Eduardo Munoz / REUTERS Making a phone call at a hospital in Santo Domingo, Dominican Republic, July 2011.

Information for the Unconnected

Letter from Santo Domingo

Today, Carlos Adon is an experienced HIV/AIDS specialist in a well-equipped private clinic in Santo Domingo, the capital of the Dominican Republic. Twenty years ago, he was like most of the country’s other recent medical school graduates: he had been sent into the countryside for 12 months of mandatory service, known as a pasantía year, as a poor community’s sole doctor. With access to only rudimentary equipment and medicines, Adon lugged around outdated textbooks and did his best to serve his patients. But his lack of up-to-date information created problems. At one point, a patient who appeared to have been poisoned by agricultural pesticides nearly died: Adon was unfamiliar with the chemicals used on the area’s farms and had no way to determine the appropriate treatment.

These days, a search through an online medical resource can help doctors quickly identify poisons and antidotes. But in the rural Dominican Republic, Internet access remains scarce, and doctors still lack the information they need, much as Adon did during his pasantía year. Some 48 percent of the Dominican Republic’s citizens lack access to the Internet, and because building broadband infrastructure in remote areas is expensive and data plans are unaffordable for many Dominicans, the country’s connectivity problem is unlikely to end soon.

The good news is that there is an affordable way to bring up-to-date information to the unconnected. So-called offline Internet technologies—or information-sharing platforms that house data originally hosted on the Web but do not require Internet access—can bring data to the poorly serviced parts of the developing world that need it most.

At the clinic of Rafael Fernandez in the Dominican Republic's Monte Cristi province, March 2017.

At the clinic of Rafael Fernandez in the Dominican Republic's Monte Cristi province, March 2017.

BEAM ME UP

Some communities with limited Internet access have developed information-sharing networks on their own. In Cuba, for example, people have created an informal network centered on a collection of data known as El Paquete (The Package), which compiles movies, newspapers, music, offline websites, and other media onto USB or hard drives that can be exchanged and updated. This system has allowed Cubans to access media that they would normally be restricted from seeing, letting them keep up with everything from American television shows to international news. Major technology companies, meanwhile, are developing offline Internet products to reach new, poorly connected markets. Google’s Web browser Chrome, for example, is beginning to offer a feature that will let mobile users minimize the amount of data they need to view Internet content and another that will let users save articles, videos, and webpages to view after their devices go offline. The Raspberry Pi 3—a cheap minicomputer—can be turned into a storage device that doubles as a local router, providing a library of information to up to 30 wireless users without connecting to the World Wide Web. Such innovations could help bridge the information gap in low- and middle-income countries as more of their citizens begin to use smartphones. 

These technologies would be especially useful for the roughly 1,000 pasantes who are sent from Dominican medical schools to rural clinics each year. The demands placed on the young doctors are intense: one pasante named Rafael Fernandez told us that he was expected to serve as “the pediatrician, the gynecologist, the surgeon—everything.” Pasantes are paid a low living wage, and many can’t afford textbooks; although most of the doctors own smartphones, cellular data can be prohibitively expensive. Some resort to downloading bootleg copies of textbooks onto their phones and then scrolling through massive files to find the information they need. 

Offline Internet technologies could improve more than just health outcomes in unconnected places.

One pasante described seeing a patient with a set of symptoms she didn’t recognize. She eventually diagnosed the patient with diphtheria—a bacterial disease that had supposedly been eradicated from the Dominican Republic and hadn’t been mentioned in her medical education. In a place with Internet access, a resource such as WikEM—an open-access emergency-medicine database—would have helped get the patient treatment more quickly. In the rural Dominican Republic, an offline diagnostic tool could have played a similar role.

Offline Internet technologies are not only useful in rural areas, however. Even in the Dominican Republic’s cities, most hospitals do not offer WiFi or make Internet-connected computers available to staff. Experienced physicians working on complex cases need access to specialized information, and they value up-to-date, peer-reviewed medical literature—such as that on the treatment protocols for HIV/AIDS, which are frequently revised and improved.

Performing surgery in Santo Domingo, December 2008.

Performing surgery in Santo Domingo, December 2008.

MORE DATA FOR THE BUCK

Offline Internet technologies can also help doctors connect with patients. Around ten percent of the people who live in the Dominican Republic are of Haitian descent, and most of them are poorly integrated into Dominican society: many, for example, do not speak Spanish. In Monte Cristi, a province on the country’s border with Haiti, pasantes we spoke with reported that most of their patients were Haitian. Because the doctors did not speak Haitian Creole and had no way to learn it, they and their patients had to rely on sign language or informal translations from Spanish-speaking relatives to communicate—hardly ideal conditions for making diagnoses or explaining treatment regimens. Open-source medical dictionaries in multiple languages, offline translation applications, or Creole-language training videos could help. Similar tools could be useful in other multilingual countries.

Indeed, the challenges that Dominican doctors encounter are widespread. Although Internet connectivity has been improving in Latin America in recent years, a number of other countries in the region, such as Guatemala and Peru, likewise have low Internet penetration and geographies that inhibit its growth, and in many countries, there is still a wide gap in access between rural and urban areas.

The rollout of offline Internet technologies in some of these unconnected places could improve more than just health outcomes. A digital library the size of a cell phone could transform local education. (Such devices have already been deployed as part of literacy programs in India and some African countries.) This so-called Internet-in-a-Box could also help farmers measure their crops’ growth against scientific benchmarks or anticipate changes in the weather.

Information cannot solve the problems of economic development, educational attainment, and public health on its own. But offline Internet technologies have the potential to bridge information gaps and create platforms that can help unconnected populations by letting them access vital information. Governments, nongovernmental organizations, and businesses should work together to bring these low-cost, high-benefit technologies to the unconnected.

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