PAC Mate Enables Blind Medical Student to Achieve her Ultimate Goal

Portland, Oregon

In a few months, the newest doctor – and one of the first doctors of her kind in the nation – will hang her shingle in the Portland, Oregon area. Chris L. Cooke will become one of the first totally blind doctors in the US with a specialty in naturopathic medicine.

The new Dr. Cooke, blind since birth, will carry the usual medical instruments in her black bag, including a blood pressure cuff, a thermometer, and a Pocket PC crammed with medical references – a tool most modern doctors rely on to help with diagnosis, prescribing the right medicine, and ordering and interpreting lab work. The difference is her tools of the trade will talk. In fact, in large part, she credits her ability to be a good doctor to a PAC Mate™ accessible Pocket PC for the blind and two Oregon men who made medical reference software accessible to the visually impaired, using the PAC Mate.

The PAC Mate is the first and only accessible Pocket PC that is founded on mainstream technology. As such, it does more than talk; it can run many programs developed for off-the-shelf Pocket PCs – including medical software. The PAC Mate also incorporates JAWS for Windows®, leading screen reading software that can easily be adapted with scripts to make those programs accessible for blind users.

Cooke, who at 40 is completing her last months’ studies at the National College of Naturopathic Medicine in Portland, chose naturopathy as her specialty because, “Naturopathy combines the prescription of (standard manufactured) drugs with natural remedies and emphasizes general diagnosis, the use of natural therapeutics and traditional medicine, and we work with diet, nutrition, life style, and botanical medicine,” she said. “Ultimately, naturopathy is about treating the whole body and finding the cause of disease and not just symptoms.”
Naturopathic specialists are licensed in 15 states and all Canadian provinces. “We study the first two years the same as any MD studies - pharmacology and all the basic sciences,” she said. “In the last two years, we do thousands of hours of clinical work, and study nutrition, natural therapeutics, homeopathy, and botanical medicine. That’s where it is important to have (portable) access to medical research and current information. Medical knowledge changes weekly. It wouldn’t be practical to scan all this information and print it. It would be too unwieldy to have to look through all those printed resources and keep them updated, even with sighted assistance.”

“In my third year of medical studies last year, I realized that all the comprehensive medical reference software out there was moving toward PDAs (Personal Digital Assistants, also called Pocket PCs) or the Internet,” she said. “You don’t always have an Internet connection, so I decided a PDA would be best for me.”

Cooke was interested in Epocrates Essentials™, an all-in-one mobile guide to drugs, diseases, and diagnostics. “I looked into what could possibly run this kind of program for me (and be accessible). Only the PAC Mate could, so I contacted the Oregon Commission for the Blind and requested the purchase of a PAC Mate.”

She chose the BX 440 model which comes with a braille display and Perkins-style keyboard, often used by the blind in place of the traditional QWERTY typewriter layout keyboard. The PAC Mate, as with any mainstream Pocket PC or PDA, allows her to take notes, write and receive e-mail, surf the Web with an Internet connection, use a calendar, calculator, and other standard PDA functions – all made accessible for the blind.

“I really enjoy my PAC Mate,” said Cooke. “I take all my chart notes on it and print them out on a portable printer that works with it. I like the flexibility of having the traditional PDA applications running on my PAC Mate.”

She still had one more obstacle in her way. The professional medical software written for PDAs was not accessible to the blind.

“I knew the PAC Mate would run the (Epocrates) software, but it would need to be scripted to be accessible to me.”’ That’s where Michael Hooks, a legally blind former assistive technology specialist at the Washington State School for the Blind, stepped in. Along with his associate, Chris Meredith who is totally blind, Hooks owns and operates Next Level Assistive Technology, a Vancouver, Washington-based business that serves the greater Northwest. The company consults with universities, government agencies, and others on assistive technology and also sells accessible technology products.

Scripting is the process of writing a series of statements that tells JAWS how to navigate or what to read under different conditions. With the blessing of Epocrates, Inc., Hooks and Meredith began writing a script for the PAC Mate that would make the software accessible.

“I’ve been writing scripts for JAWS since 1996, basically since its inception,” Hooks said. “I have a lot of experience, but this was the first time I had written a script for the PAC Mate. A week or so later, Chris (Meredith) and I had it scripted, ready to go, and functional. The PAC Mate is truly the most powerful PDA for the blind on the market today. Most (Pocket PC software) can be installed and will work right out of the box. Because The PAC Mate uses JAWS, we can easily script programs to be fully functional. Competing products don’t have that kind of flexibility.”
“I was amazed at how quickly they had Epocrates scripted for my PAC Mate,” Cooke said. “I also enjoyed being part of the process, where (Hooks and Meredith) were not familiar with something medical, I could give them suggestions about how it worked best with us. It worked out really well.”

Cooke practices 12 hours a week in her school’s teaching clinics and a community clinic. With Epocrates made accessible, “Now I have access at my fingertips to diagnosis tools, signs and symptoms of diseases, and causes and treatments. I also have a lab tool. If I want to order a lab, I know how much it’s going to cost. I can interpret the lab work. Within one tool, I also have an infectious disease component, so, let’s say, if someone comes in with Strep throat, I can look it up and see what drugs are usually used to treat it.” She also is using Pocket Excel on the PAC Mate to set up a 450-item spreadsheet of medicinal product ingredients, prices, and pertinent information she needs when seeing patients.
Hooks and Meredith have gone on to write scripts that make two additional medical reference guides for Pocket PCs accessible on the PAC Mate. One program is a reference manual for the chart codes for diseases. The other is a series of internal medicine manuals.

“I definitely get great benefit from my PAC Mate with all of these programs,” Cooke said. “I can look up things during my clinic shifts, things that all doctors are expected to look up like drugs and the interactions they might have and what herbs interact with prescription drugs. I can also look up side effects of drugs patients are on now. If I’m diagnosing a potential disease, I have the explanations there of differential diagnoses, and I can present them for a case. Mostly, it’s just a great tool to have for all of these things.”

With her accessible tools, Cooke said, she can practice medicine on a level playing field with her sighted colleagues. “The only thing I need help with is a student or doctor to assist me with things, like if a person needs me to look at a rash or needs me to look into an ear.” In fact, other doctors have asked Chris to use her PAC Mate to help them rapidly develop treatment plans.
As for her patients’ reaction to her blindness and her unique accessible medical tools, Cooke says, “Occasionally, a patient is taken aback for a few minutes, but because I talk and really listen to them, they really enjoy working with me. They are always fascinated by the PAC Mate and what it is. They are fascinated by the braille display particularly.”
Chris expects to set up her practice in Portland, with a second office in nearby Newberg.