When a nurse at a clinic in rural Botswana sees an HIV patient with a worrisome skin condition, she snaps a photo with her mobile phone and emails it to a dermatologist for a second opinion. That specialist, Carrie Kovarik, is about 5,000 miles away, in her office at the Hospital of the University of Pennsylvania. 

Using what is known as mobile phone medicine, or telemedicine, clinicians across Botswana are consulting with medical specialists at Penn to get diagnoses and treatments for patients in rural areas quickly and easily.

“Using inexpensive and ubiquitous cell phones in this way is so simple, that is the genius of it,” says Harvey Friedman, director of the Botswana-UPenn Partnership. “Cell phones are everywhere in Botswana and they work; the internet doesn’t. This will allow Botswana to jump a whole generation of technology.”

To date, the use of mobile telemedicine has been piloted in four specialties: dermatology, radiology, cervical cancer and oral medicine in this south central African country, where roadways, landlines and internet service are wanting.  

“One of the main goals of the program is to help the in-country clinicians to best utilize the resources they have,” says Kovarik, director of telemedicine and informatics programs for the Botswana-UPenn Partnership. “They have many local experts; however, most of them are concentrated in the capital city [of Gaborone]. Mobile telemedicine helps the remote clinicians access those specialists more efficiently.”

Specialists review the photographs and uploaded patient information. They then provide answers via a telemedicine website or email, cutting the typical treatment turnaround time from weeks—the time it can take for the sick or injured to reach a major healthcare facility—to sometimes less than a day.

Penn is a key collaborator in this project, providing management and medical research. The other partners are ClickDiagnostics; the University of Botswana; Orange, a division of France Telecom; Penn’s Center for AIDS Research and Center for Public Health Initiatives, as well as the United States President’s Emergency Plan for AIDS Relief.

 Perhaps the most robust use of the new system currently is in the field of oral medicine. Eleven healthcare workers in five Botswana communities, including the capital, are trained in the system, which enables Motsholathebe Phuthego, the only maxillofacial surgeon in Botswana, to view and diagnose patients in remote areas. Training sessions for healthcare workers were held in Tshabong, Francistown, Serowe and Maun, and are scheduled in three more communities this fall.

In Gaborone, camera phones have been used to identify cancerous lesions of the cervix in nearly 100 HIV-positive women and, at Princess Marina Hospital, have completely replaced cameras for image capturing and archiving.

Three workers have been trained to use the phones to diagnose skin conditions in a pilot study of more than 140 patients with HIV, and plans are afoot to expand the program.

Also, four workers have been trained for a teleradiology preliminary pilot project conducted between the community hospital in Mochudi and Princess Marina Hospital in Gaborone. A second pilot is now underway, with plans to expand to seven other hospitals. 

“We are already finding that we haven’t reached the limit of how these devices can improve patient health,” Friedman says. “What started as a dermatology program has expanded into other medical areas and it’s easy to imagine these applications expanding beyond Botswana too, to resource-limited settings like Kenya or Peru or even remote areas of the USA.”

In fact, the Botswana-UPenn Partnership is exploring other uses of this technology to expand clinicians’ access to all sorts of medical information. In collaboration with the U.S. National Library of Medicine, the partnership created a text-messaging server that enables clinicians to access the library’s MEDLINE as well as country-specific clinical guidelines using mobile phones. A yearlong focus group of medical officers, residents, medical students and professors will evaluate its usefulness. 

In yet another pilot program, Android phones with customized medical applications are connecting seven medical residents at the University of Botswana to medical information and providing a digital platform for them to receive clinical mentorship from faculty. And this year a new project was launched in collaboration with the Clinton Health Access Initiative to integrate mobile phones into Botswana’s fight against malaria. Early results suggest phones can provide the surveillance and data needed to better detect active cases, identify and investigate outbreaks and apply interventions, increasing Botswana’s ability to meet its goal of eliminating malaria by 2015.

“The GPS capabilities of the smartphones will enable us to prepare the first-ever geographic map of recorded malaria transmission sites in the country,” says Ryan Littman-Quinn, mobile telemedicine programs manager for the partnership. “Mobile phone-based malaria case-reporting will develop a comprehensive epidemiological portrait of Botswana and significantly improve surveillance for malaria elimination.”