Tag: telemedicine

Amader Daktar: Improving Rural Health Care via Telemedicine

mHealth-telemedicine

There is one doctor per 5,000 people in Bangladesh, but doctors are not evenly distributed within the population, which means that for the majority of rural Bangladeshi, doctors are a rarity. So how can rural people have access to quality medical care?

Doctor in a Tab

Enter mPower Social Enterprises and their Amader Daktar “doctor in a tab” solution that aims to improve rural health care and reduce the number of people whose illnesses are aggravated by a lack of, or delay in, proper diagnosis and treatment. The service currently has 200 locations in Bangladesh and has served over 1,200 clients to date.

Amader Daktar is a tablet PCs and a custom-made app that allows rural healthcare practitioners to act as a telemedicine assistant. The tablet allows an rural medical professional to register patients and pass on vital medical information over mobile internet, which can then be viewed on a web portal by a remote doctor.

The doctor can then initiate a video call to talk to the frontline healthcare worker and the patient sitting in any village bazaar (with access to mobile internet). In the best case scenario, the doctor can then create and send a prescription over the internet to the healthcare worker who can then print it out at his end and hand it over to the patient.

In cases where remote consultations are insufficient, the doctor can advise the patient on the next course of action and recommend nearby facilities that can provide the necessary services.

Expansion into Myanmar

mPower Social Enterprises recently won the $10,000 USAID Mobiles for Development Award and will  expand its Amader Daktar service into Myanmar in partnership with mobile network operator, Telenor, in order to reach rural populations where health care services are difficult to access.

Jaroka is Expanding Healthcare Access in Pakistan with ICT

healthmap

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).

DoctHERS-in-the-House: Improving health care for low-income women in Pakistan

Dr Sara Khurram is a young doctor from Karachi. In 2012, she got pregnant, and this led her to quit her residency and stop her medical career.

Sara’s story is common among Pakistani female doctors. While 80 percent of medical school graduates are women, only 25 percent ever practice medicine. Pakistan being a conservative country, many have to stop working once they get married or start having babies. That’s how an estimated 9,000 trained female physicians end up staying at home.

Pakistan’s medical crisis

This home restriction phenomenon puts an additional pressure on Pakistan’s collapsing medical system. With only 0.74 doctors for 1,000 people, active physicians are overwhelmed, and of course, this has a negative impact on the population’s well-being.

Pakistan is still struggling with poliomyelitis as well as with a high rate of stillbirth and tuberculosis cases. Moreover, the examples of malpractice and medical negligence are numerous. In Lahore, for instance, a toddler with a small burn on her hand passed away after a doctor injected her with too much anesthesia. A teenager had his appendix removed when in fact he was suffering from colon cancer. And every day, newborns with jaundice symptoms are misdiagnosed, making them either deaf or brain-damaged.

The main victims of this predicament are the 56 million Pakistani who earn less than three dollars per day. Whenever they get sick, they are left with three choices: get no treatment, go to an insalubrious public hospital, or visit the often unskilled local doctor. For pregnant women living in poverty, the situation is even more dramatic, as many refuse to be examined by a male doctor. Therefore, 95 percent cannot access quality health care; and in the countryside, 1 in 5 mothers dies every day, because she delivers at home, in an unsafe environment.

Bridging the gap between female doctors and female patients

While expecting her baby, Dr Sara Khurram had to spend most of her time on bed rest, and she was doing a lot of thinking. In particular, she thought about her own situation and the current medical crisis.

One day, she came up with a clever idea to circumvent Pakistan’s main socio-cultural barriers: she would open a telemedicine clinic! Thus, female physicians could stay at home, and yet, provide poor women with primary and OB/GYN cares. To lower the risk of misdiagnosis and enhance the human interaction, the young woman decided to rely on Lady Health Workers.

In Pakistan, there are about 90,000 of these community-based women, and they play a key role in preventive health care. Dr Khurram, therefore, thought she could hire some of them and train them further to assist the physicians.During an ante-natal visit, for instance, the nurse would conduct the patient’s examination, and since the entire consultation would be video-conferenced, the doctor would not only supervise her assistant. She would also see in real time what appears on the monitor, and thus, give accurate medical counsel.

At the time, considering opening a virtual clinic was a bold idea. For sure, telemedicine had been spreading across the world for a while. But it was far from having reached Pakistan, and it is well known that many people in the country are wary of ICTs. On the other hand, mobile penetration was already high (85 percent), and Dr Khurram believed mobile and video consultations were workable in most regions.

“On the seventh day, one patient came in”

It did not take long for the young woman to take the leap and give her ‘DoctHERS-in-the-House’ project a try. To test its feasibility and sustainability, she decided to start a pilot in Naya Jeevan‘s health center of Sultanabad, a conservative slum of 250,000 people in Karachi.

In May 2013, everything was ready, and Dr Khurram could open her virtual clinic, the first telemedicine facility in Pakistan. “For six days, she said, not even one patient came in; […] but on the seventh day, one patient came in.” Since then, the clinic has always been full, encouraging the young woman to hire more doctors and replicate her model throughout Pakistan.

It has turned out that video-conferencing is not an obstacle for the female patients. In fact, since DoctHERS-in-the-House started, women have been thrilled by this new type of consultation. For sure, they are happy to pay 50 percent less than they would do for an in-person visit. But what satisfies them the most is the good quality of the care they receive. In Sultanabad only, DoctHERS-in-the-House have provided 500 women with ante- and post-natal care. For 14 percent, they anticipated medical complications and sent their patients to a hospital, where they could get a safe delivery.

And this has certainly saved a few lives!