This is a great step in an African country!! Most important we should
develop our own in house tools to connect doctors within .
By Sisay Abebe
Super-fast internet connections and digital technology are changing
the face of medicine. A multi-million- dollar venture between India
and Ethiopia will see doctors in Addis Ababa using telecommunications
to consult fellow medics in Indian hospitals. But will `telemedicine'
help more than a lucky few? Sisay Abebe reports.
[PANOS FEATURES] When 14-year-old Binyam Yosef developed a nasty
swelling under his left knee, his worried parents took him to the
Black Lion Teaching Hospital in Addis Ababa. They approached Swiss
professor Jacob Schneider who examined Binyam thoroughly and
concluded that he was suffering from a malignant cancer. It looked as
though his leg would need to be amputated, but Schneider was not 100
per cent sure of his diagnosis.
"I discussed the case with staff in the pathology department,"
Professor Schneider recalls. "We could not come to a definite
decision." In the end, Schneider referred the case to an old
colleague in Switzerland. Using the latest technology, he took a
digital photograph of the boy's knee tissue through a microscope and
e-mailed the photo to Professor Gernot Jundt, head of the bone tumour
registry at the University of Basel. "Within days we received his
diagnosis and detailed recommendations for the treatment," Schneider
remembers." We were able to save the boy's leg."
Binyam Yosef is one of a lucky few in Ethiopia to be treated through
the use of information technology. His case dates back to 2004, and
results from the efforts of a group of health professionals to
improve medical diagnoses and treatment over the past decade, and
whose efforts led to a partnership between telecoms bodies, the
health ministry and the United Nations Economic Commission for
Africa. "With personal commitment and enthusiasm this project
produced a number of activities which gave a glimmer of hope to the
country," says Dr. Fassil Shiferaw of the Ethiopian Telecommunication
Medical Service.
Now things have moved further: a US$2.13 million grant from India
will fund a more ambitious telemedicine venture for the next three
years. Doctors in at least two Ethiopian hospitals, including Addis
Ababa's Black Lion Teaching Hospital, will consult their counterparts
in India using digital technology. It is the start of a venture in
which India plans to establish ten `super specialty' hospitals in
Africa under its Aid-to-Africa Budget programme. India hopes it might
capitalise on its investment in the future by charging fees for
advice given by Indian doctors.
The medical facilities at the Black Lion Teaching Hospital are a
world away from the health services available to most Ethiopians.
Most of Ethiopia's 74 million people live in rural areas. Many
villages still have no access to basic health care, and patients
often travel over 50 kilometres on foot to get to a health post.
Those who are too ill to walk or to be transported (if transport is
available) frequently die.
Under-investment in rural health care facilities, a shortage of
doctors and the lack of incentives to retain medical staff in rural
areas all serve to increase the problem. Patients are referred to the
Black Lion Teaching Hospital from all over the country. If they do
not die on the way to Addis Ababa, they often face long waiting times
once they get there.
Demissie Sahle is one of those who made the journey. The 68-year-old
farmer lives in Amhara, Sela Dengay district, about 200 kilometres
north of Addis Ababa. He was sick for six months and tried his best
to obtain treatment at the nearest health post, but without success.
Together with his son Laike, he raised nearly 4,000 birr (US$500) to
travel to the capital. Father and son embarked on an exhausting
journey. "Whatever we could sell, we have sold to get here and to pay
for treatment, including our only oxen," said Laike. They left their
families and their land behind, unsure whether anyone would take good
care of them.
Telemedicine, if it were to be rolled out to rural areas, could make
Demissie Sahle's expensive journey a thing of the past. The Ethiopian
government has already declared its commitment to information
technology – it plans to connect the entire country to broadband
access points over the next two to three years and Ethiopia's prime
minister Meles Zenawi has described IT as a crucial weapon to fight
poverty.
But the country's five-year health sector development plan does not
include policies for how digital technology could be used to improve
rural health services. The government's main objective in rolling out
the IT infrastructure is to get local councils and schools connected
to the internet – `telemedicine' is not a priority.
"Ethiopia has signed a US$2.13 million agreement with India for the
coming three years for these specific projects, but I am afraid it
will take some time to prepare the entire health sector for the
latest ICT developments, " said Gadissa Lemecha, team leader of the
Ministry of Health's Information Processing and Documentation
department.
Gadissa says the absence of a policy to use IT within the health
sector does not rule out expanding telemedicine into rural areas but
it will be dependent on a number of factors – the successful
upgrading of the currently weak telecommunications infrastructure,
the results of the Indian project, and funding. It is not clear at
this stage how `telemedicine' might become available to the poor.
Dr Shiferaw, one of the initial telemedicine pioneers, believes a
solid commitment to use digital technology in the health sector would
at least help the private sector to embark on these new methods of
diagnosing and treating patients once the country is connected.
Another telemedicine pioneer, Professor Schneider, cannot hide his
frustration at what he sees as the slow pace taken to implement the
technology on a wider scale, saying: "I don't know why it took the
government so long to make use of this simple technology which could
benefit many Ethiopians a lot."
In the meantime, patients like Demissie Sahle, the farmer from
Amhara, have no choice but to undertake long journeys in search of
treatment. Three months have passed since he arrived in Addis Ababa.
Cases of sick people have been reported who had to wait for a year or
more to get a bed in the teaching hospital. Like Demissie and his son
Laike they often sold everything they owned. If the money runs out,
they are forced to beg. "I can't bear to see my father die in front
of my eyes," says Laike, "I will spend whatever I have to save him."
This feature is published by Panos Features and can be reproduced
free of charge. Please credit the author and Panos Features and send
a copy to Panos London, 9 White Lion St, London N1 9PD, UK.
