Improving rural health care using 4IR technologies


We are witnessing digital transformation coupled with providing solutions for some of our most deep-seated problems including in medical technology.

Last week I was invited by the MEC of Health in the Limpopo Province, Dr Phophi Ramathuba, to launch the computerised tomography (CT) scans at Tshilidzini Hospitals. In case you were wondering, Tshilidzini Hospital, even though I was born there, was not named after me. It was built in 1956, when my mother was only six years old, by the anti-apartheid activists Nico and Ellen Smith. Tshilidzini means a place of grace. My connection with this hospital is extensive.

The CT scan is a technology that takes a series of x-ray images at different angles to generate cross-sectional images of bones, soft tissues, and blood vessels. It reveals more information than a standard x-ray. The genesis of CT scan is in South Africa. Nobel Prize Winner Allan Cormack, one of the inventors of this vital technology, was a South African physicist who migrated to the United States (US) and played a prominent role in medical technology. Of course, this trend of South African inventors migrating to the US, including the second richest person in the world, Elon Musk, continues up to today.

I hold three patents in medical technology. A patent is a right one gets when one invents a new system or device. One of the inventions I co-invented with David Rubin, Megan Russell, and Brian Wigdorowitz is the artificial larynx. The artificial larynx uses artificial intelligence (AI), a palate device, and the tongue’s movement to restore a lost voice. This invention was featured in the influential MIT Technology magazine. The other invention I co-invented with David Rubin and David Starfield is a method and apparatus for radiation imaging, which improves medical images from gamma-ray cameras. Starfield has migrated to the US. Given the prominence of South Africans in medical technology, why has medical technology not taken off in South Africa, and what can we do about it?

One of the mechanisms that we should adopt to create the medical technology industry, is the new set of opportunities presented by the fourth industrial revolution (4IR). The 4IR is the age of intelligent machines, characterised by technologies such as AI, the internet of things, augmented reality, and 3D printing. These disruptive technologies are deeply changing the way we live, work, and relate to one another.

Speaking on the 4IR in 2016, Klaus Schwab from the World Economic Forum said, “For all the opportunities that arise from the 4IR – and there are many – it does not come without risks. Perhaps one of the greatest is that the changes will exacerbate inequalities. And as we all know, a more unequal world is a less stable one.” Four years on from Schwab’s sounding of the alarm, we have intensified our discussions on the 4IR, and there is evidence that we are not falling prey to these fears. We now find ourselves engulfed by a pandemic that has forced us to confront many of the changes the 4IR would have presented sooner. We are witnessing digital transformation coupled with providing solutions for some of our most deep-seated problems including in medical technology.

Healthcare in South Africa all too often does not cater to a large bulk of our population. In a bid to improve access and quality of services to rural communities, the Department of Health in Limpopo installed CT scans and Picture Archiving Communication System (PACS) in the province. This is 4IR in action and will certainly go a long way to reaching those who were previously without these services. Before, the services of CT scans were only available in tertiary hospitals in Pietersburg, Mankweng or Gauteng and patients would often have to travel long distances multiple times and at great cost before a test or report became available.

As Marije Versteeg-Mojanaga from the Rural Health Advocacy Project (RHAP) put it, “That process can take the whole day. The conditions at the hospitals where the patients sleep are not good. There is no safe accommodation. Some patients sleep on the floor and some don’t have food for when they stand in long queues for medical attention.” The availability of this equipment at our rural hospitals improves the speed of diagnosis as well as management of the associated conditions.

Last year, a Protecting Rural Healthcare in Times of Economic Crisis study argued that “People in rural areas should have, if not equal access, at least reasonable and dignified access to healthcare services.” I would argue that if digital technologies are harnessed correctly, they have great potential to increase efficiency and accuracy while providing solutions for many who are without medical care. In fact, a study by Lancet Digital Health suggested that the diagnostic performance of deep-learning models is equivalent to that of health-care professionals. This does not mean doctors will become obsolete. Instead, digital technologies imply faster and earlier diagnoses, giving doctors space to treat more patients.

As Lancet Digital Health puts it, “Scans are never interpreted on their own, they’re analysed alongside blood results, historical data, prescriptions from GPs and previous hospital admissions, referral letters, taking the patient’s history and then taking it again, what the nurse told you before they went on their lunch break, and any number of other sources of information.” This will still fall to our healthcare professionals but many of the tedious aspects will be automated. In fact, we should see technological advancements in any industry as a way to augment our abilities.

This is significant when you consider that according to the General Household Survey conducted by Statistics SA, “only 17 in 100 South Africans have medical insurance, the essential key that opens the door to private healthcare. As many as 45 million, or 82 out of every 100 South Africans, fall outside the medical aid net, and as a result are largely dependent on public healthcare.” Still according to Statistics South Africa, “81% of households using public healthcare services in 2017 were either “very satisfied” or “satisfied” with the provisions they receive at public facilities.” There is nonetheless scope for improvement when you consider this in tandem with private healthcare. There is scope to provide better service delivery using 4IR, particularly for those who cannot reach it. This, of course, is a continent-wide concern. The projected growth in Africa’s population and the lack of appropriate resources and infrastructure are some of the challenges obstructing the delivery of quality healthcare on the continent.

As Versteeg-Mojanaga reminds us that “To realise the right to health, the specific conditions and realities of rural areas need to be taken into account. This in turn requires sufficient insight by policy makers into rural health systems, so that implementable policies are designed that can achieve their intended goals equally among citizens. The focus on inequities related to race and socio-economic status needs to be broadened to include the explicit link to geographical location.” This demonstrates how we cannot cower from the 4IR in fear of the possibility that it will broaden our disparities. Instead, we need to be prepared for this shift so that we can deploy medical technology in a way that is beneficial to all facets of society including the rural areas. It is my hope that this will spur many more initiatives, that not only help to bridge our divides and diminish inequalities but also place us on the cutting edge of technology. The goal, after all, is to ensure that Schwab’s fears are not realised and that we subvert the very narrative that the 4IR could be an omen.

Professor Tshilidzi Marwala is the Vice-Chancellor and Principal of the University of Johannesburg. He is the author of the book: Closing the Gap: The Fourth Industrial Revolution in Africa. Follow him on Twitter at @txm1971.