October 6, 2017

Doctors and nurses in rural regions of the Caribbean, Central America, and South America could get better access to valuable medical information thanks to research conducted by Maria González and her classmates Lucia Haro, Katie Nelson, and Jorge Salem. All are second-year students in SIPA’s MPA program in Development Practice (MPA-DP).

“The idea is to see how the Internet can be used in places without connectivity,” said González.

The four students traveled to the Dominican Republic in March 2017 as part of a semester-long workshop led by faculty advisor Anne Nelson. There they studied the feasibility of providing Web-downloaded medical knowledge to doctors and nurses at rural public clinics via a prototype storage device. They also interviewed stakeholders including officials from the government and universities, and public health personnel.

“We saw a lot of need,” said González. “Doctors don't have reliable access to information other than old books. Some use the Internet, but the signal in rural areas is poor and data plans are costly.”

The studies were developed in collaboration with Internet-in-a-Box, a project led by technologist Adam Holt of Cambridge, Massachusetts. Internet-in-a-Box loads a wealth of information—including Wikipedia, medical resources like protocols and encyclopedias, and instructional videos—onto a small, inexpensive device similar to a hard drive. The device, which can be operated wirelessly and without an Internet connection, allows up to 32 users to connect to it through laptops, tablets, and smartphones, allowing them to search and read multimedia information.

The project is one in a series by MPA-DP students devoted to the use of Information and Communications Technologies for Development, or ICT4D, under Nelson’s guidance.

An earlier such project, in 2016, was ICT4Cuba. After surveying ICT infrastructure in Cuba, student researchers found that residents without reliable Internet access had devised creative means to access information through offline digital media.

“We realized that this approach could benefit many areas of the world with lagging infrastructure,” Nelson said.

Mariela Machado MPA-DP ’16, the team leader in Cuba, served as a technical adviser to González, Haro, Nelson, and Salem, helping them to build on the earlier project’s findings.

After the trip to the Dominican Republic, the students recommended ways to improve the content of the box—by including the country's public health guidelines and manuals, and providing content in Haitian Creole to better serve local immigrants.

González then expanded on the spring trip for her MPA-DP summer placement in 2017, returning to the Dominican Republic to launch a 10-clinic pilot implementation program.

She visited each clinic every two weeks, recording the feedback from doctors and hosting focus groups. The effort gave her new insights on how to make the tool even more practical—by editing Wikipedia articles to provide advice regarding dosage and potential complications, and making sure content is easily viewable by smartphone.

González then conducted additional feasibility studies in Guatemala and Peru.

In Guatemala she worked with Dr. Sam Zidovetzki of Mount Sinai’s Global Health Program, a partner in the project; among other things, the Global Health Program seeks to train health personnel in places without connectivity. González and Zidovetski found that a device like the box could be a valuable tool for rural clinics with no connectivity, but nurses would need smartphones to access it. (A pilot for medical students in training remains a possibility.)

González found more promise in Peru, where Internet connectivity remains extremely costly in a complex landscape filled with mountains and jungles.

“Everyone we interviewed [in Peru] told us the box would be a useful tool," she said.

The Peruvian Ministry of Education has since asked González and the MPA-DP program to help design and implement a program in which the box could be used to provide educational resources to primary and secondary schools in rural areas.

 “Offline technologies can revolutionize the practice of teachers, doctors and nurses in remote areas and close the gap of information that will not be closed otherwise in the next years,” said Haro, a native of Peru who rejoined González for the last leg of the summer project.

“The most interesting lesson I learned this summer was that, although technology can solve real problems, context is really important," González said. “The political, the economics and the cultural aspects really matter, and you can't just throw technology out there and expect it to work. You have to tailor the technology to the needs of development.”

“This has been an extraordinary opportunity for [González] and her team to put international development principles into action,” said Nelson. “The project has the potential for direct benefit to underserved populations throughout the world.”

The project also reflects the philosophy of the MPA-DP program.

“Ultimately development practice needs to be a partnership. This project exemplifies that approach, and that's why it's been getting buy-in from the participants. We're not just advancing a project, we're developing process,” Nelson said.

González and Zidovetzki shared the team’s finding in a presentation at SIPA on September 20. They said follow-up could include Spring 2018 pilot projects in Peru and/or exploration of the potential for medical aid workers to use the device in humanitarian crises.

Project sponsors include the Earth Institute, which provided financial support for spring travel, and Wikimedia Foundation, which provided financial support for both the spring and summer projects.

— Mia Li MPA ’18

Related links:

"Information for the Unconnected: Letter from Santo Domingo," Foreign Affairs

Video: "Offline Innovation: Bridging the Digital Divide in Latin America"

"Internet-in-a-Box: Connectivity for the Rest of the World," State of the Planet