“You’re Not From Around These Parts” Building a Rationale for International Faith-Based Telemedicine

  1. Share
1 0

By James B Kline

All I said was, “Unsweetened tea, please” and it was obvious to the waiter that I was a Yankee in the Deep South.  It was obvious that iced tea had to be sweet, like really, really sweet.  I should have known better for at that point I had been married to a southerner for nearly 11 years.  For us, coffee-black and bold was our beverage of choice and as a result we never argued about the ‘right way to drink iced tea.’

Now imagine your first day in a hospital or clinic in a remote village nearly anywhere in Sub-Sahara Africa.  Your patient is a young child presenting with fever, headache, and nausea.  Your North American ‘go to’ diagnosis is the flu.  Fortunately for the patient, a local healthcare worker is nearby and essentially says to you, “You’re not from around these parts.” 

He’s worked here for years and knows the local disease patterns, so he offers the more plausible diagnosis…malaria.  He is aware that it is the rainy season.  He knows that the population is generally poor so he assumes that the child has been sick at home for several days because the parents couldn’t justify the cost until they were certain that their child needed medical care.  He’s also aware that the local population generally does not use mosquito nets.  Furthermore, he’s seen more than ten patients within the past week the same symptoms that have all tested positive for malaria. 

Understanding local epidemiology is one of the important reasons for the establishment of regional telemedicine centers.  Local practitioners can aid you in realizing that your bread and butter diagnoses might not be the most accurate given the local setting. There are many other reasons for these centers…culture, language, time zone, capacity, and ownership, to name a few.  Each is significant and deserving of its own blog.  One or any combination of these is the rationale for the organization and support of a regional telemedicine center.   While much of telemedicine can be effectively delivered using asynchronous communication (communication featuring email or text resulting in non-real-time responses), an additional advantage of the regional center is its potential to offer real-time medical consultation in the event of a medical emergency.  Even seasoned physicians value access to medical specialists (intensivist, traumatologist, cardiologist or pulmonologist) in real/near real-time when they need help with a case. Every effort should be made to offer the same capability to healthcare providers in remote access medical facilities around the world.  Establishing regional telemedicine centers makes this a viable option for these providers when they wouldn’t otherwise have this access.

If we agree on the many important roles that telemedicine can and will play in the future of healthcare delivery, we must build towards the establishment of regional telemedicine systems so the system is effective on an individual basis.  Building regional capacity is part of a sustainable program.  These centers are arguably the most efficient way to implement telemedicine.  Western based doctors and administrative personnel can serve as trainers providing the backstopping needed during the development stage.  We might identify a hospital that has good infrastructure and medical capacity located in Cote d’Ivoire, for example, that can serve as a telemedicine resource for that region’s remote and under-served French speaking healthcare facilities.  Lessons learned from this pilot program will serve as the foundation from which similar regional centers are created to impact healthcare needs throughout Africa and beyond.

The world is changing.  As telemedicine plays an ever more important role in the developed world, so it will in remote and under-served parts of the world.  We dare not let this opportunity pass us by. 

Telemedicine Blog 3 of 4

Are you interested in exploring telemedicine more?  Would you like to contribute your experiences and suggestions to help develop some new solutions? Please fill out this survey!

 

Community tags

This content has 0 tags that match your profile.

Areas of the World Show all (206)

Comments

To leave a comment, login or sign up.

Related Content

0
Could You Put On Your Doctor's Hat? Building a Rationale for International Faith-Based Telemedicine
By Donald Thompson MD, MPH & TM As a physician I have friends who call me for medical advice from time to time.  Actually, all the time…  I really do love it when they ask if I can put on my doctor’s hat.  These friends who contact me via email, text, WhatsApp, phone, and/or Skype do so from both domestic and international settings.  The use of any medium of communication with me while I’m wearing my doctor’s hat is a form of telemedicine.  If you are currently working internationally as an expatriate, there’s reason to ask if there’s a role for telemedicine to support you while you pour your life, skills, and family into your ministry work.   When you have a potential medical problem, what are your options?  You may have access to qualified medical personnel in a proper clinical setting, and you might need to use a local clinic. Otherwise your options are to wait it out, praying, of course for God to intervene and provide healing.  Quite often, those who call me asking me to put on my doctor’s hat have already searched the internet to find out what Dr. Google might diagnose.  It’s likely that you’ve done the same and it’s likely that your ‘fatigue’ may be diagnosed as a ‘potential heart issue’ or your ‘headache’ is diagnosed as a ‘potential brain tumor.’  One thing is sure…Your search on the internet is not very reassuring! As I tell my patients, Dr. Google is not always wrong… But most of the time, an internet search is not sufficient. Perhaps a better option is to have access to a vetted doctor who understands your cultural and geographical settings and the very limited resources available where you are posted.  As telemedicine is becoming more medically acceptable and common in the west, it figures that telemedicine has a vital role to offer to those serving internationally.  While real-time face to face interaction may be limited by bandwidth issues, keep in mind that advancement in communication is almost certain to permit this in the not too distant future.  If at your post you have internet and phone service it is most certain that telemedicine can offer medical counsel and a fair measure of peace of mind. My conversations with my friends seeking medical advice are almost always by delayed interaction such as email or text, and this is adequate for most issues.  They have access to someone who knows the context in which they are serving, and with a little back-and-forth texting, I can often figure out what is going on and what next steps are most appropriate. Nothing hinders your work in an international setting like the uncertainty that you feel when you or a family member is struck by an illness and it's unclear what course of action should be considered.  If, on the other hand, you could find the right person for advice then it might be as easy as picking up medicine the next time you or one of your team members goes to the city.  You don’t have to ignore it.  You don’t have to panic.  Oh, to sleep better at night… Telemedicine Blog 1 of 4 Are you interested in exploring telemedicine more?  Would you like to contribute your experiences and suggestions to help develop some new solutions? Please fill out this survey!    
1
Can Somebody Call a Doctor? Building a Rationale for International Faith-Based Telemedicine
By Donald Thompson MD, MPH & TM In many international ministry settings, you as the ex-pat are seen as the medical expert, whether you are medically trained or not.  While you might be a highly accomplished doctor, nurse, pharmacist, or community health worker, often pastors, church planters, evangelists, or project managers are sought out as “the medical experts.”  In spite of the fact that there may be a good national medical infrastructure available, you can count on being asked “to consult” on your national partner’s aunt, or the son of the village elder, or the brother of the local Imam, just because of your western perspective!   I have a friend whom I will call ‘Pete’ who had served as a church planter in the Philippines for about a decade.  Approximately 25 years ago he stayed in my home while he attended a two week tropical medicine intensive at Tulane University.  This two week course colloquially known as the “Missionary Doctor Course” was stuffed with all the tropical medicine training that medical personnel needed for their third world setting.   This two week course has been replaced with a one semester certificate level course that is now available at other universities.  Though designed for physicians, nurses, and those with medical training, ‘Pete’ just devoured everything in it because he had been ’doctoring’ for the previous 10 years!  You might be another ‘Pete’ or perhaps even as a skilled family practice physician, nurse practitioner, or physician assistant, you are regularly stumped by various skin conditions, fevers of unknown origin, or chronic abdominal pain with weight loss and cough. You may work alongside a very competent national counterpart but there will often be cases where the diagnosis and management options are not clear.  Who are you going to call? There was a time not long ago when you may not have had access to a computer with video capability or a strong enough internet signal to support video.  Not having a dependable electrical supply from local grid may also have created issues if you did not have redundancies in the form of a generator or solar power system to keep you functional when the power goes out.  Technology now permits, for the most part, almost everyone to have access to a smart phone and data network that will support real-time consultation.  ‘Pete’ did not have internet access. ‘Pete’ did not have a smart phone.  YOU do!  In most settings, your national counterpart does as well!  That being said it still begs the question: who are you going to call?  The good news is that even a smart phone will connect you to that person.  Need a Dermatologist?  Need a Pediatrician?  Need an OB/GYN? What is the typical need where you work? Telemedicine can address that need!  Do you or your national colleagues need to speak with an experienced medical specialist while you have a patient in front of you?  Telemedicine can do that!   Does your hematology analyzer need to be re-calibrated?  Telemedicine can access a bio-lab technician who can walk you through this process!  Does your medical staff need training but can’t afford the cost or time away? Does your office staff need support developing a spreadsheet for budget?  Iterations of telemedicine can and will address these needs.  If you’ve asked if there’s a way to use a telemedicine network to build capacity within the national healthcare delivery system where you serve, I believe that you now have the answer. Call the Doctor! Telemedicine Blog 2 of 4 Are you interested in exploring telemedicine more?  Would you like to contribute your experiences and suggestions to help develop some new solutions? Please fill out this survey!