Training increases HINARI and AGORA benefits
More than 100 publishers have opened up their online subscription journals to researchers in the world's poorest countries. But using information isn't easy if the users have no experience of such resources. Siân Harris finds out how training is helping
What do librarians do when they retire? There must be nearly as many answers for this as there are librarians, but Lenny Rhine’s retirement activity has to score pretty highly on the list of interesting responses.
Since taking early retirement from the University of Florida, Rhine has been spending much of his time travelling the world. He’s not in search of a great sun tan, though; his aim is to train librarians in the developing world in how to use digital resources.
In 2002, medical staff and researchers in the world’s poorest countries began to have access to the latest cutting-edge research thanks to the World Health Organization’s (WHO’s) HINARI (Health InterNetwork Access to Research Initiative) programme . Through this, around 100 biomedical publishers – from the giants with hundreds of journals to small society publishers with one or two titles – opened up electronic access to their products to those who cannot afford to subscribe to any journals. This resource currently gives access to around 3,750 biomedical journals, which would be equivalent to around £1.5 m per year in subscription costs. This gives trainee doctors in Sierra Leone, for example, access to the same range of resources as their counterparts in Oxford University or Harvard. Such resources have the potential to transform clinical practice, medical training and research in such countries, and 2,500 institutions in the developing world have so far signed up to access these resources.
However, there is a challenge: until recently many institutions in the developing world have been relying on 20 or 30 year old books for their research and teaching and have little or no experience of using the internet. This is where Rhine comes in. He runs training courses to teach medical librarians and health workers how to use the massive array of resources that have now become available to them. ‘They have gone from nothing to almost too much, so we spend a lot of time teaching search skills,’ he commented.
Rhine started doing workshops in the developing world in 1997, while still working as a medical librarian at the University of Florida. ‘It started off about health information on the internet,’ he explained. This led to his involvement with HINARI as these resources became available. He worked with the WHO to develop the original training modules and is now in the process of updating them. ‘Being retired now means I have time to work on this. I have hours to spend updating the training modules,’ he pointed out.
Lenny Rhine has recently returned from training medical libraries and other staff in Vietnam
Training material needs regular updating because, for example, when publishers’ websites and databases are redesigned, the screenshots and guidelines on how to navigate these sites must be changed and then the updated versions translated into several languages. Rhine’s aim is to ensure that at least the English versions of these training materials are up-to-date.
This training material forms the basis of eight training workshops that Rhine is running this year in Africa and the Asia-Pacific region, as well as an email course for those who cannot attend one of these workshops. Funding for this comes from Elsevier, which has given a grant of $80,000 this year through its ‘Libraries Without Borders’ partnership with the Medical Libraries Association. Half of this money will be spent on health-based training, to train HINARI users and half will be spent training users of a sister initiative, AGORA , which provides agricultural information (see box below).
‘Lenny has been training in Africa as long as I’ve known him. He knows everybody and knows where the need is. We thought we could do more to help,’ explained Tony McSean, Elsevier’s director of library relations. ‘Rather than do it by ourselves as an Elsevier initiative, we thought we’d team up with the Medical Library Association and give them the money to coordinate the training activities that Lenny does.’
McSean and his colleagues at Elsevier have been very impressed with Rhine’s training courses. ‘It’s amazing value for money. Because Lenny is doing it there’s not a penny wasted. He’s not a man to take a taxi if there’s a bus running. It works out at about $10,000 per trip, which includes all the flights, materials and everything. It is an extraordinarily good thing,’ said McSean.
So what do Rhine’s courses cover? Firstly, there is how to use the internet and to search for resources. As well as the resources included in HINARI there are open-access journals and also preprints in databases such as PubMed Central. ‘I see people interested in whatever way they can get the full text,’ he said. ‘When we teach PubMed, we teach them how to do keyword searches to get all HINARI and open-access papers.’ Links to open-access journals are also provided from the search pages of HINARI and its sister sites.
A second aspect of the training is showing people what their institution’s HINARI licence permits them to do. ‘One of the most fascinating dynamics is explaining how you can and can’t use HINARI,’ said Rhine. ‘For example, you can’t download or print complete journals. You can print out and include material in courses. You can also charge for printing costs but must not charge for the material itself.’
He also observed differences in attitudes about the institutional passwords that are required for access to HINARI. These are intended to be used by all members and guests of a registered institution. However, he said, ‘sometimes librarians guard the passwords and don’t give them out, whereas others are too liberal in giving them to all their friends.’
Such attitudes about passwords were also observed in a recent study about awareness and access to free resources published in the journal BMC Health Services Research . The study interviewed over 300 researchers and medical students in five African countries and reported that librarians sometimes limit access to passwords. The study also revealed that while 90 per cent of respondents had heard of PubMed, only 47 per cent had heard of HINARI. The authors of the paper concluded that awareness of free-access initiatives is limited.
This finding highlights another important goal of Rhine’s training courses. ‘We also need to teach librarians about marketing. They need to learn not just how to use HINARI but how to promote it, by, for example, going to faculty members and telling them they need to teach students about online information and put it in their courses,’ he said. ‘Staff are giving the same lectures as they were 20 years ago because they have had no access to new information. We have to talk to people about how to integrate new information into the curriculum.’ As Elizeus Rutebemberwa of the Institute of Public Health, Uganda, commented, ‘I am enjoying the exercises and I am sharing the skills with my students.’
The latest updated course material that Rhine is now working on includes a new component too: information about publishing skills, which he anticipates could also be useful to other programmes. This element of the course includes, for example, how to submit papers to journals, how to identify good journals, other resources on the web and case studies.
Elsevier’s McSean agrees with the importance of this area. ‘One of the side benefits that we hope to see from HINARI is an increase in authorship from the developing world. We are already starting to see new research that probably wouldn’t have taken place without resources like HINARI,’ he commented. ‘It’s a long-term good: the more working scientists become used to high-quality research the better their research and the more they’ll want to publish.’
Mohamed Jalloh of Senegal believes that this aim is successful: ‘There is no doubt that I will be more efficient in using HINARI after completing this training. HINARI has helped me a lot in the few publications I have done with my colleagues. Thank you for helping.’
Despite the impact of opening up access to HINARI and its sister sites and the training in how to use the resources, there are still big challenges. The research resources may be the same as those available at leading developed world institutions but the computers and bandwidth are generally very different. ‘In some areas, especially in Africa, it can take an hour to download a PDF,’ pointed out Rhine.
McSean added that delegates at a recent conference in Africa reported working at night or even hiring dedicated staff to work night shifts in order to use the most available bandwidth to access HINARI.
Nonetheless, things are improving, according to Rhine and McSean. Rhine described how a radiologist in Tanzania attended one of the training courses and then wrote a grant proposal to get the necessary bandwidth and computers for his library. And McSean commented: ‘We’ve discovered that once you’ve got deans of faculties who’ve been trained to use HINARI they will find the broadband access. In one African university, for example, a faculty member paid for the broadband access himself out of his earnings from his private practice. That’s one of the things we are hoping to achieve.’
So, what’s next? Elsevier’s training grant lasts until the end of this year. ‘We hope that it continues or another publisher wants to get involved and continue it,’ said Rhine. ‘It’s very rewarding to teach bright people and help to bridge the information gap. I’m motivated all the time.’
 HINARI: www.who.int/hinari
 AGORA: www.aginternetwork.org
 ‘Access to electronic health knowledge in five countries in Africa: a descriptive study’, BMC Health Services Research 2007, 7, 72
 OARE: www.oaresciences.org