According to the International Telecommunication Union, approximately 8 out of 10 Nicaraguans have cell phones (ITU 2011). And according to the Nicaraguan Dispatch, all 153 municipalities have cell phone coverage (17 Sept. 2012). This means that if you live in a city or out in the most rural of rural places, you have a cell phone. If your family is rich or if your family is poor, you have a cell phone. If you have running water or if you schlep buckets from the river every day, you have a cell phone. And despite a nominal texting fee, you use it daily. You use it to chat with your friends. You use it to chat with your relatives. You use it to forward cute little poems about Mother’s Day, and birthdays, and friendship. And even when you don’t have electricity, you walk to the nearest place where there is electricity and charge your cell phone there, so you can keep using it from home.
With a country as connected as Nicaragua, it’s a wonder that we still hear statistics such as: 1 out of 3 adolescent girls will be pregnant by the time they reach the age of 19 (INIDE 2005); and nearly 3 out of 4 women between 15 and 49 have reported physical and/or sexual violence at some point in there lives–a level that is, according to the WHO, 57 times higher than what is considered an epidemic (Nicaraguan Dispatch, 17 Oct. 2012). After a year and a half of talking about sexual and reproductive health with rural women during my Peace Corps service, I’ve learned that a major barrier to seeking sexual health information is the PERCEPTION that if a woman asks a medical professional for condoms, or for an HIV test, or simply for information regarding her sexual health, her community will find out and think her to be “unfaithful,” “a prostitute,” or “a bad woman.” The only way to access information from a trained professional is a face-to-face conversation, and many women can’t bare the potential embarrassment.
Meanwhile, in several developing countries, a new revolution is taking hold. Mobile health, or mHealth, is a movement that harnesses mobile phones to promote positive social change. For instance, in Uganda, cell phones with cameras of at least two megapixels are being used to diagnose Malaria, simply by swabbing a drop of blood on the lens, snapping a picture, and sending it directly to a lab (Scientific America, 14 Dec 2011). According to Scientific America, the blood samples “were often so clear that specific stages of the malaria parasite could be identified.” Similarly, in Nairobi, Kenya and in Dar es Salaam, Tanzania, a project called m4RH (Mobile for Reproductive Health) has developed a series of interactive text messages about family planning, which the 13,000 users can access via text messaging from their cell phones (try out the system for free on the m4RH website! Click “m4RH Demo” on the right-hand side bar. It’s super cool!) Research has indicated that this simple technology is influencing behavior change with regards to family planning.
Similarly, for the past six months, I have been working with a couple other PCVs, the Nicaraguan Red Cross, the Ministry of Health, and other local partners to create ChatSalud, the first-ever sexual and reproductive health SMS-based hotline in Nicaragua. The goal is to use low-cost mobile phones to provide a 100% anonymous means for Nicaraguans to access sexual and reproductive health information. According to the m4RH study, users indicated that they like the privacy of text messaging. For instance, a woman could be lying next to her partner in bed and text ChatSalud, “how do I convince my partner to use a condom?” and he would be none the wiser. A user could be sitting in the middle of a crowded bus and text “how do I know if I am HIV positive?” And no one would know. It can eliminate barriers to accessing health information for the 4.8 million cell phone users in Nicaragua.
The way ChatSalud will work is much like how m4RH runs (seriously–check out the demo!) but with a larger scope. While m4RH only covers family planning methods, ChatSalud will cover HIVaids, STIs, Safer Sexual Practices, Family Planning, and Risk Factors during Pregnancy, Birth, and Postpartum. Like m4RH, part of the hotline will be automated. Simply by typing “info” or “1” (we haven’t decided yet) to ChatSalud, you’ll receive an automatic response with a menu list of options. The menu would say, for instance, type “2” for information regarding HIV; “3” for information regarding STIs; “4” for information regarding Safer Sex…etc. Check out this picture of my cell phone when we were testing out the system:
For questions that cannot be answered by our automatic system, we will train the Nicaraguan Red Cross’s existing core of volunteers on how to be hotline operators so that they can add an element of genuine human interaction to ChatSalud. We are also exploring the opportunity of merging interests with local universities such as UNAN’s CIES (Center for Investigations and Studies in Public Health) and local health centers to target specific populations for appointment reminders.
So where are we at with the project?
- In early October, Nishant, Gabe, and I recruited four Health 58ers: Hannah, Chloe, Talia, and Jessica, to learn everything there is to know about ChatSalud before our group departs in March, because they’ll still have another year.
- Nishant and I presented ChatSalud to CONISIDA, the Nicaraguan Commission on Aids on October 17 (my 25th birthday!) If they like the project, they will write a letter of support saying that the Nicaraguan Red Cross can officially partner with us.
- Afterwards, we need to re-approach Claro, one of the two major phone companies in Nicaragua, (Nishant originally gave a presentation to them back in September), and see if they can, minimally, provide us with free text messaging.
- We need to find a developer with some Java know-how who can help us add some functions to FrontlineSMS, the open-source software that we will use to run ChatSalud. IF YOU ARE A DEVELOPER AND/OR KNOW A DEVELOPER THAT WANTS TO DO SOME PRO-BONO WORK ON AN EXCELLENT PROJECT, LET ME KNOW! (See the “contact” tab in my blog above).
- We are also in the process of testing out the ChatSalud system on FrontlineSMS, which includes writing in all of the automated responses and working out any kinks that surface.
- Look for a funding source.
- And lastly, we’ll need to plan an intensive training session for the core of Red Cross Volunteers who will be the hotline operators.
ChatSalud is the major project I am focusing on at this point in my service. I hope we get it off the ground before my departure in March–if not, I might consider extending for a few months. With each week that passes, ChatSalud is gaining more and more momentum. It’s hard to believe that this project started with Nishant, Gabe, and I sitting around a table in a coffee shop thinking that all we’d need was a cell phone and a couple PCVs to answer questions, when now it has the potential to become a major national-level project with functions that can serve at-risk populations, collect data for the Ministry of Health, and become an influential example of how mHealth can thrive in Nicaragua as well as Latin America at large. Thank you to Peace Corps staff for supporting us 100% of the time. Updates to come!