Author Topic: Another idea (M-health) that need to pick up steam  (Read 30120 times)

Offline RV Pundit

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Another idea (M-health) that need to pick up steam
« on: August 11, 2015, 03:15:05 PM »
http://www.businessdailyafrica.com/Corporate-News/M-Shwari-clients-to-get-mobile-medical-consultation-services-/-/539550/2827254/-/kdoehuz/-/index.html

Offline Georgesoros

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Re: Another idea (M-health) that need to pick up steam
« Reply #1 on: August 11, 2015, 03:29:47 PM »
In my experience this is  a good idea but its not the solution. If its a video conference, then it may help a lot. Whenever there's a doc-patient interaction a lot goes on. The doc watches for a lot of non-verbal interactions and makes a decision based on multiple factors. Misdiagnosis can be deadly. There should be guidelines from professionals on how this is used.

Offline RV Pundit

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Re: Another idea (M-health) that need to pick up steam
« Reply #2 on: August 11, 2015, 03:43:21 PM »
Compared to overworked and under trained doctors; this is better than nothing. Most folks in these parts of the world consults witch doctors or use herbs or just don't go to hospitals...when they are sick. Those that go...see a community nurse...who misdiagnosis everything probably as malaria or typoid. Let not bring in regulations and standards this early....let this flourish first.
In my experience this is  a good idea but its not the solution. If its a video conference, then it may help a lot. Whenever there's a doc-patient interaction a lot goes on. The doc watches for a lot of non-verbal interactions and makes a decision based on multiple factors. Misdiagnosis can be deadly. There should be guidelines from professionals on how this is used.

Offline Georgesoros

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Re: Another idea (M-health) that need to pick up steam
« Reply #3 on: August 11, 2015, 03:47:38 PM »
The should be guideline , not regulations from industry itself like Kenya Medical Association. Humans are greedy, so guidelines are necessary. These are human lives and some pple tend to e greedy and want to turn it into a "get rich quick scheme" at the expense of patients.

Offline Kim Jong-Un's Pajama Pants

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Re: Another idea (M-health) that need to pick up steam
« Reply #4 on: August 11, 2015, 03:58:59 PM »
In my experience this is  a good idea but its not the solution. If its a video conference, then it may help a lot. Whenever there's a doc-patient interaction a lot goes on. The doc watches for a lot of non-verbal interactions and makes a decision based on multiple factors. Misdiagnosis can be deadly. There should be guidelines from professionals on how this is used.
It's more like a forum or group on Facebook.  Really.  I agree on the limitations of diagnosis without physical interaction. 

Most people there die of Malaria.  It's not clear how such an application can be useful.  It seems to me to be a case of a solution looking for a problem to fix rather than the other way round.

If every county can invest in real doctors and medical services the kind the folks at Kapsowar Mission hospital provide.  That should be a priority.
"I freed a thousand slaves.  I could have freed a thousand more if only they knew they were slaves."

Harriet Tubman

Offline RV Pundit

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Re: Another idea (M-health) that need to pick up steam
« Reply #5 on: August 11, 2015, 04:10:38 PM »
Right now the focus should be encouraging kenyans to start using this like they did with Mpesa and Mshwari.
The should be guideline , not regulations from industry itself like Kenya Medical Association. Humans are greedy, so guidelines are necessary. These are human lives and some pple tend to e greedy and want to turn it into a "get rich quick scheme" at the expense of patients.

Offline RV Pundit

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Re: Another idea (M-health) that need to pick up steam
« Reply #6 on: August 11, 2015, 04:16:44 PM »
Medicine has not always been like this..and will not always be like this. I think future generation will find the current hospitalization quite primitive. This to me is the future. The time when folks got some physiological treatment after just seeing the doctor is over. Why should I waste time to go and visit the hospital..endure 5hrs on the queue..before going see a doctor for less than 10mins...and then doctors direct you to go XYZ test.

The future for me is something like this..make phone call to the doctor......doctor redirects you to agents of nurses/labs technicians/pharmacist in every village...for more test or for drugs..tests are emailed...you have another talk with doctor..and you head to pharmacist or hospitalizations...end of story...unless you really need to go to theatre....you should never go to an hospital.Such model makes the 1:X doctor:patient very affordable for Africa countries...which are cash -trapped.

And this future like MPESA will be lend by those that don't have nothing close to functioning hospitals.

It's more like a forum or group on Facebook.  Really.  I agree on the limitations of diagnosis without physical interaction. 

Most people there die of Malaria.  It's not clear how such an application can be useful.  It seems to me to be a case of a solution looking for a problem to fix rather than the other way round.

If every county can invest in real doctors and medical services the kind the folks at Kapsowar Mission hospital provide.  That should be a priority.

Offline MOON Ki

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Re: Another idea (M-health) that need to pick up steam
« Reply #7 on: August 11, 2015, 05:11:33 PM »
One of the assumptions here is that people are taking up doctors' time with "small things".   I have no conclusive data, but, from the people I have seen at clinics/hospitals in Kenya, I doubt it; I suspect that the typical Mwafrika goes to the doctor only when he or she feels pretty bad.   Typically, a doctor's visit in Africa will end up with some prescription, some injections or other medicine given, admission to hospital, etc.   It's hard to see any of that happening on the basis of a short phone conversation.

Another questionable assumption is  that if a doctor spends 10 minutes of time talking on the phone, then he or she miraculously gains 10 minutes elsewhere.     Not so.   In terms of the doctor's time, there is no difference in spending 10 minutes on the phone or 10 minutes in person.    In fact, given the shortage of doctors in Kenya, it's not hard to imagine a situation where a doctor could get tied up for the entire day just doing these phone chats.   So the idea that this would miraculously free up a doctor's time is questionable.    (The matter of a patient having to travel and wait  to be attended to is a different one.)

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The majority of people who go to see a doctor are not necessarily suffering from a life-threatening condition.   And the implied assumption that non-life-threatening conditions can be dealt with by phone is a questionable one; even such cases require proper diagnosis, with a proper cause of action recommended.    What sorts of conditions are amenable to treatment-by-phone?

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Why should I waste time to go and visit the hospital..endure 5hrs on the queue..before going see a doctor for less than 10mins...and then doctors direct you to go XYZ test.

Because the doctor may need to conduct a proper examination in order to know what test to recommend.   And here it is important to keep in mind that patients might not understand their symptoms, might not describe them accurately, etc.   
 
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The future for me is something like this..make phone call to the doctor......doctor redirects you to agents of nurses/labs technicians/pharmacist in every village..  for more test or for drugs..tests are emailed...you have another talk with doctor..and you head to pharmacist or hospitalizations


Kenya is a long way from having such personnel in every village---right now over 50% of all doctors in Kenya practice in Nairobi---and perhaps that should be the goal before technological gimmicks.   

I don't see a situation where doctors will willy-nilly write (non-renewal) prescriptions for drugs or recommend hospitalizations without actually examining the patient.    In a place like Kenya, where people are always willing to cut corners, it is certainly possible, but the practice of medicine will---for fairly obvious reasons---always be regulated, and no proper system of regulations or law will allow such a "cowboy" approach.

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The time when folks got some physiological treatment after just seeing the doctor is over.

They are far from over.  And when they do get "over", it is hard to envisage Africa as the "pioneer" in that regard; MPESA folks should not think that "sending medical advice" is similar to "sending money".   Such futuristic outlooks would do well to consider the progress of "telemedicine" in places like the USA, which have the technology, the personnel, etc.

Another thing is that payments have to be made.   Leaving aside the "mechanics" of the payment---presumably somebody is going to suggest MPESA for that---how many people will willing to pay for these phone conversations? 

A much more serious issue on payments is in regard to insurance companies: it is doubtful that they will be prepared to pay for these phone chats.   Setting aside the possibility of scams that would be inevitable in a place like Kenya, there are also legal aspects: what happens in a malpractice suit where the doctor has only given advice over the phone? 
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Offline Kim Jong-Un's Pajama Pants

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Re: Another idea (M-health) that need to pick up steam
« Reply #8 on: August 11, 2015, 05:37:07 PM »
Medicine has not always been like this..and will not always be like this. I think future generation will find the current hospitalization quite primitive. This to me is the future. The time when folks got some physiological treatment after just seeing the doctor is over. Why should I waste time to go and visit the hospital..endure 5hrs on the queue..before going see a doctor for less than 10mins...and then doctors direct you to go XYZ test.

The future for me is something like this..make phone call to the doctor......doctor redirects you to agents of nurses/labs technicians/pharmacist in every village...for more test or for drugs..tests are emailed...you have another talk with doctor..and you head to pharmacist or hospitalizations...end of story...unless you really need to go to theatre....you should never go to an hospital.Such model makes the 1:X doctor:patient very affordable for Africa countries...which are cash -trapped.

And this future like MPESA will be lend by those that don't have nothing close to functioning hospitals.

It's more like a forum or group on Facebook.  Really.  I agree on the limitations of diagnosis without physical interaction. 

Most people there die of Malaria.  It's not clear how such an application can be useful.  It seems to me to be a case of a solution looking for a problem to fix rather than the other way round.

If every county can invest in real doctors and medical services the kind the folks at Kapsowar Mission hospital provide.  That should be a priority.
I agree that adoption of digital technologies can be faster where there was no analogue equivalent or very little to begin with.  From an African perspective, most of Africa at least, it can be argued that any interaction with a doctor, even digital is better than nothing.  It would be interesting to see how this develops, though my first impression is that this is just a glorified forum.

I think the real problem, is how to motivate these professionals, including nurses, to not only leave their countries in large numbers, but be serious professionals in their work.  How does the country ensure that mid-level professionals who are trained at great cost like nurses don't just disappear?

I am not against the digital aspect of the whole thing.  But I am skeptical that it is the solution to the scarcity of doctors and nurses.
"I freed a thousand slaves.  I could have freed a thousand more if only they knew they were slaves."

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Offline RV Pundit

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Re: Another idea (M-health) that need to pick up steam
« Reply #9 on: August 11, 2015, 05:45:58 PM »
This is exactly what folks said about M-pesa. I think we had long winding debate with Terminator about this about 10 yrs ago and in the end M-pesa won. Fact that telemedicine didn't work there is more reason to try it here....where most folks have no options.

What you're describing are just attitude change....from doctors, from patients, from insurances and from everyone..and secondly the availability of trusted brand name to provide lab/nursing changes.

Folks trust hospitals. Folks trust physical doctors. You can make them trust M-health by providing the same reliable service.

I think the first one can be sorted out easily...with heavy advertisement (people need to know this thing is real)..and the second one is even easy...all you need is Aga Khan (or any trusted medical brand) rolling out standardized mini-hospitals linked to the doctors via internet or video-conference.

Or even own branded M-health health centers at market places...as long as they are trained and meet the standards, have internet connection, they can provide services under supervision of a doctor in Nairobi.

You make the phone call..you get a tracking number...talks to a doctor....and if it something that sounds serious..you're advice to go the agha khan lab near you....and you're results are emailed the doctor...the doctors calls you back ...recommend medications..or follow up.

The customers benefits...Lab benefits..doctor saves more lives and get more mullah. There is less hassle for everyone. Opportunity cost savings. Incredible ability to scale it up.

One of the assumptions here is that people are taking up doctors' time with "small things".   I have no conclusive data, but, from the people I have seen at clinics/hospitals in Kenya, I doubt it; I suspect that the typical Mwafrika goes to the doctor only when he or she feels pretty bad.   Typically, a doctor's visit in Africa will end up with some prescription, some injections or other medicine given, admission to hospital, etc.   It's hard to see any of that happening on the basis of a short phone conversation.

Another questionable assumption is  that if a doctor spends 10 minutes of time talking on the phone, then he or she miraculously gains 10 minutes elsewhere.     Not so.   In terms of the doctor's time, there is no difference in spending 10 minutes on the phone or 10 minutes in person.    In fact, given the shortage of doctors in Kenya, it's not hard to imagine a situation where a doctor could get tied up for the entire day just doing these phone chats.   So the idea that this would miraculously free up a doctor's time is questionable.    (The matter of a patient having to travel and wait  to be attended to is a different one.)

Quote

The majority of people who go to see a doctor are not necessarily suffering from a life-threatening condition.   And the implied assumption that non-life-threatening conditions can be dealt with by phone is a questionable one; even such cases require proper diagnosis, with a proper cause of action recommended.    What sorts of conditions are amenable to treatment-by-phone?

Quote
Why should I waste time to go and visit the hospital..endure 5hrs on the queue..before going see a doctor for less than 10mins...and then doctors direct you to go XYZ test.

Because the doctor may need to conduct a proper examination in order to know what test to recommend.   And here it is important to keep in mind that patients might not understand their symptoms, might not describe them accurately, etc.   
 
Quote
The future for me is something like this..make phone call to the doctor......doctor redirects you to agents of nurses/labs technicians/pharmacist in every village..  for more test or for drugs..tests are emailed...you have another talk with doctor..and you head to pharmacist or hospitalizations


Kenya is a long way from having such personnel in every village---right now over 50% of all doctors in Kenya practice in Nairobi---and perhaps that should be the goal before technological gimmicks.   

I don't see a situation where doctors will willy-nilly write (non-renewal) prescriptions for drugs or recommend hospitalizations without actually examining the patient.    In a place like Kenya, where people are always willing to cut corners, it is certainly possible, but the practice of medicine will---for fairly obvious reasons---always be regulated, and no proper system of regulations or law will allow such a "cowboy" approach.

Quote
The time when folks got some physiological treatment after just seeing the doctor is over.

They are far from over.  And when they do get "over", it is hard to envisage Africa as the "pioneer" in that regard; MPESA folks should not think that "sending medical advice" is similar to "sending money".   Such futuristic outlooks would do well to consider the progress of "telemedicine" in places like the USA, which have the technology, the personnel, etc.

Another thing is that payments have to be made.   Leaving aside the "mechanics" of the payment---presumably somebody is going to suggest MPESA for that---how many people will willing to pay for these phone conversations? 

A much more serious issue on payments is in regard to insurance companies: it is doubtful that they will be prepared to pay for these phone chats.   Setting aside the possibility of scams that would be inevitable in a place like Kenya, there are also legal aspects: what happens in a malpractice suit where the doctor has only given advice over the phone? 

Offline MOON Ki

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Re: Another idea (M-health) that need to pick up steam
« Reply #10 on: August 11, 2015, 05:48:35 PM »
I think the real problem, is how to motivate these professionals, including nurses, to not only leave their countries in large numbers, but be serious professionals in their work. 

Take a look at this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283025/
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Offline MOON Ki

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Re: Another idea (M-health) that need to pick up steam
« Reply #11 on: August 11, 2015, 05:56:55 PM »
This is exactly what folks said about M-pesa.

I anticipated such a response.   That is why I wrote a remark on the difference between medical consultations and sending money.    Apart form many obvious differences that you claim require no more than an "attitude change", the practice of medicine will always be, and should always be regulated in a manner that is very different from the practice of finance.

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Fact that telemedicine didn't work there is more reason to try it here....where most folks have no options.

Tremendous steps have in fact been made in telemedicine.    Places worth looking at include  Montana (and other backward parts of the USA), where many rural folks are not within easy reach of a doctor.

Like "Windy City Assassin",  I don't see this doing much for the fundamental healthcare problems in Kenya.   But if it is just an online forum, then why not?   
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Offline RV Pundit

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Re: Another idea (M-health) that need to pick up steam
« Reply #12 on: August 11, 2015, 06:20:15 PM »
Medicine and finance have been evolving..and will evolve. What you call modern finance is maybe 150 yrs old...and that is getting pretty much destroyed. The same with medicine. The idea of a doctor in hospitals with nurses is very very new. Spend time reading history of things.

The future is tele-medicine/e-medicine..whatever you want to call you it..it may take time...it may faces challenges..but future generation will not waste time and money on an inefficient systems...like visiting an hospital bed and probably end up contracting more diseases...when all you need is to email a report of your blood and fluid samples...right in your houses.

Future generation will find the current practice completely dumb and primitive in very many levels....and Kenya should be in the fore-front creating that future.

the practice of medicine will always be, and should always be regulated in a manner that is very different from the practice of finance.

Offline RV Pundit

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Re: Another idea (M-health) that need to pick up steam
« Reply #13 on: August 11, 2015, 06:24:51 PM »
I actually chose to ignore the regulation part because it dumb. Everything is regulated. Including tele-medicine or e-banking. Who says you cannot regulate a doctor offering his service via internet or phone? The difference is the mechanics....not the regulation...which gov does and will adapt it's laws with the changing reality.

The future for finance, medicine, education ,name it is E- or M- or something.

These are ideas that out of research labs and now even Kenya company like CBA think it can fly.

If there are missing pieces in the puzzles...trust they will slowly and surely fall in places...and viola...the current primitive medicine will be confined to history.

Yes, I could spend more time reading up on the history of things.   In what specific ways would that enlighten me on the need to regulate medicine and finance in different ways?

Offline MOON Ki

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Re: Another idea (M-health) that need to pick up steam
« Reply #14 on: August 11, 2015, 06:29:02 PM »
I actually chose to ignore the regulation part because it dumb. Everything is regulated. Including tele-medicine or e-banking. Who says you cannot regulate a doctor offering his service via internet?

You are certainly free to consider it dumb, but you might want to take a look at countries that been at this telemedicine thing for a while.     

They certainly can be regulated.   In fact, the "problem" in many places is that they are regulated in an extremely tough way.   

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The difference is the mechanics....not the regulation...

I'm afraid not.    There will be no mechanics if the regulations forbid it or has serious consequences.
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Offline RV Pundit

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Re: Another idea (M-health) that need to pick up steam
« Reply #15 on: August 11, 2015, 06:30:40 PM »
That is dumb regulation. M-pesa thrived because CBK refused to regulate it. You need to let the idea flourish before you regulate it. So the over-regulation is regulating who? Nobody. Let people die from tele-medicine first..before you jump in to regulate. Otherwise many are dying from simple ailments coz they can't get to hospital fast enough...or they never can afford it.

In fact, the "problem" in many places is that they are regulated in an extremely tough way.   

Offline MOON Ki

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Re: Another idea (M-health) that need to pick up steam
« Reply #16 on: August 11, 2015, 06:33:52 PM »
You need to let the idea flourish before you regulate it. So the over-regulation is regulating who? Nobody. Let people die from tele-medicine first..before you jump in to regulate.

"Let people die first"  does not appear to be the standard attitude in such things---at least in sensible places.   The general expectation---codified in all sorts of rules, regulations, and laws---is that one must show that people are unlikely to die.

Whether that's dumb or not may be debated, but there it is.  What's more, it seems unlikely to change---at least in sensible places.

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Otherwise many are dying from simple ailments coz they can't get to hospital fast enough..

It's hard to see how "MPESA Telemedicine" will get them to hospital any quicker.

Also, many "simple ailments" that kill people in places like Africa---and I am here thinking of something like diarrhea---can be dealt with quite easily (e.g. good basic hygiene) and without the involvement of any fancy ideas.
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Offline veritas

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Re: Another idea (M-health) that need to pick up steam
« Reply #17 on: August 11, 2015, 06:47:15 PM »
I'm assuming this is referring to general doctors and not specialists or surgeons. Majority if not all non-student doctors are chock-a-block busy with conducting theatre (surgical procedures). Everywhere else outside hospitals- its the pharmacist who are regarded as doctors because they have access to medicines. Very basic medicines like cough syrups. Experience tells me that malaria and HIV are the accepted western medical diagnosis. Reason for seeing a pharmacist might be to purchase malaria tabs, cough syrups, pain killers, birth control pills and not much else.

I'm not seeing what benefit a virtual doctor would be over Googling your symptoms or seeing a pharmacist, nurse or lab technician who can order tests as well. If it's more serious they make referrals to hospitals but in that case the patient has a serious disorder like HIV, obstructive deformity etc. a virtual doctor can't do much about that. I think we've forgotten hospitals in Kenya are like war zones. You win some and lose some to senseless botched operations and other mysterious occurrences. Doctors get too much leverage in East Africa. I don't blame them because they don't get the luxury of dealing with first world problems. The ones I've spoken to went into medicine to get the hell out of Kenya before they contract something deadly and die in their 30s. Let's not forget the life expectancy of doctors in Kenya are in their 30s.

However, the culture of healthcare may benefit using mobile technology. In the sense the doctor connects with villages. It might be confusing though because withcraft is still rampant and it'll undermine pharmacists, nurses and lab technicians who in my opinion are better people than the average doctor trained in Kenya. Kenyan doctors are unskilled and are too snobby to interact with village folks. There's a stiff hierarchy in Kenya's healthcare system. I see more likely MSF designing an APP of somesort but on the same token demanding money from the govt perhaps money better spent in equipping pharmacists, nurses,  lab technicians with prescription privileges or running anti witch doctor public health campaigns.

Offline RV Pundit

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Re: Another idea (M-health) that need to pick up steam
« Reply #18 on: August 11, 2015, 06:57:42 PM »
Why is it so hard to standardize test and common treatment for common diseases? Lab test should pretty much tell you what to look for and that should pretty much be the first line of treatment which can be done via tele-medicine. Only emergency cases get admitted. Otherwise first port of call...is your medical 911...and if you don't get well say after 3days-1 week...then you go see a doctor.

This certainly would lessen the burden of any health care systems.

Kenya last year had 40M hospital/dispensary visits..40% of basic diarrhea cases..another 40% on basic respiratory problems....all these overburdened the few doctors unnecessarily.

I'm assuming this is referring to general doctors and not specialists or surgeons. Majority if not all non-student doctors are chock-a-block busy with conducting theatre (surgical procedures). Everywhere else outside hospitals- its the pharmacist who are regarded as doctors because they have access to medicines. Very basic medicines like cough syrups. Experience tells me that malaria and HIV are the accepted western medical diagnosis. Reason for seeing a pharmacist might be to purchase malaria tabs, cough syrups, pain killers, birth control pills and not much else.

I'm not seeing what benefit a virtual doctor would be over Googling your symptoms or seeing a pharmacist, nurse or lab technician who can order tests as well. If it's more serious they make referrals to hospitals but in that case the patient has a serious disorder like HIV, obstructive deformity etc. a virtual doctor can't do much about that. I think we've forgotten hospitals in Kenya are like war zones. You win some and lose some to senseless botched operations and other mysterious occurrences. Doctors get too much leverage in East Africa. I don't blame them because they don't get the luxury of dealing with first world problems. The ones I've spoken to went into medicine to get the hell out of Kenya before they contract something deadly and die in their 30s. Let's not forget the life expectancy of doctors in Kenya are in their 30s.

However, the culture of healthcare may benefit using mobile technology. In the sense the doctor connects with villages. It might be confusing though because withcraft is still rampant and it'll undermine pharmacists, nurses and lab technicians who in my opinion are better people than the average doctor trained in Kenya. Kenyan doctors are unskilled and are too snobby to interact with village folks. There's a stiff hierarchy in Kenya's healthcare system. I see more likely MSF designing an APP of somesort but on the same token demanding money from the govt perhaps money better spent in equipping pharmacists, nurses,  lab technicians with prescription privileges or running anti witch doctor public health campaigns.

Offline MOON Ki

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Re: Another idea (M-health) that need to pick up steam
« Reply #19 on: August 11, 2015, 07:00:34 PM »
However, the culture of healthcare may benefit using mobile technology. In the sense the doctor connects with villages.

Not really.  The village folks are ones who are most likely to want a "doctor in flesh" when they are really ill.  And when they go to see one, they have expectations: a white lab-coat, a big injection (preferably of antibiotics, no matter what the ailment is), etc.   

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It might be confusing though because withcraft is still rampant and it'll undermine pharmacists, nurses and lab technicians who in my opinion are better people than the average doctor trained in Kenya.

Witchcraft doesn't undermine that.   "Modern" or "religious" Africans will profess not to have much use for it, but they will have it as a Plan-B, in case Western gods or medicine don't come through.   The rest will have it as Plan A or Plan B according to what alternative is available and what needs to be done.
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