e-Health, Solution to Doctor Shortages

Debbie Peters

I was waiting for a table at the entrance of the upscale restaurant at Washington, DC’s Maine Avenue Fish Market when I heard a man shouting with a strong Nigerian accent. Looking up I saw a man wearing his mask under his chin standing with his wife and daughters arguing with the manager who was trying to persuade him to pull up the mask over his nose. What was most surprising about his cringe-worthy behaviour is that there are many highly-educated, professional Nigerians in the District of Columbia-Maryland-Virginia (DMV) area so it is rare to see one behaving badly like that in public. Almost everywhere I go in the DMV, I am guaranteed to hear a Nigerian accent, especially in Maryland, where there is a large community. Recently I was having dinner with a Nigerian friend at National Harbor in Maryland when I heard a Nigerian man speaking on the table behind us. For me it is lovely to hear familiar accents and be surrounded by a community that I identify with. There are plenty of African nationalities in the DMV; many Uber drivers are African, which leads to interesting conversations during my rides. Even the driver from the moving company that drove my furniture from Seattle to Washington, DC was Nigerian, so I am making friend. The flip side of this growing African community in the US, is that it leads to a brain drain in Africa. Especially in the healthcare industry where specialist doctors are the highest paid professionals in the US. I am meeting a lot of Nigerian doctors, pharmacists, and nurses in the DMV and if you search the healthcare provider directory for health insurance companies, you will come across Nigerian names.

There is a global war for healthcare talent; doctors and nurses earn much more in the US than they do in Africa so at some point even the most dedicated ones give up and leave. The current Covid pandemic has highlighted the competition for healthcare workers. When New York City was in the apocalyptic phase of their Coronavirus crisis where some hospitals had refrigerated trucks outside to put dead bodies after the morgues ran out of space, the governor sent an SOS for doctors and nurses to come from anywhere and work in the city from. They did away with immigration and registration requirements. I tried telling some doctors in Zimbabwe that this was their chance to come and work in the US, but they were afraid of catching the virus. At the time, there was video was circulating on social media of emergency room doctor Monalisa Muchatuta describing her bout with Covid and she recovered quickly. Volunteer nurses coming to New York from other states got free flights from the airlines, free hotel stays and often got free food donated by city restaurants. They were also paid more than $20,000 per month because of hazard pay, which led to complaints from local workers, so Governor Andrew Cuomo was requesting hazard pay for the local doctors and nurses. Some private hospitals were paying so much money I would have jumped at the chance if I could. Coronavirus infection rates are well under control now so by the time I started getting queries from doctors in Nigeria, the opportunity in New York had passed.

I spend a lot of time trying to understand what is going on in Africa when it comes to healthcare in order to find solutions. Doctors tell me we need more clinics and hospitals as well as to upgrade the facilities we have. The latest global trend in healthcare delivery is eHealth or digital health which will allow Africa to leapfrog the infrastructure shortfalls on the ground. I have been speaking to the team from Telenet Health which provides eHealth solutions so that nurses or lower-level health worker can go out into the community with instruments like blood pressure monitors, glucometers and cardiac monitors to set up a mobile clinic to carry out basic disease screening and monitoring. They can even upload the data afterwards; all they need is basic GSM connectivity. Doctors provide remote consultation and are therefore be able to cover a larger area. Patient data privacy is protected by having servers in each country. Recently I had a call with the team from eHealth Africa in Nigeria led by Adam Thompson and they are doing interesting things in eHealth as well as running a Covid clinic in Abuja. Digital health in the US is the latest trend as every major player including McKinsey is establishing a practice. It has reached a point where wearables like the Omron HeartGuide watch, which I have been lusting after, will monitor your blood pressure on the go. No more sitting down with a blood pressure cuff and recording your readings because all you have to do is download later and share your readings data with your doctor.

For telehealth to be successful, we must figure out how to get laptops or tablets in the hands of the community workers running the mobile clinics then get them connectivity as well as reliable power. In areas where power is not available, like in villages, alternative power sources like solar chargers are essential for the devices. Some eHealth services like Telenet Health provide the devices but to reach scale, tech companies will have to come to the table with devices and internet access. Most corporate companies in the US upgrade their devices every 2 years so if those devices are donated and refurbished, we can ship them to Africa. Device retailers like Best Buy and manufacturers like HP or Dell surely cannot sell all their stock so the beauty of registering a non-profit in the US is that you can approach their environmental, social and governance departments for tax-deductible donations of equipment. The key thing is to have efficient implementation on the ground to ensure that the devices get to the right place. Similarly, we can obtain devices to enable students in Africa to learn remotely. Covid has taught us all the power of digital systems in business, education, and healthcare. Students and teachers in Africa need devices urgently because Covid is going to be around for a long time and things will never be the same again.

Additionally, I am linking up with African doctors here in the US because even though they left, they care about what happens in Africa. For instance, Zimbabwean doctors in the US are very sympathetic about the plight of doctors in Zimbabwe who are trying to save lives in difficult environments. They donated money for Hurricane Idai last year but sometimes giving money is not always the answer. I was in Zimbabwe when that hurricane hit, and the most effective relief effort was coordinated by Highlands Presbyterian Church. When you are trying to solve problems in Africa from abroad, you need to find out the reality on the ground from the people doing the work. The reason why so much aid goes into Africa with no impact is because the donors have their own ideas, but it is not what the people need. Technical assistance is popular and while it is necessary, often the only thing it does is satisfy the donors’ metrics, not solve the problems. Putting a dollar value on technical assistance, which is a cash in kind, will not put food on the table or medicines in the mouth of Africans. Even though I have not raised any funding yet, I am already outsourcing some work to people in Africa because they need to make a living.

On a final note, it is interesting to see the Covid response in African countries compared to the US. Most states in the US do not have a quarantine policy whereas most African countries do. A few restaurants in the US are starting to check temperatures and the last time I flew, in July, airports were not doing temperature checks yet. The only thing that is mandatory is masks and I choose to wear gloves when I go out. I hear African countries have some stringent policies. Zimbabwe currently has a curfew from 6pm to 6am with police roadblocks checking to see that people are wearing their masks. South Africa has some draconian lockdown policies where the police clashed with crowds who were defying the lockdown. African governments have been a bit heavy-handed in their Coronavirus response and I am not saying that they must be as lax as Sweden, but the economic impact of this pandemic is going to be felt for many years. Here in Washington, DC retail businesses are open again, but office workers are still working from home. I live within a few minutes’ walk from The World Bank, IFC and IMF offices which all remain empty. It is a pity I have relocated when the city is not at its prime, but it is slowly getting vibrant again. In fact, some people our neighbourhood on the ‘Next Door’ app are already complaining about crowds and noise from nightclubs in the areas. This weekend the city is alive though, with visitors coming for ‘The Commitment March’, the 57th anniversary of Martin Luther King’s March on Washington, which was organized by Rev. Al Sharpton.

· Peters is the CEO of Nyasha Africa, a non-profit based in Washington. DC. Her email address is deb.n.peters@gmail.com and Twitter handle is @debbie_nyasha