Monday, April 14, 2014

Ideas: The Chronic Conditions Card

Warm greetings to everyone out there. My current pre-internship at one of Nairobi’s District Hospitals currently occupies a lot of my time (…and let’s not even get into the 3-4 hours I spend in traffic each day), and so it is ideal that I should give you a slice of exactly what it entails.

Now, my previous pre-internship was at Kenya’s main referral hospital – The Kenyatta National Hospital (KNH) – and, suffice it to say, it was an eye-opening experience. Having only been to private hospitals anytime I’ve been ill, Kenyatta Hospital afforded me a chance to see the best the public health sector had to offer, which surprisingly is alright. KNH is usually in the headlines for all the wrong reasons, but it is a creature of wrongful circumstance; given the right kind of resources and backed by adequate political will, KNH could rightfully live up to its reputations as “East & Central Africa’s Largest Referral Hospital”.

True to my nature, while I was at KNH, I complained about the inefficiencies that I came across; however, I usually complain about things that, in my opinion, are rather easy fixes …surely there can’t be anything more frustrating than being pummeled by easily solvable problems. But as my friend Maria would keep on telling me, there is definitely much worse that I could be facing at Kenya’s myriad public hospitals; and after this stint at the District Hospital, I can see that she was totally right.

The public health system is understaffed, overwhelmed and faces shortages of essential drugs, equipment and linen that are required to save lives …or at least just make it more manageable during the convalescence period. One source of inefficiency is the crux of this blog, and it is by nature more of a ‘medical speak’ vs ‘layman’ conundrum. Every day at the hospital, we are faced with patients suffering from diseases like Diabetes, HIV or TB, and in one way or another the situation tends to play out the same. In treating any sort of chronic disease, the clinician needs to determine the history and severity of the disease condition, determine a baseline for the patient’s health parameters since the inception of treatment, and come up with the best drug regimen for the disease at hand.

In the case of HIV/AIDS, the doctor is looking for the date of the patient’s HIV diagnosis, presenting complaint (Skin lesions, TB, Meningitis, etc), CD4 count & Viral Load, and Anti-Retroviral medication (ARVs). To a clinician this is just the nature of the business; however, patients are typically plagued by a bunch of problems, not least of which is confusion/denial about their HIV diagnosis, ignorance of their most recent CD4 counts or viral load values, and forgetfulness concerning their current drug regimen. Again, in this regard, I can’t really blame the patients because a lot of them have a very limited grasp of the medical concepts behind their problem and its relevant medication; it is also a great exercise in wishful thinking to expect them to remember laboratory values for tests that were carried out almost 6 months prior to the juncture at which you encounter them at the hospital. One last problem is that the patients usually migrate to different parts of the country, meaning their condition is handled at various Comprehensive Care Centres (CCCs), and between these centres they usually tag along a tattered small blue card that relays some information concerning their status.

Using only HIV as an example, you can get a semblance of what clinicians have to deal with when treating chronic conditions at the hospital; things like Hepatitis, Diabetes, TB, Cancer, Chronic Lung Disease or Autoimmune conditions. Since the educational levels of patients runs the full gamut from illiterate to well educated, I think some measure should be put in place to simplify this whole process, entrusting the specialized details to the medical professionals so that treatment need not be hindered by any of the patient factors I have previously listed.

The best solution to this, I believe, would be the creation of a Chronic Conditions Card (CC Card). This would be a machine readable card – that uses the patient’s ID Number as a keyword - that would store the patient’s relevant details, Disease vital statistics and current drug regimen information. This would ensure that the details of any patient suffering from a chronic disease would be handled through a digital database and should be available to any clinician when required.

As we strive to gain some control over Chronic diseases – both communicable (Hepatitis, TB, HIV) and non-communicable (Diabetes, Autoimmune conditions, Cancer) – this notion of a CC Card and the associated database would give us a clear-cut method of tallying these disease sufferers, thus giving us an estimate of the kind of resources and financing that need to be put towards alleviating them.

The biggest hindrance to rolling out this card is probably the limited computer availability in most of Kenya’s hospitals. This would be one of those areas where political will could really make a big difference. I daresay that a mere fraction of the money intended to roll out The Primary School Laptops project would be enough to minimally computerize the country’s hospitals towards this end. In the short term, I’m pretty sure someone with basic IT skills could find some way to make a very basic mobile phone app that could interface with a national database, thus relaying the results where needed. It’s all still a basic idea right now, but I’m sure it is very workable and would save lives in the long run (which is the meat-and-potatoes of medical practice, in any case). Hope you have a great day. God Bless

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