Telemedicine in South Africa

Imagine you are in downtown Toronto. You are a young energetic 20-year old college kid. No kids to worry about, you are just enjoying your youth and having fun. You are going to see a Beetles concert with two of your closest friends and are just waiting for a streetcar to get onto to take you to where you need to go. People have been talking about this concert for weeks now and you and your friends are super excited to finally get to see the big show. Up ‘til now you guys have travelled by bus, subway and taxi to get from your urban homes to the point where are you are at now.

Now imagine that you live in a small rural village in South Africa where your community is very much family-oriented. Everyone gathers their own food to feed their families. On many days you see your neighbour’s two small children running around with a ball in their hands. Their faces glowing with laughter and smiles as they play in the dirt track that crosses your little shack home that’s made from tree branches with those of your neighbours. Sometimes, your neighbours might supply you with their favourite dish just as a nice gesture. The village itself lies several kilometers through the bush with no electricity, no telephone and no running water.

You are a poor South African 35-year old woman who already has 10 children you need to support. You work on the land that surrounds you: gathering maze you planted in early spring, digging deep into the soil to extract the nutritious roots and vegetables that are part of your diet, you squeeze your cow every morning so she can provide your children their daily milk intake. You work hard every day from dawn ‘til dusk, every day of your life to support those children. But, what if you fall ill with a serious disease, such as malaria or HIV? The nearest clinic is 20 kilometers away by wagon and isn’t even fully equipped to treat your disease. And the nearest major hospital that does have the capacity to treat you is another 30 kilometers away. Now what?

ICT or information and communication technology is a growing trend in developed countries, such as Canada and the U.S. However, in some fields, such as in healthcare we aren’t the only ones who can benefit from it. Telemedicine has been around for almost 40 years, first in the form of experimental programs to see how it works communicating with patients from different hospitals then being installed permanently in some North American hospitals. Now it’s gone global, but still relatively few people know about this technology within general society and even within the scholarly community itself. So, what exactly is telemedicine anyway?

According to the American Telemedicine Association, “telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” In simpler terms telemedicine is the use of video conferencing to connect with patients at a distance. Telemedicine also ranges in its capabilities to help people in different parts of the country and in different parts of the world. The spectrum ranges from simple video consultations through two-way video with the doctor-at-hand to “virtual hospitals” offering a full range of home care for HIV patients

Telemedicine allows for South Africans who are living out of reach of major hospitals in poorer areas and suffering from HIV/ AIDS to get treated by connecting qualified North American doctors with South African hospitals and their patients. Physicians are able to build up their knowledge of the patient, treat them more confidentially, and make fewer referrals by video conferencing because telemedicine enables doctors to connect with HIV specialists as well as the patients themselves simultaneously. Telemedicine has also been proven to be cost effective by reducing travel times, allowing HIV positive patients to interact with North American doctors from the comfort of their own homes instead of being hospitalized, and studies have shown that telemedicine provides the same or higher quality healthcare than traditional hospitalizations.

Despite these pluses in incorporating telemedicine as part of the healthcare system, South Africa has been slow in implementing the ICT into its system. Why is this? We as citizens in the developed world may take even the simplest things for granted forgetting that millions of people worldwide sometimes don’t have enough food to feed their families, never mind having ICT advancements put in place by their government for ordinary people to use. An academic research study called ICT applications as e-health solutions in rural healthcare in the Eastern Cape Province of South Africa both confirmed this seemingly obvious fact and added more reasons to why healthcare in South Africa hasn’t caught on with the developed world.

The results from this 2010 research study indicate that the local economy has been compromised by the lack of infrastructure, services and expertise; this includes lacking specialization in the ICT industry. Interestingly, the study also found that there may be psychological barriers stopping South African practitioners from using telemedicine. The psychological barriers come under one umbrella term known as the Technology Acceptance Model (TAM). TAM then branches out in two ways. One is the perceived usefulness of the technology or “the extent to which a person believes this particular technology will benefit or enhance job performance”. The second barrier is the perceived ease of using the technology. Is it too complicated to use frequently? Another issue is geographic location where most South African reside in rural areas where rural hospitals/ clinics are the ones struggling to connect with ICT.

A study of 56 South African participants in five healthcare centers throughout Eastern Cape were put three categories 1) the hospital managers 2) staff (doctor, nurses, administrators) 3) the hospital inpatients at the time of the survey. The results show that:

Hospital #1: had telemedical equipment and internet capabilities, but very few computer which limits the realization of benefits to ICT.

Hospital# 2: technology is slightly better, but still limited.

Hospital# 3: had decent--quality ICT, however, they weren’t available in all hospital departments. The ICT is widely distributed.

Hospital# 4: had computers for telemedicine, but due to unreliable internet sometimes the ICT worked, other times it did not.

Hospital# 5: has ICT technology, but again internet connection is unreliable.

As you can see overall the study confirmed that ICT use in the Eastern Cape region of South African was weak due to the unreliability of the Internet. This data can be expected from a nation that is so new to ICT industry and has a history of being at a disadvantage economically.

In my own primary data collection I asked 15 people eight questions about what their experiences were using Skype, their thoughts on Skype technology being used in the healthcare industry, and on any negatives to use in terms of language barriers and/or any issues directly associated with the ICT itself.

These are my results. When I asked the question, “Do you see any setbacks to using Skype when re-connecting with loved ones? 13 out of the 15 people questioned answered a firm “yes”. When asked to be more specific and say what kind of troubles they had when using Skype many of them said the trouble starts when Skype freezes up mid conversation, there is poor internet connection similar to the issues present in the Eastern Cape study, or the camera completely blanked out.

Similarly, when I asked “Do you foresee any drawbacks with telemedicine technology?” since Skype and telemedicine share the same video conferencing system my respondents had similar replies with an additional language barrier issue.

When I asked how can we” fix” the language barrier problem many replied that there should an interpreter standing with the North American doctor or the South African practitioner and the patient and who translate between the patient and the American doctor. Yes, getting a interpreter may be the first thing people think of when there is a language barrier involved. However, what people don’t realize the cost of hiring an interpreter and the relative difficulty of finding one that knows those two languages. This is especially true for South Africa where each community may speak a different language or dialectic from the one neighboring it.

The second most popular response I got from asking this question was having a diverse group of medical professionals that speak many languages. This is also a problem because most South African practitioners don’t even know as much in their medical specialization as do their North American counterparts. A South African doctor that knows multiple languages is a rarity because of the education levels associated with such a poor country as South Africa. On the other side of the telemedical screen North American doctors don’t know any African dialect to be able to communicate with their South African patients unless they have some African ancestors in their family lineage.

One solution to the problem is to get a translator installed right into the video conferencing software. Skype recently invented a translation system that is an add-on to the overall Skype experience. Presently, the app can translate speech in six languages: English, German, French, Italian, Mandarin and Spanish. Skype is planning to introduce even more languages in the near future, but how it works is if two people are talking through Skype but both only speak in their native tongues (perhaps one person only speaks English and the other knows only his native Italian) the app will automatically translate the other person’s conversation as that person speaks. In this way, both of them have no trouble understanding each other despite knowing not one word of the other person’s language. This same kind of translating app can be installed in telemedical technology when more languages are released to help the South African patients and their North American doctors understand each other. This would also get rid of the possibility that the patients didn’t take the right prescription or totally wrong drug than the one the doctor prescribed just because s/he misunderstood the doctor’s instructions. Telemedicine is the future of medicine, although there is much that still needs to be improved in South Africa’s acceptance and use of ICT in the healthcare industry.

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"What Is Telemedicine?" What Is Telemedicine. American Telemedicine Association, n.d. Web. 01 Dec. 2015. Illuminated Blog posts can be found at: https://stephanie-bell-m08b.squarespace.com/config#/|/blog-season1/