Every time Catherine Coulibaly’s 19-year-old son had to make a routine appointment with the cardiologist for his heart condition, she gritted her teeth as she silently counted the financial cost. It wasn’t just the hospital fee. There was also the transport, food and accommodation, too, all of it amounting to a hefty burden for an Ivorian family on a modest income. But thanks to telemedicine this cost is now a fading memory.
Telemedicine involves the consultations that doctors conduct through the internet or by phone. Now, Coulibaly’s son can book an appointment at a telemedicine facility in a nearby town in northern Ivory Coast. There, a technician attaches him to monitoring machines. These machines then send the data sent to Bouake University Hospital in the centre of the country. There, a heart doctor scrutinises it.
The fledgeling technology has long been championed by health advocates for poor rural economies. Ivory Coast has become an African testbed for it, thanks to a project linking the Bouake hospital’s cardiac department with health centres in several northern towns, some of which are a four-hour drive away.
Telemedicine “caused a sigh of relief for the population of Bouake, Boundiali, Korhogo, everyone”. Auguste Dosso is the president of the “Little Heart” association, which helps families with cardiac health issues.
About 45% of the Ivorian population live below the poverty line, according to the World Bank’s latest estimate in 2017. And the minimum monthly wage — not always respected — is only around $100, or 90 euros.
Heart disease surging
The pioneer behind the scheme is cardiologist Florent Diby, who set up an association called Wake Up Africa.
In Ivory Coast, heart disease, diabetes and other “lifestyle” ailments are surging, Diby explained. “Urbanisation is making people more sedentary, and there’s the rise in tobacco consumption, changes in diet, stress.”
Three decades ago, only around one in eight of the Ivorian population had high blood pressure — now the figure is one in four, on a par with parts of Western Europe. But in Ivory Coast — and across Africa — well-equipped cardiology units are rare.
“Ninety percent of heart attacks can be diagnosed by telemedicine, so for us cardiologists it’s a revolutionary technology,” said Diby.
The beauty of the telemedicine scheme is that neither the doctor nor the patient has to travel far.
A technician in a local health centre hooks up the cardiac patient to the electrocardiogram (ECG) and other diagnostic machines. The technician then connects this to a computer in Bouake’s University Hospital. The cardiologist there can then see the results in real time, provide a diagnosis and prescribe treatment.
The five-year-old project has already linked 10 health centres to the seven cardiologists at Bouake, enabling 4,800 patients in other towns to receive consultations by telemedicine each year. The goal is to expand this to 20 sites, doubling the intake.
Expertise France, the French public agency for international technical assistance, subsidises up to 185,000 euros of the network, which pays for equipment such as computers, artificial intelligence software and internet connections.
Diby now calls for the expansion of telemedicine in other medical fields such as neurology and psychiatry. This is not just in the Ivory Coast, but across West Africa too.
Other experts share that opinion too. 60% of Africans live in rural areas, where shortages of doctors are usually acute. But we need to cross over numerous hurdles, especially investment in computers and access to the internet.