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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sources:

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 et.al [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
Sources:
³ J.L Paleaz, Medical Ethics Manual – Physicians and Patients, CORBIS
໊C.Chen et.al.2012, A survey of Sub-Saharan African medical schools. Human Resources for Health.

 

 

 

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.

Background

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.”

Sources

http://www.unicef.org/
ᶜ A survey of Sub-Saharan African medical schools, Chen et al, Human Resources For Health, 2012, 10:4
http://www.our-africa.org/
ᶛGSMA The Mobile Economy – Sub Saharan Africa 2014: ssa.gsmamobileeconomy.com