The Covid pandemic forced us to change our approach to almost every aspect of daily and working life, and whilst we are very glad to say goodbye to some of those changes, others have become innovations whose full potential we need to explore.
For the team at TLM Bangladesh, digital healthcare (particularly for Leprosy Complication Care) was one of those innovations.
As lockdowns prevented patients with leprosy complications from accessing health centres, our medical personnel needed to find new ways of supporting people who are suffering from leprosy complications and who are living in remote places. The answer was remote consultations, conducted over video call.
This innovation proved such a success that the team applied to the American Leprosy Missions' NTD Innovation Prize, which they were awarded at the NNN Conference last year. In 2023, they have the task of scaling up their Covid-era digital health project with their $40k prize money.
We spoke to Mr Jiptha Boiragee about what this is going to look like.
JB: There are approximately 2,500 people in Bangladesh who require leprosy complication care, and while there are great services available through hospitals, a sizeable number of those 2,500 people find it hard to get to a hospital.
For people who live in the coastal areas, in the Chittagong Hill Tracts, or in other remote areas, getting to a hospital is not an easy task. So while people in urban areas have been able to return to hospitals since pandemic restrictions were ended, people in remote areas of Bangladesh are continuing to face challenges in accessing health centres.
If we can provide remote healthcare through digital innovations, we can save patients time and money. We can also increase their health-seeking behaviours if we make it easy for them to access treatment; the sooner we can treat complications, the less severe they are.
JB: This project would not work without ALO, Bangladesh’s national organisation of persons affected by leprosy. ALO were instrumental in making this intervention work during the pandemic and they are going to be instrumental in making this project work, as well.
ALO is the umbrella body for the 100 federations of 1500 self-help groups that TLM has been developing over the last 15 or so years. Over the years, we have been building the capacity of these self-help groups through training and mentoring and there are now hundreds of these groups operating almost by themselves all under the umbrella of ALO.
Because of the investment we made in these self-help groups over so many years, ALO was perfectly placed to help during the pandemic and are going to be the main implementing partner of this pilot project.
The project will see ALO Members’ Community Resource Person (CRP) visiting the homes of persons affected by leprosy to check for leprosy complications. When they find complications, they arrange a video call with one of TLM’s medical personnel. The doctors can examine the complication and make suggestions for self-care and recovery. The ALO team will sit with the patient during the consultation and will encourage other members of the household to join the call and listen the doctors.
We found this process is effective on a number of levels. First, it is easier than travelling to a health centre. Beyond that, video calls make the patients feel heard by the doctors and the ALO team, which motivates them with their self-care and health-seeking behaviour. Including other household members is also crucial, because the patient is much more likely to keep up their self-care practices if they feel supported and encouraged by their family.
ALO teams will continue to visit the households of patients every month or every quarter and will set up further consultations with TLM medical personnel if it is necessary, or arrange access to a medical centre if an emergency intervention is needed.
When they are in conversation with patients, they will also talk to them about the benefits of self-help groups, such as livelihood support, access to financial support, and having a collective voice in their district. The will also teach people a few of the basics of contact tracing and how to monitor their household members for early signs of leprosy.
JB: ALO are undoubtedly a key enabler. Because they have received support and investment for so many years, they are now able to fly on their own. The funding we received from the NTD Innovation Prize has been sent straight on to ALO, who have distributed it across their federations, all of whom have received financial training over a number of years.
They are well-governed, well-run, and sophisticated organisations. Because they are at an advanced level and because their networks are so extensive, they are ideal implementers of this project, helping us to reach hard-to-reach communities. They can also empathise and encourage patients in ways that you can only do if you have experienced leprosy for yourself.
They are well-governed, well-run, and sophisticated organisations. Because they are at an advanced level and because their networks are so extensive, they are ideal implementers of this project, helping us to reach hard-to-reach communities.
Their extensive networks and dedicated teams are going to allow us to expand this project from the five districts we supported during the lockdowns to 20 different districts across Bangladesh.
The Community Resource Persons within the ALO federations are also key enablers. They are the professional staff within each federation and will be doing everything from facilitating meetings, managing finances, and connecting with government departments.
Another key enabler for this project is the mobile network in Bangladesh. This has strengthened a lot over the years and it is because of this network that we can have reliable video calls with even those patients in the most remote locations.
Lastly, but most importantly, the funding from the NTD Innovation Prize is what has enabled us to move this innovation forward after the pandemic. We were pleased they saw the potential of the project, as well as the importance of having a leprosy peoples’ organisation as a key implementing partner. We hope that digital healthcare in this model can be used to support other NTDs, as well.
JB: We have a few key medical indicators. We will track how many patients benefit from digital healthcare support through our project. We will be monitoring how many patients are released from care through this project. We will also check how many patients still need to attend a medical centre to resolve their complication.
Then there are a few non-medical indicators that we will track. We will consider how many patients’ families will engage in self-care and treatment. We will talk to the ALO federations to find out what challenges they are facing, as they are crucial to making this sustainable.
A final indicator of success for us will be the attitude and skill of the team at ALO. Are they boosted by this experience? Will they feel encouraged to offer their communities further support like this? For them, it is a really exciting moment to give back to a large number of people in their districts and it is important that the project will not only reduce the burden of leprosy complications but will also boost ALO and their ability to act as an implementing partner.
