The Ivory Coast, also known as Côte d’Ivoire, is a West African country with a population of around 24 million people. Yet, despite its idyllic sounding name, the Ivory Coast is a tough place to live. It is ranked 172 on the UN Human Development Index - an index created to emphasise that people and their capabilities should be the ultimate criteria for assessing the development of a country - not economic growth alone. Norway ranks number one of the HDI, the US ten and the UK 16.
In the Ivory Coast, this statistic translates into real hardship. Average life expectancy is just over 50 years, children spend under nine years at school and infant mortality is high. The Ivory Coast has a gross national income per capita of around $3,171. Norway’s GNI is over $80k and the US’ is just under $60k.
Sean O’Neil was, however, driven to make a difference and to save lives in the Ivory Coast. He was determined to build the Walgreens for rural Africa: a fully functioning and resilient pharmacy where people could buy the drugs they need to stay alive.
Why don’t you introduce yourself?
I’m Sean O’Neil and I’ve been working on the Ivory Coast project since 2012. It’s very much a labour of love - something I’ve done in my spare time. It’s been a great learning experience and also really great to make a difference in an area of the world that could use all the help it can get.
And, your project, tell us some more about that
It’s called the Emerging Business Builder Initiative. The goal is to deliver a modern pharmacy experience, one that would be familiar to anyone in the UK or the USA - a pharmacy that has supply chain management, back office, inventory management and a modern point of sale. It also has a loyalty programme - spend money to gain points that are redeemable against future products.
I worked for Optum, which is a US health company. I worked there for 21 years. My day job (I run enterprise architecture) introduced me to the idea of pharmacy management and from there this project - my hobby - was born.
So, what’s life like in West Africa?
If you think of the world’s population as a pyramid and you stratify income, three billion of the seven plus billion people on our planet occupy a big chunk at the pyramid’s base. They live on less than two dollars and 50 cents a day. If you go to the very bottom of the pyramid, there’s 1.3 billion people that live of less than a $1.25c a day.
Looking specifically at the Ivory Coast - the area I’m most familiar with - you have a life expectancy of only 51 years. When I present my project to people at Optum, that’s about the median age of people in the room.
These low life expectancy statistics come from the fact that so many children die. If we look at the leading causes of death, it’s dehydration from diarrhoea because they have malaria, or because they have a protozoa or a bacterial gut infection.
They get a high fever and if they’re not given electrolytes they’ll die. So, one of the biggest sellers at our pharmacy are electrolyte packages that a mum can mix into clean water. It’s only pennies but it’s the difference between life and death.
What about the costs of drugs?
Ironically, when I pay for drugs in the US, I’m reminded of how comparatively inexpensive drugs are in West Africa. Over there they’re price controlled by the government - the government sets the retail and the wholesale prices. You can go under those prices but not above. Prices are fiercely capped.
Talk to us about the technology and the infrastructure challenges you’ve faced
It’s extremely challenging and in ways that I didn’t anticipate. Electrical power is a big challenge. Clean and consistent power is completely unheard of. We lose power a few times a day and that’s normal. The power line quality is extremely variable... You can’t run a PC off it without conditioning - you’d fry your computer. So, all our lines are buffered with cheap, consumer grade UPS.
Back when we first started off our pharmacy I brought in some high-end PCs with touch screens and a consumer grade server. We had never-ending power failure problems.
And, of course, the internet doesn’t exist as a landline. Everything is done with mobile. In the Ivory Coast, people don’t even think of the internet as something that’s wired. There aren’t even WiFi hotspots - it’s all on your phone.
So, when we want synchronisation with the cloud, we do it with 3G and 4G USB modems. They synchronise our inventory up to the cloud at various times during the day. And they do so in an extremely minimal fashion because you’re charged by kilobyte.
When you’re synchronising, you need to think about the bytes you’re sending and only send what’s needed. Designing systems where there’s no waste is extremely gratifying. On a highspeed internet link in the States you just send the data. You don’t consider whether you’re sending redundant data or whether the handshake and the protocols are expensive. You don’t think about it because they’re all free in the US.
What about the PCs?
The PCs failed all the time and they were too expensive to expand. I’d been playing around with Raspberry Pis - those wonderful mini-computers. They’re $35 in the US. Add in a case, a power supply and a keyboard. Before you know where you’re at, you’re looking at $50. And that’s radically different from an $800 or $900 consumer-grade, touch screen PC.
I run the entire pharmacy off one Raspberry Pi and the other Pi does the point of sale - the reception. The reception connects to the ‘server’ - I laugh when I call it a server -through a browser. I laugh because, in IT, a server is a big machine with lots of fancy cooling and redundancy.
But, this little Raspberry Pi is even more fault tolerant than any other machine because it only sucks down 2.5 amps. So, unlike a big PC that might only have ten of 15 minutes of life on a UPS, a Raspberry Pi can last run for hours! That power problem goes away. We can lose power for hours and keep functioning.
And, there are no moving parts. In the dust and the heat of West Africa, moving parts like fans fail all too often. If a motherboard or power supply fan fails then the component is useless. The fan bearing might be just two cents but that entire piece of hardware is dead.
Everything in the Raspberry Pi is solid state. It runs off a mini-flash drive and it’s all extremely resilient. What’s more, this approach means a pharmacy can get started for a few hundred dollars.
What kind of software do you run?
It’s open source. We give away the software. A pharmacy can download it for free, download it to a flash drive and be up and running in under a day.
How is the project changing lives?
Bringing the pharmacy to the village has been amazing. It’s made a huge difference to people’s health and to their lives - people can get the drugs they need, when they need them. Oftentimes it’s the difference between life and death.
Before we built the pharmacy, people with health problems needed to take a twenty five kilometre taxi drive to the next village, and the taxi is a shared taxi. They sell five seats in a Honda Civic. If you need to go right away, you buy all five seats or you wait until all the seats have been sold. If you didn’t have enough money to buy all five seats, you could be stuck there all day.
Also, when you have a pharmacy, other businesses will start to grow. People can see that the town has economic viability. The local government paved the road after we built the pharmacy. And, once we had a paved road and a pharmacy, more businesses started to appear. It’s sparked economic vitality.
What’s more, the pharmacy staff are getting exposure to IT. So, I hope people can gain a comfort and familiarity with IT and hopefully go on to leave the pharmacy.