What can a 1970s medical textbook tell a physician or nurse practitioner as they’re caring for patients with critical medical complications? Not enough.
In many areas of the world, including parts of the United States, patient access to quality healthcare is being negatively impacted by a lack of provider access to timely medical information. In fact, more than a billion people currently live in rural, underserved areas with inadequate access to healthcare, and nearly one-third of countries are experiencing critical shortages of skilled healthcare workers. Often times, nurse practitioners are the only staff – with no access to physicians or the decision-support tools needed to properly diagnose and treat diseases or complications specific to their region.
Building on the belief that everyone, in every corner of the globe, should have access to high-quality healthcare, we launched Health eVillages in partnership with the Robert F. Kennedy Center for Justice and Human Rights, a program that arms clinical providers with mobile access to the highest-quality medical references.
Mobile health technology: Every corner of the globe
The program, which has launched pilot sites in Haiti, China, Uganda, Kenya and rural Louisiana, has impacted patient care in the developing world by providing mobile phones and handheld devices to healthcare professionals. Due to the lack of infrastructure and Internet available in these remote and at-risk regions, the program also supplies solar panels to ensure the devices receive the power they need to work properly.
In Kenya – the site of one of our pilot locations – “the rate of under-5 mortality has stagnated between 93 in 1998 and the current 92 per 1,000 live births,” according to the World Health Organization (WHO). “Maternal mortality worsened from 365 in 1994 to 414 in 2003, and maternal death is the leading cause of death in women of child-bearing age. This stagnation is attributable to the high disease burden due to existing and new conditions, and an inadequate response to manage the disease burden. The health impact indicators also suggest wide disparities in healthcare across the country, closely linked to underlying socio-economic, gender and geographical disparities.” WHO also found that the health system is hampered by “inadequate quantities and qualities of resources.”
Bringing telehealth to communities where access to healthcare information and medical references is desperately needed has already proven its value. While conducting training sessions and delivering mobile devices in Lwala, a rural village in Kenya, we bore witness to the power of the mobile healthcare movement: A nurse practitioner saved two lives during a child delivery with life-threatening complications for the mother and baby.
Nurse practicioner Okari holds
Katherine’s newborn baby.
Okari and Katherine
On day eight of our training and delivery tour in Africa, we stopped at the Lwala Community Alliance and Clinic, which was founded by two native brothers who lost their parents to AIDS. The brothers, who dreamed of bringing desperately needed healthcare home to Lwala, studied at Vanderbilt University in the United States and raised the capital needed to open the health center. Now in its fifth year, a staff of 25 Kenyans treats more than 1,700 people each month.
As we began training the healthcare providers to use mobile phones and iPads to access healthcare information, a nurse practitioner named Okari researched neonatal resuscitation using the Skyscape software provided on an iPad. The clinic had just admitted Katherine, a patient whose unborn baby was at risk for prenatal asphyxia, a deficient supply of oxygen to the body. Also known as apnea, the complication can be fatal for infants when breathing slows down or stops in short episodes.
That review, and the immediate, on-demand delivery of medical information on the device, prepared Okari for what was to come. Late that night, he performed neonatal resuscitation when Katherine went into labor and the baby was delivered not breathing. The next day, Okari, inspired by the experience and at how simple it was to put the mobile device and its information to use, led a training session on neonatal resuscitation for the rest of the nurses using the devices.
Katherine was incredibly lucky to have had access to quality care and was grateful to take home a healthy child, but unfortunately her experience is different than so many in underprivileged areas with little access to current medical resources, information, infrastructure and a fully staffed facility. These stories and the life-saving power of mobile technology are the reasons that Health eVillages was established.
Lessons learned
This was one of our earliest proof points of the impact of mobile health, especially in those regions of the world where a strong infrastructure and access to updated medical references are lacking. By replacing outdated textbooks with a mobile device in even one clinic, we have seen the power of knowledge at work. The information one nurse practitioner accessed with the touch of a button has now been imparted to the entire staff, and that knowledge has been used to save lives.
By bringing mHealth – or the applications and care solutions supported by mobile phones, tablets and other mobile devices – to developing nations, we are building tools to support and extend an overworked and understaffed healthcare infrastructure. Programs, such as TRACnet in Rwanda and our own Health eVillages, bring the opportunity to all countries – established, poor or emerging – to harness mobile communications for the improvement of care in their areas. The story of Okari and Katherine proves that in these countries – despite the lack of higher education and irregular power or Internet infrastructure – physicians, nurses and practitioners can efficiently and effectively do their jobs.
In addition to staying updated on current medical conditions and drug dosages/treatments, these devices can be tailored to provide content on the region-specific conditions and diseases that can put an entire village at risk.
Reaching new horizons in mHealth
Many rural and developing regions have long been suffering from lack of resources and infrastructure – electricity, little or no access to the latest in medical research and a severely underwhelming amount of trained medical staff. mHealth is addressing a real need for medical education and information, especially in regions with a high population of patients needing medical attention for everything from HIV/AIDS to local outbreaks and epidemics of diseases that are unique to their region.
mHealth, as a solution, represents an unprecedented opportunity for improving public health in impoverished or hard-to-reach regions, especially as nearly 70 percent of people in the developing world have a mobile subscription and the familiarity with these tools already exists. Although these programs are not a cure, they do have the ability to provide a long-term solution by being used for more than access to medical information, references and resources.
In hard-to-reach regions where community data was previously nonexistent, mobile devices are capturing information and providing tracking on diseases and preventive care that can be analyzed. Since chronic diseases – such as cancers, diabetes and heart disease – account for more than 60 percent of all deaths and are by far the leading cause of mortality, according to WHO, reporting and mobile information can be valuable resources for healthcare workers who are struggling to adequately treat ongoing medical conditions. Having up-to-date medical information available at their fingertips directly at the point of care empowers the clinician to better understand how to manage these conditions.
The opportunity is real. It begins with funding and building programs that make life-saving changes to developing communities, such as the one that saved the lives of Katherine and her baby. Programs have been launched and will continue to expand, bringing mHealth and technology resources to both professionals and consumers. And as these programs grow along with the mHealth trend, technology will continue to advance, building a sustainable model to improve patient care in every corner of the globe.
About the author
Matt Linder is project coordinator, Health eVillages. For more on Health eVillages, click here.
