Where Technology and Medicine Meet in Rural Zambia
By James Jeffrey, Inter Press Service
When health officer Kennedy Mulenga was faced with a male patient developing breasts at the remote Ngwerere Clinic 30km north of the Zambian capital, Lusaka, he logged onto Virtual Doctors to get help solving the medical mystery.
After taking notes and creating a patient file he took a photo with the camera in his computer and then uploaded all the information to the Internet cloud.
A UK-based doctor then reviewed the file and offered diagnostic advice: the HIV-positive patient was experiencing gynecomastia, the swelling of breast tissue and a side effect of antiretroviral medicine, but was in no danger.
Virtual Doctors uses so-called telemedicine software to improve local primary healthcare in rural areas lacking doctors. It was started by former safari guide Huw Jones, now based in the UK developing the technology.
“It’s really very simple to do and I’m surprised there’s not more of it,” 45-year-old Jones told IPS. “There’s lots of research it seems but not so much action, and so we went for it—this is the intersection between technology and medicine.”
Zambia has roughly 1,600 doctors for a population of about 14 million, of whom about 9 million live rurally, and relies heavily on remote healthcare workers like Mulenga. He has worked for six years at Ngwerere Clinic, using Virtual Doctors for three years.
“It’s difficult on your own,” 30-year-old Mulenga told IPS. “There’s always stuff you can’t diagnose and when you need a specialist. So if it’s complicated you have to refer a patient to a hospital, but with Virtual Doctors the clinic has a doctor.”
Mulenga said he remembered another patient arriving at the clinic with a growth at the base of the spine. Mulenga debated whether the abscess just needed piercing and draining or whether that might risk paralysis, so he consulted a virtual doctor who confirmed specialist surgery was required. The patient had the surgery and then recovered.
In many developing countries, including parts of Africa and Asia, communication infrastructure has not followed the same path as in the West. There, countries began with fixed networks and moved to mobile networks, but developing economies have skipped a phase and gone straight to mobile.
This is having a particular impact in healthcare where innovative practitioners are using connectivity to change how care is delivered to patients. Virtual Doctors is not alone in using the power of mobile Internet to bring healthcare solutions to Africa.
In South Africa, telemedicine has gained wide acceptance with numerous projects springing up, such as one by Telemedicine Africa, to establish private telehealth centres across the country to reduce patient waiting times in an efficient and cost-effective manner.
A telemedicine project by the University of Lagos in Nigeria, sponsored by the ministries of education, health, and science and technology, enables a patient accompanied by a Nigerian doctor to see and speak with an Indian medical consultant via an interactive screen for additional advice to diagnose an ailment.
While in Monrovia, to help slow the spread of Ebola in West Africa, a robot created by Vecna Technologies using a two-way communication system, basically a tablet computer on wheels, enabled doctors to assess incoming patients without physically examining them, reducing potential infections in healthcare workers.
The idea for Virtual Doctors followed a life-changing experience for UK-born Jones while a safari guide in 1998. Driving through the Zambian bush, he came across a blood trail on the ground. He followed it for 5km and caught up with a heavily pregnant woman slumped on the bicycle her husband was pedalling frantically. The woman and her unborn baby died in Jones’s jeep on route to hospital.
“If you could rewind the clock on so many undiagnosed problems and illnesses you could prevent so many deaths,” Jones said of why he founded Virtual Doctors in 2007 on a part-time basis before going fulltime in 2013. “A lot of people said it was never going to work, introducing sophisticated technology in rural areas.”
Now supporting six clinics, the plan is to include another 13 by early 2016 and serve between 12,000 and 17,000 patients each. Jones spent this September in Zambia visiting health officers and handing out new tablet computers to replace the original children’s netbooks issued because they were easy to use and robust.
He also showed health officers how to use new software, developed during the previous 9 months by a team of nine volunteer software engineers from UK-based Landmark Information Group, a company specialising in digital mapping, property and environmental risk information.
“The old system was a bit clunky, there were lots of data fields that had to be filled in,” Jones said. “We did research and asked the health officers, What do you need? Something simple, was the answer, so that’s what we created.”
Something simple can have a significant impact. A common problem in rural Zambia is people with suspected tuberculosis must travel to typically distant hospitals to see radiographers for X-rays. But often a radiologist isn’t available to interpret an X-ray and a patient must wait, paying for accommodation after already forking out for transport.
This can total about 50 kwacha about 5 dollars, a significant sum for those earning about 1 dollar a day. Through Virtual Doctors patients can immediately return to villages with X-rays sent to international radiologists who confirm the presence of TB or not.
Another challenge for healthcare workers and nurses who have far less training to draw on than doctors is gynaecological problems, such as ovarian cysts. “I have to decide whether the cyst can be left to clear up itself or if medication or even surgery is needed,” Mulenga said. “If I can send the scan to a virtual doctor I don’t have to worry.”
At Kazimva Clinic in the outskirts of Lusaka, 27-year-old health officer Daniel Mwewa told IPS how Virtual Doctors boosted his credibility with patients: “If I make a mistake then an expert corrects me, which helps my patients have trust in me.”
Mwewa explained how the clinic only has a simple laboratory and before Virtual Doctors he was limited to simple tests. “Now I can think outside the box, ” he said.
With so few doctors, Zambia needs all the medical expertise it can get.
“If our health officers can get into discussions with experts they will learn through those discussions,” Elizabeth Chizema, the Director of Disease Control, Surveillance and Research at the Zambia Ministry of Health, told IPS. “And next time they will remember, so it’s like they are being mentored.”
Chizema is also encouraged, she said, by the opportunity through Virtual Doctors to involve overseas Zambian doctors, many of whom get in touch and say they want to help their homeland.
Currently run as a charity, Jones runs endless rounds of fund raising and seeking donor patronage. He also pointed out how the times are changing.
“With donors, such as the UK’s Department for International Development, there’s been a paradigm shift toward backing the private sector to create jobs and enterprise to boost countries. Too many NGOs fizzle out after a couple of years.”
Hence Jones is liaising with the Zambian government, working toward it taking more ownership of the service provided by Virtual Doctors.
“Any country without enough specialists faces a problem, and this service fills that gap,” Chitalu Chilufya, Zambia’s Deputy Minister of Health, told IPS. “We need to get the Internet network providers on board in public-private partnerships.”
Jones said he appreciates such vocal support but cannot help wondering when, or even if, it will turn into tangible action.
“This is a big space to be a part of, information and communications technology is very exciting due to all the possibilities,” Tyrell Junius, a mobile delivery and tracking unit Project Manager for the World Food Programme in Zambia, told IPS. “But how do you get buy in? Organizations and governments want to see hard numbers and know it is scalable.”
If Virtual Doctors became self-sustainable in Zambia that would enable Jones to set his sights elsewhere. “We’ve proved the concept, now we could take this anywhere in Africa,” he said.