Telemedicine has great potential to improve the efficiency of healthcare in South Africa, particularly in the case of patients who live in remote areas and struggle to gain access to specialists.
It could ensure that healthcare is available, affordable and accessible to all. It can be anything from a simple webcam or a sports wristwatch to a high-definition video conferencing unit that monitors vital signs and blood pressure and hooks up to electrocardiograms and endoscopes. Put simply, telemedicine is the use of any technology that can provide medical diagnoses or patient care
over a vast distance.
The South African Medical Research Council (MRC) has been working with the health department since 1999 on telemedicine projects and last week the MRC hosted the first-ever telemedicine conference in the country.
MRC’s telemedicine platform manager, Jill Fortuin-Abrahams, says the technology is aimed at those who need it most: “Those living in rural areas and those accessing public health facilities can wait weeks or months to consult a specialist. Telemedicine affords people the basic right of access to healthcare.”
Fortuin-Abrahams says it can “never replace a doctor”, but the purpose is to ensure that healthcare is available, affordable and accessible. “Consultation would not only be cheaper, but greener, as patients no longer needed to be transported from peripheral hospitals to large tertiary hospitals. This not only reduces costs, but also reduces the emissions of harmful gases.”
She says the advantages are numerous: “Shorter time to see a specialist, less time taken off work, a decrease in the cost of transport and more efficient delivery of healthcare.” The disadvantages are “the security of data and unreliable broadband connectivity”.
Andrew Graley is director of health care markets in the European region at Polycom — a company that provides video, audio and data conferencing systems — and is an expert in the field of implementing telemedicine solutions for clinical applications.
“It can enable or stretch the reach of doctors and nurses,” he says. “Specialists can stay in one location, but reach clinics across the country. “Telemedicine can reduce the cost of consultation and alleviate the burden on the hospital system. You will save a lot in the social and public-care system.”
Telemedicine can also be used in homes, but it needs people who are trained to operate it. Its use as an educational tool is another exciting prospect, Graley says.
Medical students can now see what happens in an operating theatre and even view live footage from cameras inside the patient’s body. This would normally not be possible within the tight regulations of operating rooms.
Telemedicine is widely used in Australia and Norway is considered to be the leader in the telemedicine field. But Dr Karl le Roux, the chairperson of the Rural Doctors Association of South Africa, says it may not be a silver bullet for South African healthcare.
“Simple forms of telemedicine, such as emailing photos of fractures or skin rashes to an orthopaedic surgeon or dermatologist, is free and probably as effective, if not more so.” Le Roux says if it is done correctly, it can be useful, but there are significant technological challenges and setting up takes time.
“It may be difficult to get busy doctors at a rural hospital to link up with busy doctors at a tertiary hospital especially if the set up is time-consuming. Also, the costs can be very high and unless you have a dedicated group of doctors at the teaching end it can turn out to be a waste of money.”
Dr Jenny Nash, who works in rural clinics in the Eastern Cape, is also sceptical about the benefits of telemedicine. She previously worked at Mseleni Provincial Hospital in Northern KwaZulu-Natal, where she found the technology unreliable.
“We tried it for a few meetings, but often it takes longer to set up than the actual meeting,” says Nash. “I’ve had good experiences with it, but once it’s broken, it’s really broken. My impression is that it’s quite a fragile thing and you need a dedicated person on the other end.”
But David Bayever, research director at Wits Medical School who is based within the department of pharmacy and pharmacology, says telemedicine is an essential tool for any developing country to embrace as a solution for supplying support to
remote and rural medical facilities.
“Clearly, there is no incentive for these experts to travel distances to see such cases and it would certainly not be cost-effective. “Using the available technology will address the poverty stricken who are denied access due to circumstances. “The idea is not to replace the doctor, but to utilise him or her in areas they would otherwise not be able to reach.”
Dr Hervey Vaughan-Williams, a district family physician in northern Kwa-Zulu Natal, says telemedicine is unlikely to be the answer to a shortage of specialists. “The emailing of photos might enable a specialist to rattle off a number of expert opinions in a fairly short time, but a live telemedicine consultation will take up more time than usual and will not change the specialist-to-patient ratio.”
South Africa, Graley says, is definitely ready for telemedicine: “It is in a good position to learn from other countrys’ successes as well as the pitfalls experienced.” These include inadequate training of personnel who operate the equipment and positioning the network in the wrong places, subsequently hindering connections.
Graley says Polycom has many models to put telemedicine in the hands of the people who need it. “The leasing and rental of telemedicine equipment works well in some countries,” he says. “It doesn’t have to be expensive.” Potential users can pick and choose what best suits their budget.
“We can run our equipment on their existing systems.” If resources could be provided to implement this technology effectively, Graley believes it could be extremely successful, but “it needs to be a government-led initiative. And it all comes down to the medical and national system in use”.