Leveraging Telemedicine to Improve Maternal and Newborn Health

Dr. Felicitas Makokha is the only government paediatrician working in Bungoma County, serving a population of more than 1.7 million people. Vumbua News sat down with her to understand what this means, and how telemedicine – or remote clinical consultation through the use of technology – might help.

Her typical day is hectic. She does daily ward rounds at the referral hospital’s newborn unit and paediatric unit, and then runs the paediatric and the neonatal outpatient clinics. She trains medical officers and interns on the job, attempting to build their paediatric knowledge and skills. She also supports policy formulation and dissemination, feeding into the development of new clinical guidelines and ensuring that these materials get out to smaller facilities.

On Sundays Dr. Makokha goes to church with her family and then returns to the hospital to check on ‘her children’. As the only specialist in the county, she finds herself working regularly even when she’s on leave. “My conscience just doesn’t allow me to sit back when I don’t know what will happen to these children_’’. On average she sees 50 paediatric patients per day, suffering from broad ranging conditions such as severe malaria, pneumonia and anaemia, meningitis, sickle cell disease, birth asphyxia and cerebral palsy. ‘’I rarely rest. It’s been very tough for me for the last three years, and this is my fourth year working in the county alone.”

The Bungoma County Referral Hospital, where Dr. Makokha works, is overcrowded - typical of many public hospitals throughout Kenya. The paediatric ward has a bed capacity for 39, but the hospital routinely admits 60-90 children at a time with children sharing two or three to a bed. The county struggles with a limited availability of trained clinicians at lower level facilities, with only five clinical officers trained in a higher national diploma in paediatrics working across 10 sub-counties. Staff at these facilities often lack the knowledge, skills and confidence to manage complicated paediatric cases. Dr. Makokha estimates that half of the referrals she receives should be managed at the sub-county hospital level, but she cannot be on the ground everywhere to build the necessary clinical capacity to handle them.

Telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology. If used correctly in a setting like Bungoma, the results could be transformative. When hiring enough specialists is not immediately possible, telemedicine can help maximize the reach of one specialist through the use of technology. Prior to referral, the referring nurse or officer can seek remote guidance, increasing their capacity to manage the case at their level. When referral is necessary, the specialist can provide guidance on the care that should be administered prior to transfer.

Like many specialists, Dr. Makokha already practices her own form of telemedicine. She has given out her personal mobile number to her colleagues throughout the county, and they regularly call her – day and night – to seek her advice. The use of a standard telemedicine platform could widen her reach substantially, to see even better health outcomes in the county. “When I treat children and they get well or when I see those preterm babies grow and I see a smile on their face that is my reward.” Mount Kenya University, with funding from CICF, is supporting Bungoma County to establish a telemedicine solution that will enable Dr. Makokha to do just that.

This edition of Vumbua News features two telemedicine initiatives that are helping to bring specialist health care closer to Kenyans living in remote communities of Turkana and Garissa Counties. It also profiles the current national policy framework for telemedicine, through a Q&A with the Ministry of Health.

Enjoy the reading.

Kimani Karuga

CICF Technical Fund Manager