Emergency rescue response available at tap of a button

As Kenya strives to implement universal health coverage (UHC), making emergency healthcare available is crucial, especially if the populations that need primary healthcare most are to access it.

And using information and communications technologies (ICT) in emergency medical response and to make diagnoses are key to the attainment of universal health coverage.

ICT makes emergency medical response services more efficient, affordable to the masses and effective, says Mr Moses Omeri, the chief executive officer of ResQ247 Ltd, a Nairobi-based firm that provides emergency medical rescue logistics and response solutions across the country. He adds that this would prevent untimely deaths, he added.

"An estimated 54 per cent of all annual deaths occur between the emergency and the person being able to access a health facility," says Dr Jeremiah Gitau, the executive director of the Emergency Medicine Kenya Foundation (EMKF).

According to EMKF, Kenya records about 5.8 million injury-related deaths annually. “This is 32 per cent more than deaths related to HIV, TB and Malaria combined,” adds Dr Gitau.

Article 43 of the Constitution Kenya, 2010, states that no Kenyan should be denied emergency medical treatment. But it is silent on who should pay for these services.

LEGAL LOOPHOLE

This legal loophole has exposed Kenyans, especially road accident survivors and other casualties, who genuinely need emergency care services, to potential health risks that further threaten their survival.

“Unfortunately, the realisation of this right has been hampered by the fact that medical services were devolved, with little regard to the capacity that county governments had to manage healthcare services, says Mr Omeri.

In addition, the ability of the counties’ health facilities to provide evidence-based, adequate emergency care is critical for UHC to work. There is a shortage of skills, particularly for emergency healthcare, to function effectively as an entire system. The private sector plays a major role in filling the gaps, but the coordination between the stakeholders is a big impediment to the realisation of a functional response to emergencies and rescue, Mr Omeri noted.

Aware of these challenges in the country’s public health emergency response systems, ResQ247 has developed a mobile phone application with an all-round solution to almost all emergency requests and services. The company has been working with counties to implement technological rapid-response systems that put all providers of emergency medical services (EMS), fire rescue and towing and recovery services all under one roof.

DISPATCH CENTRES

“This literally turns a normal PC computer in a county office into an emergency dispatch and command centre, easing coordination and timely response to distress calls,” Mr Omeri observes.

In addition, the ResQ247 platform enables EMS providers to turn their vehicles into fully fledged dispatch centres on the go, using the resources at their disposal. EMS providers can operate the ResQ247 app using their smart phones.

"The ResQ247 App supports emergency medical services and the attainment of UHC in that it is a crowdsourcing application that links clients and emergency medical service providers in the system in real time, especially for road rescue and ambulances logistical services,” he adds.

The ResQ247 Ltd control centre works 24/7 to address requests coming in through their toll-free numbers and connecting those seeking the services in real time.

For quality control, all the registered service providers are vetted to determine their communication skills, academic competencies, and professional experience in their area of expertise. This is especially so for paramedics and road-rescue service providers, since it could mean the difference between life and death, he adds.

Once a customer makes a request through the app, they can see on a map all the available service providers around them. “The customer can then place a call and the nearest service provider made available from any cellular phone on a toll-free number in case they cannot use their smart phone,” he adds.

In addition, ResQ247 GPS/GPRS electronic systems make it possible for patients and casualties to be rescued from any location, even when they are unconscious, or cannot talk since the gadgets help direct medics to the scene, Mr Omeri reveals.

The gadgets can effectively monitor those whose memory has been affected by Alzheimer’s disease or dementia.

FASTER RESPONSE

To enhance integrity in healthcare financing and to seal loopholes in emergency health insurance cover/accident cover, ResQ247 is currently working with medical insurance service providers to develop products that will see Kenyans get faster responses to most medical emergencies from anywhere in the country.

“We are putting together a package for comprehensive motor vehicle and accident insurance policy,” he shares.

The app minimises fraudulent insurance claims. For instance, in case someone had an accident at point A but they claim it was at point B, the app can locate the exact scene of the accident.

The underwriter can easily follow up on the report from a back end Web application — which details the coordinates that were generated — and compare them with the claim, he says.

“If the vehicle had ResQ247 tracking gadgets, it is easy to detect the speed at which it was moving at the time of accident,” he adds.

There are cost benefits to the application, especially for insurance companies. The app reduces the distance that would ordinarily be covered by an ambulance, if insurance companies use the conventional method. It links the patient with the nearest ambulance, which reduces the time taken to hospital, reducing the magnitude of complications which might otherwise be difficult and expensive to treat. This could also make the difference between life and death.

“Further, this saves on logistical costs, which increases efficiency in medical insurance and accountability in service provision,” Mr Omeri points out.

It is such features hat make the technology ideal for the mass market.

DATA

“In addition we are able to provide the government and NGOs with the much-needed data on the emergency medical needs of Kenyans, which can pinpoint key areas of intervention. This would lower the number of pre-hospital deaths,” he adds.

The firm works with various emergency medical service providers and rescue operators across Kenya in major towns including Mombasa, Nairobi, Kisumu, Eldoret, Kakamega, Nakuru, Kericho, Kisii, Nyeri, Embu, Kitale, Kitui, Garissa, Bungoma, Machakos, Emali and Thika. It provides air rescue and emergency evacuation and is planning to expand to Rwanda, Uganda, Tanzania and South Sudan by the end of the year.

From early 2014 until late 2016, ResQ247 Ltd conducted a market survey in both public and private health facilities in Kapenguria, Mombasa, Nairobi, Nakuru, Kisumu, Nyeri, Garissa and Eldoret. The findings exposed serious gaps in emergency medical response and rescue in Kenya, especially for victims of road accidents, fires, building collapses and other emergencies that warrant urgent medical attention.

“At both the national and county level emergency medical care and response remains under-developed, under-equipped and unsophisticated, even in private facilities. Most of the stakeholders have not tapped into technology to resolve the ever-increasing challenges in EMS,” explains Mr Omeri.

DIAGNOSIS VIA TECHNOLOGY

To promote the use of e-health technologies for diagnosis, Tambua Healthcare has developed the Tambua App, a Web- and mobile-based platform that uses spectral analysis of waves, artificial intelligence (AI) and machine learning to recognise lower respiratory tract infections. The app can detect TB, pneumonia, pertussis, chronic obstructive pulmonary disease, asthma and lower respiratory tract infections. “It can also be used to track response to treatment for lung cancer,” offers Lewis Wanjohi Wanyeki, the chief executive officer, at Tambua Health.

A user records their cough through their smart phone or microphone and loads it onto the Tambua App, then enters their clinical information such as their gender, geographical location, the frequency of the cough and its duration.

“To diagnose the cough, its sound wave is broken from its original analogue form and transformed into a discreet format which can be stored and analysed,” says Mr Wanyeki. The user receives the diagnosis within seconds via a text message, he adds.

Pathologically, a cough has a specific frequency, wavelength and energy. “A pneumonia cough sound wave has a higher amplitude than a normal cough. Similarly, a bronchitis cough has a higher frequency than an ordinary cough,” he explains.

The technology uses pattern recognition to match any recorded cough with stored information. Using the clinical information provided, the app applies machine learning algorithms to increase the accuracy through matching and open characteristic recognition. Such characteristics could be if one is a smoker, how frequently they smoke, and for how long they have smoked, and such details.

"The technology stores all these data sets together to increase accuracy,” he shares.

The Tambua app also engages patients, advising users to visit a medical facility as soon as possible.

“It can also be used to track response to treatment for lung cancer,” Mr Wanyeki offers.

The Tambua app targets healthcare facilities, doctors and public health officials. It also encourages self-diagnosis because of the stigma associated with TB. “Mothers can use it to diagnose their children,” Mr Wanyeki says.

The mentors and advisory board at Tambua Health comprises people with diverse expertise in the medical field. Some of them are working with Havard Medical School, the National Aeronautics for Space Administration (Nasa), the Food and Drug Administration (FDA), among other institutions.

There is still a lot of ongoing research around cough segmentation, which creates room for continuous invention.

ONLINE DIAGNOSES

In early 2018, the Tambua app was piloted in Migori County, where 850 people were diagnosed through mobile clinics. “We managed between 75 per cent and 85 per cent accuracy for TB only,” shares Mr Wanyeki.

“In 2019, we are looking at segmenting over 100,000 coughs, in partnership with Merck Pharmaceuticals,” says Mr Wanyeki. With online diagnoses comes the issue of data privacy and patient confidentiality.

“How we handle clinical information is very critical; our technology is very secured and safe,” he notes.

It took Mr Wanyeki and his team one-and-half years to develop the Tambua App, while ResQ247 took slightly more than a year to put together the ResQ App.

“Technology is very expensive since it keeps changing. What you know today might not be applicable in the same form tomorrow,” notes Mr Omeri, who has been in software and applications development for the seven years.

ResQ247 has a 22-member administration team drawn from different professional backgrounds — among them insurance underwriters, paramedics, road rescue operators, emergency medical providers and ex-police and investigation officers.

Meanwhile, Mr Wanyeki, 19, has been in software development for six years. Tambua Health has five Nairobi-based employees, with a backup team in the US.

A non-invasive technology, the Tambua App offers a new way of diagnosing diseases that turns smart phones into diagnostic tools. The technology can be integrated into existing medical records such that data is stored electronically.

“If integrated with telecommunication companies with interactive voice response (IVR), the technology can be used to target many people,” say Mr Wanyeki.

Having no prior data sets on TB in Kenya has meant that Tambua Health collects data in their system. In addition, they have to standardise these data sets so that they can be stored and analysed.

“This requires funding so that we can get more people to use the platform. This will make us more efficient and raise accuracy levels,” he adds.

The Tambua App eliminates the huge costs associated with TB diagnosis such as chest X-rays, CT-scans and laboratory analysis of sputum.

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Government could borrow a leaf from apps to improve primary healthcare service

Emergency treatment is a key component of primary healthcare. According to the African Federation for Emergency Medicine, emergency treatment is the provision of initial resuscitation, stabilisation, and treatment to acutely ill and injured patients, and delivery of those patients to the best available definitive care, regardless of their ability to pay.

Dr Benjamin Wachira, an assistant professor of emergency medicine at Aga Khan University Hospital, Nairobi, says the first point of emergency care is the place the victim or survivor of an accident, disease or robbery, is picked up from.

“Most Kenyans pay little attention to point of injury treatment, exposing the victim to prolonged trauma and pain,” Dr Wachira says. Uncoordinated emergency response could lead to disability and death.

These could be issues of the past if the government takes advantage of e-health technologies like the ResQ247 App, which ensures timely emergency healthcare, and the Tambua App for timely diagnosis of TB.

The World Bank says that the implementation of “effective, prioritised, timely emergency care can address 45 per cent of deaths, and 36 per cent of disability in low- and middle-income countries”.

It is estimated that 54 per cent of all deaths in Kenya are pre-hospital deaths and occur between the time an emergency occurs to the point of arrival at a medical facility. In addition, the country’s tuberculosis burden is attributed to late diagnoses.

The high-impact emergency healthcare challenge in Kenya involves road accidents. Data from the National Transport and Safety Authority (NTSA) indicates that the number of people who have died on Kenyan roads this year, as at July 29, is 1,731, which is slightly higher compared with the 1,664 who had perished within the same period last year. These comprised 666 pedestrians, 180 drivers, 381 passengers, 149 pavilion users, 30 pedal cyclists and 325 motorcyclists.

“These are preventable deaths if the golden hour is observed,” says ResQ247 CEO Moses Omeri.

Chances of survival for accident victims — be it road, water, burns, or emergency illness — depend mainly on the golden hour, which requires a patient to receive emergency care within the first hour.

“No one walks from their house straight into the ICU. Intensive care is meant to be part of the continuation of care offered to a stable patient,” adds Dr Wachira. It is, therefore, important for Kenya to rethink its emergency medical care systems if it is to ensure universal health coverage, notes Mr Omeri.

In Kenya, tuberculosis is the fourth leading cause of death, having killed 9,081 people, double the number that died from the disease (4,735) in 2016, according to the Economic Survey 2018.

Further, some 40 per cent of tuberculosis cases remain undiagnosed and untreated. Technologies like the Tambua App reduce the time taken to diagnose TB in Kenya from three weeks to just seconds.

To emergency medical services and TB researchers, both the ResQ247 App and Tambua - will be able to map out data on new areas of emergency healthcare interventions and new disease patterns, respectively.

This will help strengthen primary healthcare system in a country that does not have enough data on the same.