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

[veritas]

MK, it sounds like you were born with a gold spoon in your mouth. I'm going to have to direct you to my health blog: https://kenyamedical.wordpress.com/

The majority of populaces live in villages and can't get to the district hospital. In most instances, transportation and otherwise are organized by the hospital or sponsoring organisation if a local clinic can't treat the pt. Port-of-call when a pt is still very sick after a few days even after consuming malaria tabs, diarrhea tabs etc. is to visit a clinic. At the clinic, the pt is tested for malaria in the local lab. Refer to my post: https://kenyamedical.wordpress.com/2011/02/12/checking-for-falciparum-malaria-in-a-lab-rural/ and are put on drip if found to be malaria +ve: So quinine and saline combinations. In most cases quinine does the trick for everything. In severe cases pts die before reaching a hospital. This happens when the malaria has penetrated the cerebral regions and the pt becomes delirious. I witnessed firsthand the devastating fx of malaria. I get the impression you haven't. There isn't much hospitals do for pts, again, I refer you to my blog: https://kenyamedical.wordpress.com/2011/02/12/common-procedures-in-district-hospitals/

At the district hospital, each month approx. fifty major surgical procedures are performed in theatre. The most common three being:

1. Caesarean section (comprise near half of procedures)
2. Herniotomy
3. Herniorrhaphy

The rest are not as common:

1. Laparotomy
2. Prostatectomy
3. Cystectomy
4. Re-section/anastomosis
5. Splenectomy
6. Hysterectomy
7. Sphincterotomy
8. Scalpingectomy
9. Hydrocelectomy
10. Myomectomy
11. Appendectomy
12. Thyroidectomy
13. BTL

You refer to doctors and medical systems from first world countries but in Kenya it isn't like that. It's like this:

[MOON Ki]

MK, it sounds like you were born with a gold spoon in your mouth ... The majority of populaces live in villages and can't get to the district hospital.

Skipping that little, unhelpful, and unwarranted introduction, which somehow assumes that I know little of the healthcare system in Kenya, I think you've missed the point.    And rather badly at that.   
Here it is, in summary:

(a) Much of what kills Kenyans is not the lack of access to hospitals; on the contrary, public hospitals in Kenya are extremely dangerous places for anyone's health and especially for those in poor health. 

The health of most Kenyans and Africans can be substantially improved in relatively simple ways, none of which requires the mobile-phone "apps" or even the involvement of hospitals.  And that, to my mind, is what folks should focus on, even of they have tinker-toy mobile-phone "forums" to play with.

(b) You write that:

In most instances, transportation and otherwise are organized by the hospital or sponsoring organisation if a local clinic can't treat the pt. Port-of-call when a pt is still very sick after a few days even after consuming malaria tabs, diarrhea tabs etc. is to visit a clinic. At the clinic, the pt is tested for malaria in the local lab. Refer to my post: https://kenyamedical.wordpress.com/2011/02/12/checking-for-falciparum-malaria-in-a-lab-rural/ and are put on drip if found to be malaria +ve: So quinine and saline combinations. In most cases quinine does the trick for everything. In severe cases pts die before reaching a hospital. This happens when the malaria has penetrated the cerebral regions and the pt becomes delirious. I witnessed firsthand the devastating fx of malaria. I get the impression you haven't. There isn't much hospitals do for pts, again, I refer you to my blog: https://kenyamedical.wordpress.com/2011/02/12/common-procedures-in-district-hospitals/

All that may be true.   And it is relevant how?  I don't see how MPESA Telemedicine will help in any way.   So, once again:

(a) Please state exactly what the problem at hand is.

(b) Then state exactly how MPESA Telemedicine will help.

Once we are clear on those, I think we will be able to have a more fruitful discussion.

By the way, unlike fly-in/fly-out do-gooders, I actually grew up in Malaria Country.  I know full well and first-hand its effects---as in experiencing, as opposed to just "witnessing".  And I generally try to keep abreast of ongoing research etc. in that area.   So I can't  see that there is much for me to learn from that "post" of yours.  Try to avoid unwarranted assumptions, and try not to weep louder than the bereaved.

Your "blog" on "common procedures in district hospitals" is, perhaps, a bit more interesting.  But, again, I ask: how exactly is MPESA Telemedicine going to help with any of that?

[RV Pundit]

Very interesting insight Veritas. You want to avoid dealing with our ignorant but argumentative prick who think consulting a doctor over the phone is useless. And that doctors should turn into public health officials and go around preventing diseases....instead of treating them.

MK, it sounds like you were born with a gold spoon in your mouth. I'm going to have to direct you to my health blog: https://kenyamedical.wordpress.com/

The majority of populaces live in villages and can't get to the district hospital. In most instances, transportation and otherwise are organized by the hospital or sponsoring organisation if a local clinic can't treat the pt. Port-of-call when a pt is still very sick after a few days even after consuming malaria tabs, diarrhea tabs etc. is to visit a clinic. At the clinic, the pt is tested for malaria in the local lab. Refer to my post: https://kenyamedical.wordpress.com/2011/02/12/checking-for-falciparum-malaria-in-a-lab-rural/ and are put on drip if found to be malaria +ve: So quinine and saline combinations. In most cases quinine does the trick for everything. In severe cases pts die before reaching a hospital. This happens when the malaria has penetrated the cerebral regions and the pt becomes delirious. I witnessed firsthand the devastating fx of malaria. I get the impression you haven't. There isn't much hospitals do for pts, again, I refer you to my blog: https://kenyamedical.wordpress.com/2011/02/12/common-procedures-in-district-hospitals/

At the district hospital, each month approx. fifty major surgical procedures are performed in theatre. The most common three being:

1. Caesarean section (comprise near half of procedures)
2. Herniotomy
3. Herniorrhaphy

The rest are not as common:

1. Laparotomy
2. Prostatectomy
3. Cystectomy
4. Re-section/anastomosis
5. Splenectomy
6. Hysterectomy
7. Sphincterotomy
8. Scalpingectomy
9. Hydrocelectomy
10. Myomectomy
11. Appendectomy
12. Thyroidectomy
13. BTL

You refer to doctors and medical systems from first world countries but in Kenya it isn't like that. It's like this:

[RV Pundit]

Yeah, go ahead and tell us what our basic health problem is..and how we can help you deal with it. You sure have done something better about this than this brave attempt to do something about it via M-health application that is billable via Mshwari/Mpesa.

And before you do it learn the difference btw public health issues and medical issues. One focus on preventing diseases (access to clean water to prevent dysentery)...the other focus on curing diseases (treating dysentery)..and each is needed...you cannot let folks die from dysentery...as you focus on providing clean water.

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.

[MOON Ki]

Yeah, go ahead and tell us what our basic health problem is..and how we can help you deal with it. You sure have done something better about this than this brave attempt to do something about it via M-health application that is billable via Mshwari/Mpesa.

And before you do it learn the difference btw public health issues and medical issues. One focus on preventing diseases (access to clean water to prevent dysentery)...the other focus on curing diseases (treating dysentery)..and each is needed...you cannot let folks die from dysentery...as you focus on providing clean water.

I'm afraid the question remains unanswered:

What is the exact problem that MPESA Telemedicine is supposed to solve?   And how, precisely?

Once we have an answer to that, I think we will be in a good position to discuss all these other issues, including "the difference btw public health issues and medical issues". 

As an example, RV Pundit wrote that:

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 soon as we are clear on  what MPESA Telemedicine can do, we will be able to  get on to discussing how to avoid all that diarrhea in the first place.  In fact, it could be that that dealing with the fundamental causes of runny shit would be more effective than relying on "Apps".

Friend Pundit also had other arguments.   E.g.   

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

Perhaps true.   And MPESA Telemedicine would help in what way?

And, lest folks misunderstood, I wish to make it clear that I'm almost always for any "brave attempt" to do "something".   But, surely, it is not too much to enquire about the "something" and how the said "brave attempt" will help.   I'm just saying ...

So, please, one step at a time.   Asante sana.   

[MOON Ki]

Very interesting insight Veritas. You want to avoid dealing with our ignorant but argumentative prick who think consulting a doctor over the phone is useless. And that doctors should turn into public health officials and go around preventing diseases....instead of treating them.

The red is simply not nice!  Please do try to be a bit more friendly.  Perhaps this will help:

http://www.amazon.com/How-Win-Friends-Influence-People/dp/0671027034/ref=sr_1_1?s=books&ie=UTF8&qid=1439528333&sr=1-1&keywords=how+to+make+friends+and+influence+people

Nowhere have I stated, or even implied, that consulting a doctor over the phone is useless.   Nor have I stated, or implied, that doctors should turn into public health officials and go around preventing diseases ... instead of treating them.   My main issues have to do with:

(1) What problems MPESA Telemedicine would solve and how.  For example, how would it help with the "40% of basic diarrhea cases" that has been put forward by "For" side?

(2) The legal and ethical issues that would be involved, here including my view that "let people die first" simply won't do.

How about we have some clear answers on blue and then proceed from there?   

[RV Pundit]

You want us to substantiate the obvious. Even when we have given you tonnes of examples.

Most kenyans cannot afford to consult a doctor...due to distance, cost, time,long waiting list , doctor being absent tc. You'd be surprised that majority when they get sick mainly pray that the disease go away, some sleep over it hoping it goes away, others try herbal remedies of the yore and finally those that eventually go to see a doctor, go when it's too late.

Now someone can just pick his phone, use mshwari to buy small time insurance and everytime he feels something not right about them or their children (I know a lot about that, because as a parent sometimes you call everyone trying to figure out why fever is up and should you rush to hospital), they just call a real doctor.

I don't have to know all the details about this mobile app...but I know if it reduce the cost, time and distance to talk to a real qualified doctor...then it has done a great thing. It a good start. And like Mpesa which began as simple tool...you can build on top of that...to unleash the full potential of tele-medicine or e-medicine.

As for legal and ethical issues...when did we become lawyers here? those are the details am least concerned about;  I won't bore you with the mechanics of C# or Python programming languages even if they are very interesting...and I don't expect us to go around the "technical" details.

(1) What problems MPESA Telemedicine would solve and how.  For example, how would it help with the "40% of basic diarrhea cases" that has been put forward by "For" side?

(2) The legal and ethical issues that would be involved, here including my view that "let people die first" simply won't do.

How about we have some clear answers on blue and then proceed from there?   

[Kim Jong-Un's Pajama Pants]

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.)

Yep.  I underestimated how difficult it would be to replace entrenched systems.  I had thought that plastic would be replaced by the phone.  M-Pesa would be competing with banks, payment by fingerprints at POS, online bill payment etc.

This discussion was prior to the widespread adoption of the smartphone.  So some functionality, eg wiring funds, while readily available had to be done on a personal computer.

[Kim Jong-Un's Pajama Pants]

Very interesting insight Veritas. You want to avoid dealing with our ignorant but argumentative prick who think consulting a doctor over the phone is useless. And that doctors should turn into public health officials and go around preventing diseases....instead of treating them.

MK, it sounds like you were born with a gold spoon in your mouth. I'm going to have to direct you to my health blog: https://kenyamedical.wordpress.com/

The majority of populaces live in villages and can't get to the district hospital. In most instances, transportation and otherwise are organized by the hospital or sponsoring organisation if a local clinic can't treat the pt. Port-of-call when a pt is still very sick after a few days even after consuming malaria tabs, diarrhea tabs etc. is to visit a clinic. At the clinic, the pt is tested for malaria in the local lab. Refer to my post: https://kenyamedical.wordpress.com/2011/02/12/checking-for-falciparum-malaria-in-a-lab-rural/ and are put on drip if found to be malaria +ve: So quinine and saline combinations. In most cases quinine does the trick for everything. In severe cases pts die before reaching a hospital. This happens when the malaria has penetrated the cerebral regions and the pt becomes delirious. I witnessed firsthand the devastating fx of malaria. I get the impression you haven't. There isn't much hospitals do for pts, again, I refer you to my blog: https://kenyamedical.wordpress.com/2011/02/12/common-procedures-in-district-hospitals/

At the district hospital, each month approx. fifty major surgical procedures are performed in theatre. The most common three being:

1. Caesarean section (comprise near half of procedures)
2. Herniotomy
3. Herniorrhaphy

The rest are not as common:

1. Laparotomy
2. Prostatectomy
3. Cystectomy
4. Re-section/anastomosis
5. Splenectomy
6. Hysterectomy
7. Sphincterotomy
8. Scalpingectomy
9. Hydrocelectomy
10. Myomectomy
11. Appendectomy
12. Thyroidectomy
13. BTL

You refer to doctors and medical systems from first world countries but in Kenya it isn't like that. It's like this:

I think MOON-Ki is saying that you can solve 90%(random figure) of health problems just by improvement in areas not necessarily directly associated with health.  Guaranteeing clean water for everyone can reduce the burden on the undermanned Kenyan healthcare.  As can getting rid of stagnant pools of water.

veritas is more concerned with those already sick.  MOON-Ki is concerned with prevention.  Neither is wrong.  But it's legitimate to discuss both of them.  Interestingly the ultimate solution to both might lie far away from the hospital and long lines.

[RV Pundit]

How do you hijack a thread about m-health and turn it into one about public health issues.  There are many problems,variables, solutions...and this to me is one of them.

I think MOON-Ki is saying that you can solve 90%(random figure) of health problems just by improvement in areas not necessarily directly associated with health.  Guaranteeing clean water for everyone can reduce the burden on the undermanned Kenyan healthcare.  As can getting rid of stagnant pools of water.

veritas is more concerned with those already sick.  MOON-Ki is concerned with prevention.  Neither is wrong.  But it's legitimate to discuss both of them.  Interestingly the ultimate solution to both might lie far away from the hospital and long lines.

[veritas]

WindyMK the buzzkill owl- he needs to R&R stat.

Those who call a doctor over clean water and hygiene for prevention are called hypochondriacs like MK.

Who doesn't want clean water ? Why state the obvious? He's been brainwashed by that "Clean water" NGO. I swear they've bought millions of dollars worth of ad time. It's gone Christian viral.

MK is brainwashed Windy and feeling the fx of withdrawal.

Thank god for sober chaps like RVP. Thank you RVP. 

[veritas]

Let me also add, I've extensively studied chaps like MK in this state. I think this pear visualises his current state of mind (quirks, ticks, confusion, fish-out-of-water- I get it):

















The man needs to find vision. I wish him well.

[Kim Jong-Un's Pajama Pants]

Pundit/veritas,

MOON-Ki's is constructive and healthy skepticism.  We all enjoy being right and the like.  Personally I also enjoy being shown to be wrong, maybe misguided, or plain silly.  He is not off-topic because I think that his ideas bring into question the relevance of m-health.

A good doctor will tell you certain things that may have nothing immediately relevant to your medical complaint, depending on context.  In Kenya, he might suggest you refrain from drinking and smoking.  In the US he'll in all likelihood give you suggestions and medications that can lower your cholesterol.

[veritas]

Clean water is a public health issue.

Village folks don't walk for miles and spend pesa to see a doctor who cost ten fold more than a local clinic nurse to be told their problem is because of a lack of clean water and hygiene. Clean water is a govt mandate from a lack of investment in infrastructure and beyond the scope of what a mobile app can do. Grassroots initiatives are not top down.

[Kim Jong-Un's Pajama Pants]

Clean water is a public health issue.

Village folks don't walk for miles and spend pesa to see a doctor who cost ten fold more than a local clinic nurse to be told their problem is because of a lack of clean water and hygiene. Clean water is a govt mandate from a lack of investment in infrastructure and beyond the scope of what a mobile app can do. Grassroots initiatives are not top down.

If a patient needs treatment, he should be treated.  I am assuming m-health would probably link him to a specialist who can assist, all the caveats MOON-Ki points, applying.  Maybe he might learn that boiling water before consuming it is something he should consider.  I don't see the ideas as divorced.

[veritas]

He'd learn that from a public health official/nurse educator if for prevention through posters and info sessions. I did this as a volunteer and routinely visited numerous schools to pop a deworming tab in each child's mouth and give a talk about washing salads, hands, boiling water, STDs, HIV etc. I ran a mobile infirmary in the slums and I assure you they boil their water and this isn't the problem.

A doctor contacts the CDC or local public health official if the pt is tested +ve for cholera or other infectious diseases. The public health official will then ask questions like have you been boiling your water? and investigate further etc. it's considered discrimination for a doctor to make assumptions on infectious disease causes. They can't tell a pt, boil your water ! There are nurse educators who go through info sessions with a pt and family post-treatment/discharge.

[Kim Jong-Un's Pajama Pants]

He'd learn that from a public health official/nurse educator if for prevention through posters and info sessions. I did this as a volunteer and routinely visited numerous schools to pop a deworming tab in each child's mouth and give a talk about washing salads, hands, boiling water, STDs, HIV etc. I ran a mobile infirmary in the slums and I assure you they boil their water and this isn't the problem.

A doctor contacts the CDC or local public health official if the pt is tested +ve for cholera or other infectious diseases. The public health official will then ask questions like have you been boiling your water? and investigate further etc. it's considered discrimination for a doctor to make assumptions on infectious disease causes. They can't tell a pt, boil your water ! There are nurse educators who go through info sessions with a pt and family post-treatment/discharge.

Just reading your last paragraph.  I think MOON-Ki wants to know how m-Health is going to help in that situation.  Isn't that a fair question?

[RV Pundit]

Windy,
Your friend Moonki is just obnoxiously conceited smart alec hijacking every debate with tangential issues. If this debate is about Call a Doctor then we should confine it there..otherwise like I previously said we can spawn as many problems,challenges and solutions as we can imagine in broad topic like health & medicine.

Nobody has claimed this thing that I am praising is panacea to all our problems; a silver bullet; hell no I have just said this is  start ; a great example of private sector innovation into a difficult area and we shoud all laud and wish them well.

Well apparently not everyone is that "patriotic".

[veritas]

Windy

I guess it would be the e- health system like RVP said. This is a new thing in Australia. It's a medical records web interface which allows pts and health providers access to your medical records. That way you and your doctor can keep abreast with treatment schedules and your medical history. I did case studies of this- medical records getting lost in back room file drawers, different doctors not knowing your medical history, negligence and wrong diagnoses. My lecturer was actively advocating this initiative in the early phases- she had no support because doctors her age could barely type and people branded her a nut. She's now spearheading this govt backed initiative.

With EMR (Electronic Medical Records) you can access your medical records anywhere like your mobile phone and you can page your doctor during emergencies, schedule an appointment online, request a phone appointment call etc. the problem in Australia at the moment is consent. Some are trying to make this mandatory while others cite privacy. In Kenya it could be a godsend revolution in delivering more accessible, convenient, seamless healthcare- so long as it has govt backing and support from health providers.

[veritas]

Since Kenya has a mobile banking system- pts could pay prepaid credit to speak with their doctor. Takes the hassle out of a medical billing system. Even better if the govt can pay for prepaid credits for low income households or those with serious medical conditions. The potential to revolutionise Kenya's healthcare system using mobile IP technology is huge. I wish I had more time in my life to contribute to this.