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Smartphones could be a vital healthcare tool in developing nations

Written by Rob Cahill

Dr. Iyengar holding smart phone

The son of an officer in the Indian army, Iyengar traveled extensively as a child and visited many parts of India, the world's second most populous nation, which has more than a billion residents. He received an undergraduate degree from the Indian Institute of Technology in Madras, India, and a graduate degree from the Indian Institute of Science in Bangalore, India.

Imagine you are a community health worker in a developing nation. You are not a doctor but you have had medical training. Everyone in your village counts on you for their healthcare needs. A woman arrives with a moaning baby and is anxious for help. The closest hospital is a six-hour drive on dangerous roads. You are on your own. Unsure what to do, you reach for a booklet from the World Health Organization and start combing through combinations of symptoms. The child’s condition worsens. The mother becomes frantic.

This is a situation in which many of the community health workers in Colombia, India, Haiti and other parts of the world often find themselves.

But soon, searching for a diagnosis could get easier –and faster. Many community health workers have cellphones and these computer-like devices could be converted to a useful healthcare tool. If M. Sriram Iyengar, Ph.D., an assistant professor at The University of Texas Health Science Center at Houston (UTHealth) School of Health Information Sciences, has his way, the smartphones of community health workers around the world will soon have a new application called GuideView.

“What I’ve done is put a lot of healthcare information in a cellphone application,” Iyengar says. “The task-oriented application walks you through the diagnosis and treatment process using rich media, such as audio,images and video. Giving the information in small steps makes it easier to understand.” Community health workers can read the instructions on their cellphones, hear the directions read aloud in their native language and look at pictures of the desired task, Iyengar says.

Help where it’s needed most

Some community health workers could use the help. A recent study by the U.S. Centers for Disease Control and Prevention found that the community health workers in one developing nation make errors as much as 60 percent of the time.

“The results of such mistakes can be serious, causing high mortality and morbidity. This burden falls heavily on the neediest, infants and women,” Iyengar says.

More people in these areas have access to cell phones than you might imagine. One of Iyengar’s collaborators at the UTHealth School of Health Information Sciences, Jose Flórez-Arango, M.D., Ph.D., estimates that about eight in 10 either have a cell phone or can access one.

They know how to use them, too. During a recent field test at a patient simulation laboratory in Medellin,Colombia, the community health workers with theGuideView application made significantly fewer errors than those using printed healthcare guidelines.

Smart phone images

According to Flórez-Arango, community health workers fill a void in parts of the world where physicians can be scarce and disease can be common. “Many community health workers are volunteers. They feel a need to help out in their underserved communities. Other community health workers are people who aspire to be healthcare professionals.”

In Colombia, where Flórez-Arango lives, community health workers used to be called promotores de salud, but are now commonly referred to as public health helpers. In India, where Iyengar was born, community health workers are sometimes called barefoot doctors. The next step in Iyengar’s research involves testing how well health workers adhere to the guidelines.

Inspired by NASA

Iyengar came up with the idea for GuideView while working with NASA on extended space missions and how to care for astronauts when the closest emergency room is thousands – if not millions – of miles away. The project also received support from the U.S. Army Telemedicine and Advanced Technology Research Center and Microsoft Research.

Because weight is a big concern on a space flight, the NASA folks were looking for a software program that could be loaded onto a CD. “Astronauts have to travel light and they all can’t be physicians,” he says.

GuideView works on cellphones based on WindowsMobile and on iPhones. It stays in the phone’s memory and can work without a cellphone network or Internet access. It can be used with headphones so caregivers can keep their hands free.The GuideView system records each step the community health worker takes when interacting with a patient and these records can be used to provide feedback.

The smartphone application is programmed to dial the closest emergency center if the situation is deemed too serious for the health worker to handle.

GuideView also has a software component called GuideView Author, which allows users to create their own “guideviews” without programming.

Flórez-Arango said GuideView is a cost-effective way to support the efforts of community health workers. “If you think that the World Health Organization invests about $30 per book, then public health programs could assume the cost of cellphones and services by replacing the investment in paper,” he says.

This new technology is licensed to a portfolio company of UTHealth called Advanced Guidance Systems LLC and is funded in part through a Texas Ignition Fund grant from The University of Texas System and Microsoft Corporation.

“This is a platform technology with many applications in addition to health care,” says Bruce Butler, Ph.D., vice president of research and technology in the Office of Technology Management at UTHealth, which has facilitated the establishment of 17 startups.

Rob Cahill

Rob Cahill is senior media relations specialist/Office of Advancement. He formerly served as a daily newspaper reporter at the Laredo News and San Antonio Light. He has a master’s degree in communications and was twice named Communicator of the Year by the Houston Press Club.