1. A RABIES CELL PHONE ADVISORY SYSTEM: A CULTURALLY TARGETED TOOL DESIGNED TO REDUCE HUMAN RABIES SUFFERING IN THE PHILIPPINES Introduction Rabies in the Philippines is endemic, with several hundred fatalities reported each year in the archipelago. Significant morbidity also exists from dog bite injuries, which often require rabies post-exposure prophylaxis (PEP). Rabies illness is virtually 100% preventable if appropriate and timely PEP is provided. Barriers responsible for the ongoing rabies problem in the Philippines and other developing countries include lack of knowledge regarding many aspects of the disease and its prevention. Information to empower a large segment of the population can be made available in a culturally appropriate format – through the use of cell phone technology. E. Adriano 1, M. Vinluan 2 and S. J. Scholand 3. 1. ARF World Philippines, Quezon City, Philippines 2. Department of Health, Manila, Philippines 3. A Rabies Free World, Philadelphia, United States of America. Morbidity and mortality from human rabies in the Philippines remains high. Major factors responsible for the continued problem include lack of knowledge regarding aspects of disease prevention, perceived high cost of treatments, cultural inhibitions to legitimate medical care, as well as finite resources. In resource constrained areas where rabies is endemic, low cost technologies developed to address these issues could reduce suffering by providing information to make more intelligent decisions. We sought to develop a cell phone tool to disseminate information about rabies to the people of the Philippines. We envisioned users of the system to increase their understanding of rabies so as to more appropriately access existing health resources. We contracted a private company to develop a cell phone accessible information system designed to provide basic information about rabies. Through ‘text messaging’, users can download to their cell phone information on rabies including: rabies prevention, rabies prevalence, disease basics, appropriate treatment for potential rabies exposures, and animal and dog information. Additionally, the system provides the location of Department of Health (DOH) approved Animal Bite Treatment Centers and Bureau of Animal Industry recognized veterinary diagnostic laboratories. The three major telephone carriers in the Philippines now support this tool, with the potential to reach up to 20 million cell phone users. Promotional efforts to make the tool more widely known are ongoing. Future studies to assess the impact of the rabies cell phone advisory system in terms of health access and utilization are planned. We identified areas where lack of awareness lead directly to fatalities from rabies: Exposure risk No medical care sought Delayed, inappropriate or absent PEP Medical care sought from local non-physicians (‘tandoks’ or faith healers) Perceived high cost of treatment Incomplete follow up Results A rabies cell phone advisory system was designed using existing technology. The system was launched and implemented. Formal studies to test efficacy as a learning tool are planned. References 1. Knobel DL, et al., Re-evaluating the burden of rabies in Africa and Asia. Bull of the WHO. 83(5):360-8, 2005 May. 2. Alera M, et al., Clinical and epidemiological features of human rabies cases, San Lazaro Hospital, Manila, Philippines, RITA, Brazil. Oct 2006. www.rabiesfreeworld.net Conclusions Cell phones are widely available in the Philippines and other Asian countries where rabies is endemic Education about rabies disease and prevention saves lives A tool designed to provide valuable health information to the people of the Philippines supplements other anti-rabies efforts. Maricar Dizon Figure 2. ‘Fighting against the deadly virus’ Table 1. Excerpted data from database Abstract Materials and Methods Manila City Unciano Medical Center, Sta Mesa, Manila Manila Health Department, Division of Preventable Diseases, Manila City Hall Research Institute for Tropical Medicine (RITM), Alabang Muntinlupa (02) 8072628 San Lazaro Hospital, Rizal Ave, Sta Cruz Manila Rabies is caused by animal bites or scratches. One in 100 dog bites is from a rabid animal. Signs and symptoms of rabies are: fever, numbness at the bite site, agitation, fear of water, and paralysis. The victim might act crazy. Rabies does not develop right away. It can take weeks to months to develop. It is a must to consult an Animal Bite Treatment Center once exposed or bitten. Rabies Tips Animal Bite Treatment Centers Rabies Approved Diagnostic Labs Modified from original by Dr. E. Miranda < 1 1 – 19 20 – 29 30 – 39 Bureau of Animal Industry, DA, Visayas Avenue, Quezon City Research Institute for Tropical Medicine (RITM) Alabang, Muntinlupa (02) 8072628 San Lazaro Hospital, Rizal Ave, Sta Cruz, Manila Manila City Figure 1. Rabies Fatalities in the Philippines 2005 We designed ‘rabies bullets’ of information that could be accessed via cell phone following a subscription to a rabies advisory system (see Table 1). We included information on local Department of Health (DOH) approved Animal Bite Treatment Centers and Bureau of Animal Industry (BAI) diagnostic labs. We contracted a private company, DotEnable, to build this system, vis-à-vis other cell phone informational systems and manage it.