Now here’s an often forgotten rule for a happy working life: Celebrate your successes! Especially since some things are not that easy to achieve. Tasks that might seem quite simple at first sight here can be incredibly difficult to complete. Take tele-medicine, for example. There is a simple free service available from a British charity (swinfencharitabletrust.org).  It’s a no-frills online platform for writing up case referrals and uploading photos of x-rays, ultrasound images, visual indications of the patient’s condition etc. Within a day or two a volunteering specialist doctor from somewhere around the world will reply via the platform and comment on the case. Often a dialogue ensues, more detailed information is requested, provided and commented upon.

Given the lack of people called doctors in most hospitals, let alone well qualified specimens or specialists, this service seems heavens-sent, a no-brainer. The service was introduced in all hospitals before we arrived here in 2011. It wasn’t used. And now it’s taken us over half a year to get the first hospital hooked on this.

So what are the barriers?

Technical:

• You need a PC
• You’d better have a camera
• You need more or less stable and not too slow internet
• You need technical support if there are problems

Skills-related:

You need to be able to:

• use a computer
•  use a camera and upload pictures
• write medical referrals in English
• understand medical advice in English

Attitudinal:

• Admittance that help is required
• Interest in trying something new
• Willingness to enter into a medical dialogue with a peer
• Willingness to commit time to writing the referral and reading replies
• Ambition to help the patient (you thought every health worker had this? Come to Africa.)

Now you can probably guess which of the three types of barrier is the trickiest to overcome. You can buy computers, sit people down in front of them, give them lessons in this that and the other. If you don’t have someone with the right attitude it’s all going to go nowhere. I have to say, out here it’s a constant reminder: It’s all about people, people, people.

So now we are super delighted that we have found the right kind of people in one of the hospitals in Pemba. We’ve set up computers they can access in the little hospital “resource centre” we have established, with the link as a bookmark on it, easy to access.

The new resource room

The charity has provided them with a camera. The internet is semi-stable, there is an administrator who can give a bit of technical support. We have the nurse matron who can use a computer, can use a camera and whose English is reasonably good. And a radiographer whose English is pretty good and who is also computer-savvy. Note: They are both not doctors so under usual circumstances would be seen as the wrong kind of people!  BUT: They are both dedicated, ambitious, disciplined and charitable. What a find! When we did an induction with them we submitted the first couple of cases together.

Interruption a serious team effort at posting case number 1

By the way, it took anything between 1 and 25 minutes to upload a photo such as this one.

Pneumonia?

We agreed with them that the matron would make the rounds each Wednesday to ask doctors whether they had cases worth referring, help them with the camera if photos were necessary, help them write the referral. I promised to keep track of what they are doing in the system and ask them for regular feedback to see how things are going.

Since mid November they have submitted 8 cases. In one case the doctor suspected Huntington’s disease to be the diagnosis for a 34-year old woman and asked whether videos showing her sitting, moving her hands and walking were available. They made three vids and uploaded them, without asking for help, advice, anything. The specialist’s suspicion has been confirmed and advice on medication and treatment was given.

After having had many attempts with doctors in other hospitals at getting this up and running, I must admit I just wanted to cry when I checked in the system for the first time and had seen that without any prompting whatsoever from our side they had made 2 additional referrals. Cases cover skin diseases, all sorts of infections, tuberculosis, tumors etc.

We’re now inviting them to come with us to the other hospitals on the island when we organise induction sessions. Let them inspire the others.

It might not seem like a big thing to you, but this does mean contributing to saving lives or at least making some people’s lives more bearable. A small success. Hongera! Congratulations to all involved….