ABSTRACT
This chapter describes an application of telehealth using cell phones and the Internet to collect, transmit and monitor data in real-time from female sex workers (FSW) who are part of a large project in Peru to reduce sexually transmitted diseases (STD). According to a national survey conducted in Peru of 4479 FSW in 2002, the prevalence of STDs and bacterial vaginosis was 26% and 34% respectively (PREVEN, 2003). Early detection and treatment of STDs represents one major strategy for preventing transmission of STD, including infection with HIV (Sanchez, Campos, Courtois, Gutierrez, Carrillo, et al., 2003). New technologies and information systems can help public health in terms of prevention, surveillance, and management of public health data. Consider the following case.
At 6 p.m. on a Friday night in a rural community in Piura, north of Peru, nurse Raquel Butron takes a taxi for the hour ride to the brothel. Raquel is part of a mobile team that screens female sex workers every 2 months as a sentinel surveillance. She provides medication for bacterial vaginosis, namely metronidazole. As part of her job, she carries three or more folders full of papers to track codes, medications, and adverse events such as nausea and vomiting that the participants might experience from the metronidazole they are receiving. This night, she is hoping that she won’t be robbed like the week before. Although she recovered the folders and medications 3 days later, she is guarded about being robbed again.
Raquel and a peer-educator arrive early in order not to interrupt the women while they are working. They are well-received. Raquel starts screening “Paola,” but Paola gets a call on her cell phone, so Raquel has to wait. Even among female sex workers who earn just 5 dollars a night, cell phones are a mainstay of life.
A year later, as Raquel heads to the brothel, she is going more discreetly. She is not carrying folders full of papers, just a cell phone. Helped with a hands-free device, she performs the interviews. Following a voice menu prompt on her cell phone, Raquel goes through a list of questions, pressing one and two on the phone’s key pad for yes and no answers. She can also leave a voice message for a doctor in Lima at the end of the interview.
“A cell phone makes my job easier” she said. She doesn’t worry as much about getting robbed because rather than sticking out, she appears like anyone else making a phone call. She also doesn’t have to carry folders full of papers, or have to ship her reports every weekend to Lima. “I send the reports in real-time” she said.
Doctors in Lima, meanwhile, monitor in real-time the reactions female sex workers are having to medication and respond immediately if there is a strong reaction such as vomiting. Each time the system detects a serious adverse event, the system sends an alert to the cell phones of doctors in Lima. Using the Internet, the doctors can also monitor the activities of the health workers. After logging in, doctors can see the entire list of participants registered by the mobile team, day-by-day, or on a weekly basis. If Raquel leaves a voice message, the message is registered in the database as an audio file. Doctors in Lima can hear her message by accessing the database from the web. Doctors also have the capability to perform searches, and they can download the database for further analysis.
By using the cell phone, Rachel can enter the code for a female sex worker to get her past results from the lab. Because female sex workers do not stay in one place all the time, being able to tap into a database makes accessing records a world easier. “I don’t have to wait weeks or months to share results with patients who may have traveled to another city”.
