MEDICAL TECHNOLOGY REGULATION IN AFRICA

Last week, the continent’s medical regulatory Boards and Councils held their annual conference in Cape Town, South Africa. This was the 21^st such meeting, bringing together medical regulators under the umbrella of Association of Medical Councils of Africa (AMCOA).

The driving force behind the founding of AMCOA was the need to have a support system for medical regulatory authorities in Africa in their endeavor to protect public interest by promoting high standards of medical education, registration and regulation, and facilitating ongoing exchange of information between the regulators. These objectives are geared towards achieving standardized medical regulation across the continent.

This conference was honored to have one of the founding fathers of AMCOA attend as a keynote speaker, Professor T. Mariba. The theme for the conference was “Technology and Medical Regulation”, with apt sub-themes that included:

1.      Medical technology: from the stethoscope to the robot

2.      Litigation: who is liable, the doctor or the machine?

3.      Use of social media in healthcare

4.      Regulation of electronic or digitised medicine

The conference addressed challenges that are very current and very critical at a time when Kenya as a country has made massive leaps in technology, unprecedented in any other developing country. As technology takes over all facets of our life: education, finance, trade, social interaction; the effect in healthcare has also been profound.

The outcome of the conference was that protocols were developed and adopted by all the member countries present. Thereafter, each country will customize these within the confines of their local legal jurisdictions and mandates, and implement them for the protection of their citizens.

Every facet of healthcare has been unassailably invaded by technology. Medical education, which is the start of the journey for any practitioner, is heavily dependent of technology, from information access to use of digital imaging to teach medical students, to accessing international specialists to teach remotely, to ability to share experiences about medical conditions and research findings with one another.

The practice of medicine by practitioners is heavily dependent on technology for diagnostics and treatment interventions. This is further egged on by patients who are easily awed by technology, regarding it as superior to traditional ways of doing things. If the exodus to other countries for medical care is anything to go by, it is clear that patient preference is heavily leaning towards machines, robots and technology.

One of the most successful uses of technology in healthcare has been m-health, the use of mobile phones in patient care. With a mobile phone penetration of up to 80% in Kenya, it is no wonder that the success of mobile money transfer has been astronomical, with resultant natural progression to finding other uses of the phone.

The success of patient care in HIV has been buttressed by m-health, assuring patient support, monitoring and follow-up away from the hospital or doctor’s office. Reproductive health services have been made more accessible to women via short message services. Doctors can review their patients on phone, convey laboratory results and confirm prescriptions in real time.

With growth of m-health and the ease of care, so is the growth of the potential minefields around this form of service that is not well appreciated by the service user. In an effort to avoid inconveniences and costs, many patients will easily opt for the quick fix that mobile health solutions provide. The patient does not want to spend time getting to the doctor, queuing at the hospital, waiting for lab results or undergoing x-rays. Instead, he will prefer to call a doctor and describe his symptoms on the phone and ask for a prescription.

For most minor issues, this will work quite well, but in the same vein, major medical complications presenting with minor symptoms will be missed, putting life at risk. This makes me remember a vivid example narrated by my Professor during my specialist training. He had a patient in his care who was pregnant, on follow-up for ante-natal care. She was in her late thirties and had issues that listed her as a high risk pregnancy. One Saturday morning, she called him and asked for a prescription for a yeast infection because she had noticed some whitish discharge.

Professor categorically asked her to come into the clinic for a review and he declined to give a prescription. The patient reluctantly passed by the clinic and the good professor, always keen to apply his age-old clinical skills, carried through to a speculum vaginal examination. Staring back at him was a half-open cervix for a mother who was only 25 weeks pregnant, with the baby’s bag of waters bulging through. The patient never left the couch on her feet. She was wheeled straight to the hospital ward where she remained in bed for 10 weeks to give her precious baby every possible chance of escaping severe prematurity and having a shot at survival with minimum complications.

Lessons learnt from this past week are two-fold. To the medical practitioners, technology serves as an enabler. It cannot replace the basic clinical skills taught at medical students. Machines are exciting but they do not replace our hands. We must listen to our patients and touch them! This we were taught and we must practice. Examination of our patients is irreplaceable.

For our patients, technology enables us to serve you better. It is made, programmed and instructed by man. It is subject to error and the error can cost a life. Its use must be combined with our traditional skills. As technology continues to distance the doctor from the patient, let the distance not result negative outcomes. If your doctor refuses to treat you on phone because they feel that they do not have sufficient information about you to safely care for you from a distance, please understand that this is in good faith. The inconveniences you are avoiding could be saving your life.

My most bewildering experiences are on social media when I see mothers consulting fellow mothers on facebook about the medical conditions of their babies. The responses given vary from home remedies to outright witchcraft. It is imperative that we put technology to use responsibly in a manner that maintains safety, for us to be able to fully benefit from it, without taking hostages.