Staging Posts (34)
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Helga's anxieties are all valid but not insurmountable. It may be reas-
suring (or not) for her to hear that similar constraints (albeit, on a
smaller scale) apply to developed countries with publicly funded (and
therefore, cash constrained) health services like the NHS in the UK.
The NHS was a late entrant into the health information superhighway
compared to the US and Canada and health service professionals and man-
agers voiced anxieties not very different from those raised by Helga.
However, most of these worries can be dealt with or accommodated and
should not be seen as valid reasons for not taking a step in that di-
rection.
In response to her list of constraints:
1. The speed of access to internet data is dependent mainly on local
telephone networks and with the increasing availability of cable net-
works - replacing standard telephone lines in many places - this is a
problem on the decline.
2. Nothing is ever TOTALLY RELIABLE, especially in health care. We use
a lot of pharmacological and surgical interventions in health care that
are far from "totally reliable". If we waited for all technology to be
"totally reliable" before applying them, we would never have got to
where we are today. Surely, the measure should be the "potential to
benefit" significantly outweighing the risk of harm?
3. & 4. Limited availability of hardware such as printers and worksta-
tions can be addressed by simple administrative procedures - rosters
for use, designated users for each team etc.
5. One "potential user" skilled in it's use is a start. There will
never be a time when all potential users will be "really skilled" in
using computer technology, the same way that not all surgeons will be
"really skilled" in a specific procedure.
6. Aneurin Bevan, the "founder" of the UK's National Health Service,
made this statement about the NHS in 1948 and it is still true in the
NHS today and I'm sure is true also in Zimbabwe: "We shall never have
all we need. Expectations will always exceed capacity. The service must
always be changing, growing, improving - it must always appear inade-
quate". Even if your hospitals were staffed to current "full" capacity,
advances in healthcare and increasing expectation will always indicate
room for expansion. If access to information on the internet means that
the few staff you have provide the best care within their limited re-
sources, surely that is a good thing?
7. If one believed that a new skill is worth having and will improve
the quality of care delivered to patients, then, time can and should be
squeezed out for training.
8. I agree that there is a lot of non-validated health information on
the internet, however, this problem has been recognised and free serv-
ices exist on the internet whose aim is to provide access to peer re-
viewed information available on the net. Also, some peer -reviewed
medical / health service journals now provide free access to full texts
of published papers. Restricting access to such services only could re-
duce the problem of non-valid information and time wasted surfing the
'net.
I am from Nigeria and envy the progress made by countries like Zimbabwe
in increasing access to internet services and hope that anxieties like
those expressed by Helga, do not slow down this progress.
Ebere Okereke
mailto:Ebere.Okereke@bradford-ha.northy.nhs.uk
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