TelemedKG in Kyrgyzstan

Children with disabilities are underserved in Kyrgyzstan for many reasons, including a lack of specialists qualified to diagnose them (Tyrymgol, 2017; UNICEF), lack of resources, difficulty caring for children in nomadic populations, and lack of access to care in rural areas. The number of children with disabilities in Kyrgyzstan is recorded, by governmental sources, at close to 30,000 children, representing approximately 1.3% of the children in Kyrgyzstan (Prentis, 2017). However, MICS (2018) indicates that 8.7% of children have functional difficulties, meaning that more efforts must be made to identify CWDs in Kyrgyzstan.

Identification is also difficult as many living in Kyrgyzstan are nomads. This leads to two major problems:

• nomad populations eat food that is available in the region at the time, leading to nutritional deficiencies like anemia in both pregnant mothers and children (these deficiencies can lead to preventable disabilities, it is estimated that 70% of disabilities in the Kyrgyz Republic are preventable)
• the nomadic lifestyle of many families also poses problems for healthcare providers, as there is little data on how many CWD there are in the country – a problem we hope to solve.

Many families are unable to meet with a medical professional. If they are able, there is a high chance of misdiagnosis, and they may have to pay a bribe to have their child certified as disabled (UNICEF). They may be referred to another doctor, but the referral process is often unclear and prohibitively confusing (Prentis, 2017). If the child is certified with a disability, he may be sent to a residential facility, where they often “experience neglect, inappropriate medical treatment, and discrimination” (Human Rights Watch, 2020). Mothers who keep their children at home note that they often do not have access to medical services (Makanbai, 2020).

Public awareness of government assistance for CWD is also a problem. Most families only know about resources if they happen to visit a local health professional who both knows about the resource and recognises that it could be of benefit. Families also worry about having their child identified as a CWD because there is still a serious social stigma around disability, and they worry they may be pressured to institutionalise their child.

Finally, rural healthcare poses challenges. The Kyrgyz Republic lacks healthcare workers in rural areas, with the ratio of community members to doctors reaching as high as 18,000 to 1 in some regions (Funken et al., 2020). At the same time, the country’s population is growing rapidly, taxing healthcare professionals even more (Funken, et al., 2020). Some districts of Kyrgyzstan are also active conflict zones, making it even more difficult for families to access healthcare. Our solution allows both treatment of CWDs and identification of those who are at risk no matter where they are.

Introduction of Telemedicine services on a primary health care level to ensure children with developmental delays and disabilities have access to quality health services. When using Intelehealth, families visit their primary healthcare centre to access providers across the country or abroad. These providers can then identify disabilities, even at a distance, and refer to other appropriate specialists.  The technology prevents families from having to travel to a city to visit a specialist, and it allows families access to the best specialists regardless of their location.

Intelehealth use state-of-the-art technology to allow parents of Children With Disabilities (CWD) to access specialists to help diagnose and treat their children’s conditions using the EI/EI approach (Early Identification/Early Intervention).

It uses a 2-phase approach:

• in Phase 1, we treat CWDs who have already been identified: Phase 1 has already been successfully piloted in 3 out of Kyrgyzstan’s 7 states and 150 medical facilities, with over 150 professionals trained on our system;
• in Phase 2, we will use our solution to identify more CWDs and treat by scaling our training to more medical professionals.

Intelehealth aligns its platform with the World Health Organisation’s 10 best practice recommendations. The telemedicine platform comprises a Provider-to-Provider app, a Direct-to-Patient app, and a Direct-to-Patient Helpline, all powered by a novel digital assistant called Ayu. Ayu is a decision support system that contains 150+ evidence-based protocols for delivering high-quality health services and improving patient outcomes. Ayu helps shift the crucial task of clinical history taking from a qualified Doctor to a semi-skilled health worker, thereby supporting local health workers to provide evidence-based health services. For conditions that are beyond the capacity of the health worker, it can connect the health worker and patient with a virtual doctor over telemedicine, leading to conclusive diagnosis. All three modes of communication – text chat, audio & video calls – are supported.

The Clinical Decision Support System also has baseline screening examination protocols. Ayu ensures continuum of care by maintaining the Patient Health Record of clients, with the ability to book appointments for follow-up visits. In the case of the Direct-to-Patient app, Ayu allows the patient to directly engage a health provider over a video call. Intelehealth’s telemedicine platform is cloud-based, uses cutting edge technologies, and has a scalable tech stack. To further improve the quality of care, our platform can be integrated with third party point-of-care diagnostic devices to measure parameters like blood pressure, blood sugar, ECG readings, malaria diagnostics tests, blood tests, and urine analysis.

UNICEF has also adopted Intelehealth for use in caring for children with disabilities in Kyrgyzstan.

Telehealth has been proven even more effective than traditional in-office care for CWDs. Some key benefits of telemedicine for CWD and their families include 1) Improvements in accessing specialists who can currently diagnose and treat CWDs; 2) Increased accessibility of health services for patients living in remote areas where the availability of health providers is poor. 3) Reduction in the distance travelled, as well as time and money spent traveling to the nearest town to consult a medical provider; 4) It helps overcome health workforce staffing gaps in places where there are shortages of medical providers; 5)  It promotes effective management of children with developmental disabilities by enabling monitoring of the treatment process and adjusting the treatment plans of patients without the need for them to travel; 6) It reduces isolation of providers in remote facilities by connecting them with higher level providers for continuous learning and development and 7) It improves the capacity of providers in remote locations, as they can get updated with the latest advancements in medicine (Marcin et al, 2004; WHO, 2019).

Intelehealth will provide a platform for remote training of medical professionals so that more doctors, nurses, and specialists in the Kyrgyz Republic are qualified to work with children with disabilities, and so that we can dispel common misperceptions and stigmas around disability.

Finally, it will improve community understanding of both disability and Telehealth by increasing the number of community members using services, by spreading information and educational material about disability, and by providing screening for pregnant mothers and children.