Drones battle TB in remote Madagascar villages with help from Montreal researcher

For medical workers to reach residents of remote villages in Madagascar, they often have to travel for days on foot, trekking through wilds and rice farms.

Or else, ill villagers must make the trip themselves to reach clinics, leaving their families behind for days or even weeks at a time. 

But a Montreal researcher is determined to speed up the process of diagnosing and treating the inhabitants of remote Madagascan villages.

Dr. Simon Grandjean-Lapierre, an infectious-disease expert, has joined a team that is using drones to get medical help to tuberculosis patients in the farthest reaches of the island nation.

With the assistance of local volunteers, the drones can both collect samples and deliver medical supplies.

"What this system allows us to do is diagnose and then do some counselling and care for the patient throughout the treatment period without having the patient leave the community," Grandjean-Lapierre told CBC Montreal's Daybreak.

"People can keep working and it also saves a lot of time for medical teams."

In 2017, there were nearly 30,000 cases of tuberculosis reported in Madagascar, which is located approximately 400 kilometres off the coast of East Africa. 

Combining drone and app-based technology 

Grandjean-Lapierre's home institution, the Centre hospitalier de l'Université de Montréal (CHUM), is collaborating with Stony Brook University in New York and the Pasteur Institute of Madagascar on the pilot project, which flies unmanned, bi-directional aircraft in and out of 61 remote villages.

The drones can cover long distances over rough, hilly terrain that is thick with flora in some areas and saturated by rice paddies in others.

Drones, too, are more reliable than off-road vehicles, which can only be used during the dry season. During rainy season in Madagascar, it's often foot travel only.

Doctors Without Borders and other groups have been using drones to assist medical workers for several years, but this pilot project is looking to improve the capabilities of drones by incorporating a range of technologies and services.

"The drone is one technology," Grandjean-Lapierre said in an interview from the capital city of Antananarivo. "This project integrates a bundle of different kinds of technology."

Along with the drones, the project relies on mobile-phone apps and training given to volunteers in the remote villages.

Those volunteers have minimal medical training, but serve as a communication link between medical workers and the village, calling for assistance when needed and ensuring medications are properly delivered to patients.

Blood samples can be loaded onto the drones and sent to labs for testing. The community volunteers also educate patients on the importance of taking medication, how to take it and what relapse signs to look for further down the road.

Treating tuberculosis can take up to nine months even if patients take their medication properly throughout the treatment period.

"We have these digital adherence monitoring boxes which are plastic boxes with an electronic chip and a SIM card that will record whether a patient opened and closed their pill boxes when they're expected to on a daily basis," Grandjean-Lapierre said.

Researcher says project is a success 

When the project first got underway a year ago, there were worries that medications or blood samples would get lost or damaged during the trip, but that hasn't happened.

And though some of the communities he's worked with have never even seen a plane, Grandjean-Lapierre said villagers were informed about the project before the drones arrived and none have reacted negatively. 

"It's all been really smooth sailing," Grandjean-Lapierre said. "It's well-accepted by communities."

He estimates that access to diagnosis has increased by about 50 per cent since the project began, and twice as many patients are now being treated. 

It's a project that could be used around the globe to diagnose and treat not just tuberculosis, but a range of diseases, such as malaria or HIV, he said.

Grandjean-Lapierre said the more regions that adopt the practice, the more cost effective and efficient the medical drones will become.