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A role for telemedicine in Mali

April 30, 2013
While studying at Bamako University’s Medical School in Mali, Cheick Oumar Bagayoko and his peers often worried about being sent to Mali’s sparsely populated interior after graduation. It was known that once a doctor was sent to a rural area, lack of access to continuing education and a general experience of isolation meant they began to lose knowledge learned in medical school.   Bagayoko’s concerns as a medical student point to a wider problem for Mali’s health system. A serious shortage in healthcare workers is contributing to health inequalities between rural and urban areas in Mali. Rural residents have less access to health services and limited or no access to more complex diagnostic equipment.  Cardiologists, for example, are rarely located outside Bamako, Mali’s capital.
Bagayoko’s idea to create a peer-to-peer network of virtually connected medical staff has the potential to link doctors from Bamako to those in rural settings. With a grant from the Global Health Research Initiative, a partnership between IDRC, the Canadian International Development Agency, and the Canadian Institutes of Health Research, researchers are assessing the potential  of this technology and its impact on Mali’s health system.
Telemedecine and accessibility

Efforts to increase recruitment and retention of health workers in rural areas are challenged by isolation and lack of incentives for staff. At the same time, patients are forced to take on a heavy financial burden and travel to urban areas for treatment.   As Internet access began to increase in Bamako, Bagayoko became interested in the possibility of using the Internet as a relatively inexpensive way to improve access to health care across Mali. When Bagayoko chose telemedicine as the focus for his doctoral thesis, he knew it was a risky choice. Telemedicine projects were rarely seen in low- and middle-income countries, and in a country with slow and sporadic Internet coverage, the choice seemed impractical. But Professor Abdel Kader Traoré encouraged him to pursue the idea and agreed to become his thesis advisor.   From the Swiss Alps to remote Mali   Bagayoko looked outside Mali to find someone with experience in telemedicine. He contacted Dr Antoine Geissbuhler, at the University of Geneva, to ask him to be on his thesis committee. Geissbuhler agreed, based on a shared interest in medical imaging, e-health, and new medical applications for information and communication technologies.   While in Switzerland, Bagayoko came across mobile technology used for ski rescues in the Alps. The portable technology allowed first responders to carry out diagnostic tests on the ski hill, far from the hospital. He saw that this could be used to perform diagnostic tests on patients in rural Mali, in particular electrocardiograms and ultrasounds. The idea was to have a specialist based in the capital assist rural doctors in diagnosing patients. “I am convinced that these tools will enable physicians to remain on site in rural areas,” says Bagayoko.   The project evolved into a web-based network where physicians seeking training on a particular subject were able to access an online course provided by a specialist. Doctors practicing in remote communities now had access to training opportunities and colleagues that could assist with complex cases even though they were located hundreds of kilometres away.   This contact went a long way in alleviating the sense of isolation experienced by rural doctors in Mali.   An international network

The success and growth of this network began to draw the attention of neighbouring countries. With assistance from Geneva University Hospitals and the Fonds de solidarité internationale de Genève, Bagayoko and Geissbuhler created the Réseau en Afrique francophone pour la télémédecine (RAFT) in 2001. The network has since expanded to include 28 countries, including several where English is spoken. With the support of the World Health Organization, the network now provides dozens of English language courses online.   Bagayoko and Kader are continuing their collaboration as co-principal investigators on the GHRI supported project.   The research team is testing the effectiveness of distance medical training and telemedicine services, including transmission of medical images for cardiac and obstetric care and support to rural medical workers in the diagnosis and treatment of patients.   The goal is to determine whether this technology raises levels of recruitment and retention of health personnel and improves access to quality care in rural Mali. Bagayoko, Kader, and their team are helping to develop an organi­zational model for telemedicine services that is effective and responds to the local contexts in which services are implemented.

This article was written by GHRI Program Management Officer, Esmé Lanktree, with files from Gyde Shepherd and Marie-Danielle Smith.

Learn more about the Global Health Research Initiative

Read more about this project: Information and communication technologies can increase access to health professionals in francophone Africa

Read more about research supported by the Africa Health Systems Initiative — Support to African Research Partnerships:

Photo (right): Mali Telemedicine Team
Dr Kassim Diabaté, based at the Dioila District Hospital in rural Mali, conducts an abdominal ultrasound during a training session in Bamako.