The Internet for obstetricians and gynaecologists in Latin America

Jorge Amado, a Brazilian writer, once remarked: ‘The common bond in Latin America is poverty; there are very few cultural bonds’. The countries of Latin America do not share a common Internet identity founded on demography, economy and culture. It would be a mistake to regard the region as homogeneous with regard to health care systems. In fact, it might be a mistake to regard the region as an homogenous entity at all given the wide differences in standards of living, cultural values and economic development.

Internet research firm eMarketer (www.emarketer.com) predicts that the number of Internet users in Latin America will reach 60.6 million by 2004. It estimates that there will be over 43 million Internet users in the region by the end of 2003. By 2004 Argentina, Brazil and Mexico will account for 65% of the total Internet population in Latin America. The Internet user base in Argentina is the third largest in Latin America after Brazil and Mexico, and has doubled over the past year, reaching 2 million people in mid-2001, according to a recent survey conducted by the Argentine market research firm D’Alessio IROL (Figure 1) [1]. Other estimates for Argentina range from 2.5 million (International Telecommunications Union and Gartner Research) to as high as 3.9 million users (Nielsen//NetRatings; www.nielsen-netratings.com). This enormous growth has increased Internet penetration to 6.8% of Argentina’s population of 37 million. In Latin America the Internet is spreading most rapidly in Mexico and Argentina but continues to be restricted to the high and middle socioeconomic groups.

Because the penetration of Internet services has primarily targeted those with access to the private sector, a digital divide has also emerged in health provision opportunities. Even though the private sector is growing, the majority of the population still relies on public sector health care and has therefore little access to health-related Internet services. From recent surveys, we know that in Latin America Internet sites tend to be utilitarian and most visits are for study or work purposes and searches do not generally go beyond national boundaries (Figure 2).

Spanish-language health information on the Internet has not grown at the same rate as the number of Internet users. Some sites cover personal accounts of illnesses and patient discussion groups (scarce in the Spanish language), journal articles (not usually peer reviewed) and clinical decision support, but most sites are institutional belonging to scientific societies and universities. Defining the quality of such a disparate collection of resources is challenging. Furthermore, different users and different cultures sharing the same language may have different needs, hence different quality criteria. Patients and carers may want simple explanations and reassurance, whereas health care professionals may want clinical trial data. Maternal and perinatal health remains a considerable problem for Latin America and the Caribbean. Despite the enormous potential in the region, the figures for maternal and perinatal mortality are alarming. Although infant mortality has diminished in the last 25 years, perinatal mortality has shown few changes, and the figures for maternal mortality continue to be disturbingly high. Many proven methods in caring for mothers and their unborn infants are ignored and some interventions are still being carried out that have been shown to be ineffective or even harmful. This situation is partly due to the lack of access of financial health care decision-makers to pertinent, up-to-date and evidence-based information on maternal and perinatal health.

“Access to scientific information is a fundamental condition for improving the quality of medical care.”

Access to scientific information is a fundamental condition for improving the quality of medical care. For the Spanish-speaking countries and Hispanic communities of Latin America, the search for information is difficult due to the lack of qualified information and the fact that health information that is valid in a specific health care context may be not applicable elsewhere.

The information given in this article is not meant to be comprehensive. Instead, it seeks to list some of the most important Latin American sites, chosen for their origin and content.

Spanish-language Internet sites aimed at the gynaecologist are mostly institutional sites belonging to scientific societies. These sites are reliable but do not have much medical news; instead they concentrate on society activities (mainly congresses) and provide institutional information (directors, members, etc). Most contain information aimed at both doctors and patients:
- the Buenos Aires Society of Obstetrics and Gynaecology (www.sogiba.org.ar/sogiba.html) has password-protected information for its members and news available for both members and non-members;
- the Colombian Society of Obstetrics and Gynaecology (www.scog.org.co);
- the Sociedad Espaola de Obstetricia y Ginecologa (www.sego.es) is one of the best institutional sites in Spanish for obstetricians and gynaecologists;
- the Argentine Society of Paediatric and Adolescent Gynaecology (www.sagij.org.ar);
- the Society of Obstetricians and Gynaecologists of Uruguay (www.chasque.apc.org/sgubib/index.html);
- the Latin American Federation of Societies of Obstetrics and Gynaecology (www.flasog.org).

Other sources of health information on the Internet are sites linked with public health, mainly women’s health, often under the auspices of the WHO, the Pan American Health Organization (PAHO) (www.paho.org) or the Centro Latinoamericano de Perinatologia y Desarrollo Humano (CLAP) (www.paho.org/clap). The mission of CLAP (Latin American Center of Perinatology and Human Development of the PAHO/WHO) is to contribute to an improvement in maternal and child health by co-operating with other Latin American countries to identify and solve the most important perinatal health problems. This site also contains medical literature, news, articles and information about courses.

The Maternal and Perinatal Virtual Health Library (perinatal.bvsalud.org/html/es/home.html) consists of a collection or network of health information sources in the region, providing information on up-to-date techniques in maternal and perinatal health. This database of knowledge makes a particular contribution to improving maternal, perinatal and infant health in Latin America and the Caribbean. Some independent sites function as internet journals. Among the peer-reviewed journals are:
- OBGYN.net Latina (latina.obgyn.net), the Spanish section of the well-known OBGYN.net site. This site was founded in 1998 as an international resource centre for doctors and patients and its information is continually updated and monitored by physicians. It has a calendar of events and a professional forum, and is updated monthly.
- IntraMed (www.intramedglobal.net) is targeted exclusively at the Spanish-speaking medical community and offers comprehensive medical and health information, arranged in chapters; a sizeable chapter is devoted to obstetrics and gynaecology.
- Gineconet (www.cpcweb.com.ar/default.asp) focuses on colposcopy, cytopathology and gynaecological infections, and is designed for women and health professionals. The women’s section provides up-to-date featured articles and has access to online discussion forums. The medical professionals’ page contains daily news, reviews, original articles and an image colposcopy library.
- GineWeb (www.unizar.es/gine/home.htm) provides online information in Spanish about health and female well-being. It also provides information about congresses, scientific articles, and news for the non-professional. It includes a newsletter.
- SIIC Ginecologa, Novedades diarias, (www.siicsalud.com/main/Mujerysalud.htm) publishes daily medical news in Spanish and Portuguese, scientific information on medicine and health care, arranged according to specialty and themes. Articles are selected and written by the Sociedad Iberoamericana de Informacin Cientfica (SIIC).

There is no doubt that good, evidence-based information is now available worldwide and that the Internet is providing the tools for low-cost and effective dissemination and retrieval of information. Availability of information is one thing, access to and use of the available information is another[3]. For developing countries to achieve the benefits of access to health data, they must invest in producing and disseminating information in their own languages and promote public health literacy[4].

The Reporting Group of the Sixth Regional Congress on Health Sciences Information, CRICS 6, which took place in Puebla, Mexico, in May 2003, stated that ‘Information is a global public asset that does not end by consuming, but enriches by sharing. It is like the candle that does not lose light when another candle is lit and together they shine more to all. It is fundamental to assure and maintain equitable access to this public asset so that any citizen may participate in all decisions related to their individual and collective health’[5]. It is fundamental that governments and health organisations around the world understand this sentiment and facilitate the dissemination and access to knowledge, so that Latin America will be able to bridge the gap to the developed world.

References:

References

1. D’Alessio IROL. Argentine Internet users doubled in one year. Press release, 25 June 2001.

2. Soong R. Preference for foreign vs. local websites. Available at: www.zonalatina.com/Zldata170.htm. 4 April 2001.

3. Odutola AB. Developing countries must invest in access to information for health improvements. J Med Internet Res 2003;5: e5. Available at: www.jmir.org/2003/1/e5.

4. Rodrigues RJ, Risk A. eHealth in Latin America and the Caribbean: development and policy issues. J Med Internet Res 2003; 5: e4. Available at: www.jmir.org/2003/1/e4.

5. Cantú P, Londoño R, Pellegrini A, et al., for the CRICS 6 Reporting Group. Available at: www.crics.info/crics6/en/ relatoria.htm.