The Zika virus became a global health issue in 2015-2016 as it spread across the world. Above all it affected the poor and the excluded very hard. ICT can play a crucial role in prevention but needs to address problems of poverty and inequality.
In August 2014 physicians in North-eastern Brazil started to see what they initially thought was an outbreak of dengue fever. Dengue is endemic in Brazil, as it is across tropical parts of South America. Smaller epidemics do happen from time to time. However, medical doctors were perplexed to find that it was not Dengue fewer this time as it was ruled out after testing patients. Therefore doctors now faced the uncertainty of trying to prevent an unknown disease from spreading (McNeil et al 2016).
In the year that followed the” new disease” spread throughout northern Brazil, leaving physicians perplexed. Finally, in May 2015 the agent that caused the sickness was identified – it was called the zika virus (GloboNews 2018, ProMed 2015).
The Zika virus originated in Africa and is believed to first have spread to French Polynesia from where it reached Brazil. There, it found the perfect environment to infect as many people as possible. It became a global health issue as it spread across the world, revealing an extremely dangerous deformation of the foetus while in the womb (microcephaly). This condition spread throughout the region along with the zika virus (Duffy et al 2009).
Photo: The economist.com The Zika virus became a global health issue in 2015-2016 as it spread across the world. It was especially severe in areas that suffer poverty and exclusion.The virus quickly became endemic across the tropics in northern South America (Mainly Brazil, Colombia, Venezuela, Ecuador, Peru, Guayana) but it also reached the US and Chile/Argentina.
Response and Action
In a public health crisis communication is absolutely crucial. The nature of the disease meant that transmission could be deterred were people not be exposed to infected mosquitos. Therefore; the use of repellent, avoiding open water sources, fumigating areas that have seen cases of Dengue, Yellow Fewer and now also Zika would be effective to prevent zika from spreading further. Therefore authorities needed to engange with communities and transmit this information as quickly as possible.
Lima et al (2014) found in a study that 78% of Brazilians have access to the internet, this mainly through cheap accessable mobile phones. Due to this most Brazilians would be reachable through those very same devices.
Hence, a lot of people were reached by such communications. However, it is important to also look at how power relationships affect how public health is communicated and promoted. Why was the effort not successful enough to prevent the virus from spreading further?
Public Health and Power
The view of what Health Promotion actually is, is key to understanding how Zika prevention was communicated using ICTs. Behind the view that ICTs can help those in need to empower themselves is a view of how one group (western, wealthy countries) enmancipate another group (developing poorer countries) using a specific medium (ICT) (Unwin 2017:27,28). This material background affects how health promotion is carried out.
There are usually two general ways to view Health Promotion: a preventive approach, or a medical understanding of health where absence of disease is the desired state and that this is achieved through disciplining of communities. This usually means that actions are taken to correct any health problems through legal or other coercive ways. The other view is an educational approach more of a bottom-up approach, that is mainly focused on enganging the community in their own health. Here education is key – it becomes a way to enpower communities and make them participate in their own health (Tones & Green 2004:16,23,24).
One example of a preventive approach for the Zika-crisis is evident in Sareen et al (2017) when they argue that we could:
”… prevent and control the spread of Zika virus disease using integration of mobile phones and Internet… Google Maps Web service is used to provide the geographic positioning system (GPS)-based risk assessment to prevent the outbreak. It is used to represent each ZikaV infected user, mosquito-dense sites, and breeding sites on the Google map that helps the government healthcare authorities to control such risk-prone areas effectively and efficiently…”
In the above solution the communities are largely perceived as a problem that can be controlled using technology and instrumental reason. However, as it has been shown by Michael Marmot (2005, 2015) public health as a lot to do with inequality. If you are poor you are more likely to get sick. If you are poor you are more likely to get infected by Zika. So an approach only focusing on technology, and not also equality, would shoot above the target. If you live close to an open sewerage where mosquitos breed in their thousands your problem is not whether the ministry of health sends you a WhatsApp with information regarding Dengue or Zika – your problem is the open sewerage! Hence, in such cases it is less to do with maps and GPS and more about understanding day-to-day problems in the affected community (access to basic services).
Living in the aftermath of Zika Infection
To get an idea of how hard it actually is to cope with zika in a situation where poverty is widespread a recent BBC World Services (2018) special entitled Zika Love Stories provides something of an insight. In the program we meet Sofia a single mum and her day-to-day struggle of raising a child that suffered Microcephaly. She is dependent on support from local and federal governments and, all though she is almost always smiling (even when she is crying) she explains how very difficult it is to live like this as a single mother of four.
Photo: BBC World Services
Children affected by microcephaly require constant attention, medical care and therapy. All this makes already difficult conditions even more challenging for those mothers who are affected. Many times their social economic background makes them dependent on whatever support regional and federal governments can provide. Sofia (the photo) is a single mum of four who is really trying to get by in an area that is already socially and economically excluded.
Sofia’s story also shows us something important about public health. Access to care is hugely dependent on socio-economic status across the world. Sickness leaves a mark on already empoverished communities and expose them to even more financial hardship (Marmot 2015).
Summary
Thus, solutions to public health crises should involve communities. It is important to empower them to become owners of their own health. Meanwhile efforts should be undertaken to mitigate the structural injustice across society.
Similarly Lucena et al (2018) have proposed that technology could be used to pursuit community engangement in order to contain and prevent the spread of Zika. In this approach technology is less about mapping and containment and more about information exchange between authorities and communities. In order to prevent disease we need to understand the social processes that cause it.
Additionally, Pia Riggirozzi (2017) questions whether any good intentioned efforts to contain Zika will achieve any results of value as long as poor infrastructure, inequality and the fact that socially and economically excluded groups are those most affected remain a fact across the region. This may appear pessimistic, but indeed any development of technology for zika containment must include the social aspect and not just perceive communities as problems to be managed. Surely activism about zika must also be activism about poverty and exposure to disease.
References
“Identificado vírus causador de doença misteriosa em Salvador e RMS – notícias em Bahia”. GloboNews (2018) (in Portuguese). http://g1.globo.com/bahia/noticia/2015/04/identificado-virus-causador-de-doenca-misteriosa-em-salvador-e-rms.html São Paulo, Retrieved October 2018.
“Zika virus – Brazil: confirmed”. ProMED-mail. International Society for Infectious Diseases. May 19, 2015.
BBC World Services (2018) Zika Love Stories, https://www.bbc.co.uk/programmes/p06m70zb (retrieved October 2018).
de Lima, J. P. C., Rochadel, W., Silva, A. M., Simão, J. P. S., da Silva, J. B., & Alves, J. B. M. (2014). Application of remote experiments in basic education through mobile devices. In Global Engineering Education Conference (EDUCON), 2014 IEEE (pp. 1093-1096). IEEE.
Duffy, M. R., Chen, T.-H., Hancock, W. T., Powers, A. M., Kool, J. L., Lanciotti, R. S., Pretrick, M., Marfel, M., Holzbauer, S., Dubray, C., Guillaumot, L., Griggs, A., Bel, M., Lambert, A. J., Laven, J., Kosoy, O., Panella, A., Biggerstaff, B. J., Fischer, M. & Hayes, E. B (2009). “Zika Virus Outbreak on Yap Island, Federated States of Micronesia”. New England Journal of Medicine 360 (24): 2536–2543.
Lucena, T. F. R., Velho, A. P. M., Dorne, V. D., & Domingues, D. M. G. (2018). Devising Mobile Apps: Participatory Design for Endemic Diseases Transmitted by the Mosquito Aedes (Dengue, Zika and Chikungunya). In Mobile Story Making in an Age of Smartphones (pp. 139-150). Palgrave Pivot, Cham.
Marmot, M. (2015). “The health gap: the challenge of an unequal world.” Bloomsbury publishing, London
McNeil, Jr. Donald, G, Romero, S. Tavernise, S. (2016). How a medial Mystery in Brazil Led Doctors to Zika, The New York Times, https://www.nytimes.com/2016/02/07/health/zika-virus-brazil-how-it-spread-explained.html. Retrieved October 2018.
Sareen, S., Sood, S. K., & Gupta, S. K. (2017). Secure internet of things-based cloud framework to control zika virus outbreak. International journal of technology assessment in health care, 33(1), 11-18.
Tones, K., & Green, J. (2004). Health promotion: planning and strategies. Sage.
Riggirozzi, P. (2017) Las Injusticias del Zika, https://elpais.com/elpais/2017/06/27/planeta_futuro/1498572397_103973.html (Retrieved October 2018).
Unwin, P. T. H., & Unwin, T. (2017). Reclaiming information and communication technologies for development. Oxford University Press.