Mbingo Hospital: The Mayo of Cameroon!

In January of 2014 while attending a regional conference in Bamenda, Cameroon, I was asked to fix an imminent network problem at a large hospital an hour away. It had been down for over a week and they knew the problem was internal. I happened to guess what the problem was off the top of my head so just hours later with the help of Chris Jackson, it was working again. I was asked to return as soon as I could and teach their IT guys how to manage their fairly complex network.

I packed the family up a month later (then living in Banyo, Cameroon) and moved out there for a month commitment, taught a 2 week class to all the regional hospital IT guys, worked on the hospital's networks, servers and databases, and lots of little stuff.  Fourteen IT guys (and even a girl!!!) came from as far as 9 hrs away to attend my class.

They spent 2 weeks, 3 hrs a day (including Saturdays) listening to me babel on about subnet masks, parabolic antennas, and structured wiring.  I gave them a quiz everyday and even a final exam. They all tried very hard and did very well. I was impressed that they understood me as well as they did. They each received a certificate of completion. Two of the Mbingo Hospital IT guys and one expat, Jesse Paulsen, took the class and continued to work with me for the next month at Mbingo hospital.

 

The above diagram is the logical layout of the network while below is the physical layout.  I created these to help future IT guys (most likely voluntary expats) to understand the system as rapidly as possible.

We completely rebuilt the network. Mbingo Hospital is a massive hospital with over 300 beds, digital X-rays, Electronic Medical Records, case logs, and electronic billing. It has 24 routers/APs (even after it was greatly simplified), 12 switches, 12,000 ft of Cat5 cable, 5 servers and spans over ¾ of a square mile. There are over 275 devices on the network including each doctor's tablet. Needless to say, I worked continuously alongside the three other guys the entire time. We greatly simplified the network, removing stuff that had built up for the last decade without anyone redoing it. We removed 2,000 ft of cable that was causing loops and reorganized the rest so that future folks could more rapidly understand and make adjustments to it. The problem was that so many people had come and worked on it for short periods, but no one had spent the necessary time to completely reevaluate it. We trekked around the premises removing bad APs, realigned them, changed the frequencies, relocated them, optimized them, removed them, simplified them... Overall the wireless network was running considerable better. We added a Linux firewall to filter inappropriate content, block bandwidth hogs, and block facebook and other social media sites during work hours (extremely popular amongst some and not so much for others). We added an internal portal website which allowed the staff to more rapidly look up phone extensions, connect to internal servers, and test their connections.

We also created a program which would monitor all the devices on the network and alert when something went down. I presented my findings to the heads of the hospital and made some future recommendations which they seemed to take seriously. Overall I had a wonderful time, lost some weight, and felt some significant improvements to the hospital's network were made. Hopefully the training I did will allow these 14 Cameroonian IT guys to further improve the Cameroonian hospital system.

What I learned:

• Terrestrial Internet is unreliable even when you have the CEOs number on speed dial.  Mixing a satellite connection with terrestrial connections gives you the best of both words.  If politics or rain conditions take out your terrestrial connection, you've always got satellite at 10x the price and 1/10th the speed.  Having a satellite provider in the blend even at a slow speed can at least keep things moving.
• I did not feel I did a good job working with the local staff.  I tried. I really did, to involve them but deadlines and efficiency took over.  I would say I have a lot of patience but still greatly lacking for the task.  I have kept in contact with them and we have a good relationship.  They would like me to return once again to help install the CHIAS software.
• DOCUMENTATION.  I can't stress how important it is to properly document your work in Africa.  Since there will likely be dozens of future IT people coming along with tight schedules creating accurate, up-to-date documents of things can be a God-send for anyone volunteering.  The learning curve on a system of this size could take you the entire trip just to wrap your mind around how it is built much less make improvements.
• Medical information on the Internet is incredibly useful to Doctors.  I didn't realize how powerful some of these free sites are to doctors in  the US much less doctors in Africa.  Access to UpToDate, epocrates and emedicine to name a few can GREATLY increase the medical care provided.  Pass the Word!
• Never ever put a 2.4GHz wireless backbone in place.  There are way too few channels in that band.  I put a 5GHz system in at Banyo and I can only hope that someday we can upgrade Mbingo to 5 GHz.  We spent tons of hours using MetaGeek inSSIDer trying to fix overlap.  And that's with no noisy neighbors!
• Clearly label switches and routes that are using Spanning Tree Protocol so when future people replace a dead switch they will realize they are crashing the network by replacing it.  Label every wire, every time.
• Great programs used in this project: MetaGeek inSSIDer and Wifi Analyzer for Android for troubleshooting wireless problems.  Wireless management: Ubiquiti AirControl2, Ubiquiti Unifi Controller.  For documentation: Network Notepad, Google Earth, and spreadsheets