Oh no! Power out, internet down! Two challenges in running training courses in low- and middle-income countries.

Abstract

We have just completed our 13th Operational Research Training Course, run jointly by the International Union Against Tuberculosis and Lung Disease and Medecins Sans Frontieres–Luxembourg. The aim of each course is simple: to train and mentor participants from low- and middle-income countries in the development of a research protocol all the way through to publishing a paper in a peer-reviewed journal, with a view to this research making a difference for policy and practice.1 To date we have run six courses in Europe, while seven have been decentralised to other countries: Kenya (n = 1), Ethiopia (n = 1), Nepal (n = 2), Fiji (n = 2) and India (n = 1). In all the decentralised courses, two of the main challenges we have faced have been irregular power supply and poor and/or intermittent internet access. The latter is particularly frustrating, as uninterrupted access to the internet is needed for 1) demonstrating the on-line use of the various software packages used for data entry and analysis (Epi Info and EpiData), literature searches (PubMed) and free reference management such as Mendeley; 2) demonstrating on-line paper submission; and 3) enabling protocols and papers to be shared by e-mail between participants and mentors as ongoing iterations develop during the five-day modules. To resolve these issues, we took a dedicated ‘Network Kit’, including an alternative power source, to our most recent operational research course in Addis Ababa, Ethiopia. It had to be used within a day of arrival . . . Power outages were tackled by plugging the LCD projector and the lecturer’s computer laptop into a UPS (uninterruptible power supply, i.e., a battery that provides up to 2 hours of autonomous power). Although the lights went on and off almost every hour, signifying power interruptions, the lectures proceeded smoothly and seamlessly as the UPS provided continuous power. Issues regarding the exchange of information were taken care of by the network part of our solution, consisting of a network switch and a firewall-router/wireless access point, both providing connectivity to an NAS (network attached storage). The NAS, acting as a server, provides for basic file sharing in a simple workgroup environment, allowing people to exchange and access different resources in a private, secured network space (anti-virus and password protected access). It also offers other network services such as printer sharing. The whole setup is powered by the UPS, resulting in a whole package of services able to withstand up to 2 hours of power outage. Both parts of the kit are packed in a flight case (approximate weight 50 kg) for ease of transportation and to protect the different components from damage. In a future iteration of this setup we plan to include: 1) a common workspace, customised for every trainee and replicated to ‘cloud’ storage (data storage accessible through the internet), making the network accessible seamlessly from within or outside the course environment; 2) an automated installation procedure for the different components and services, obviating the need for an IT (information technology) specialist during setup in the courses; 3) expanded wireless coverage; and 4) alternative internet connections (multi WAN—wide area connection network), so that if one connection fails the internet traffic is automatically routed to the other. As a result of these initiatives, our previous anxieties and frustrations with the power supply and internet connections were resolved. At a cost of about 1600 EURO (∼US$2000), this was a relatively inexpensive ‘fix’ for a problem that plagues training courses throughout low- and middle-income countries,2,3 and we highly recommend such a system.