Telehealth in low-resource settings: In conversation
INTERNATIONAL HOSPITAL FEDERATION, Geneva, Switzerland
Article by Victoria Del Pozo from the International Hospital Federation:
Dr. Sai Praveen Haranath, Lung and Critical Care specialist and leadership of the Apollo Hospitals Telehealth Initiative, sat down with Sharon Allen CEO of the World Telehealth Initiative (WTI), for a conversation on the use of telehealth in low-resource settings.
“What we have seen through the IHF is that there’s great interest in delivering care remotely. Many people have realized that through this medium, you’re able to cross barriers and reach those who cannot be reached otherwise. It has huge potential for underserved populations”.
Sharon Allen described how WTI started as the vision of Dr. Yulun Wang, who has been in medical robotics for his entire career. With the knowledge that half the world’s population does not have access to adequate healthcare, he knew the technology he had developed could help deliver necessary expertise where it’s needed.
“WTI leverages volunteer medical experts and telehealth to deliver care to impoverished areas of the world. We use advanced telehealth technology, yet we can establish programmes in vulnerable communities for low to no cost. And we can do that because Teladoc Health donates their network access and their telehealth devices to WTI. Our medical experts also donate their time and expertise, which allows us to serve very low resource communities for free”.
As an example, Sharon shared the compelling story of Julian, a three-year-old boy from rural Argentina, who had weakness in his limbs, and was having difficulty breathing. WTI connected his remote health facility with a pediatric neurologist, who worked with on-site colleagues to review MRI images and was able to point out tiny lesions in Julian’s nerves. With this expertise, they were able to diagnose and prescribe medications. “He rapidly improved and started breathing on his own. Now I’m told he’s at home playing with his five siblings”.
Is lack of technology a barrier in low-resource settings?
Dr. Sai explained that all patients want to know if you understand them and their health issue, regardless of the setting. “People have the notion that tech is difficult. But to be honest you see people all around the world using their phones for various services. Mobile phones have become integral to our lives and a lot of telehealth is being done through that. What I realized is that technology is not a barrier anymore…”
Sharon added that in many countries internet access is becoming increasingly available thanks to the efforts of government and NGOs.
"With 5G and Starlink, WTI can connect clinicians requesting support to providers that have that required expertise. Since the start of the conflict in Ukraine, our partners have primarily been using Starlink and it has been tremendous. One example is a patient requiring neurosurgery. The team of neurosurgeons in Ukraine were familiar with a new procedure that would yield the best outcome but hadn't ever done it. They requested virtual support by a neurosurgeon familiar with that operation, who gave surgical mentoring throughout the procedure, leading to a very successful result for the patient" Sharon shared.
Patient and clinician trust of telehealth
When it comes to patient trust, Dr. Sai has found that most patients focus on the outcome rather than the delivery method. “You know, when you’re on an airplane, you don’t know who the pilot is, nor who filled the fuel in the plane. And then it turns out that you’re safe and you’re moving from one place to the other”.
Sharon shared a story of the positive reception of telehealth by patients in one of the remote WTI sites. “We work in the very remote village of Opoji, Nigeria and it was very difficult to get our devices there as there were bandits on the road. The patients in this very remote village were moved to tears at the sight of advanced healthcare tools reaching their community, creating lasting trust and appreciation”.
From the perspective of telehealth care providers, Sharon points out the positive experience of many doctors, based on a very rich engagement between providers in different locations.
“For example, we’re doing POCUS training with many of our partner sites. A group of emergency room physicians from the US share the curriculum that they use with new doctors. Doctors in the partner sites learn how to diagnose pneumonia, one of the primary causes of death in sub-Saharan Africa for children under 5, and how to diagnose internal bleeding. We’re able to teach this in a live training. The teachers in Florida can see the ultrasound images via telehealth because of the interoperability of the Butterfly diagnostic device”.
The technology of telehealth is changing so rapidly that we are only at the start of the telehealth journey.
“We are at a critical juncture where we can make healthcare delivery far more efficient and effective and actually make a meaningful and sustainable impact on global health disparities”.