Togo hospital employs Raspberry Pi 400 as a thin client

The first day back after the Christmas holiday can be a Godzilla of the Sunday Scaries for some, but ours was made much more pleasant by the discovery of another update from Togo, courtesy of local philanthropist and longtime friend of Raspberry Pi Dominique Laloux. Read on to learn how Raspberry Pi 400 is helping to transform essential record-keeping at Bethesda Hospital in Togo, West Africa.

bethsheda hospital togo 2023 dominique laloux

A small Ubuntu server has been in place at Bethesda Hospital since March, speeding up the essential record-keeping previously done by much slower and less secure means. Patient demographic data, medical procedure records, pharmacy sales, and other essential information are securely stored on the system and accessed around the hospital on Raspberry Pi desktop units. Another module is currently in development to record more sensitive medical data, such as logging symptoms, treatment plans, lab reports and official diagnoses. A third module is also being considered so that all pharmacy purchases no longer need to be processed by the ageing inventory software currently in use. A replacement fleet of Raspberry Pi 400 units has been trickling through the hospital for several months now, churning through the work done by much older, bulkier hardware. The Raspberry Pis are working alongside some remaining older laptops and PC towers, but the Ubuntu server has updated and streamlined everything across the hospital.

bethsheda hospital togo 2023 dominique laloux

Cross-departmental change

Departments across Bethesda Hospital have already switched to the new system, with many now working solely on Raspberry Pi hardware, including the intensive care unit, maternity ward, anaesthetists, dentistry, and accounting. Next in line for an upgrade are the radiology and ophthalmology units – and once they’re equipped, pretty much the entire hospital will be covered.

bethsheda hospital togo 2023 dominique laloux

Hard-working thin clients

We were very happy to hear that the Raspberry Pi 400s are so far behaving perfectly as thin clients in Dominique’s setup, despite the heat and humidity during the rainy season. There was an issue of frequent power outages causing recurrent SD card corruption, but that was resolved by switching to write-protected cards running Raspberry Pi OS, which saw the Pi 400 units restart without complaint after power cuts.

bethsheda hospital togo 2023 dominique laloux

Going paperless in 2024

Despite many hurdles, mainly related to very tight budgets and limited user computer-related skills, Dominique feels the project has reached “a point of no-return”, with hospital staff accepting the clear benefits of a centralised record-keeping system. The goal for 2024 is to gradually discard the current paper-based records once user confidence in the online system is cemented. The progress made so far is all the more impressive when you learn that most employees at Bethesda have never used a keyboard until this new system was implemented. While they all use smartphones, computers have not featured in their lives at all until now.

bethsheda hospital togo 2023 dominique laloux

An impossible task?

Bethesda Hospital was built by a German mission in 1969 and has been a referral hospital in Togo for many years. It tries to make medical care attainable at the lowest possible cost for local families on very limited incomes, but a history of financial difficulty has made this mission increasingly difficult. Dominique was approached by hospital director Dr. Sowu with a seemingly impossible task: provide potential commercial partners, in Togo and abroad, a clear view of hospital activity and finances, but without spending a penny and with the knowledge that hospital staff had no previous IT experience. We’re just glad to see Dominique’s decision to include our affordable hardware in the scheme is going well and hope to hear that the goals for 2024 have been reached by the next time we sit down in front of a New-Year’s inbox.

bethsheda hospital togo 2023 dominique laloux
Hospital grounds

Jump to the comment form

Jack avatar

For a venture of this type, and for operations like schools, is there a bundle pricing option, or can it be available at a wholesale pricing?

Reply to Jack

Rahul Dubey avatar

I did not quite understand how switching to write-protection helps. “There was an issue of frequent power outages causing recurrent SD card corruption, but that was resolved by switching to write-protected cards running Raspberry Pi OS, which saw the Pi 400 units restart without complaint after power cuts”.

Reply to Rahul Dubey

Carlos Luna avatar

If the card is “write protected” (TBH what I think is happening here is that the OS is configured as reado-only) then there are no write operations happening on the SD card, so there is no possibility of data corruptioin when a power outage happens – in other words, no write operation will ever be interrupted by an outage, so no data will be corrupted.

Reply to Carlos Luna

crumble avatar

Most file system have problems, when not all data of an atomic operation has been written to the media. This can happen during an power cut.

So you can either protect each Pi with a battery, so it will be written or you write only on the server. At least in theory. In real life a lot of software expects to write logs and temp files. You can configure the system, so that it can use a RAM file system for this. So you will lose only this data and the one you are currently editing.

This reduce the cost for the system. Only one secured power supply is needed. Users cannot store corrupt config files on their system => less support is needed.

You can boot from network without any SD card, as well. This will reduce cost for updates, because you don’t need a second sd card an walk around to change them. But booting a huge amount of clients at the same time will be slow. Especially if you have low cost servers and network infrastructure.

Reply to crumble

D Laloux avatar

Yes, Carlos and Crumble, that’s the idea.
Locking sd-cards to avoid incomplete writes and files left open appears to work well for us (and raspi-config makes the process quick and simple).
Ideally, we would attach each workstation to a UPS, but that has an additional cost and we are on a very limited budget. We purchased several UPS to protect the server, switches and key users, and we intend to buy more as soon as we can afford them.
Laptops with their batteries may sound like an interesting alternative. But the rationale to use the Raspberry Pi was based on our past experience using both laptops and RasPi (1, 2, 3, 4…) in computer labs in rural schools in this area. Laptops tend to have limited lifetime here, where conditions (temperature, humidity, dust…) are far from ideal, and repairs are difficult and/or expensive (as parts are not easily available).
The Raspberry Pis are remarkably resilient and their accessories (power supplies, keyboards, screen…) are both available and affordable.
In terms of performance: I am amazed each time I sit at a Raspberry Pi 400 (or 4) to access the server — the interaction is as fast and smooth as one could expect.
Not sure yet if we’ll ever come across serious drawbacks (perhaps with the keyboard on the Raspberry Pi 400 ?) but, as of today, they work like a charm, and users enjoy having such tiny devices on their desk !
I would be very happy to share more details about the project, if you are interested.

Reply to D Laloux

Hope avatar

Is there a website or an address to donate resources?
Can’t seem to find any information about the hospital glaring omission from the article.

Reply to Hope

Ashley Whittaker avatar

I don’t give out personal contact details on the blog but if Dominique responds to your comment, they may wish to provide their email address.

Reply to Ashley Whittaker

D Laloux avatar

Hello Hope,
The website of our small “not-for-profit” is at (it is unfortunately in French only at the moment). You are of course welcome to contact me at [email protected].
Kind regards,

Reply to D Laloux

D. Laloux avatar

Oups… I really meant:
Apologies for the missing ‘www’.

Reply to D. Laloux

Steve W avatar

Hi Dominique. This is a very inspiring project. Congratulations on your success. Yes I’d be interested in hearing more about the technical aspects of the project. e.g .how the Pi’s are set up as thin clients (OS and software) and also are they basically a front end to a database on the server (MySQL?), and also is it a wired connection?
Aside from that, I was wondering if say, a Pi 4 with less RAM would cope. I was thinking that A: given the conditions you work in having the keyboard and mouse as separate units might be better for maintenance. The Pi could be attached to the back of the monitor, if in a suitable case.
B: if for example a 1 or 2Gb Pi 4 was adequate they are cheaper than the Pi400, and it would be much easier and effective for interested parties to donate a box load of Pi 4’s and get them to you than a few Pi400’s.

Reply to Steve W

Sven Dohmen avatar

We also use Raspberry Pis as thin clients for most use cases for the children and teenagers who come to see us and for our team members in our outpatient unit for child and adolescent psychiatry in Esslingen Germany scince a couple of years. Now we have Raspberry Pis 4 which are also connected to a Ubuntu terminal server.
We choose to do so to deliver a good learning environment for the development of tech skills in addition to our medical treatment for our young patients. Furthermore the Pis are energy-efficient and Pi OS and Ubuntu save.
Kind regards and a happy New Year to everybody especially to the colleagues from Togo hospital and the Raspberry Pi Team,
Sven Dohmen

Reply to Sven Dohmen

Kumar Gopal avatar

@Dominique – kudos to you and your team for making the revolution happen.

Is the thin client delivered via VNC?

Reply to Kumar Gopal

DavidB avatar

This is awesome and shows the power of the Pi, a very inspiring story.

Reply to DavidB

Leave a Comment