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1000 telemedicine units for Africa Print E-mail
 
The DSF proposes a new digital solidarity partnership
1000 telemedicine units for Africa
 
Within the framework of digital solidarity, the DSF offers towns and local authorities of the north, the possibility to finance telemedicine units in Africa.

This project (which may accompany twinnings or activities of decentralized cooperation already undertaken by the town) enables local mobilisation of doctors, hospitals and civil protection units for remote diagnosis.

To this end, the DSF suggests “à la carte” partnerships in the context of a far-reaching project across the African continent.
 
First partners: 
  • The Network of French-speaking Africa for Telemedicine (RAFT), University Hospitals of Geneva (HUG)
  • The Africa Health Highway (AHI), World Health Organisation (WHO)

The Project
 
In the area of health, information and communication technology (ICT) represents an essential tool in medical practice. The main areas of application for which there is an obvious need for access to ICT, and for which studies show a clear benefit, are medical and surgical emergencies and also mother and child pathologies (obstetrics, gynaecology, paediatrics).

The Telemedicine

1000 telemedicine units for Africa
Telemedicine tools permit an exchange of information in electronic form and facilitate access to medical expertise from a distance. A doctor who finds himself far from medical expertise can thus consult colleagues at a distance in order to resolve a difficult case, follow a continued education course broadcast on the Internet, or access knowledge banks or digital libraries.
 
The potential of these tools is obvious in countries where specialists are rare and where distances and quality of infrastructure make it difficult for doctors or patients to travel. This is the case for most of the countries of sub-saharian Africa.

Objective

More particularly, the project aims to reinforce the skills of doctors at district hospital level. Making Internet access available, together with equipment for diagnostic aid, enables knowledge to be brought to the same level and will, in the long run, enable the practice of telemedicine.

Rationale


1000 telemedicine units for Africa
District hospitals are located in areas where electricity, mobile telephony and Internet are available but where current equipment does not allow transfer of medical data to the upper end of the scale in the country, or to hospitals of high international standing.
 
Due to a lack of diagnostic means and the absence of specialists, care given to patients in district hospitals is often far from adequate.
 
Delays in the implementation of treatments or unjustified evacuation can be responsible for poor use of already scarce resources and unnecessary suffering for patients.

One way of improving this situation is to implement modern diagnostic means, adapted to the field, together with tools to enable long-distance mobilisation of the specialists’ expertise along with logistical support. The advantages of such an approach have been demonstrated, but there is not yet any wide scale deployment of these tools.

1000 telemedicine units for Africa
The hospital of a health district in sub-saharian Africa is usually used as an initial reference point for 50 000 to 200 000 inhabitants. There are several doctors, as well as a minimal medical and technological platform (laboratory, operating theatre, conventional radiology) which enable some difficult and urgent cases to be taken care of. Continued training for first call health professionals is also dispensed at district hospital level along with their supervision and coordination, as well as the collection and consolidation of field information and indicators which, going up to ministerial level, enable the health system to be managed.

Description of the Project

The project consists of equipping district hospitals with modern and adapted diagnostic tools (ultrasound scan, electrocardiography), as well as Internet connections permitting live or deferred exchanges with experts at a distance and the continued training of health professionals by e-learning.

For district hospitals (intermediary step between regional hospital centres and local dispensaries), the simultaneous availability of the connection and adapted medical tools presents three major advantages:
  • speed of roll-out, through installation of light-weight infrastructures, (VSAT satellite connection, plus one computer per doctor), easily managed at local level.
  • fast and easy appropriation of IT and medical tools through “hands-on” training.
  • connection with existing active networks in the area of telemedicine.
Equipment Required

Electronic and computer equipment:
  • Satellite aerial and terminal (VSAT)
  • Laptop computer with webcam
  • Data projector to equip training room (as required)
Medical equipment:
  • Portable digital ultrasound scan station
  • Digital electrocardiograph machine
  • SOS Kit (blood pressure and glycemia monitoring)
Electric production:
  • Electric supply by solar panels (as required)
The Bandwidth

1000 telemedicine units for Africa
The bandwidth shared within the same network, the solution we recommend here, costs between 2150 and 6000 euros per year (for a throughput of 64/128Kbps and of 256/512 Kbps respectively). This option allows basic telemedicine applications.
 
Optimization of the shared bandwidth depends on the number of sites (video-conferencing is possible starting from 60 operational sites).
 
Other connection solutions exist:

A dedicated individual bandwidth costs at least 3,600 euros per month, for a throughput output of 1024 Kbps. It enables on-line applications (video-conferencing, downloading of large _les). However, without significant external financial support, this option is not economically viable in Africa.

Support Network

The towns and local authorities taking part in the project are invited to mobilise a local resource of telediagnosticians (volunteer doctors, hospitals, aid centres). Operational support structures are necessary, at least at the level of each country concerned, to guarantee an effective mobilisation of experts and a response to questions from teleconsultations within a worthwhile timeframe.

The Network French-speaking Africa for Telemedecine (RAFT – University Hospitals of Geneva, Switzerland), has a pool of medical and technical co-ordinators available in twelve African countries, ready to extend their activities to support these new telemedicine and e-learning services. The collaborative platform of RAFT allows the teleconsultation activities to be structured by defining closed groups who can thus work in a network of confidence and make up “virtual communities”.

The co-operation of other active telemedicine networks in Africa has already been assured:
  • World French-speaking Digital University, Paris, France
  • World French-speaking Virtual Medical University, Paris, France
  • E-Health stakeholders'club (CATEL), Vannes, France
  • World Health Organisation, e-Health Unit, Geneva, Switzerland
  • EMISPHER telemedicine network, Charité Hospital, Berlin
  • Etc ...
Training organisation

Training workshops for learning the manipulation of diagnostic tools are required. 3 days training should be allowed for the case of telemedicine and remote diagnosis tools, and 10 days for training in the principles of ultrasound for prioritizing emergencies and obstetrics. In both cases, distance training support is useful and easily attainable.

Two additional training sessions in ultrasound scanning are also planned: on the one hand, a targeted training in imagery for emergency situations (abdominal and thoracic ultrasound scanning) which in two weeks teaches the basic techniques in directing the care of the patient and his possible evacuation to a regional hospital, as well as the realisation of emergency invasive procedures (punctures, drainages) under ultrasound guidance.

Secondly, a training focused on foetal ultrasound scanning, which generally requires a month’s training, enables pregnancy monitoring and early detection of cases which could pose problems at the time of the birth.

These training programmes, together with the initiation in use of telemedicine tools, will be supplemented by distance learning courses.

Monitoring and evaluation

Evaluation of the impact of these tools is necessary to demonstrate the advantages and justify the expansion of their use. The following indicators can easily be measured:
  • number of scans used for diagnoses and procedures carried out under ultrasound
  • number of scans which modified patient care
  • number of teleconsultations which modified patient care
  • number of medical evacuations avoided
  • number of continued training courses followed
An evaluation of changes in practice resulting from these tools will be the subject of field studies. A measure of the improvement of the state of health of the populations will have to be carried out in the longer term.

Example of an operation from the RAFT network:
 
Dimmbal rural hospital, area of Dogon, Mali

1000 telemedicine units for Africa
The rural hospital of Dimmbal is located 120 kilometres from Mopti, the regional capital where the Internet currently stops. The satellite connection, put into operation in this rural hospital in 2003, has enabled a doctor to be recruited and maintained on site. He benefits from remote diagnosis and teleconsultation support, regularly following the continued training broadcast on the RAFT network from the university hospital of Bamako. Without leaving his post, he has recently obtained a diploma in epidemiology from Bordeaux University, by distance learning.

The same satellite connection enables him to manage aeromedical evacuations and to communicate with the pharmacy and other suppliers, but also to maintain contact with his social and family network who, for the most part, have stayed at the capital 800 kilometres away. It is also used to supply a cybercafé, from which the revenue is used to partially finance the connection costs, and is available to the Town Hall and to the school teachers of the commune.
 
Dr Diakaridia Traoré, doctor in charge of the hospital, in front of his telemedicine station run on solar energy (on his desk, the computer, webcam and satellite terminal: on the ground the batteries and the generator.

 

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