A few weeks ago, Jared Okumu took his daughter Monica to Suba Sub-County Hospital.
This was one of many such visits for the 16-year-old secondary school student. Monica has had persistent pain in her stomach since she was four years old.
“We first tried to treat it using traditional medicine but it did not work. We were referred to several hospitals in and around Homa Bay and then they diagnosed her with malaria yet the treatment she was receiving was not working,” he recalled.
These long trips were, however, reduced when the nearest hospital to Monica’s home was connected, through a telemedicine project, to Gertrude’s Children’s Hospital in Nairobi.
Now, through Daktari Smart, Monica is examined by a specialist through online consultation, reducing the costs for travel and ensuring access to a specialist who is hard to come by in the rural facilities.
During the live consultation, a HD camera on both ends – Suba Sub-County Hospital and Gertrude’s Children’s Hospital in Muthaiga – are turned on.
Once connected, the doctor at Suba uses a digital stethoscope where Monica’s heart rate readings are recorded and simultaneously monitored at Gertrude’s. The specialist at Muthaiga interprets the readings and advises the doctors in Suba. There is also a virtual ultrasound that is passed over Monica’s stomach and spleen to check their condition, if they have a growth in their stomach, they are informed.
Beyond these tests, a patient’s ears can also be examined using an otoscope for the specialist at Muthaiga to identify if there’s a problem and the best course of treatment. Heart issues are diagnosed using an echocardiogram machine.
“I used to spend as much as KES 3,000 to take my daughter to Homa Bay for treatment. This adversely tore into my budget and plans. The cost of healthcare is simply too high, yet I am just a simple fisherman. But with this technology, I can manage to come from Rusinga which is just 20 kilometres from my home,” says Jared, the father of eight who is optimistic that finally, his daughter can get the much-needed treatment.
For medics like Dr Gordon Okomo, the County Director of Health Homa Bay, the project by M-PESA Foundation, Gertrude’s Children’s Hospital – Nairobi, and the County Government of Homa Bay could not have come at a better time.
“Look at what we are getting, someone is in some corner in Suba and is getting highly specialised services in Muthaiga. That to me is Universal Health Coverage (UHC),” said Dr Okomo.
Homa Bay County has about 14 islands most of which are hundreds of kilometres away from the county referral hospital. But this is not the main challenge, the county has only one paediatrician for a population of 58,000 children who are under 5 years, who are deemed the most vulnerable.
In Mbita and Suba for example, there are about 18,000 children under 5 years who are underserved and lack access to specialist care.
A shortage of specialists has affected access to healthcare where residents from far-flung areas of Mbita and Suba have to travel long distances to get services from the sole paediatrician in the county.
“Human resource is a challenge, we need more clinicians and physicians who can offer specialist care instead of having a situation where patients from here in Suba being referred to Kisumu, Kisii and even Nairobi,” says Dr. Brian Akuom, the Medical Superintendent at Suba Sub-County Hospital.
Kenya’s doctor to patient ratio stands at 1 doctor to 16,000 patients, against WHO’s 1 doctor for every 400 to 600 patients. This has led to congestion in public hospitals, long waiting periods to see specialists, poor health outcomes including high disability and deaths rates due to lack of timely quality care.. ?
Apart from Homa Bay, Daktari Smart is active in Samburu, Lamu and Baringo counties. Its overall goal is to improve access to high-quality healthcare for children in rural and underserved areas in the country by utilizing technology to provide treatment to 32,400 children in the four counties over a period of three years.
As part of the partnership with the M-PESA Foundation and Gertrude’s Children’s Hospital, clinicians and physicians are trained on how to operate the telemedicine technology and how to identify cases that need consultation.
“We have trained clinicians and nurses on how to identify cases that need consultation. We are able to know which cases for instance need a physician, oncologist or surgeon in Muthaiga before we set up a live consultation and book a patient,” says Dr. Akuom, pointing to the upskilling of medical workers to offer services.
They are able to manage emergencies and stabilise patients before consultation sessions with Gertrude’s Children’s Hospital.
Telemedicine has also helped lower medical fees.
“On average consultation costs KES 4,000 to KES 5,000. Imagine having to refer a patient to Eldoret or Kisumu, the cost of transport and healthcare can be more than KES 10,000. They cannot manage,” says Dr. Akuom.
Dr. Akuom says that 18 patients have so far accessed Daktari Smart in just less than 3 months since it was launched. He is amazed they received a patient from as far as Tanzania with others coming from neighbouring counties such as Migori.
Some of the cases reviewed include rare and uncommon ailments that require a specialist. This includes diseases such as Kawasaki Syndrome (a condition, usually hard to diagnose, that causes inflammation in the walls of some blood vessels in the body), chronic epilepsy, sickle cell and intestinal lymphoma.
Initially, patients were seen via telemedicine three days a week but are now booked from Monday to Friday.
To increase access to telemedicine services, Dr. Okomo says the county has been doing community engagement and social mobilization. They also have a local radio station that informs the public of the availability of telemedicine services in Suba Sub-county Hospital for them to access specialist care.
However, it’s not all rosy. One of the major challenges Daktari Smart faces is technical hiccups caused by unstable internet connectivity.
“We sometimes have network challenges which delay services and technical issues involving the equipment and camera. Sometimes, patients must wait at the hospital for almost half a day as we sort out the issues. But thankfully, Safaricom is always on hand to support us whenever we have network issues,” says the county director of health.
The other challenge is that a specialist might recommend a drug that is not readily available at the hospital and must source for drugs from Kisumu.
Another challenge still revolves around the availability of health workers.
“We still need more health workers. In this hospital, we need 20 medical officers but I’m the only one, we need at least 50 clinical officers, but we have very few. Some skeptics see telemedicine as a short cut not to hire medical staff,” said Dr. Akuom.
To keep the project going even after the current devolved administration leaves office in August, Safaricom will provide internet for the next three years, to ensure that Monica and other patients get the timely and specialised medical care they need.
