Applications of Telemedicine in the fight against HIV / AIDS

Sub-Saharan economies have been affected in a major way by the HIV / AIDS pandemic. With an average of less than 10 doctors in 100,000 people and 14 countries without a radiologist, Sub – Saharan Africa was and continues to be far from adequately equipped to mitigate this scourge.ᵃ A number of programs promoting early detection and interventions have since been implemented across the region. Anti – retroviral therapy has also been widely adopted in both public and private institutions as the primary method of managing the condition. Strides have definitely been made in reducing the stigma and fear that used to be associated with the disease. People are more forthcoming to testing and treatment as well. It is thus an unfortunate state of affairs that in as much as awareness and acceptance of HIV / AIDS in communities is improving, what often lets patients down is the shortage of health personnel and medication. The economic implications of comprehensive treatment for HIV / AIDS place a huge burden, which most governments are just unable to meet. The resultant vacuum is an area in which telemedicine could be a cost effective solution.

The first challenge first by AIDS patients has to do with their care situation at home. As medical infrastructure is usually stretched and oft inadequate, most patients are discharged as ‘Home – Based Care patients.’ Community caregivers as well as family members are then tasked with the upkeep of the patients. While this model has improved the quality of life of many individuals suffering from the terminal condition, there are some practical challenges that beset it. In most rural households, people depend on primary industry for their upkeep and welfare. These include, but are not limited to farming and artisanal mining. Such economic activities mean long working hours as well as arduous tasks. Resultantly, a trade off becomes evident; stay at home to take care of the sick while forsaking any kind of income or subsistence or committing to making a living, to the detriment of the person living with HIV / AIDS. While this is a horrible situation to find oneself, it is a reality for most communities. Introducing telemedicine to such communities can help ease this disagreeable situation. Patients can personally connect with practitioners to receive helpful information about their dosages and opportunistic conditions among other things. The technology also brings a certain dignity to patients as they are able to have some level of autonomy in terms of their health. Home care monitoring help the patient to keep track of their drug intake, vital signs and other aspects of recovery, without needing a third party to assist.

As already alluded to, the quality of life that an HIV positive individual will enjoy is largely influenced by the management of the disease. A multi – pronged approach that includes good nutrition, consistent and quality medical care as well as a positive attitude are just part of that approach. Consistent medical attention then means visiting the local clinic and doctor for routine CD4 count tests, blood pressure, glucose levels and such. This increased need for check-ups can become quite costly for many patients. However, using telemedicine it is possible to connect with doctors as well as the clinic / hospital for a number of consultations. Using Store and Forward channels, a home – based patient can forward video, picture and / or text describing specific conditions he / she is facing. Real time consulting can also be utilized in instances where the physician wants to assess the patient’s health through video observation. Whichever  method used, using telemedicine would effectively decrease the medical costs to the patient.

Telemedicine has been proven to decrease costs of consulting with doctors for patients.  Studies have shown that the average estimated cost of a telehealth visit ranges from $40-50 dollars while an in-person visit can cost as much as $176 dollarsᵇ. The importance of this innovation in combating the HIV / AIDS virus cannot be overemphasized, given the progressive care that patients require. In Sub – Saharan Africa this need is even higher, given the prevalence of the disease. Med-eSmart is looking to pioneer this technology in the region, with our crowdfunding campaign kicking off on the 15th of July. Please find us on Twitter and Facebook and show your support today.























ᵃWorld Health Organization, WHO advisory meeting on radiology education, Geneva, 1999.




Patient Confidentiality, Implementing Best Practices In Southern Africa

Anyone who has seen a hospital series or crime show will surely have come across the concept of patient confidentiality at some point. It may be of interest to explore what this exactly means. All health personnel are obliged to protect the privacy of all the information, historical and primary, that comes to them during and after patient treatment. This means anyone not involved in delivering the health service has no right to access the information even after treatment or eventual death. Recently I traveled to Mutambara Mission Hospital in Zimbabwe and got some interesting insights from both the local personnel as well as visiting practitioners from Norway*.

Several inadequacies in our medical landscape have led to the conceptualization of Med – eSmart. An example of such shortcomings is the poor emphasis placed on patient confidence.  Fanuel** from Gonzoni village in Mutambara for instance, stated that he went to an HIV/AIDS counselling and testing center in Mutare, 120km away as he felt that his status would be common knowledge otherwise. ‘’At least at provincial [hospital] no one knows me and I can come back to my life in peace. ‘’ One of the harsh realities for most patients in Southern Africa is that medical care is fairly inaccessible, both financially and / or geographically. Because of this, many fail to realize that ‘The right of patients to make decisions about their healthcare has been enshrined in legal and ethical statements throughout the world.³’ This problem of patient confidence can also be traced to the training [or lack of it] of primary caregivers. Most African countries face a growing shortage of qualified medical personnel. Chen [2012] for example, found that ‘Sub-Saharan Africa suffers a disproportionate share of the world’s burden of disease while having some of the world’s greatest health care workforce shortages.໊’ Med-eSmart looks to give full control to the patient. When signing up, the patient determines the level of consent they are comfortable with. Whether it’s having patient information shared across practitioners or availing treatment history for second opinions, it is the patient’s prerogative.

Socio – economic differences also play a huge part in determining the nature of medical care one receives, and the consequent confidentiality of the treatment process. Two major obstacles to good physician-patient communication are differences of language and culture.³ Medical facilities in Southern Africa, such as Mutambara Mission Hospital, benefit from various foreign aid programs. This entails ‘visiting practitioners’ who volunteer their services to under-served communities. Matter of fact, during my trip, there was a team of Swedish dentists who had just arrived to help out at the dental department. While the significance of such projects is immense, the patient – doctor dynamic becomes rather lopsided. In most African communities it is considered disrespectful to query an elder or authoritative figure. This demeanor is evident across different institutions, from schools to hospitals. This may not be the case for an individual born in Europe or the Americas. In such instances, it can happen that a patient is passed off as being shy or unwilling to cooperate. Acquiring informed consent takes a backseat as practitioners feel they have no choice but to make the ‘best decision’ for the patient. Case studies, for example, may be used for med students on the other side of the world, without the patient’s knowledge or consent. By subscribing to Med-eSmart’s multilingual platform, patients access medical facilities in a language familiar to them. When the occasion to consult with a doctor arises, each available practitioner’s language competencies are available to the patient, meaning he / she will go through the appointment in the most understandable and comfortable manner.

Providing healthcare is a consultative process that involves the patient and the doctor. It should be emphasized that patient confidentiality is a duty to the practitioner and a privilege for the patient. Even in marginalized communities lacking in resources and skilled personnel, an effort should still be made to treat patient information with respect, dignity and discretion. It is however understandable that most institutions prioritize the actual treatment process, faced with dwindling funding sources and an ever – growing sick population. Med-eSmart provides a low cost solution that puts the patient’s rights at the fore. Should more be done to enhance patient confidentiality? Join us on Facebook or Twitter and have your say.

*Special mention and appreciation to Dr M. Gaarder for her wonderful insights on patient confidentiality and medical practice in Norway
**Not his real name
³ J.L Paleaz, Medical Ethics Manual – Physicians and Patients, CORBIS
໊C.Chen, A survey of Sub-Saharan African medical schools. Human Resources for Health.




The Benefits Of Telemedicine To Practices and Practitioners.

As health technology continues to gather momentum, the benefits to patients and the delivery of healthcare as a whole is unquestionable. While most policies, such as the MDGs, ObamaCare etc. are targeted at improving the welfare of patients, the practitioner’s plight can be left hanging in the balance. In most instances, the onus lies upon the relevant medical association or labor union to represent the needs of their doctors and physicians. Given that healthcare is a fundamental right to all, the issue of profitability can be somewhat contentious if not downright controversial. However, like any other business, medical practices need to make healthy profits in order to sustain their existence, grow and adapt to persistently increasing health care costs. The Telehealth Alliance of Oregon defines telemedicine as ‘’the use of telecommunications technology to deliver clinical diagnosis, services and patient consultation³’’. This practice has been seen to have marked benefits for practitioners and there is a lot to be gained in adopting it.
The first upside to implementing telemedicine as part of a practitioner’s service offering is an improvement in efficiency. This is mainly propagated by an increased access to information and better cooperation across physicians. By digitizing the treatment process, from diagnosis to discharge, case – related information and consultative decisions can be arrived at instantaneously. In addition to that, practitioners in otherwise remote locations can get access to health journals and literature that would otherwise be out of reach. The sum result of this would be a progressive up-skilling of the practitioner allowing him / her to tend to complex patient ailments that would otherwise be referrals to other doctors or facilities.

Another benefit to consider is increased profitability for the practice. It is no secret that in most cases, the current method of booking a doctor’s appointment requires time and effort on the part of the patient. For the working population, one needs to apply for a sick day from their employers. In cases of children, arrangements with either day-care centres and / or schools are a requirement. Patients also need to call in to set an appointment date and then actually travel to the doctor’s office. Depending on location and the practice’s catchment, there may be a long wait for the patient before he / she is attended to. Finally, the consultation itself needs to be paid for, a cost which is often quite high. Resultantly, patients would rather put off going to the doctor’s unless it is a dire situation. Even then, cancellations are a reality that most practices have to live with, as patients often battle to integrate visits into their daily schedules. By introducing telemedicine to its other service offering, a practice would make it much easier for patients to visit their doctors. This would subsequently streamline any practitioner’s operations and increase turnover.

One of the risks that loom over any physician’s head is the occasion of getting sued for malpractice. In any business, occupation or profession, instances do arise in which the client is not satisfied with services rendered. While a simple refund or exchange can be enough to quell a disgruntled customer, for medical practitioners, the stakes can be a bit more grave. Practicing licenses can be revoked and in cases, facilities shut down due to a scathing civil suit. Even in situations where a doctor is vindicated through legal recourse, the negative publicity is usually enough to dissuade patients altogether. Using telemedicine can help avoid this unpleasant eventuality in a number of ways. Firstly, because all interaction between the doctor and patient happens over electronic channels, conversations can easily be traced. There is also little to no chance of misplacing, losing or mishandling patients’ documentation. In addition to that, instances of patients failing to follow-up their appointments due to costs are reduced. As already mentioned, because doctors are able to access a lot more information and consult with fellow professionals, they are also bound to arrive at more accurate diagnosis and patients’ advice.

It is of great importance to stress that in the millennial timeline of medicine and healthcare, telemedicine is a very new concept. Empirical information substantiating the long term benefits and drawbacks of the practice is still quite limited. With further research, increased implementation and the progress of time, more substantial information may become available regarding telehealth. However, at present the above – mentioned advantages are but a few reasons for any practitioner to consider integrating telemedicine into their occupational routine. As Med-eSmart, we are interested in learning more about the experiences and viewpoints of both doctors and patients. Gladly share your thoughts on our Facebook and Twitter pages and together, let’s reshape healthcare.

Streamlining Efficiency and Profitability Of Medical Practices Through Technology

In 2004, 5334 physicians from sub – Saharan Africa made their way to the USA, in search of greener pastures°.  Most  medical health personnel who leave their countries ‘to further their careers, or improve their economic or social situation’ leads to a global health labour force ‘imbalances that may be detrimental to the health systems of source countries.’  It has to be noted that this ‘brain drain’ occurs on the backdrop of the home countries having invested millions of dollars into educating the very graduates who then take their skills abroad. The fact that some countries such as Botswana, Lesotho, Namibia or Swaziland actually have no medical schools to provide the growing need for doctors does little to help the situation. There are no winners in the process unfortunately as most who undertake medical studies usually do so stemming from a passion to serve their communities and effect positive change in their countries. To then turn their backs on all their passions and motivations for unknown lands and prospects is not the most desirable option either.

One challenge that has persistently afflicted the medical practice in Africa, particularly in public hospitals and clinics, relates to bureaucracy and administrative inefficiencies. Hospital policy and infrastructure in most Sub – Saharan Africa was established during colonial times. Ministries responsible for health and welfare operate on frameworks that predate the countries they serve. This means that when one visits a hospital, long queues, paper based document keeping, and old equipment are all part of the process. This makes for an unattractive working environment for most practitioners.

Over and above job enrichment, old – fashioned hospital systems and procedures are still based on inclusive policies that are reminiscent of post – independence populist movements. All this marginalizes the practitioner and fails to address both the work environment as well as operational efficiency. Integrating technology in the medical process could be an answer to some of these issues. Cloud based software has long been used as an enterprise solution for document management and storage. This could lower the wage bill of practices and ensure patient data is not lost or misplaced. Implementation of such solutions can also offer effective communication channels across practitioners and medical administrative offices.

A primary motivation for getting into any career is the monetary aspect. Investment in education, more so medical school, is prohibitively expensive and out of the reach of most. In some cases students make it through school by way of government bursaries and grants. This puts added pressure to clinch well paying jobs upon graduation as these loans have to be paid back. As a result, junior doctors often shun working in their local hospitals which often pay paltry salaries on the back of an immense workload. The allure of foreign postings, earning hard currencies presents itself as a viable option. While it may be a challenge to try and compete with the pay scale of doctors in ‘developed economies’ , Southern African countries can do a lot to make practitioners’ remuneration more attractive.  Telemedicine for instance, has been proven to improve the profitability of medical practices in various parts of the world. A big advantage of employing this innovation is the reduction of appointment cancellations and no shows. Because patients sometimes have pressing schedules at work, school or otherwise, enabling them to consult from a distance makes visiting the doctor’s office easier. By allowing doctors to attend to more patients practices can increase their monthly earnings.

There are numerous ways in which doctors and medical practices in Africa can integrate technology into their systems. This can have tremendous benefits for both profitability and the reach of medical operators. In the next article, focus will be placed on the benefits of telemedicine to the doctor, hopefully making the prospects of working in their local facilities more attractive. As we look to positively contribute towards the health and welfare of patients it is integral to hear others opinions and alternate points of view. Follow us on Twitter and Facebook and let us know what you think state of health where you are and your thoughts on the future.


The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain. Hagopian et al. BioMed Central. 2004

Virtual Doctors in Crisis Situations – The African Context

Early last year, West Africa saw the worst Ebola outbreak ever recorded in human history. Horrific image of bodies strewn across city streets and ailing patients in crowded makeshift hospital quarantines filled television screens across the world. A year later, the bustling metropolis of Johannesburg, South Africa went into frenzy as cases of the highly infectious typhoid fever and an eventual fatality were reported. Epidemics of different forms are a reality that most have to contend with. A lot of infrastructure and financial support is continually dedicated to mitigating the devastating effects of such disasters across the world. It is however difficult to contain highly communicable diseases, stretching economies and resources to breaking point in the process. The Zika virus that has ravaged South America in recent months is a prime example of how devastating a pandemic can be, despite immense intervention. The American Administration for instance looked to devote a total of $1.9 billion dollars towards combating the virusᶛ.

The afore – mentioned cases clearly illustrate the fact that the traditional approach to disaster response has its limitations. To begin with, poor transport networks and road infrastructure make it difficult to reach infected individuals in dire need of medical assistance. In Sierra Leone, for instance, ‘’inadequate road networks and infrastructure’’ resulted in some patients waiting at home for up to 6 days for a diagnosis, ‘’all the while leaving their families at risk of further infection.’’ᶞ A similar pattern can be observed in most of the “developing economies” in Africa, Asia and South America. While waiting for the relevant governments to develop better road networks may be a tedious effort, there can be an effective alternative. Introducing virtual doctors in Africa could make a great, positive difference in the lives that may be saved during times of outbreaks

Zimbabwe, a country in Sub – Saharan Africa went through a terrible cholera outbreak in 2008.    Once a bustling and growing state, economic ruin and a dysfunctional political framework systematically led to the country’s health sector deteriorating to deplorable conditions. At the time of the epidemic, the conditions in the country were described as having caused ‘’an unprecedented deterioration of healthcare infrastructure, loss of healthcare sector personnel and a drastic decline in the quality of health services available for the population.’’໊ Poor sanitation and access to clean water led to the disease quickly spreading across major cities and rural areas. The country was totally unprepared for a disaster of this magnitude and intensity. At Mutambara Hospital, a rural hospital in the eastern province of Manicaland, the writer witnessed diseased individuals, wrapped in refuse bags, being taken to designated burial sites, in wheelbarrows. These casualties were transported through neighborhoods populated by families, children and all. The risk to the surrounding community was heightened because of the lack of preparedness and capacity to deal with the crisis. In contrast, the presence of a virtual Doctor would have been a clever and efficient way to provide medical assistance while safeguarding the health of those in the vicinity.

Another application of virtual doctors in Africa has to do with safety and security. It is no secret that war, turmoil, civil strife and violence have been a vice that has plagued nations the world over. Africa has not been spared of this scourge either. Civilian insecurity takes many forms, sometimes state organized and at other times spontaneous. Regardless, life does not come to a halt and people make the most of whatever situation they find themselves in. In the year 2008 and 2015, violent xenophobic attacks against foreign nationals residing in South Africa erupted across the country. Lives were viciously taken, property destroyed and many displaced. In such situations both immigrants and sympathizers were looked at with disdain. Rendering medical aid to this sect of the South African society changed from being a routine appointment to a life threatening act overnight. Once again, employing virtual doctors in such a scenario would have made it possible for practitioners to reach needy patients sheltered in crisis centers across the country safely.

Whether it is to overcome infrastructural barriers or ensure the safety of the practitioner, the applicability of virtual doctors in Africa is undeniable. Crisis and epidemics are weaved into the history of Africa and will probably continue to be a risk facing a large part of the continental population. Rather than to solely depend on an over – subscribed medical framework battling numerous challenges, the innovation of virtual Doctors could go a long way in controlling and possibly preventing the spread of such outbreaks in future. Follow us on Twitter and find out what others are saying about virtual Doctors in Africa


ᶛ  Senate Approves $1.1 Billion in Emergency Zika Funding. The Wallstreet Journal, 2016/05/17 :
ᶞ A Long Way to Go: The Ebola response in West Africa at the sixty day mark. OXFAM,
໊Zimbabwe – Global Health Workforce Alliance. WHO,


Telemedicine in Sub – Saharan Africa, Opportunity Unexplored

Africa like any other continent has a rich diversity that highlights differences in economy, population and welfare, among other things. Economies such as South Africa and Nigeria have experienced impressive growth over the past decades while the likes of Zimbabwe and Somalia have been plagued by fiscal stagnation and trade isolation. The overall disparity that characterizes the region has resulted in most countries lagging behind in areas of health and technology. A case in point can be made for telemedicine in Sub – Saharan Africa.


Western countries such as the United States of America, Canada, Britain and the greater part of Europe have integrated telemedicine into their health sectors. The many demands of modern day life have resulted in the health industry evolving to accommodate patients’ needs. By incorporating high quality IT infrastructure with a skilled practitioner labour pool, superior medical care is made accessible to millions of patients. The marked growth in the telemedicine industry in the aforementioned countries is testament to the popularity of this method with patients. Benefits such as access across various platforms (e.g. Android, iOS and Windows), convenience and lower consultation costs have made telemedicine an obvious choice for numerous individuals.

The health situation in the opposite hemisphere unfortunately is not as progressive. According to UNICEF, 21 children [below the age of 5] die every minute, the highest rates being in Sub – Saharan Africaᶛ. On the contrary, there are only 1.7% of the world’s physicians practicing in the region according to a survey of Sub-Saharan African medical schoolsᶜ. The regrettable reality is that quality medical healthcare is largely inaccessible to most households in the region. A common trait across the expanse is the comparatively higher quality of medical care afforded by private practices and hospitals as opposed to public facilities. Bureaucracy, corruption and lack of adequate funding have progressively deteriorated state run clinics and hospitals in most Southern African countries. During 2000-2010 for instance, Zimbabwe had fewer than two doctors for every 10,000 people according to the World Health Organization (WHO)ᶝ.Telemedicine in Sub – Saharan Africa, though largely unexplored, provides an exciting solution to the problem of equitable access to quality healthcare.

The Rise Of IT Vs Telemedicine in Sub – Saharan Africa

Technological advancement has however, not been insular to the Northern Hemisphere. Digital innovations and the relentless search for consumer markets by IT manufactures has resulted in a steady proliferation of state – of – the art hardware and software across the continent. In June, 2014, there were 329 million unique smartphone subscribers in Southern Africa, equivalent to a penetration rate of 38%ᶞ.  The advent of cheap technologies and apps, particularly from the Asian bloc has seen a massive uptake of basic 21st century communication platforms such as instant messaging and social media. While these developments have had marked impact in such areas as showbiz, music and sport, the applications of technology in medicine, in the region, has been minimal at best. The majority of medical institutions still rely on dated, bulky machinery, a dwindling population of skilled practitioners and systems established during colonial eras.

Med-eSmart And The Future

Telemedicine, the provision of medical care from a distance, has made substantial strides in the northern hemisphere. Patients find themselves presented with numerous options of doctors and medical advice. The benefits of this model also extend to business and employers as people apply for less sick days and time off, for what would otherwise be minor and easily treatable conditions. It stands to reason that in Southern Africa, plagued by bureaucracy, systematic inefficiencies and outdated technologies. It is under this premise that Med-eSmart is established. Connect with the Med-eSmart Facebook page to become part of this exciting movement as we ensure “A Doctor For Every Child.”

ᶜ A survey of Sub-Saharan African medical schools, Chen et al, Human Resources For Health, 2012, 10:4
ᶛGSMA The Mobile Economy – Sub Saharan Africa 2014: