How Stanford medical student Gabriela Asturias brought life-saving medical information to millions of Guatemalans during the COVID-19 pandemic
By Jamie Hansen, Global Health Communications Manager
In early 2020, Stanford medical student Gabriela Asturias was preparing for winter quarter exams when she began getting calls from colleagues in her home country of Guatemala. They were concerned about a new coronavirus that was spreading around the world.
Asturias considered the lack of public health resources in her country and a tendency to allocate the few resources that existed to the country’s capital, rather than the poorer rural areas. “I was terrified,” she said.
She and her Guatemalan colleagues decided to do something about it.
“People were getting information from unreliable sources like social media and WhatsApp,” she recalled. “We wanted to fill a gap in translating difficult-to-understand evidence into relatable language in Spanish.”
The resulting innovation brought life-saving health information to more than 3 million people across Guatemala and led to a digital tool that is still being used to foster health literacy. Asturias has received numerous recognitions for her role in this initiative, including the MIT Technology Review’s list of Innovators under 35 Latin America in 2020, and, this spring, the Velji Student Leader in Global Health award from the Consortium of Universities for Global Health.
Committed to improving health in Guatemala
Asturias, a precocious student and entrepreneur who will complete her medical degree in 2024, had been committed to serving her country since she moved to the United States to study at Duke University in 2013. In 2015, she co-founded Fundación Desarrolla Guatemala (FUNDEGUA), a foundation to foster scientific research, inclusive technology, and innovative health solutions in Guatemala, in collaboration with US medical institutions.
Leveraging FUNDEGUA’s platform and relationships, she began working with young Guatemalan software engineers and a doctor to develop a free, publicly accessible chatbot, called ALMA, which answered common questions about COVID-19. Asturias and her colleagues worked with medical anthropologists and public health experts to ensure the tool would be culturally appropriate and useful. Local healthcare professionals developed answers to common questions people were asking over social media, providing the information in Spanish and eventually in five Mayan languages.
Combining AI with local expertise
The AI-based chatbot reached Guatemalans over popular social media platforms, WhatsApp, and a dedicated website, in the form of a friendly, relatable character – ALMA. ALMA stands for Asistente de Logística Médica Automatizada, and is also a common name in Guatemala.
ALMA provided users with actionable information to guide their choices about when to leave home, wear a mask, or test themselves after COVID-19 exposure. And it met people where they were used to seeking information: messaging tools and social media.
ALMA quickly gained public, governmental, and international support, receiving a $100,000 Inter-American Development grant and support from Guatemala’s National Secretariat of Science and Technology to implement the pilot in 2020.
ALMA also became a public health tool: through its call center network and chatbot technology, it assisted the “forward triage” of COVID-19 cases in rural Guatemala, helping identify as early as possible if a patient had COVID-19 and forwarding those patients with concerning symptoms to a hospital for care. The data ALMA gathered were also visualized through dashboards for healthcare authorities, helping them identify potential hotspots for COVID-19.
Alongside this initiative, Asturias co-led the production of a TV show for kids about COVID-19 that aired nationally alongside filmmaker Jayro Bustamente and Sesame Street.
In the early days, Asturias managed ALMA while also juggling her first clerkships at Stanford.
“It was very stressful to do those things at the same time,” she recalled.
Expanding ALMA’s impact
As the pandemic evolved, so did ALMA. As vaccines were rolled out in the fall of 2021, ALMA became a valuable tool for addressing vaccine misinformation and helping residents understand when and where they could be vaccinated.
“We became the official source for vaccine information, and the Ministry of Health would refer people to us for vaccine information,” Asturias said. Seeing the public excitement and engagement with this information “was probably the most exciting thing I’ve ever experienced,” she recalled.
In 2020, FUNDEGUA received $455,000 in funding from the Centers for Disease Control and Prevention to scale the ALMA system over two years. In 2021, they received a $1.45 million grant from the Inter-American Development Bank to scale up the ALMA system over three years.
Now, with the pandemic emergency declared over, Asturias and her colleagues are pivoting the tool to provide trustworthy and timely information about personal health while generating epidemiological data to aid public health decision-making. In partnership with Guatemala’s Ministry of Health, the initiative currently provides information on all vaccines, water and foodborne illnesses, and acute respiratory infections. The initiative is expanding to noncommunicable diseases and chronic illnesses, such as diabetes and hypertension, to help Guatemalans navigate healthcare information and services throughout their entire patient journey.
“ALMA is growing to become the first stop for those who need help navigating healthcare information and services in Guatemala,” Asturias said.
In 2022, the initiative hired a dedicated director and began growing a support team, which has expanded to 35 people.
Andres Rubio, who works for the Inter-American Development Bank’s Bid Lab which has funded this project, said he’s most impressed by the project’s groundbreaking nature as “the first public-private health platform model that allows the development of a health-tech ecosystem in Guatemala.”
This model, he says, stands to reach millions — “allowing the Ministry of Health and other actors to work efficiently to improve access to basic services to the most vulnerable populations of the country through technology.”
Post-graduation, Asturias hopes to become a child psychiatrist and address the dearth of mental health services in Latin America, particularly in Guatemala.
In 2019, Asturias received a Stanford MedScholars grant to lead a study on mental health services in Guatemala. Now, she’s using that data to build mental health services into Alma as peer support groups.
“There’s an enormous unmet need for mental health services in my country,” she said. “I’d like to see if Alma can help fill that gap.”