Written by Kizito Makoye in Dar es Salaam – The Evangelical Lutheran Church of Tanzania (ELCT) has introduced telemedicine- a distant diagnosis platform in which health workers use cell phone technology to carry out distance diagnosis through a web-based programme.
Cell phone diagnosis-which was initially applied in the field of dermatology (skin disorders) -has apparently come to the rescue of many patients in rural Tanzania- who could not be diagnosed due to lack of expertise necessitated by poor logistics and infrastructures.
Through telemedicine- clinical officers could use of their cell phones to capture images and record information of complex medical conditions and share it with specialists wherever they are around the globe using a secured database called iPath platform.
The project’s resource person Kizito Mrema says the goal is to have an online consultation network operating between 43 health facilities in the country, where about one hundred consultations are taking place weekly of which 20% are second opinion.
According to Mrema with support from IICD organisation the effect of telemedicine on the quality of consultations of participating health workers is measured and recommendations developed to improve this quality.
The Lutheran church owns 20 hospitals, five paramedical institutions, over 160 dispensaries and health centre thus providing health care within a range of about 15% of the national health services in Tanzania.
Mrema says several training programmes have been conducted to equip medical doctors working in a chain of hospitals owned by the church. The training included the use of iPath( web-based consultation system),the use of digital camera and i-teach for distance learning.
“ In the beginning we had about 60 consultations taking place mostly in internal medicine, paediatric, radiology and dermatology” he says adding that doctors who had been introduced using this system have literally continued using it.
Mauri Niem is a medical doctor who has been using of a cell phone to consult specialists whenever he comes across complex cases which require specialized knowledge. The specialists he consult have always supplied him with medical advice.
Working at Kilimanjaro Christian Medical Centre better known by its acronym KCMC doctor Niemi travels variously to see patients in remote areas, he does not leave behind his gadget.
As a clinical officer his job is mainly treating and advising people on clinical matters, but for complex medical cases he need specialist advice which could be at his finger tips since he uses iPath installed in his mobile handset.
With this system he easily send x-rays, photos of skin conditions and tissue samples and patient information to specialist doctors for consultation online.
Telemedicine platform can be accessed by any web browser but the use of mobile phone makes it easy and convenient- all you need is a cell phone with GPRS connection.
Dr. Niemi has recently met a toddler from Hai district- who had a swollen infection on the left ear which was causing a very severe pain … at first he thought the case could be sorted out by prescribing antibiotics alone but that was not enough ….the infection became even worse when the child started using amoxylin cyrup. The child, according to his parents has been suffering from an infection for almost a year and they did not know what to do. But doctor Niemi used his cell phone to take a picture of the affected area and upload it with all relevant information to the telemedicine platform. Luckily an ear specialist doctor from Muhimbili National Hospital in Dar es Salaam saw the information and suggested a minor operation be carried out to remove a swollen skin to prevent it from re-occuring. Based on this advice Dr. Niemi asked the parents to send the kid to KCMC so that the operation could be performed.
The operation was carried out successfully in close to where they live and the kid was visibly in a steady condition after he had recovered from anaesthetic.
Although computers can also be used to upload cases, Niemi prefers his mobile phone. “Network coverage is often a problem with our office computer or laptop to upload telemedicine cases. With a camera phone with GPRS connection, it is very simple to upload cases from anywhere. We discovered that a mobile phone can open the web program needed for telemedicine quite easily and fast,” he says.
Dr Niemi has recently held a presentation in Dar es Salaam about telemedicine and explained the facts about it
-Simple, easy to use consultation tool which brings specialist services to rural people
-Works on slow network and can be used also with phones with camera
-Suitable from small dispensaries to hospitals
-Also used between teaching hospitals to get second opinion
-Information about patient (text, pictures, x-rays, microscopic views, etc) sent on secure website
Automatic notifications to consultants and replies to doctors has made it fast (replies in 24-48hours)
-Has been used in all specialties
-Spares time and costs when more people treated in close by hospitals”
In Tanzania many people reside in rural areas where access to health care is poor. Health care expertise and resources remain in the cities consequently isolation from the rest of the medical world, lack of up-to-date reference material and lack of consultation possibilities has led to low quality of diagnosis in rural areas. People who can afford it come to cities for their health care in huge numbers and at enormous cost.
Telemedicine is beneficial for patients, because they can get specialist consultations in their own hospital. Patients are willing to pay for quality care in rural hospitals.
According to a clinical analyst Deusdedit Mjungu, a new generation of doctors, who are used to Internet, will change the old practice if they are encouraged in remote hospitals.
He cautions that the main challenge is how to integrate telemedicine in the current practice of health workers, in the health facilities organizations, in the billing system, in the certification and accreditation. “This project is conceived to tap the potential of telemedicine in Tanzania and to develop the relevant technology and practices” he concludes
Kizito Makoye is a journalist based in Dar es Salaam Tanzania