Practicing medicine without borders: tele‐consultations and tele‐mentoring for improving paediatric care in a conflict setting in Somalia?

Zachariah, Rony; Bienvenue, B.; Ayada, L.; Manzi, Marcel; Maalim, A.; Engy, E.; Jemmy, J. P.; Said, Analise; Hassan, Ameer E; Abdulrahaman, F.; Abdul‐Rahman, Omar; Bseiso, Jehan; Amin, Hesam; Michalski, Dominik; Oberreit, J.; Draguez, Bertrand; Stokes, Christopher; Reid, Tony; Harries, Anthony

doi:10.1111/j.1365-3156.2012.03047.x

Cited by 46 publications

(38 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…34,35 Beyond this, activity can be seen in many developing countries; for example, Brazil, Cambodia, Ecuador, India, Nepal, Philippines, and South Africa, among others. 32 In Asia, recent growth in application of telehealth has been seen in both India and People's Republic of China, with continued growth expected in the coming decade.…”

Section: Current Usementioning

confidence: 99%

Telehealth in the developing world: current status and future prospects

Scott¹,

Mars²

2015

SHTT

161

131

View full text Add to dashboard Cite

Abstract:In a setting of constant change and confusing terminology, telehealth continues to gain ground in both developed and developing countries within the overarching milieu of e-health. Evidence shows telehealth has been used in essentially all countries of the world, but is embedded in few. Uses and needs of telehealth vary between the developed and developing world; the latter struggles with both communicable diseases and noncommunicable diseases, and with very few resources. Common clinical applications include teleconsultation, telecardiology (transmission of ECGs), teleradiology, and teledermatology. Many telehealth projects exist throughout Latin America and the Caribbean, Asia, and Africa, but there is little published evidence and only isolated examples of sustained programs, although several sustained humanitarian networks exist. Application of mobile solutions (m-health) is on the rise in many developing countries. Telehealth is still not integrated into existing health care systems globally. Reasons vary: lack of proven large-scale operations, poor evidence base, inadequate implementation, lack of attention to the "soft side" of implementation (readiness, change management), and many others. For the developing world, reasons can be more pragmatic, including limited resources, unreliable power, poor connectivity, and high cost for the poverty stricken -those most in need. Telehealth is poised to improve health and health care in the developing world, driven by both altruistic and profit motives. But to have the desired effect, telehealth must address very specific and evidence-based health "needs" of each facility, region, or country; the shortage of health workers and specialist services; and the required skills upgrading and training, allowing the developing world to establish its own critical mass of experts. This will only be achieved by raising awareness, understanding, and ability regarding telehealth capability and limitations, and by the coordinated political and professional will of all those involved to guide public and private innovation and telehealth integration.

show abstract

Section: Current Usementioning

confidence: 99%

Telehealth in the developing world: current status and future prospects

Scott¹,

Mars²

2015

SHTT

161

131

View full text Add to dashboard Cite

show abstract

“…Other studies have demonstrated the effectiveness of similar programs for other medical specialties [10,11]. In the future, the development of a civilian medical toxicology teleconsultation service to assist both local and volunteer physicians in locations with limited subspecialty care may aid in reaching those in greatest need.…”

Section: Discussionmentioning

confidence: 99%

Wartime Toxicology: Evaluation of a Military Medical Toxicology Telemedicine Consults Service to Assist Physicians Serving Overseas and in Combat (2005–2012)

et al. 2014

View full text Add to dashboard Cite

Those medical providers deployed to remote countries and tasked with caring for military personnel must diagnose and treat diseases and nonbattle injuries that result from exposures rarely seen in developed countries. Military providers must also function with limited resources and a lack of access to physician specialists, to include medical toxicologists. There have been limited published approaches to addressing this clinical gap for medical toxicology. To address this void, the US Army Medical Department deployed an electronic mail telemedicine system to provide teleconsultations for remote health-care providers worldwide, including Iraq and Afghanistan. This study aimed to describe the types and the frequency of toxicology teleconsultation and consultant responses using electronic mail to assist physicians serving in resource-limited locations. This was a retrospective observational study in which an unblinded data extractor independently reviewed all medical toxicology email consultations. Using a previously developed data collection worksheet, the extractor recorded the type of question asked by the consultant (overdose case, envenomation, occupational exposure, etc.) and the duration of time from when the teleconsultation was placed until the consultant replied. The extractor also recorded if the patient was adult or pediatric and if the patient was US military, US contractor, or local national. The extractor also recorded how often the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. In addition, for clinical teleconsultations, the extractor documented the frequency that the consulted toxicologist (i) provided a differential diagnosis or specific diagnosis, (ii) provided specific management guidelines for a patient, and (iii) recommended to evacuate or not evacuate a patient. The results were analyzed using descriptive statistics. Of the 99 consultations evaluated, the most common consultation was for snake envenomation and antivenom recommendations (n=23, 23 %) followed by accidental chemical exposures (n=14, 14 %), drug testing (n=13, 13 %), and substance abuse (n=10, 10 %). In 41 % of consults, the toxicologist provided a differential diagnosis or specific diagnosis, and in 60 % of cases, the toxicologist provided specific management or evaluation guidelines. In 11 % of cases, the toxicologist recommended for or against evacuation of the patient. In 25 % of consults, the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. The most frequent consultations for the military telemedicine consultation service were for direct patient cases, specifically snake envenomation management and accidental chemical exposures. Our results may be used to educate physicians prior to military deployment or international humanitarian efforts and to create toxicology clinical There is no prior publication, conflict of interest, or copyright constraint. Th...

show abstract

“…Médecins Sans Frontières has previously used both store-and-forward and real-time telemedicine (5, 6). Although the real-time telemedicine work was considered successful, the requirement for good quality Internet connections makes real-time telemedicine much more expensive than store-and-forward work.…”

Section: Discussionmentioning

confidence: 99%

The Development of a Multilingual Tool for Facilitating the Primary-Specialty Care Interface in Low Resource Settings: the MSF Tele-Expertise System

Bonnardot

Liu

Wootton

et al. 2014

Front. Public Health

View full text Add to dashboard Cite

In 2009, Médecins Sans Frontières (MSF) started a pilot trial of store-and-forward telemedicine to support field workers. One network was operated in French and one in English; a third, Spanish network was brought into operation in 2012. The three telemedicine pilots were then combined to form a single multilingual tele-expertise system, tailored to support MSF field staff. We conducted a retrospective analysis of all telemedicine cases referred from April 2010 to March 2014. We also carried out a survey of all users in December 2013. A total of 1039 referrals were received from 41 countries, of which 89% were in English, 10% in French, and 1% in Spanish. The cases covered a very wide range of medical and surgical specialties. The median delay in providing the first specialist response to the referrer was 5.3 h (interquartile range 1.8, 16.4). The survey was sent to 294 referrers and 254 specialists. Of these, 224 were considered as active users (41%). Out of the 548 users, 163 (30%) answered the survey. The majority of referrers (79%) reported that the advice received via the system improved their management of the patient. The main concerns raised by referrers and specialists were the lack of support or promotion of system at headquarters’ level and the lack of feedback about patient follow-up. Because of the size of the MSF organization, it is clear that there is potential for further organizational adoption.

show abstract

Practicing medicine without borders: tele‐consultations and tele‐mentoring for improving paediatric care in a conflict setting in Somalia?

Cited by 46 publications

References 19 publications

Telehealth in the developing world: current status and future prospects

Telehealth in the developing world: current status and future prospects

Wartime Toxicology: Evaluation of a Military Medical Toxicology Telemedicine Consults Service to Assist Physicians Serving Overseas and in Combat (2005–2012)

The Development of a Multilingual Tool for Facilitating the Primary-Specialty Care Interface in Low Resource Settings: the MSF Tele-Expertise System

Contact Info

Product

Resources

About