1. 1 An effort towards bridging the digital divide... Going the last kilometer in the Peruvian Jungle – for HEALTH CARE ENLACE HISPANO AMERICANO DE SALUD – EHAS* *Hispano American Health Link

2. Four institutions collaborate working for the EHAS program in Perú: §TWO are from Spain: §Universidad Politécnica de Madrid (UPM) with the Grupo de BioIngeniería y Telemedicina (GBT) §Asociación Madrileña Ingeniería sin Fronteras (IFS) §TWO are Peruvian: §Pontificia Universidad Católica del Perú (PUCP), with the Laboratorio de Comunicaciones de Bajo Coste (LCBC) §Universidad Peruana Cayetano Heredia (UPCH), with the Centro de Coordinación Nacional (CCN)

3. Funded by: Actors: PUCPISFUPCH AECICYTEDCONCYTEC GBT-UPM Other support Entities Enlace Hispano Americano de Salud EHAS Program in Perú Microsoft U NIVERSIDAD P ERUANA C AYETANO H EREDIA (Antiviral program)(Software Licences)

4. 4 The EHAS program has established a pilot in 40 communities in Alto Amazonas, Dept. of Loreto, working with the Ministry of Health... One of them is Sucush-Yacu, a riverine community on the Huallaga river. The river is almost the only way of reaching this small town...

5. Shucush - Yacu Seen from above

6. Travel conditions in the Peruvian Jungle Health personnel travel away from their Posts some 30-50 times a year, because of service needs EHAS-PERÚ

7. EHAS Program Keys of the EHAS program: Communication and health information services Targeted to the health personnel in rural areas of developing countries Appropriate low cost technologies Spanish language services

8. General Objective Contribute to the improvement of the public health system in rural areas of Latin American countries EHAS Program

9. Specific Objectives Improve the working conditions of rural sanitary personnel by acting on: The telecomunication infraestructure of the more remote and isolated rural health establishments, specially those without telephone lines and services Provide health information services, so as to give: Remote access to specialized health information Access to distance learning courses Remote access to consultation with expert health personnel Improvement of the epidemiologic surveillance system EHAS Program

10. And... What is the communications tool going to be?... the COMPUTER Theres NO telephone in most of the Health Posts... and theres NO hope of having one in those communities, for many years Therefore RADIO has to be used for both VOICE and DATA communications And TRAINING the personnel for proper use of the new tools is paramount... Remember:

11. The Alto Amazonas Province EHAS-PERÚ

13. Health Establishments involved in the EHAS Alto Amazonas Pilot In June 2001, OSIPTEL/FITEL placed telephones in 7 establishments: * Saramiriza, * Santa Cruz, * Pampa Hermosa, * San Lorenzo, * Shucush-Yacu, * Jeberos and * San Gabriel de Varadero

14. EHAS-Alto Amazonas

15. From: "Puesto de Salud Munichis" To: Sent: Tuesday, November 06, 2001 7:28 PM Subject: ofidismo (SNAKE BITE) hola Señor Carlitos como esta me da mucho alegría que alguien tenga un tiempito para dedicarnos a nosotros apesar que estamos tan distante pero mediante este sistema fácilmente se comunica, quería pedirle una lección te cuento que en este mes he tenido 02 casos de mordedura de serpiente (jergón nombre común) yo quiero que me envíes el tratamiento correcto de un paciente con este Dx, Ud., sabe que nosotros somos técnicos a mucha honrra ¡verdad! yo trato así coloco una vía de cloruro de sodio 9%, suero antibotropico polivalente, dexametazona, metamizol 1gramo,PG sódica 1000,000UI, y después de las 24 horas ya empiezo con vía oral es decir según casos si el paciente ha mejorado y dime siempre en necesario para prueba de sensibilidad, bueno señor carlitos espero su respuesta ya que estoy tratando un caso de esto. chau hasta otro momente. (The punch line: " I expect your answer because Im treating a case ") AN AUTHENTIC MESSAGE FROM THE FIELD

16. Some of the didactic material prepared specifically for Loreto By the Primary Health Care – Loreto Project

17. And the Sanicho newsletter – Which has its own trajectory! Primary Health Care – Loreto Project NOW, theres an electronic version...

18. Costs of the EHAS system (per establishment) Infrastructure costs: US$ 4195 Energy supply: US$ 1450 (two 75Wp solar panels; a 225 Ah battery bank; a photovoltaic regulator; a 75 W inverter; two 13W lights; supports, battery box, etc. Communications system: US$ 685 (a VHF transceptor; a radio MODEM; box, etc. Antenna & accessories: US$ 800 (a 15 m robust mast; a VHF antenna; a grounded lightning rod; coaxial cable, etc.) Workstation: US$ 1260 (a laptop computer; a matrix printer; a worktable-enclosure)

19. Communications Costs : Local voice and data communications – most (~ 80%) of these are FREE Access to external addresses: ONE local call every 3 hours, shared throughout the network Maintenance Costs: Paid, so far, by the EHAS project as part of the funded activities

20. Initial Evaluation (at 9 months operation) : Most communication occurs locally, and is on patients while they are seen - better care! Health personnel travel is reduced – savings! Patient evacuations are avoided or simplified and streamlined – further savings! Out of 237 urgent evacuations, in 60 cases the EHAS system is credited with saving lives Time for report making is reduced and less data errors are likely to be made - no rewriting! Health personnel appreciate e-mail consultation and training – Courses satisfied 70% of expectations! Satisfaction and confidence of the Health personnel in the new tools is high – 95%!

21. Initial Evaluation (at 9 months operation) : Taking initial investment, maintenance and repair costs, avoided travel pays back in 32 months If tangible indirect savings (avoided productivity and time losses of Health personnel) are factored in, the system is amortized in 13 months! Calculations of economic benefits for the reduction of lost workdays by the patients, less deaths or discapacities, etc., would result in even less time to amortization. And then, there are the intangibles… better health, greater equity, improved community life, citizen pride, etc…

22. But… we have to think of all the rural areas of Perú...... And Theres a greater challenge…: The map shows the distribution of the 36 native mother - languages spoken in Perú

23. Within the Universidad Peruana Cayetano Heredia, the EHAS project is housed at the Instituto de Medicina Tropical Alexander von Humboldt §Director: §Dr. Eduardo Gotuzzo §egh@upch.edu.pe §EHAS Coordinator : §Dr. Humberto Guerra §hguerra@upch.edu.pe Mailing Address: A.P. 4314, Lima 100, Perú Phone: (511) 4823903 Fax: (511) 4823404 Website: http://www.upch.edu.pe/tropicales/upch.htm

24. Instituto de Medicina Tropical Alexander von Humboldt of the UNIVERSIDAD PERUANA CAYETANO HEREDIA Within the Hospital Nacional Cayetano Heredia, Lima 31, Perú