What’s everyone texting about?

A few, very committed individuals – my mother and sister – set out to answer that question. My mom, Casey Nesbit (DPT), receives every message that is sent to the hospital, via email (thanks to a simple forwarding command in FrontlineSMS). Those messages are in Chichewa. For four months, she translated every message to English.

My sister, Elizabeth Nesbit, decided to code and organize every SMS sent by the CHWs. She’s a sophomore at Rice University, making her way to medical school. She categorized messages by keywords and/or phrases (e.g. symptoms, supplies, patient updates/referrals, deaths, requests for help, requests for visits, meeting coordination).

Under this introduction is a list of all the symptoms found in messages communicated to the hospital. Elizabeth sorted these symptoms out into categories (body pains, digestive and urinary tract, respiratory tract, swelling, skin and sores, malaria and fever, weakness, heart problems, cancer, and other). She broke apart every incoming message this way.

Below the symptom list, you’ll find the fruit of their combined efforts – charts explaining the subject matter of texts to the hospital. Click on any of the charts to view a larger version. These messages fell between mid-August and early December. Shoot me an email if you want to see more of Elizabeth’s analysis.


scabs, TB, sores on lungs, swollen leg, swelling, weakness, bowel problems, begun to be sick, vomiting, hypertension, disease of the blood pressure, coughing, weak stomach, bowels, rash, malaria fever, HIV positive, coughing, weakness on ARVs, porridge coming out of nose, diarrhea, headache, weakness, swollen legs, delayed reactions, sick, swollen eyes, headache, weakness, loss of appetite, painful scar, unable to walk, leg and joint pain, cannot take medicine, itching stopped, trouble with teeth, sores, swelling in the legs, stomach, swelling, joint pain, trouble straightening leg, congestive heart failure, chest pain, headaches, pain in the joints, paralysis from knees up to waist, asthma, two patients ill, swollen leg, TB, high blood pressure, arm and leg, sores in mouth, mouth sores,TB patient with swollen legs, high blood pressure, stomach swelling, HIV, cough for three weeks, out of breath, swollen, sores, diarrhea, difficulty with legs, patients with diarrhea, stomach twisting, cramping, coughing, TB, HIV, trouble breathing, TB, pain in legs, legs not swollen, can walk, diarrhea, malaria, TB, can’t eat, cancer, not eating, vomiting, burning feet, swollen hand, back pain, severe headache, pain in middle of stomach, sick on ARVs, chest cold, frequent pain, lost voice, chest cold, coughing, chest cold, TB, asthma, trouble walking, boil, swelling, passing blood, TB patient feeling itchy, passing blood, swollen legs, itchiness, shaky because of food, head fever, or malaria, TB, shortness of breath, swelling in armpit, rash, eye, headache, malaria, drinking, convulsions, swollen stomach, elderly, needed food, diarrhea, ear problems, blood oozing out, body wounds, vomiting, swollen, fever, swelling of neck, swelling of stomach—head chief, cough, swelling in legs, stomach problems, out of breath, legs and stomach pain, wound, leg numbness, body aches, diarrhea, difficulty after stomach operation, HIV, crying, hot feet, coughing, malaria, vomiting, sick, trouble with legs, bursting sores, swollen feet, swelling, urine with blood, stomach pain, fever, congestive heart failure, unable to eat, head, fever, general body weakness, demented, swelling, chest cold from TB, body wasting, can’t walk, weak legs, trouble breathing, TB, malaria, body weakness, fever, chest cold, diarrhea, shortness of breath, back ache, leg pain, coughing, sick—malaria, vomiting, loss of appetite, headache, vomiting, malaria, feet pain, fever, back ache, arm pain, body aches, swelling, puss, pregnancy trouble, leg pain, not eating, difficulty breathing, oozing wound, swelling, legs, fever, leg swelling, legs, fever, swollen stomach, slight headache, swelling of legs, face, chronic heart failure, oozing, difficulty with legs, chest cold, stomach pain, diarrhea, leg pain, wound breaking out, leg pain, HIV positive, shingles, leg difficulty, body ache, coughing, cancer—passing urine, yellow body, malaria, convulsions, body aches, body aches, foot pain, swelling of feet, passing urine, soft voice, sleeping for many days, abdominal pain, diarrhea, malaria, cough, weakness, paralysis in feet/toes, illness of head, swollen stomach.

Message Summary


Symptoms and Illnesses



Patient Updates and Referrals

Requests for Help


Many, many thanks to my mother and sister for all their work.

Posted: January 11th, 2009
Categories: HIV/AIDS Care, Home-Based Care, Other posts, Technology, Tuberculosis Management
Tags: , , , ,
Comments: 19 Comments.
Comment from kiwanja - January 12, 2009 at 8:43 am

Hey Josh

Not only some incredible analysis, but also a great team/family effort. There’s obviously something in the water back home!

There is sadly a major lack of impact data in many mobile-based projects, and many FrontlineSMS projects are no different (we hope to begin putting this right in the coming months). This is a great example of what’s possible.

The interesting thing will be to see how this replicates and scales, something which I know you’re working hard on right now.

Keep it up! Awesome work…


Comment from Enrique Allen - January 12, 2009 at 5:49 pm

Great job Josh, may I reblog on Captology?

Btw, who is sending the patient referrals?

Comment from Josh - January 12, 2009 at 6:04 pm

Thanks for the note, Ken! I'll be posting soon regarding everything that's happening outside Malawi.

Hey Enrique,

Feel free to reblog! Re: patient referral, here's the SMS line: CHW with patient symptoms –> Clinician responds with instructions to refer to hospital –> Confirmation of referral from CHW (this is what's referenced in the graphs).

Thanks for reading,


Comment from Anne Marie - January 13, 2009 at 4:09 pm
Comment from Hima Batavia - January 16, 2009 at 4:13 am

Josh, this analysis is wildly interested. I’m so intrigued.

Comment from Jeff Rafter - February 5, 2009 at 6:29 am

Hey Josh, awesome stuff. So do we get some guest writers (your mom and sister) soon to explain their methodology? Clearly, automated translation for Chichewa is tricky, but if the combination of keywords and translation could be used together then you might simplify the amount of work. It seems as though it would be useful to have a guide on coding the type of messages the project receives and how Elizabeth ultimately analyzed the results.

Comment from Chris Blow - February 6, 2009 at 10:34 pm

Wow a very impressive data set that would typically not be exposed. Super great work!

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one time i got diarrhea attack while riding on a long bus trip, it really sucks:~’

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diarrhea can sometimes be cause by spoiled foods or salmonella:”`

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Great. Thanks for typing this. It is always cool to see someone educate the public.

diarrhea is far from deadly but it is sure hell annoying and it sucks `

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