In this episode we are going to meet TELESAN, an organization that uses technology to democratize access to health in the most diverse corners of Honduras. The biggest challenge: for all people to have health everywhere.
Host: TELESAN was created by a group of doctors, among them Eimy and Brian, who experienced the difficulties of the health system from the inside and decided to do something about it.
Eimy: It is a social enterprise that was born approximately in 2017 from the shared vision of doctors who were serving in one of the most difficult to access communities in our country. When you are working in this health system, you feel that it never gives enough or that it is never giving the maximum in comparison with the need that you perceive from the patients.
This entrepreneurship started from seeing firsthand the lack of coverage of universal access to health care. We are years away from having the infrastructure for health personnel to practice.
Brian: It came about because of the first-hand experience of the barriers to health services. Many of us had the opportunity to be working in very remote communities in the country, on the coast, here in the biosphere, that part of the country can only be accessed by air, by rivers. So that experience in the flesh gave us a certain awareness of the reality these communities live.
Our starting point was health personnel’s frustration: They do not feel supported, and there is a lack of resources and tools.
Host: In Honduras, about 60% of the people live in rural areas, but almost all the medical specialists are located in Tegucigalpa, the country’s capital. How can people in isolated communities receive timely, quality specialized medical care? This was one of the questions that prompted the creation of TELESAN, a telehealth network that connects remotely located health centers with high-specialty hospitals.
Eimy and Brian tell us why they decided to strengthen the public health network and inter-consultations between health professionals, instead of directly connecting specialists with patients and how they put it into practice.
Eimy: Our model for implementing care services is not, as we normally would imagine a telehealth teleconsultation process to be. They do not go directly to the end user. We, therefore, make these implementations directly in the health facilities already in the community that have doctors or health workers that have been working for years.
Brian:
We have been working on agreements with specialists and with the country’s hospitals to create a remote response network connecting them with rural health centers.
For example, we have the furthest health center, which is in the very tip of the country, called Villeda Morales. There we provide Internet, we guarantee energy and computer and biomedical equipment, unfortunately we found a gap there too. They didn’t even have a computer.
In the first instance, our communication is between health workers.The staff at this health center, Villeda Morales, acts as an intermediary with specialists in Tegucigalpa. This was a strategic decision because people today do not have internet at home. Sometimes they have no signal. There is also a cultural barrier. So it was decided that our point of recruitment would be outside the health center and in the community, and there we equipped them, for example, with cameras to take very specialized skin photographs. So that the dermatologist can give guidance from here, from Tegucigalpa. We have also had experience with a psychiatric patient, for example, we only have two psychiatric hospitals in the country so he is attended in the health center via video call.
Host: Moving to receive medical care is not only a matter of geographic distance but also of economic possibilities, which not all families are able or willing to afford. Now let’s see how TELESAN generates a positive economic impact in rural communities. We will hear the voice of Cynthia, a general practitioner in the municipality of Oropolí, who treats patients in her community and sends teleconsultations to specialty hospitals.
Cynthia, TELESAN physician: Through TLC we have benefited the population that does not have the economic means to be able to travel to seek these services remotely. Through we still provide inter consultations to different hospitals in the country. TELESAN in our area has been a great support in improving the health condition of the state.
Brian: The main point of impact, because we open the door for all those people who just don’t have the means.
There were cases of people from rural areas who, when told that they had to go to an urban area to see a specialist, fled from the hospital because they knew they could not afford it. Most of them live in poor conditions.
Basically, we have seen a huge gap because sometimes when we started the program we used to say that we wanted people to save. But it wasn’t that they saved, it was that they just couldn’t save.
Eimy: I totally agree that this is our biggest impact, on the out-of-pocket expenses that you mentioned, because when we talk to someone and ask them “If I tell you you have to travel to Tegucigalpa today for an emergency situation. What do you do?” they would answer “Well, I die.” That was it. It is extremely complex for them to even leave the community and be able to access specialty medical service.
Host: They shared a case with us that caught our attention. A 9-year-old girl arrived at the hospital in Puerto Lempira with a condition that could have been related to the immune system or something related to cancer. From this hospital they sent the remote consultation to the Pediatric hospital in Tegucigalpa. Brian tells us what the outcome was and who intervened in the process to make it a success.
Brian: The situation was so complex that when it was explained to the family that the case might at some point require sending the girl to Tegucigalpa they fled the hospital because they interpreted that this was going to bring them higher costs. They imagined a whole scenario that they could not take on with their family conditions. We managed, through the community networks to alert the family that we already had an initial response from the pediatric immunologist and that all we needed was for her to finish her tests at the hospital. Then, with the community networks that exist in La Mosquita, we were able to bring her back to the hospital. She had another remote consultation with the exams in which it was determined that it was more of an immunological problem and not so much a cancer type, which would require a transfer to Tegucigalpa. There was a lot of community participation to be able to convince them and everything because here there are many, many cultural processes as well.
Host: It is clear that in addition to having a positive impact on the rural population in general, they have a specific impact on the health professionals who live in the rural areas.
Eimy: We approached them and carried out a series of steps from the diagnosis to find out how they feel about the technology they have used so much with cellular computers, because we are talking about health personnel who are in remote units and who, for example, eight years ago went to live in this community and do not come to the city or do not go to the city for continuous medical updating. Subsequently, we also provide personalized training for the health staff.
Brian: First we establish agreements with them and sensitize them about the advantages and challenges the process has, and then we move on to a training process where we certify them in remote health care and in turn we also then train them week by week.
TELESAN has two parts: the assistance, which is what is generally understood when talking about telemedicine. And the remote training, which is provided every Friday by specialists from Tegucigalpa to the network of rural health centers.
Host: Support, infrastructure and continuous training. This is what a physician needs to work and feel better and better. While this is not a reality for most healthcare professionals who accept the challenge of working in remote locations, TELESAN is doing its part to change that.
Brian: In most health centers, unfortunately the first reaction is: Finally, someone is accompanying us or supporting us in a certain way because they have been neglecting us. So the situation with the health personnel has also been quite critical because they come to feel almost helpless due to the different actors that interact with them. But there is a very important psychological effect that we often do not measure, and we hope that in the future, when we have more experience, we will have these more qualitative measurements.
Eimy: Yes, okay, according to what Brian says. We’ve also noticed, they’re usually used to it being that if there’s a project that includes them, it’s a one-time thing, one time they asked us questions, they gave us this, and then we never saw the useless people again like that continuity. We call them, we visit them. For example, they can now talk to a specialist. Every Friday they are in these meetings with different specialists so it suddenly became like the Specialty Hospital. We are going to write to them and they are going to scold us because maybe we do not know and now there is no longer that excuse. They now have that more direct communication, that accompaniment.
Health personnel feels supported. Many times they say: “thank you before we didn’t even have the equipment to take blood pressure, and suddenly we see how to manage these tools to improve diagnoses”
It is really incredible to see their expressions when they answer the first part of the consultation, they really feel like Wow, we were able to answer. In this community we have patients scattered in all the communities and we don’t see them again and the interest that forms that bond of we are going to be able to reach these patients, we know that they can’t come to the communities.
It is also very satisfying to see the health worker’s response when they are already involved, they answer the first online consultation, they feel that they are helping someone on the other side of the screen and they see that it is a reality that works.
Host: Hearing this story makes us think: we want this to happen more and more. TELESAN and their team are already thinking about the future and everything they can do to make this movement expand. Their challenge, to use more and more technology and data to generate a smarter healthcare system. So, Brian and Eimy end by saying what their big ambitions are and what we can expect from this powerful venture.
Eimy: I see us exporting this type of enterprise and implementing it in other areas. In a region where there are many very similar areas that have a lack of online access, these very difficult topographies. So I see it as totally viable in two years, but we can just say well, we are going to start implementing it in Guatemala, we are going to start implementing it in the Dominican Republic, for example. I think that would be what we are aiming for.
Brian: And at the local level it can be consolidated in a sustainable way, as a national program that basically lasts over time and then also diversify in the other areas that we are still weak as a country in terms of digital health.
As if that were not enough, the TELESAN platform is open source for the country and uses sustainable energy. So far they have benefited more than 25,000 people, especially children under 5, pregnant women, adults with diabetes and hypertension.
We can only congratulate them for such a project and hope that many initiatives like these are promoted in Latin America!
TELESAN and all the organizations that promote this program are working to accelerate the transition to the new paradigm: more conscious, collaborative, inclusive, and in community. We invite you to join us, to contribute from where you are, and to do it now.
