Approximately 98 % of the world’s population are now owners of cellphones, including many adults in remote, hard to reach locations. This proliferation of mobile devices has the potential to improve our ability to diagnose and track disease; to tackle and disseminate timelier, more actionable public health information; and provide expanded access to ongoing medical education and training for health workers in developing nations.
This was the essential message of a speech that I presented at the United Nations 58th Commission on the Status of Women, at a session sponsored by the Global Alliance for Women’s Health and entitled: “How Digital Communication Impacts Health Care in Developing Nations,”
The Global Alliance for Women’s Health was formed in 2003 to advance women’s health in all stages of life and at all policy levels, through advocacy, education and program implementation. They engage in collaborations with government and non-government agencies (NGOs), the private sector, academics and individual citizens, all of whom were represented at this session.
The m-Health applications I discussed include: collecting community and clinical health data by local health workers, and delivery of that data to practitioners, researchers, and patients in real-time; monitoring of patients’ vital signs; and educating patients in basic health practices, all of this done in areas that have no electricity or running water and depend upon the solar powered charging stations and wireless satellite communications that enable the cellphones, tablet computers and PDAs to work.
Although not a panacea, the technology helps address some of the overwhelming medical issues prevalent throughout the developing world, including: malaria, diabetes, maternal mortality, HIV, Typhoid fever, Hepatitis, food, water and airborne bacterial and viral infections, and severe malnutrition and anemia which become an underlying cause of many of these illnesses, and result in infant, child and maternal mortality.
Some of the specific pilot projects that I included in my presentation are the following:
In Bangladesh, The Mobile Alliance for Maternal Action (MAMA) sends twice weekly vital health text messages to new and expectant mothers with reminders about check-ups, taking medication and improving their nutrition.
Throughout Africa, Short Message Services (SMS) are providing new and innovative opportunities for disease prevention. Sponsored by a number of different agencies and organizations, the SMS text messages to individuals’ cellphones, translated into the local dialect, provide reminders about immunizations, nutrition, basic hygiene, malaria preventions and care, and more. According to World Health Organization (WHO), 55 million mobile users receive such information. One of the proven, studied benefits has been a 50% reduction in infant mortality in some areas of Africa. This is just the beginning of a far more comprehensive e-health effort.
In Uganda, pathology samples are collected, stored and emailed by local health workers using cell phone to send this data to Kampala hospital for diagnosis. Pathologists, using a high-powered microscope called the CoolScope. Provide diagnosis and treatment recommendations back to healthcare workers who meet with the patients and determine best, next steps.
In Botswana, local health care workers have been capturing images of skin rashes from patients with HIV, since 2006, and sending them to Gaborone or to the US for review. This project has served thousands.
Also in Botswana cervical cancer screening is now being performed by local health workers who take images of anything that looks suspicious with their cellphones. They send those images to Gabarone for diagnosis and treatment suggestions.
In Cambodia, Partners Connected Health at MGH in Boston, MA has been providing thousands of patients with basic health services. Health care extenders in remote villages of Cambodia are given kits that include everything needed to do a standard physical exam, draw labs, and take images. This data is aggregated and sent via email to primary care physicians in Boston, MA, where the doctors donate their time to review the exam notes and the data and determine how these patients will be treated going forward. The local health extenders meet with the patients once the results are returned, to determine next best steps.
In the Congo, Guatemala, Zambia, Kenya and Pakistan, OB Ultrasounds of women with difficult pregnancies are taken and the ultrasound images are sent via Samsung smartphones to a central health facility where they are transferred to flash drives or emailed to a radiologist for analysis.
This is not an inclusive list but merely examples of pilot projects being executed under conditions that are extremely difficult, in political situations/economies that are tenuous, at best. Each of these projects happen because of the dedication of individuals who give time, money and expertise to insure that with the most basic equipment, communication and connections that are not dependent upon time and place, are enabled and deployed.
There are many new technologies that will continue to provide patient-centered care in the developing world as the prices come down and support expands.
Wearable Devices that have built-in sensors to monitor heart rate, pulse, blood pressure, blood sugar,and weight; wireless robots that are used for diagnostic purposes as well as remote assistance with complicated surgery; telemedicine that connects local health workers with trauma centers throughout the world; and personalized medicine are among the technologies that promise to change health care for everyone, going forward.
To succeed, however, there must be a strong commitment from the national ministries of health, and collaborations with sponsors and private foundations who must continue to build and expand the mHealth infrastructure and telemedicine networks that have the potential to empower and educate health workers and patients, and help so many in need.
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