UKZN’s Telemedicine Expert Recognized for Breaking Barriers to Clinical Training

2011/03/23 09:53:08 AM

National Minister of Health, Dr Aaron Motsoaledi, has appointed Professor Maurice Mars, Head of the Department of TeleHealth at UKZN’s Nelson R Mandela School of Medicine to the Ministerial Advisory Committee on Health Technology. The five-year appointment is significant as telemedicine, which falls within the scope of this committee, has been identified as a national priority. Telemedicine is the practice of medicine over geographical distances using information and communication technologies. Contrary to perceptions, it is not new. Medical services were provided using telegraphs before the age of the telephone and the first documented telephone consultation took place in 1879. The department of TeleHealth is the only department of its kind in Africa offering formal academic qualifications in the fields of telemedicine and medical informatics.

It has been a busy time for Mars who has also been appointed to an Expert Working Group of the African Union working towards Harmonizing e-Health and Telemedicine in Africa. He is President of the newly-formed South African Telemedicine Association whose objectives are to advance telemedicine in South Africa and to provide a platform for experts in the field to interact with government and the private sector to help meet their respective needs. He also chairs the Educational Committee of the International Society of Telemedicine and e-Health and has developed a basic two-day telemedicine training course which has been taught in Rwanda, Mozambique and Tanzania.

Mars has a longstanding interest in computer-based education and tele-education and introduced Videoconferenced Tele-education to the Medical School in 2001. This has grown to a service run by the Department of TeleHealth that broadcasts over 40 hours a week of interactive videoconferenced teaching to postgraduate and undergraduate students in and around KwaZulu-Natal. Through a Fogarty International Training Grant the small department of two academics and three technicians is currently using its distance learning expertise in assisting institutions in Uganda, Zimbabwe and Mozambique to set up medical informatics training by teaching postgraduate students at these sites and building the capacity of staff in these institutions. Some of the technologies used are video-conferencing, Skype, podcasts and the distribution of CDs with recorded lectures all co-ordinated through Moodle. The UKZN telemedicine course is also taught to students in Nigeria, Namibia, Botswana, Rwanda and around South Africa. Mars said that many of the registered students are based outside of South Africa and do not come to Durban.

Medical informatics is a rapidly expanding field. In 2010, the United States set aside $19 billion to ensure that every medical practice and hospital will use an electronic patient record by 2015.  As there is a worldwide shortage of medical informaticians, the American Medical Informatics Association (AMIA) has come up with the concept of Health Informatics Building Blocks (HIBBs) which are lectures and teaching sessions recorded using PowerPoint, and audio and video files. Over time, it will be possible to assemble appropriate education and training programmes in resource constrained settings using HIBBs. Mars’ department is the first site in Africa to develop HIBBs for AMIA as part of a pilot project. Mars said: ‘The HIBBs have a significant role to play bearing in mind the shortage of informatics specialists internationally. By archiving the teaching through recorded sessions one is able to build capacity in this field without face-to-face sessions.’

In keeping with the University’s Mission, the teaching of specialists across Africa is being facilitated through tele-education. Every Wednesday morning, for example, a paediatric surgery seminar is video-conferenced to an average of 65 doctors and students at other hospitals in KwaZulu-Natal and South Africa.   The seminars are recorded to DVD and posted on a monthly basis to seven medical schools in Central and East Africa that do not have sufficient bandwidth to join in a videoconference. Mars estimates that a further 300 surgical specialists in training and medical students are viewing these recorded sessions each week.

Mars is passionate about medical specialists’ training through e-communications. His department has assisted in driving specialist telemedicine services in various hospitals in the Province. In the Port Shepstone area, a medical officer communicates with ophthalmologists from the Nelson R Mandela School of Medicine by email with attached photos of the surface and interior of the patient’s eye; the diagnosis is made based on the history and the images and the management is emailed back to the medical officer. This has saved 80 percent of the patients managed in this way from having to travel to Durban to consult with a specialist. A telemedicine Diabetic Retinopathy Screening Programme involving emailed photos of the retina has also been set up at Stanger Hospital.

At the Church of Scotland, Manguzi, Kokstad and Port Shepstone Hospitals, tele-dermatology telemedicine services have been established. This allows, through video-conferencing, for a medical officer and patient to liaise with consultants in Durban without the patient having to transfer to a Durban hospital. Mars’ said that an analysis of the service provided from Durban to Port Shepstone indicated that all patients opted for the videoconferenced consultation rather than going to Durban and that 75 percent of patients treated in this way were then managed successfully at their local hospital. Another example is the tele-orthopaedic service run from Grey’s hospital to the Church of Scotland Hospital. Local doctors place X-ray films on a viewing box and discuss the patients’ problems with a specialist through videoconferencing.

The Department’s main research interests include the legal and ethical issues facing telemedicine in the developing world, the economics of telemedicine, factors affecting eHealth implementation in the developing world and the use of artificial intelligence and machine learning to forecast CD4 counts and drug resistance in HIV patients.

From teaching a two-day course in telemedicine to doctors in Rwanda, to reaching out to hundreds of students across Africa and facilitating consultations across hospitals in KwaZulu-Natal, Mars remains passionate about promoting telemedicine in Africa. He said: ‘Telemedicine allows rural patients access to specialist care that they would not normally receive and provides continuing medical education to doctors and nurses in peripheral hospitals. With modern communication technology it’s a joy to be able to teach so many students across Africa from my office, home or even hotel room. This ensures that teaching is continuous even when attending a conference.’

MaryAnn Francis