Kenya will upgrade its healthcare system using methods and technologies developed at the Jerusalem-based Terem Emergency Health Centers.

By Desmond Bentley

For over 20 years, the Terem chain of five emergency medical centers in the Jerusalem area has buoyed the city’s healthcare system by treating non-severe cases that would have otherwise ended up in a hospital ER. Now the Kenyan Health Ministry has decided to adopt this successful model.

Kenya plans to establish about 50 emergency care clinics using the latest telecom technologies, says Dr. Nahum Kovalski, assistant medical director of Terem.

Kenya will purchase technologies from the Israeli chain that were developed by Kovalski, including software for transferring images and diagnoses from the emergency centers to doctors and hospitals at a higher resolution. Each clinic will serve several hundred thousand people in this country of 35 million.

“As long as you have Internet, you can have real-time streaming of information,” explains Kovalski, noting that most Kenyans have cell phones, and the country is upgrading its Internet infrastructure. “Mobile help using cell phones has been proven as practical, with proven numbers. It decreases both the cost of delivery of care, and the speed of delivery of care.”

Answering Kenya’s needs

The Kenya project came at an opportune moment for Terem.

“We were in the midst of developing our own company in terms of computerization when we were approached by a Canadian company that was developing an educational project in Kenya — a virtual university. Because we are a flexible company, we could quickly come up with a suitable model for the Kenyans.”

Not that the process has been smooth: “We sent a medical team to Kenya four years ago. We traveled around Kenya, submitted a formal proposal, then Kenya underwent a period of internal strife, which they’ve thankfully come out of,” says Kovalski.

“The Kenyan health minister visited us in Jerusalem two years ago, and came away impressed. We upgraded our proposal to a full-scale solution that includes physical ‘Terems’ across Kenya, which would be linked through Internet infrastructure.”

Kovalski stresses that one cannot “just take solutions that were developed for the Western world and drop them into the developing world. Our attitude is that we don’t have all the answers, but we know the technology.”

His dual background in computer science and medicine has helped him come up with customized solutions, what he refers to as “tools that have a very low learning curve.”

Such tools, combined with portable ultrasound devices, can revolutionize healthcare, he says.

“With technologies, you can do a lot more than you could before, such as training and consultations. A lot will be done by cell phones, and by using questionnaires. This will save lives, instead of the patient traveling to Nairobi and dying along the way.”

Expanding throughout Israel

Established in 1989 by Dr. David Appelbaum, Terem has become the largest provider of urgent and emergency care in the area, treating some 215,000 patients annually. The chain is expected to grow significantly in the coming years.

“We’ve been approached by communities throughout [Israel]. We’re in a hurry to expand — but only where it is appropriate. We hope to open in Bnei Brak soon, and after that in the north. Within five years we should have a presence across the country. Then we’ll become a true national chain,” says Kovalski.

He relates that Terem family physician Dr. Karen Djemal was recently awarded a 2011 Outstanding Physician prize by the Association of Medicine and Law in Israel.

First-time visitors to Terem clinics cannot help but notice the amount of English spoken by its staff. “Terem attracts a lot of ‘Anglo’ doctors because our approach to emergency medicine is closer to the American approach,” explains Kovalski, who hails from Canada.

He cites Israeli Health Ministry statistics showing that where Terem is active, 30 to 50 percent fewer patients pass through hospital emergency rooms.

“Only about 7% of our patients are referred to hospitals,” he says. “This fits in with anecdotal evidence. Physicians tell us that they see fewer non-severe emergency cases, which frees them up to attend to other patients. Every time you use a hammer to kill a fly, you’re expending unnecessary energy. There’s no need for such overkill.

Terem’s approach is indicative of Israel’s embrace of cutting-edge technology, he says. “Israel is one of the most advanced countries in the world in terms of computerized medical records. More data is being shared than ever before.”

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