Dr Fran’s March column

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This month: the case of a patient previously diagnosed with diabetes who hadn’t taken his medication for two years. This patient had arrived unwell at Mount Makulu in rural Zambia, but it’s something I encounter surprisingly often in Oxford too.

This particular patient had become increasingly dehydrated and unwell due to his increasing sugar levels. Luckily Clinical Officer Elyse was able to rehydrate him and start oral diabetic medication right away.

It again reminded me of a universal theme of patients all over the world – playing down their ill health and forgetting or not taking their medication. It’s a constant battle for clinicians trying to keep them healthy.

In fact, chronic diseases (things like diabetes, hypertension, heart disease and cancer) are becoming more common in Africa with changing lifestyles and more Westernised diets. In time, promotion of a healthy lifestyle as prevention will soon become as important as infectious disease management in developing countries.

However, chronic diseases can be difficult to look after in resource-poor settings as the tests and medicines normally used are not widely available. For example, providing insulin for diabetic patients could prove logistically challenging. Also, clinical training has also tended to focus on the infectious diseases; certainly the Virtual Doctor’s Clinical Officers are more confident in treating malaria and TB than diabetes.

Chronic diseases are certainly one of the challenges facing developing nations.

Dr Fran Fieldhouse is the Virtual Doctors’ Head of Clinical Governance. Follow her @franvirtualdocs

Dr Fran’s February column

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Telemedicine is a fantastic way to build bridges between health workers and educate and enable those in the developing world. It is, however, imperative that the advice given by the Virtual Doctors is evidence-based and of good quality. So I have started reading each question sent from Zambia and the volunteer’s doctor’s response. I am doing this for the first quarter of 2015, gathering data on the timeliness and quality of the volunteer doctors response. Of course I’ve informed all the volunteer doctors and the Clinical Officers (CO’s). I have also asked for, and would be delighted by, their feedback including any issues they are encountering and possible solutions.

Two things have struck me so far. One is (certainly) my lack of knowledge of the drugs available to the CO’s. This can risk a delay in treatment if volunteer doctors suggest treatment or investigations not available locally. On emailing Dr Bonface Fundafunda (who is both involved with the Virtual Doctors as an adviser and is the Managing Director of Zambia’s Medical Stores) I received a copy of Zambia’s essential medicine list (plus a wealth of other information). I have distributed this to all the volunteer doctors and hope this is helpful.

The other is that when the CO’s send photos of dermatological (skin) conditions they are often very close up images. Photos are incredibly helpful, but as well as a close up, a distance shot helps give the volunteer doctors extra information about exact location and state of surrounding skin etc. I have passed this request on to the CO’s.

Next week is the Virtual Doctors trustee meeting and I’m looking forward to meeting everyone face to face for the first time!

Dr Fran Fieldhouse is the Virtual Doctors’ Head of Clinical Governance. Follow her @franvirtualdocs

Dr Fran’s January column

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Recently I have had several gynaecological questions from Clinical Officers in Zambia.

These always remind me that patients often have similar illnesses, regardless of location, and these are cases that I could as easily see in Oxfordshire.

74% of Zambia’s population is under 30, so young female patients commonly present with complaints about menstruation and fertility. Heavy menstruation (menorrhagia) is especially problematic in Africa, with severe anaemia a common consequence, and this is compounded by frequent child bearing (and, commonly, hookworm infestation as well). Currently the average family in Zambia has 6.2 children.

Depo-Provera injections every three months work both as a contraceptive – thus helping women space their families – and reducing (in fact often stopping) menstruation. However one of the side effects is that it can take up to nine months for fertility to return (which is one of the questions I am asked). This contraceptive is especially popular in the UK, as the injections avoid the consequences of forgetting to take pills!

Dr Fran Fieldhouse is the Virtual Doctors’ Head of Clinical Governance. Follow her @franvirtualdocs

Virtual Doctors welcome Zoe

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Zoe Marlow will be helping out at the Brighton office for the next few weeks, giving her valuable time one day a week.  Zoe has an impressive CV and will be a great asset to our small team. 20141117_133148

Thanks Zoe, we appreciate your support.

Virtual Doctors interviewed by CNN

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Fran Fieldhouse describes her experience as a Virtual Doctor to CNN

Earlier this month I found myself in Greece on holiday talking to CNN’s Inside Africa presenter, Soni Methu, via Skype. She was in Zambia at the Ngewerere Rural Health Centre as part of a programme on technology development in Africa. As a GP volunteer at the virtual doctor project, I was delighted to be interviewed and to finally meet Kennedy, the local Clinical Officer with whom I have had many email correspondences.

I became actively involved in the VDP in early 2014 and have since received over 30 emails for advice and diagnosis. Topics have varied from infectious diseases, to hypertension and fertility. Having worked in a rural hospital in Zambia in 2001 and visited rural health centres during that time, I am humbled by the incredible work the Clinical Officers do in such a resource-poor setting. The emails I have received have been intelligently thought out and frequently the Clinical Officers have tried various medicines or thought of potential diagnoses prior to emailing. Sitting at my desk as a GP inOxfordshire, with tests and hospitals at my fingertips I am constantly reminded of how lucky I (and my patients) am.

For me the beauty of the project lies in the simplicity of providing email support to these isolated workers, educating them with each email so they can easily treat the condition should they see it again, and allowing Zambian clinicians to maintain ownership of their patients whilst getting an expert opinion.

Here’s to its expansion over the coming year across Zambia and my 20 seconds of fame on CNN!

Dr Fran Fieldhouse is Virtual Doctors’ Head of Clinical Governance

Sad farewell to Caroline and Lauren

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The Virtual Doctor Project recently said a sad farewell to two of our trustees, Lauren and Caroline. Lauren has been with us for five years and Caroline for a year now. Both have contributed significantly to the charity and due to increasing personal commitments, they have decided to step down as trustees.

We thank them both for their kind commitment and contributions to the work of the Virtual Doctor Project and wish them well for the future.

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Caroline Pinder (left) and Lauren Foster Mustarde (right) receive their certificate of thanks from Huw Jones

MtGox Bankruptcy – Where are our Bitcoins?

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As one of the first charities in the UK to accept donations in Bitcoins, we were delighted when more than 40 members of the Bitcoin community chose to show their generosity and did just that over the last six months. Unfortunately the bankruptcy of MtGox, the largest Bitcoin exchange which held our wallet, means we have lost access to those donated funds. We will continue to watch developments in the hope that we can reclaim our missing funds and in the meantime we have opened another wallet on a different exchange. Please use the following address for donations:



Case Study: Malnutrition means six year old Towani is the height of a three year old

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Heather Ashcroft (Zambian Project Coordinator) describes one of her weekly visits to Ngwerere Rural Health Centre

Weekly visits to newly trained Clinical Officers are a critical part of the implementation of the Virtual Doctors Project into rural health centres. After initial training, I visit each site once a week in order to review the files the clinical officers want to submit and help them through the process. As practice makes perfect, the clinical officers then become responsible for building the Project into their own weekly schedule.

Ngwerere Rural Health is approximately 20 kilometres outside the centre of Lusaka on the Great North Road. Kennedy Mulenga is the only Clinical Officer at the site which services a catchment area of approximately 12,000 people. I visited this site in February 2014 and Kennedy invited me to sit in the consultation room during the treatment of a patient and see how he uses the VDP system in practice to help him with the case.

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This particular case involved six year old Towani (shown sitting on the floor in the photo) who came to the clinic along with her mother and her 9 month old baby sister. Nelia was feverish, irritable and suffering from painful sores on her lower body. As the mother is HIV positive, Kennedy ran tests on Towani to see if the infection had been passed onto her daughter. When the test came back negative, Kennedy wanted to know whether there were complications with her condition due to her diet. Towani was the height and build of a three year old child and her distended stomach pointed to severe malnutrition. The mother explained that Towani ate nshima (ground maize) for most meals, with the occasional banana.

Kennedy made some preliminary suggestions to the mother and advised that he would call her with a date for her to return to the clinic. He then used the VDP system to submit a patient file, along with the patient’s history and photographs of the lesions on her abdomen to an expert, looking for advice on the best medication for her condition. The expert was able to diagnose her with kwashiorkor (malnutrition due to lack of protein) and advise on a course of treatment and medication.

Kennedy explained to me that he was able to call patients who needed to return to the clinic, or advise on a return date by which point he would have received feedback from the expert. The feedback in this case involved a dietary program for the patient which the mother could implement immediately. Medication was also recommended, however, this was not stocked at the clinic and the patient was referred to the hospital with their prescription. Not only was the timing of the patient’s return to the clinic in line with the expert’s response to Kennedy, but unnecessary referral for treatment at the hospital was prevented. Unfortunately rural health centres still remain under stocked in terms of medication but time spent in waiting rooms and in consultation in this case was minimised and Towani is already on the road to recovery.

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