Telemedecine

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In Africa, there is a silent crisis. While AIDS is particularly devastating, heart disease now ranks among the continent’s chief threats, killing more than a million Africans every year.

Top risk factors include high blood pressure, high cholesterol, and tobacco and alcohol use, as well as low vegetable and fruit intake. While these risks can be prevented, routine diagnosis and treatment remains beyond the reach of most.

That is because African countries are spending a lot less on health resources and services than most. For example, Ghana rates 135th among all countries in health expenditures per person—spending a tiny fraction of what richer countries do.

Ghana has made little progress—like its neighbors—in training doctors in cardiology, despite the growing death toll.

“The doctor-patient ratio is problematic,” said Harry Blavo, a retired diplomat, who is hypertensive and diabetic. “There is always difficulty getting a doctor to take care of you when you have a health situation.”

This year, however, Blavo became a patient of Dr. Gordon Attoh. “Health practitioners in Ghana face a number of problems,” said Dr. Attoh, who is an obstetric gynecologist at Alpha Medical Clinic in Ghana’s capital Accra. “There aren’t enough state-of-the-art materials. So you need to work and do your best with the little that you have at your disposal.”

“There is a great deal of demand for cardiothoracic surgeons in Ghana—not only in Ghana but in Africa as a whole. For now, the challenge is so huge. The hands to do the work are very few.”

APPROACH

GDLN enables African Heart Institute, based in Germany, to train African doctors

Professor Charles Yankah, a native of Ghana, is tackling this challenge head on. As a cardiothoracic surgeon at the German Heart Institute in Berlin, Yankah performs various heart surgeries, including heart transplants, and also trains the next generation of German surgeons.

“I want to take this knowledge to my people in Africa, share my knowledge with them, and see how we can develop cardiovascular medicine in Africa,” said Yankah, who has been practicing medicine in Europe for almost 40 years.

In 2004, Yankah and a South African colleague, Dr. Willy Koen, launched the African Heart Institute. The mission was to create more awareness about the epidemic of cardiac diseases in Africa and introduce the latest developments and medical advances to African doctors.

Professor Yankah organized several seminars in South Africa, but then collided headlong into a stark reality—how would he scale up the program? Although demand for the seminar among African doctors was sky high, few could attend. Those who came spent as much as several months’ salary simply for airfare.

There had to be a better way. “We decided to develop telemedicine in addition to our seminar so that we could reach as many physicians as possible in Africa,” said Professor Yankah.

“This was very unique,” said Vivian Attah, the Global Development Learning Network’s representative in Ghana, who coordinated the event. “I had to find out exactly what [Professor Charles Yankah] wanted to do and then give him some suggestions as how to go about it, because he had never done such a thing.”

Attah and her team developed an event agenda based on concrete learning objectives, and used the institution’s technical facilities to connect Professor Yankah’s surgical team in Berlin, Germany with the local group in Accra. The live surgery from the University of Erlangen featured echocardiographic and computer imaging diagnostics.

To spread the learning even further, Attah invited various stakeholders in Ghana, including pediatricians, nursing officers, and health instructors.

Dr. Gordon Attoh, who had attended three previous seminars of the African Heart Institute, attended: “The objective of the course, number one, was for us to appreciate what they do with state-of-the-art technology in advanced countries. Number two, for us to acquire certain basic knowledge, which we can use down here in Ghana. And number three, to integrate and to connect some doctors both here in Ghana and then elsewhere in the world.

Dr Attoh and his colleagues in Accra witnessed the live surgery that was taking place in Berlin. All participants saw the echocardiography reports and contributed when they wanted to: “We had the opportunity to ask questions and to interact with the surgeon. We could stop him at any time,” said Attoh. “It was like you were there in theater just like in a live operation. So it was wonderful.”

RESULTS

Ghanaian doctors now integrate more cardiovascular medicine in their work: Dr. Yankah continues to extend outreach to more African countries.

To date, the African Heart Seminar has connected with doctors in 11 countries: Mauritania, Senegal, Burkina Faso, Cote d‘Ivoire, Ghana, Benin, Uganda, Kenya, Ethiopia, Tanzania, and Mozambique. For five consecutive years, it has held a seminar: two in South Africa, two in Ghana, and most recently in July of 2008 in Dar Es Salaam, Tanzania—facilitated again by the GDLN.

Today, Dr. Attoh is integrating what he learned into his obstetrics practice, and even taking on more patients with heart issues.

But Attoh and his peers have gained a lot more than new techniques: “The value of GDLN is priceless,” enthused Dr. Attoh. “We established a network of doctors and that to me is very important, because I can call them and discuss my patients with them. We share ideas and they tell me what I can do, what options we have and what we can do.”

And Harry Blavo continues to benefit from Dr. Attoh’s growing expertise in heart medicine.

At the highest country level, there is a genuine recognition that this approach can accelerate development and reduce poverty.

“We believe absolutely that the only way to stimulate rapid development in our country is through the development of ICT and e-learning,” said Elizabeth Ohene. Ghana’s Minister of State in Charge of Tertiary Education. “We can’t do it through traditional methods alone. So when we sponsor these [events], then we have the whole world here and we can learn from the world. It’s cheaper in the long run.”

And Professor Yankah continues to press forward. “My hope is to establish cardiovascular medicine in Africa, so that we can achieve more results, have more impact, and also reduce cardiovascular mortality.”

The Global Development Learning Network (www.gdln.org) is a partnership of over 120 centers in 80 countries that offer solutions to the knowledge and learning needs of clients around the world. 

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