No Country for Online advocacy

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San Lorenzo, rural community in Ecuadorian coastline
In 2018, only 16,1% of houses in rural areas of Ecuador had access to internet

In the spawn of three months, grandparents learned how to use Zoom, professors that had been teaching since the last millennium had to learn forcefully about live-streaming and virtual conferences, and humanity realized that many daily activities can be done online. Technology had been swallowing slowly our daily routines during the last decade; however, it took an accelerated and imposed growth due to this pandemic 

This change to online-based society seems easy and even unavoidable in the so-called High-Income countries. But Low-Middle Income countries got stuck in a slow development, where the lack of tech prove insufficient during the situation; and COVID-19 did not stroke in the same magnitude everywhere.

When Chernobyl exploded in 1986, people said that Pripyat was trapped between the age of the atom due to the thermonuclear plant; and the age of stone due to the way of life of the majority of the population. The accident demonstrated how hard it was to explain the people something as complex as radioactivity and that something invisible was killing them slowly and they have to leave everything they knew behind because of an “invisible enemy”.

In the coastal city of Guayaquil, in South America; Ecuadorian government experienced the same trouble thirty-fourth years later as they have to explain this issue to a city with an illiteracy rate of 4.97% and digital illiteracy, defined as people older than 15-yo that have not used internet mobile phone or a computer in the last six months; of 27,8% in males and 33,21% in females according to the Ecuadorian National Institute of Census and Statistics, in their technology and information census in 2018.

Prove to be the case that reading the WHO tweets and online advocacy campaigns about social distancing, were not effective if almost 3 out of 10 people were not able to read the expert recommendations, among other factors; resulting in Guayaquil having 15,365 confirmed COVID19 cases, 67,6% of the confirmed cases in the country and an increase in mortality of 4200 deaths more, compared to the mean of deaths during the times before the pandemic.

And the situation gets worse in the rural areas of Ecuador where COVID-19 arrived earlier than the internet. Where in 2018, only 16,1% of houses had access to the internet, and 37,9% used the internet in the last month. As Pripyat in 1986; Ecuador, and many other low-middle income countries; are trapped between adapting to the age of digital information in a nonstopping globalizing world, and not leaving behind the vast majority of their population that lack access to this new world due to inequities carried on for centuries. And COVID-19 only widened this breach for the following decades.

Therefore we should adapt the incoming campaigns and every advocacy or health effort; to our country idiosyncrasy. The same quarantine that has saved millions of lives in Germany and South Korea is not suitable for the Ecuadorian Amazon Region where there are only 9 ICU rooms available.

So when it comes to health policies; start by adopting guidelines that had to prove efficacy in Evidence-based medicine, but adapting them to the way our people will respond.

- Health care practitioners and Epidemiologists should not work without a sociologist; representatives of rural areas and vulnerable groups, without teachers/health care workers from the local communities that know their environment.

- Next time a health care recommendation will be released by social media, which is nowadays the fastest way; think of ways to include the less benefit; attach a way of spreading it to the ones without internet. 

- As a health care practitioner, researcher, or as the main role player in health determinants; when communicating to the scientific community use the most technical language as possible; but also think of ways to adapt the benefits of your work to the ones that can not read the latest journal. 

- Making scientific advances available for people in rural areas in low-middle income countries is also fighting for equity. Take in consideration translation for local health practitioners that do not dominate the English language; consider what is the most used media in the community, since it can go from Facebook to the old fashioned radio television or physical posts in the local market or announcements during the district events. Maybe it will be slower than social media, but it will reach the target.

To sum up; COVID-19 has marked a definitive change for the society to come; where the digital information will dominate; and as a world post-pandemic will require a more globalized society and with even more online working in every aspect; encouraging the development of technology and science is the obligated path to follow. On the other hand, society must not forget that there is still a part of the population lacking basic services where scientific expansion should catch up to improve their lives. Let's jump in the train of future and technology without leaving behind those who are still walking barefoot.

Let's make the science available for those that were never able to read it.

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Andean school being lecture by med students
In rural areas of Ecuador, digital illiteracy, defined as people between 15 and 49 y-o that have not used in the past 12 months a computer or internet; round up to 19,1% in 2018
Let's jump in the train of future and technology without leaving behind those who are still walking barefoot.
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