KENYA: What we need are more doctors, not video links

May 2015 DailyNation; Last week we learnt that doctors at the Kenyatta National Hospital can now communicate instantly via a video link with their colleagues at the Machakos Level Five Hospital. Apparently, it was a breakthrough worthy of being unveiled by the health Cabinet Secretary.  

But before I comment on this development, let me remind you of the state of healthcare in the country.

In November last year, we learnt, courtesy of the Journal of Tropical Medicine and International Health, that the quality of surgery in public hospitals is unacceptable and theatres a sorry training ground for new doctors.

It should worry us that training of doctors at the university is done in spotless environments while the actual surgery in hospitals takes place in deplorable conditions.

The study, which looked at 22 district and provincial hospitals offering internship for new doctors, revealed that surgery patients share beds, lack water or soap for hand washing as well as basic medicines, and that in many cases, simple treatment procedures are ignored.

More than half the hospitals do not have clean toilets.

It is perhaps particularly apocalyptic that we have hospitals with dirty toilets. It is criminally negligent to have a dirty toilet in a hospital. A hospital should be a place to get cured of diseases, not one to pick them up.

But we now have video-link services.  

GOOGLE DOCTORS

Back in 2013, a WB report reminded us about the state of our health services.

The profession suffers from a rate of absenteeism almost as bad as that of teachers. A quarter of all medical staff, including those in private institutions who are on a tighter leash, are away from their work stations at any given moment.  The rate of absenteeism is as high as 40 per cent in some public hospitals.

Worryingly, the number of absentees increases with the caseload associated with the hospital, meaning that public doctors are ducking patients in places where their expertise is needed the most.

I hope the doctors will stick around long enough for the video conferencing, though.  

Less than half of medical staff stick to correct medical practice (I’m not sure it is good that our doctors are improvising so much), a quarter cannot accurately diagnose (don’t just sit there, google your symptoms; your doctor could have got it wrong) and slightly less than half of all hospitals do not have medicine. 

Thankfully, we now have video-link services between hospitals.

We aren’t training doctors fast enough. The ratio of doctors to people is growing at the rate of our population growth, according to the World Bank, meaning it will not improve.

 We are also self-sabotaging when in this area. A doctor friend of mine who was forced to relocate from Ukraine could not find a job despite there being a shortage of doctors. Another Uganda-trained friend is volunteering at a district hospital after six years in medical school because she can’t get a job. Several doctors who started working in April are complaining about working conditions and pay.

We do have a teleconferencing unit to think about.

SILICON SAVANNAH HOSPITAL

The CS said that the new system will enable us to achieve universal medical coverage.

Doctors on screen is beyond farcical and turns into a tragedy. Healthcare cannot be silicon savannahed. There are no digital shortcuts: we need physical hospitals with doctors present.

When you need a doctor to perform a procedure or check physical symptoms, you need him in person, not in Nairobi on a screen.

“This will facilitate early detection of infections and diseases such as cancer, which times have shown have always been diagnosed quite late, of course with adverse effects,” the CS claimed.

I asked a doctor how many types of cancer she thought could be diagnosed via a screen and she could only come up with one: skin cancer. How, for example, will these TVs linked to modems test for cervical cancer?

We are also told that the sydtem will enable doctors to share medical information. Yet, there’s no standardised system for recording patient data across the country. That seems to be the first thing the government should concentrate on. Besides, shouldn’t private hospitals be roped in because medicine isn’t just limited to the public sector? Shouldn’t we set up a standardised form of recording patient medical history before putting up a system to share that data.

The CS also said TVs will help rid the country of counterfeit drugs. How exactly does that happen?  

Well, there is already a faster, SMS-based system to check whether drugs are genuine. Should patients queue in front of a screen to wait for a pharmacist in Nairobi to tell them whether the medicine they have is real? How practical is that?  

 Luckily, though, most patients won’t have to deal with the disappointment of being told that their drugs are fake because half of all government hospitals do not have any drugs at all.

Finally, we are told that the screens will eliminate middlemen in medicine. Who are these middlemen plaguing the health sector? Are doctors and pharmacists middlemen?

BAD IDEA

With this scheme, we have a project that was announced very loudly in the hope that we would not notice the inadequacies on the ground. They praise the virtual and ignore reality.

This is an attempt to misdirect us from reality.  The entire sector is underfunded. 

The problem is that this government insists on leaning all its weight on digital baubles when more rudimentary, less PR-friendly methods are what will work.

The CS seems to have an exaggerated view of exactly what a screen connected to the Internet can do to medicine. Perhaps it wasn’t such a good idea to put a banker in charge of medicine.

 The doctor will see you now…on the screen.

 

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