Medicine and entrepreneurship - Croquemort: A biographical journey in the context of Chad

The Dawa Mobile-Health project

After he went to Pala, capital of the Mayo-Dallah department in south-western Chad, to give a concert in 2013, Didier/Croquemort discovered his ‘home’ region anew and was shocked by its poverty and need for development. Being a medical doctor, he recognized the high child mortality caused by schistosomiasis, a disease caused by infection with the bilharzia worm. An easy-to-cure disease when caught in time, this parasitic infection causes deaths among children that cannot access early diagnosis in the region. To address the underdevelopment of healthcare in this area, Didier and a group of young doctors from Chad have set up a health project in one of the sub-prefectures of Mayo-Dallah, Torrock, which is in the border region with Cameroon.

Schistosomiasis is a parasitic disease that can eventually cause death due to destruction of the urinary tract. It is one of the most important and neglected tropical diseases in the world, especially in Africa and Asia. The disease is caused by contact with stagnant water which has been infested by snails that carry the disease. Treatment can be undertaken effectively by anti-helminthic medication (Praziquantel). Re-infection by renewed contact with stagnant water is a major problem; and, at later age, people suffer from secondary malignancies (bladder cancer) due to schistosomiasis. The disease is particularly endemic in parts of Sub-Saharan Africa, due to a lack of knowledge of the spread and effects of the disease, and to the inadequate organization of healthcare in the regions where infection is high.

Although in the area of Torrock schistosomiasis is a serious health problem, there is no government program to combat the infection. In general, Chad’s healthcare organization is insufficient to serve the population. Widespread poverty and a lack of health infrastructure and hygiene are structural problems in the country, where there are few trained medical personnel, and the lack of education on health issues feeds beliefs in religious and traditional practices. Torrock has a population of 50,000 people, and its health centre (not a hospital) serves the region, while the nearest hospital is three hours’ drive from Torrock.

The pilot project adopted an m-health approach, based on SMS-services, to organize the detection, treatment, and prevention of the disease by reaching out to remote villages. This system allows decentralization of the health sector in the region and speeds up the diagnosis process, making the treatment more effective. In this system, local health carers, personnel at an equipped laboratory, and a team of doctors in N’Djaména communicate through SMS technology. The pilot project was very successful and many children were cured. In the next phase, the SMS system will be combined with a mobile laboratory equipped with e-health technologies, such as e-microscopes and e-ultrasound, that connect to specialists through a digital platform. It may in the end constitute a virtual hospital, linking the population in remote villages to regional and even international health centres.

The project’s first stage was developed with funding and training from both the Swedish NGO Reach for Change and the phone company TIGO. The project is promoted by the Tchad Plus association, of which Didier is a founding member, which seeks to promote development by using the possibilities offered by the digital revolution.

The mobile laboratory will reinforce the m-health project, as an ultrasound assessment allows detection of schistosomiasis cases with urinary tract complications and identifies subjects that need extensive treatment. The mobile laboratory will also serve research purposes, as it will enable a mobile team to conduct epidemiological research/surveys in the area.

Didier has been able to turn this project into a PhD study, based at University Medical Center Utrecht in the Netherlands. The model of m-health for schistosomiasis is being tested over a period of three years to better understand whether and how mobile health can be a sustainable solution to provide accessible healthcare in remote areas (both urban and rural) in different parts of West and Central Africa.

In this project, Didier shows his other self: the person who wants to ‘invent’, to make things, to create the impossible. His wish to study game programming has returned as an interest in using digital technologies with creativity, in order to go beyond predictable solutions. While medicine as a study subject was his father’s choice, combining this with the establishment of an m-health project in his home region is for Didier a fascinating combination with his childhood interest in computers.

It also demonstrates his flair for entrepreneurship. Indeed, it was for this project that Didier won several prizes as a social entrepreneur (the most recent at the Francophonie 35>35 in Abidjan, October 2016).