This week on the blog we are hosting a guest post by Heather Baily, a Doctoral student in Anthropology at Case Western Reserve University. Here, she presents some of her research on telemedicine in Ghana.
In November 2015, Tanja Ahlin and Mark Nichter issued a “Take a Stand” statement in the Critical Anthropology for Global Health interest group (available here), calling for more anthropologists to study telemedicine. Telemedicine is the use of telecommunication tools, namely cell phones and computers, to exchange information regarding patient health. A recent report from the World Health Organization (2016) states that universal health coverage cannot be achieved without this form of e-health. Universal health coverage, as well as comprehensive primary health care, has been an overarching goal of the international health and global health community since the Alma Ata conference in 1978, but these goals are very difficult to achieve. Telemedicine is poised to help achieve greater health coverage and access, yet the field is still very new, particularly in resource-poor settings, and is evolving rapidly alongside cell phone technology.
In June of last year, I traveled to Ghana to investigate the ways in which telemedicine is being used there. Ghana is in the midst of scaling up a successful telemedicine pilot project into a national telemedicine program through Ghana Health Services. Public health administrators in the pilot project districts, as well as doctors and nurses who worked with the program, all spoke favorably of the new technology. Each clinic and hospital has a designated smartphone to be used for various medical communication purposes, including receiving calls from patients, over-the-phone consultation from doctors at the regional hospital call center, and direct contact with the other clinics and district health offices through encrypted instant messaging apps, such as WhatsApp.
Practitioners reported decreased maternal mortality since the implementation of this program, as well as an increase in utilization of local clinics and trust in the staff. In Ghana, once someone has completed medical training of any kind, such as a community health nurse or a registered midwife, they must complete their “national service,” a two-year contract in an assigned village. Typically, community health nurses are younger and not from the village in which they are assigned to work. A “small girl/boy” is a common term used in Ghana for a young person, indicating not only their age, but their social status and lack of social legitimacy. Thus, being able to access and connect a patient to a doctor at a hospital over the phone has helped the nurses achieve more legitimacy and overcome their “small girl/boy” status.
I draw from several areas of anthropological theory when examining the impacts of telemedicine in Ghana, specifically the anthropology of reproduction since my dissertation research focuses on obstetric care. The concept of authoritative knowledge is particularly useful in this case. Authoritative knowledge is knowledge that is given more weight than other types of knowledge, or ways of knowing, by collective assessment in a local setting and is displayed in everyday practices (Jordan, 1990; Davis-Floyd & Sargent, 1997; Ivry, 2010). This concept relates to legitimacy in the health care setting as authoritative knowledge shapes interactions between patients and caregivers, access to knowledge, and health care decision-making. Access to physicians may alter the hierarchy of who has authoritative knowledge, adjust healthcare seeking patterns, or disrupt local power structures and “knowing” about birth.
Science and Technology Studies provides a foundation from which to examine the historical contexts and meanings of technologies and how people interact with them. The introduction of a communication technology which links rural areas to clinicians at a regional hospital complicates questions of the way people interact with technology, especially as it regards obstetric care. Rayna Rapp (1999) examined technologies used in assisting reproduction, which she calls “technologies of knowing.” In this study, she examined the production of knowledge as a result of new technology. Following this tradition, it is important to examine the intersections of technology, reproduction, and knowledge by investigating ways in which the introduction of a new technology changes how a patient might acquire and use knowledge.
Studying telemedicine from an anthropological perspective builds on our understanding of how people interact with technology, particularly when seeking healthcare treatments, and how technology can influence a universal human experience, such as pregnancy and childbirth. As telemedicine is widely regarded as the much-needed direction medical care is heading around the world, it is crucial to examine ways it can shape an individual’s interaction with a technology and with the community at large.
Heather Baily is a dual degree Ph.D./MPH student in Anthropology at Case Western Reserve University. She has a MA in Anthropology from CWRU and a BA in Anthropology and Sociology from Colorado State University. Her research investigates the intersections of new telecommunication technologies used in healthcare and local structures of reproductive knowledge and authority in Ghana.
Davis-Floyd, R., & Sargent, C. F. (1997). Childbirth and authoritative knowledge: Cross-cultural perspectives. Berkeley: University of California Press.
Ivry, T. (2010). Embodying culture: Pregnancy in Japan and Israel. New Brunswick, NJ: Rutgers University Press.
Jordan, B. (1990). Technology and the social distribution of knowledge: Issues for primary health care in developing countries. In J. Coreil and J. D. Mull, (Eds.), Anthropology and Primary Health Care pp. 98–120).
Rapp, R. (1999). Testing women, testing the fetus: The social impact of amniocentesis in America. New York: Routledge.
World Health Organization. (2016). Global diffusion of eHealth: making universal health coverage achievable. Report of the third global survey on eHealth. Geneva.