Collins Chinyama, an information technologist at the Central Board of Health, describes the concept of tele-medicine as a multimedia system — using voice, video and data — to deliver medical services remotely. “People may phone their doctors and prescriptions are done either by telephone or fax,” he says.
But the new technology overcomes the limitations of the telephone and fax to ensure that patients are diagnosed from remote locations. Tele-medicine has its plus and negative sides: though it meets government needs for bringing health care as close to the family as possible, the need for medical workers will also diminish. But it has the potential to bridge the gaps created by Africa’s brain drain as health professionals seek greener pastures in developed nations. “There is need for tele-health in Africa because it has very few doctors and there are increasing health needs and staff constraints in most hospitals,” says Chinyama.
Tele-health works by installing information technology — such as digital cameras, camcorders, digital senders and other medical equipment — in all health centres. Lusaka women and their babies are the first beneficiaries of new technology in health, with the establishment of an electronic prenatal record system.
It is fitting that this new technological adventure should start at the source of life: many of the basic needs in the care of pregnant women and newborns have largely been unmet in Zambia. And this despite the fact that inadequate resources can literally be a matter of life and death in the maternity situation. Zambia’s maternal and infant mortality indicators are unacceptably high. United Nations statistics show a one in 14 lifetime risk of death in pregnancy for women. The just released demographic and health survey show that these statistics have not improved over the past five years, making this a high priority concern.
Customised software designed by doctors from Lusaka district, the University of Zambia Teaching Hospital and the Central Board of Health will eventually replace the paper records currently in use. Computers in all Lusaka clinics that provide antenatal care will be linked with several wards at the teaching hospital through a high speed wireless network. Patient data will, therefore, be entered just once and not a dozen times. Whether or not a woman goes to the same clinic, the nurse attending her will be able to see all the relevant information about her without having to ask for it and re-entering it again.
Healthcare for pregnant women in Lusaka is a large and complex system. Nearly 50,000 deliveries take place in Lusaka district clinics and the teaching hospital. Most mothers make multiple antenatal and postnatal visits, and many of them go to several sites for health care. Benefiting groups will receive better care because clinicians will have more information and more time to focus on giving care.
Maureen Chitalu, a mother of three, says she hopes the use of information technology to manage complicated cases. She explains: “I live in Mutendere, where I also go for my antenatal care. During my previous pregnancies, nurses kept on referring me to the University Teaching Hospital, where there are specialists, because I delivered by caesarean section. It was not easy. I had to spend a lot of money on transport and, in the process, wasted a lot of time. But this should now be a thing of the past.”
At one time, clinic staff at the teaching hospital could not find her records as they were never kept in an organised manner. But the tele-health project now means clinicians will be able to monitor and track patients, see their entire history at a glance and analyse the outcomes. Health care officials will be able to generate better information about the population.
Tele-health will also ensure security and confidentiality of patient information because it will be more difficult to gain access to patient data. Nurses and doctors will have to enter a password to see individual records. Although officials of the Central Board of Health ad the district health management board will be able to see statistical information but only authorised clinicians will have access to personal patient information.
For now, an automated referral system is being written for Lusaka and it will be the first programme that will be used in the computers. It will be introduced in October this year.
Chinyama explains that each clinician will receive an individual e-mail address. Telephones will be connected to the computers, allowing phone calls throughout the network and training manuals will be available on the computers. Free computer training is expected to take place through the end of 2003. It will include general computer knowledge, e-mail, filling out web-based forms, refereeing patients using the automated referral system and using Acrobat reader to access training manuals.
The benefits to clinical care will be that training materials will be easily available and there will be better communication between sites and automated checks on care quality. Voice Over Internet Protocol telephone will allow district health management board midwives to speak to teaching hospital midwives or doctors at any time. The health management board midwives will also be able to track their referred patients as the system will allow more accurate monitoring.