How telemedicine is saving children’s lives in Tiaty

Because of the dozens of kilometres she had travelled the previous day, Cheponot Lochulia was drowsy as she had spent sleepless nights monitoring her sick baby.

Lochulia, who hails from the remote Naudo in Tiaty East, had on Sunday taken her 10-month-old daughter to Chemolingot Sub-County Hospital, more than 45km away after her condition worsened from acute pneumonia and malaria that had also led her to be anaemic.

“The nearest health facility is Riong’o dispensary, about 10km away, where I was also not certain that I could get drugs anyway. This meant a long day’s trek to the dispensary …I resorted to buying some painkillers from a kiosk to relieve the high body temperatures, but it never worked,” said Ms Lochulia.

The mother of five opted to give herbs a try, but her baby’s condition deteriorated, forcing her to walk to Riong’o dispensary, where the baby was referred to Chemolingot Hospital for specialised treatment.

She, her husband and the sick child, the scorching sun notwithstanding, boarded a motorcycle because going to Chemolingot was the only option if they wanted to save their daughter, who was too frail to breathe.

Owing to limited access to modern health facilities, retrogressive cultural practices, poverty and high illiteracy levels in the area, locals seek unconventional treatments, and only go to health facilities when the situation gets out of hand.

This has led to many deaths that could have been avoided if they were treated on time.

“Many referrals to the facility are severe because there are few health facilities and residents must walk long distances to reach them,” said Isaiah Matundura, a health worker at the facility.

“Locals in far-flung areas resort to herbal medicine and only come for medications here when the situation worsens.”

Lochulia represents the agony of thousands of locals in remote villages in Tiaty East and Tiaty West sub-counties who have endured pain and suffering while seeking health services, with some, especially young children, expectant women and the elderly dying of curable diseases.

Many people have lost their lives after being referred to health facilities several kilometres away in Kabarnet, Nakuru and Eldoret for specialised treatment.

But now telemedicine has come to the rescue. It involves remote diagnosis and treatment of patients using telecommunications technology.

It was launched at Chemolingot Sub-County Hospital on Monday in a partnership between the county government, the M-Pesa Foundation and Gertrude’s Hospital Foundation.

The technology, called Daktari Smart, seeks to reduce referrals, increase the number of patients treated and address delays in treatment in remote areas.

M-Pesa Foundation has committed over Sh168 million to the initiative while Gertrude’s Hospital Foundation will invest over Sh35 million in the next three years.

Electronic medical devices

The Daktari Smart kit includes electronic medical devices such as an electronic stethoscope, vital signs monitor, derma scope camera, ultrasound machine, otoscope (for examining the condition of the ear canal and eardrum) and an electrocardiogram (ECG), used to check the heart's rhythm and electrical activity.

Unlike conventional video conferencing, Daktari Smart allows a healthcare worker at local partner health facilities to place the electronic medical devices on the patient.

A specialist at Gertrude’s Hospital is then able to see the patient and hear the sounds in real-time without the intervention of the health worker at the local facility.

The bandwidth required for the equipment is low, ranging from 512 kilobits per second (Kbps) to 2 megabits per second (Mbps).

This means that the platform can be installed in rural and underserved areas that do not have fibre connectivity.

Screens will also be used for video conferencing to facilitate regular capacity building for over 300 health workers serving in rural health facilities; and training of 360 social workers and community health volunteers in the local community who will support social mobilisation.

The telemedicine technology connects the hospital with medical specialists from Gertrude Hospital via video link who will thereafter diagnose and prescribe medication for the patient. If the patient, in the opinion of an expert, needs more specialised treatment, referrals can be advised.

“Many facilities in rural areas have few paediatricians and many children who need specialised treatment are normally attended by clinicians and those with complications will need to travel long distances to get services in a major town, which has forced families to spend a lot of money and worse still, many lose their lives in the event,” said Gertrude’s Hospital Foundation CEO Robert Nyarango.

He added: “If a clinician here is attending to a child and discovers there is a complication they cannot handle, they will refer the patient to a paediatrician at Gertrude’s Hospital in Nairobi using the technology.”

For instance, for children suffering from heart complications, a clinician at Chemolingot hospital puts a stethoscope on the heart of the patient and a paediatrician in Nairobi can listen to it and recommend treatment.

Qualified medical professional

M-Pesa Foundation Director Les Baillie said the technology - initiated in three other pilot counties, including Samburu, Homa Bay and Lamu in the three-year programme - aims to use telemedicine to link and provide treatment to 32,400 children in six hard-to-reach counties in Kenya.

According to the Kenya Medical Practitioners and Dentists Board, the doctor-to-patient ratio stands at about one for 6,355 people, limiting access to a qualified medical professional.

This ratio increases when it comes to specialists.

The participating counties in this programme have only one or no paediatrician to treat children in these counties.

“Our mission is to transform communities by improving access to quality healthcare services to needy and disadvantaged children in the country. This involves embracing innovation and technology, as well as research,” Mr Baillie said.

“The Daktari Smart programme will enable us to provide the much-needed specialist care to children in far-flung areas, as well as develop appropriate data and information to support paediatric healthcare in the country.”

Baringo Governor Stanley Kiptis lauded the programme, saying it will help improve healthcare for children in rural areas.

“Many people in remote villages in Tiaty are poor and cannot access quality services, especially in patients with complications, and this will save lives,” he said.

He noted that the county has only two paediatricians, one in Eldama Ravine Sub-County Hospital and the other at Baringo County Referral Hospital in Kabarnet.

Tiaty MP William Kamket said: “This technology will greatly help children, especially those from poor set-ups who cannot afford special medication.”

For instance, in Akoret division, Tirioko ward, there is not a single operational health facility, in an area prone to malaria, with locals having to walk more than 100km to Chemolingot Hospital or Kapedo health Centre, more than 45km away, which they cannot access because of runaway insecurity.

Locals, who are also prone to snake bites and neglected tropical diseases like Kala azar, walk more than 50km to Lomut and Sigor in neighbouring West Pokot County for health services.

The Baringo County government started building more than 45 dispensaries in far-flung areas between 2013 and 2017. Most of them have been completed but are yet to serve their intended purpose, because of the lack of health workers.

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