Interview with Dr. Patricia Mechael, Principal and Policy Lead at HealthEnabled, an Africa-based not-for-profit that helps governments integrate life-saving digital health solutions into their health systems.
What made you want to get into the field of digital health? How did you get involved?
I don’t think I put two and two together until recently. Both of my parents were computer scientists who were on the cutting edge of banking innovation in the 1970s and 1980s. I had gone into global health, and I was off to a great start in a career in that field. Then I spent a year in South Sudan in 1999, and it was fascinating; there was very little infrastructure, no roads, no running water, no electricity. The only mode of communication was two-way radio, and you could only really communicate with someone who had his or her own two-way radio. So it was very limited in terms of the ability to communicate.
I was there to help rehabilitate a health facility. And there was this one situation that really drove home for me the importance of communication and the need for communication. There was a very young woman who came in for a delivery. She was very petite and pregnant with twins, and it was a complex delivery. There was a nurse midwife on staff at the health facility, but there was only one OB/GYN serving the region. We were able to coordinate through two-way radio with the one OB/GYN, who was about five hours away, and we were able to transport the young woman to the OB/GYN. She had a successful delivery, and both she and the twins were okay. That was only because we were able to coordinate through communications technology. Three days later, we learned that the woman and her twins all died because of the poor quality of nursing care in the facility. What really hit home for me was that technology is an enabler and a really important component of accessing health services, but it is only as good as the services and the people to which that technology can connect patients. Technology is part of a larger intervention, but it can’t do everything.
About a year and a half later, I was working in New York for a dotcom, and a mentor said she was writing recommendations for me to do a PhD. She asked where I wanted her to send them. I had never thought of doing a PhD but thought, wouldn’t it be interesting to look at how technology can be used to improve public health programs in developing countries? At the time most people in this field were talking about the “digital divide” and looking at the Internet as the solution. But the people in the countries where I had been working, mostly in East Africa, did not have Internet; they don’t even have electricity! But I thought, what can we do with cell phones? At the time, the penetration rate for mobile phones in developing countries was around 1% (no more than 3%) and was concentrated in the urban areas, with wealthy people who could afford mobile phones. Despite this, I thought, what if we found a way to use those mobile phones to improve health?
I was fortunate to find a science and technology studies sociologist at the London School of Hygiene and Tropical Medicine who was enthusiastic about my interest in researching mobile phones and health. This led to my PhD exploring health-related uses of mobile phones in Egypt, which I completed in 2006 for which I was recently awarded the UK Education Social Impact Award by the British Council.
What are you personally most proud of in your career? What has been the most rewarding part for you?
I am most proud of sticking to my gut. When you are one of the first people to start to explore an area – and especially an area in which you are already pretty well-established (for me, that area was public health) – people are going to say, “You’re crazy! What are you doing?” So for me, the thing I’m proudest of is sticking with it.
The time between the start of my research in 2000 to the time when things in this field started to take off around 2007 or 2008—was tough. I continued to work in other aspects of public health, and I never thought I’d have a career focused on mobile phones and public health. What I’m really proud of is that it became a field, and I was able to be very involved in defining what “mHealth” is and would be in the future. Navigating the field, adapting to the changing environment, and watching it grow over the past 15 years has and continues to be incredibly rewarding.
What has been the most surprising thing to you about your career and your work to improve global health?
I think it’s the gender aspects of it. Interestingly enough, mHealth was largely started by female pioneers; and then the field’s leadership shifted largely toward more established men. There was a time when I was invited to speak on a panel, entitled, “The Women of mHealth,” because there were only women leading the field at the time. What I have come to learn since is that there is a significant lack of women in STEM in general. Having grown up with a mother who was a mainframe computer programmer and an older sister who followed suit, it never dawned on me that there was this gap in women in the sciences until I got into mHealth. Many of the mHealth applications that are being developed and implemented target women as beneficiaries, but the applications are often developed by men. So there’s a disconnect between the work we do and the people we’re trying to serve. We see these gender dynamics everywhere in the world. But in technology and health, it’s really palpable.
Do you have any advice for young leaders?
Go with your gut. A lot of the time, people will push you on the logic. But there’s a lot you can intuit. Be brave, take courage, and pursue your unconventional idea until it becomes very clear you should not be pursuing it anymore. There were a million times I could have thrown in the towel and gone back to more traditional roles in public health. But sticking it out has made such a difference. Take courage, and don’t be afraid to break ground in a whole new area. As my dad, who immigrated to the United States from Egypt so he could pursue a career in computer science, once said to me, “I can guarantee you one thing… you won’t get there if you don’t try.”