A clinical officer uses The Virtual Doctors' app to get more information about a girl's symptoms.

Can telemedicine revolutionise rural healthcare in Africa?

Interview with Huw Jones

Executive Director & Founder at The Virtual Doctors

Location: Zambia

“If you’re got education and health, that’s a foundation.”

Huw Jones traces the earliest origins of The Virtual Doctors to a trail of blood he saw while travelling through rural Zambia to buy pumpkins for soup. It was the mid-1990s and he was employed there as a safari guide.

Soon, he found the source of the bleeding: A woman riding on a bicycle pedaled by her husband. She’d gone into labour and they were trying to reach a hospital about 60 miles away. Jones gave the couple a ride in his car, but it was too late. “It kind of just blew me away, watching her bleed to death in the back of my vehicle,” he says.

The more Jones learned about health care in Zambia, the more problems he discovered. Twenty to 30 percent of visits to rural clinics ended in a referral to the local hospital, resulting in expensive and time-consuming trips. Particularly if the patient was the head of a household, these journeys could cause real financial damage. Often, the referrals could have been avoided if the local clinician had access to more information.

Jones was not a doctor, so he couldn’t help patients directly. But he knew many doctors from around the world who’d worked in Zambia and wanted to stay involved. He imagined a network of volunteer doctors who would take questions from health clinic workers in the countryside, thereby providing better diagnoses at the local level and reducing the need for referrals.

The question was how to get the clinics connected to the volunteers—and an answer came in the development of the African mobile technology. In 2007, Jones set up an early version of the programme, grabbing broadband internet access through a satellite dish connection. That worked—at least when electricity was available—but it was expensive and prone to being knocked out of order when birds landed on it.

Soon, the development of Zambia’s mobile network came into play. A tower was built near the health clinic where Jones was working, and began providing service. In 2009, The Virtual Doctors switched from satellite to the tower, and the monthly costs dropped from US$200 to US$20 overnight.

A clinical officer in rural Zambia uses The Virtual Doctors' custom app on a laptop to help diagnose a child's illness. The programme has since moved from laptops to smartphones.
A clinical officer in rural Zambia uses The Virtual Doctors’ custom app on a laptop to help diagnose a child’s illness. The programme has since moved from laptops to smartphones.

With that hurdle out of the way, The Virtual Doctors purchased small, cheap laptop computers that allowed rural health clinic workers to access the group’s network of medical professional. In 2015, they switched over to smartphones or tablets running the project’s own custom-built app. Today, the nonprofit works in 22 rural health centres and two rural hospitals, which together serve an area that’s home to 1 million people.

Development of the app was one of the main challenges along the way. Most existing diagnostic software had been built for the Western health system, and wasn’t appropriate for rural health clinics where technology was limited and time was at a premium. Jones saw that a custom app could solve the problem, but there was no way his group, which has a yearly budget of about US$160,000, could pay a team of software engineers.

The solution was volunteerism. Jones found a firm that was willing to contribute a team of pro bono coders, who work on the project once a week. He says they’ve put in a total of about 2,500 hours so far, and have travelled to Zambia to see the results of their work on the ground. “We pay for the pizza and they do the coding,” he says.

The flexibility of custom software allowed The Virtual Doctors to control the flow of information to its rural users. For example, the questionnaire in the app captures only the bare minimum of information a doctor would need to be able to give advice. “They can’t do a long-winded form,” Jones says. So the app asks only for age, sex, pulse, blood pressure, an image, and symptoms.

Once the form is complete, volunteer doctors in the network get an alert they can use to view the encrypted information. In many cases, they’ll simply concur with the local clinician’s opinion. In others, they’ll suggest a new diagnosis or send the clinician additional information.

Jones says that system helps local health workers keep learning. “They need to use the app less and less,” he says. “They’ll have that knowledge”.

A clinical officer uses The Virtual Doctors' app to get more information about a girl's symptoms.
A clinical officer uses a smartphone to enter information into The Virtual Doctors’ app.

A few years from now, Jones would like to see the project continue to grow. He hopes it can provide service to 100 to 200 of Zambia’s total 1,200 health centres, and to reach into neighbouring countries like Malawi and Tanzania as well.

He’s also hoping to broaden the sources of The Virtual Doctor’s funding, most of which today comes from trusts and foundations in the United Kingdom. He’s been doing outreach to Zambian businesses, with a special focus on local telecom companies that might be able to donate bandwidth.

“They’re beginning to listen now,” he says. “Mobile phone companies haven’t contributed yet, but maybe, when they see the potential, they might.”

—James Trimarco, Writer and researcher @jamestrimarco

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