In 2002, between graduating high school and starting my post-secondary education in medical studies, I worked for ten months in strenuous manual labor at a corn factory in the Kasese District, in Western Uganda. Using the savings from that work, I was able to buy myself a brand new Ericsson T10 mobile phone. Acquiring my first electronic gadget elevated me to the first million Ugandans who were "tech-savvy", able to make calls and send text messages. Owning a phone then was expensive. Handsets were the same price as an acre of land in city suburbs, and in addition, one had to pay a monthly $4 service fee to keep his phone connected to a network, as well as airtime fees.
In 2015, there are 17 million active mobile phone subscribers, more than 80% of the adult population, distributed widely across the country. This has been facilitated by the availability of cheap smartphones as well as favourable prices for voice and data. The overwhelming success of mobile solutions, especially Mobile Money, has demonstrated that a cell phone is the most practical technology in Africa. With our health indicators looking bleak, inspired technologists became motivated to find digital mobile health solutions to Africa and other low resource regions around the world.
Hack-a-thons, incubation spaces, design competitions and other initiatives have resulted in many innovations taking on problems in areas such as data management and disease surveillance. However, despite the many phones, apps, and other electronic medical devices available, the lingering question remains: why are these technologies not yet offering maximum impact to the patient, the doctor and the health system as a whole?
Medicine is a practice taught by apprenticeship. This practice is heavily guarded, more like a secret society, swearing by the Hippocratic Oath to enter and abide by strict protocols and guidelines. The practice is standardized world-over and medical professionals are kept updated through journals, conferences and peer review meetings. Every new approach proposed is weighed against the existing proven method, and the "council of elders" approves or disapproves its usage. In total contrast, the world of technology is very liberal, totally free of restriction. Without rules and protocols, led by imaginative millennials, technology innovation is spreading like a wildfire. This wave of growth is fast outpacing our snail pace in health. Mobile health technology advances have been cautiously received, with many of them paused at the concept stage. Why is this?
First of all, most of the technologies cannot be 'peer-reviewed,' as they are developed by technology graduates in labs, whose methodologies are different from how medicine is practiced in a real world context. Despite a few doctors joining telemedicine and mobile health, new technologies are still largely peripheral to mainstream practice. Therefore, peer reviewing is still difficult to execute, especially in places like Africa where the number of advanced technology literate doctors is still small.
Third, some of these technologies are seen as threats by the doctors in their paternal roles; they fear that new apps and devices have the potential to empower patients as their own doctors. The avalanche of medical information on the internet and digital devices makes patients sometimes feel that they are more informed than doctors. They ask 'unnecessary' questions and crosscheck whatever they are instructed to do against what is on the internet. These 'difficult' patients threaten doctors` invincibility and many doctors subconsciously fight back. Empowering patients is a good idea in general, but in a health field that is driven by monetary gain, knowledge can create an adverse effect on the industry.
Lastly, technology attempts to merge different disciplines in health. Take, for instance, a bloodless app/device that tests for malaria. When widely used, such a device will take the place of a laboratory technologist, a specialized field in medicine. This enables a doctor in a consultation room to comfortably diagnose malaria without a laboratory. As traditional as medicine is, such technical advances cannot quickly swim upstream through a murky bureaucratic health system.
More awareness and investment is required to overcome the issues which have limited the impact of potentially life saving mobile technology in Africa. What could happen if we brought the world of medicine and technology together? What impact could be created if doctors and technologists worked closely together to generate world changing innovations? If this were to happen, the tech labs would generate rapid prototypes that would be tested faster in the field to judge their effectiveness and safety. Doctors could enhance the complementarity of technology to medicine and not look at technologists as alien or competitors. Africa needs such collaborations to fully reap the benefits of its young population and reverse the disappointing statistics in health and other social sectors. Until we create new spaces and opportunities for this type of exchange, digital mobile health technologies in Africa will show promise, but never reach their full life-saving potential.
Editor's Note: This article is part of the InSTEDD blog series "Digital Diary of a Ugandan Doctor", which provides an African born medical professional's perspective on the potential and pitfalls of technology and innovation for improved health in Sub-Saharan Africa.
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