AKDN eHRC and the Aga Khan University (AKU) Stroke Program collaborated to develop Movies4Stroke, a series of educational movies for stroke patients and their caregivers. The movies are designed around conditions faced by stroke patients in a low-and middle-income country that lacks rehabilitation centres and chronic support systems.
Leveraging Pakistan’s 77% mobile phone density level, the project tests the effectiveness of a mobile phone-based video intervention. Five-minute videos on stroke are placed in a mobile application that patients and their caregivers watch during multiple sessions at discharge and afterward.
Outcomes such as patient’s medication adherence; functional progress; blood pressure; caregiver’s knowledge; hospital readmission; and stroke-related mortality are assessed to test the effectiveness of the intervention.
Maryum and Asma – Afghanistan
When Asiya gave birth to twin girls, she found out they were conjoined, partially connected at the abdomen and pelvic area. In search of medical assistance, she and her husband Ali took their daughters to Faizabad Provincial Hospital (FPH). Realizing the critical and time-sensitive nature of the case, the doctors at FPH scheduled a live teleconsultation with Dr Jalil Wardak, Head of Paediatric Surgery, at the French Medical Institute for Children (FMIC) to get his expertise on the case. Dr. Wardak examined the twins remotely and determined that a surgery was needed. Considering the severity of the case and the family’s financial condition, FMIC also agreed to provide the treatment for free, through one of its patient welfare programmes.
At FMIC, the twins underwent a series of tests and assessments from doctors from the surgery, anesthesia and radiology departments. The five-hour long surgery, performed by Dr Wardak and his team of local doctors and nurses, resulted in the successful separation of the twins. This was also the first successful case of separating conjoined twins in Afghanistan.
The twins, Maryum and Asma stayed at FMIC for 15 days before getting discharged. “I was worried that all this might be a dream. But when I saw my daughters sleeping in separate beds, I realized that my dream has come true” said Asiya.
Sara – Afghanistan
Sara was born with a congenital brain malformation. When she was only a month old, her family consulted a local paediatrician in Faizabad who advised them to take her to Faizabad Provincial Hospital (FPH).
A live teleconsultation between FPH and Dr Mohammad Akbar Shirzad, Consultant General Surgeon at the French Medical Institute for Children (FMIC), Kabul enabled Dr. Shirzad to diagnose Sara’s condition as a complicated case of occipital meningoencephalocele, a protrusion of the brain through a birth defect in the skull bones. Realizing the severity of Sara’s condition from the teleconsultation, Dr. Shirzad decided that she needed to come to FMIC for surgery.
“Three decades of war, poverty and malnutrition have led to an increase in such cases in Afghanistan. The teleconsultation enabled us to detect Sara’s condition on time as there was a very slim chance of her survival,” said Dr. Shirzad.
Sara’s father Samir Ahmad is a primary school teacher in Badakshan and the only bread winner for a family of eight. His modest salary could not afford the trip to FMIC or the cost of surgery. The Children House Project, one of FMIC’s patient welfare programme’s sponsors, arranged for funds including full medical cost, transportation and accommodation for the family.
At FMIC, a team of surgeons successfully operated on Sara, excising the occipital mass. A second operation was performed a week later to insert a ventriculoperitoneal shunt to relieve pressure from her brain caused by fluid accumulation.
“Without the welfare programme’s assistance, it would have been impossible for me to afford Sidra’s operation. We are grateful to the doctors at Faizabad and FMIC for saving my daughter’s life,” said Samir Ahmad.
Sara stayed in the paediatric ward for two days before returning with her family to Faizabad. She soon made a full recovery.
Thomas – Tanzania
Three-month old Thomas had struggled with his health since birth. At only two weeks old, he was unable to keep food down, continuously vomiting after every feed, sometimes as many as six to eight times a day. His birth weight started at 3.3 kg and hit a low of 2.5 kg. It was at this point that Regina, Thomas’s mother, brought him to the Primary Medical Centre (PMC) in Mwanza for a consultation. Doctors assessed the baby and referred him to the Bugando Medical Centre (BMC), a zonal hospital in Mwanza for treatment. He was admitted at BMC for a week, where he was given IV fluids and medications which reduced the vomiting. But it wasn’t long after being discharged that he fell ill again. The vomiting returned indicating that the cause of his condition had not been addressed.
Thomas was brought back to the PMC where Dr. Gulshan Himani, a Family Medicine Physician requested a live teleconsultation with Dr. Mariam Noorani, a paediatrician at Aga Khan Hospital, Dar es Salaam (AKH, Dar).
Dr. Noorani assessed Thomas’s condition via the teleconsultation and requested further tests including an abdominal ultrasound and electrolyte assessment to confirm diagnosis of infantile hypertrophic pyloric stenosis. Upon confirmation of diagnosis, the next course of treatment was surgery. However, since a paediatric surgeon was unavailable in the Lake Zone Region, it was recommended that Thomas be brought first to AKH, Dar.
After an in-person consultation with Dr. Noorani, Thomas was referred to Muhimbili National Hospital (MNH) for surgical correction and stabilisation. The surgery was successful and Thomas was discharged three days later. Regina had follow-up visits with Dr. Noorani who monitored Thomas’s development. After the surgery, he started gaining weight and looking healthy.
This story is an example of how, through JHI’s eHealth Programme, expertise is shared across regions to provide quality patient care, easing the barriers of distance. Early identification of unusual and difficult cases allows for early treatment and improved quality of care for families. Thomas’s case is an example of referrals within a public-private partnership with the Mwanza PMC, AKH, Dar and MNH collaborating to improve the health outcome of patients such as Thomas.
Nasima – Afghanistan
Nasima had been suffering from epilepsy for ten years. She sought treatment from several hospitals including ones in Kabul, which would take her five hours to reach. But she wouldn’t see any improvement. She then heard about Bamyan Provincial Hospital’s (BPH) eHealth clinic, only 20 minutes from her house.
At BPH, an emergency teleconsultation was scheduled with Dr. Esmatullah Hamed, Neurologist, at the French Medical Institute for Children. Dr. Hamed examined Nasima, prescribed medication and asked her to come to BPH for follow-up teleconsultations with him. Before receiving treatment through the teleconsultation, Nasima used to have three to four convulsions a day; now she does not have a single convulsion.
“I used to go to Kabul multiple times for treatment, but never saw any improvement in my condition. Now, after being treated through the teleconsultation, I am better and am very happy.”
Names of patients and family members have been changed to respect privacy.