Tag: Lady Health Workers

Fighting Hepatitis in Rural Pakistan with Tele-Healthcare

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Viral hepatitis is the main cause of liver infection worldwide. In Pakistan outbreaks are frequent, and 7.4 percent of the population is infected with Hepatitis A and E. Many live in rural regions where there is no clean water and sanitation. In 2014, the Umrana Mumtaz Healthcare Trust decided it was time to tackle the issue, and this is a good news for the most disadvantaged!

A woman’s dream

One night in 2003, Mrs Umrana Mumtaz had a dream. She was dying from cancer, and yet, she dreamed of opening a small healthcare facility in rural Pakistan. She told her dream to her husband Ali. And since they had some money left despite her medical treatment, he swore to have her dream come true.

At the time, Mumtaz was working for the Ministry of Commerce and he had no experience in healthcare. But he is a man of action and he had been doing some social work for a long time. He decided to build a two-story hospital in the rural outskirts of Mardan in Northwest Pakistan. In the region, there were only two public hospitals, and they were located in the urban district. Most patients had to walk several hours to get treatment, whose quality was very poor. As a result, the local maternal mortality rate was high.

Telemedicine

Soon the UM Healthcare Hospital would welcome a hundred patients a day. For the doctors, it was overwhelming, as they had to treat an incredible variety of diseases. However well qualified they were, they did not have the required knowledge to treat them all.

Mumtaz thought ICTs could solve this issue. So he turned to his son Atif, who at the time had already started a few high-tech companies. With Stanford University, Atif developed Jaroka Tele-healthcare, the first telemedicine solution in Pakistan. Whenever the doctors faced a complex case, they could seek for advice from qualified specialists all around the world. They would email them the patient’s electronic medical record as well as the relevant photos and videos. This would allow the specialist to assess the situation and advise on the best procedures. For the patients, it meant they would get the best possible care, and the cost was minimal.

Sociocultural barriers

Jaroka also allowed the doctors to circumvent the local conservative culture. In the region of Madran it is considered shameful for a woman to see a male doctor. Well aware of the situation, Ali Mumtaz had hired a female physician, but she had to step down, leaving the job to the two male medical practitioners. So women became reluctant to come; they would also refuse to undress. Of course, this made examinations quite difficult.

This conservative culture is widespread in Pakistan. This is why in 1994 Prime Minister Benazir Bhutto launched the Lady Health Workers (LHWs) program. The goal was to ensure women have access to primary healthcare services. Today there are 110,000 LHWs across Pakistan, and over 70 percent of Pakistani rely on them for their medical needs.

Ali Mumtaz decided to use the Jaroka platform to connect the local LHWs with the doctors at the UM Healthcare Hospital. They distributed mobile phones to those operating in the region of Madran. When they had a doubt or did not know how to treat a patient, they would easily contact the doctors, so they could give them advice. Today 53 percent of the UM Healthcare Hospital’s patients are treated by Lady Health Workers using Jaroka.

The dream has gone beyond expectations

In only one decade, the dream of Mrs Umrana Mumtaz has come true, probably beyond her own expectations. Overall the UM Healthcare Hospital has provided medical treatment to over 200,000 patients, 90 percent of whom live beyond the poverty line. More recently, it has been tackling another critical public health issue: the prevalence of viral hepatitis in the region of Madran. For instance, at the UM Healthcare Hospital more than 20 percent of the patients suffer from Hepatitis A or E.

To try to eradicate the virus, Mumtaz and his team have been leveraging on the Jaroka setup. The Lady Health Workers raise awareness in the villages; they are also responsible for recording all the hepatitis cases they encounter. The data are then agglomerated in real time, allowing the UM Healthcare doctors to identify and prevent imminent outbreaks.

And since early detection is the key to complete recovery, it means that they are saving a lot of lives!

Jaroka is Expanding Healthcare Access in Pakistan with ICT

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For a nation whose healthcare system is chronically underfunded, Pakistan is all too familiar with disaster. In 2005, a magnitude 7.6 earthquake ravaged the country, killing over 79,000 people. In 2010, heavy monsoon rains triggered massive flooding which destroyed almost 2 million homes, yet Pakistan’s health expenditure that year was just 1% of its GDP. There simply aren’t enough medical personnel in Pakistan to meet demand during times of peace, let alone emergency situations. There are some estimates that up 70% of Pakistanis don’t see a doctor in their entire lifetime.

Jaroka Tele-healthcare

The UM Healthcare Trust, a hospital facility located in rural Mardan, has developed an mHealth system intended to connect rural Pakistanis with the both the daily and disaster healthcare that they need. The system, called Jaroka Tele-healthcare, was developed in tandem with Stanford University. Jaroka directly connects healthcare providers at the Mardan facility to specialists in Pakistan’s urban centers, as well as the United States. This connection allows for specialist review of complex cases without forcing the patient to travel.

Jaroka incorporates an Electronic Medical Record (EMR) into the UM Healthcare Trust system. The EMR allows all medical information, including all records, vital signs, prescriptions, and lab reports to be stored and managed online. These records can be readily accessed when consulting a specialist, or by a healthcare worker in the field.

Lady Health Workers

While there are very few trained doctors and nurses in Pakistan, there are over 110,000 Lady Health Workers (LHWs). LHWs are trained to provide preventative and curative health services to their neighbors, while using their peer status to navigate local customs and languages effectively. Utilizing Jaroka’s SMS enabled features, the LHWs can add new patients to the system, update disease records, search for patients via unique ID’s, retrieve patient history, and access a dictionary of terms. Prior to Jaroka, these capabilities were restricted to the hospital.

Quality care provided by LHWs reduces one of the largest barriers in the Pakistani healthcare system: cost. There is no national health insurance in Pakistan, and 78% of the population pay for their own medical expenses. With over half of Pakistan’s population living under the poverty line, low cost (or free) care provided by LHWs is the only option available. The tools Jaroka provides, used in combination with LHWs peer status, allow them to be efficient intermediaries between the community and the traditional healthcare system.

These intermediaries are even more critical during times of disaster, when the disconnect between hospitals and rural Pakistanis is magnified. One of Jaroka’s key features is a GIS mapping system which allows doctors to track the spread and incidence of diseases in real time. The disease data is received from LHWs in the field who send SMS updates for patients into the Jaroka Electronic Medical Record. From there it is uploaded into a Google Map, allowing real-time tracking. In a disaster scenario, this tool allows doctors to direct resources to areas with the most critical demand.

The Future

The value of Jaroka’s regional disease monitoring capability carries directly over into daily healthcare practice. Pakistan is currently battling a Polio crisis, and ranks fifth in the world for Tuberculosis disease burden. Jaroka provides the UM Health System with the capability to monitor disease trends in the Mardan region, and allocate resources to prevent outbreaks from turning into epidemics.

While Jaroka is currently only deployed in Pakistan’s rural Mardan region, the UM Healthcare Trust is working with the National Rural Development Program to extend mHealth platform throughout the Punjab province. To date, over 200,000 people have received care through Jaroka and the UM Healthcare Trust system.

The UM Healthcare Trust publishes their regional disease trends monthly via Twitter (@Jaroka).