Why you don’t have to travel miles away to see a doctor

Little Abdirahman Abdi lay in his mother’s arms, writhing in pain. He was hungry, but could not eat or hold anything down.

According to his mother, Yurub Mohamed, the four-month-old boy had not been breastfeeding well.

“He does not have an appetite, I have tried everything possible but he just can’t hold any anything down,” says Mohamed.

After making a number of trips to Daadab sub-county hospital, doctors told her that the boy urgently needed to see a paediatrician.

Abdi had acute malnutrition and his life was hanging by a thread.

To reach a paediatrician, his mother had two options. She could travel to Garissa Level Five Hospital, a three-hour journey on a rough road, or travel more than 400km to Nairobi. Though the city has many specialists, Mohamed has to face extra costs in travel and accommodation.

Vital signs

Luckily, Yurub did not have to take the one-day trip to Nairobi to have Abdi seen by a paediatrician. Thanks to technology, Dr Renson Mukhwana could see him from the comfort of his office at Gertrude’s Children’s Hospital. 

Using a set of computers and some accompanying devices, Dr Mukhwana was able to examine Abdi from 414km away. He was able to read the boy’s vital signs, including his heartbeat, blood pressure and temperature.

With a video camera zooming on Abdi’s body, Dr Mukhwana could see Abdi’s bones outlined on his emaciated body and his distended stomach.

When Abdi cried out of discomfort, Dr Mukhwana could hear him as clearly as if he was in the room with him.

Through an interpreter and a clinical officer sitting in Daadab, Dr Mukhwana could ask Abdi’s mother a series of questions on the baby’s medical history.

Apart from the distance between patient and the doctor, there was nothing else that made the doctor-patient interaction any different from a one-on-one hospital visit.

Welcome to the era of telemedicine, a technology that makes it possible for a doctor to treat a patient from any part of the globe.

In 20 minutes Dr Mukhwana had seen Abdi; recorded his vital signs, checked his general body condition, captured his medical history, arrived at a diagnosis and and written a prescription.

“When I am examining a patient, I use sight, hearing and feeling. Images and sound are promptly transmitted. The only thing I cannot do is use my hands to palpate the patient,” says Dr Mukhwana.

Telemedicine runs through a twin technology set comprising of a computer with a video camera and a speaker.

Another computer is connected to a Welch Allyn unit- a set of medical diagnosis devices  and patient monitoring systems.

The unit, operated by a clinician, was able to record and dispatch vital signs to Dr Mukhwana who had a similar set in Nairobi.

“It makes it possible to handle the patient from miles away,” says Dr Mukhwana.

If Dr Mukhwana needed the patient checked by touching, all he had to do was ask the clinician sitting with the patient on the other end to do so and give feedback.

Saving lives

“In the end I am able to treat the patient much in the same way I would treat the one sitting in my office,” he says.

In the end, Abdi’s life was saved at Daadab without having to transfer him to Garissa or Nairobi.

According to Dr Mohamed Shuriye, the medical superintendent at Dadaab sub-county hospital, anything could have happened during the transfer.

A week earlier, an oxygen tank malfunctioned while a boy was being moved to Garissa.

“The ambulance had to turn around. He was brought here but he did not survive,” says Dr Shuriye.

The Kenya Health Workforce Report indicates that Kenya has 295 paediatricians, serving a population of over 40 million.

Garissa, a sprawling dry-land that is home to more than one million people,  has only two paediatricians.

“Though telemedicine in Daadab was a pilot project, it has immensely helped patients who needed specialist care,” says Garissa county chief officer of health, Mohammed Gure.

Even so, thousands of residents still cannot access a doctor, least of all a specialist. The health workforce report indicates that Garissa had 19 doctors in 2015.

There is only one doctor at Daadab sub-county hospital.

“I am here for one month – serving round-the-clock. I am then replaced by my colleague for a similar duration,” says Dr Shuriye.

Clinical officers

According to Dr Shuriye, between 100 and 150 outpatients visit the hospital every day. Out of these, between 10 and 20 patients are admitted.

Usually patients are first seen by a clinical officer. If the patient’s case is complex, the doctor takes up the matter. If he too cannot treat the patient he refers them to Garissa, or, like in Abdi’s case, resorts to telemedicine.

“With this technology, a specialist in Nairobi can provide much needed treatment for a patient in Garissa,” says Dr Shuriye

Abdi had another appointment with Dr Mukhwana a week later. He is among the first Kenyans to be treated by a specialist through telemedicine.