CHWs use their own smartphones to control dengue in Hermosillo, Sonora

…I’d say my internship project last Summer gave me good practice in turning lemons into lemonade. Although my original internship plan fell through, I ended up stumbling upon an exciting new topic within Public Health: equipping frontline health workers with smart-phone applications to improve surveillance of infectious disease.

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Brigadistas of the Sonoran Health Department

How did the stumbling happen? I’d originally planned to evaluate prevention of Rocky Mountain Spotted Fever in a small community outside Hermosillo, Sonora. Just as I arrived, the local doctor who I’d intended to work with suddenly needed to move his family out of the community in response to a personal emergency. Because collaborating with him was crucial for my original project, I had to pivot my internship in a totally new direction.

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CommCare platform can be installed on simple Android phones

Thanks to guidance from Dr. Kacey Ernst and my internship preceptor, I was able to work directly with several different teams of “brigadistas” (Community Health Workers) who focus on controlling dengue fever in urban Hermosillo. The Sonoran health department has a very well organized system for controlling dengue, and CHWs are essential for performing various activities to control Aedes aegypti mosquitos and detect cases of dengue. Hermosillo’s CHWs walk door-to-door through the city, and I traveled alongside them, observing how the system works.

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Brigadistas (CHWs) drive in this bus on their way to work

One of the tasks of my project was to see if CHWs might be interested in using their own smartphones to do their work more easily. I started by asking CHWs to try using a paper-based questionnaire to interview residents about any dengue-like symptoms they may have had. While the paper-based survey was informative, I wanted to find a way to actually try using the CHW’s smartphones. A friend told me about new mobile health platforms like “CommCareMobile” and “KoboToolBox.” In some ways these platforms are similar to Qualtrics or SurveyMonkey by allowing users to create simple questionnaires, however these can be installed as applications on android smartphones that are common in “low-resource settings.”

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Mexico’s public health system funds door-to-door CHW work

After some initial tinkering, I was able to enter the same questions about dengue-like symptoms into a CommCare template, and thanks to the help of some of the CHWs, install CommCare on their phones. With a little practice, they were able to quickly enter interview responses into their phones, and then securely transmit responses to the platform which can be downloaded by local epidemiologists. There are many benefits to using this type of system compared to the paper-based system that CHWs primarily use, such as speed of communication and bypassing data-entry. Obviously there are obstacles too, such as limited WiFi access, and concerns about security, despite reassurance from CommCare.

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Guillermo the CHW conducting an interview with CommCare

Overall I’m very grateful to have gained some experience in an exciting new field within Public Health, as well as help answer an important question: how can new mobile health technologies serve vulnerable populations of rural Arizona and the US-Mexico border region? When equipped with mobile health technology, I believe CHWs are capable of saving lives by reporting probable cases of infectious disease that have previously been difficult to detect.

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