Peter Wanyonyi
On August 10 2015, First Lady Margaret Kenyatta quietly launched a service, dubbed Sema-Doc, that promises to disrupt and completely revolutionize the medical care sector in Kenya. In a first for the region, the service seeks to utilize mobile phone and Internet communications to expand the reach of health services in the country. And, frankly, it’s difficult to think of a country better suited to this initiative than Kenya.
Being Kenya, however, the initiative has come in for lots of criticism and skepticism, especially from the medical fraternity. Doctors are wondering how patients will be able to get quality healthcare without actually physically visiting health institutions to be seen and checked by a medic. They are all missing the point.
Everyone growing up in rural Kenya knows that there is just one remedy for every illness: Panadol. Or aspirin, depending on where you live! Rural people in Kenya self-medicate in alarming proportions, and the vast majority respond to illness in the same way: if you are not feeling well, you go to the nearest shop, buy a couple tablets of Panadol or another mild painkiller, lately, Mara Moja, swallow them and move on. The reason for this is simple: in Kenya, there’s just one doctor for every 8,000 people. We simply haven’t got the number of medics required for each person to be able to see a doctor when they feel ill.
This situation is compounded by the very poor public health facilities on offer in the country, and which are frequently exposed in the media as little more than excuses of health centres with little or nothing to offer in the way of medical care. To round off the tragic tale, many medics have gone into private practice even as they are employed by the public service, and will simply not bother to show up at public hospitals to provide healthcare to the public. There is no real system of holding them accountable, so they get away with it. And of course this is only in those cases where public health facilities do exist: in most of Kenya, there simply are no any public health facilities. However, thanks to an astonishing rate of mobile phone adoption, 30 million Kenyans – fully 75% of the population – have a working mobile phone connection. It’s against this backdrop that the initiative launched by Mrs Kenyatta must be viewed.
Telemedicine is the provision of clinical health care remotely using telecommunications. It is a field within the broader discipline of telehealth, which is the provision of health-related services and their attendant information using telecommunication facilities. Telehealth comes in dozens of forms and shapes, depending largely on the telecommunications and IT infrastructure of the region in question, and the sorts of medical or health needs of the target population.
At a very basic level, telehealth involves the provision of health-related information to citizens. This can be as simple as messages about cleanliness and how to avoid infection by certain diseases. These health tips will form part of the telemedicine initiative that is Sema-Doc. But the service aims to go further, and has been said to also include elements of remote diagnosis by text message. This might seem dangerous to patients, but these are people who have been self-medicating – or even simply ignoring illness all their lives. Being able to contact a doctor by text message and describe their symptoms for an interim diagnosis is a massive improvement on their current situation.
And this must be just the beginning. Kenya has suffered many decades of poor healthcare, a sate of affairs usually attributed to the prohibitive costs of setting up public health facilities and training medics. These are, of course, excuses that political figures trot out to justify the appalling state of our medical facilities and the complete absence of any serious attempt to address the situation. It is not as if we lack the resources: tiny Rwanda has met all of her health targets under the Millennium Development Goals, and pretty much everyone in Rwanda is covered by health insurance. In our case, it is just a lack of political will that sees us pay MPs millions every month instead of spending that money training doctors and nurses, or setting up healthcare centres.
Our telemedicine initiative needs to evolve beyond just text-based patient-doctor interactions, because there is only so much you can do with a mobile phone service. In this, we are hampered by that perennial hurdle that afflicts most of Keya: lack of electricity. Innovative solutions, perhaps employing solar and wind energy, must be found to allow clinicians to access their patients using video links. This is, for Kenya, the real Holy Grail of telemedicine: that a doctor in an office far away can actually see a live image of a patient on the other side of the country, and make a judgement on the basis either of live video feed, or even photos from a mobile phone messaging app.
Due to our unequal access to medical facilities across the country, telemedicine in Kenya will be at two different levels depending on where a patient is in the country: the most basic level will be the phone-based diagnosis described earlier. But here are places like Nairobi that have excellent broadband and reasonable electricity connections. For these places, telemedicine holds the most technological promise. It will be possible, for example, for doctors in Nairobi to train health workers in Kisumu remotely, using video-conferencing facilities that are an integral part of urban telehealth. Medics in Nairobi can remotely monitor patients in Mombasa, and cases of emergency trauma can be stabilized from a distance if there is an attending ambulance with telehealth facilities. For patients with medical prescriptions, telepharmacy can be used to remotely monitor drug therapy, while prescriptions can be provided and altered remotely without the need to physically incur the cost of travelling to go see a doctor.
There will be issues with telemedicine. One of these is patient privacy – Kenyans are not the most technologically savvy of people, so patient-doctor confidentiality will not always be assured given the need to sometimes involve ICT professionals in transmitting patient data to medical centres far away. The almost universal lack of probity, and the massive corruption in both the private and the public sectors in Kenya, will also be difficult to overcome so that medical services can be delivered to far-off patients. And of course the model needs to overcome the significant hurdle that is reluctance on the part of medical personnel to change their model of service delivery.
This will be extremely difficult, because the medical sector in Kenya is one of our more egregious cartels, jealously guarding itself against any advancements or developments that could threaten the medical gravy train that sustains our elitist medics. But change must come, and telehealth is just what we need. The initiative launched by the First Lady is the first step in a long journey that will change the delivery of medical services, as we know them, and no amount of resistance or derision will stop that boat from sailing. It’s about time, too!
