Telemedicine to shore up healthcare training

The Egyptian government has pledged to help Rwanda Military Hospital, Kanombe with the putting in place of a telemedicine unit at the facility.
Doctors at Rwanda Military Hospital, Kanombe, perform an operation. (File)
Doctors at Rwanda Military Hospital, Kanombe, perform an operation. (File)

The Egyptian government has pledged to help Rwanda Military Hospital,  Kanombe with the putting in place of a telemedicine unit at the facility.

The pledge was made last weekend by Egypt’s envoy to Rwanda, Amb. Namira Nabil Mohamed Elmahdy Negm, during the inauguration of a hemodialysis unit, the first of its kind in the country.

Telemedicine allows healthcare professionals to evaluate, diagnose and treat patients at a distance using telecommunications technology and, Rwandan doctors say that, once established, the new facility – a mobile telemedicine unit – will significantly shore up healthcare provision and teaching.

Col Alex Butera, an orthopaedic surgeon at Rwanda Military Hospital, Kanombe (RMH), said telemedicine is used to connect medically deprived or geographically distant areas with medical centres so that on-site personnel can provide services with distant help.

Telemedicine services can range widely by specialty.

Butera said it has diverse technologies and applications, including “teleconsultation” in numerous specialties such as internal medicine, pediatrics, ophthalmology, surgery, orthopaedics, dermatology, cardiology, urology and disaster medicine.

There is also application in what he termed as ‘teleradiology,’ the “transmission of radiological patient images such as X-rays, CTs from one location to another for purposes of sharing studies or helping in interpretations” and telepathology, among others.

Telepathology is the practice of pathology at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education and research.

“The functions are getting better and more advanced day by day as we get better internet facilities and more clear pictures through augmented vision, real time augmented reality, and artificial intelligence,” said Butera.

Currently, referral hospitals like RMH, King Faisal Hospital, Kigali (KFH), or Central University Teaching Hospital of Kigali use teleconferencing with district hospitals in Rwanda and with other hospitals abroad (US, India and elsewhere).

According to a 2010 World Health Organisation (WHO) report on the second global survey on eHealth, which examines trends in the uptake of telemedicine, telemedicine applications successfully improved the quality and accessibility of medical care by allowing distant providers to evaluate, diagnose, treat, and provide follow-up care to patients in less-economically developed countries.

“Telemedicine has been advocated in situations where the health professional on duty has little or no access to expert help,” reads part of the report.

By opening up new channels for communication, telemedicine connects rural and remote sites with health-care professionals around the world, overcoming geographical barriers and attempting to reverse brain drain.

“Telemedicine is definitely something that will be very beneficial in a developing country like ours, where we have a big shortage in health care specialists or doctors in different fields,” said Dr Edgar Kalimba, a consultant paediatrician and pulmonologist at King Faisal Hospital, Kigali.

“Telemedicine bridges the gap between the people or the centres and institutions that have the expertise in terms of doctors with people like us who have very limited expertise.

Lower cost of service

According to the Egyptian envoy, the impact of telemedicine is basically the capacity to diagnose and operate more complex cases.

“For example, if a surgeon faces a complicated case, that he or she is doubting the diagnosis, through the unit images of the case; X-ray, CT scan can be seen on the spot by a more senior surgeon in Cairo or anywhere else in the world,” she said.

“The specialist far away will be able to assist the Rwandan surgeon in the diagnosis. Moreover, if this complex case will require surgery, the senior surgeon will be instructing the junior surgeon during the operation and will be able to monitor the case online. It is an absolute revolution in medicine.”

According to the envoy, this will lower cost of the service rendered to patients “and many cases won’t need to be transferred” outside of Rwanda.

This, she said, is basically what happened in Egypt when telemedicine was first integrated in healthcare. She explained that in many teaching hospitals, where they use telemedicine, physicians were able to perform more complex operations and not turn the patients away.

“Seeking treatment abroad is very costly for many, and people can’t afford to go to more expensive destinations for treatment,” she said.

“It helps a lot in advancement of health services without the need for receiving senior specialists from abroad so frequently. It helps in training doctors in their respective places and it helps in delivering better health services to the population.”

According to Dr Theophile Dushime, the director-general of clinical services at the Ministry of Health, some 50 patients, on average, are referred abroad by the national medical referral board for treatment annually.

“But you must not forget that other people go abroad for treatment without seeking government support or being recommended by the referral board,” he added.

Opportunity for learning

Besides giving Rwandans access to highly specialised healthcare providers, Dr Kalimba noted, telemedicine will add value in the process educating the country’s health professionals.

“Telemedicine will also be extremely beneficial in terms of teaching whereby an expert in a certain medical field can teach doctors and medical students from anywhere around the world,” he said.

Dr Francoise Gahongayire, a dermatologist at King Faisal Hospital, Kigali, said telemedicine facilitates continuous medical education.

“Healthcare providers in developed nations are provided with an opportunity to learn to treat neglected diseases, which they very seldom see in person,” he said.

According to the WHO report, telemedicine creates a university without borders that fosters academic growth and independence because local participating surgeons have direct access to experts in the developed world.

Amb. Elmahdy said the machines will be delivered to Rwanda Military Hospital, Kanombe, by Saturday.

Several hospitals in the country use teleconferencing facilities. However, telemedicine projects have only started at Shyira Hospital in Nyabihu District, and Ruli Hospital in Gekenke District.