加納遠程護理救死扶傷

“It started like a runny stomach but it was soon followed by vomiting. I was so scared that I thought I would lose my pregnancy and life”， says Faith Kuwornu， a 27 year-old pregnant mother of three， in Ghana’s coastal town of Keta， in the Volta Region.

Faith was among the dozens who escaped the deadly cholera disease that threatened the town of about 20，000 people in 2014.

Despite the 8.4 kilometer sea defence wall， rising sea levels caused by climate change expose Keta to heavy flooding.

This is worsened when it rains， as insanitary conditions and health hazards cause diarrhoea and cholera among the affected population. The floods effectively cut off most communities making it difficult for health workers to provide care for the people.

Between 2008 and 2013， Keta recorded an average of 100 cholera cases annually. “Aside from cholera and other diarrhoeal diseases， malaria cases increase any time it floods”， says Dr. Andrews Ayim， the Keta Municipal Health Director.

But in 2014 when more than 28，000 cholera cases and 200 deaths were recorded in Ghana， Keta had none， even when the rest of the Volta Region reported 646 cholera cases.

Teleconsultation is an innovation to quicken surveillance response and provide prompt health care to people in remote areas and other places cut off by the effects of climate change such as extreme flooding. It takes advantage of mobile telephony where coverage is available， to provide medical consultation services on mobile phones to patients and health facilities at referral levels.

It is an initiative of the Climate Change and Health project， supported by the United Nations Development Programme （UNDP） and Global Environmental Facility （GEF）. The project aims to develop systems and response mechanisms to better integrate climate change risks into the health sector. It involves training health sector workers and sensitize decision-making bodies at local and national health policy levels.

In Keta， the project provided about 30 android-enabled mobile phones， preloaded monthly with 500 minutes of talk-time and 20MB mobile data to doctors and nurses at 11 health centers and six community health facilities in the municipality. The project also trained 180 disease surveillance volunteers across the area.

Health nurses share their telephone numbers with health volunteers， opinion leaders and other community members for timely updates on health situations for prompt medical advice， especially during flooding. “Anytime community health nurses encounter a situation that they cannot manage at their level they call senior officers for advice so that referrals are reduced to the minimum，” says Perfect Titiati， a Principal Health Nurse.

When suspected diarrhoea cases are detected， patients are treated for free； in Oral Rehydration Therapy corners - rooms stuffed with requisite medical supplies to help restore lost body fluids.

Faith is grateful for the intervention which saved her pregnancy and life. “When I first called the community health nurse at dawn， she offered first aid on the telephone until she arrived at my house with another nurse an hour later. I was treated with Oral Rehydration Salts and Zinc tablets and rushed to the hospital because of my pregnancy. They saved my life and the unborn baby” she says.

The UNDP and GEF are supporting the Climate Change and Health project with US$1.9 million in partnership with the Government of Ghana. The project， implemented by the Ministry of Health and the Ghana Health Service is piloted in regions where prevalence of diseases， climate change impact and poverty incidence are high.

“Seeing that Keta recorded not a single incidence [of cholera] when our neighbouring district had about 120 cases， we are confident that our interventions of teleconsultations， awareness creation and the Oral Rehydration Therapy corners worked”， says Dr. Andrews Ayim.

2008年到2013年，平均每年加納keta地區報告有100起霍亂病例。然而2014年，該地區霍亂病例為零起，而周邊Volta地區則報告有646起霍亂病例，這要歸功于聯合國人居署和全球環境基金會支持的氣候變化與健康項目。該項目的內容之一——遙控會診可以加快監測回復的速度，為由于洪水等氣候災害與外界阻斷聯系的偏遠地區的居民提供健康救助。

[http：//www.undp.org/content/undp/en/home/ourwork/ourstories/nursing-by-phone-helps-save-lives-in-ghanas-coastal-town/]