Ptolemy project: a scalable model for delivering health information in Africa, The

Introduction

How is Africa to build up the medical research it needs? Doctors in African research communities are starved of access to the journals and texts their colleagues in more developed countries regard as fundamental to good practice and research. The Global Forum for Health Research gives priority to interventions designed to build research capacity in developing countries and correct the disparity in health research.

Origins of the Ptolemy project

The Ptolemy project was conceived in a discussion between a surgeon and a librarian. The librarian (WH) is an electronic resources coordinator at the University of Toronto Library, the largest academic library in Canada and the third largest in North America, and was interested in expanding access to full text health information in and from developing countries.

Bioline International, also housed at the university, provides electronic publication for several scientific journals from developing countries, including the East African Journal of Medicine and the Central African Journal of Medicine. The Association of Surgeons of East Africa represents the 400 surgeons who care for a population of 200 million people in eight east African countries.

Summary points

Named after Ptolemy I Sotor (367-283 bc), the general who built the great library in Alexandria that housed the written corpus of the ancient African, Mediterranean, and Middle Eastern worlds, the Ptolemy project links the four institutions (University of Toronto Library, Office of International Surgery, Bioline International, Association of Surgeons of East Africa) in a partnership to build a research community, provides educational resources and clinical information, and investigate whether access to medical literature has a positive effect on surgical research, teaching, and practice in east Africa.

Development of the project

All of the library's 20 000 full text journals, 2538 of them medical journals, and hundreds of medical texts and links to free online health resources are available through Ptolemy click here. The Ptolemy project was introduced at the annual meeting of the Association of Surgeons of East Africa in Lusaka, Zambia, in December 2001. A subgroup of Ptolemy participants is now engaged in a Delphi process to identify the priorities for surgical development in East Africa.

The Ptolemy survey

Of the remaining 97 Ptolemy participants, 58 were surgeons, 42 were active in research, and 51 taught medical students, interns, and residents. Seventy-eight of the participants were in Africa, and 69 were in the eight countries of the Association of Surgeons of East Africa. We asked the participants about the impact and relevance of information derived from Ptolemy to three areas of practice—clinical, teaching, and research.

Fifty-eight respondents rated their overall satisfaction with the Ptolemy project as high or very high. The respondents' comments elicited by an open ended question in the survey paint a good picture of the impact Ptolemy is having in Africa

Sample comments from Ptolemy participants

"Up until I joined the Ptolemy project, I was only using abstracts for my work. This made life difficult, and my publication record to date is not good. The last good paper I published was in 2000, when I finished my PhD. I certainly regretted going back home to Africa as I thought my academic career was over. I now know that I will be up to date, and I will certainly come up with innovative research proposals." JC (Malawi)

"I am writing my dissertation for a masters in public health, and Ptolemy is assisting me at just the correct time." MS (Tanzania)

"I am very much interested in medical education, especially clinical education. The Ptolemy project helped me to find relevant information about the subject. It should be noted that, due to financial difficulties, we do not subscribe to any medical education journals." PG (Mozambique)

"I do my hernia operations differently just for starters." JB (India)

"Our library is poor in Lusaka, Zambia—no journals or books. Ptolemy opened for me a new world of knowledge. Like a child in a toy shop. It is difficult to stop once you start browsing. Unfortunately internet connection is often very poor, and downloading or opening a page is difficult. That is the time when I stop. Preparing a lecture in wound healing, I performed almost entirely from Ptolemy." GJ (Zambia)

"I have been able to write my proposal on a burns unit using the information I obtained from Ptolemy." PO (Kenya)

"My research on areas of developmental biology has received a tremendous boost, particularly that one is able to get full articles, as opposed to other sources such as PubMed where only abstracts may be available." RM (Kenya)

"I did not have access to most journal articles full text, and if I needed a paper badly, I would have to ask a colleague from Europe or North America to search, print and fax me the article. It would take forever, and I could not use this method too often. Now if I want a paper I download it off my computer. The only hitch is a slow and unreliable internet link... and I don't have to go to the library, where services are usually slow and crowded." OK (Uganda)

"The internet access in Gondar College of Medical Sciences, where I work is not good. Since the line is very slow, often I had difficulty of logging into your server. But during the limited time that I was able to access the server of the University of Toronto, I was able to retrieve relevant materials which enabled me to draft a paper, which hopefully will be published in the Ethiopian Medical Journal. I am grateful to the Ptolemy project for this." SB (Ethiopia)

"... no digital divide as long as Ptolemy is there. I have been able to access all I need from the library." SKS (Tanzania)

Appraisal

Ptolemy was designed to provide access to electronic health information and to analyse whether that service had a positive effect on surgical research, teaching, and practice in east Africa. Ptolemy provides free access to local, regional, and international journals, major online texts, and the Cochrane Library, but our participants clearly preferred journals (75%).

The commonest criticism of the utility of electronic health information in the developing world relates to slow, unreliable, and costly or non-existent internet access. Although it is costly to the participants personally, many surgeons valued library access from home.

Beyond providing access to the literature, Ptolemy draws them into an electronic community linked by medical curiosity, which can identify priorities and find solutions to regional surgical problems. Building surgical research capacity in east Africa requires far more than mere access to the literature, it involves drawing individuals into the larger project of solving problems. Ptolemy participants are presently involved in the East African Surgical Initiative-Delphi ("EASI-Delphi") process to identify priorities for surgical development in the region.

Comparison of electronic health information sources Ptolemy and the World Health Organization's HINARI. To view this table click here

Comparison with other information sources

We were not able to compare Ptolemy with other electronic health information sources such as the World Health Organization's HINARI, because no Ptolemy participants have yet been able to use it. The table lists the features that distinguish Ptolemy and HINARI. Essentially, Ptolemy links a large university library and a well defined community of end users and provides convenient access to a broad resource collection and assesses how they use it.

Expanding Ptolemy

Helping 100 surgeons to be better equipped for research, teaching, and clinical practice is a useful end in itself, but can the Ptolemy project grow.Although our respondents represent a substantial portion of the active academic surgical community there, their 100 proxy server accounts comprise only 0.2% of the University of Toronto's 50 000 proxy server library accounts. The cost of running Ptolemy lies mostly in its evaluation mechanisms.

Expanding access to health information in the developing world is likely to involve a mosaic of complementary approaches. Ptolemy provides both access for a well defined group of end users and a mechanism for evaluating their response. University libraries, the publishers' principal clients, should work towards enshrining access for research affiliates from the developing world in the licence agreements they negotiate. If other universities formed partnerships similar to that in the Ptolemy project it would be an effective and economical way to build essential health research capacity in Africa.

For more infomation contact:

Office of International Surgery

University of Toronto

Sunnybrook and Women's College Health Sciences

Ross Tilley Burn Centre

2075 Bayview Avenue

Toronto ON

M4N 3M5

Canada

massey.beveridge@sw.ca