Social Media Could Improve Health In Developing Nations

Twice a year, I travel to the Dominican Republic as part of a medical service team.  While there, we work in a barrio called Paraiso just northwest of the capital city of Santo Domingo.  We provide medical care for urgent needs and are working to establish systems for chronic care management: many of the community’s residents have high blood pressure (often poorly-controlled), and the rates of diabetes and high cholesterol are likely significant (though harder to measure).  The residents of Paraiso–especially those in the more-marginalized community of Esfuerzo–face many obstacles to accessing health care.  The nearest hospital is about 2 miles away, a distance which might not seem like much unless you envision an 80 year-old woman with arthritis or heart trouble walking under the tropical sun, up the hill and along the rough roads to reach it.  She could hire a taxi, but this is expensive when one has no reliable income, and the cheapest taxis are motorcycle taxis (“motoconchos”) which are not the safest method of transportation.  If she makes it to the hospital, she faces a clinic that is over-crowded, under-resourced and under-staffed.  If she goes to a private clinic, she will need to travel farther and will pay more for both the office evaluation and her medications.  As a result, many patients with chronic illnesses do not access care reliably.

These chronic illnesses exist within the context of the “social determinants of health” that adversely impact health, including education, living conditions, poverty, etc.  (Read more about the social determinants of health here from the CDC, here, and here from the WHO.)  People who lack education, have uncertain employment and uncertain food security, who live in communities without safe drinking water and with endemic parasitic diseases will face greater challenges in achieving good health than would be the case if these barriers were absent.

Some solutions to this include low-tech interventions: regularly taking anti-parasitic medications to reduce the burden of disease, working to provide safe and low-cost drinking water, and helping individuals take better control of their health by providing them with personal health records that will allow more effective care coordination.  At the same time, social media (SM) could provide a higher-tech answer to meet some needs.

In the Dominican Republic, as is the case in much of the developing world, mobile phones are becoming more and more widespread.  In countries that lack the necessary infrastructure to support “land lines”, mobile telecommunication is a very effective alternative.  This article notes that nearly half of the world’s population has a mobile phone, and that nearly one-quarter of the world’s population has internet access.  Other articles suggest that mobile internet might become a primary way that people in developing countries will access the internet (here, and here).  Finally, some organizations suggest that mobile internet access could affect the underlying social determinants of health in developing countries (here, and here).

In the Dominican Republic, cell phones are widely available.  Many people purchase lower-cost phones and purchase “pay-as-you-go” phone cards instead of a month-to-month contract.  This indicates that health-related communication that is based on mobile technology could successfully reach communities that traditional models of medical care might overlook. SM (especially if you include SMS or text message alerts from SM sites) could be used to send out public health announcements, suggestions for healthy diet and exercise habits, etc.  In addition, public health authorities could receive reports of outbreaks of illnesses or health concerns from individuals via the same means of communication.  Expanding this further, individuals with mobile internet access could use SM sites such as Twitter or Facebook to interact directly with health care providers.  Patients could discuss health concerns with their health care providers, and providers could contact patients directly to actively manage acute illnesses or to monitor chronic problems (within the limits of a nation’s privacy laws).

Obviously, this is a long way from being the standard, and there are barriers that need to be addressed to make this idea successful.  High-speed wireless connections would need to become ever more widespread and robust, and internet-capable mobile phones will need to become ever more affordable.  Service plans will need to become less expensive, or the pay-as-you-go cards will need to provide enough usage for people to use mobile net services.  Privacy restrictions will need to be defined.  Health care providers and public health authorities will need to adapt to these new means of communication, and will need to re-evaluate hierarchical models of health care in which physicians are in charge and patients follow behind.  Communities will be best served by having at least a lay health promoter or community health worker who is trained in basic medical evaluation (such as taking blood pressure measurements, assessing a sick child for dehydration, etc) who can help facilitate communication between patients and health care providers.  And even if this is all in place, it may be some time before the benefits are noted–time during which costs will need to be covered.

However, envision how this could work once a system is in place: isolated communities could notify public health authorities of disease outbreaks at an early stage.  A community health worker could check patient’s blood pressures and relay them to a health care provider, who could suggest medication changes without having to be on-site.  Patients and communities can learn about low-cost interventions that could benefit their health, and can have dialogues with health care providers about how to prevent chronic illness and how lifestyle modifications (diet, exercise, etc) could improve one’s health status even if a chronic disease is already present.  There is evidence that one of the best ways to improve a family’s health is to educate the mother: SM communication could increase the access women have to information they can use to keep their family healthy.

Mobile telephone and internet technology can be joined with SM tools to allow health care to reach marginalized and distant communities, and to reduce the morbidity and mortality associated with disease.  There is much work to be done, but the stepping stones are already in place.  More-developed nations (such as the US, Canada, and Europe) could help move the process along by using similar approaches to provide care to rural communities that lack their own health care providers.  Small-scale projects have shown promise in the United States, while in India there are a number of services offering physician consultations via the internet and accessible via mobile devices.

We can make this happen, but we need to open our minds to the possibilities.

10 Responses to Social Media Could Improve Health In Developing Nations

  1. Zimbarama says:

    Great write up here, and awesome with the work that you do in the Dominican Republic.

    I have read this post quite keenly and I agree with alot of what you have said in it. I think what we have to agree upon is that technology alone is not going to help populations in developing countries or underserved populations as we need to consider a number of things that are taken for granted in the developed nations : access to technology, access to the internet, electricity. and if we even break ti down further, Many people in these situations are looking to improve their basic living conditions – or in terms of Maslows Hierarchy of Needs the Physiological Needs, and after those are met do they start thinking about the Safety Needs – under which health falls into. Technology or the access to it may seem like a luxury when placed in such a context.

    however as you have raised it is the mobile phone, which i agree, that can be the technological tool that can help promote well health as well as health monitoring for those that are sick. Your example of using a community health worker would be ideal.Even if they are the only person in the village that has access to an internet able phone, they will be able to access information which they can share with the rest of the village community on their normal phones.

    Tools like Twitter don’t need to have an internet enabled phone to be used, thus the power of Twitter can still be made available to these communities.

    I agree with you, these are not out of this world ideas and with a bit of thought, some planning and a little bit of money this can be a reality for some communities.

    you may find these interesting

    http://jhidc.org/index.php/jhidc/article/view/37/69

    http://www.hinz.org.nz/journal/2010/06/Providing-healthcare-services-in-rural-India—Innovative-application-of-mobile-technology-/1021

  2. richmonddoc says:

    Thanks for the comments, and for the added links–they add great info to the argument.

    Re: Maslow’s heirarchy of needs–I agree that a cell phone won’t automatically be at the top of everyone’s list. However, in the DR we see extensive use in our community, even among low-income families. This seems to result because much work is carried out via the informal economy: catch-as-you-can work opportunities can show up all of a sudden, and if one is not in a position to hear about it, then the opportunity will be missed. Therefore, inexpensive mobile phones are used more often than we might expect.

    The point re: the mobile phone assigned to a community health worker is also very valid. It may be that a single phone could make a substantial difference.

    • Zimbarama says:

      totally agree about the cell phone, I was recently in Africa and similiar to what you have mentioned about DR most peopel have inexpensive cell phones that allow them to text and voice call so that they dont miss any oppurtunites OR just so that they can be in touch, I think inexpensive mobile phones could be an ideal medium for healthcare

  3. s_eller says:

    I agree with both of you about the increased availability of cell phones – and ways that they could be used to maintain remote contact with health care providers. I do see benefits in having the community health workers have access to SoMe, both for using apps as disease tracker etc – and to Zimbarama’s point, for disseminating health tips and information.

    Elizabeth Farmer (University of Wollongong, Australia) also used social media to instruct medical students into using a medical home model to provide care to aborigines. This distributed model of care worked well for them – not sure if that is worth looking into.

    In my own role as educator, I see benefits if the cell phones have some type of video capacity. Giving community health workers access to podcasts regarding bag-valve-mask techniques or fundal massage could train in simple procedures that can make a difference in infant or maternal outcomes.

  4. Leonard Kish says:

    Great solution would be some sort of simple SMS API to the physician’s web-based systems where patients can be tracked and monitored for a variety of conditions. I know there was a guy working on something similar. I’ll see if I can find and post here.

    Was in Brazil recently and they’ve done a great job segregating urgent care clinics at low cost away from hospital ERs and implementing web-based systems. They haven’t gotten too much into the social/mobile realm, but I’ll be helping to try to push them in that direction… more hopefully soon.

    • richmonddoc says:

      Leonard: thanks for the post. Nice to hear from someone who has experience in this stuff, as opposed to just theory/ideas. Would love to hear more about this as things move forward.

  5. Leonard Kish says:

    My pleasure.

    Here’s a related paper on SMS integration for developing health care: http://www.cs.nyu.edu/~jchen/publications/sigmod09-kumar.pdf

    • richmonddoc says:

      Sorry I hadn’t replied sooner. Thanks for this article, though I have to note that my tech skills are not nearly advanced enough to follow all the way through. Even so, it’s great to see that tech developers and programmers are taking this effort so seriously.

  6. Leonard Kish says:

    Here’s more on SMS microsyntax developed by @aviars. http://bit.ly/uyOME

  7. ValentinaJ says:

    Hello Mark!
    First of all thanks for sharing this post and congrats for what you do in Dominican Republic.
    I agree with what you, Zimbaram, s_eller, and Leonard Kish say but I think there is one important topic that wasn´t mentioned and it is education.
    I think that education can be a limiting factor so we definitively have to take it into account and besides the internet and cell phone availability there has to be an educational campaign that comes with the project.
    Like you said, Mark “There is much work to be done, ………. We can make this happen, but we need to open our minds to the possibilities.”
    We need to keep doing so that more people in developing countries can benefit from this and the small scale turns into a large scale projects.

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