Multidisciplinary Teleconsultation in Developing Countries PDF
Preview Multidisciplinary Teleconsultation in Developing Countries
TELe-Health Series Editors: Fabio Capello · Giovanni Rinaldi · Giovanna Gatti Michelangelo Bartolo Fabio Ferrari E ditors Multidisciplinary Teleconsultation in Developing Countries TELe-Health Serieseditors FabioCapello CumberlandInfirmary NorthCumbriaUniversityHospitals Carlisle,UnitedKingdom GiovanniRinaldi OspedaliRiunitiMarcheNord Pesaro,Italy GiovannaGatti EuropeanInstituteofOncology(IEO) Milan,Italy Recentadvancesintechnologyandmedicinearerapidlychangingthefaceofhealth care.Arevolutionisoccurringindiagnosisandtreatmentthankstotheimplementa- tion of instrumentation and techniques deriving from engineering and research. In addition, a cultural conversion is taking place in which geographical and social boundariesareabouttobeovercome,resultinginenhancedavailabilityandquality ofcare.Telemedicinehasbeenconsideredapossiblemeansofimprovinghealthcare worldwidethat islikely tochangetheway inwhichdoctorsdealwith patients and diseases.Whilevariousrestraintscontinuetolimittheapplicationoftelemedicinein different settings and different areas of health, the innovations emerging from eHealth and telecare could stimulate a great leap forward for medicine, provided thatsomebasicrulesaretakenintoconsiderationandfollowed.Inthisseries,diverse aspects of tele-health – preventive, promotive, and curative – will be covered by leadingexpertsinthefieldwiththeaimofrealizingthefullpotentialofthenewand excitingtechnologicalsolutionsatourdisposal. Moreinformationaboutthisseriesathttp://www.springer.com/series/11892 (cid:129) Michelangelo Bartolo Fabio Ferrari Editors Multidisciplinary Teleconsultation in Developing Countries Editors MichelangeloBartolo FabioFerrari TelemedicineUnit UniversityofRome‘LaSapienza’ SanGiovanniHospital Rome,Italy Rome,Italy ISSN2198-6037 ISSN2198-6045 (electronic) TELe-Health ISBN978-3-319-72762-2 ISBN978-3-319-72763-9 (eBook) https://doi.org/10.1007/978-3-319-72763-9 LibraryofCongressControlNumber:2018933390 #SpringerInternationalPublishingAG,partofSpringerNature2018 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartofthe materialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation, broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionorinformation storageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilarmethodology nowknownorhereafterdeveloped. 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Theregisteredcompanyaddressis:Gewerbestrasse11,6330Cham,Switzerland Foreword Nowadays,globalisationisperceivedassomethingnegative,aninevitableevilthat creates inequality, and something that nobody seems to be able to avoid. Conse- quently,anythingthatbringspeopletogetherandletsthemcommunicatewitheach otherisseenassuspicious.Threatssuchasanincreaseinthemigrationflowsandthe spread of terrorism, which appear to be encouraged by globalisation itself, only increasepeople’sfear. The reality is actually more complex than that. History, for example, is full of periodsofmigration,likethoseinvolvingItaly,between1800and1900.Likewise, therehavebeenothertimesofterror,eveninrecentEuropeanhistory. Nonetheless, there is another aspect of globalisation, which is related to the development of technology, infrastructures, connections and greater accessibility. This is the case of the improvement of the global health service which has come aboutthroughtheopportunitiesofferedbynewformsofadvancedcommunication. In this way, high-income and technologically developed countries could offer support to those left behind, making life in poor-resource settings easier at a relatively low cost. Helping people in their own countries would give one reason lessforthemtoleavetheirhome. Thisbookinfactdealswiththecreationoftechnologicalnetworkstobeusedfor training and health. In technical terms, this is called “telemedicine”; it offers “best practices” through connections between places that are very far away from each other—a sort of globalisation of medicine. This subject is fully discussed in the followingpages:itisawaytocreateanewformofinternationalcooperationthrough technology,whichwillbringafutureanddevelopmentnotonlytothecountriesthat benefitfromitdirectlybuttobothsidesofthenetwork. Until2011,therehadbeenadecreaseintheItaliancommitmenttoInternational Cooperation in Africa. In the 1990s and in the 2000s, donations were significantly lower compared to the previous decades; sub-Saharan Africa was particularly affectedbythat.During theseyears,supporttoAfricawasgrantedmainlybynon- governmentorganizationsthatreceivedmoneyfromtheCatholicChurchandother religious movements, or from NGOs and government organizations. However, v vi Foreword fund-raising for health projects and developing programs became increasingly difficult. In 2012 the trend was reversed and now Italy is again one of the main EU,G7andOECDdonors. We also changed our approach: in August 2014, a new cooperation law was approved1(n.125),whichwehadbeenlookingforwardtofor20years.Asaresult there was the creation of the Development Agency and the possibility for the Deposits and Loans Fund to become an Italian development bank. There was also anexpansionintermsofthetypesofpeopleinvolved,withthediasporas,theprivate sector,thenon-profitorganisationsandthenon-profitsectoringeneral.Thisimme- diately caused an all-round increase in the number of people involved and in the numberofprojects,anditalsoheightenedtheinterestoftheEuropeanCommission. The missions toAfrica and the African delegationspassing through Rome became farmorenumerous. ItisnotjustamatterofrenewedItalianinterestaimingtoincreasehumanitarian worksandprojectsinsomecountriesthatlackinfrastructures.Africahasbecomea strategic priority, as former Italian Prime Minister Matteo Renzi stated during his visit to Mozambique: “an opportunity and not only a continent receiving develop- mentassistance”.2Thisnewstrategicpresenceistheresultofhavingunderstoodthat AfricaisofstrategicvalueforItaly,forEuropeandforthefutureglobalgeostrategic balance. Africahaschangedtoo.Thecontinenthasgrownandtherearenewopportunities forItalyandforEurope.ThepresenceofactivismofChina,Turkey,andotherAsian countries,whichtodateiswellconsolidated,expressesthisnewglobalinterestinthe continent.Africaisayoungcontinenttoday.Forty-threepercentofthepopulation ofsub-Saharaisunder 14yearsold3—ageneration bornwith digitaltechnology— and despite the digital divide, they are perfectly technology savvy. Practically everyoneownsasmartphonetoday,andthiscanbecomeavehiclefordevelopment andcloseness. Duringtheyears,IhavebeenresponsibleforItalianinternationalcooperationand havevisitedseveralexcellenthealthfacilitiesinAfrica,setupbymanyofourNGOs. Last November I went to the Global Health Telemedicine multi-specialist teleconsultationcentreinBangui,CentralAfrica.Withthissystem,CentralAfrican doctorscanrequestandreceiveanyconsultationfromspecialistsintheWestwhoare inthenetwork,inrealtime.Clinicalrecords,admissioncharts,orconsultationnotes, togetherwithimaging,andreportsfrominstrumentalandlaboratorytestsareeasily accessible and sharable. This allows real-time or delayed consultations offering support for diagnosis and treatment. With this technology, even very poor Central Africa can come out of isolation and benefit from the best treatments. One of the problems with the global medical sector is in fact its separation, which technology 1http://www.gazzettaufficiale.it/eli/id/2014/08/28/14G00130/sg 2http://www.huffingtonpost.it/2016/05/18/conferenza-italia-africa_n_10024618.html 3https://www.internazionale.it/opinione/nicolo-cavalli/2015/08/20/africa-economia-sviluppo Foreword vii canovercome,andthesametechnologycanbeusedtoprovidedatathatisusefulfor medicineinrichcountries. Everythingdescribedinthesepagesisscientificallybased;itisnotjustaseriesof successstoriesinhealthcooperationbutitrepresentsamodelthatcanbereplicated in other geographical contexts and, why not, even in our countries. I visited many DREAM centres (in Mozambique, Malawi, Tanzania, etc.) and people with HIV whostartedlivingagain.Ialsometmotivated,well-trainedAfricanhealthstaff,with career prospects, precisely because they can operate within a network and use the bestinstrumentsanddevices.TheseareItalianprojectsthatexpressnotonlyanew health model that consists of thehighestqualitytreatment anddiagnostics butalso warmth,support,developmentandtraining. Awhileago,theHealthMinisterofGuinea,adoctor,toldmeunhappilythatall thestudentswhograduatedfromAfricanuniversitiesendedupworkinginEuropean hospitals.Irealisedthatitwasnotjustforthesalary:ifarecentlygraduatedAfrican student expects to be isolated from the continuous cycle of research, which is particularly true inmedicine, he will go wherethe informationis. So how can you keep healthcare in Africa at a level of excellence and also hold on to its doctors? Technology can solve this problem by creating a global network. The network of exchanges and contacts that are created through the thorough application of tele- medicinerepresentsaformoflong-distancetraining,aswellasanexchangeofdata and research. This provides dignity and increases the scientific knowledge and awarenessonbothsides:healthmodelsthatareintegratedandcanspreadandgrow. ItisnottruethatpoorhealthcareisenoughforAfricabecauseAfricaispoor:the experiencesdescribedinthisbookshowthatthereisonlyonekindofhealthcareand onlyonekindofhealth,thatis,foreveryone. Rome,Italy MarioGiro DeputyForeignMinister Responsiblefor InternationalCooperation Foreword Therichestandmostdevelopedcountriesintheworldhaveaseriesofservicesfor theirmanydailyhealthcareneedsthatareextremelyevolved,althoughtheydohave theirlimitsandproblems.Theyreachalmostallthepopulation,andingeneralthey alsocreateanelementofsocialstability.Wearesousedtothemthatwedonoteven askourselveshowtheyaresetup,howmuchtheycostandwhatittakestokeepthem going. We just use them; that’s all. In more advanced healthcare systems, like in Italy,weareabletomaketreatmentsandassistance,involvingconsiderablycomplex technologicalandorganisationalaspects,easilyaccessible.Oneexampleisthefact thatinsomeItalianregions,itisevenpossibletohaveabloodsampletakenathome; it is taken immediately and safely to a laboratory that operates within the regional healthservice.Thelaboratoryperformsthebloodtestandrecordstheinformationin the region’s computer systems, the administrative work is carried out and the laboratory is then paid through an electronic bank transfer. People who use this servicecanreceivetheirresultsinjustafewhoursandforwardthemtotheirdoctor inrealtimeintheInternet.Thisallappearstobequitenaturaltothem.Actuallythis service works, thanks to this complex system that absorbs considerable economic resourcesandrequiresthattheinfrastructuresinvolvedbeworkingperfectly,likethe electricpowerdistributionandtheInternetconnectionnetworks. Unfortunately,systemslikethisarenotyetpracticalindevelopingcountries,like thoseofsub-SaharanAfrica.Therearemanyreasonsforthis,butitismainlybecause of the lack of resources that has obstructed the evolution of the infrastructures and the distribution networks (of drugs, biomedical products, instruments, etc.). It is therefore difficult for healthcare organisations to be set up throughout the whole country, and progress in the use of digital technologies is very limited. Then the healthcarefacilities,mostofwhichareprivate,donotcollaboratewitheachotherto createanorganisedsystem,sotheyareunabletocarryouteffectivepreventionand providecontinuingassistance. Inordertolookatthisinrealisticterms,onecanconsidertheideaofmovingthe wholelaboratoryofourexampleabovetooneofthesecountries.Ifitwerehanded overtothepeoplewholivethere,theywouldnotbeabletomaketheserviceswork ix x Foreword ontheirown.Infacttheywouldnotbeabletoprovidethenecessaryinfrastructures and supplies, which in developed countries are considered routine and in fact do involveroutineactivities.Theywouldnothave,forexample,efficientelectricpower supply networks to avoid the malfunctioning of any of the sophisticated electronic laboratory systems. Neither would they have enough qualified technicians to take careofthemaintenanceoftheequipmentandrepairingbreakdowns.Moreover,the Internetconnectionswouldbeunstableandnotevenbeavailableineverypartofthe country. Inthepoorestcountries,theseissuesconcernallthehealthcareactivities,boththe most basic ones and even more so the highly technological activities, such as telemedicine.Soitlooksasthoughitwouldbeverydifficulttosetuptelemedicine services and impossible to keep them running efficiently, in the very places that wouldbenefitfromthemmost. ThebenefitofthecollaborationbetweentheDREAMprojectoftheCommunity ofSant’EgidioandtheGlobalHealthTelemedicine(GHT)non-profitorganisationis thatitproposedaneffectivesolutiontotheabove-mentionedproblems,whichcanbe maintained over time, and this solution has already been successfully set up in several countries in Africa. In fact, by using the features of telemedicine and the brilliantinnovationsintermsoftheITprocesses,theDREAMandGHTnetwork,in collaboration with the local authorities, is able to overcome these apparently unre- solvable issues, and it also covers the costs of setting up and running all the necessary IT systems. With extensive telemonitoring and clinical teleconsultation services, this network makes it possible for the African healthcare staff to use biomedicaldevicesandreceivespecialistmedicalconsultingfreeofcharge. What has made it possible to achieve this extremely valuable result is basically the fact that the whole telemedicine system was designed and set up with the very highest clinical standards. This is why the Italian Society of Digital Health and Telemedicine is actively promoting the DREAM and GHT platform, which has alreadybeensupportedbyauthoritativeItalianexperts,andislookingforwardtoand encouragingamoreandmoreextensiveuseofthissolution. Another interesting aspect of this solution is that the teleconsultation activities performedbytheGHTnetworkhavemadeitpossibletoincreasethecollaboration betweenItalianexpertsandlocalhealthstaff. The local health staff obviously had to be trained to be able to use the digital instrumentsandbecomefamiliarwiththeinnovationsintheprocessesused.Onthe other hand, the Italian GHT Teleconsultation specialists sometimes found them- selvesdealingwithsevereclinicalsituations,withoutbeingabletoresorttosophis- ticated diagnostic instruments. Theyhadto rely on simple rural healthcare centres, maybe run by just one nurse, for the advice they gave regarding diagnosis and treatment. This was a new situation that the specialists, although experts in their field,hadtoquicklylearntocopewith,frombothatechnicalandahumanpointof view,inorderto“rethink”theiroperativeclinicalresponses. Itwasaquestionofdirectingthetherapeuticsolutionstowardsthegoodpractices they areused toandoffinding solutions thatcould be applied inthelocalcontext.
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