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Pre-Flight Checks – Tanzania and Kenya
The renowned Flying Doctor service carries out specialist health care across Africa. The airborne doctors are often the only medical support available for the remotest regions. But these doctors are hampered by a lack of information about the cases they will face when they land, or even the availability of medical equipment and supplies on the ground. Now technology is giving them a head start in preparing for their flights of mercy.
The Flying Doctor Service
The Flying Doctors Service is part of the African Medical and Research Foundation (AMREF). This was established in 1957 by three surgeons – Sir Michael Wood, Archibald McIndoe and Thomas Rees. AMREF’s mission is to improve the health of disadvantaged people in Africa. Specialised essential health care is taken out to rural, remote and disadvantaged communities to enable them to improve the quality of their lives.
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| AMREF staff carrying out an emergency transfer so that a patient can receive hospital attention. |
Here AMREF flies rotating teams of urban hospital specialists to rural hospitals across Africa. There are over 5000 consultations yearly, costing an average of £28 ($70) per patient.
The Service operates 24 hours a day, 365 days of the year through its control centre located at Wilson Airport in Nairobi, Kenya. It covers the countries of East Africa (Uganda, Kenya and Tanzania) and, when clearance can be obtained, most neighbouring countries. In addition, subject to flight clearances, the Flying Doctors will carry out emergency evacuations from anywhere on the African continent.
AMFEF Outreach Service
The AMREF Outreach Service supports rural hospitals and over 100 health facilities in seven countries – Kenya, Tanzania, Uganda, Ethiopia, Southern Sudan, Rwanda and Somalia. The Service flies medical staff to these hospitals two to six times a year, providing a major medical service and training support. Using its own doctors and nurses, as well as medical staff from the main teaching hospitals in Kenya and Tanzania, and dedicated volunteers from around the world, it diagnoses and treats hundreds of patients a year. Treatments range from common conditions such as burns to major operations on road accident victims. The training programme provides continuing education for local medics on the latest treatments and how to deal with long-term case management.
The overall AMREF Outreach programme consists of five inter-related projects:
1) Specialist Outreach covering 17 rural district hospitals in Kenya, 49 rural hospitals in Tanzania and, since 2005, 17 hospitals in Uganda.
2) Surgical Outreach covering 30 hospitals in Kenya, Tanzania, Uganda, Southern Sudan and Somalia.
3) Leprosy/Reconstructive Surgery covering 25 hospitals in Kenya, Tanzania, Uganda, Rwanda and Ethiopia.
4) Medical Radio Communication that enables radio communication between these hospitals. It provides support to all Outreach Services and other AMREF projects in Kenya and throughout the region. Most of the hospitals are very remote and have no access to telephone facilities. Therefore, the use of the radio communication network helps with the planning and operation of the service, including details of patient operating lists, supplies required and times of flights.
5) Telemedicine Pilot project – a new test project that started in June 2004 that aims to improve the communication between specialists and the rural hospitals.
Telemedicine Project
People have sometimes travelled over 100 km on poor roads to get to their nearest hospital only to find, once they arrive, that there was no consultant doctor with the appropriate specialism to help them. Although the Service is connected via a network of over 100 rural radio stations, detailed information about individual patients is difficult to transmit. Doctors flying to the hospitals often do not know what to expect on their arrival. If they had this information they could bring the necessary equipment and appropriate medicines.
| Patients waiting at a local outreach clinic– they may have travelled many kilometres to reach here. |
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In June 2004 Safaricom Ltd, with project funding from Vodafone, set up a pilot telemedicine project covering four of the most remote hospitals – the desert towns of Mandera and Kakuma in northern Kenya, and Rubya and Kibono by the shores of Tanzania‘s Lake Victoria. Each site received a standard ICT package to enable it to communicate with AMREF’s clinical services located in Nairobi. The aim of the project is to connect rural healthcare facilities to academic medical centres in the cities electronically in a regional ‘health intranet’. This makes it possible to access bodies of medical knowledge that were previously inaccessible to these remote areas. In this way healthcare is taken to the patient rather than the other way round.
Using an audio-visual satellite link, clinical AMREF staff from the rural hospital can communicate with specialist consultant physicians. A local doctor will see the patient, taking case notes and digital pictures. These notes can be scanned to produce images of handwritten notes, or be computer-based using proprietary software such as Telemedmail™. Accompanying the notes will be a full digital image of the patient, together with digital images and/or video clips of any visible lesion.
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| Surgeon John Wachira examines a digital X-ray |
Digital images of X-rays can accompany the notes together with the results of any other diagnostic procedures. Using e-mail, via the internet, this information is transmitted to a specialist doctor for a second opinion. The outreach clinic accesses the internet for transmission of the clinical notes and attachments, and begins the virtual consultation.
Consultants meet to prepare opinions and, at an agreed time, a teleconferencing connection will be established. On completion of the consultations, the entire record is saved on a dedicated library file on the AMREF server. In this way, AMREF will be able to access thousands more patients in remote areas every year in an increasing number of hospitals in Eastern Africa.
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Dr Johnson Musomi using the internet to discuss the
treatment for a patient. |
Training on the equipment has been given to the staff in these locations, increasing their skill base and lifting morale. Technical support visits have been made to all the sites several times to ensure the equipment is functioning correctly. Due to the remoteness of the sites, this maintenance and repair work is a big challenge and, as with most internet-connected services, the system can be susceptible to computer viruses.
Moving On
The project aims to continue developing to reach a wider audience and keep up with the latest technology, expertise and medical needs. It plans to do this through:
- The development of a virtual referral centre.
- Establishing partnerships with academic medical centres.
- Developing specialist teleconsultation support to pilot sites, particularly radiology, pathology, dermatology and ophthalmology.
- Producing an AMREF Telemedicine Manual as a tool to establish and maintain future telemedicine sites in poor rural areas.
- Developing a business plan to sustain the pilot sites after the funding period.
At the moment the scheme is still in its pilot stage, but staff have shown a high level of interest in telemedicine and seem keen to keep this facility.
Acknowledgements
Hands On would like to thank Nancy Maksud, AMREF’s Corporate Communication/Fundraising Manager for her help in putting together this case study.
Further Information
Participating Organisations
| African Medical and Research Foundation (AMREF) |
Langata Road
P.O. Box 27691 - 00506
Nairobi
Kenya
Tel: +254 20 6993000
Fax: +254 20 609518
Website: http://www.amref.org/ |
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Safaricom Ltd
Safaricom House
Waiyaki Way
P.O. Box 46350
Nairobi
Kenya
E-mail: customercare@safaricom.co.ke
Website: http://www.safaricom.co.ke/2005/default.asp
The Vodafone Group Foundation
Vodafone House
The Connection
Newbury
Berkshire RG14 2FN
UK
E-mail: groupfoundation@vodafone.com
Website: http://www.vodafonefoundation.org/0.html
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