In 2010, MSF (Doctors Without Borders) assigned ten year veteran Ivan Gayton as Head of Mission to Haiti immediately following the devastating earthquake that shook Port-au-Prince almost to the ground. Gayton knew about epidemiology from his long experience, and knew the importance of “contact tracing,” the ability to ask incoming patients “Where are you from?” in order to build a picture of where trouble is focussed.

Damaged buildings PaP
Damaged buildings post earthquake in Port-au-Prince, 2010. Photo Credit Wikipedia.

Cholera cases were beginning to mount, and the sensible course was to find out where they were coming from—English physician John Snow had pioneered the method of mapping patient origin during the London outbreak in 1854, and is credited with pioneering the field of epidemiology. By finding out where people lived, he was able to deduce that the water they were sharing was a possible cause of their illness—by ordering a couple of particular water pumps locked (a model is still on display in its original location in London, England, on Broad Street), he was able to stop the spread of Cholera and save lives.

Gayton realized the situation was similar, and needed a patient origin map urgently. There was a secret weapon at hand: members of the Haitian diaspora had been contributing to an emerging open source map called OpenStreetMap, and Port-au-Prince was quite well mapped. (This is an extremely important point in many low-income contexts, where names can be very ambiguous—Port-au-Prince had more than a dozen streets named “Street of the Church” and some countries have scores of villages named “Place where the people live.”)

John Snow’s incidence map, London, 1854.

Google responded to the call for assistance, and sent two of their best programmers to customize a “Dashboard”—a visual representation of the city in the form of a map that ALSO showed the incidence of case load originating in different areas of the city. The Dashboard was initially developed by British Red Cross , with some input form Gayton. This gave him access to the relevant information on the Cholera outbreaks. Just like John Snow had done, he was able to pinpoint probable trouble spots. He was the one calling the Port-au-Prince water department; he had information before they did.

Missing Maps is Formed

Upon returning, Gayton co-founded Missing Maps, which sparked during discussions at MSF’s highly respected Manson Unit in the UK. Manson is an interdisciplinary unit that handles research and development of MSF field policies and methodology. One of the keystones of MSF philosophy is a bias for action—innovation is expected to be part of every crisis field assignment. At the Manson Unit, they are encouraged to develop new ideas that will be game changers. That is exactly what the Missing Maps project did.

Sierra Leone, Ebola Outbreak, 2014

West African Eboloa outbreak 2014-2016

Leap to 2014, and this time Gayton is on assignment for MSF in West Africa. Conditions are stringent and stress is high. Staff is under a strict protocol to touch no other human being during the time of their deployment. Patient origins can only be identified in 20% of the cases that are coming to the Maburka unit. Its a heartbreaking tragedy; patients must also be kept in strict isolation even while they suffer, and excruciating to realise that accurate contact tracing would save lives.

Missing Maps Trailblazing Work

Missing Maps was in its infancy. A partnership among the American Red Cross, British Red Cross, Medicins Sans Frontieres and the Humanitarian OpenStreetMap Team. The field of humanitarian mapping was bursting out with possibilities to orchestrate mapping efforts leveraging freely available open source data. Apps like Open Data Kit – which can be installed on an Android based phone – and QGIS, a Geographical Information Systems software. In reviewing areas that lacked accurate maps, it was all too apparent that the extent of the problem was large. Many official maps were extremely dated.

Mapping locations of place names doesn’t begin to scratch the surface of the possible applications of humanitarian mapping.. All kinds of NGO projects can benefit from data visualization—but the accurate naming of places is a foundation for all of them. Gayton was in his element working at the frontier of the possible, but demands of a growing family, and another opportunity offered, caused his departure after a long 13 year tenure with the MSF organization.

West Africa Motorcycle Mapping is Born

By the fall of 2016, Gayton thought that conditions were right to bring some of the suite of field techniques together in a new project with the aim of developing a Playbook which could be shared, and could ultimately empower people in Sub-Saharan Africa with better access to health care. He had travelled all over the world during his time with MSF, but Africa was particularly close to his heart, and, in fact, he had moved his family there earlier that year. He knew full well that that some theatres presented extreme challenges for deployment of any kind of project. He had spent time in South Sudan, and had earned a nickname from the French Army after successfully taking a convey through CAF to deliver aid to South Sudan (there was no possible air access); the French had claimed the road was impassable.

Williams and the Art of Motorcycle Maintainance Clearing the flood waters after getting swamped
Maintenance time!

The idea of WAMM was to merge the ubiquitous technologies available on the ground with the high tech savvy of modern information management. What was everywhere in Africa? Motorcycles and Cellular phones. The idea wasn’t completely new, but Gayton had an extreme ambition—ground proofing the delivery of the bespoke incidence monitoring Dashboard software in concert with mapping efforts.

Where the Rubber Hits the Road

More than six months of detailed planning came to fruition as the initial team hit the ground On June 8, 2017, arriving in Freetown airport, and dragging their bags over to the Ferry which transfers newcomers across the Bay—otherwise it is a six hour drive by land. The team got quickly to work, heading out to the Kailahun District in the South East of the Country, aiming to meet with Ed Monk, a UK doctor who was very interested in Epidemiology, and was volunteering for a 4 month stint at the Nixon Memorial Hospital perched on the hill above the small town of Segbwema.

Typical ward at Nixon Hospital, similar as to how it looks today.

Monk and Gayton had been plotting a possible contribution to the Nixon Hospital—a modern, and accurate, Gazetteer with a complete list of place names in the catchment area—and to combine it with a state-of-the-art incidence visualization dashboard which could be read, over time, to show blossoming problems, just as the dashboard in Haiti had been able to show Gayton the exact locations of compromised water quality that were causing Cholera outbreaks in Haiti after the earthquake.

Gayton had a secret weapon in his plan to get the dashboard up and running—long time associate and expert computer programmer Ka-Ping Yee, who had actually been one of the team which Google had sent to Haiti after Gayton called for help. The race was on for the ground team to get mapping fast—the dashboard couldn’t be built without a substantial number of place names—and especially their properly associated administration divisions. Ping (as he prefers) arrived for a whirlwind tour on July 7th. He had a week to get his dashboard built, left with a smile on his face—success!

Ground Proofing

Screen shot 2
A sophisticated incidence tracking system, the one in use now at Nixon.

For this, the community-sensitive sharp end of the operation, approximately ten teams (a surveyor with an Android phone and a rider-motorcycle driver) travel the tracks, rivers, even rock-faces of the deep interior, using a complex set of skills only found in capacities of the locals. Outsiders couldn’t do it! The coordination of this needs to be dynamic yet delicate. To join him in this work, Gayton called in field-mapping coordinator Rupert Allan, who, already supporting the project design from the UK, had coordinated Missing Maps projects like West Africa Post Ebola Border surveying in Sierra Leone in 2016. With field coordination and ongoing international support split between the two coordinators, the mission is anchored in Sierra Leone by Randy Jones, stationed as Project Director, watching day-to-day operations.

Withe the aim to complete the Kailahun District bye the end of July 2017, this phase has provided the opportunity to field test communication and deployment strategies in an environment which provides many logistical challenges. The objective is to create an agile and adaptable system of operation that is responsive to emergent conditions. There is difficulty with transmission of data at times; the unexpected looms daily, and friendships need to be formed quickly with local people in order to get motorbikes across rivers, train surveyors and get communities mapped.

Off the Edge of the Known World

The team is highly confident that methods can be developed which are both flexible and accountable to international data standards. After taking the developing processes through more iterations and subjecting them to field testing, we aim to deploy a team sometime in 2018 in either Congo or South Sudan, taking the hard won expertise into some of the most extreme social environments on Earth to see if we can move closer to the goal of putting EVERYONE on the map!