The Business Marketing Manager, Ultrasound at Philips Africa, Anari de Wet and Business Development Manager, Philips Healthcare in Nigeria, Mr George Uduku, tell EMMANUEL ABODUNRIN that wrong medical diagnosis in Nigeria can be addressed with the right technology and what the company is doing in this regard
From your understanding of Nigeria’s health care system, what is the current state of our adoption of imaging technologies?
There are always opportunities to improve. It’s an established fact that if you compare the ultrasound density in Nigeria with OECD countries, there is a significant gap. If you further drill down, that gap is wider in the rural areas compared to urban areas. Of course, there are root causes for this gap, there is always the question of affordability and availability of skilled resources in the remote areas, and they are all issues we are trying to address with technologies like Lumify.
How will this technology boost health care delivery in Nigeria?
Lumify is an app-based ultrasound system. Ultrasound systems are traditionally big machines, and we have managed to miniaturise it into smaller sizes, laptop styles, but now we have been able to put all of that technology, including all the electronics, inside the phone.
The principle of this product is as easy. Step one, you download the app from Google Play Store, it is called Lumify. Step two, you plug in your transducer, it registers, and step three, you scan. It is as simple as that. You choose your own screen size. Whether you choose a phone screen size or 17 inches tablet, it is up to you. The idea is that you can then customise it according to what works for your practice. You are able to have an ultrasound where and when you need it.
We have three probes; first, we have the curvilinear, or curve probe, which is developed particularly for obstetrics scanning and abdominal scanning, among others. The second probe is a linear probe for small parts imaging. This is popular in sports medicine. And the third probe is our cardiac probe for heart scans, screenings and examining outlying areas for risks. Instead of just listening with the stethoscope, cardiologists like to use Lumify to examine the patient to see if they are doing well or if they need to be sent for further evaluation.
But more importantly is the small design features, because sometimes it is the cables that get fractured and damaged but that should also be a nominal cost because you buy those for your phones in any case.
So, from your market analysis, what are the opportunities that exist for this technology in Nigeria?
We think there are tremendous opportunities and it is in two particular areas; the hands of potential new users, some of who will buy it on a personal basis. We have already generated interest in a number of customers on our first day at Medic West Africa and they range from obstetricians to general practitioners and family medicine. We are very excited about that opportunity but what really excites me is thinking about future opportunities for partnerships in different counties or MRH where we can establish not just the product, but a full programme to roll it out at scale underpinned with proper training, and, therefore, increase access. That is really the avenue that I’d like to explore.
Is it possible for a non-medical practitioner to use this technology?
It is possible, but I would proceed with caution. For instance, we had two brand ambassadors at Medic West Africa, who are not medically trained at all. I showed them how to do a quick cardiac, just one particular window so that they could give me a break and they were there scanning. So, they could use the user interface with ease. As you said, everyone is quite tech savvy. However, when it gets to medical diagnostics, that would require some medical training. But I do believe you don’t necessarily have to have been a qualified radiographer or a nurse or doctor to use the device. You could be a primary health care personnel trained in a very specific restricted way to just do first line limited ultrasound screening, especially supported by something like REACTS to keep you in check.
We have a number of primary health care centres in Nigeria and most of them are ill-equipped to handle critical cases. How can this technology help improve the quality of care provided at these centres?
First of all, it will help mature the referral process. Because of the way I see it now, if you think you have a complication, you cannot go to a primary healthcare centre, you’ll have to go to a tertiary (healthcare centre). I think just from the screening or a referral process, it has an impact that the major hospitals will then only see the right patients at the right time and not be burdened by patients that are not necessarily needed there. But more importantly, the right patients will get there on time, because they were screened in time at the primary healthcare centres. That for me is a significant impact. So, it helps with the referral process and to determine where your patients are at which time. And ultrasound, specifically, is one of the easiest ways to upskill and improve care quality at primary healthcare centres. It is the most affordable imaging tool that there is. It is dynamic; it is live, real-time, unlike X-ray or CT-Scans which are a static image, (though, I’m not in any way saying that this is replacing that). So, with ultrasound, you can see dynamically what is happening and make your decisions based on that.
For us to improve the healthcare system in Nigeria, the government has to be involved. Given the potential of this technology to improve the quality of healthcare in the country, are you taking any steps to try to get the government to buy in? Some sort of advocacy?
We will continue to engage with multilateral organisations and use them as a bridge to engage with the government at the federal and state levels. We can sell this to individual care centres, but the real impact comes when we can roll out large scale programmes at the federal and state levels.
Apart from the formal health sector, we have a network of what are called traditional birth attendants and they are all over the country. They are patronised by some Nigerians that can’t afford the formal healthcare system. Can this technology help them in any way?
We believe it is a policy issue; it is now widely acknowledged that traditional birth attendants are important stakeholders as far as discussion around maternal and child health is concerned. They are widely patronised and widely trusted. And as a matter of fact, at the level of the states’ Ministry of Health, and state and national primary care development agencies, there are all kinds of discussions ongoing on how to integrate traditional birth attendants in the whole ecosystem of providers.
There are a lot of associations in the Nigerian health sector. We have Nigerian Medical Association and others. Are you looking to partner with any of them to create awareness and knowledge about this technology?
We will reach out to all relevant associations and stakeholders in the industry that we think will benefit from this technology and help us roll it out at scale.
Let’s look back at the role of imaging in improving health care practice in Nigeria. I’d like you to reemphasise the need for us to take imaging seriously if we are to address a whole lot of problems we have in the sector.
Imaging plays a central role in terms of healthcare. If you look at the practice of healthcare, first, you need to have a good discussion, then you need to do a thorough physical examination, but then, of course, it is always important to know what you are dealing with. Imaging has a central role to play in terms of identifying complications very quickly and making a confident diagnosis and providing appropriate intervention.
The problem of the wrong diagnosis persists in Nigeria. As a technology company, what is Phillips doing to help develop the capacity to reduce wrong diagnoses in the country?
Wrong diagnoses continue to be a challenge in Nigeria, as much as it continues to be a challenge in any developed country.
This is something that is almost said all the time, but it’s really unspoken. It is when we talk about putting ultrasound into the hands of people who necessarily did not have it before. Something else that we think of is as simple as image quality. It is of critical importance. I cannot stress enough that the Lumify transducers provide exceptional image quality, because that always aids in diagnostic confidence and I find that when you make too many compromises in other to make affordable products, usually the first thing that gets sacrificed is image quality, and that is something that Phillips has never sacrificed. So, image quality is critical to diagnostic confidence.
Can we totally exonerate the health practitioners in the problem of wrong diagnosis in Nigeria? Is it an issue of capacity?
The practice of medicine is such that if the steps are followed right, you should have less of those challenges. It starts with having a very good discussion with the patient around the history, doing a thorough medical examination and ensuring that you have the right tools and technologies to investigate. And at the end, the diagnosis is a sum total of this interaction. It also has to do with the access to the right technology. I don’t think that the challenge of wrongful diagnosis can be attributed to a single cause. I think it is a combination of factors that all needs to be addressed. Yeah, the medical schools have their parts to play, and we at Phillips also have our part to play by introducing the right technologies into the market, the right image quality, decision support algorithms. And also the doctors themselves have to practice medicine the way medicine was designed to be practiced.
If you have the figures, by what percentage do you think this product can improve Nigeria’s ultrasound density?
I would not venture out to actually put a figure on that, but I can throw a few numbers at you that can hopefully give us an indication of what to expect in Nigeria. What we can see is that putting an ultrasound in the hands of a midwife. A two weeks training course can prove that she can have up to an 80 per cent concordance of a qualified obstetrician. I think that’s the way we should think about it.
We also have to keep in mind that this is not a fully fledged ultrasound. It is a specific product designed for a specific area.
Support Adura Foundation
…we have a small favour to ask.
As our reader, we appeal to you to support Adura Foundation from as little as N1, 000.00 (One Thousand Naira). Every contribution we receive from readers like you, big or small, goes directly into funding our faith renewal journalism and helping the very poor in our society.
Adura Foundation International
Stanbic IBTC Bank