The importance of telemedicine has increased dramatically over the past 6 months. Technology that was previously predominantly used by the military, in remote and offshore locations, or by private GP services, has now become ubiquitous, as a result of the worldwide COVID-19 pandemic. Telemedicine is of particular relevance in low- and middle-income countries, especially in rural areas which often have a low density of health-centres, and fewer doctors per capita, which can result in significant health inequity.
The Virtual Doctors is a UK-based NGO, that uses a bespoke telemedicine app, to connect isolated rural health-centres (RHCs) in Zambia, with volunteer doctors, based in the UK and Zambia. The UK has one doctor for every 360 people whereas Zambia has one doctor per 12,000 people. Clinical officers (COs) working at RHCs may see 60-100 patients a day, and will treat both adults and children, as well as managing dental problems, obstetrics and trauma. We have partnered with the Zambian Ministry of Health for over 10 years, and now have over 150 volunteer doctors, offering text-based diagnostic and treatment advice across a range of specialities.
Our service is text-based, with the option to send images, rather than using real-time video-calls to give advice. We are often asked why this is the case. The answer lies within the context of how our service was developed. Intermittent data bandwidth makes video calls impractical in much of rural Zambia. It also means that UK volunteers can answer queries at a time that suits them, and work around their NHS commitments.
Since 2016 the number of RHCs we have supported has increased from 6 to 140. The corresponding number of COs we advise has increased by 2,233%. We now answer an average of 220 monthly cases, a total of 5,512 since our new IT system was introduced in late 2016.
90% of the time the advice given has improved patients’ symptoms. It has prevented referral to hospital in 76% of cases and 94% of the time the advice given was judged educationally beneficial by the COs. The service is also helping to reduce professional isolation and to improve the resilience of healthcare workers who can often be posted to isolated rural clinics away from friends and family.
We have found that It is possible to develop a bespoke telemedicine service that can be used effectively in a resource-limited environment. Throughout our development we have been led by our end-users to ensure that our service has remained relevant to their setting. It is important to ensure constant solidarity between the users and service providers with ongoing support, evolution and feedback.
photos by Virtual Doctors