27 July 2011

The Mirror Doctors - the Somaliland Telemedical System for Psychiatry

Photo: IRIN news

Emerging out of decades of conflict in the Horn of Africa, the Republic of Somaliland is plagued by mental health problems, yet has very few professionals to treat the mentally ill. Some estimates put the number of mentally ill at 20,000 out of population of 3.5 million. At the same time the country is one of the most advanced nations on the continent when it comes to information technology. The stunning combination of complete absence of mental health expertise in a country with a good IT infrastructure may jumpstart a revolutionary national mental health care system based on telemedicine

In March 2010, Somali psychiatrists living in Europe started treatment of mental health patients in Somaliland using a system made up of internet connections, laptops, webcams and free software. So far all experiences point in the right direction. Local health authorities, commercial telecommunications companies, medical personnel in Somaliland and the country’s diaspora are enthusiastic. By December 2010, 103 people, some 80% of planned treatments, had been treated using the continent’s first tele-psychiatric system.

The system was initiated in 2009 by Somali diaspora psychiatrists, the NGO PeaceWare-Somaliland and the University of Copenhagen, where the research platform PeaceWare ICT4D is located. In Somaliland the system is situated at a mental hospital in Burao, the second largest city in the country. Local nurses, under the supervision of a general practitioner, prepare the treatment, which takes place in front of a laptop with a webcam and is based on normal psychiatric practices. The patients’ records are kept in Burao and notes are kept with the treating psychiatrists. In the future, server-based record software with global access may be implemented. The medicine is administered by the local health professionals after having been prescribed by the mirror doctors, as the patients call the psychiatrists.

Across research, migration and development

The next step, set for 2011, is the opening of a web portal based, aimed at involving more diaspora psychiatrists. The equipment at the Burao facility will be upgraded and a second facility will open in the city of Borama in Western Somaliland. After getting underway in 2010, the project will come to a close in 2016, when its fourth and final phase wraps up. At that time, it is hoped that a total of six facilities will be in operation.

The researchers at the University of Copenhagen see the main challenge in building a cross-disciplinary approach that spans research, projects and institutional networking. This involves studying the role of communication platforms, migration, diaspora resources, global health and development.

Economically feasible through private-public partnerships

The project involves several focus areas. The primary focus is on psychiatry, social innovation and the cultural context of the users. Another focus is on new opportunities that the setup might offer. A solid and reliable telemedical system, which is supported by authorities and the local health care system, could be used by other health services and in other contexts and provide professional care in many low-income settings.

For this reason, a central  aim of the research project is to establish private-public partnerships which ensure that the Somaliland Telemedical System for Psychiatry can continue operating after the research-based funding ends.

Text: Anders Michelsen

This article is also published in the Profile / GLOBAL HEALTH # 2 magazine.
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