Not many American HIM professionals can claim that they’re helping fight AIDS-related cancers and stroke in Kenya, but two West Virginia women, working in collaboration with a team of clinicians, are doing just that.
Pam Moats, RHIT, CTR and Megan McDougal, MS, RHIA, CHTS-IM, who work on the cancer and stroke registries at the West Virginia University Healthcare hospitals, respectively, are taking part in a project dedicated to fighting stroke and cancer in Kenya, where prevalence is high and treatments are limited.
According to Moats, who is the cancer registry coordinator at WVU’s hospital in Morgantown, WV, Dr. Scot Remick, medical director of the university’s Mary Babb Randolph Cancer Center, observed a need for cancer registries in his own travels to Kenya when he noticed startling numbers of HIV/AIDS-associated malignancies such as Kaposi’s sarcoma, non-Hodgkin’s lymphoma, squamous cell cancer of the cervix, squamous cell carcinoma of conjunctiva, and Hodgkin’s disease, which often cannot be tracked in detail from existing cancer registry data.
Thanks in part to a National Institutes of Health grant, Remick brought Anne Korir, a cancer registrar from Nairobi, Kenya, to the United States, along with a group of other Kenyan researchers, to learn American techniques for documenting and abstracting clinical data.
In the spring of 2011, Korir spent a week with Moats in Morgantown. The biggest challenge, Moats says, was her inability to grasp how few resources Korir had to work with in Kenya compared with registrars in the US. Moats says registrars in Kenya have to travel for miles, from one rural hospital to another, where the only medical records available are on paper.
“They are not nearly as electronically defined there as we are,” Moats says. “Anne told us that she would go out to these hospitals, open up file cabinets, and go through hundreds of lab slips to try and find blood work for these patients. Hopefully with our training, and her coming here once a year, we can make a difference.”
Although the benefits of Moats’ work with Anne may be difficult to see, given that Moats herself hasn’t been to Kenya, the process of working with her was rewarding.
“We really don’t need all the electronic equipment that we have. We take our job for granted because of the equipment we have. We all work from home. It was really eye opening to see what they have to work with, and really, how well we have it compared to other countries,” Moats says.
Korir came back to Morgantown in the spring of 2013 to train with McDougal on stroke registries. While the incidence of stroke is common everywhere, mortality rates are high in Kenya due to lack of treatment options and specialists such as neurologists to treat it.
In Kenya, if a stroke patient is lucky enough to make it to a general hospital, the most common intervention is aspirin, not the clot-busting injections or surgeries available to Americans in trauma centers.
“Something else they don’t have there is electronic records of their inpatient or outpatient stays for the past five or ten years,” says McDougal. “If the patient comes in, they have to start from square one. Having a medical history might help if a patient has had more than one stroke, they might be able to tie that down a little bit.”
McDougal and Korir worked together to create their own simplified stroke registry form.
“We had to sit down and go through the registry form, which is for Joint Commission, which they don’t have over there, and figure out what data they could use off that form and maybe come up with a few additional measures they could use,” McDougal explains.
She adds that Remick tracked down a World Health Organization registry form that was a little simpler than the Joint Commission’s.
“I sat with her for maybe five or six hours. We just took a very basic-level approach and went through each question one by one,” McDougal adds.
McDougal says she was surprised to find some commonalities between stroke registrars in the US and Kenya. For instance, registrars in both countries have similar troubles with physician documentation.
“When you’re trying to find the answer to a registry question, the documentation isn’t specific enough to answer your question. Maybe a doctor doesn’t specify what kind of medication a patient is taking or prescribed, or when they’re discharged, or sometimes it’s not clear when a patient’s symptoms started,” McDougal adds.
Like Moats, working on this project made McDougal grateful for all the technology available to HIM professionals in the US, even those who aren’t fully electronic yet.
“It was very humbling. Here in the US we have access to all sorts of technology and electronics, so we kind of get used to having a computer around, and electronic medical records. Everything we need is at our fingertips. You kind of had to take a step back and appreciate what you have here,” McDougal says.