I recently had the great pleasure of speaking to Huw Jones, CEO and Founder of the Virtual Doctors. It was great to find out more about how the charity started, the greatest challenges it faces and Huw’s mission to bring telemedicine to rural Zambia.

What gave you the idea to set up a charity that provides healthcare in rural Zambia? 

Huw worked out in Zambia for many years as a British safari guide. He therefore lived and worked among rural African communities and got to know many people there. It was an amazing place to live and work but one thing that always shocked him was the amount of unnecessary death and mortality that he witnessed. Often people were dying from common illnesses which would easily be cured in the UK. He found himself thinking ‘surely these deaths could be prevented, simply with the help of a trained doctor’. 

With this on his mind, Huw then had two encounters in the space of a week which really sparked his determination to try and improve the standard of healthcare in rural Africa. The first came when he was working in a rural area with a team of filmmakers, who were shooting a documentary. A man came over to him and asked for help getting a woman to hospital. He showed Huw into a room where a woman was in labour and in need of urgent medical attention. They needed his car in order to get the woman to a hospital. Huw quickly took the team and equipment back to their base and came back with the car to help the woman. But by the time he returned, she had died. 

It was then just a couple of days later when he had another similar encounter. Huw was driving down a track in the bush when he noticed a trail of blood. He followed this trail for quite some time and came across a young man and his heavily pregnant wife on a bicycle. The man was pedalling as fast as he could, trying to get the woman to a hospital which was miles away. This woman clearly needed urgent medical attention so Huw offered to drive them. Despite his efforts the woman sadly died in the car on the way to the hospital. 

Speaking of this encounter Huw says, ‘after often thinking about whether there was anything that could be done to help rural communities in Zambia, seeing this woman on the bike was like a slap in the face with a wet fish.’ This was the point at which Huw really thought about what he could do to help. He says ‘I knew there must be a way to prevent such needless deaths.’ This was the crucial moment in the genesis of the Virtual Doctors. 

So, following on from this, what were the first steps in setting up the charity?

Huw knew a number of doctors back at home as well as a few in Africa in cities such as Lusaka. His first step was therefore to approach them with the problem and see if they would be willing to help rural African communities in some way. Everyone he spoke to wanted to help, but the majority were of course unable to travel to Africa and provide treatment. The other main concern was that they had no experience in treating people in the region or any knowledge of rural life in Africa. 

Huw also spoke to clinical officers working in rural clinics in Zambia. At this time the only help they could get was through an HF radio system, used to connect small clinics with bigger health centres in the towns and cities. This system was not very effective. One of the clinical officers said to Huw ‘there are a number of cases when, if we could just talk to a doctor, it would help hugely and we would not have to keep referring people to hospitals which are a long way away.’ This was the point at which, Huw says ‘we needed to somehow link rural communities in Africa with Doctors in the UK. Everyone wanted to provide assistance, but it would have to be done remotely.’ 

Telemedicine was the answer

Huw then built up a small team of volunteers and got permission to do a telemedicine trial in 6 rural Zambian clinics. They bought some satellites and used desktop PCs. The initial project proved to be positive but the software was very slow and clumpy. It faced a number of issues such as the satellites being unreliable and load shedding meant the system was ineffective whenever the mass power cuts took place because they were relying on mains electricity. Huw says, ‘it wasn’t bad, but we needed something better.’

One day Huw found himself looking at his phone in a small African village which had previously had no mobile data. He realised that his phone was picking up a data signal. A satellite had been installed within the community and it had gone from being a rural isolated village to one that was connected to the rest of the world. Huw says, ‘it blows me away to think about a community in Africa that struggles just to get books and then overnight they get access to Wikipedia, to a whole wealth of information. This technology is very powerful and we are able to harness that power for good, to be used in healthcare.’

It was at this point that Huw thought ‘why not just give everyone a smartphone?’ If all clinical officers in Zambian clinics had telemedicine technology installed on a smartphone, they could really start saving lives.  

How did you go about building the app?

This was when Huw called upon the work of Ian Clarke, Chief Technology Officer at Landmark Information and now the Virtual Doctors’ Technology Trustee. Ian recruited a small team of volunteers and they built a bespoke smartphone app based around the needs of the charity and designed specifically for use in rural Africa.

Based on the trials done in 6 rural clinics, the team knew that the system had to be easy to use and learn. A Clinical Officer in Zambia sees double the number of patients in a day than a GP would in the UK, it was therefore important that inputting patient data took no more than 5 minutes. Huw worked with a small team of doctors to determine the absolute minimum amount of patient information needed by a doctor in the UK in order to advise on treatment. The system was then built by the dedicated team of volunteers at Landmark and has proved invaluable for the charity. Huw goes out quarterly to get feedback from clinical officers as to how they can improve the system, so it is constantly being developed. Overall, the clinical officers are happy with the technology and there is no doubt that it is saving lives. There are now 106 doctors volunteering and using the software from across the UK, and a few in Zambia, and between them they offer 22 different specialities.  

Can you explain your mission to embed the service into the Zambian healthcare system?

Since setting up the charity, Huw has been working closely with the Ministry of Health in Zambia. The Ministry has fully endorsed the Virtual Doctors and given them the rights and permissions to approach clinics in any district within the country. The charity has therefore succeeded in building a strong presence in every corner of Zambia. In terms of embedding the telemedicine service into the Zambian healthcare system to the point where the Ministry of Health can take it on and run it, Huw says ‘this will of course be a long and slow process.’ The ministry needs the resource to take on the work and manage it and, as with all projects, they will also have to budget for it very carefully. Huw mentioned that, since the Virtual Doctors have been working with the local government, an e-health co-ordination unit has been set up in Zambia. This is a great step in the right direction and shows just how well the charity’s work is being received and integrated into the community. The Virtual Doctors are now able to liaise with this unit and work directly with the e-health coordinator. They will continue to build up this relationship as the charity grows. Huw says, thanks to the support of Zambian authorities ‘despite being a small charity, we are able to have a significant impact on a shoestring’. 

The fact that the system set up by the Virtual Doctors can one day be managed by the Zambian authorities, freeing up the charity’s resource to expand further into other African countries, shows how sustainable the charity is. This sustainable aspect of the charity is something that other volunteers have mentioned during my interviews with them. Was it always part of your mission, or has this become more clear as you have been working with the Zambian communities?

In short, the answer to this is yes, it has always been part of the mission. Huw tells me that, from the outset, they were aiming to solve a problem and get the job done. He says ‘it was always the aim to empower people and improve their knowledge and skills to the point where they would no longer need us’. This strategy would then enable the charity to continue helping more and more rural communities in Africa. 

The success of this strategy is evident by the fact that usage in Zambia is slowly dropping. This is no bad thing, it shows that the clinical officers are learning from the advice and guidance given by virtual doctors in the UK. Their guidance is having a lasting impact and helping to significantly improve the standard of healthcare in rural Zambia. 

What are your plans for the charity going forward?

Huw has no doubt about the potential of the charity going into the future and knows that it could scale in a number of different ways. He sees expansion as the main goal for the future and plans to continue expanding the charity across southern Africa. Huw makes the interesting point that they are not limited to working solely with governments, there are many NGOs working in the region that could benefit from the Virtual Doctors telemedicine systems. A collaboration such as this would bring great benefit to local communities and is a distinct possibility in the future. 

Huw also mentioned the idea that they could one day provide a real-time telemedicine service. This is a very bold vision which brings a lot of challenges and would take a long time to put into practice. What volunteers like about their roles currently is the fact they can chip in and provide assistance as and when they have time, it can easily fit around other commitments. This would of course not be the case with real-time service, but the possibility is there and could perhaps be explored in the future. It would be exciting to see whether it is possible and the positive impact it could bring. 

I always ask volunteers where they see the charity going in the future and there have been quite varied responses to the question. One thing they all share, is an enthusiasm and excitement to see what the future brings for the charity, and there is absolutely no doubt the work will continue, steadily reaching more African communities. I think that this shared enthusiasm comes from the fact that everyone can see the impact the charity’s work is having and the benefit it is bringing. Huw says, ‘we really are improving people’s lives, not only that we are saving lives’. This incredibly worthwhile work certainly makes for a dedicated and supportive team of volunteers who will be crucial as the Virtual Doctors continues to expand and develop. 

What is the biggest challenge you have found in your work with the Virtual Doctors?

Given that they are a small and relatively young charity, the impact that the Virtual Doctors has is huge, particularly given that they operate on a shoestring. Of course working with governments has its challenges and the remote aspect of the charity can, at times, cause difficulties. In this respect, the local team in Zambia are invaluable. However, Huw considers the biggest challenge facing the charity to be funding. He says, ‘the potential it [the Virtual Doctors] has is vast and if we had all the funding we could expand very quickly.’ Huw understands that it will take time to build up the funds required for more expansion. This is why the belief that he and the whole team of volunteers have in the charity’s work is vital. He says, ‘You have to really believe in what you are doing and just keep going. When working with a charity you need a lot of patience and a lot of tenacity.’ 

Huw and the team’s patience and tenacity is certainly proving worthwhile. So far, the Virtual Doctors have responded to 4500 cases, expanded their work into Malawi and sparked the interest of governments in almost every country south of the Sahara and north of Lesotho. While on this ambitious journey, Huw has learnt that ‘if you have an idea, and you think you can do it, just go for it.’ I was left inspired and excited to see what the future has in store for the Virtual Doctors.