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How Can Lack of Resources Spur Innovation?

Scarcity of resources can be difficult to imagine: It automatically causes innovation in the form of the adaptation of clinical guidelines, palliative care instead of treatment, and clinicians accepting that they can’t help everyone but need to choose who to save and who to palliate.

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Khalida Soki is a consultant physician and kidney specialist working in Nairobi. She moved back to Kenya in 2018. She participated in over 20 kidney transplants in Nairobi, successfully run a large hemodialysis unit, grown a clinic for kidney disease and helped write the COVID19 guidelines for the Ministry of Health in Kenya. She is also the organizing secretary for the young nephrologists committee at the African association of Nephrology and an honorary lecturer for the East African Kidney Institute.

In this discussion, she explains:

  • how did her transition from NHS to Kenya look like,

  • how clinicians operate daily with lack of resources,

  • how they innovate because they have to,

  • how is technology helping educate patients and improve access through telemedicine.

Main Healthcare Challenges in Kenya

Kenya's healthcare system faces several significant challenges, prominently underscored by the overwhelming number of patients requiring medical attention. “When I worked in the NHS, in a small center, the staff consisted of 10 nephrologists and about 10 renal registrars for a small population. And that's already 20 people who are maybe seeing patients. But when I came back to Kenya, we were about 30 nephrologists in Kenya for a population of 55 million. And the work was overwhelming. And while in England, the approach was more multidisciplinary, in Kenya, because of the financial challenges that most people have, you'd find yourself being the sole provider of everything that the patient requires. You'd find yourself as doctor, clinician, nurse, dietitian, counselor, all in one session,” describes Khalida Soki.

Workforce shortages are a critical concern, with Kenya experiencing a similar situation to many African nations where there's an insufficient number of medical professionals to meet the growing healthcare demands.

Clinician Innovation in Kenya

Many patients don’t get treated or get a late diagnosis. They either don’t realise they should go to a hospital, or have misconceptions due to myths and rumors around health-seeking behavior and practices, especially in the rural areas, says Khalida Soki.

The lack of resources forces clinicians to innovate.
"You have to think of out-of-the-box solutions to be able to help your patients. For example: around the world, the standard of care is three times a week hemodialysis. We are grateful because many African countries are not even able to afford the support for any form of renal replacement therapy. We offer patients twice-a-week dialysis. We are able to at least bridge quite a number of patients towards transplantation, which we weren't able to do before. But what guidelines are we using? There's no guidelines for this. Nobody in the world does twice a week dialysis, we have to innovate,” said Khalida Soki.

The use of electronic medical records (EMR) is increasing in Kenya, enhancing data management and patient care efficiency. Clinicians like nephrologists have adapted to the scarcity of specialists by utilizing online training platforms, collaborating with global experts to improve local expertise and give advice to patients.

The Role of Technology and Innovation in Healthcare

Remote consultations via phone or online platforms have become increasingly common, allowing healthcare professionals to provide timely care to patients located far from medical centers. “I'll use daVita website, the AFRAN website, which is the African Association of Nephrology, the International Society of Nephrology, which has leaflets and pamphlets in many different languages. I can use these resources and send links to patients on WhatsApp, say to patients go have a look at this, read about it, come back and let's have a conversation about it. Clinicians have to make use of a lot of the resources that are out of there to try and help their patient population.”

Telemedicine has significantly improved access to healthcare, especially for the elderly and those living in remote areas. Mobile applications for monitoring vital health parameters and online prescription services have made healthcare more accessible and efficient. Additionally, online resources and apps have been instrumental in patient education and management, especially for chronic conditions like kidney disease.

Technological advancements have not only improved patient outcomes but also allowed for a broader reach, enabling healthcare professionals to impact more lives positively.

Asked what she wishes to see improved, Khalida Soki replies: “I do wish we could have more data and more access to research facilities, especially basic research. In kidney medicine, we can't even say that we know what causes the majority of our kidney diseases in younger people. I wish we had improved food quality regarding health, and I wish we had better or more robust preventative programs, especially in uncommunicable diseases. This is what I think we need to do in terms of strengthening our health systems.”

Tune in to the full discussion.

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