July 5, 2007
Low-cost technology — a boon for global health
Young adults chatting on their mobiles wind their way through a crowded, steamy street. They stop occasionally, jostled by passers-by, and type into their keypads. A man heading to an Internet café passes a farmer herding his goats to market. Such scenes are increasingly common in cities in developing nations.
It would not be unusual in, say, a Peruvian bar, to see a woman dialing a cell phone no bigger than an open matchbook. No one would notice that she was entering data for a public health project, and getting back a text message. Immediate, inconspicuous communication was key to this public health project, led by Dr. Walter H. Curioso. He is a physician who obtained his public health degree at the UW, and who now holds faculty appointments in the UW School of Medicine’s Department of Medical Education and Biomedical Informatics and at the School of Medicine and School of Public Health at Universidad Peruana Cayetano Heredia in Lima, Peru.
Curioso and his colleagues set up a system combining cell phones and the Internet to conduct a confidential, real-time surveillance of side effects for a medication given to female sex workers in three areas of Peru. The drug, metronidazole, treats certain vaginal infections, but can cause headaches, stomach pain, loss of appetite, a metallic taste, and other symptoms in some women.
This method of data collection in the community and analysis and decision-making at a central location was faster, more efficient, and less expensive than filling out paper forms, which could take days, weeks, or months to compile and consolidate. The cell phone system took seconds, and enhanced the ability of sexually transmitted disease clinics to quickly manage adverse drug effects, such as severe vomiting. Unlike laptops, cell phones are less obvious and less likely to be stolen in sex-trade locations.
The company Voxiva provided technical support for collecting and securely storing the data for Curioso and his team. The team was from the UW, The Wellcome Trust, Imperial College of London, and Universidad Peruana Cayetano Heredia.
Curioso is looking at other ways to tap into communications technologies and Internet behavior to prevent and treat sexually transmitted diseases. Research in Peru suggests that cabinas publicas (Internet cafés) are sometimes used by men to meet other men for sex. Cabinas are small, store-front operations that rent time on the Internet, typically in private booths, at a low hourly rate. Cabinas can be found even in poor urban slums.
The cabinas, Curioso suggested, may be logical places to evaluate interventions, such as Web programs, condom distribution, and brochures, in preventing HIV and other sexually transmitted infections. He noted that this may be a way to convey prevention and STD-testing messages to a large number of people who are not reached by more conventional counseling in bathhouses and dance clubs.
In other work in Peru, he is collaborating on a nursing research project using personal digital assistants in assessing HIV patients’ adherence to antiviral medication regimens and to safe sex practices, and what makes compliance easier or more difficult for these patients.
Curioso has also collaborated with others in Peru to create a Web Health Portal to give medical workers access to training and information necessary for their care of patients and their public health responsibilities.
The Web has truly become worldwide. Impoverished nations have gained greater Internet access through telecommunications that no longer have prohibitively expensive infrastructures. Learning how these technologies influence people’s social behavior has, in Curioso’s research, resulted in studies of interventions to better prevent and treat communicable diseases. He also sees a key role for telecommunications technology in gathering population health data, analyzing information, and developing responses to a variety of critical public health problems.
The pervasiveness, declining prices, and simplicity of cell phones made Curioso realize, “You don’t need to have the latest, most advanced technology to create a sophisticated public health surveillance system in developing or developed countries.”
