A revolution in telehealth is helping practitioners to share real-time expertise from Sumatra to Somaliland, saving thousands of lives.
In a remote village on the island of Sumatra, a worried midwife uses her mobile to upload the latest blood pressure and temperature of one of her patients. Within minutes an obstetrics specialist in a hospital miles away is in touch. She’s arranging an intervention that will save the woman’s life – and that of her baby.
Resting on a break from weeding, a Bangladeshi farmer checks his mobile. On the screen is a series of healthy living tips, and he makes a mental note to call a doctor when the day’s work is done.
In Somaliland, a breakaway state in the north of strife-torn Somalia, a group of young doctors is gathered around a screen, talking to their peers in the NHS as they work to set up their country’s first national health service.
Three very different initiatives, but with one thing in common: they’re using quick-fire mobile IT to deliver developed-world standards of healthcare to some of the world’s poorest. It is part of a rapid trend towards the digitisation of healthcare which is promising huge benefits across the globe.
Once a toy for yuppies, the mobile phone has shape-shifted into one of the most effective tools for development ever conceived. In countries such as Bangladesh it’s brought undreamt of connectivity to remote communities, boosted education, earning power and access to information on an unprecedented scale.
This has huge potential for healthcare – and it’s being exploited by the country’s main mobile provider, Grameenphone (an offshoot of the Grameen Bank, which pioneered micro credit, but is now majority owned by Norway’s Telenor). It has launched a scheme providing health information, along with 24-hour access to doctors (at minimal call cost), to all of its 57 million subscribers. It includes a Bengali language website, mytonic.com, optimised for mobiles, which gives users health tips relevant to factors such as their age and gender.
A Philips telehealth service midwife working at a bedside in Sumatra. Photograph: Philips
The Sumatran scheme, meanwhile, has been developed by Philips as part of its Hospital to Home telehealth initiative. Known as the Mobile Obstetrics Monitoring (MOM) service, it addresses the grim statistic that around 830 women die from pregnancy or childbirth problems every day – 99% of them in developing countries. Many could be prevented if early warning signs could be spotted by obstetric specialists. So the MOM scheme combines training for midwives with a simple-to-use app enabling them to record vital signs, such as blood pressure, temperature and weight. These are synced to the MOM portal, allowing specialists to monitor the condition of women far from hospital via computer.
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The scheme was trialled with the Bunda Medical Centre in Padang, west Sumatra, in 2015, and proved a striking success. It recorded a threefold increase in early detection of high-risk pregnancies, allowing women to be brought in in time to save their lives. Not a single one of the 650 women involved died from preventable causes. According to Derek Smith, general manager at Hospital to Home, “Giving women access to the right healthcare technology at the right time is helping to prevent complications before they even occur.”
Interventions like these can work wonders in countries where a healthcare system is already in place. But what about areas where healthcare in any modern sense barely exists? That’s the situation in Somaliland. It’s relatively peaceful, but – partly because it lacks official international recognition – one of the poorest in the world. Now a group of determined young doctors there have partnered with Medicine Africa.
It’s an initiative set up by Alexander Finlayson, a Scottish doctor who has seen conditions in the territory, where facilities are so poor that psychiatric patients, for example, are held in chains. With backing from King’s College and the Tropical Health and Education Trust, Medicine Africa is developing an online platform to connect health workers in Somaliland with their British counterparts to deliver real time, clinical based mentoring.
Finlayson is impressed with the potential of digitisation to improve health outcomes, but cautions that for it to be effective, “you need a healthcare system that’s working properly first. Otherwise you’re spending a lot on putting in one widget in a system that doesn’t work, and that’s of limited use.” So in Somaliland, the focus is much broader. Together with the few local doctors, he says, “we’re capacity building across the whole system, from the health ministry down to midwives”. As well as the learning platform, the initiative includes a peer-to-peer partnership between medical students in Somaliland and those at King’s.
“Essentially”, says Finlayson, “we’re creating a window between the UK health system and the Somaliland one – a window which is open all the time.”
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