{"id":780,"date":"2019-04-18T10:06:17","date_gmt":"2019-04-18T10:06:17","guid":{"rendered":"http:\/\/horizon.peachpuff-wolverine-566518.hostingersite.com\/?p=780"},"modified":"2019-04-18T10:06:17","modified_gmt":"2019-04-18T10:06:17","slug":"real-time-whatsapp-advice-aids-surgery-in-rural-malawi","status":"publish","type":"post","link":"https:\/\/scienceblog.com\/horizon\/780\/real-time-whatsapp-advice-aids-surgery-in-rural-malawi\/","title":{"rendered":"Real-time WhatsApp advice aids surgery in rural Malawi"},"content":{"rendered":"
\"A<\/a>
A WhatsApp group for surgical advice is reducing the number of patients needing to be transferred between hospitals in Malawi. Image credit – Jakub Gajewski<\/figcaption><\/figure>\n

In remote, rural corners of Malawi, hospitals are often faced with life-and-death decisions. Women in need of emergency caesarean sections, older people with hernias, and children with appendicitis need surgery. But should they be rushed to the operating theatre or transferred to specialists in city hospitals?<\/strong><\/h3>\n
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The answer depends on the patient\u2019s condition, the distance to the city, and the facilities available at the local hospital. Surgical skill, clinical experience and confidence are also critical factors.<\/p>\n

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Until recently, smaller hospitals, typically with around 200 beds and just two or three qualified general practitioners (GPs), usually recent graduates with a couple of years\u2019 experience, often felt it safer to transfer patients for surgery.<\/p>\n<\/div>\n

A handful of clinical officers \u2013 a grade of health professional without a medical degree \u2013 is responsible for transfers and sometimes provide routine surgical procedures in rural clinics. While vital to local health systems, their surgical experience and clinical judgment may be limited and many feel professionally isolated from teaching hospitals.<\/p>\n

\u2018Clinical officers are not surgeons per se and they are not well connected to surgical specialists. But with supervision, there is a lot they can do,\u2019 said Gerald Mwapasa, a researcher at the College of Medicine, University of Malawi.<\/p>\n

Mwapasa is the moderator of an invite-only WhatsApp group that allows health workers to ask specialists for advice before \u2013 or sometimes during \u2013 surgical operations.<\/p>\n

\u2018Before the WhatsApp groups, doctors in regional hospital felt specialists were difficult to reach, now they are approachable,\u2019 he said.<\/p>\n

The group\u00a0arose as part of a project called\u00a0SURG-Africa<\/a>, of which Mwapasa is the Malawi project coordinator. The aim is to expand access to safe surgery in sub-Saharan Africa through training, supervision and the increased use of the\u00a0World Health Organization\u2019s surgical safety checklist<\/a>.<\/p>\n

As part of the project, researchers in Malawi are working to strengthen district-level surgical teams and the links between rural and urban referral hospitals. They considered developing an app to connect health professionals and enable them to share images and videos, but they realised that WhatsApp was a solution right under their nose.<\/p>\n

Vital support<\/strong><\/p>\n

The group has become a vital support for rural hospitals faced with clinical dilemmas.<\/p>\n

\u2018It gives clinical officers confidence when making decisions,\u2019 Mwapasa said. \u2018They can get advice on performing hernia surgery, or how best to prepare a patient for transfer rather than attempt a procedure that the hospital might not have the facilities to manage.\u2019<\/p>\n

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\"In
A WhatsApp group for surgical advice is reducing the number of patients needing to be transferred between hospitals in Malawi. Image credit – Jakub Gajewski<\/figcaption><\/figure>\n

In 2018, 65% of the cases submitted to the WhatsApp group received a recommendation from a specialist within an hour. Image credit – SURG-Africa<\/p>\n<\/div>\n

In 2018, around 200 cases were discussed by the group, all of which would have previously been referred to urban hospitals. Thanks to the advice given, less than two-thirds of these patients had to be transferred.<\/p>\n

Martin Malunga, a clinical officer who does surgery at Mulanje District Hospital in southern Malawi, says the group is a valuable educational tool.<\/p>\n

\u2018If one district (hospital) posts a case and a consultant responds, then all of us learn,\u2019 he said. \u2018The WhatsApp group has improved management by providing advice on how to operate or what to do before to referring a patient to a specialist.\u2019<\/p>\n

This view is echoed by Dr Tiyamike Kapalamula, a paediatric surgeon at Queen Elizabeth Central Hospital in the financial capital Blantyre who offers advice via WhatsApp.<\/p>\n

\u2018The cases that are recommended for referral arrive here in better shape because the basic investigations, resuscitation and preparation work is already done at the district level,\u2019 she said.<\/p>\n

Strict guidelines apply on what content can be posted. To safeguard privacy, no patient names, faces or identifiable images are shared. Around 40 questions per week are shared, usually by clinicians at one of the nine participating district hospitals. Initially it was a challenge to brief people on the group\u2019s purpose, says Mwapasa, but it\u2019s now easier to manage.<\/p>\n

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\u2018If one district (hospital) posts a case and a consultant responds, then all of us learn.\u2019<\/p>\n

Martin Malunga, clinical officer, Mulanje District Hospital<\/p>\n<\/blockquote>\n<\/div>\n

Since starting in March 2018, more than 160\u00a0healthcare workers have signed up. Another group has started focusing on obstetrics and gynaecology.<\/p>\n

Teams of specialists also visit remote areas to provide training and mentorship, according to SURG-Africa project leader Dr Jakub Gajewski, who is at the Royal College of Surgeons in Ireland. Before, rural clinicians had limited contact with specialists between visits, but with the group they now stay in touch.<\/p>\n

\u2018This helps reduce the sense of isolation for doctors working far from teaching hospitals,\u2019 he said.<\/p>\n

Whole system<\/strong><\/p>\n

Dr Gajewski says the project is helping to unlock the potential of health workers and, by cutting out unnecessary referrals, specialists can focus on complex patient cases they are trained for. \u2018The whole system benefits from this,\u2019 he said.<\/p>\n

With representatives from the Ministry of Health, the Medical Council and the blood transfusion service in the group, members have been able to flag supply shortages and swiftly receive replacements for tools such as surgical lamps.<\/p>\n

The initiative has garnered interest in Zambia, Tanzania, and Rwanda where surgeons are keen to explore how a messaging app could bridge the gap between surgical communities and improve the lives of patients and doctors.<\/p>\n

But for health services in sub-Saharan Africa, one of the biggest challenges remains the limited availability of health professionals. Too few are trained and many leave Africa to develop their skills. Most African nations have\u00a0fewer than one doctor per 1,000 people<\/a>\u00a0\u2013 the\u00a0EU average<\/a>\u00a0is more than 3.5 per 1,000.<\/p>\n

The\u00a0implications of this can be devastating.<\/a>\u00a0Take maternity care, for example. While Africa is the continent with the\u00a0highest birth rate<\/a>\u00a0–\u00a0Malawi\u2019s fertility rate is 5 births per woman<\/a>, for example – maternal mortality rates in sub-Saharan Africa are significantly higher than other regions of the world at\u00a0920 maternal deaths per 100,000<\/a>\u00a0live births<\/a>. \u00a0<\/a><\/p>\n

\u2018Without enough health professionals, either the quality or accessibility of care is dramatically affected,\u2019 said Professor Paul Cunningham of International Information Management Corporation (IIMC), an Irish tech company coordinating\u00a0mHealth4Afrika<\/a>, a project focused on improving primary healthcare in Ethiopia, Kenya, Malawi and South Africa.<\/p>\n

Technology is critical for strengthening the delivery and and scaling access to primary healthcare, he says.<\/p>\n

For local health decision-makers, a key challenge is collecting accurate data from clinics so that they can predict demand and therefore plan future investments. For patients, better use of resources would reduce the long waiting times for high-demand health needs.<\/p>\n

Primary care<\/strong><\/p>\n

While there has been a move towards electronic patient records in urban hospitals in many African countries, Prof. Cunningham says paper-based records remain the default mode for primary care data collection.<\/p>\n

Working with partners in Africa, Norway and Turkey, IIMC has co-designed a patient-centric health IT system used by health ministries and district offices, clinic managers and nurses in the four African countries. He described it as a \u2018cradle to grave\u2019 approach to patient care, tracking health information throughout their lives \u2013 and building confidence in healthcare IT in the process.<\/p>\n

This electronic system can capture and integrate personal health records as well as compare medical data over time. The platform can save time during consultations and gives health professionals up-to-date patient information to help guide decisions.<\/p>\n

By automating the counting of key health indicator data, such as births, deaths, vaccination rates and illnesses, staff can instead focus on clinical tasks, while health ministries have access to more accurate data to inform policy and service planning.<\/p>\n

The platform now incorporates key medical programmes including maternal health, tuberculosis, HIV\/AIDS and cervical cancer screening. Support is currently being added for diabetes, malaria and hypertension \u2013 all major challenges in the region.<\/p>\n

The research in this article was funded by the EU. If you liked this article, please consider sharing it on social media.<\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n

This story was originally published on Horizon<\/a><\/em><\/div>\n

More info<\/strong><\/p>\n

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SURG-Africa<\/a><\/p>\n

mHealth4Afrika<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

In remote, rural corners of Malawi, hospitals are often faced with life-and-death decisions. Women in need of emergency caesarean sections, older people with hernias, and children with appendicitis need surgery. But should they be rushed to the operating theatre or transferred to specialists in city hospitals? The answer depends on the patient\u2019s condition, the distance … Read more<\/a><\/p>\n","protected":false},"author":313,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"generate_page_header":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[12],"tags":[37,249,248,28,250],"class_list":["post-780","post","type-post","status-publish","format-standard","hentry","category-health","tag-health","tag-malawi","tag-surgery","tag-technology","tag-whatsapp"],"yoast_head":"\nReal-time WhatsApp advice aids surgery in rural Malawi - Horizon Magazine Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/scienceblog.com\/horizon\/780\/real-time-whatsapp-advice-aids-surgery-in-rural-malawi\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Real-time WhatsApp advice aids surgery in rural Malawi\" \/>\n<meta property=\"og:description\" content=\"In remote, rural corners of Malawi, hospitals are often faced with life-and-death decisions. 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