Imagine you live in a village in rural KwaZulu-Natal. You have a cut that's been bothering you for a few weeks, but you've no idea if it's just slow to heal, or something more serious. The nearest clinic is a good day's travel away and you'll have to stand in the queue for hours. Then there's the taxi fare there and back, and having to take leave from work. All things considered, it's easier to just wait it out and hope it goes away.
Similar situations face millions of South Africans, and people around the world, every day. But technology is increasingly being used to overcome barriers, as the ability to reach scarce resources at minimal cost opens up a wealth of potential solutions.
While health services are often out of reach, a cellphone is only ever as far as one's pocket. Given that the number of mobile subscriptions in the developing world is pushing the four-billion mark, m-health initiatives have been touted as a way to bring information and support to billions, without easy access to formal healthcare.
Some services offer potentially life-saving information about HIV testing and infant care, or remind patients to take chronic medication. Others allow health workers to transmit visual data from remote sites to specialists in medical facilities, without having to transport expensive equipment.
Despite its promising future, ITC-based healthcare has come under fire in SA recently, with two new services getting a lashing from the Health Professions Council of SA (HPCSA), for reasons that lie at the core of the medical field... ethics.
Firstly, some background: the “Hello Doctor” offering was introduced last month, following the maiden broadcast of a TV show with the same name. The aim is to give the public direct access to qualified doctors, who dispense advice on established illnesses or symptoms and the best means of sorting out medical issues.
The public can call a doctor and pay a “tele-consultation fee” (R200), or subscribe on a monthly basis to gain unlimited access to doctors. Medical content and Web-based interactions with doctors is free.
Whether the medical world likes it or not, modern technology is going to play a greater facilitating role in healthcare.
Lezette Engelbrecht, online features editor, ITWeb
Then there's MTN and Sanlam's new advisory line, CareConnect, which aims to offer basic guidance on common complaints such as stomach aches, fevers, possible poisoning, and child care.
It consists of a call centre manned by qualified nurses round the clock, seven days a week, who provide callers with simple health-related information, in 11 languages, at R5 per minute. Based on the caller's situation, nurses offer relevant info, suggest the patient visits a medical facility, or if needs be, route the call to emergency services and help organise an ambulance.
The HPCSA has called both Hello Doctor and the CareConnect line “unethical”, arguing that offering the services of a doctor as “just a call away” is in breach of patients' rights. It's also referring both programmes to its undesirable business practice committee for consideration.
Hello Doctor is now withholding its dial-a-doctor service, until it can sort things out with the medical body.
It seems like something of a knee-jerk reaction from the health professionals community, especially as Hello Doctor says it approached the HPCSA to discuss its protocols, but never received any response. If the council is really that concerned about the “unknown offerings” people may receive from these “unethical operators”, why not take the time to engage with the companies involved?
Also, it's not like the people on the other side are bored students hard up for cash - they're trained doctors and nurses. Sure, at R5 a minute, a short conversation with a CareConnect nurse could set one back a good R50. But the transport costs to get to a nurse that's going to offer similar information often work out the same. Plus there's the intermediate emotional stress of not knowing what's wrong, the time and effort it takes to get there, and so on.
The council says its ethical regulations are there to protect the public and guide professionals in providing quality healthcare. But one of the reasons so few South Africans have access to quality healthcare is because the system is burdened by millions of citizens with complaints that range from the trivial to the life-threatening, with few intermediary channels to lighten the load.
Surely, pointing the many who have simple queries in the right direction could help relieve the clogged-up national system.
Sanlam and MTN were quick to stress that the nurses' line is in no way a replacement for seeing a doctor. The goal is simply to give consumers access to basic health-related information, such as how to treat a burn, for example.
It begs the question: isn't it also unethical to deprive people of the option to access professional medical information and advice, if it's their choice, which can inform decisions and give them a better idea of the severity of their conditions?
On the same team
Hello Doctor, however, ventures into more of a grey area, as medical practitioners plan to offer diagnosis via the Web, phone and TV; one-on-one consultations; and in certain instances, prescriptions.
The point is, whether the medical world likes it or not, modern technology is going to play a greater facilitating role in healthcare. And that's the key - these services are a platform for communication and information exchange, not a replacement for professional help.
Even Hello Doctor's Ts&Cs contain the usual word of warning, that the site is not intended to be a substitute for professional medical advice and doesn't create a doctor-patient relationship. People aren't great at reading legal jargon online though, so granted, there are aspects that need re-looking, with input from regulatory bodies and established institutions.
That's why it's essential that the medical community engage with emerging complementary healthcare services, and get involved in making them safe, rather than condemning them outright.
Anyone who's ever Googled their symptoms or asked a doctor friend for some freebie advice knows the hunger for information about one's physical wellbeing. If you're worried about something, you're going to try find out what's wrong somewhere, and if there's a way to offer informed guidance on a large scale, why not pursue that, rather than leaving people to consult other, possibly dubious sources.
US health policy expert Don Berwick is known for the saying “information is care” and, while the HSPCA's concerns regarding patient confidentiality are valid, it shouldn't underestimate the value of providing quality information, to the masses, when and where they need it.
With healthcare being such an integral part people's lives, they not only need to be protected, but empowered as well. And what the medical community has to realise is that when it comes to the latter, technology is becoming people's weapon of choice.
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