When early diagnosis saves lives
How telemedicine and home visiting are changing children's lives in Suzak, Kyrgyzstan
Today, Nuria Ziyadinova’s home is quiet. Her youngest daughter, 1.5-month-old Sofia, is sleeping peacefully in her cradle. For many families, this is an ordinary scene – but for Nuria, it’s a precious moment of calm after weeks of worry.
A couple of weeks ago, during a routine home visit for newborns, a family doctor diagnosed Sofia with prolonged jaundice. In the past, Sofia’s parents would have had to travel hundreds of kilometres to the capital of Bishkek for a more qualified consultation. Instead, their family doctor arranged a remote consultation with a Bishkek neonatologist who confirmed the diagnosis and adjusted Sofia’s treatment plan, as well as providing guidance on maternal care and nutrition.
Sofia’s story is one of many examples of how early diagnosis and intervention are changing the lives of children in Suzak, a small town near the border with Uzbekistan. For the first time, thanks to an initiative of the Ministry of Health of the Kyrgyz Republic supported by UNICEF, telemedicine can be used at the primary health-care level in Suzak. This gives families the opportunity to identify developmental and health issues in their children much more quickly – reducing the risk of disability and even death.
Roughly since both the home visit service and telemedicine programmes were implemented, neonatal mortality in Jalal-Abad region, where Suzak is the largest and most densely populated district, has decreased sixfold.
Why home visits matter
The comprehensive home visiting service for newborns began in 2019, when the Ministry of Health, with the support of UNICEF, implemented it in several districts including Suzak. During the visit, a family doctor and nurse check the child’s health and development, the mother’s health and the family’s living conditions. They identify any signs of health or developmental problems in the newborns, as well as any symptoms in the mother.
Depending on what they see, the healthcare team creates any needed action plans and provides advice on childcare, feeding, hygiene, bathing, and preventive check-ups.
OdinŠ° Matyakubova, Deputy Director of the Family Medicine Centre in Suzak who trains healthcare providers in the early detection of developmental delays in children, is one of the providers who performs the home visits.
“We examine not only the newborns but also the mothers," she says. "In the past, parents could underestimate the signs of dangerous health conditions and delay seeking medical assistance. There were cases in which we lost children because of this.
"Now, however, the family doctor visits the newborn at home during the most critical moments of the baby’s life, examines the child, assesses their condition, and provides important advice to the parents."
The nurses in Suzak work in challenging conditions. Each nurse additionally to other services is responsible for 10 to 20 women who have given birth, while one doctor is responsible for approximately 12,000 people in the area. Due to a shortage of staff, the nurses see up to 60 patients a day, spending no more than 30 minutes with each.
This is an enormous workload, but the programme is already achieving results, notes Dr. Matyakubova.
From 2018 to 2023, the coverage of home visits for young children from the poorest families by primary health-care service (PHC) workers across the country has doubled.
Telemedicine: assistance at a distance
One of the key steps in ensuring universal access to quality medical care for sick children has been the introduction of telemedicine, which allows for consultations with specialists who are only available in cities. Every doctor working in Suzak is equipped with a tablet that enables them to gather complaints, document the examination, and record the assessment results according to the approved clinical protocol. If there are doubts about the diagnosis or treatment, the doctor can request a consultation with a specialist from a secondary or tertiary health-care facility, without the need to travel to larger cities such as Osh or Bishkek.
All the patient information entered by the family doctor on the tablet is accessible to the consulting doctor. They can upload test results and examination data, and record video and audio. Then the family with the child arrives at the Family Medicine Centre for a telemedicine consultation at the agreed time.
This especially helpful for families who live far from the capital, are limited in resources, or cannot leave other children in the care of relatives or neighbours.
Telemedicine also enables rapid access to qualified consultations – crucial for making timely decisions. “Using video communication, we can send all the necessary information to specialists in the capital, which allows us to respond quickly to changes in the child’s condition," says Dr. Matyakubova.
For Sofia's mother Nuriya, the convenience of the programme turned out to be especially valuable. “When I was informed about the possibility of receiving consultations and diagnosis without having to travel to the city, I immediately agreed,” she says. “There was no need to go anywhere, which was very convenient, especially with an infant.”
After Sofia’s diagnosis, the necessary therapy was prescribed, and Nuriya received important recommendations for caring for her daughter and feeding. Thanks to the timely intervention, Sofia's condition stabilized.
Nuriya also said that seeing her daughter healthy again made her realize how important is to be informed and to have to an opportunity and access to essential health services.
