So-called mobile health, including text-message “blasts” to a wide
swath of mobile phone users, could be the key to communicating with
hard-to-reach patients in sub-Saharan Africa and other remote parts
of the world, the authors write online November 16 in JAMA Facial
Some 5 billion people in the world lack access to safe surgery and
anesthesia, the study team notes.
“Everyone has a phone, no matter how poor, and they come into the
clinic with those phones. How can we use that to help?” said study
author Dr. David Shaye of Massachusetts Eye and Ear in Boston, who
travels to Zimbabwe annually to provide cleft lip and palate
“Even a Maasai tribe member from rural Kenya who lives in a cow dung
hut can be my friend on Facebook,” Shaye told Reuters Health in a
phone interview. “He has no electricity but travels to a charging
station with solar panels and car batteries. We can use that to
inform more people.”
A majority of patients with cleft lip and palate in sub-Saharan
Africa say a lack of awareness about available clinics and about the
surgery itself is a major barrier to receiving care, Shaye’s team
writes. At the same time, mobile phones are in about 97% of
households in Zimbabwe.
To see what would happen if the information was broadcast widely in
advance, Shaye and colleagues arranged for an SMS text message about
available cleft lip and palate surgery to be sent out one week
before the surgical team visited Zimbabwe in early 2017.
The message was sent by the largest cell service provider in the
country to 25% of its subscribers, and provided information about
the surgical clinic and its location.
At the clinic, the surgical team asked all patients about their age,
home village and how they learned about the clinic.
During the surgical team visit, 53 patients showed up, and all had
access to mobile phones. Of those, 37 patients, or roughly three
quarters, had heard about the surgical team through the mass text
message or their parents had. The patients ranged from newborns to
46 years old, and the average patient was around 9 years old.
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Notably, the patients traveled an average distance of 100 miles to
get to the surgical team site. Those who were informed by text
messages, however, traveled shorter distances of 86 miles compared
to those informed by other methods, who came from an average of more
than 133 miles away.
“We were not expecting the vast majority to have heard about us
through the text. We’ve been traveling there for seven years,” Shaye
said. “This seems more promising than imagined, especially as phones
evolve in Zimbabwe from basic ones.”
More complex phones would allow surgeons to offer follow-up phone or
video consultations to save patients from traveling long distances
for care. Future studies could also look at transportation as a
barrier to accessing care.
“The barriers for patients coming to the city are much higher if
they live farther away,” said Dr. Mark Shrime of the Program in
Global Surgery and Social Change at Harvard Medical School in
Boston, who wasn’t involved in the study.
“We’re also interested in the intersection between poverty and
surgery, as in people who are impoverishing themselves in the search
for surgical care due to the cost of surgery, transportation and
food,” he told Reuters Health by phone. Shrime is currently studying
ways to address this problem in Papua New Guinea.
The current study also indicates how African countries are
“leapfrogging” technology by skipping landline phones and moving
straight to mobile devices, Shrime added. Mobile health technology
could advance quickly and in different ways from developed
countries, he said.
“Traditional marketing techniques and notifications that have worked
in the United States may not work in Africa,” Shrime said. “However,
we could make great use of this new media to improve health.”
JAMA Facial Plast Surg 2017.
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