# MAM-AI: An On-Device Medical Retrieval-Augmented Generation System for Nurses and Midwives in Zanzibar

arXiv: https://arxiv.org/abs/2606.29580 · HTML: https://mlsanity.com/paper/2606.29580/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and biomedical RAG, one of 15 directions in Retrieval-augmented generation.
- Builds on 10 of its 25 references that are in the map.
- First posted on arXiv 28 Jun 2026.

## Placed in

- Retrieval-augmented generation / [Medical and biomedical RAG](https://mlsanity.com/rag/medical-and-biomedical-rag/)

## Builds on (most cited first, 10 of 10)

- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [LLM.int8(): 8-bit Matrix Multiplication for Transformers at Scale](https://mlsanity.com/paper/2208.07339/) (2022)
- [HealthBench: Evaluating Large Language Models Towards Improved Human Health](https://mlsanity.com/paper/2505.08775/) (2025)
- [Benchmarking Retrieval-Augmented Generation for Medicine](https://mlsanity.com/paper/2402.13178/) (2024)
- [MiniCheck: Efficient Fact-Checking of LLMs on Grounding Documents](https://mlsanity.com/paper/2404.10774/) (2024)
- [MedCPT: Contrastive Pre-trained Transformers with Large-scale PubMed Search Logs for Zero-shot Biomedical Information Retrieval](https://mlsanity.com/paper/2307.00589/) (2023)
- [EmbeddingGemma: Powerful and Lightweight Text Representations](https://mlsanity.com/paper/2509.20354/) (2025)
- [Lynx: An Open Source Hallucination Evaluation Model](https://mlsanity.com/paper/2407.08488/) (2024)
- [AfriMed-QA: A Pan-African, Multi-Specialty, Medical Question-Answering Benchmark Dataset](https://mlsanity.com/paper/2411.15640/) (2024)
- [MedAide: Leveraging Large Language Models for On-Premise Medical Assistance on Edge Devices](https://mlsanity.com/paper/2403.00830/) (2024)

## Abstract (arXiv)

Maternal and newborn mortality remain among the highest in sub-Saharan Africa, where midwifery care is often delivered by nurses who lack midwifery training to international standards, and consulting authoritative guidance at the point of care is hard: the guidelines are long and connectivity is intermittent. We present MAM-AI, a medical question-answering assistant for nurse-midwives in Zanzibar that runs entirely on a commodity Android device: a question is embedded (EmbeddingGemma, 300M) and matched against a curated corpus of 87 guideline documents (63,650 passages), then answered with citations by a 4B int4 generator (Gemma 4 E4B), fully offline, with no query leaving the device. We evaluate the exact deployed configuration with a layered methodology -- retriever, generator under oracle context, end-to-end, and latency -- scored by LLM judges validated against physician rubrics. The evaluation relocates the hard problem. On-device retrieval is essentially solved: the 300M embedder ranks third of seven retrievers and rivals cloud systems, so the passages the system needs are usually found. The small generator is what remains in doubt: adding retrieved context does not improve its answers, and at 4B it cannot be both helpful and safe at once -- of two same-size candidates, the more helpful one commits genuine dangerous errors, so we deploy the other, which is about twice as faithful to its sources (as faithful as a frontier model), and recover its helpfulness with a redesigned prompt that cuts deflection from 33% to 3%. Corpus quality is decisive for the same reason: where the corpus holds the right passage the answer is specific and actionable, and where it does not it goes vague. MAM-AI is a thoroughly evaluated, open-source research prototype, not a fielded product; the system, knowledge base, benchmarks, and evaluation harness are released.