A few weeks ago in mid-November, VSee got to be a part of a really neat field test using telemedicine to bring Ear, Nose, and Throat (ENT) specialist care to rural Rwanda.
A Critical Shortage of Doctors
To give you some background, Rwanda is one of 53 countries with a critical shortage of health workers. For a population of nearly 10 million, there is on only 1 doctor for every 18,000 inhabitants and 1 nurse for 1,476 inhabitants (MOH Rwanda, 2013). Moreover, 87 percent of the population live in rural areas while specialist healthcare is located primarily in the teaching and referral hospitals of the capital city, Kigali. For most ENT patients, this means long journeys, unpredictable delays, and additional travel and care expenses just to receive a specialist opinion. Furthermore, at the current level of medical staffing, ENT specialists risk being overwhelmed by patient demand.
The good news is that Rwanda is uniquely positioned to benefit from Telemedicine with its universal 3G and widespread 4G/fibre Internet system. Telemedicine platforms like VSee provide the perfect opportunity to empower rural health facilities and healthcare workers. Telemedicine gives them the ability to offer otology advice services that can save patients unnecessary journeys to Kigali. It also allows them to provide health education support and to make more efficient use of specialist services.
Can ENT Telemedicine Work in Rwanda?
One effort to improve healthcare delivery in Rwanda through telehealth and telemedicine is being spearheaded by Joseph Lune Ngenzi. He is a certified Telehealth expert and the coordinator of E-Health at the University of Rwanda College of Medicine and Health Sciences.
Ngenzi and a team of doctors decided to use VSee to conduct remote ENT consultation field tests during a one day ear camp organized by the Starkey Hearing Foundation. The idea was to see if medical students with minimal training (less than 2 hours) to use telemedicine equipment could effectively facilitate ENT consultations. The ear camp was held in the town of Nyagatare in North-East Rwanda. The doctors consisted of ENT specialist Dr. Kaitesi Mukara and her team from the Ear, Nose and Throat Department at University Teaching Hospital of Kigali and Dr. Rob Daniels, a general practitioner from the Townsend House Medical Centre in the UK.
Before the field test, Dr. Daniels received a 30 minute training session on using VSee. He also trained medical student Theoneste Hakizimana to use the equipment (digital otoscope) which took less than an hour to be competent. (Note: at the ear camp it ended up that Theoneste took the patient histories while Dr. Daniels took the ear photos.)
At the ear camp, first Dr. Mukara and her colleague Dr. John Bukuru screened all attendees, and directed any with ear disease to Dr. Daniels. Then with the patient’s consent, an online consultation was conducted. Theoneste, the medical student took a one line history of the patient, and Dr. Daniels photographed the patient’s eardrum with a Welch Allyn digital otoscope. Using VSee, they relayed the history and shared the image of the eardrum to Ngenzi and Dr. Isaie at the central hospital of the University of Kigali. The online diagnosis was then compared with Dr. Mukara and Dr. Bukuru’s diagnoses. The results were very favorable with Dr. Isaie correctly diagnosing 9/9 cases, with only one patient being unsuitable for imaging in this way.
Over the 3G network the mean time from sharing the image at the ear camp to its being visible in Kigali was 38.2 seconds. Although the 3G mobile Internet connection was too slow to support live otoscope images clearly, it was adequate to support a live teleconsultation with audio and real-time transmission of otoscope images.
Having successfully tested this concept, the team plan to start rolling out the system in 2016 to rural health facilities for continuing professional development, conducting remote clinical consultations, and using the system to train more ENT residents wherever they may be located in Rwanda.