Another idea (M-health) that need to pick up steam

[veritas]

MK, you misunderstand me. First of all I support mobile health technology like RVP's  brilliant idea but within a framework that works.  In my opinion there should be a new certification - health technicians? So training nurses, pharmacists and lab technicians in mobile health interfaces (so they speak to doctors via free SIP technology - another reason to endorse data cabling so prescribing medicines for HIV and specialist disorders with doctor permissions- sort of like nurse practitioners in first world countries who do the same general doctor duties working for NGOs or underprivileged regions but charge dirt cheaper than doctors and are hell of a lot better at diagnosing than doctors. American doctors are awful. Kenyan doctors are near just as blind and completely out of touch with village culture.

[MOON Ki]

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.

As I see it, we should be trying to deal with such cases much earlier, rather than trying to reduce burden on doctors and hospitals.    Clean water and basic hygiene will take care of a great deal of what would otherwise be diarrhea cases.

In relation to the topic at hand: by the time a person decides that his or her diarrhea is so bad that a doctor is needed, it's hard to see how there will be much use in "MPESA Telemedicine".  So I don't see how the "overburdened ... few doctors" will be helped by this system.

[MOON Ki]

MK, you misunderstand me.

And you misunderstand me.   I understand that you support the general idea ... "telemedicine for Africa" and all that.    What I was getting at is that you misunderstand the general situation/context: diarrhea, witchcraft, etc. are as African as apple-pie is American.  Telemedicine won't change any of that, although, with respect to the first,  something as simple as clean drinking water could save lives, reduce burdens on doctors and hospitals, etc.

I hope that clarification helps you understand the misunderstandings here.   

[veritas]

Diarrhea and respiratory infections could be rooted in any underlying health disorder.  With proper training, a health technician can perhaps be equipped with tools to make a more fine tuned diagnosis. That means providing village labs with more specialised equipment for detecting cholera from salmonella poisoning. If this isn't feasible. Have a system which would allow biological samples picked up by lab vehicles and transported to district labs. The problem I see here is lack of infrastructure and working with what we have. Why not employ specialist matatus to transport biological specimens? Why not train village clinics in health informatics and login systems usually privy in hospitals? Why not break the social class barriers between doctors and nurses so nurses aren't intimidated to consult a doctor for advise or vice a versa a doctor not be too snobby to give honest advice to a pharmacist. These are inherent cultural problems and I do believe mobile technology when cleverly implemented can break down those barriers.

If I had to understand the misunderstandings here between you and I... I see technology as a means of social empowerment whereas you seem to see it like a logic board with no vision other than selected facts. Are you a visionary ? I'm not seeing it.

[MOON Ki]

Diarrhea and respiratory infections could be rooted in any underlying health disorder.

I can't comment on the latter.   On diarrhea in places like Kenya, the roots are well known and have been for ages.   The solutions do not require "more fine tuned diagnosis ... village labs with more specialised equipment" etc.   

Why not employ specialist matatus to transport biological specimens?

Can they be relied on to transport a dead chicken?

Why not break the social class barriers between doctors and nurses so nurses aren't intimidated to consult a doctor for advise or vice a versa a doctor not be too snobby to give honest advice to a pharmacist.

These exist all over the world, and the doctors will ensure that things stay that way.   But, more importantly, I don't see that as being a key issue in healthcare in places like Kenya: we have more basic problems.

If I had to understand the misunderstandings here between you and I... I see technology as a means of social empowerment whereas you seem to see it like a logic board with no vision other than selected facts. Are you a visionary ? I'm not seeing it.

I don't know what to make of the big words, like "social empowerment".   My view is this: technology can never be better than the people who use it, in the sense that it cannot fundamentally change who they are.   The failure or refusal to understand this produces the Kenyas of the world.   

Consider, for example, the notion that the moral deficit in Kenyans (w.r.t corruption) can be fixed with technology.  And then you have a whole cabinet secretary say that close to Sh. 1 billion is getting stolen because someone got her password.    Some obvious questions: why does the CS have total and free access to the financial side of the ministry?  What checks are there to ensure that a single password cannot allow one to do as one pleases?    The issue here is not whether or not there is the "right" technology; it is whether Kenyans will stop thieving.

On health: What are the real serious problems with the healthcare system in Kenya?    Is it merely a matter of having the "right" technology?   Not really.

For Kenya to really move forward, Kenyans will have to give up on ideas such as "our people above all", "eat before the other person eats it", etc.   At the root of such attitudes are "problems" that cannot be solved with the mere application of technology; there is certainly little evidence to suggest that the most "technologically advanced" Kenyans are any more advanced onthose issues than the manamba villagers.   

[veritas]

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.

40% of medical diagnoses are misdiagnosed in places like America due to doctors who just don't bother investigating further or because of poor lab results e.g. false positives, true negatives. Also lab specimens are dependent on the lab technician's skill. Add to that mix- unreliable results published in medical journals and Big Pharma incentives to entice doctors to prescribe their drugs. It's really the patient in majority of cases who know their body best. Second, third, fifth doctor opinions on complex disorders are a must in today's healthcare. To avoid Kenya falling into such a first world healthcare crisis- health technicians should be empowered so institutional forces like Big Pharma and medical journals bear little influence in manipulating the healthcare system.

[veritas]

MK, I don't wish to get into the politics of healthcare in Kenya. We could be here for years.

Kenya is one of few countries in the world to successfully implement mobile technology at unprecedented levels- socially and economically. Mobile technology is a link to the global world. Mobile culture is already flourishing in Kenya. Mzungu medicine may not be accepted but mobile technology has become a social mandate. Such things should be maximised as much as possible.

Talking with a health practitioner over the phone is much more practical than catching a dozen matatus to get to a provincial hospital and then wait half a day to meet the doctor who then tells you there's a waiting list for surgical procedures. I think however doctors call nurses more these days to book procedures beforehand. Such infrastructure could be maximized.

Matatus can be refurbished with fridges and buffered adequately to transport biological specimens. It can be contracted out so they don't have to speed for money. A van is useful for many things. Instead of transporting people it could be used for trade like telecommunication services. With enough investment, these vans have immense potential.

[Georgesoros]

My two cent opinion is that we should adopt this, but it should be by video conference with a patient. Provider can decide whether to have a face to face meeting. Ive seen surgeries performed in India while the practisioner in in Oregon via video conference.

[MOON Ki]

Talking with a health practitioner over the phone is much more practical than catching a dozen matatus to get to a provincial hospital and then wait half a day to meet the doctor who then tells you there's a waiting list for surgical procedures.

It certainly is easier, but what do you mean by "more practical"?   

If you look at the small things that are finishing Kenyans, how would a phone chat help?   And the fact that  Kenya has supposedly been able to "successfully implement mobile technology at unprecedented levels- socially and economically" doesn't answer that question.  Dealing with diarrhea, cholera, etc. does not require high-tech mobile anything. 

If the patient is sufficiently ill to require a surgical procedure---and that can be determined only by a real consultation by a doctor---then he or she will simply have to swallow the inconvenience that you refer to.  MPESA Telemedicine can neither shorten such waiting lists nor do away with the need for a proper examination.

[MOON Ki]

My two cent opinion is that we should adopt this, but it should be by video conference with a patient. Provider can decide whether to have a face to face meeting. Ive seen surgeries performed in India while the practisioner in in Oregon via video conference.

I too am all for such things; I think telemedicine can make a huge difference in some ways, and the only way is onward and upward, as one might say.    But it has its place, and that does not include the basic health problems that many Africans face. 

MPESA Telemedicine purely as a "forum", why not?  Those already exist all over the place:

You can post "I ate a goat-head and drank 3 beers last night, and now my poop is green and I feel woozy?  Am I dying?  Should I call 911?".

And somebody, medical or medically inclined will write back with "No, you aren't dying. Just drink some strong black tea.   If the symptoms persist, then take two aspirins.  And next time don't mix goat-heads with beer".   

I imagine that a real doctor on such a "forums" would also probably say: "I'm not going to make any money here, but bait was made for fish.  Oh, that sounds very serious.   We need to get you into this here clinic right away.   We have seen a lot of this, and we are experts at it

[Georgesoros]

I think cyber docs are ok as long as there's secondary follow up. Someone Whois 40 miles from the closest medical facility will appreciate a cyber doc who makes an initial diagnosis of appendicitis than wait 12hrs later.

[Kim Jong-Un's Pajama Pants]

My two cent opinion is that we should adopt this, but it should be by video conference with a patient. Provider can decide whether to have a face to face meeting. Ive seen surgeries performed in India while the practisioner in in Oregon via video conference.

I too am all for such things; I think telemedicine can make a huge difference in some ways, and the only way is onward and upward, as one might say.    But it has its place, and that does not include the basic health problems that many Africans face. 

MPESA Telemedicine purely as a "forum", why not?  Those already exist all over the place:

You can post "I ate a goat-head and drank 3 beers last night, and now my poop is green and I feel woozy?  Am I dying?  Should I call 911?".

And somebody, medical or medically inclined will write back with "No, you aren't dying. Just drink some strong black tea.   If the symptoms persist, then take two aspirins.  And next time don't mix goat-heads with beer".   

I imagine that a real doctor on such a "forums" would also probably say: "I'm not going to make any money here, but bait was made for fish.  Oh, that sounds very serious.   We need to get you into this here clinic right away.   We have seen a lot of this, and we are experts at it

Hehehe...

The idea by itself is okay.  Commendable actually.  But the marketing is misplaced when they suggest it is the solution to the fundamental problem of healthcare delivery.  But maybe that is the only way they can sell it.

While technology is an excellent multiplier when applied in the appropriate context and problem, it's not the solution to everything.  You mention elsewhere about the diseases of poverty like diarrhea.  These were largely eliminated in the west just by a rise in the standards of living.  No new super drug, or mobile app.  But widespread access to clean water.

@veritas, I know you have recently shown some heightened interest in technology.  You might want to look at water purification technologies.  Those ought to be something very appropriate in many places in Kenya and Africa.

[veritas]

Talking with a health practitioner over the phone is much more practical than catching a dozen matatus to get to a provincial hospital and then wait half a day to meet the doctor who then tells you there's a waiting list for surgical procedures.

It certainly is easier, but what do you mean by "more practical"?   

If you look at the small things that are finishing Kenyans, how would a phone chat help?   And the fact that  Kenya has supposedly been able to "successfully implement mobile technology at unprecedented levels- socially and economically" doesn't answer that question.  Dealing with diarrhea, cholera, etc. does not require high-tech mobile anything. 

If the patient is sufficiently ill to require a surgical procedure---and that can be determined only by a real consultation by a doctor---then he or she will simply have to swallow the inconvenience that you refer to.  MPESA Telemedicine can neither shorten such waiting lists nor do away with the need for a proper examination.

Better in practice.

Are you talking about cholera from poor sanitation? That's a public health issue. I'm not talking about pts who see a health practitioner because of diarrhoea due to poor sanitation in refugee camps. That rarely happens because you need pesa to even see a  nurse and refugee camps rely on WHO handouts. If a pt has ongoing or painful diarrhoea it could be bowel obstruction to HIV. You don't need a doctor to make diagnoses in Kenya but you do need referrals to district hospitals to gain access to certain medicines not in pharmacy kiosks or for booking surgical procedures requiring hospital equipment. The medical system is completely different to first world countries. Last time I checked, only one hospital in Western province had an incubator for premature born babies. These hospitals function like the Florence Nightingale era with the wide white nurse hats. The likely instance is when calls are made by a rural nurse to a doctor living in first world countries through an NGO about a complicated condition.

[MOON Ki]

Are you talking about cholera from poor sanitation? That's a public health issue. I'm not talking about pts who see a health practitioner because of diarrhoea due to poor sanitation in refugee camps.

OK.  Now I know what you are not talking about.  What I don't know is what you are talking about.

You don't need a doctor to make diagnoses in Kenya but you do need referrals to district hospitals to gain access to certain medicines not in pharmacy kiosks or for booking surgical procedures requiring hospital equipment.

I doubt that most sick people in Kenya wait for referrals to hospitals.   As far as I can tell, when they feel sufficiently ill, they simply pop up at the hospital.

Last time I checked, only one hospital in Western province had an incubator for premature born babies.

And MPESA Telemedicine will help how?

The likely instance is when calls are made by a rural nurse to a doctor living in first world countries through an NGO about a complicated condition.

I don't think that's what they have in mind here.

I note that this service was launched in South Africa about 4 years ago, and on their website they are now proudly advertising the "Kenyan Launch":

http://www.hellodoctor.co.za/

So how effective has it been?   I'll await answers.   But I note that their claims and goals are decidedly more modest than what is being peddled right now in Kenya:

We could never replace face-to-face consultations with your GP.

and

"We enable consumers to make informed decisions about their health; no diagnosis or treatment decisions are made,"

They do, however, cast aside their modestly when it comes to specifying how many versions of the app you can buy (online, with debit or credit card).

It also appears that the most frequent recommendation from these chats is "go see a doctor in person".   I would not be surprised if that  recommended in-person also turned out to be the person making the recommendation.

The general news from South Africa suggests that they haven't exactly had a happy time of it down there:

http://www.news24.com/Archives/Witness/Diagnosis-bad-for-Hello-Doctor-20150430

and

SAMA supports HPCSA's denunciation of Hello Doctor

https://www.facebook.com/SAHIVSoc/posts/626807940712455

It is also interesting to note that what Hello Doctor claimed it would offer in South Africa in 2011 is very similar to what is supposedly going to be on offer in Kenya.   But there has since been a significant retreat from in South Africa---to the extent that exists if hardly recognizable relative to the initial high-flying talk.

[RV Pundit]

Someone does something finally about something and all you hear are the usual 1) it not a priority 2) there are better ideas 3) this won't work. Now what stopping you from doing it.

This idea is laudable...at least for for the single fact...they are trying something. It may not work. It may work. CBA has trail blazed with Mshwari..and has within 2yrs overtaken all banks to have more than 10M bank accounts...and have loaned out billions..and recieved nearly 100B deposits from the poorest.

We had the same same arguments with M-pesa...how it was not a real bank...cookie called it Morse code technology...I think City called it smoke tech....but right now folks are using it to wire trillions of kshs..it morphed into many many things.

Poor folks in kenya are not stupid...they are very literate...and such ideas may stutter but they will work..because there is NO ALTERNATIVE.

[Kim Jong-Un's Pajama Pants]

Someone does something finally about something and all you hear are the usual 1) it not a priority 2) there are better ideas 3) this won't work. Now what stopping you from doing it.

This idea is laudable...at least for for the single fact...they are trying something. It may not work. It may work. CBA has trail blazed with Mshwari..and has within 2yrs overtaken all banks to have more than 10M bank accounts...and have loaned out billions..and recieved nearly 100B deposits from the poorest.

We had the same same arguments with M-pesa...how it was not a real bank...cookie called it Morse code technology...I think City called it smoke tech....but right now folks are using it to wire trillions of kshs..it morphed into many many things.

Poor folks in kenya are not stupid...they are very literate...and such ideas may stutter but they will work..because there is NO ALTERNATIVE.

Just a correction.  I recall having an argument with you about who developed M-Pesa.  Not its utility. 

I also remember thinking, mistakenly that it will be adopted by a major US cell phone company.  Arguing against cookie in that respect.

While you might be right about cookie, you seem to want to lump every objection one makes into one box.  Let's try and stick to the facts.  I have zero to gain from arguing against facts.

[RV Pundit]

No problem. Apologies If I mixed it up. The m-pesa debate went on for ages. My point though remain the same. These guys (private sector) are trying out an idea that could revolutionize health care in kenya and maybe globally like Mpesa did. Others need to do their job...gov being one...but certainly these guys deserve all the kudos for trying.

Just a correction.  I recall having an argument with you about who developed M-Pesa.  Not its utility. 

I also remember thinking, mistakenly that it will be adopted by a major US cell phone company.  Arguing against cookie in that respect.

While you might be right about cookie, you seem to want to lump every objection one makes into one box.  Let's try and stick to the facts.  I have zero to gain from arguing against facts.

[Kim Jong-Un's Pajama Pants]

No problem. Apologies If I mixed it up. The m-pesa debate went on for ages. My point though remain the same. These guys (private sector) are trying out an idea that could revolutionize health care in kenya and maybe globally like Mpesa did. Others need to do their job...gov being one...but certainly these guys deserve all the kudos for trying.

Just a correction.  I recall having an argument with you about who developed M-Pesa.  Not its utility. 

I also remember thinking, mistakenly that it will be adopted by a major US cell phone company.  Arguing against cookie in that respect.

While you might be right about cookie, you seem to want to lump every objection one makes into one box.  Let's try and stick to the facts.  I have zero to gain from arguing against facts.

No issue there.  The real beef I have had with M-PESA has always been about publishing the API.  I have always thought that was a win-win situation for safcom, but obviously they think otherwise.  They prefer to limit access and exploit their monopoly on it, in the process slowing down innovation, much like Microsoft did with its products until it was overtaken by events.

[MOON Ki]

I also remember thinking, mistakenly that it will be adopted by a major US cell phone company.  Arguing against cookie in that respect.

It's hard to imagine what use something like MPESA would be in a place with a decent banking system:

* Most people, except possibly some criminals, who prefer "cash money", will have bank accounts.  And in many places it is easy enough to "send money" from a computer or a mobile phone.

* Folks who don't have bank accounts or the right sorts of plastic cards have other options, such as pre-paid credit cards, and it is possible to put money into those, either by computer/phone or by going to the right place (the equivalent of a MPESA agent).

* Cash (more than trivial amounts) is both "suspicious" and unnecessary.   (I am right now reflecting that I hardly ever have cash at hand or the need for it; and that seems to be the case with most folks I see wandering around.)

[MOON Ki]

Someone does something finally about something and all you hear are the usual 1) it not a priority 2) there are better ideas 3) this won't work. Now what stopping you from doing it.

This idea is laudable...at least for for the single fact...they are trying something. I

It is certainly laudable, in so far as "something is better than nothing"; but that seems to be about it.

It may work. CBA has trail blazed with Mshwari..and has within 2yrs overtaken all banks to have more than 10M bank accounts...and have loaned out billions..and recieved nearly 100B deposits from the poorest.

We had the same same arguments with M-pesa...

Nevertheless matters of health are different.    There are serious ethical and legal issues in health that are both different and not easy to get around; in that regard, a reference to "same arguments" is entirely misplaced.   (Moreover, the mere fact that something that was scoffed at, by some, ended up working does not necessarily imply that everything that is scoffed at will work; "proof by exception"  generally does not work.  Each "innovation" must be judged on its own merits.)

And there's another thing to keep in mind here: Whereas more technologically advanced places might not have tried something like MPESA---because there is little use for it---they certainly have been hard at work on telemedicine.  So the notion of Kenya/South Africa blazing trails with this "forum" is simply off.   What's more, there are important lessons to be learned from the others.

Poor folks in kenya are not stupid...they are very literate...and such ideas may stutter but they will work..because there is NO ALTERNATIVE.

The basic issues have little to do with "stupidity" or "literacy", and there is no need to inject irrelevant "emotion" into this.    And it depends on what you mean "will work".   Will it work as a "forum"?   I don't see why it can't; it might even be useful in that way.   Beyond that?   One only has to look at the initial ideas in South Africa---diagnosis by phone, prescriptions by phone, etc.---and what Hello Doctor in South Africa currently is.   

To my mind, the matter here is quite straightforward, and  I will put in thus:

(a) What are the basic health problems that most Kenyans (Africans) face?

(b) What are the prospects that this Hello (Sema) Doctor will be able to address those?

In (a), we have, for example, diarrhea, which you mentioned.  Another is malaria.  Cholera is never too far away.   And so on, and so forth.  We know that there would be tremendous improvements in the health of Kenyans (Africans) just by having toilets and latrines, people pooping right and washing hands, having clean drinking water, etc.   No type of fancy mobile-phone "app" will change that.

So, unless people will be using mobile phones to plug their butts when they have diarrhea, or using them to whack mosquitos, it's hard to see where this particular "high tech" thing is going in that regard.  The basic problems of health in Africa will not be solved with such gimmicks.  What is required is real hard and serious work, with attention paid to the fundamentals---and that there is the ALTERNATIVE.  To the extent that anyone claims otherwise, it behooves them to explain exactly how.  And that can be done this way:

(a) A statement of the health problem.

(b) An explanation of how MPESA Telemedicine will help.