A Malian app to help rural doctors treat patients

In Mali, it's hard to find specialised doctors outside the capital, Bamako, where fully 95 percent of them are based. To help the populations of the country's far reaches get access to these specialists, a Malian doctor and computer buff has launched a telemedicine application called Bogou. The software allows doctors in isolated areas to ask questions of their specialist colleagues, and to help patients avoid making unnecessary trips to the capital.

Cheick Oumar Bagayoko received his medical training in Bamako. Near the end of his studies, he grew passionate about computers and devoted himself entirely to developing telemedicine applications to allow doctors to treat patients remotely.

In May, he won Radio France Internationale's Challenge App Afrique prize for his application Bogou, which means "to help another" in Zarma and Songhay, two languages spoken in Niger and Mali. He received 15,000 euros to continue development work on the application, which was launched on the Web in 2007; Bogou is soon slated to include a mobile app and a text message service to facilitate use in zones without wired Internet access.

Seydou Kone, a doctor using Bogou at the community health centre in Massigui, in western Mali. Photo provided by Cheick Oumar Bagayoko.

"Travel is expensive and some inhabitants of isolated areas won't go get treatment"

"Lots of my general practitioner colleagues were assigned to places in the bush in their first year of work. Most of them came back saying that it'd been a bad experience. They found themselves all alone, cut off from the world and unable to make ends meet financially, given how little the health centres in these areas are in fact visited by patients.

Additionally, they were often obliged to send their patients to other health centres when they needed to consult a specialist, a gynaecologist for instance. Except that travel is often very expensive for the inhabitants of these areas. The result is that they don't go get treatment. The biggest problem is for women whose pregnancies aren't monitored and whose health can be in danger. [Editor's note: According to World Bank estimates, in 2015 the maternal death rate in Mali was 587 women per 100,000 births. By way of comparison, the rate in France way eight in 100,000.]

Health workers in Dioila, in western Mali, being trained to use Bogou. Photo provided by Cheick Oumar Bagayoko.

"Doctors can send photos of their patients to specialists"

That's when I thought to myself that we had to put the on-site doctors in contact with specialists, and notably gynaecologists, so that they would quickly know what sort of treatment to give. So I started working on my app Bogou, thanks to financing from the Network for Telemedicine in Francophone Africa (RAFT), an organisation based in Geneva.

The application lets doctors and nurses who work in isolated regions ask questions of specialists, such as gynaecologists, dermatologists and cardiologists, via an online platform. The specialists try to respond to these questions as quickly as possible. For a skin problem, a doctor can take a photo of the patient and, via the application, send it to specialists who will give a diagnosis and tell him or her how to proceed.

Screen capture of a message from a generalist to a dermatological specialist on the Bogou web application.

We've also started little training sessions to let doctors and nurses or midwives in isolated areas learn to carry out ultrasounds on their own. Via Bogou, they can then send the images to specialists who analyse them.

The ultrasound can be sent via the application.

 

The medical data that are sent are protected, which means only the specialists receiving them have access to them. Doctors who are seeking information can choose to send a message to one specialist in particular, or to different groups, such as the 'Mali cardiology group.' Ninety-five percent of the participating specialists are African.

"An increase in district hospital visits of between eight and 35 percent"

We started working on the web application in 2007, but this year we're launching the mobile version. We want doctors to be able to ask questions by text message, and [we want] a mobile application to be accessible via 3G. Some areas, in the bush in particular, don't have a wired Internet connection. Today, the service is available in four languages – French, English, Spanish and Portuguese – and it's in regular use in eight African countries.

Screen capture of the mobile application, which is under development.. 

Our studies in Mali show that Bogou has allowed for an increase in district hospital visits of between eight and 35 percent. This is a very big deal; it's getting health workers from isolated areas motivated again. It's also allowing for significant savings. In the course of a year in Mali, helping 215 patients from isolated areas avoid having to travel to the capital creates about 65 million CFA francs in savings, or 100,000 euros.

With the application, there's no additional cost to the patient. He or she pays the price of a normal appointment, but the sum is divided in three. One fraction goes to the local doctor, another to the specialist who responded and, lastly, a fraction goes to the app's development department.