It was a great shock to learn that Dr. Marc Mitchell, one of the pioneers of digital health, passed away at the end of June. There is much to celebrate about Marc’s life and achievements, whose loss has left a huge hole.
Marc had a deep, personal impact on our and many careers. We started working together around 2005, with a shared interest in using technology to improve global health. Marc was the principal investigator on the first grant we worked on together: a grant at the Harvard School of Public Health to use handheld computers to help counselors triage HIV patients in South Africa. While we were eager to learn about health systems in low-income countries, Marc was already an expert thanks to his years of work in Tanzania and Papua New Guinea. He helped channel our enthusiasm for applying digital technology to the world’s great problems into ideas and solutions that could actually make a difference. So much of what we decided to focus on since 2005 has been a direct result of his guidance and vision.
Marc founded D-tree to improve public health delivery through digital interventions. Remarkably early on, he had a clear vision of how digital decision support could transform health systems. In the early 2000s, there were all kinds of ideas flying around. But the things that Marc was saying then now seem quite prescient, and he held steadfast to his vision of providing digital decision support on handhelds to frontline workers. Many of us are still trying to realize this vision today. Among other things, Marc’s support of decision support applications for both nurses and CHWs led to the creation of CommCare, which was initially a collaboration between many organizations.
Marc was a teacher through and through. There was no way to be in a conversation or a meeting with him without learning something from his wisdom, conviction, and forthrightness. Marc always impressed upon us that the technology was just a means to an end: The health system and patient were the real end game. Many of us at Dimagi have fond memories and formative stories of Marc, including this experience with Brian DeRenzi:
“I first met Marc Mitchell in Tanzania. I do not remember the exact moment, but I was a fresh Computer Science graduate student looking for a way to combine my desire to affect good in the world and my computer science background. Marc provided that direction with D-tree and his vision of deploying mobile tools for frontline workers. The initial three months that I spent in Tanzania – working with Marc, Neal, and others – cemented the direction of my career.
“The project, which we called e-IMCI, was to take the Integrated Management of Childhood Illness (IMCI) protocol and adapt it for use on a mobile device. In those days it was on a PDA, but now runs on an Android smartphone. Marc’s early vision was to increase adherence to diagnostic protocols, while simultaneously building a digital record as a byproduct of care. There were a few PDA-based projects elsewhere in the world, but it safe to say that with Marc’s clear vision, he was one of the early pioneers.
“Early in the project, the team traveled to observe a refresher IMCI training. It was a warm morning just outside of Dar es Salaam. We arrived via taxi at a health facility where approximately two dozen health workers had gathered for the training. As was customary, we were asked to introduce ourselves once we arrived.
“I went first, proudly greeting the group in awkward, stilted Swahili drawn from my extremely limited vocabulary, then immediately switching to English. The rest of the non-Tanzanians on our team all followed a similar pattern, fumbling with a greeting, then speaking to the group in English and pausing to allow their words to be translated. The health workers sat patiently and politely while we stated our names and expressed excitement about being able to learn from them.
“Marc introduced himself last, requiring no translation as he spoke in confident Swahili. The reaction was immediate. The polite interest turned to palpable excitement as murmured exclamations rippled through the group. Marc completed his personal introduction and continued in Swahili, describing the project and discussing the work that we were doing. His words were met with agreements and encouragement from the health workers. When he tentatively used a word at the edge of his knowledge of the language, the group responded with encouragement and affirmation that he was correct and being understood.
“The exact details of what Marc said have long since faded away, but undoubtedly he spoke about how important the work was that these individuals were doing. He would have encouraged and empowered the health workers, ensuring that they knew they were the key to improving health outcomes in their communities, that they were the experts on the frontlines working with the people, and that we were merely there to attempt to amplify their efforts. It would have been Marc’s nature to make it clear that they were equal partners in this project, working together as a team towards a simple, but difficult, common goal: to improve the health of the children in their communities.
“Despite the fact that almost 15 years have passed since that day, Marc’s introduction has stuck with me. I was humbled and inspired by his ability to connect and engage with the health workers. He was able to generate excitement, communicate his vision and make it clear that their opinion and perspective was not just required but essential for any success.
“For many, Marc provided leadership and vision in the digital health space. For me, Marc provided an output for my desire to work with technology and people. To say that he influenced my career and the way that I engage with communities is an understatement.”
Marc left behind further guidance, wisdom, and encouragement for the future of digital development. He recently co-authored a paper, “Digital Technology and the Future of Health Systems,” which lays out a roadmap for the ways in which digital technology can play an even bigger role in achieving universal health coverage for the poorest populations around the world. In re-reading the paper, it was comforting for us to hear again from an old friend and teacher.
Marc built D-tree into a wonderful, thriving organization that Dimagi has collaborated with for years. He was a driving force in our field ever since he stepped into it, and our entire industry will sorely miss his leadership and vision.