Positive Telehealth Project: The Addis Clinic & CADFIN-Cameroon

13920604_10207156243733410_1389492176660437271_n.jpg

Earlier this year, The Addis Clinic and one of our partners, Mr. Joanes Jang of Child Aid Development Foundation International (CADFIN) in Cameroon, submitted a proposal to the Start Free Challenge sponsored by ViiV Healthcare.  This positive action challenge recognizes the potential of innovations implemented at the local level to rapidly reduce new HIV infections in children.

We were excited to announce late this summer that our Positive Telehealth proposal was one of the four 2018 winners!  Positive Telehealth was developed through a collaborative effort of The Addis Clinic andCADFIN in an attempt to break the barriers of preventing maternal to child transmission of HIV and providing the most effective antiretroviral treatment available for every child, adolescent, young woman, and pregnant or breastfeeding mothers living with HIV/AIDS in the Mezam Division of the North West Region of Cameroon . 

With the funding of this program, we were able to get Positive Telehealth off the ground this month! CADFIN has coordinated additional partnerships with 5 health centers in North West Cameroon, and they have all started training on how to utilize teleconsultations and The Addis Clinic services to better reach their HIV/AIDS patients.  We are excited to progress further in this initiative and are grateful for the support of ViiV Healthcare and the Start Free Challenge.

Case Spotlight

15cameroon.xlarge1 (1).jpg

For one of our final cases in November, The Addis Clinic received the urgent referral of a 2-year-old boy in Kenya who presented to his local clinic with a 4-day history of seizures, high fever and jaundice. While at the clinic he developed difficulty breathing and became increasingly dehydrated as he actively seized. The clinical officer treating him ran an initial panel of tests which revealed that the young child was positive for malaria and had a low level of hemoglobin in his blood. The clinician was concerned about potential cerebral malaria and sent the case to The Addis Clinic, as he knew the patient needed to be treated quickly and might not have the opportunity for transport to a higher level of care.

The case came in over a weekend, and despite this, we quickly found multiple volunteers available and willing to consult on the case.  A volunteer pediatrician responded with multiple recommendations on how to approach treatment based on the detailed case information sent by the clinician in Kenya.  Using our asynchronous telemedicine system, the physician walked the clinical officer on the ground through multiple methods for breaking the patient’s seizures, treating the malaria, rehydrating the child and monitoring his blood count.  The volunteer’s detailed assistance took many variables into account, to include medication and testing availability, which is very important when critical care is being managed in such a remote and low resource setting. 

Two days later we were thrilled to receive an update that the boy was rapidly improving after receiving the treatment recommended by our volunteer.  We look forward to following his continued recovery and are grateful for the hard work and dedication of time and talent by everyone involved in this case!

Graph of the Month

In November, The Addis Clinic utilized 8 different medical specialties as we facilitated consultations between global frontline health workers and physician volunteers. 30% of the cases this month were pediatric patients and our pediatric volunteers guided referring clinicians through diagnosis and treatment plans for severe conditions such as epidermal necrolysis (a severe skin reaction) and cerebral malaria, as well as more common pediatric complaints like ear infections. This teamwork between physician volunteers and referring health workers is crucial in an area of the world where there is a severe shortage of physician-level health care.

November Breakdown.jpg

Graph of the Month

In October, 15% of cases received by The Addis Clinic required an Emergency Medicine consultation.  Our Emergency Medicine volunteers are always willing to assist with urgent cases and need for this quick attention is growing as we expand to areas where patients do not travel to seek medical attention until they are quite ill. 

To meet this demand The Addis Clinic is putting together an “Urgent Care” team of physician volunteers across all specialties who are willing to take more cases with faster turnaround times and ensure our partner health care providers receive the support they need.

October Breakdown.png

Expanding our reach with Mr. Sylvester Gero, Telemedicine Coordinator,  IHOPE Foundation

IMG_7038.JPG

As you may know, The Addis Clinic had the opportunity this past July to visit many of our partners in East Africa.  As part of these visits, we spent ample time brainstorming ways to better serve not only existing partners but all providers and patients throughout these communities.  One byproduct of these sessions was the decision to advertise the position of a telemedicine coordinator to work with one of our longest standing partners, the IHOPE Foundation, based out of Migori County, Kenya.  The use of telemedicine in this region has expanded at a very fast rate, and IHOPE and The Addis Clinic recognized the need for a dedicated individual on the ground to bring on new partner clinics, train new referrers, and assist in troubleshooting when issues arise.  

In September, after extensive interviews, Mr. Sylvester Gero was hired in this position, and he has already made an extraordinary impact in his new role.  Mr. Gero holds a Diploma in Clinical Medicine & Surgery, has worked in a DigiMedicine program and has a wide knowledge of health facilities and the handling of patients on a day to day basis.  In his first month on the job, Mr. Gero has already connected The Addis Clinic with two new clinics and trained them in such a way that they are already submitting cases.  This is an exciting development and we are very happy to have him as part of our team!

076A8339.jpg

Case Spotlight

Read about how one of our partners used asynchronous telemedicine this month:

In early October, The Addis Clinic received a referral from East Africa describing a gentleman who had been attacked with gasoline and suffered burn injuries to his face and abdomen.  He was being attended to in a local hospital, and the physician managing his care needed additional guidance on how to proceed with such a complex case.  

In high resource areas with access to advanced medical care, this patient would have been immediately transported to a regional burn center staffed with physicians and nurses specially trained in the management of burn patients. However, due to the constraints of his location, this was not an option and the local physician treating this patient turned to The Addis Clinic to fill this specialized need.  

While we do not have a burn specialist on our team of volunteers, we do have a very experienced emergency medicine physician who agreed to take the case.  Over the course of 3 days, this volunteer physician in Pennsylvania and our partner physician in Kenya "discussed" this patient's management, status, and progress over our asynchronous telemedicine platform.  

The emergency physician requested very detailed additional information and pictures of the patient, and based on the response he received he was able to provide specific recommendations on wound management, pain control, antibiotics, hydration, and nutrition.  The patient is currently healing well, and in the next week or so the volunteer and referring physicians will discuss his progress and any further management that is needed. 

We are thankful for the referral of this case, and to be involved in this patient's care! 

Untitled design.png

Graph of the Month

In September, 88% of our cases came from rural Kenya, where word has spread throughout the region about the clinic's ability to connect with specialist physicians.  Additionally, we received cases from Haiti, Cameroon, and Egypt. The cases we receive come from rural counties, impoverished urban neighborhoods, and established hospitals. This graph highlights the diverse needs of each of these partners, and we are grateful to be able to connect each of them with the specialists they need.

Screen Shot 2018-09-30 at 5.22.17 PM.png

Case Spotlight

Earlier in September, The Addis Clinic received a case from a clinical officer in rural Kenya describing a young woman who was bitten by an unknown snake.  The referrer needed assistance from The Addis Clinic for two things - identifying the snake which had bitten the woman, as well as guidance on how to care for the bite. This was the first snake-bite case that we ever received and we immediately turned to our large network of physicians and supporters for assistance.

It was important to first identify the snake, as that would guide the care and treatment of the patient.  We shared the picture with our supporters on social media and were immediately flooded with connections to experts who quickly identified the snake as an East African Garter Snake. This request for help had over 5500 views on Facebook! We were happy to learn that while venomous, a bite from this snake has never been known to be fatal, and there is no anti-venom prepared or required for this type of injury.   After identifying the snake, we quickly allocated the case to a physician with experience working in the East African region, and she gave the local clinician expert advice on how to care for the bite wound as well as what to look for as possible complications and how to care for those complications.  Furthermore, she provided access to a great reference for practicing medicine in low-resource settings that this clinician will no-doubt find a useful resource not only for this case but many future cases as well. 

According to the snake experts we were connected with, bites of this kind are very rare and not well documented. The experts have remained actively involved in the case over the last two weeks, interested to follow up on the woman’s condition - which we are excited to report is excellent. Even a few days after suffering the bite she was only experiencing mild swelling and minimal pain.

This case truly showed the ability of asynchronous telemedicine to quickly provide assistance and feedback to clinicians, and it was truly a team effort as we worked to get this young woman the answers and care she needed.

WhatsApp Image 2018-09-20 at 10.29.08 AM.jpeg

Graph of the Month

Screen Shot 2018-08-30 at 9.49.47 AM.png

We have recently noticed an increase in the number of urgent cases we receive.  The patients served by our partners do not usually seek out care until they are very ill due to the long distances they must travel.  By the time they encounter our partner clinicians, a telemedicine consultation is needed quickly, and we are thankful to have a dedicated team of volunteers who work hard to meet that need. 

In August, 30% of our cases required Family Medicine expertise, 25% required Pediatric volunteers, and 20% required guidance from Internal Medicine physicians.  Additionally, Infectious Disease, Dermatology, and Emergency Medicine physicians offered their thoughts on a variety of cases from Kenya, Haiti, Cameroon, and Ethiopia. 
 

Referrer of the Month - Eli Chacha Thomas, Chang Medical Clinic

The Addis Clinic receives referrals every day from community health workers, nurses, and physicians serving their communities across the globe. 

WhatsApp Image 2018-08-21 at 1.58.14 AM.jpeg

This month we are happy to introduce you to Eli Chacha Thomas, the founder of Chang Medical Clinic.  Chang Clinic opened its doors in November 2017 and is located in a rural locality of Opapo which is in Ringo, a sub-county of Migori County, Kenya.  

Mr. Thomas is a clinical officer with a Diploma in Clinical Medicine and Surgery, and also holds a diploma in Medical Laboratory Technology.  When asked why he opened Chang Medical Clinic, he replied, "Well, I decided to start up this facility for I saw the need the people had. Opapo is a remote place and the nearest public health facility is over 15km away.  Children and mothers now have a place to run to for medical attention."

In discussing the incorporation of The Addis Clinic & asynchronous telemedicine into his patient care, Chacha says, "I can't mention enough, but The Addis Clinic telemedicine works for me perfectly.  Our patients now get the services of specialized doctors without having to go to these big facilities which are expensive.  I have seen my clients responding well to the treatments recommended by The Addis Clinic doctors.  We also have learned a lot from the doctors as well."

The Addis Clinic is excited about our partnership with Chang Medical Clinic, and looks forward to expanding our relationship in the coming months!