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The day Bluetooth brought a cardiologist to every village in Cameroon

Illustration: Didier Kassaï for Heidi.news

With 60 cardiologists for 25 million inhabitants, getting diagnosed with a cardiovascular disease in Cameroon is a real struggle, especially in the bush. But the Cardiopad, invented by Cameroonian Arthur Zang patients and cardiologists don't necessarily have to meet anymore.

This article was originally published in French on Heidi.news. It is the sixth episode of an exploration entitled "11 African Solutions for the Future World".

With 60 cardiologists for 25 million inhabitants, getting diagnosed with cardiovascular disease in Cameroon is a real struggle, especially in the bush. But the Cardiopad, a small, white, connected briefcase invented by Cameroonian Arthur Zang, could well change all that. With it, patients and cardiologists don't necessarily have to meet anymore.

His heart has been throbbing and racing every day for the past ten years. Maybe even for fifteen or twenty years: it's been a long time since Hélène Meka Meke Akoa has stopped counting the years of fatigue and shortness of breath that her old heart inflicts on her. "When things didn't go well, my children used to take me to the rheumatologist or a general practitioner because they were easy to reach [...] I was prescribed an electrocardiogram, but each time, we gave in to discouragement," she says.

Being 72 years old, this Cameroonian housewife never had the physical strength or the financial means to travel to Yaoundé, the capital, to be diagnosed by a cardiologist. Her village is more than 100 kilometres away. At the end of 2018, heart palpitations accelerated. Hélène Meka Meke Akoa had to leave her village urgently to reach the hospital in Abom, a remote neighbourhood on the eastern edge of Yaoundé. Hélène Meka Meke Akoa had no cardiologist working there:

"My children were about to take me to a big downtown hospital. That's when a young doctor told us that he could do the electrocardiogram and diagnosis right here on my hospital bed. We got the results in less than 15 minutes," the old woman enthused.

The young doctor from Abom was not a cardiologist, however. But the Cardiopad, an electrocardiogram device with telemedicine capabilities, allowed the GP to easily perform the examination, transfer it via Bluetooth to his phone and send it to a cardiologist based in another hospital. Ten minutes later, the GP received the diagnosis from the specialist. Hélène Meka Meke Akoa had left ventricular hypertrophy. She is now under treatment.

Read the article in French: Le jour où Bluetooth amena un cardiologue dans chaque village

Decentralizing care to combat medical deserts

With Cardiopad, villagers like Hélène, who live in the most remote areas of Cameroon, can consult a cardiologist remotely at a health centre near their home. In this vast Central African country of more than 475,000 km2, the needs are enormous. "We have only sixty cardiologists for more than 25 million inhabitants and three-quarters of them work in the country's two largest cities, Yaoundé and Douala. We have to decentralise care, it's a real public health issue," says Arthur Zang, the inventor of Cardiopad, before going on, with modesty: "It's a personal issue for me. I've lost a lot of people to heart disease. One of my uncles died from it."

This past gave him the strength to move on. As early as 2009, as a student at the Yaoundé Polytechnic, the apprentice engineer became obsessed with heart signals. He wrote a thesis on the transmission of heartbeats through wireless networks. Then this university work became a software which, with the help of prototypes, eventually resulted in the Cardiopad in 2016.

Today, the small white case is implanted in about a hundred Cameroonian hospitals and is also exported to Comoros, Gabon, Guinea, Kenya and Nepal, among others. 150 Cardiopads are used abroad. But the cost of the device is still high for health structures: 1.5 million CFA francs (2,280 euros / CHF 2,450). "We're working on it," says Arthur Zang.

The engineer's objective is set: to fight against medical deserts by bringing cardiologists closer to the villagers. Because for those with a sick heart living in the bush, consulting a specialist is often a struggle. Some are forced to drive more than six hours by bus to be diagnosed. A journey as tedious as it is expensive, which discourages many. The consequences for their health are sometimes dramatic.

"We see patients from the hinterland arriving at the hospital in terminal stages of cardiovascular disease just because they were unable to travel and consult earlier. For some, it's too late and they die. In the bush, cardiovascular disease is under-diagnosed because there are simply no cardiologists to check them," sighs André Gilles Ahinaga from the Efoulan District Hospital in Yaoundé.

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9'800 remote diagnostics performed

Tired of watching, helplessly, these dramas that could easily have been avoided, André Gilles Ahinaga joined the team of virtual cardiologists at Himore Medical, Arthur Zang's company. When, on the other side of the country, a patient passes under the radar of the Cardiopad, a cardiologist from Himore Medical instantly receives the electrocardiogram curves on his phone, via a dedicated application. All he has to do is enter his diagnosis and it is automatically sent to the health worker present with the patient.

Since 2016, 9,800 remote examinations have been carried out with the Cardiopad. However, this telemedicine leads to an overload of work for the partner cardiologists. Arthur Zang:

"About 20 cardiologists work with us for remote interpretation. They are overwhelmed. The tests come from everywhere, their phone memories are full of consultations to be interpreted. We need to expand our network to the rest of Africa. With the internet and mobile phones, there are no limits! A Guinean cardiologist can interpret a test done in Cameroon within a minute!"

Cardiovascular disease is wreaking havoc on the continent, more so than malaria or AIDS. From the hospital in Efoulan, Dr Ahinaga watches in horror as the numbers rise each year in his country. "Cardiovascular diseases are emerging in our country," the cardiologist warns. They are progressing because, with development and globalization, Cameroonians have westernized their habits. We have become sedentary, we have started to eat more fat and very salty food with the arrival of fast food. We walk less because we now have cars. We are also more stressed. All of this has led to an increase in high blood pressure, which is one of the main factors in cardiovascular disease. One in three Cameroonians is affected!"

Two new solutions in the lab

In his laboratories, Arthur Zang is tackling two other roots of heart disease: diabetes and respiratory problems. Together with his 15 employees, the engineer is developing new types of blood pressure and blood glucose monitors that will enable diabetics to monitor the progression of their disease. Covid-19 also gave him another idea: to create a connected medical oxygen production station for hospitals. Called Oxynnet, the device can be controlled remotely and makes health facilities self-sufficient in medical oxygen, enabling them to avoid shortages and thus deaths due to lack of respiratory assistance. Arthur Zang:

"Currently, deliveries of medical oxygen cylinders are managed by companies that don't go to the remotest corners of the country. During Covid-19, this led to patients from these areas coming to the city for respiratory assistance. The coronavirus is highly contagious and these patients infected others."

The 30-year-old now has a new ambition: to revolutionise the treatment of respiratory diseases in Africa by continuing the fight against medical deserts in the bush.

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Didier Kassaï is a self-taught illustrator, watercolorist and cartoonist, born in 1974 in the Central African Republic. His first comic book, L'Odyssée de Mongou, was published by l'Harmattan BD in 2014. The following year he published Tempête sur Bangui, in two volumes La Boîte à Bulles. For this series on African solutions, he created eleven original illustrations for Heidi.news.

11 African Solutions for the Future World