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27 January 2009

Idea: HIV Register + Hua Tuo SMS diagnosis

1. This Chinese New Year, Year of the Ox, hongbao, goes to all, esp those at higher risk of HIV infection.

2. HIV is mostly transmitted through sex with a HIV positive person, a lesser number through blood transfusions using tainted blood, a few from sharing needles among drug addicts and a tiny, even lesser few from lab exposure to the germs infected through broken skin which allowed penetration of the HIV virus.

3. From the several methods in Para 2, a HIV Register will not mean anyone on it got it through sex, although the sex transmission is so big that this will be the main aim of the Register.

4. First, laws must be enacted, such as an HIV Register Act, that compulsorily enrols or lists anyone diagnosed with HIV. This may mean that HIV will have to be a Notifiable Disease compelling any doctor who has tested a patient positive to report him or her to the Register. This may be a privacy problem in some countries but not in others. The rationale is that HIV is as deadly as smallpox, leprosy, etc, and so equally in need to be a Notifiable Disease.

5. Once the Register is set up, each person on the Register will also have his or her personal details filed in the HIV Register database, such personal information corresponding to the easily obtainable details in his or her driver's licence or national identity card, including a photo.

6. The Register will be completely automated once set up. So, when a man or woman wants to have sex with another man or woman, he or she will obtain his or her sex partner's cellphone number, this being the easiest to obtain in all dating or sex situations. This person then sends his partner's cellphone number by SMS to the HIV Register Telephone Number, which should be as short and simple as possible, like 1800-HIVREGISTER, for example, toll-free.

7. The Register Computer, once it receives the cellphone number of the person being queried, will search its database and return an SMS stating whether the User of the Cellphone Number being queried is on the HIV Register or not. The SMS will also give the bare info as contained in a driver's licence or identity card, such as Age [calculated instantly by the computer], Race, and whatever is deemed providable. A second, separate, SMS will send the person's photo for easier identification, in case the person is using a borrowed or stolen cellphone.

8. For countries with strong privacy traditions, an additional step may be imposed. When a man wants to query whether his prospective sex partner is on the HIV Register, he sends an SMS to the Register but the Register first sends an SMS to the prospective sex partner asking if he or she allows the HIV Register to go ahead to divulge the info. Thus, no partner would have his or her HIV status revealed without first agreeing by a Reply SMS to the Register Computer. This additional step will safeguard against frivolous or malicious abuse of the Register. For multiple sex partners, all must send back Reply SMSes agreeing and any one who refuses would cancel the whole query. The SMS from the Register Computer can read like this : "The User of Cellphone Number 12345 has queried our HIV Register whether you, User of Cellphone Number 56789, is listed in our HIV Register or not. If you allow us to reveal your HIV status to 12345, Reply to this SMS with a single YES. To refuse, Reply NO; or just ignore. For more info, visit . The Register Computer can read and process such YES or NO [or ignore] instructions automatically.

9. The man who queries on a woman will thus know whether his prospective sex partner is on the HIV Register or not. However, HIS cellphone number [he must use a cellphone number for such queries, not any landline or other such as VOIP phone] will also be captured by the Register Computer, which will then send an SMS to the woman being queried. This SMS will be worded like "The User of cellphone number 12345 has just queried if you, User of cellphone 56789 is on the HIV Register and we have SMSed this person that you are [or not]. This info is given to the Enquirer according the HIV Register Act. Under this Act, if you believe that the Enquirer is obtaining your HIV status not for personal but for other or malicious use/s, you have recourse under the Act. Please visit for more info on your rights and redress. A copy of all SMSes we sent to each of you will be sent to the other. The Enquirer is ON [or NOT ON] the HIV Register."

10. Thus, both parties, the Enquirer and the Enquired, will have a copy of all SMSes generated by the Enquirer.

11. A disclaimer about the accuracy of the HIV Register may need to be incorporated into the SMS and/or the website if legalese requires.

12. Thus, a man who approaches a woman for a date and sex will have a good likelihood of obtaining her cellphone number and can quickly check whether she is HIV positive or not. The woman being checked will also know she has been checked on and also get to know whether HER prospective sex partner is HIV positive or not. All done quickly and automatically. Through cellphones. SMS is a must because every cellphone in use has SMS while only the better cellphones and mobile subscription plans can receive photos, which must therefore be sent separately from the text SMS to ensure at least the text SMS gets through.

13. However, for threesomes or group sex or orgies, 1 SMS containing all the participants' cellphone numbers should be enough to inform all the participants.

14. Some time AFTER the HIV Register Computer has sent out the SMSes for the query, the query and its info can be deleted from the Computer if necessary. In countries with strong privacy laws and practices, this may be necessary. It can be minutes, 1 day or more. The Computer program can be written such that it auto deletes all the query info after the lapsed time after all the SMSes have been reliably sent out.

15. For countries which can keep all such data, there is a further benefit : tracing back all sexual contacts for follow up checks for HIV upon any one of the partners getting into the HIV Register later. Assuming a man has had many sexual encounters and queried each partner, this builts up a chain of sexual contacts, each of whom is traceable through his or her cellphone number. [So only cellphone numbers based on subscriptions should be allowed to use this HIV Register service, not prepaid cards, rented cellphones or other where the User cannot be traced to a contact address or location]. Once this man is put on the Register as HIV positive, all his previous sexual partners can be traced [and THEIR partners also traced] and a warning sent by SMS to urgently go for HIV tests. Common sense would allow only for a period of likely infection and not every single partner going back decades.

16. With global travel patterns, there is a need to allow queries from a foreign cellphone but used in the country. But this would mean that the foreigner will not be on the HIV Register even though positive. Unless there is cooperation among major countries to allow each other's Register Computer to query theirs. This will require possibly a UN directive and close cooperation among prevalent countries.

17. This HIV Register is a balance between impossible to apply draconian measures and voluntary measures that won't work. It balances between the rights to privacy against rights of not being exposed to danger, health and medical costs of treatment. Above all, it is workable since anyone about to have sex with a partner can reasonably be expected to be able to obtain the partner's cellphone number, at least. Abuse should be minimum and depends entirely on how the Act is legislated. By being completely automated, this protects privacy, too, and makes it practicable and workable. A good hongbao, no?


1. I switch on the online Guangdong Chaozhou Radio Opera FM103.1 for my mother-in-law every day, so I listen, too, even though my Teochew is poor. On the programme every day is a doctor who gives medical and medicine advice to phone-in callers. He is doing very important work, by not only asking the callers for symptoms, then identifying their maladies and prescribing medicines or treatments, but also in educating all the listeners who are listening in. Many listeners learn much from the good doctor. There should be more such programmes on radio, and tv as well.

2. Thus, educating the public on health matters is a good way to keep the population healthy, thus lowering healthcare costs both to the individual and the state. Much more should be done on tv, radio and internet to help keep the population healthy, thereby preventing more of their illnesses and diseases in the first place, from HIV to diabetes, etc. Govts may want to consider introducing medical subjects or courses from Upper Secondary school levels, to help keep their populations healthy and lower healthcare costs.

3. However, a huge part of the population have already left school, so the other public education media like internet, tv, radio, newspapers and magazines, will have to educate those who have already left school. There is much that these media can do, to help keep their audience healthy. With that, I leave this part to you, the govts.

4. Many people will not bother to read up or search the internet for medical advice, although the internet is a brilliant source of information on maladies. In the case of China, there are only 420m internet users out of a population of 1.33b. Clearly, the internet, brilliant as it is for medical advice, cannot reach everybody. But for these 420m Chinese with internet, I hope they can find all the medical websites they need to understand their symptoms, maybe identify their malady and hopefully find a treatment -- home treatment if minor or see a doctor for more severe maladies. In English, googling for "online medical symptoms diagnosis" gives many websites


I believe there are -- or should be -- many similar websites in Chinese. Since China, Taiwan and Hongkong use the same Chinese language, the difference being only some words are written differently in Traditional or Simplified Chinese, this is a good opportunity for all 3 entities to pool their combined medical knowledge to create more of such Symptom Diagnosis websites in Chinese. Especially since all 3 entities also use Traditional Chinese Medicine [TCM] for some treatments. More importantly, all these medical advice are suitable for all Chinese, who share the same genetic background, diet and even predispositions to certain illnesses and diseases.

5. But we still come back to the insufficient internet penetration in most countries. Even Norway, which has the highest internet penetration, can only achieve 90.9%. China's 420m internet users thus leaves out most of its 1.33b population. TV, radio and print media can reach a huge part of this 1.33b population but these media are more suited to mass and public [medical] education than for diagnosing symptoms, which the internet does brilliantly. But there is one more media -- the device almost every human carries in his pocket -- the cellphone. In China, about 800m people, or about 60% of the population, carry a cellphone. So, leaving out the babies and little children, or the very old, just about every Chinese adult carries a cellphone. The cellphone is always with us in our pocket, unlike a pc, so it is even more ideal.

6. If we want to use the cellphone like a pc accessing a Symptom Diagnosis website, we have to modify the procedure since the cellphone is not a pc. Some of China's cellphone users have smartphones that can access the internet and so is actually a small pc, but data charges for using the cellphone to access the internet make this group a small minority. So I will ignore this.

7. How to turn the cellphone into a medical aid to help diagnose symptoms? We could set up hotlines manned by nurses and doctors, but this will be very expensive. Much cheaper and more practical will be SMS, fully automated using computers, and software and databases with medical guidelines.

8. Suppose a cellphone user has a slight symptom he is worried about. He will key in a single number he should have already stored in his Contacts list of telephone numbers. You may want to name this service or Contact that he has in his cellphone as Hua Tuo or some other name that does not promise or imply 'doctor level' expertise or professional accuracy, but more a 'senior nurse level' kind of advice. Once he has keyed in this number, say, 111111, and sent this SMS out, he gets a reply SMS quickly [so please ensure that the telecommunications facilities for this number has sufficient or even excess capacity, so no waiting for a reply].

9. The SMS reply to his 111111 SMS begins with a caution: "If you are bleeding, in severe pain or have a broken bone, see a doctor immediately. This service is only for non-emergencies." This cautionary message will be followed by a list of separate telephone numbers for faster service, namely:

If you are a male between 10 and 20 years old, SMS 222222.
If you are a male between 20 and 30 years old, SMS 333333.
If you are a male between 30 and 40 years old, SMS 444444.
If you are a male between 40 and 50 years old, SMS 555555.
If you are a male between 50 and 60 years old, SMS 666666.
If you are a male between 60 and 70 years old, SMS 777777.
If you are a male between 70 and 80 years old, SMS 888888.

[etc, repeat for female].

10. Our caller is a male, 55 years old, so he SMSes 666666. He quickly gets a reply SMS, which offers another list:

If your symptom is around your head, SMS 666666 01.
If your symptom is around your upper body, from neck to stomach, SMS 666666 02.
If your symptom is around your lower body, from stomach to genitals, SMS 666666 03.
If your symptom is around your limbs, that is, arms or legs, SMS 666666 04.

11. Our caller has a slight ache in his stomach, so he SMSes 666666 03. He quickly gets a reply SMS asking further questions. From this stage, the diagnosis works much like the medical websites on the internet, except broken into shorter questions and answers to suit the short text nature of the SMS.

12. If all goes well, the computer, which is doing all this, this system being fully automated and working nonstop 24/7, identifies several possible causes of his stomach ache and recommends either medicines to eat or some procedures to perform to see if the symptom goes away. He gets a final SMS which is a unique Code generated by the computer, which uses this Code to identify this caller for further follow up or tracking. If he needs to call again, he simply keys in this Code and SMSes it, and instantly, his case will be recalled by the computer, who will note the earlier exchanges of SMS and will not repeat the earlier SMS questions and answers, but go on to further questions and answers, thus saving unnecessary work. If he does not call again, the computer SMSes him a few days later to ask if the advice given him by the computer worked. If he SMSes back "Y" or maybe better to use "1" for "Yes, it worked" and "3" for "No, it did not work" [1 and 3 are furthest apart on the top row of the cellphone number pad], then the computer records that this particular symptom and its advice worked, that is, correct medical diagnosis and advice, and therefore learns. With enough learning, the computer becomes better and better and more and more accurate. It is a self-learning system, and fully automatic. It also inputs into its database all the data of the patient, namely his age group, his gender, and his complaint [symptom] for mass epidemiological analysis.

13. This use of the Hua Tuo system for epidemiology is like what Google has done, but more accurate because we have better patient data. Google has used the large numbers of users who type in search terms like "flu tablets" or "most effective flu tablets' to help identify mass outbreaks of flu in a certain area, because when many people in an area googled for "flu tablets" then the reasonable assumption is that a flu outbreak has happened in that area. Our Hua Tuo system is far more accurate than this. We can not only count exactly how many callers SMSed to complain about symptoms but we also know their ages, gender, which part of their bodies they complained about, whether these complaints -- if many occurring in an area -- have been correctly diagnosed by the computer and solved. Using the cellphone base stations operated by the telcos, we can very precisely pinpoint the location of the caller when he called. Thus, our Hua Tuo system can quickly identify if an outbreak of something has occurred in an area, and even which part of the body is usually showing the symptoms and the age and gender of the affected people.

14. Suppose our caller's symptoms still remain despite the advice from the computer. He then sees a doctor. He gives his Code to the doctor who keys in this code, either into his computer, or his own cellphone, together with his own personal ID or PIN number to identify himself as a doctor following up on a patient whose symptom the computer failed to help. He gets all the patient's exchanges of SMS with the Hua Tuo computer, so this helps him improve his diagnosis and saves him from repeating what the computer has already asked.

15. At first read, all this may seem a bit complicated but not from the patient's point of view. For the patient, it is a very simple procedure, almost like he is SMSing with a friend, who is a doctor or knows some medical knowledge. From the patient point of view, all he does is key in his patient data, then this 'doctor friend', actually the Hua Tuo computer, then SMSes him questions which he SMSes back replies. Exactly like what he would be doing with a friend. So all very natural and easy. Even a young person can do all this.

16. To create this system, the work is also fairly simple and straightforward. Most of this kind of Symptom Diagnosis already exists on the internet, usually created by medical experts with a great deal of experience, often the best experts in their areas of specialisation. You only need to adapt all this existing medical knowledge and symptom diagnosis into SMS form. As for the computer software to run all these, again most China computer companies can do this, so not difficult. The only big work is to bring in all the doctors in the country into this system, and it is not necessary. If some doctors prefer to stay out of the system, then they don't need to use the Patient Code and their assigned Doctor PIN to access the records. They can simply see their patient as normal. For those doctors who would like to see the record of SMSes between the patient and Hua Tuo, they can register their computer's unique IP address or their own cellphone number into the Hua Tuo system so that they can access the patient's record of SMSes.

17. Thus, for the hundreds of millions in China and India who don't have internet, but have a cellphone, this use of the cheap SMS system can not only give the patient free medical advice [if a fee needs to be imposed, then the easiest method is to include this fee into the patient's cellphone account bill. If he is using a pre-paid cellphone card, these special numbers for the Hua Tuo service can instantly deduct the fee from his card account]. But more important than giving the patient medical advice is that we can build up, very easily, with no human work at all, a clear picture of outbreaks of any mass medical event, from flu to mass poisonings to longterm ill effects of say, air or water pollution, etc. This cheap and automatic method of building up a medical database will be very important to solve many mass medical events and even for new, or to improve, govt medical policies. For this epidemiological reason alone, the Hua Tuo system is worth creating.