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Health care in South Africa can benefit from technology
Author: FMHS Marketing & Communications / FGGW Bemarking & Kommunikasie – Sue Segar
Published: 10/10/2022

South Africa has been slow on the uptake of technology to assist in medical care – all to the peril of the patient.

This is according to Dr Nadiya Ahmed, a general surgeon and intensivist at Tygerberg Hospital (TBH) and Stellenbosch University (SU)'s Faculty of Medicine and Health Sciences (FMHS). She delivered a state-of-the-art lecture at the FMHS' 66th Annual Academic Day, entitled 'Robodoc – bringing the ICU to you'.

It is vital for government to support the use of technology in providing medical care, but this is sadly not the case in South Africa, said Ahmed, who is involved in a number of educational activities at TBH and the FMHS.

“There has been a general lack of support from government and private health institutions, and we have been slow on the uptake of technology," said Ahmed, but pointed out that the Covid-19 pandemic had taught us to embrace the use technology in our work.

She summarised the stark realities of health care in South Africa, saying that around 48 million South Africans are dependent on the public health-care sector – yet they only have access to 396 acute hospitals. “Of those, only 91 can provide any form of critical care, such as intensive care unit (ICU) or high-care beds."

She added that at last count, there were only about 90 practicing intensivists in South Africa. There are also big disparities of access to care, with the more urbanised provinces having the preponderance of ICU beds.

“We know that care during the first eight hours of any critical illness makes all the difference."

When patients require emergency care and have to go to an ICU, emergency room (ER) doctors (who often do not have the required experience) have to deal with the patients. These doctors could benefit from consulting via technology with more experienced doctors, she said.

According to Ahmed, South Africa's use of technology in medicine was very poor before 2020. In the early 2000s the National Department of Health put out a mandate recognising that telemedicine was required, and decided on a 10-year pilot in primary and antenatal care, but very little came of it, she said.

“Other institutions decided to implement tele-education and a pilot project was done in KwaZulu-Natal in early 2000 – it showed some promise, but then issues arose. Other initiatives included one by some Stellenbosch University graduates who developed an application, EM Guidance, which helps with triaging and management tools and drug dosing in the ER. Later, the Vula app greatly reduced transfer times of ophthalmology patients who could receive care at primary health-care level instead of being transferred to tertiary level for a diagnosis that could have been treated."

Since then, the Vula app had been used to assist fifth-year medical students who were working from peripheral hospitals – allowing them to interact with specialist mentors at Tygerberg Hospital. “It introduced an entirely new interface for decentralised teaching, especially with a large number of medical students coming through."

According to Ahmed, more and more associations have started much-needed national teaching programmes as they become more confident in the virtual interface. “I have been assisting with critical care training at the University of the Free state as they currently don't have an intensivist."

The South African Colleges of Medicine – the national body that conducts all examinations – have also started doing exams using virtual interfaces.

“But none of this helps the ER doctor who is waiting for someone to answer the phone. The vast majority of our ER doctors are actually newly qualified junior doctors or interns who have been thrown in the deep end, and are not confident in their abilities to decide who needs critical care, who doesn't.

“We asked them what they thought of telemedical interventions, and their responses were overwhelmingly positive, with many saying they wanted telemedicine interventions with intensivists – for both triage and ventilation – as well as with medical ethicists who are making those difficult calls."

The impetus driving the use of more technology in medicine is that “we want to leverage the workforce. We want to get that one intensivist to as many hospitals as possible, and it is not always physically possible. The idea is for telemedicine to help us do this."

Ahmed concluded: “We need to impress upon government and the private sector to set up the infrastructure for technology in order to improve health care in our country rapidly rather than waiting for the numbers of doctors to arrive or to be trained."

Caption: Dr Nadiya Ahmed