International Network for the Availability of Scientific Publications
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The impact of information on healthcare in developing countries

EXAMPLES OF IMPACT

Are you aware of any examples of IMPACT of health information?

If so, please contact Neil Pakenham-Walsh at <[email protected]> 

"In your role as a leading provider of practical information for healthcare providers in developing countries, we would like to request your help to identify 'real-life' examples of impact. We are particularly looking for examples of 'human stories' where access to healthcare information has saved a life, or helped to make a diagnosis. We are also looking for 'human stories' where lack of access to information has resulted in misdiagnosis, or mismanagement, or even death. There is no need to include identifiable names or places, if you feel this is inappropriate. It is hoped the document will not only raise awareness of the importance of health information, but will also help to strengthen political and financial commitment to health information activities worldwide."

Disclaimer: These 'Examples of Impact' are meant to demonstrate the impact of 'access to health information', not the effectiveness or otherwise of different treatments. The content is anecdotal and is *not* intended as a source of reliable health information in itself. Healthcare providers are advised not to change practice on the basis of anecdotal material. Healthcare providers should consult evidence-based textbooks, guidelines and systematic reviews before making any changes in practice.

ATHLONE HOSPITAL, BOTSWANA

In 1992, a woman brought her ill husband to the district hospital for "...treatment by you because you said this condition (Kaposi sarcoma) can be treated in your workshop where you showed us those pictures (TALC slides)." The patient had been sent home to "...discuss with family and consider possible amputation of both lower limbs due to gross Kaposi sarcoma, with severe swelling of both feet". I referred the patient to a renowned Consultant in a neighbouring country. Today the patient is continuing to receive cytotoxic therapy and wears shoe-size 8. Edwin M.Mapara, MBChB, Former Chief Medical Officer, Athlone Hospital, Lobatse, Botswana

BOOK AID INTERNATIONAL, UK

"The books have helped our training programme significantly. As a result we were able to take care of the war-wounded during the crisis in Freetown - we were the primary facility for the treatment of the war wounded during the conflict. We performed over 900 different surgical procedures - we lost only 7 due to severe haemorrhage - we had no blood transfusion facility. The books played a major part in our effort to forestall a serious humanitarian disaster in Freetown as our nurses and junior medical personnel were in a better state of preparedness." Dr Kojo Carew, Medical Director, Curney Barnes and Netland Hospitals

HESPERIAN FOUNDATION, USA

"I am a missionary serving in Cote d'Ivoire, West Africa among village people. I have been in country for a little over a month. Recently, I was able to help a young girl who had diarrhea using the book, Where There Is No Doctor. I was able to give the simple recipe for the rehydration drink and give further instructions from the book and the girl quickly got better. The family was afraid that the girl would die. They were so happy when, with the simple instructions I gave, the girl became well." Mrs. Kimberley A. Forsythe, Ivory Coast

"The first 1,000 prints [of the Urdu edition of Where Women Have No Doctor] went out like hot cakes... A wonderful response came from a mountain village of Hazara: ' One night, a village woman had labour pains start. The nearest health unit was 7 hours away. We tried the methods and illustrations of the book and she gave birth to a baby girl safely. It saved the life of the woman who was otherwise in very bad condition." From the Urdu translator of Where Women Have No Doctor, Pakistan

"A 19 year-old received the medical attention he needed only after his father read in this book (Donde no hay doctor) the possibility that his son might have peritonitis. The doctor who operated said the boy's life was saved only because his family followed, step by step, the procedures described in the book..." Letter from Bolivia

"I am a district pastor with 26 churches in 26 towns and villages. I have therefore started using the book (Where There is No Doctor) during my treks and visitations to these communities. By the help of the book, ailments such as headaches, diarrhea and dysentery, skin diseases, convulsion, toothaches, constipation, dehydration, etc. have been treated at little or no cost at all. The book has really been a blessing!" Letter from Ghana 

ICDDR: CENTRE FOR HEALTH AND POPULATION RESEARCH, BANGLADESH

"Tracking pandemic diseases is essential to monitor the outbreaks and epidemics in a local area.  From Internet awareness and alerts, we are able to know from WHO about where the disease outbreaks are occurring and how they are being transmitted by travelers, e.g. tracking epidemics is a useful tool countering the threat. Vibrio cholerae 0139 was tracked from its origins in the Indian subcontinent to Europe and the USA as well as to Japan. These countries could set up their own surveillance on electronic databases and alert local public health physicians to remain aware of possible cases. Advice about treatment protocols could be offered by WHO through e-mail, e.g. about the drug sensitivity to resistant strains of infectious diseases, such as STDs, diarrhoeal diseases, and other diseases. Electronic communications can be used for transmitting patients' vital signs and conditions to out of country experts who can prescribe proper treatments." Dr. A.K. Siddique, Head, Epidemic Control Programme, ICDDR, B.

"Before the development of IT, I used to search literature and references manually from different indexing materials, e.g. Index Medicus.  That was very time-consuming and hectic. I also tried to find out relevant references from the reference list of published articles.  But for most of the time I could not find my desired articles. With the development of IT, I use mostly PubMed for searching research articles/authors. I find it very convenient and useful. Within a very short time, I can find it, and it helps me write my research papers. It is difficult to express the advantages of computer searching of materials. As an epidemiologist, I am involved in research on ARI, diarrhoea, TB, etc." Dr. K. Zaman, ICDDR, B international health physician.

INTERNATIONAL RESOURCE CENTRE FOR PREVENTION OF BLINDNESS, UK

"In the management of retinoblastoma. The regime in the journal [Journal of Community Eye Health] is now strictly followed. One child with bilateral retinoblastoma has survived for three years, for the first time in my hospital" Ophthalmologist, Nigeria

MARIA MUSOKE PhD, UGANDA

"A 12 year old child was brought to the health centre bleeding from the nose profusely. After positioning him properly, I needed to find information about the reaction of one of the medicines I wanted to prescribe because I remembered from my training that this particular medicine, if not administered properly, could cause serious clotting which may result into death. So, I rushed and referred to a manual (Standard treatment guide) which fortunately provided the information about the correct dose of the medicine..." Clinical officer in charge of a rural dispensary/maternity unit, Bushenyi district, western Uganda.

"Recently I examined a patient and thought he had an intestinal obstruction; on opening, I found a ruptured gall bladder yet I had never done cholecystectomy before. I called in a colleague; before he came, I decided to read the CME materials which provided the details of what to do. When my colleague came, he brought a copy of Primary Surgery textbook by King which also gives step by step account of what to do in order to carry out that operation. These assisted us to successfully do the operation." Medical doctor, rural hospital, Lira district, northern Uganda.

"The short course I attended about 'Integrated Management of Childhood Illnesses' (IMCI) updated me a lot. I also got the latest (1997) edition of IMCI manual. Before then, some paediatric diseases were very difficult to handle ... actually we didn't know how to manage them; so, we used to refer such cases to the district hospital, and some used to die on the way! But now, I know what to do and I have also had some sessions with my staff. All in all, this health centre is now in a better position to effectively handle childhood illnesses." Clinical officer in charge of a sub-county health centre, Mayuge district, eastern Uganda.

"The presence of CME materials in a hospital where I worked before coming here used to give me confidence and peace of mind about the management of surgical cases because I was able to perform certain procedures, I had never performed before, just by referring to these materials and following the guidelines or instructions. Since I came here, I feel the gap ... feel professionally 'insecure' without these materials ... I think the CME materials are the most relevant type of information in a surgical emergency in a rural setting where other sources of information are difficult to come by ... which makes me recommend that these materials should be distributed to all health units because they are so valuable; the MoH should endeavour to do this at least up to health centres." Medical doctor, rural hospital, Masaka district, central Uganda.

"Since I did not receive formal training in nursing, the seminars I have attended have provided me with books, hand outs and notes, as well as motivation and practical exercises. These have really trained me and enabled me to acquire knowledge and skills which keep improving the services I provide to my patients and clients; for example, the counselling skills enable me to counsel women, and to guide them through acceptance and choosing appropriate FP method. They also assist me in counselling HIV /AIDS patients." Nurse aide in a rural dispensary, Iganga district, eastern Uganda.

MEDICINE DIGEST (now incorporated in Africa Health)

"I credit Medicine Digest with helping save the life of one of my patients some years back. She was stabbed repeatedly in the abdomen by her mentally ill son. She was so hypotensive as we began to operate that she didn't even bleed from the incision but I had just read an article about autotransfusion in MD so quickly collected two units of free blood from the abdominal cavity as described and immediately gave them back to her." Dr Stephen Griffiths, National Leprosy Control Programme, Cambodia

MIRKASIMOV REPUBLICAN CLINICAL HOSPITAL, AZERBAIJAN

"Between 1999 and 2001, physicians at a hospital in Baku, Azerbaijan, were noticing an increase in mortality from heart failure among its refugee patients. Using the Internet, one of the physicians began to search for information on potentially more effective treatments. The physician came across reports about a drug that some sources indicated to be more effective for certain groups of patients. Other physicians at the hospital demanded to see more proof, however, before they would agree to use the drug. In September 2001, the hospital's Learning Resource Center received its quarterly update of the Cochrane Library on CD-ROM, which contained 11 reviews demonstrating the efficacy of using this drug to treat patients with severe forms of heart failure and hypertension. With this scientific evidence in hand, the cardiologists began to use this medicine to treat some of their patients. In the four months following the introduction of the new drug, the hospital has had no lethal cases among its cardiac patients. The physicians also claim that the patients now are recovering more quickly, helping to reduce the costs of treatment." Mark Storey, American International Healthcare Alliance

POLYCLINIC, MINSK, BELARUS 

"To determine proper antibiotic treatment for a patient with acute cystitis, a urologist used the Internet, Ovid's on-line full-text biomedical collection, and the Cochrane Library on CD-ROM. As a result of this research, he discovered an antibiotic treatment not previously used at the clinic. After receiving the treatment, the patient quickly recovered. The urologist presented the results to his colleagues, who worked with him to develop a new protocol for the treatment of acute cystitis at the polyclinic." Mark Storey, American International Healthcare Alliance

TALC, UK

"We found the TALC HIV Infection and counselling slide-set excellent for helping to educate people; by showing them actual pictures of HIV/AIDS and those affected by it we solved our problem and the slides have become the backbone of our health education programme. In areas where support groups have been using the slides HIV infections have fallen to 32%, compared with 44% before." Dr Edwin Mapara MD, CBH. Medical Officer in charge of the Botswana AIDS programme.