Video-otoscopy has been around for a few years, but it has required considerable investment and a high degree of training. The equipment Witkoppen Health and Welfare Centre’s Audiology Department is testing brings Video-otoscopy within the financial reach of smaller medical facilities and can be operated by a facilitator or nurse with basic training.
What is Video-otoscopy?
Two experts in this field, from Sweden, Thorbjorn Lundberg, a general practitioner who has become fascinated with this form of medical science, and ENT Professor Claude Laurent have been working with Witkoppen Clinic staff, training them to use this technology. They have also had on loan during their visit from 20th to 31st August, an Oto Microscope, courtesy of Leica, a powerful piece of sophisticated equipment worth hundreds of thousands of Rand for in depth examination of patients’ ears, which only major medical facilities in South Africa would be able to afford.
Professor Laurent was very happy with the progress of the project. “We were hoping to conduct testing on 70 needy children but thanks to the smooth organization of the Witkoppen Health and Welfare Centre we were able to test double that number. As a result 140 children with ear problems have been examined with the help of this highly sophisticated piece of equipment and, once the video-otoscopy has been studied and the results evaluated, appropriate treatment can be administered.”
Leigh Biagio, a local audiologist who is also a PHD student at the University of Pretoria, is co-ordinating the project with the University of Pretoria. Prof De Wet Swanepoel from the University of Pretoria, an internationally recognised authority on tele-audiology, is also one of the research supervisors on the project and co-ordinated the collaboration between the local and international researchers. Leigh is impressed with the aptitude of the Witkoppen audiology staff, headed up by Violet Mugodo, in adapting to this technology so quickly and readily.
Violet is very excuted about the project. "Our objective at Witkoppen Health and Welfare centre is to ensure that the indigent communities surrounding our clinic have access to both high quality comprehensive medical care and social services. Our multidisciplinary team of health workers is dedicated to treating the patient and his/her family as a whole and in so doing ensuring the physical, mental and social wellbeing of individuals and families. We adopt a unique holistic, multi-disciplinary approach where we not only address both the medical and social needs of patients but also these needs in relation to their families. We offer both adult and paediatric acute, curative and chronic disease management services; HIV counselling, testing, care and treatment; a TB clinic, antenatal services, immunizations, family planning and Well Woman Clinic, an in-house pharmacy, nutritional advice from a registered dietician, Child and Family Mental Health, social, dental, laboratory and audiology services as well as social welfare services including care of mothers and vulnerable children, statutory work (e.g. foster care or adoption) and community projects. Being able to add cutting-edge technology for the diagnosis of ear and hearing disorders adds yet another service we can offer our patients."
Leigh Biagio provided some background: "The Health Professions Council of South Africa [HPCSA] (2008) defines telehealth as an exchange of health care information at a distance in order to facilitate, improve and enhance clinical, educational and scientific health care and research, particularly to the underserved areas of South Africa. Telehealth may be used to overcome barriers related to access to services caused by distance, unavailability of specialists and/or subspecialists, and impaired mobility of patients. Telehealth offers the potential to extend clinical services to rural, remote, and underserved populations, and culturally and linguistically diverse populations."
"The reality of hearing health in sub-Saharan Africa is that there are approximately 250,000 to 7.1 million people per otolaryngologist. Early diagnosis of middle ear disease is particularly important as otitis media (middle ear infection) is responsible for a significant burden of disease in developing countries in which access to medical care is limited. Complications from untreated middle ear disease include permanent hearing loss, damage to the middle ear bones, perforation of the ear drum, infection in the bone surrounding the middle and inner ear structures, and even meningitis, which is life threatening. HIV-infected children with low T4 lymphocyte counts have a nearly 3-fold increased risk of recurrent middle ear infection. The global revolution in internet connectivity and continuing advances in technology mean that hearing health care delivery through telehealth is becoming increasingly possible to underserved regions. The video-otoscope is an example of technology that extends the capabilities of the conventional otoscope as a tool for ear canal and ear drum examination, allowing short video recordings to be reviewed, stored, archived, and transmitted for medical specialist opinion. Video-otoscopy conducted via telehealth to primary health clinics in underserved areas may contribute to the prevention of complications from middle ear pathology, and to significant improvement in the health and quality of life."
According to Leigh, "The video-otoscope, incorporated into a hearing telehealth program, has the potential to allow provision of specialist care to people in rural and remote areas." She added: "It would of course require some in service training and a period during which the clinic facilitator can build up experience."