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Dr. J. is a refugee and physician from developing country A now living in country B. Civil war has wracked country A for some time, and there is a constant flow of refugees and migrant workers from country A coming into country B.

Dr. M's clinic has six outpatient clinic rooms under bamboo roofs and 30 inpatient beds, as well as a small procedure room for minor surgery (including landmine trauma care.) The clinic is staffed by a dozen medical asssistants whom Dr J has trained, and there is an irregular presence of foreign physicians who visit during the dry season months.

Last year Dr. J's clinic saw 25,000 visits by both refugees and migrant workers.Some of the refugees had to walk for four days in country A to cross the border into country B. Malaria is a huge burden accounting for 5,000 visits last year.
However Dr. J's clinic is well prepared with a small but specialized laboratory that processes 10,000 malaria slides a year. Hemoglobin tests and urinalyses are also done at the laboratory. There is a pharmacy on site that was started by an
international NGO. Patients requiring more complex care than the clinic can provide are sent to the county hospital two miles away, which though modern is usually too expensive for country A people to use. The hospital does however
donate vaccine and prenatal lab tests. Dr. J also runs a weekly child nutrition clinic, an immunization clinic, a family planning clinic, and a prenatal clinic. Last year there were 2,000 prenatal visits, and 200 deliveries at the clinic.

Currently the clinic keeps patient notes on A4 size cardboard in a central registration file. Each patient has their own card; children have an additional growth chart.  In addition Dr. J's medics keep daily and monthly logs of the
number of visits seen in each of the clinic's departments (inpatient, outpatient, prenatal, etc.), but it's too cumbersome to keep accurate statistics on the numbers of patients.

As the clinic has grown busier, Dr. J is interested in a computerized medical records system that can keep data on individual patients, track visits, and store lab test results. Dr J would like to be able to quickly compile monthly and annual statistics on specific diseases, immunizations, child nutrition, new patients, and create research databases to study subpopulations of patients. This data would be useful to  funders and would enable staff to better forecast the clinic's resources. The clinic currently has three pentium 200 desktop computers in a ceiling fan room, with fairly reliable power. A small group of medics has proficiency in Microsoft Excel and Microsoft Word, and have been exposed to Microsoft Access.

There is internet access through a modem, but is too expensive for more than intermittent e-mail each week. Dr J would like to implement a system quickly (within a few months) because the political situation in country B makes it difficult to plan very far into the future.