HERA: Digital Health Platform for Refugees

What is HERA?

HERA is an innovative mobile health platform that helps Syrian refugees navigate the Turkish medical system. HERA is open-source and available for Android and iOS devices. We are seeking funding to provide free phones with HERA pre-downloaded for the most vulnerable communities.

HERA’s COVID-19 Response

In March 2020, in response to the changing needs and realities of the global community, the rapid spread of SARS-CoV-2 virus, and ongoing contextualized risks for the Syrian refugee population in Turkey, the decision was made to incorporate a COVID-19 response into the HERA platform:

• Educational content was adapted to include updated outreach and general information for refugees surrounding protection measures during the COVID-19 pandemic.
• Since the initial incorporation of educational features to the HERA App, we were able to access 75% of the user-base for symptomatic assessment at two-week intervals over the month of April.
• We are continuing to adapt the platform to include symptom questionnaires and referrals to nearby hospitals for users who report potential COVID-19 cases. This will assist in remote triaging of cases and relieve some of the burden on the already overloaded Turkish medical system.
• We want to continue our ongoing assessment of our user base, which will require contact tracing with data analysts and Istanbul-based points of contact.

While many around the world are aware of the precautions to limit the spread of coronavirus—hand hygiene, social distancing, self-isolation, and adequate nutrition—these measures are often not possible for the 5.6 million Syrian refugees in neighboring countries or asylum-seekers living under difficult conditions in Europe. It is imperative to pre-emptively understand and take into consideration the needs of refugees when planning and operationalizing COVID-19 response including national surveillance, preparedness, and emergency response planning. Prevention is the best way to protect both refugees and host communities.

HERA is a rapid-response way to operationalize prevention solutions, like hand hygiene and social distancing, that are a) quickly evolving; and b) must be adapted to the specific needs of the refugee community. HERA removes the barriers to disseminating critical information about the COVID-19 to vulnerable communities. Additionally, HERA can be used to facilitate both contact-tracing and symptom triaging, thereby relieving pressure on the already overwhelmed medical system. Finally, HERA can provide critical information to refugees who are navigating an unfamiliar medical system. One important facet of this is clearly communicating which nearby hospitals are accepting COVID-19 patients; at present, some smaller hospitals in Turkey are not accepting these cases.

While HERA has been piloted within the Turkish Syrian refugee community, its core functionalities can be used by other mobile populations. At present, HERA exists in English, Turkish, and Arabic. There is strong potential for expanding HERA’s usage to additional locations around the world.

HERA and Hardware

HERA is seeking funding to distribute mobile phones with pre-added data plans, including the HERA platform pre-downloaded, to vulnerable Syrian refugee communities living in Turkey. We will work with our already existing local liaisons to reach this population and distribute the phones. This will enable us to track the spread of COVID-19 among our refugee user population. Additionally, digitally triaging patients will reduce the strain on local Turkish hospitals.

PlatformOverview

HERA is an open-source mobile health platform that helps Syrian refugees navigate the Turkish medical system. Many refugees from Syria do not have access to basic healthcare services like prenatal check-ups and vaccinations. HERA addresses the barriers that Syrian refugees face when seeking medical care. For one, many refugees are highly transient and do not have copies of their medical records. However, more than 80% of refugees have access to a mobile telephone. HERA provides a modern, mobile, and easy-to-use app platform that refugees can use to centralize their medical records. This way, even under the most strained circumstances, patients can have access to their important documents.

HERA also assists users in making and attending important medical appointments and provides information about nearby medical clinics and emergency services. Syrian refugees in Turkey are entitled to free public healthcare, but culture and language barriers often prevent them from using these services. HERA sends users text messages or push notifications about upcoming important appointments like vaccination and prenatal check-up dates. Research has shown that text messages are highly effective at helping patients attend appointments. The platform also provides information in both Turkish and Arabic about the Turkish medical and legal system, of which many refugees have no knowledge. In combination, these features have the potential to save lives within one of the world’s most vulnerable populations.

History

Aral Surmali, M.D. and M.P.H., is the founder and CEO of HERA. Aral came up with the idea for HERA during his time at the Harvard T.H. Chan School of Public Health. Aral interned at Harvard’s Center for Global Health Delivery in Dubai, where he saw first-hand the possibility of smartphone applications in improving public health outcomes. In Dubai, Aral researched the use of text messages in increasing vaccination rates. Aral had previously founded MEDAK, the Medical Rescue Association of Turkey, which is an NGO that focuses on improving conditions for Syrian refugees. HERA was the natural combination of these two experiences when Aral returned to his home country of Turkey.

HERA was launched after Aral received an initial grant from Grand Challenges Canada. Grand Challenges Canada is a nonprofit that funds innovative solutions to critical health issues in the developing world. An initial version of the app was piloted by 300 Syrian refugees with children. This study yielded promising results, and HERA is now preparing to expand in Syria and beyond. In fact, HERA’s initial results are so promising that Aral has established a second headquarters in Cambridge, MA to support global expansion to new refugee populations. HERA is also supported by the Harvard Innovation Lab, which is an accelerator for alumni ventures.

The Syrian Refugee Crisis

The Syrian refugee crisis is the worst humanitarian crisis since World War II, according to the UN. Over 10 million people have been displaced and Turkey hosts the largest Syrian refugee population in the world. Four million displaced Syrians live in Turkey, 60% of whom are women and children. This population continues to grow: more than 300, 000 Syrian refugee children have been born in Turkey since 2011. Prenatal care and childhood immunizations are essential services that much of the refugee population does not have access to, but with the help of HERA, Aral and his team are looking to change the way healthcare is administered in refugee communities.