Global Telehealth During a Pandemic: Serving Those Most in Need

Ali Chartan

Signal sat down (virtually) with Sharon Allen, Executive Director, World Telehealth Initiative, to discuss the organization’s role in global health and how they are leveraging their telehealth expertise during the global coronavirus pandemic.

SG: Tell us about your organization’s mission. What drives you?
 
Allen: Our mission is to provide sustainable medical expertise to build local capacity and deliver core health services to the world’s most vulnerable communities, through a network of volunteer health care professionals supported by state-of-the-art telehealth technology.

Our goals include:
  • Advance the healthcare skills and capacity of local providers
  • Improve health outcomes for people in underserved communities
  • Increase opportunities for compassionate skilled health care professionals to make a difference for those in need

We are driven by the belief that every human deserves quality healthcare, yet half of the world’s population does not have access to essential healthcare services.  There are 8.6 million deaths every year in low- and middle-income countries from treatable conditions. If patients and their local clinicians had convenient access to specialized healthcare experts many of these deaths could have been prevented.
 
World Telehealth Initiative is positioned to provide sustained medical expertise to low resource countries in a manner never before possible. We improve patient outcomes and provide support and training to often-isolated clinicians in remote locations at a fraction of typical costs.
 
SG: How has your organization had to adjust due to COVID-19?
 
Allen: We pivoted with our partners across the world.  When they had to prioritize COVID-19 care, we immediately linked them with specialists in pulmonology, cardiology, anesthesiology, infectious disease, respiratory therapy, etc. so they could help patients with acute respiratory distress – as well as tap into the expertise we linked them to for advice on the construction of isolation wards, ventilator set-up and operation and oxygen therapy.
 
SG: What’s on the horizon for telehealth in your field?
 
Allen: Now that telehealth is a proven tool for delivering efficient and effective healthcare in high income countries, we aim to bring it to low and middle-income countries as well, for little to no cost for the patients.
 
SG: Do you have a telehealth success story? It could be about a person who telehealth has helped reach who may have had a harder time getting care through the traditional healthcare system?
 
Allen: We have demonstrated success with our very first program at the Fistula Care Centre in Lilongwe, Malawi. The clinic previously relied on the expertise of specialized surgeons from Baylor College of Medicine who traveled to Africa as often as they could to perform surgeries for the women in need. However, with the implementation of our telehealth program, they were able to staff the site with a young doctor that lived in Lilongwe so the care would be available on a sustainable basis. Fistula surgery experts were able to beam in hundreds of times during the first year to provide surgical mentoring for cases that were beyond the capabilities of the local clinician. They could guide her every step of the way while having an excellent view of the surgical field and completely clear, hands-free communication. After the first year, frequency slowly decreased because the local provider’s capacity had been built! She is now able to handle almost any case on her own.
 
One such case was with 19-year-old Esperanza.  She and her husband were expecting their first child last year, and when it came time for her to deliver, she began to labor at home. On the second day of labor, it was evident she needed to go to the clinic.
 
She couldn’t afford to hire a car to transport her, so her only option was to hire a bicycle. For six hours, while Esperanza was in active labor, she sat on a tiny bike seat, on a bumpy road, in route to the clinic.
 
When she arrived, the clinicians were able to provide her with pain medication but were unable to do much more because they did not have the training or facilities to perform a c-section. She endured an obstructed labor for two more days, and eventually delivered a stillborn baby.
 
Due to the trauma suffered from an obstructed labor, Esperanza developed an obstetric fistula, an injury that occurs from a prolonged labor that damages the tissues in such a way that the woman is often left with lifelong complications, such as incontinence. In Malawi, resources are limited and most women with fistulas do not have access to products or supplies to keep themselves sanitary. Often, due to the odor, women are ostracized from their communities, are abandoned by their husbands, and are unable to work. Esperanza and more than 2 million other women in Africa have suffered from obstetric fistulas (World Health Organization).
 
Thanks to our program in Lilongwe, Malawi, Esperanza was able to receive fistula repair surgery and reclaim her life. Our program in Malawi provides many women, like Esperanza, with transformational surgery, so they may return to society again as healthy, productive women.
 
As a side note – we have expanded our support in Lilongwe to include surgical mentoring and clinical consultations at a new hospital that has a novel 4-room operating theater. It will be available for C-sections, should one be required, for safe deliveries in order to eliminate the occurrence of obstetric fistulas.
 
SG: Do you have any predictions about the future of telehealth? Usage? Areas primed for key opportunity?
 
Allen: It has been said that the telehealth advancements that occurred over the past few months would have taken 10 years, if not for COVID-19.  Our prediction is that 30% of clinical consultations will occur via telehealth in the near future – it has simply become a recognized method of healthcare delivery.
 
Because countries with the highest burden of disease currently have the lowest level of healthcare resources, we have a tremendous opportunity to partner with them to increase their local healthcare capacity.
 
SG: Do you see any policy or regulatory challenges that need to be addressed to facilitate/ensure telehealth use for the long term?
 
Allen: The U.S. made several policy changes to allow increased usage of telehealth during the pandemic.  As the legislation is reviewed to determine which policies will revert back, the focus should be on the delivery of quality healthcare.  We need to ensure that we are using platforms that use medical grade technology and are of the highest standards for HIPPA compliance and safety concerns.
 
The World Health Organization recently formed a Digital Health Board of Advisors and Roster of Experts, of which I was chosen to be part of.  They recognize that digital health needs to be part of the world’s healthcare solution.  It truly can transform global healthcare!

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