Globally, more than 50 million people are living with epilepsy with 80% of those affected living in low and middle-income countries (LMICs). Cameroon has one of the highest epilepsy prevalence in Sub-Saharan Africa and the world with more than 80% of those affected not receiving any treatment. Lack of access to doctors is an important cause of this wide treatment gap. Like in other LMICs, most patients with epilepsy are found in rural and medically underserved communities whereas the vast majority of doctors live in urban areas. Worse still, epilepsy is regarded as complicated by most doctors and many doctors will not treat it so PWE will have to go even farther from home for treatment.
Additionally, most patients with epilepsy are subsistence farmers and can afford neither the travel costs nor the time away from their land. Moreover, with epilepsy being heavily stigmatized in Cameroon, many patients usually shy away from health facilities for fear of being stigmatized. Instead, they will consult the traditional healer who at least will live nearby. It is increasingly clear that, on its own, conventional face-to-face medicine delivered by doctors is going to do little for epilepsy care in resource-constrained countries like Cameroon so alternative ways of practice must be found.
The use of telemedicine services for the provision of healthcare services has significantly contributed to the improvement of patient management in different settings. Tele-Epi is an initiative that has as main objective to improve patient-centered management of epilepsy, increase access to timely, cost-effective, safe, and effective care for patients living with epilepsy in remote areas in Cameroon. We train both non-physician health workers and villagers without any health background in epilepsy and in epilepsy identification, awareness, prevention, and management.
We provide them with educational materials about epilepsy and send them back to their communities to raise community awareness on epilepsy and offer treatment. When these epilepsy workers identify someone with possible epilepsy, they assess and offer basic epilepsy care and treatment if the person meets the criteria for epilepsy. The trained field workers will telephone a physician with advanced training in epilepsy management or a neurologist who will then further assess the patient, in the presence of the field worker(s), and prescribe/review treatment which the fieldworker then arranges. This telemedicine model has significantly improved health outcomes and patient experience and has also facilitated awareness-raising, identification, and prevention of epilepsy.