Article Text

It's good to talk! Use of electronic communication in developing countries
  1. R Aurora1,2,
  2. AW Kelsall1
  1. 1Paediatrics, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
  2. 2Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
  3. Paediatric Neurodisability, Yorkshire Deanery, Leeds, UK


Aims Many trainees from the UK go abroad to developing countries every year in programmes such as the VSO/RCPCH fellowship scheme. Trainees often work in difficult circumstances and see clinical cases that they have never experienced before. Access to senior support varies depending on location. During my 9 month placement in Malawi, I used electronic communication to liaise with consultants both locally and abroad to manage complex cases. In this abstract we present the benefits of internet (E-Mail) and mobile phone technology to optimise the treatment of children in a developing country. We note in UK there are strict guidelines around patient confidentiality and electronic communication.

Methods All electronic communication with consultants in UK and locally in Malawi was reviewed over the placement time. Parents provided verbal consent for data and image (radiographs, videos and photograph) sharing.

Results Thirty-two cases were identified. In 25 (62%) of cases E-mail was the preferred method of communication. Other methods of communication included mobile phone calls to local consultants in neighbouring cities. Malawian consultants were contacted in 15 (47%) of cases compared with 13 (40.5%) cases with international contacts by E-mail. Both were contacted in the remaining 4 cases (12.5%).

The most common cases discussed were cardiology 7 (20%) and oncology 5 (14%); others included: neurology, infectious diseases and neonatal cases. Twenty eight cases were discussed with consultants who had an appropriate specialist interest. Most requests (28 cases, 87%) for advice by Email or phone were answered within 72 hours. Six cases (19%) were transferred for further management including surgery to other countries. Overall, 10 cases (31%) survived.

Conclusions This study illustrates that trainees working abroad need to access senior support to provide advice on clinical management. Electronic communication guided the clinical management of a number of children. In the UK there are strict guidelines around patient confidentiality and electronic communication based primarily on Data protection Act, 1998. Having obtained verbal consent from parents, electronic communication ideally through a secure system such as NHS.NET could be used to support trainees working in under-resourced posts to improve clinical care.

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