This week, I want to reflect on Project Masiluleke and offer a critique of the project. I will focus on the positive as well as the negative aspects. For those of you who did not read my last blog, Project Masiluleke is based in South Africa, and it focuses on using mobile technology to remind people to get tested for HIV and stay on their medication, to provide support for those who have received a diagnosis already, and to facilitate home testing in order to up the rates of people getting tested. It is one of the first projects of its kind, and has already made a great deal of headway in its first phase. The amount of call traffic that the HIV hotlines receive has tripled since the project’s inception.
I first want to comment on the positive aspects of this project. Obviously, the idea is a novel one and I think it really capitalizes on available technology in the developing world. As I have mentioned before, over two thirds of people in developing nations have cellular telephones. Thus, learning how to use them as a health tool is an intelligent and innovate idea. Project Masiluleke has done just that. It has partnered with Vodafone/Nokia to send out free text messages that remind patients to get tested and to take their medicines. Only about 10% of those who start taking ARVs continue to take them. If this medication can save the lives of so many, it is imperative that those affected by the disease learn how important it is to continue taking it. Simple reminder messages are the first step.
Additionally, the project has really brought forth community based solutions, which I see as an important step. The HIV+ call center will be run by HIV positive patients from the community. This way, it is not like anybody from the outside world is coming into the small villages to offer advice. It is people within the greater community that serve as role models, detailing how they got tested and how they cope with their own diagnosis. This provides a communal support system, and it can all be anonymous because it is via phone.
Although I see many positive aspects to Project Masiluleke, there a few downfalls as well. One disadvantage that I see in this project is the safety and validity of at- home tests. The last phase of the project calls for people to perform an at-home HIV test that is currently being developed. In theory, this idea is great because it erases the stigma attached to going to public testing centers. Yet, how accurate are these at-home tests?
And, are patients emotionally strong enough to cope with their diagnosis on their own? At testing centers, those who prove to be HIV + are then given information about how to go on living their lives. I have a fear that some people who test positive will not call the mobile support to receive help—they may feel discouraged and try to deal with the diagnosis on their own.
A second con that I envision sprouting from this project is the lack of personal, one to one healthcare. No matter how far technology advances, the personal relationship that can form between a doctor and his or her patient is irreplaceable. Mobile support allows for trained professionals to educate and advise those who call in, yet doctors will always be a necessity. Programs like Project Masiluleke improve the situation, yet they do not diminish the need for doctors. It is important that we understand that person-to-person contact cannot be replaced by technological advances. There is still a huge need for more doctors in these areas of the world.
All in all, Project Masiluleke is an innovative, efficient program that has the potential to do a great deal of good in Sub-Saharan Africa. Despite its few cons, it has set a precedent for programs like it to follow in the future, and I am excited to see what springs from this project.
Sources:
http://www.poptech.org/project%5Fm%5Fthe%5Fsolution/
I think you point out two very important problems with using cell phones to substitute for doctors, especially with such a devastating disease as HIV. I definitely do not think that at-home tests should be introduced into communities where there is no support system for HIV positive patients, as they might find their diagnosis even more isolating and frightening if they learned it at home versus in a clinic. The support network/hotline idea strikes me as a great one, however, and I think this model could be successfully implemented in a lot of different situations- even in the developed world. I could see it having great advantages especially in countries divided along racial or religious lines, since people speaking on the phone would be more likely to listen to each other without much bias (examples I am thinking of would be people with indigenous blood, of mixed race, or other often stigmatized ethnic backgrounds who may not get quality care just because of their appearance).