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Digital doctors

Super-fast internet connections and digital technology are changing the face of medicine. A multi-million-dollar venture between India and Ethiopia will see doctors in Addis Ababa using telecommunications to consult medics in India.

When 14-year-old Binyam Yosef developed a nasty swelling under his left knee, his worried parents took him to the Black Lion Teaching Hospital in Addis Ababa. They approached Swiss professor Jacob Schneider who examined Binyam thoroughly and concluded that he was suffering from a malignant cancer. It looked as though his leg would need to be amputated, but Schneider was not 100 per cent sure of his diagnosis.

"I discussed the case with staff in the pathology department," Professor Schneider recalls. "We could not come to a definite decision." In the end, Schneider referred the case to an old colleague in Switzerland. Using the latest technology, he took a digital photograph of the boy's knee tissue through a microscope and e-mailed the photo to Professor Gernot Jundt, head of the bone tumour registry at the University of Basel. "Within days we received his diagnosis and detailed recommendations for the treatment," Schneider remembers." We were able to save the boy's leg."

Binyam Yosef is one of a lucky few in Ethiopia to be treated through the use of information technology. His case dates back to 2004, and results from the efforts of a group of health professionals to improve medical diagnoses and treatment over the past decade, and whose efforts led to a partnership between telecoms bodies, the health ministry and the United Nations Economic Commission for Africa. "With personal commitment and enthusiasm this project produced a number of activities which gave a glimmer of hope to the country," says Dr. Fassil Shiferaw of the Ethiopian Telecommunication Medical Service.

Now things have moved further: a US$2.13 million grant from India will fund a more ambitious telemedicine venture for the next three years. Doctors in at least two Ethiopian hospitals, including Addis Ababa's Black Lion Teaching Hospital, will consult their counterparts in India using digital technology. It is the start of a venture in which India plans to establish ten 'super specialty' hospitals in Africa under its Aid-to-Africa Budget programme. India hopes it might capitalise on its investment in the future by charging fees for advice given by Indian doctors.

The medical facilities at the Black Lion Teaching Hospital are a world away from the health services available to most Ethiopians. Most of Ethiopia's 74 million people live in rural areas. Many villages still have no access to basic health care, and patients often travel over 50 kilometres on foot to get to a health post. Those who are too ill to walk or to be transported (if transport is available) frequently die.

Under-investment in rural health care facilities, a shortage of doctors and the lack of incentives to retain medical staff in rural areas all serve to increase the problem. Patients are referred to the Black Lion Teaching Hospital from all over the country. If they do not die on the way to Addis Ababa, they often face long waiting times once they get there.

Demissie Sahle is one of those who made the journey. The 68-year-old farmer lives in Amhara, Sela Dengay district, about 200 kilometres north of Addis Ababa. He was sick for six months and tried his best to obtain treatment at the nearest health post, but without success.

Together with his son Laike, he raised nearly 4,000 birr (US$500) to travel to the capital. Father and son embarked on an exhausting journey. "Whatever we could sell, we have sold to get here and to pay for treatment, including our only oxen," said Laike. They left their families and their land behind, unsure whether anyone would take good care of them.

Telemedicine, if it were to be rolled out to rural areas, could make Demissie Sahle's expensive journey a thing of the past. The Ethiopian government has already declared its commitment to information technology – it plans to connect the entire country to broadband access points over the next two to three years and Ethiopia's prime minister Meles Zenawi has described IT as a crucial weapon to fight poverty.

But the country's five-year health sector development plan does not include policies for how digital technology could be used to improve rural health services. The government's main objective in rolling out the IT infrastructure is to get local councils and schools connected to the internet – 'telemedicine' is not a priority.

"Ethiopia has signed a US$2.13 million agreement with India for the coming three years for these specific projects, but I am afraid it will take some time to prepare the entire health sector for the latest ICT developments," said Gadissa Lemecha, team leader of the Ministry of Health's Information Processing and Documentation department.

Gadissa says the absence of a policy to use IT within the health sector does not rule out expanding telemedicine into rural areas but it will be dependent on a number of factors – the successful upgrading of the currently weak telecommunications infrastructure, the results of the Indian project, and funding. It is not clear at this stage how 'telemedicine' might become available to the poor.

Dr Shiferaw, one of the initial telemedicine pioneers, believes a solid commitment to use digital technology in the health sector would at least help the private sector to embark on these new methods of diagnosing and treating patients once the country is connected. Another telemedicine pioneer, Professor Schneider, cannot hide his frustration at what he sees as the slow pace taken to implement the technology on a wider scale, saying: "I don't know why it took the government so long to make use of this simple technology which could benefit many Ethiopians a lot."

In the meantime, patients like Demissie Sahle, the farmer from Amhara, have no choice but to undertake long journeys in search of treatment. Three months have passed since he arrived in Addis Ababa. Cases of sick people have been reported who had to wait for a year or more to get a bed in the teaching hospital. Like Demissie and his son Laike they often sold everything they owned. If the money runs out, they are forced to beg. "I can't bear to see my father die in front of my eyes," says Laike, "I will spend whatever I have to save him."

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