GNU Health embedded project using Khadas for Artificial Intelligence in Medicine
What is truly revolutionary is that we will be using affordable single board computers, like the Khadas VIM3, where they could work alone or in the context of the GNU Health Federation, doing massive virtual parallel computing.
Citizens, health professionals and institutions don’t have to spend millions to access the latest in technology. In GNU Health, this has always been our philosophy. Health is must be remain a universal human right, and that is what we do in GNU Health. We deliver state-of-the-art technology all over the world with Libre Software. No hidden lines of code, no hidden agenda.
One of Khadas devices, the VIM3 includes a Neural Processing Unit (NPU) that will be the heart of the AI engine.
GNU Health HMIS with genetics package running on a Khadas VIM3 Pro
We can use our GH Federation model which gathers massive information of protein natural variants, and combine it with the latest tools in Artificial Intelligence. We will be giving a giant leap, unveiling the real clinical significance of many mutations that today remain a mystery about how they would affect our health. In GNU Health we are determine to build this critical bridge between the person, the clinician and the researcher.
Another area that we’ll work on is Dx imaging. Training Khadas devices to differentiate many types of lesions will help the pathologist or the surgeon to take real-time decisions in the operating room based on the picture GNU Health camera takes and the diagnostic that the GH embedded return about the specimen.
In the upcoming GNU Health Conference – GHCon2020– , there will be sessions about this project, so we invite anyone to register at the conference, that this year will be online due to the COVID pandemics. Register at GHCon2020
GHCon2020, the annual GNU Health conference
About GNU Solidario: GNU Solidario is a non-for-profit organization that works globally, focused on Social Medicine and health informatics (using Libre Software).
GNU Solidario is the organization behind GNU Health, the award winning Libre Health and Hospital Information System, deployed in many health and research institutions around the globe.
About Khadas: Khadas develops superior quality, high performance single board computers for makers, developers, and tinkerers, that come with open source, professional technical support, and a global community for issue discussion & idea sharing.
GNU Health implementation anniversary at Laos Center of Medical Rehabilitation
Laos is one of the most heavily bombed countries in the world. During the period from 1964-1973, over 2 million tons of bombs were dropped by B-52 aircrafts across the 2/3 of the country during the “Secret War”. This nine-year period bombing caused thousands of deaths and a unprecedented human displacement that exceeded a hundred thousand civilians from the poorest areas of the country.
The tragic legacy of that period remains today. Thirty percent (30%) of those bombs remains active (Unexploded Ordnances – UXOs – ), causing over 300 victims every year until 2008, and now down to 50 / year. Nearly 60% of the UXOs accidents result in death, and 40% of the victims are children[1].
If the explosion does not kill the person, it causes severe traumatic injuries resulting in the amputation of limbs in many of the victims. Physical and emotional trauma that takes many years to heal. In addition, many UXO victims suffer from Post-traumatic stress disorder (PTSD), a serious condition that can be devastating for the victim and their families[2].
But there is hope. The wonderful people from Laos are resilient, and they are willing to cope and move forward. I have been in Laos several times in the last few years, in the context of GNU Health implementations both in Mahosot Hospital and the Center for Medical Rehabilitation – CMR – .
The Center for Medical Rehabilitation (CMR), located in Vientiane, is a specialized institution that helps people with disabilities and victims survivors of UXOs. The CMR, formerly known as the National Rehabilitation Center initially provided prosthetic limbs for victims of war. Today they have extended the services to provide services to children with disabilities across the country. Some of the services include medical and community based rehabilitation, special education for the deaf and the blind and vocational school for people with disabilities.
At the moment I had the meeting with the hospital directors, I knew that we had to focus both in short term surgery as well as in the long term psychological, physiotherapy and occupational therapy that would allow the person to be fully functional in the society. Again, I was facing a project in need of Social Medicine.
We trained a localmultidisciplinary team of nurses, doctors, physiotherapists, social workers, computer scientists, psychologists, administrative personnel, pharmacists and accountants.
CMR nurses. The heart of the institution
It was during that period that I created the package “functioning and disability“.
General patient information and Functioning & Disability tab. Red boxes on these two sections denote UXO related information
Some of the GNU Health functional modules that CMR decided to use included surgery, socio-economics, ICD-10, nursing, physical therapy, stock, accounting, lifestyle, reporting, health services and diagnostic imaging, among others. In addition to those, we included the “functioning and disability” package.
The GNU Health “Functioning and Disability” package integrates the ideas of WHOHealth Organization International Classification of Functioning, Disability and Health. This functionality complements the ICD-10 classification of diseases, with the concept of functionality. For example, after a person has been diagnosed with diabetes, we must go beyond the biology and molecular bases of the disease, and evaluate how diabetes impacts of on her daily activities and integration in the society and environment.
GNU Health contextualizes the health condition in the particular individual, key for personalized medicine. In the UXOs example, the related ICD10 codes are visible from the main chart:
S88 : Traumatic amputation of lower limb
F43.1: Post-traumatic stress disorder
This diagnostic information is relevant and key for epidemiology and statistics, but if we want to practice medicine, we must take into account the social aspect of these conditions, and how they affect the person in her particular environment.
The GNU Health Functioning and disability assessment has two sections. The first section is a summary of impairments related to the Cognitive, Visual, Hearing, Speech, Hand, Mobility and Activities and Participation .
The second section is a detailed assessment of Body functions, Body structures, Activities and Participation and Environmental factors and barriers. Each of these groups has its own set of qualifiers and components that will provide the health professionals where to put the focus to the time and the context of that person, as well as to evaluate the progression of the conditions.
We can now study, with a multi-disciplinary team, how the body structure and body functioning impairments relate to the person capacities and engagements in social activities; daily household tasks; using the current public transportation system or the level of access to Labor and employment services.
This is my concept of medicine, the assessment of the bio, psycho, social determinants of health and disease. Medicine is, first and foremost, a social science, and GNU Health is first and foremost, a social project.
Example of GNU Health person functioning and disability assessment
Celebrating the success of cooperation: During a two-year period of using GNU Health, they have provided over 67,000 medical services, automated their finances, prescriptions, stock management, medical appointments and evaluations, diagnostic imaging, and the demographics tracking for the thousands of patients they assist.
CMR Cope team helping people in Lao rural areas
Local capacity building: CMR trained its own local group of professionals who customize and maintain GNU Health, in their own Lao language. This creates a local and ethical business model, very important for the long-term sustainability of the project.
A well-deserved award. The work that CMR has been doing in Laos for the rehabilitation of their people has been magnificent. Their multidisciplinary approach to trauma, from the acute care and surgery, to the physical therapy and the work in the field is an example for many of us. CMR has helped thousands of people every year healing from the UXO physical and emotional scars, moving forward and being able to get re-inserted in society, and we are so proud to have been part of it.
A delegation of the Laos Ministry of Health presented at GNU Health Con 2016 the implementation in the Lao Center for Medical Rehabilitation – CMR – and in Mahosot hospital. We are so proud that they are part of the GNU Health community.
CMR received the GNU Health Social Medicine Award in 2016 for best Institution.
– Somnuk Vorasarn, Chansaly Phommavong, Khonephet Sely. GNU Health in Mahosot Hospital – GNU Health Con 2016
A cross-sectional community study of post-traumatic stress disorder and social support in Lao People’s Democratic Republic
Science can not advance at the cost of the pain and agony of sentient beings. If saving a human life means killing a nonhuman being, then we need to move away from that model and towards a humane and effective medical research.
I am honored to be among the 77 scientists who joined forces with Animal Free Research UK[1], Safer Medicines Trust[2] and the Alliance for Human Relevant Science[3] to call for a change in regulation to enable medical research without the use of animals for all diseases. The open letter[4], a call to international regulatory bodies, was released on this Tuesday (July 14th, 2020) and it was published in The Guardian the same day.
An animal is someone, not something. Human and nonhuman animals are sentient beings. They are capable feel joy and to suffer physical and emotional pain. Can we then call a nonhuman animal a “person” ? I’d say so. A person is someone, not something. A person has the right to live in freedom and dignity. Not doing so will generate discrimination based on species, that is, speciesism. Discrimination wrongfully empowers morally ( and in many occasions, legally) the oppressor. Discrimination based on sex, IQ, race or species varies on the victim. The mechanism of slavery lies on tearing apart the dignity and freedom of someone, turning them into property, a something. Examples of modern slavery are sex trafficking, child labor and factory farming.
Philosopher Mary Midgley wrote a very nice essay on this subject “Persons and Non-persons“[5]. It is important to reflect about the rationale of the judge.
Wrong educationalmodel: It is appalling how junior medicine school students are “trained” to accept animal suffering as part of being a doctor or a scientist. Undergraduate students “learn” about acute mesenteric ischemia (AMI) with live animals, cutting them open, ligating the artery and then observing the evolution (slow and painful death). The physical and emotional pain that these sentient beings undergo can not be described. Being exposed to such horrendous actions won’t make the students better doctors. On the contrary. There is plenty of literature about AMI on humans that will result on a more relevant learning experience for the future health professional.
The macabre LD50: The term “Lethal Dose 50” is is used extensively in the the pharmaceutical and cosmetic industries. In toxicology, it represents the dose of a substance needed to kill 50% of the exposed population. Dogs, mice, rats, and many other animals are given the drug by different routes (orally, intravenously, intraperitoneal…). The survivors are too sick and end up being “euthanized”.
The cruel failure of science: Sadly, all that that suffering has been in vain. According to the Animals in Science Policy Institute, emerging evidence shows that 95% of drugs testing in animals fail at human clinical trial, and close to 100% Alzheimer’s drugs tested in animals fail when tested in humans[6]
A daily holocaust: During WWII, Hitler’s doctors performed the most heinous experiments on humans, in the name of science. One of the doctors stood out from the rest. His name was Josef Mengele. He used children (had predilection for twins) . Mengele was called “the angel of death“. In addition to be in charged of sending the prisoners to the gas chamber, he conducted hundreds of experiments in children, killing them afterwards. One night, he killed 14 children by injecting chloroform into their hearts[7]. I am bringing this topic because I want people to remember and never forger the atrocities done by the Nazis. In addition, it’s important to note that his sadistic methods don’t differ much from nonhuman animal experimentation carried out every single day around the world. I am convinced that animals conceive human beings as their Angels of death.
It is ironic that many would have trouble falling asleep thinking about the atrocities committed by Mengele, yet normalize the killing of millions of sentient beings that anticipate torture and suffering equally as those innocent gypsy children in Auschwitz concentration camp. All animals, human and non-human, shiver, cry, vomit and lose control of sphincters in response to emotional and physical stress. The question remains, why our governments perpetuate this holocaust.
Different species, different physiology: Different species have different physiology. That is part of the reason some clinical trials that may show promising results in non-human animals are a failure when tested in humans.
In the context of the COVID-19 pandemic, it’s been shown that the expression of ACE2 receptors is different among rats and humans. In the open letter “A shift in focus is needed to tackle COVID-19” written this May by Animal Defenders International[8] and co-signed by scientists and academics to the World Health Organization and other regulatory entities, they wrote:
[…] mice are one of the most commonly used species in drug and vaccine research. In addition to major differences between human and mouse respiratory systems, species differences specific to research for SARS-COV-2 include that mice do not naturally have the same receptors the virus uses to infect human cells. Researchers are now attempting to “humanize” mice to ensure they contract the virus. Such fundamental differences risk impeding the production of vaccines and other treatments to help prevent and reduce the symptoms of COVID-19 in people.
Humane and effective alternatives: We now know that animal experimentation is both cruel and ineffective as a research strategy. Traditional biomedical has failed to provide solutions for human related conditions and is now anachronistic. As a physician and computer scientist, I see the enormous benefit of applying computer models, artificial intelligence or computer vision as part of the new generation, state-of-the-art technology applied to biomedical research. Thanks to the GNU Health Federation[10], we are capable of building large, distributed networks that interconnect patients, physicians and researches around the globe to provide solutions in key areas of social medicine, cancer, bioinformatics and precision medicine.
Organizations such us Animal Free Research UK are leading medical research in the areas of diabetes, cancer and neurodegenerative conditions by using cell cultures or amazing technologies like “organ-on-a-chip“[11].
There are plenty of reasons to be optimistic, from the technological to the human aspects. These actions reflect how scientific communities, NGOs and citizens are coming together towards a humane, effective and human relevant medical research.
MeanMicio 
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