To mark this year's International Day for the Elimination of Violence against Women (November 25, 2105) and the ensuing 16 days of activism, I wanted to highlight one issue that affects millions of women who fall victim to sexual violence: the challenges faced in getting the crimes committed against them documented for the record.
In many countries fewer than 40% of women who are victims seek help from doctors, law enforcement or members of the legal systems and fewer still take the necessary steps to officially report it.
Why? There are many repercussions to reporting sexual violence. Around the world, women are ostracized, cast away, exiled from their families, not believed, re-victimized, re-traumatized, blamed, physically punished, even killed, for reporting sexual assault.
When women do choose to report, and seek justice, health professionals, like me, have a crucial role: reversing the pattern of impunity - where rapists get away with rape - by documenting the evidence that will bring justice to the victims, and prosecution to the perpetrators.
But few of us, here and abroad, receive training not only in how to do it, but how to do it in such a way that our report is helpful and admissible in a court of law.
For the past 3 years I have been involved in efforts to do just that in the Democratic Republic of Congo (DRC): train clinicians how to collect evidence, how to document sexual violence and how to collaborate with their law enforcement and legal counterparts as part Physicians for Human Rights' Program on Sexual Violence in Conflict Zones.
But that's not all. We are also trying to use mobile phone technology (mHealth) to connect all the dots. How successful is it? See my recent blog post below.
The idea was intriguing - perhaps even a no-brainer: create a mobile application that would allow clinicians to document physical findings during medical examinations of sexual violence victims. Then, with the patient's consent and the click of a button, have them transmit the report to the police. Justice served. End of story.
Not so for doctors in the Democratic Republic of the Congo (DRC) - one of the world's poorest countries - known, much to the dismay of everyone I met there, as the "rape capital of the world." Physicians in the United States love gadgets and new technology. Some doctors use smartphones as bona fide diagnostic tools: to listen to somebody's heart, identify a suspicious mole, or review an X-ray or blood sample. Many of us have integrated smartphone apps into our medical care, using them for research, to calculate doses of medications, for hearing tests, to ensure timely immunizations, to assess health risks, and more.
However, mobile technology is not the same in the DRC. With more than 63 percent of Congolese living below the poverty line, Physicians for Human Rights (PHR) considered the viability of mobile technology as a resource for health care workers. Would internet access be unhindered and Wi-Fi connections reliable? Are doctors and their patients comfortable enough with digital technologies that they would agree to transmit sensitive data about brutal rapes and sexual assaults wirelessly? We needed more information before we could delve into the extensive process of publicly launching an app. Thus, in January 2014, PHR introduced the idea of MediCapt to a group of seven doctors in Bukavu, a provincial capital near the Rwandan border plagued by persistent conflict and mass rape. Most were cell phone users, but lacked smart phones and were not experienced with apps.
Yet, the doctors were enthusiastic about an app that would help them document sexual violence and that might take their patients beyond physical and emotional healing. They immediately recognized the potential of collecting important evidence and data, transmitting them directly to the authorities, and tracking the epidemiology of sexual violence.
PHR's first version of MediCapt was a bit clunky. The conversion of a paper form for the collection of medical information - which these physicians had helped develop the year before - to an electronic format didn't go quite so smoothly. Rather than streamlining the recording of medical data, the initial app inadvertently created more work for busy doctors in a conflict-affected, low-resource area. As a clinician, I could relate: who wants to create more work for over-stretched doctors?
Power outages were frequent during our sessions with the doctors, and getting acquainted with the smartphones required time. But they were persistent. During a particularly useful session on what their "dream MediCapt app" would look like, we heard about pictograms, electronic signatures, voice recognition, forensic photography, and more.
We listened, we tinkered, and one year later, we brought back a leaner MediCapt 2.0. Responding to their needs, we added a pictogram and the ability to take forensic photos. As promised, we made the interface smoother and substantially reduced the number of questions physicians would have to answer. The doctors who had been introduced to the old version were beyond thrilled. While the progression of MediCapt is both inspiring and exciting, there are still hurdles to address.
For example, office workflow - how tasks and patient-care routines are organized and carried out - can be a major factor in the level of success that doctors have in adopting new technology. A discussion about workflow in physicians' home institutions in the DRC revealed the true enormity of making all of this work. The broader, infrastructural barriers - including power outages, unreliable Wi-Fi, and uncertain leadership - first have to be addressed. We must also consider how to handle peer jealousy on select physicians getting to use this technology; how to address questions about data security; and whether or not police officers and the judicial system will be as enthusiastic about the app.
As we prepare to publicly launch MediCapt later this year, we are working to address all of these issues.
Importantly, MediCapt will have offline usability, whereby data can be stored and sent at a later time, reducing dependence on Wi-Fi. Internet connections will be required only to upload records. Other innovations, such as solar chargers for mobile phones, may provide options to avert power failures. To address hospital infrastructure and institutional hurdles, including peer jealousy, we are partnering with various hospital administrations to find ways of integrating MediCapt into their own work-flows.
Lastly, we are hoping to integrate MediCapt into workflows in phases, so that at the very least, a doctor can input information into MediCapt and print out the data once they have access to a printer (which is not always easy in the DRC). This would not only reduce the need for manual duplication of patient information, but would also allow for proper preservation of medical evidence when paper copies are compromised.
At its most integrated level - our optimal scenario - MediCapt would become part of the DRC's national health systems, allowing evidence to be transmitted directly from doctors to the police and eventually introduced in court as evidence. We have a long way to go, but doctors who begin using MediCapt now hold the key to making this a reality.
My Congolese colleagues in their eagerness to try new technologies are not that different from me and my colleagues in the United States. We all want to provide the best care, in the most efficient way, while serving as advocates for our patients.
Integrating this promising app into the daily practice of physicians in a conflict zone will require strong leadership and planning. Fortunately, we have committed partners on the ground who are working with us to make MediCapt and justice for survivors a reality.
This post originally appeared as part of the Physicians for Human Rights Tech & Human Rights Blog Series The series is meant to highlight the intersection between technology and human rights, and examine the increasing role that technology can play in advancing human rights around the world.